{"id":"alj-H107091-2023-06-12","awcc_number":"H107091","decision_date":"2023-06-12","opinion_type":"alj","claimant_name":"Margaret Macon","employer_name":"Mineral Springs, Saratoga School District","title":"MACON VS. MINERAL SPRINGS, SARATOGA SCHOOL DISTRICT AWCC# H107091 JUNE 12, 2023","outcome":"unknown","outcome_keywords":[],"injury_keywords":["neck","back","hip","herniated","shoulder","thoracic","cervical","fracture"],"pdf_url":"https://labor.arkansas.gov/wp-content/uploads/MACON_MARGARET_H107091_20230612.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/","filename":"MACON_MARGARET_H107091_20230612.pdf","text_length":44457,"full_text":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION \n \n                                                         CLAIM NO.:H107091  \nMARGARET A. MACON,  \nEMPLOYEE                                                                                                              CLAIMANT \n \nMINERAL SPRINGS, SARATOGA SCHOOL DISTRICT,  \nEMPLOYER                                                                                                         RESPONDENT \n \nARKANSAS SCHOOL BOARDS ASSOCIATION,  \nWCT                                                                                                                       RESPONDENT \n \n \n             OPINION FILED JUNE 12, 2023      \n        \nHearing held before ADMINISTRATIVE LAW J UDGE CHANDRA L. BLACK in Texarkana, \nMiller County, Arkansas. \n \nClaimant represented by the Honorable Gregory R. Giles, Attorney at Law, Texarkana, Arkansas. \n \nRespondents  represented  by  the  Honorable  Melissa  Wood,  Attorney  at  Law,  Little  Rock, \nArkansas. \nStatement of the Case \nOn  March  14,  2023,  the  above-captioned  claim  came  on  for  a  hearing in  Texarkana, \nArkansas.  Previously, a prehearing telephone conference was conducted in this matter on January \n11, 2023 from which a Prehearing Order was filed on that same day.  A copy of the order and both \nparties’ responsive filings have been marked as Commission’s Exhibit 1 and made a part of the \nrecord.   \nStipulations \nDuring  the  prehearing  telephone  conference,  and/or  hearing  the  parties  agreed  to  the \nfollowing stipulations: \n1. The Arkansas Workers’ Compensation Commission has jurisdiction of the within \nclaim. \n\nMacon- H107091 \n \n2 \n \n2. That  the  employee-employer-insurance  carrier  relationship  existed  at  all  relevant \ntimes, including on or about October 6, 2020.  \n3. The Claimant’s average weekly wage on the  day  of  her  accidental  injury  was \n$1,105.92, which was sufficient to entitle her to corresponding compensation rates \nof  $711.00  per  week  for  temporary  total  disability  (TTD)  compensation,  and \n$533.00 a week for permanent partial disability (PPD) benefits.  \n4. The Respondents have controverted this claim in its entirety.  \n5. All   issues   not   litigated   herein   are reserved  under  the  Arkansas  Workers’ \nCompensation Act. \nIssues \nBy  agreement  of  the  parties,  at  the  start  of  hearing,  the  parties  modified  the  issues  and \nnarrowed them down to the following: \n1. Whether  the  Claimant  sustained  compensable  injuries  to  her  neck  and  back  as  a \nresult of her October 6, 2020 work-related accidental fall. \n2. Whether  the Claimant’s  medical  treatment  of  record  is  reasonable  and  necessary \nmedical treatment for her neck and back injuries, and if she is entitled to any other \nrecommended   treatment   (particularly,   that   of   Dr.   Rajesh   Arakal)   for   these \nconditions, including but not limited to pain management follow-up visits with her \ntreating physicians. \nContentions \n The respective contentions of the parties are as follows: \nClaimant: \n(a)  The Claimant contends that she sustained compensable injuries to her neck  \n\nMacon- H107091 \n \n3 \n \nand back on or about October 6, 2022, when a desk that she was leaning against collapsed \nand  she  fell  to  the  floor.    She  initially  complained  of  low  back  pain  and  hip  pain  and \nsubsequently developed neck pain, pre-existing history of herniated disc at C4-5 and C5-\n6, new disc herniations at C6-7 at C6-7 following this accident; \n(b)  Claimant contends that the medical treatment she received after October 6 associated  \nwith her neck and back pain was reasonable and necessary such that Respondents should \nbe ordered to pay for same; \n(c)  Claimant contends she would been entitled to temporary total disability benefits for  \nany days that she missed from work and contends that she would be entitled to at least a \n5% impairment rating associated with the aggravation of the pre-existing conditions and \nnew disc herniations; and \n(d)  Claimant contends Respondents should be ordered to pay attorney’s fees as provided  \nby law.    \nRespondents: \nRespondents  contend  that  Claimant  did  not  sustain  a  compensable  injury  on \nOctober 6, 2020.  There was no injury in the course and scope of employment, and there \nare no objective findings of an acute injury.  Claimant’s need for treatment is associated \nwith a pre-existing condition.  