{"id":"alj-H104834-2024-11-21","awcc_number":"H104834","decision_date":"2024-11-21","opinion_type":"alj","claimant_name":"Kelli Hellums","employer_name":"Area Agency On Aging Western Arkansas","title":"HELLUMS VS. AREA AGENCY ON AGING WESTERN ARKANSAS AWCC# H104834 November 21, 2024","outcome":"unknown","outcome_keywords":[],"injury_keywords":["back","lumbar","fracture","strain"],"pdf_url":"https://www.labor.arkansas.gov/wp-content/uploads/HELLUMS_KELLI_H104834_20241121.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/","filename":"HELLUMS_KELLI_H104834_20241121.pdf","text_length":17789,"full_text":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION \n   \n CLAIM NO. H104834 \nKELLI S. HELLUMS, EMPLOYEE CLAIMANT \n \nAREA AGENCY ON AGING WESTERN ARKANSAS, EMPLOYER RESPONDENT \n \nRISK MANAGEMENT RESOURCES, CARRIER RESPONDENT \n \n \n \n OPINION FILED NOVEMBER 21, 2024 \n \n \nHearing before ADMINISTRATIVE LAW JUDGE JOSEPH C. SELF in Fort Smith, Sebastian \nCounty, Arkansas. \n \nClaimant represented by MATTHEW J. KETCHAM, Attorney, Fort Smith, Arkansas. \n \nRespondents represented by MELISSA WOOD, Attorney, Little Rock, Arkansas. \n \n \n STATEMENT OF THE CASE \n  \n On October  14,  2024,  the  above  captioned  claim  came  on  for a hearing  at Fort  Smith, \nArkansas. A pre-hearing conference was conducted on August 22, 2024, and a pre-hearing order was \nfiled on that same date. A copy of the pre-hearing order has been marked as Commission’s Exhibit \n#1 and made a part of the record without objection. \n At the pre-hearing conference the parties agreed to the following stipulations: \n 1.   The Arkansas Workers’ Compensation Commission has jurisdiction of this claim.  \n2.   The employee/employer/carrier relationship existed on August 6, 2020, when  \nclaimant sustained a compensable injury to her lower back. \n 3.  Claimant’s compensation rate is $268.00 for temporary total disability and $201.00 for  \n permanent partial disability. \nBy agreement of the parties, the issues to be litigated and resolved at the forthcoming hearing \n\nHellums-H104834 \n2 \n \nwere limited to the following: \n1. Whether claimant is entitled to additional medical benefits. \nAll other issues are reserved by the parties. \nThe claimant contends that “She received a compensable injury to her low back on August 6, \n2020, when she was helping a patient get dressed and felt a sharp shooting pain in her low back. The \nclaimant followed up with Dr. Ian Cheyne at Mercy Clinic Occupational Medicine for continued low \nback  pain. The  claimant  was  referred  for  pain  management  and  lumbar  injections. On  August  19, \n2020, the claimant received an MRI of her lumbar spine and referred for additional pain management. \nThe claimant was treated and evaluated at Ortho Arkansas for her continued low back pain.”  \nThe respondents contend that “All appropriate benefits were paid with regard to claimant’s \ninjury sustained on August 6, 2020. She was found to be at maximum medical improvement with a \n0% rating assigned on April 21, 2021. The medical records do not support entitlement to indemnity \nbenefits, and additional medical treatment is not reasonable and necessary.”    \n From a review of the entire record including medical reports, documents, and other matters \nproperly before the Commission, and having had an opportunity to hear the testimony of the witness \nand  to  observe her demeanor,  the  following  findings  of  fact  and  conclusions  of  law  are  made  in \naccordance with A.C.A. §11-9-704: \n \n  FINDINGS OF FACT & CONCLUSIONS OF LAW \n \n 1.   The stipulations agreed to by the parties at a pre-hearing conference conducted on August \n22, 2024, and contained in a pre-hearing order filed that same date are hereby accepted as fact. \n 2.   Claimant has met her burden of proving that she is entitled to additional medical treatment \nfor her compensable back injury of August 20, 2020. \n \n\nHellums-H104834 \n3 \n \n \n FACTUAL BACKGROUND \n This  case  has  a  lengthy  procedural  history. On  August  8,  2022,  claimant  filed  Form  AR-C, \nalleging a compensable injury on August 6, 2020. Because the AR-C was filed two days after the two-\nyear anniversary of the injury, respondents took the position that the matter was barred by the statute \nof limitations and sought to have the matter dismissed as untimely. I denied that motion, ruling that \nsince August 6, 2022, was a Saturday, the filing on August 8, 2022, was timely. Claimant filed a motion \nto enforce a proposed joint petition agreement between the parties. I denied both motions, and an \norder to that effect was entered on April 6, 2023. Respondents filed a timely appeal of the statute of \nlimitations decision on May 4, 2023. On February 14, 2024, the Full Commission affirmed that ruling. \n  On March 15, 2024, respondents filed a Motion to Dismiss pursuant to A.C.A. § 11-9-702, \nalleging  that  it  had  been  more  than  six  months  since  claimant  filed  her  Form  AR-C  with  the \nCommission, but there had been no request for a hearing during that time. Respondents also requested \ndismissal for failing to prosecute her claim pursuant to Commission Rule 099.13. Claimant opposed \nthe dismissal and a hearing on respondents' motion was conducted on June 5, 2024. The Motion to \nDismiss was denied and an order to that effect was entered on June 20, 2024.  \nHEARING TESTIMONY \n \n Claimant was the only witness that testified. She said that on August 6, 2020, she was working \nfor the Area Agency on Aging as an in-home aide. She had been assigned to a particular patient and \nhad been for about five years. On the day in question, claimant was assisting the patient to put on her \nshoes when “it just felt like something on my left side completely separated and I went straight down \nand was just stuck in a fetal position.”  She was taken to the emergency room in Fort Smith where she \nwas treated and released. About a week later she was again seen in the emergency room after she was \nunable to get out of her car at Dr. Ian Cheyne’s office.  \n\nHellums-H104834 \n4 \n \n \n Dr. Cheyne prescribed a course of physical therapy, which claimant said made her condition \nworse.  Following the failed physical therapy, claimant had lumbar epidural steroid injections (LESI), \nwhich seemed to help. Claimant said she had a total of three LESIs which provided some relief, and \nthen had a facet injection which did not work as well. Claimant said while she was being treated that \nshe had physical restrictions that prevented her from lifting or bending. Claimant also had a rhizotomy \nwhich did not help. \n Claimant  said  that  she  had  a  functional  capacity  evaluation (FCE) in  April  2021. After  the \nFCE,  claimant  understood  that  she  did  not  have  the  option  to  return  to  see  Dr.  Roman. Claimant \ntestified that after she had worked almost a year in the office at Area Agency on Aging, she was told \nthat she could not go back into the field and that she was fired.  \n When she was terminated, claimant lost her health insurance and was not able to treat with \nher physicians because they wanted to be paid cash.  Claimant applied for and received Social Security \nDisability benefits and after she was approved for that, she returned to see Dr. Roman and was given \nanother LESI. Claimant is now enrolled in Medicaid which paid for Dr. Roman’s services. \n On  cross-examination,  claimant  said  she  was  initially  scared  to  do  the  injections  but  was \nreferred to Drs. Roman and Becker for pain management and had several injections. Claimant said no \ndoctor had discussed surgery with her during the course of her treatment. Claimant clarified that she \nwas on Medicaid not Medicare.  \nOn redirect  examination,  claimant  testified  about  the  sequence  of  her  medical  treatment, \nwhich will be covered in the review of the records.  \n    I found claimant to be a credible witness, both in her demeanor and in the consistency of her \ntestimony with the medical records.  \n \n\nHellums-H104834 \n5 \n \n \nREVIEW OF THE EXHIBITS \n          On the day of her injury, claimant first went to Mercy Hospital in Fort Smith for an emergency \nroom visit for low back pain. She was discharged with the following summary statement: \n“Consulted neurosurgery, CT showed no acute fracture or misalignment. \nPatient  discharged  with  Medrol  and  Plex  real.    She  will  follow  up  with \nneurosurgery next week.” \n \nHowever,  instead  of  being  seen  by  a neurosurgeon, respondent  sent claimant to Dr. Ian \nCheyne at Mercy Clinic Occupational Medicine. Dr. Cheyne examined claimant made an appointment \nfor an MRI for the lumbar spine and prescribed a complete steroid pack to be followed by Ibuprofen \nor  Tylenol  afterwards. Dr.  Cheyne’s  initial  assessment  was  that  claimant’s  work  activities  had \naggravated an underlying condition. Claimant’s work status as of August 10, 2020, was restricted duty \nof lifting less than 20 pounds and limited bending, stooping, and twisting. Claimant was to alternate \nsitting, standing, and walking as tolerated. \nClaimant had an MRI on August 19, 2020, as ordered by Dr. Cheyne. The impressions of this \nMRI were: \nFacet   hypertrophy   L5-S1   with   far-right   sided  disc   protrusion   but   no \nsignificant stenosis.  \nPosterior  element  hypertrophy  L4-5  with  spondylosis  and  posterior  lateral \nsmall protrusions with canal and lateral recess stenosis. \nPosterior element hypertrophy L3-L4 with disc bulge verses protrusion and \nmild canal and lateral recess narrowing. \nAnd central disc protrusion at L2-3 with mid left lateral recessed narrowing. \nOther findings are noted. \n \nWhen claimant next saw Dr. Cheyne on August 24, 2020, she felt that she had improved and \nwas  no  longer  having  to  use  a  walker  to  get  around. Dr.  Cheyne  went  over  her  MRI  results  and \ncontinued her work restrictions as before.  \n While  there  is  no  physical  therapy  records  included  in  the  exhibits,  Dr.  Cheyne  referred \n\nHellums-H104834 \n6 \n \n \nclaimant to physical therapy and in his notes of September 14, 2020, noted that his plan of care was \nto  send  her  for  more  physical  therapy  and  at  that  point,  he  was  considering pain management  for \npossible injections if her pain was not resolved.  His diagnosis at that time was that she had “strain of \nmuscle, facia and tendon of lower back.”  Her work restrictions continued as before.  \n  Claimant returned to see Dr. Cheyne on October 5, 2020. While claimant said that she felt her \nback was improving, she gave her pain level at a five, as opposed to previous entries of four on a scale \nof ten. Under his plan of care comments, Dr. Cheyne said there has been no significant improvement \nand that he was going to try another round of oral steroids. He discussed a possible referral to pain \nmanagement or a functional capacity evaluation, and claimant wanted to consider her options. When \nshe returned on October 12, 2020, claimant decided to try the LESI. Dr. Cheyne made a referral to \npain management for that and continued her work status of restricted duty.  \n On October 20, 2020, claimant saw Dr. Eugene Becker at Central Arkansas Surgery Center \nand  underwent a  lumber epidural steroid injection at  L5-S1. Upon  returning  to  see  Dr.  Cheyne  on \nNovember 5, 2020, claimant reported she had significant improvement of pain after the LESI. Dr. \nCheyne recorded “Will place on regular duty but recommend she follow up with pain management \nfor another injection.” \n           Claimant had another LESI at L5-S1 on November 17, 2020. She returned to see Dr. Cheyne \non November 30, 2020, and reported that she felt she was not improving. Claimant also reported that \nshe felt no change after the second LESI. The plan of care after that visit was claimant was placed on \nher original restrictions, with office work recommended; however, the recommended work status in \nthat report was contradictory: “Kelli’s recommended work status is regular duty.”  She was to return \nto Dr. Becker for more pain management. \n On  December  15, 2020, claimant  had  a  transforaminal  lumbar epidural  steroid  injection  at \n\nHellums-H104834 \n7 \n \n \nbilateral L4-5. She returned to see Dr. Cheyne on January 20, 2021, reporting a pain level of four after \nher third LESI. She had not yet been released by pain management and Dr. Cheyne recommended \nleft facet injections at L3-S1. He then included in the plan of care: “consider FCE if no improvement \nwith injections.” \n On February 8, 2021, claimant was seen at OrthoArkansas prior to receiving facet injections \nat L3-S1. Claimant related that to that point, she had undergone three LESIs from Dr. Becker, had \nundergone  physical  therapy  which  exacerbated her  symptoms,  and  had  tried  muscle  relaxers, anti-\ninflammatories, and steroids dosepaks with minimal relief. On February 12, 2021, Dr. Carlos Roman \nadministered lumbar facet injections at L3-4, L4-L5, L5-S1, with medial branch block. She underwent \na second facet injection by Dr. Roman on February 26, 2021. This was followed by a rhizotomy of \nlumber facet joints on claimant’s left side at L3-L4, L4-L5, and L5-S1 on March 19, 2021. \n On   April   21,   2021, claimant  was  seen  by  physician’s  assistant  Payton  Ransom  at \nOrthoArkansas who returned claimant to work at light duty until a functional capacity evaluation was \ndone. There was as entry in P.A. Ransom’s report as follows: \n“The patient states she is unable to return to work due to her pain. My \nrecommendation is for a  functional capacity exam. If the patient has a valid \nfunctional  capacity  exam,  then they may  be  able  to  return  to  work  per  the \ndefined restrictions  of  that  valid  functional  capacity  exam. If  the  functional \ncapacity  exam  is  invalid,  patient  may  return  to  work  full  duty  without \nrestrictions.  \nI will continue patient’s work restrictions of no bending, twisting, or  lifting \nover twenty pounds until the result of functional capacity exams are available. \nThere  is  no  need  for  the  patient  to  follow  up  after  this  functional  capacity \nexam. My instructions following the functional capacity exam are clearly stated \nabove.” \n \n On this visit, P.A. Ransom stated: \n“Patient is at maximum medical improvement. Patient’s work restrictions are \nto return  back  to  work  full  duty  without  restrictions. Patient’s impairment \nrating  will  be 0% as  taken  out  of  page  113  of  the  Guides  to Evaluation  of \nPermanent Impairment,4\nth\n Edition.  