The records do not support entitlement to indemnity benefits. \n             FINDINGS OF FACT AND CONCLUSIONS OF LAW \nBased on my review of the evidentiary record, to include the aforementioned documentary \nevidence, other matters properly before the Commission, and after having had an opportunity to \nhear  the  testimony  of  the  witnesses  and  observe  their  demeanor,  I  hereby  make  the  following \n\nMacon- H107091 \n \n4 \n \nfindings  of  fact  and  conclusions  of  law  in  accordance  with  Ark.  Code  Ann.  §11-9-704  (Repl. \n2012): \n1.    The Arkansas Workers’ Compensation Commission has jurisdiction over this     \n         claim. \n \n2.    I hereby accept the above-mentioned proposed stipulations as fact. \n \n3.   The Claimant proved by a preponderance of the evidence that she sustained \ncompensable injuries to her neck and back on October 6, 2020, while leaning  \nagainst a table that collapsed, causing her to fall to the floor landing on her  \nbuttocks.  \n \n          4.        The Claimant proved that all the medical treatment of record was reasonably necessary \n                   treatment for her compensable back and neck injuries.  She also proved her entitlement  \n                   to additional treatment to include the surgery, as proposed by Dr. Rajesh Arakal. and                     \n                   any other pain management as recommended by her treating physicians.  \n                                              \n          5.       All issues not litigated herein are reserved under the Arkansas Workers’ Compensation  \nAct. \n      \nSummary of Evidence \nMs. Margaret A. Macon (referred to herein as the “Claimant”) and Ms. Cara Lee Lamb (a \ncoworker) also testified on behalf of the Claimant.   \n            The record consists of the March 14, 2023, hearing transcript and the following exhibits: \nSpecifically,  Commission’s  Exhibit  1  includes  the  above  referenced  documents; Claimant’s \nExhibit 1 comprises medical records, which includes one hundred and forty-one numbered pages; \nClaimant’s  Exhibit  2  is  the    Abstract  of  Table  of  Contents  consisting  of  nine  pages; the \nRespondent’ Hearing Exhibit Index of  Medicals includes fifty-four pages and it has been marked \nas Respondents’ Exhibit 1; and Respondents’ Hearing Exhibit Index of Non-Medicals, has been \nmarked as Respondents’ Exhibit 2,  consisting  of seventeen  numbered  pages  were  admitted  into \nevidence without objection. \n \n\nMacon- H107091 \n \n5 \n \n                                                           Testimony \nMs. Cara Lee Lamb \n Ms. Lamb holds a bachelor’s degree and master’s degree in education related fields.  She \nis  employed  by  the  Mineral  Springs  School  District.    Ms.  Lamb  works  at  the  junior  and  high \nschools teaching Special Education, Mathematics, and English. According to Ms. Lamb, she has \nworked for the school district for fifteen years.  She confirmed that on occasion she has worked \nwith the Claimant. \n With respect to the Claimant’s October 6, 2020, work-related injury, Ms. Lamb confirmed \nthat she was present when the incident occurred.  Ms. Lamb testified that she was in the classroom \nwith  the  Claimant  when  she  went  to  lean  against  a  table,  and  it  collapsed  and  fell.    Ms.  Lamb \nessentially testified that the Claimant landed on the floor, not so very nicely.  Although Ms. Lamb \ndid not recall the exact time of the injury, she estimated it to be around 11:00 a.m. before lunch.   \n Ms. Lamb explained: \nQ Did she appear to be injured or complain about any problems at that time? \nA Well, when she got up, she said she had just a little bit of a twinge back there, but \nshe wasn’t real concerned about, because she had just fell. \n Under further questions, Ms. Lamb confirmed that she had follow-up conversations with \nthe  Claimant  in  the  days  that  followed.    Ms.  Lamb  testified  that  the  Claimant  told  her  she  was \nhurting  a  little  bit  and  indicated  it  was  due  to  the  fact  that  she  had  fallen.  She  denied  being \nquestioned  by  any  school  district  officials  about  the  incident.    Ms.  Lamb  confirmed  that  the \nClaimant  ended  up  going  to  the  doctor,  within  a  week  or  two  after  her  fall.    According  to  Ms. \nLamb, the Claimant complained to her about her neck and hip. \n\nMacon- H107091 \n \n6 \n \n On cross-examination, Ms. Lamb confirmed that the Claimant complained of a twinge in \nher  lower  back  after  the  incident.    She  stated  that  the  Claimant  complained  of  her  neck  hurting \nright around the time she went to the doctor.  Ms. Lamb confirmed that if the Claimant describes \nher fall as “I fell on my bottom with her legs out in front of me,” she would agree with this account \nof the incident.            \nMargaret A. Macon \n The  Claimant  is  70  years  of  age.    She  has  a  degree  in  Sociology/Social  Work.  She  also \nholds a bachelor’s degree  and  is  certified  in  Pre-K  through  eighth  grade  Math.    The  Claimant \nteaches the 7\nth\n and 8\nth\n grades Mathematics and sometimes Algebra at Mineral Springs School.  She \nhas  worked  for  the  district  for  five  years,  since  2018.    The  Claimant  previously  worked  for  the \nAshdown School District for  eleven years.  She  explained that she  first taught in Oklahoma for \ntwenty-eight years and was over the Math Department before retiring.   \nRegarding the Claimant’s injury, she testified that after teaching a lesson, she was at the \nback of the classroom, reviewing the lesson trying to determine if the kids had any questions or \nneeded her to go back over any of the classwork.  According to the Claimant, she leaned back on \nthe table to prop on it, but she did not realize the table had adjustable legs.  There was a misplaced \nscrew  out  of  the  table  and it  collapsed,  causing  her  to  fall  straight  down  on  her  bottom.    The \nClaimant confirmed that Ms. Lamb, the Special Ed teacher, was in the classroom when she fell.  \nAccording  to  the  Claimant,  they  were  both  teaching  classes  to  try  to  mainstream  some  of  the \nstudents back into regular classrooms. \nThe Claimant explained: \nQ And how would you describe the fall itself? \n\nMacon- H107091 \n \n7 \n \nA Well, then I fell, having a classroom full of students, it startled..... Especially the \ngirls, they screamed, and some of them got up to try to ...... I said, “No,” I can get up naturally,” \nso I tried to get up quickly because they were in the room.  I got up and I felt a little something, \nbut I did not make a big deal out of it.  I just brushed it off to the fact that I had just fallen, you \nknow, pretty abruptly.  \nQ When you say you felt a little something, where did you feel it at? \nA It was kind of in my back, lower back, and I just thought, well, you know I just fell. \nThe  Claimant  confirmed  that  she  did  not  need  immediate  medical  attention  at  that  time.  \nShe completed the workday.  They had two more workdays after the Claimant’s fall.  In the two \ndays  that  followed,  the  Claimant  explained  that  her  symptoms  changed  and  got  progressively \nworse.  The Claimant testified that she was unable to turn over in bed.  She ended up having to \nsleep in a recliner because she could not lay flat.  \nShe  finally  told  the  high  school  secretary,  Ms.  Judy  Hart,  that  she  had  fallen  and  was \nleaving to go to the doctor.  Ms. Hart informed the Claimant that she should report her injury to \nMs. Marla Williams, the person who does their workers’ compensation insurance.  This occurred \non  October 9.  Following her doctor’s appointment, the Claimant reported her injury to Ms. \nWilliams.  She told the Claimant she should have reported the injury on the day it happened. \nThe  Claimant  testified  that  she  sought  medical  treatment  from  the  emergency  facility  at \nHealthCare Express instead of her primary care physician, Dr. Dean Bowman, because his clinic \nhad closed for the day.  According to the Claimant, she sees his nurse practitioner, Ellen Jones.  \nWhen the Claimant went to Healthcare Express, she complained about her hip and back.  \nThey did x-rays to make sure she did not have any broken bones, and prescribed pain medication \nfor  her.  The  Claimant  confirmed  that  she  was  taken  off  work  and  missed  work  a  day  here  and \n\nMacon- H107091 \n \n8 \n \nthere.  However, the Claimant used up her sick leave and some coworkers donated some of their \nsick days to her.    \nThe Claimant sought additional medical treatment for her back from her doctor’s (Dr. \nBowman) nurse practitioner, Ellen Jones.  She confirmed that on October 14, 2020, she saw Nurse \nJones.  At that time, the Claimant complained of hip and back symptoms.  She testified that she \nwas beginning to feel a little something in her neck.  As a result, Jones proposed sending her to \nDr. Erica (the reference appears to be to Dr. Arakal).  She testified that when she was first treated \nat Bowman’s clinic on October 14, they prescribed some pain medications for the muscle spasms \nin her hip and back.  The Claimant agreed that the medication help to relieve her symptoms for a \nwhile, by numbing the pain a little bit.   \nShe testified that she had gone to work, and her arm and neck were hurting “really, really” \nbad, when she got off work.  According to the Claimant, she laid down that night thinking that she \njust needed some rest.  However, later that night she got up and was hurting, to the point that she \nhad to hold her arm up to walk.  As a result, the Claimant’s husband took her to the emergency \nroom at St. Michael’s.  This happened on October 28.  She confirmed that between the time she \nfirst saw the nurse practitioner and her emergency room visit, her symptoms changed in that two-\nweek time limit.  The Claimant testified that she  started feeling something different up towards \nher neck and shoulder and in her arm on the right side.  She slept in the recliner during that period \nof time and ended up getting a neck pillow to prop up her neck.  \nThe Claimant confirmed that she did not have any imaging done at St. Michael’s.  After \nher visit to the ER, they sent the Claimant to Advanced Imaging for St. Michael’s to have the CT \nscan performed the next day.  She confirmed that she had an MRI of her neck and thoracic spine.  \nDr. Bowman discussed the results of the CT and MRI with her.  He referred the Claimant to Dr. \n\nMacon- H107091 \n \n9 \n \nArakal,  a  surgeon,  through  the  Texas  Back  Institute  at  Plano,  Texas.    Per  the  Claimant,  she  is \ngetting medical treatment through her personal health insurance, Health Advantage.           \nShe  confirmed  that  her  first  visit  with  Dr.  