This  is  for  a  grade  one  degenerative \n\nHellums-H104834 \n8 \n \n \nspondylolisthesis, non-operated on. Releasing patient from my medical care.  I \nwill  see  the  patient  back  only  as  needed. Continued  to  place  the  patient  on \nwork restrictions no bending, twisting, or lifting over twenty pounds.” \n \nClaimant underwent a functional capacity evaluation on May 10, 2021, during which time she \nput forth a reliable effort with 50 of 50 consistency measures. The examiner concluded that claimant \ncompleted the functional testing with reliable results and demonstrated the ability to perform work in \na light classification of work.  \nADJUDICATION \n \n The only issue to be decided in this matter is whether claimant is entitled to additional medical \ntreatment  for  her  compensable  injury  of August  20,  2020. A claimant  bears  the  burden  of  proving \nentitlement to additional medical treatment for a compensable injury. LVL, Inc. v. Ragsdale, 2011 Ark. \nApp.  144,  381  S.W.3d  869. However,  once  it  has  been  established  that  a  claimant  has  sustained  a \ncompensable injury--which was a stipulation--she is not required to offer objective medical evidence \nto prove entitlement to additional benefits, Ark. Health Ctr. v. Burnett, 2018 Ark. App. 427, at 9, 558. \nS.W.3d 408, 414. \n It is the employer's responsibility to provide for an injured employee such medical treatment \nas may be reasonably necessary in connection with the injury received by the employee, Ark. Code \nAnn. 11-9-508(a). While the doctor that saw claimant at the emergency room believed she needed to \nbe  referred  to  neurosurgery,  I do  not  fault  respondents for  first  sending  her  to  the  occupational \nmedical clinic.  Nor am I critical of the conservative course of care that claimant received in the first \nmonths; the initial course of rest, Ibuprofen, Acetaminophen, and hot showers seems reasonable, as \ndoes the referral to physical therapy and then for the various injections.  \nHowever, after  those conservative  measures failed, the  records  from  Dr.  Cheyne  and  P.A. \nRansom do not indicate that a referral to an orthopedist or a neurosurgeon was ever contemplated. \n\nHellums-H104834 \n9 \n \n \nAs  noted  above,  the  doctor  that  saw  claimant  in  the  emergency room  on the  day  of  the  accident \nthought such was appropriate; however, that was before respondent began management of her care.  \nAssuming for a moment that the release with restrictions after the FCE was appropriate\n1\n, that would \nnot bar claimant from additional medical treatment. An injured party can continue to receive medical \ntreatment  for  a  compensable  injury  after  she  has been  declared  to  have  reach maximum  medical \nimprovement, Patchell v. Wal-Mart Stores, Inc., 86 Ark. App. 230, 184 S.W.3d 31 (2004). In this hearing, \nclaimant sought the only type of treatment that has provided her with relief from her back pain. As \nsuch, I  find  that  claimant have  proven  by  a  preponderance  of  the  evidence  that  she is  entitled  to \ncontinued treatment for her compensable back injury. \nORDER \n \nRespondents  are  directed  to  pay  benefits  in  accordance  with  the  findings  of  fact  set  forth \nherein this Opinion. \n Respondent  is  responsible  for  paying  the  court  reporter  her  charges  for  preparation  of  the \ntranscript in the amount of $452.95. \n IT IS SO ORDERED. \n                                                                                              \n_______     \n JOSEPH C. SELF \nADMINISTRATIVE LAW JUDGE \n \n \n1\n The  question  of  whether  claimant  should  have  been  released by  a  physician’s  assistant at  maximum  medical \nimprovement with permanent physical restrictions but with a 0% impairment rating is not before me at this time, and \nI offer no opinion in that regard.","preview":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION CLAIM NO. H104834 KELLI S. HELLUMS, EMPLOYEE CLAIMANT AREA AGENCY ON AGING WESTERN ARKANSAS, EMPLOYER RESPONDENT RISK MANAGEMENT RESOURCES, CARRIER RESPONDENT OPINION FILED NOVEMBER 21, 2024 Hearing before ADMINISTRATIVE LAW JUDGE JOSEPH C. SELF in Fort Smith, Sebast...","fetched_at":"2026-05-19T22:46:48.922Z","links":{"html":"/opinions/alj-H104834-2024-11-21","pdf":"https://www.labor.arkansas.gov/wp-content/uploads/HELLUMS_KELLI_H104834_20241121.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/"}}