Arakal  was  on  December  4,  2020  due  to \ncomplaints of significant symptoms of neck pain.  The Claimant testified that she saw Dr. Arakal \nfor  three  visits.   She  confirmed  that  surgery  was  recommended  but  it  was  postponed  due  to  the  \nCOVID-19 pandemic and because she suffers from diabetes. The Claimant testified that she is a \nType II diabetic.  She confirmed that she last saw Dr. Arakal on July 24, 2021.  Since that time, \nthe Claimant has been self-treating through pain management, which includes the use of several \ntypes of creams and patches to alleviate her pain.  The Claimant confirmed that she continues to \ntreat with Dr. Bowman through Family Medical Clinic for her ongoing symptoms.  She testified \nthat she was referred to Precision Spine Care for pain management by the nurse practitioner, Ellen \nJones.  The Claimant confirmed that she underwent one epidural steroid injection to her neck.  She \ntestified that the injection helped for a little while, but it is wearing off.  However, the Claimant \nwas scheduled to undergo another injection on March 20, 2023, once she receives clearance from \nher endocrinologist because the injections elevate her blood sugar.   \nAs of the date of the hearing, the Claimant continued to work full-time, as a teacher with \nsome  adjustments  to  her  class  schedule.    The  Claimant  confirmed  that  she  planned  to  continue \nworking until of the end of the school year.  Per the Claimant she has turned in her resignation for \nthe upcoming school year. The Claimant testified that she has problems with both sides of neck. \nHowever, she testified that the majority of her pain is on the left side of her neck.  She confirmed \nthat she intends to return to the Dr.Arakal. The Claimant denied any problems with her neck prior \nto her accident in 2020.   \n\nMacon- H107091 \n \n10 \n \n However, the Claimant confirmed that she was struck from behind while driving from work \nin Mineral Springs.  This accident happened in 2016.  According to the Claimant, she was struck \nfrom behind by an 18-wheeler.  She admitted that she complained of neck  and back discomfort \nafter  her  MVA.    As  a  result,  they  did  an  MRI.    She  underwent  physical  therapy/PT  for  her \nsymptoms.    However,  the  Claimant  denied  seeing  a  specialist  for  her  symptoms.    She  further \ndenied having the same complaints or problems in 2016 of pain radiating down her arm.   \nThe  Claimant  confirmed  that  she  was  involved  in  second  car  accident  in  2017.    She \ndescribed her accident as a fender bender.  According to the Claimant, a young lady hit them on \nthe  left  side  of  their  vehicle.    For  her  2017  accident,  the  Claimant  treated  with  a  chiropractor  \nmostly  for  back  pain  because  when  the  lady  hit,  she  was  thrown  to  the  front.  She  also  denied \nseeing  or  being  referred  to  a  specialist  for  surgery  or  anything  of  that  nature.    The  Claimant \nessentially confirmed that her neck and back issues from those two accidents resolved, and she did \nnot have any problems until her work-related accident in 2020.  Following her MVAs, the Claimant \ntestified she was pain-free for two years before her 2020 workplace accident.   \nShe testified that she would like to continue to purse pain management through Precision \nSpine Care and put surgery off as long as possible.  The Claimant testified that she had planned to \nwork another year because her grandson is in college.  However, she explained that her commute \nto work aggravates her neck and shoulder.   \nOn cross-examination, the Claimant confirmed that she settled  the 2016 car accident for \n$32,000.  She confirmed that her second MVA occurred on May 30, 2017, which was a “fender \nbender.” \nRegarding  her  accidental  work  injury,  the  Claimant  confirmed  that  she  testified  that  she \nfell on her bottom, with her legs out in front of her.  She explained that she felt a little something \n\nMacon- H107091 \n \n11 \n \nbut thought it was just the initial shock of falling.  The Claimant agreed that she testified during \nher deposition that she felt a little bit of stiffness in her back and right hip that evening.  She further \ntestified that she noticed symptoms in her neck and shoulder about two weeks after her fall because \nit gradually got worse.  The Claimant admitted that when she fell, she did not hit her neck or left \nshoulder.  She confirmed that she uses over-the-counter medications for her symptoms. \nThe Claimant testified that if she retires from Mineral Springs this upcoming school year \nfor  2023-2024,  this  will  be  her  third  retirement.    She  confirmed  that  no  doctor  has  placed  any \nrestrictions on her as of late.   \nThere is a record of the Claimant having treated with Ellen Jones on March 23, 2021 in Dr. \nBowman’s office.  Per  this  record,  she  complained  of  pain  in  her  left  shoulder  and  arm.  At  that \ntime, the Claimant described her pain as being constant and sharp.  The onset was several months \nago and started having pain on the left side when she woke up Sunday morning.  She confirmed \nthat  she  recalled  the  incident.    The  Claimant  admitted  having  stated  that  she  thought  she  had  a \ncrick in her neck and there was no obvious injury or event.   \nNext, the Claimant was shown a copy of an AFLAC form\n1\n, which she filled out on June 7, \n2021.  She verified her handwriting on the form.  The Claimant stated on this form that there was \nan injury on October 29, 2020.   She confirmed that she completed a similar form on November 5, \n2020, a Form AR-N.  The Claimant agreed the form was not completed until July 21, 2021.  She \nagreed that at that point, she had decided to make a claim for workers’ compensation benefits.  \nOn redirect examination, the Claimant testified: \n \n1\n The Claimant was shown a copy of Respondents’ Exhibit 2, which includes various forms, such as her \napplication for AFLAC and forms relating to her injury.  \n\nMacon- H107091 \n \n12 \n \nQ Just briefly.  As you recall, when you first developed arm pain or symptoms out \nof your neck, do you recall if it was one arm versus the other?    \nA The first symptoms, it was my right side, because when I fell, I felt the ..... It was \nin my back, and as time progressed, it was in my right side, and when I went to the emergency, \nroom, that’s when I was holding my left hand. \nQ Looking at the Family Associates Medical records, they note on November 5\nth\n that \nyou reported location on the right side that radiates to the right shoulder and the right arm, so at \nthe time, were you having pain in both arms? \nA Yes.                                    \nThe Claimant explained that although when she went to the emergency room, she had pain \nrunning down her left side down her arm, currently most of her pain is in her right arm.     \n                                     Medical Evidence \nA review  of  the  medical  evidence  shows  that  the  Claimant  previously  sought  medical \ntreatment at Christus St. Michael Health System on October 6, 2016.  At that time, the Claimant \ncomplained  of  neck  and  abdomen  pain  due  to  a  motor  vehicle  accident/MVA  involving  an  18-\nwheeler.  She was discharged home that same day and was noted to have “minor injuries” from \nthe  MVA.    However,  a  CT  of  her  cervical  spine  was  performed  with  an  impression  of: \n“Straightened cervical lordosis which may be positional or secondary muscle spasm.  Significant \ndisc bulge or herniation on the right at the C4-C5 interspace.  No acute fracture.” \n It  appears  that  the  Claimant  sought  treatment  from  the  Family  Medical  Associates  on \nOctober 7, 2016.  The Claimant presented to Dr. Vernon Bowman with complaints of neck pain \nthat  radiated  to  the  right  shoulder  and  right  arm  after  being  rear-ended by a “big truck.”  Dr. \n\nMacon- H107091 \n \n13 \n \nBowman  assessed  the  Claimant  with  neck  pain  and  ordered  medications  and  discussed  the \npossibility of physical therapy.     \n An  MRI  was  performed of the Claimant’s cervical spine on  October  20,  2016,  with  an \nimpression: “1. Multilevel disc herniations, C4-5 and C5-6 levels. 2. Straightening of the lordotic \ncurvature.  Clinically correlate for under muscular spasm.”   \n The  Claimant  underwent  physical  therapy  for  her  shoulder  and  neck  pain  at  HealthCare \nExpress beginning on October 27, 2016, through November 14, 2016. \n On November 14, 2016, the Claimant was evaluated for neck pain by Dr. Bowman during \nan office visit.  The Claimant reported that she had been going to the physical therapy and it was \nhelping.    Her  pain  medication  was  causing  vomiting  and  dizziness.  His  assessment was “neck \npain.”  Dr. Bowman discussed other pain medication options with the Claimant and continued her \nphysical therapy, which she underwent. \n The Claimant completed her physical therapy sessions on January 12, 2017, at HealthCare \nExpress.  She returned for a follow-up visit with Dr. Bowman on January 26, 2017, for continued \nneck pain. \n On June 2, 2017, the Claimant presented to Dr. Bowman for a chief complaint of pain of \nthe neck since May 30, 2017.  The Claimant reported that it was the result of an injury that occurred \non  May  30,  2017,  which  was  a  sudden  onset.    Per  these  clinic  notes,  the  Claimant  had  similar \nproblems in the past.  Her current neck pain was due to a motor vehicle accident. She was in the \npassenger seat when another vehicle rear-ended them at a low force collision.  The vehicle was \ntraveling at less than 10 MPH.       \n The Claimant presented to HealthCare Express on June 13, 2017, for follow-up of her neck \npain.  At that time, she was discharged from care by ShaRhonda Gamble, FNP-C. \n\nMacon- H107091 \n \n14 \n \n On  June  26,  2018,  the  Claimant  presented  with  low  back  pain,  to  the  Family  Medical \nAssociates under the care of Calyse Roy, APRN (supervisor, Dr. Vernon Bowman).  The Claimant \nreported that her current episode of pain started three days ago.  However, the Claimant did not \nrecall  a  particular  precipitating  event  or  injury  for  her  symptoms.    Her  symptoms  were  most \nprominent in the lower spine and radiated to the thighs and characterized as constant and aching \nin nature. She also complained of persistent stiffness.  Her level of pain between one and ten was \nat a seven.    The Claimant was assessed with low back pain, for which they performed injections \nof Decadron and Toradol. \n On October 9, 2020, the Claimant sought medical treatment from HealthCare Express for \na primary complaint of back pain.  Robin Hawthorne, FNP, evaluated the Claimant.  At that time, \nshe reported an event of having fallen two weeks ago onto her buttocks.  The Claimant stated that \nshe had increased tenderness and aches going up her back.  On physical examination the Claimant \nwas  noted  to  have  lumbar  muscles  tender  to  palpation.    At  that  time,  her  assessment  was \n“unspecified injury of lower back,” for which she  was  prescribed  oral  medication  containing \nAcetaminophen-Codeine.  Imagining ordered included X-rays 2-3 Views of the L-spine, with an \nimpression of “Normal lumbar spine.” \n The  Claimant  was re-evaluated  again  at  Family  Medical  Associates/Dr.  Bowman,  on \nOctober  14,  2020,  due  to  a  chief  complaint  of  right  hip  pain.  At  that time,  her  pain  was  rather \ndiffuse in location, it radiated to the low back flank.  The Claimant described her pain as being \nmoderate in intensity, constant and sharp.  The precipitating event for her pain was a fall two weeks \nago.  The Claimant stated that she had not found anything to relieve the pain.  Her assessment was \n“pain in the right hip and low back pain,” for which received in-house  steroid  injection,  and  a \n\nMacon- H107091 \n \n15 \n \nprescription regimen that included a methocarbamol to be taken three times a day, “as needed for \nmuscle spasms.”  \n On October 20, 2020, the Claimant returned to Dr. Bowman’s office for complaints of \ncervicalgia.  The location of her discomfort was on the right side.  It radiated to the right shoulder \nand  right  arm.    The  Claimant  characterized  her  pain  as  being  severe,  constant,  and  sharp.  The \nprecipitating event seemed to have been a fall around the beginning of the month.  The Claimant \nhas continued to have pain in her neck and right arm. Per these clinic notes, the Claimant went to \nER for pain Tuesday. \n A CT of the Claimant’s cervical spine was performed for comparison the October 6, 2016, \nimaging.  This second CT was performed on October 29, 2020, which was read by Dr. Samuel T. \nGatzert, with an impression of: \n1.  Multilevel cervical spondylosis most notable for a prominent right paracentral focal disc \nprotrusion resulting in compressing mass effect upon the right lateral hemicord and severe \nfocal thecal sac stenosis at C4-5.  Additional multilevel moderate thecal sac stenoses with \ncentral and slight right paracentral components C5-6 and C6-7.  No identified compressive \nmyelomalacia. \n \n 2.  Severe right foraminal stenosis at C4-5.0 \n On  that  same  day,  an  MRI  of  the  Claimant’s  thoracic  was  performed  and  Dr.  D.S. \nCampanni’s impression was: “Mid- multilevel degenerative disease without canal stenosis.  Mild \nright and moderate left foraminal compromise at T10-T11.”   \n The Claimant had a follow-up evaluation for her continued complaints of cervicalgia on \nNovember 5, 2020.  At this time, it was noted that the Claimant was unable to return to work due \nto her pain.  She had been sleeping in a recliner because was unable to lay flat.  Dawn Lewis, LPN, \nevaluated the Claimant under the care of Dr. Douglas Black.  According to this medical note, the \nClaimant was determined to have “multilevel disc herniations at C4-5 andC5-6.”  She also was \n\nMacon- H107091 \n \n16 \n \nnoted to have a partial rotator cuff tear.”  On physical examination, the Claimant had pain with \nrange  of  motion  in  the  neck  forward  flexion,  extension  and  lateral  flexion.  Her  assessment  was \n“M54.2 Cervicalgia,” for which was given a medication regimen that included a muscle relaxer \nand pain medication.  At that time, the Claimant was instructed not to return to work due to pain.   \nThey gave her educational handouts on “cervical spondylosis.”   \n On November 24, 2020, the Claimant returned to Family Medical Associates for a follow-\nup evaluation of continued symptoms of cervicalgia.  The Claimant’s location of discomfort and \ncharacterization of her pain continued essentially unchanged.  Although the Claimant reported she \nfelt better, she still had limited ROM, and continued to sleep in a recliner.  She was requesting to \ngo  back  to  work.  The  Claimant  was  allowed  to  return  to  work  and  was  instructed  to  return  for  \nfollow-up and re-evaluation as needed.       \nThe Claimant sought treatment for her neck symptoms from the Texas Back Institute  on \nDecember 4, 2020, on referral by Dr. Bowman.  She was evaluated by Dr. Rajesh G. Arakal.  At \nthat time, the Claimant reported that she hurt her neck with a fall.  Per these medical notations, the \nClaimant’s imaging studies which were concerning for a cervical cord compression. As a result, \nshe wanted to obtain further discussion and opinions in this regard.  Since the Claimant’s trauma, \nthere had  been  ongoing  problems  with  some  acute  loss  of  balance,  dysfunction,  and  feeling  of \nheaviness.  The Claimant reported ongoing acute loss of function in her right arm for a period of \ntime and difficulty with mobilization.  She further reported having gone to the emergency  room \nand a workup revealed cervical cord compression at C4-5, 5-6 and 6-7.   Dr. Arakal noted that on \nphysical examination, the Claimant was reporting dysfunction in her balance and looking up was \ndifficult  for  her.    The  MRI  imaging  was  reviewed,  which  showed  evidence  of  spinal  cord \ncompression  secondary  to  large  cervical  disc  herniations  at  C4-5,  C5-6,  and  6-7  with  cord \n\nMacon- H107091 \n \n17 \n \ndeviation.   X-rays showed cervical spondylitis changes.  Dr. Arakal assessed the Claimant with \n“cervical spinal cord compression with myelopathy, with significant compression.  His stated plan \nof treatment included surgery given the level of compression and her symptoms of myelopathy.  \nThe Claimant also had difficulty with cervical extension.  There was some increased pain in the \ncervical spine with cervical extension, but the Claimant had not lost upper extremity function.  She \nwas  starting  to  have  some  mild  changes  her  in  urinary  function  that  was  recent.  The  Claimant \nwanted to hold off on immediate surgery until she could take time off to recover.  Dr. Arakal stated \nthat  given  the  level  of  function,  they  could  do  observation  and  clinical  checkup,  but there  was \nconcern because of the level of compression  that she will need a decompressive procedure. His \nplan included an ACDF at C4-5, C5-6, and 6-7.  Dr. Arakal noted that the Claimant is diabetic.  \nTherefore, there is potential risk of pseudarthrosis, but he believed it is reasonable to try to move \nforward given the pathology of the ventral.  Dr. Arakal ordered a CT scan to look for the level of \nbony compression. \nOn December 22, 2020, the Claimant underwent a CT scan of the cervical spine with an \nimpression of: “Multilevel degenerative disease.”  \nThe  Claimant  returned  to  the  Texas  Back  Institute  for  evaluation  of  her  symptoms  of \nprogressive arm complaints on January 15, 2021.  At that time, the Claimant stated that she was \nhaving increasing difficulty with left arm pain and driving.  On physical examination, Dr. Arkal \nnoted that the Claimant had a positive Hoffman’s signs and the Claimant stated she sensed she was \ngetting  worse.  Dr.  Arakal  stated  that  the  CT  scan  showed  disc  degenerative  changes  but  in \ncomparison to the MRI the large volume compression lesions were not  calcified at C4-5, C5-6, \nand  6-7.    He  assessed  the  Claimant  with  “Cord  compression  with  symptoms  of  cervical \nmyelopathy, positive Hoffman’s  with  cord  deviation  and  compression  at  C4-5,  C5-6,  and  6-7.”  \n\nMacon- H107091 \n \n18 \n \nDr. Arakal opined: She does not have any major ossification of the posterior longitudinal ligament \nso  the  ventral  compression  should  be  addressed  and  can  be  addressed  with  the  area  of  greatest \nventral compression which would be an anterior approach.      \nThe Claimant followed up at Family Medical Associates on March 23, 2021.  She presented \ndue  to  feet/ankle  swelling  and  upper  back  pain  and  neck  pain.  Her  current  episode  started  two \nweeks ago, with no precipitating event or injury.  She was noted to have a history of cervicalgia.  \nThe Claimant reported that she started having pain in her left arm when she woke up one Sunday \nmorning.    At  that  time,  the  Claimant  believed  she  had  a  crick  in  her  neck.  Her  assessment \ncontinued to be cervicalgia and she was directed to follow up with Dr. Arakal. \nOn July 24, 2021, the Claimant was seen at the Texas Back Institute.  Dr. Arakal authored \nprogress notes that same day.  He reviewed the Claimant’s medications with her.  The Claimant \nmoved her surgery date due to family concerns of her brother being ill.  Dr. Arakal assessment was \n“Cervical spondylosis with myelopathy.” \nThe Claimant was evaluated at the Precision Spine Care for back pain that was worsening, \non August 2, 2022, under the care of Dr. Harold Fite.  She stated that her symptoms were gradual \nwith  injury.    The  Claimant  stated  she  had  been  experiencing  these  symptoms  greater  than  two \nyears.  She  reported  having  been  evaluated  by  a  spine  surgeon  in  Plano  who  discussed  the \npossibility of cervical fusion.  The Claimant stated that she had chosen to forego surgery at that \ntime due to concerns of risk and need for further surgery in the future. At that time, the Claimant \nreported  axial  neck  pain  and  pain  that  radiated  into  the  forearm  and  hand.    She  denied  focal \nweakness,  or  bowel  or  bladder  changes.  Per  this  report,  the  Claimant  had  limited  relief  with \nconservative  measures  including  oral  analgesics,  rest,  heat,  ice,  and  physical  therapy.    Dr.  Fite \nopined:  “She has  a  cervical  MRI  showing  multilevel  degenerative  disc  disease  and  facet \n\nMacon- H107091 \n \n19 \n \narthropathy with lateral recess and foraminal stenosis at C4-5 and C5-6.  She has severe stenosis \nat C4-5 and moderate stenosis at C5-6 and C6-7.”  The Claimant reported moderate difficulty with \nwalking for more than five minutes.  Dr. Fite’s assessment was “Radiculopathy, cervical region \n(M54.12), for which he tentatively planned to perform a cervical epidural steroid injection at C6-\n7 with follow up in two weeks.  The Claimant wanted more time to discuss with her family before \nscheduling. \nOn  January  11,  2023,  the  Claimant  followed-up  at  Dr.  Leslie  Howland  FNP,  at  the \nPrecision  Spine  Care  for  chronic  pain  and  back  pain.  She  presented  with  a  report  of  increased \npain.  The Claimant wanted to move forward with the CESI. \nDr. Fite performed a Cervical Interlaminar Epidural Steroid Injection at C6-7, on February \n6, 2023.  Findings included “cervical interlaminar level treated at midline C6-7.”   \n                     Adjudication \nA.   Compensability      \n            In Ark. Code Ann. §11-9-102(4)(A)(i) (Repl. 2012), “compensable injury” means:  \n(i)  An accidental injury causing internal or external physical harm to the body ... \narising out of and in the course of employment and which requires medical services \nor results in disability or death.  An injury is “accidental” only if it is caused by a \nspecific incident and is identifiable by time and place of occurrence[.]    \n  \n  A  compensable  injury  must  be  established  by  medical  evidence  supported  by  objective \nfindings.  Ark. Code Ann. §11-9-102(4)(D).  “Objective findings” are those findings which cannot \ncome under the voluntary control of the patient.  Ark. Code Ann.§11-9-102 (16)(A)(i).    \n The employee has the burden of proving by a preponderance of evidence that she sustained \na compensable injury.  Ark. Code Ann. §11-9102(4)(E)(i).  Preponderance of the evidence means \nthe evidence having greater weight or convincing force.  Metropolitan Nat’l Bank v. La Sher Oil \n\nMacon- H107091 \n \n20 \n \nCo., 81 Ark. App. 269, 101 S.W.3d 252 (2003), citing Smith v. Magnet Cove Barium Corp., 212 \nArk. 491, 206 S.W.2d 442 (1947).       \n After  reviewing  the  evidence  in  this  case  impartially,  without  giving  the  benefit  of  the \ndoubt  to  either  party,  I  find  that  the  Claimant  has  proven  by  a  preponderance  of  the  credible \nevidence that she sustained compensable injuries to her back and neck during her work- related \nfall on October 6, 2020, when a table she was leaning against collapsed causing her to fall hard \nonto  the  floor  on  her  buttocks.   The  Claimant’s  description  and  account  of  the  incident  is \ncorroborated by Ms. Lambs and the contemporaneous documentary medical records of evidence.  \nIn this regard, I find both the Claimant and Ms. Lamb to be extremely credible witnesses.       \n The Claimant reported her accidental injury to management on October 9, three days after \nher  fall.  Her  testimony  demonstrates  that  she  put  off  seeking  treatment  thinking  her  condition \nwould improve, but it worsened.  Three days after her fall, on October 9, 2020, the Claimant sought \nmedical  treatment  from  her  primary  care  physician,  Dr.  Bowman.  Initially,  the  Claimant \ncomplained of back pain.  She was treated with a prescription of muscle relaxers for lumbar muscle \nspasms by Dr. Bowman.   These are objective medical findings of an injury to the Claimant’s back. \nAlthough the Claimant had been involved in two car accidents (one was very minor), she had not \ncomplained of back symptomology in almost three years.  Nor had the Claimant missed any work \nor been evaluated by any medical doctor for complaints of the back.  Based on  the lack of any \nmedically  documented  complaints  of  any  recent  back  problems,  the  credible  testimony  of  the \nClaimant and Ms. Lamb surrounding the circumstances and mechanism of the Claimant’s work-\nrelated  fall,  I find  that  the  Claimant  has  proven  by  a  preponderance  of  the  evidence  a  causal \nconnection between her workplace fall of October 6, 2020, and her current  back condition.  \n\nMacon- H107091 \n \n21 \n \nRegarding the Claimant’s spine condition, it is well established in workers’ compensation \nlaw that  an aggravation  of a preexisting condition is compensable.   The  medical records reflect \nthat following the Claimant’s 2016 motor vehicle accident, she under diagnostic tests that revealed \nshe  had  disc  herniations  at  C-5  and  C5-6.    However,  the  MRI  of  the  Claimant’s  cervical  spine \ndemonstrates that she sustained a recent/new trauma injury to neck involving a different disc area \nat C6-7.  The degree of stenosis is much more significant in severity in comparison to previous \nimaging.    Dr.  Arakal  characterizes  it  as  cord  compression  at  all  three  levels,  C4-5, C5-6,  C-7.  \nThese are objective medical findings of an accidental injury to the Claimant’s cervical spine on \nOctober 6.     This finding is particularly persuasive considering the Claimant was able to perform \nher job duties as a teacher before her work incident of October 6, and she had not complained to a \nmedical professional about any complaints of the neck since January 26, 2017, almost three years \nbefore her work incident. Her testimony concerning the gradual progression of her neck and arm \nsymptoms  is  corroborated  by  the  medical  records.    Moreover,  there  no  evidence  absolutely \nwhatsoever demonstrating that the Claimant injured her neck during some other event or injury in \nthe interim.  Likewise, the mechanism of the Claimant’s fall is consistent with a neck injury, as \ndescribed by both Ms. Lamb’s and the Claimant’s account of the incident.  Both credibly testified \nthat the Claimant’s suddenly fell to floor on her buttocks.  \nI  find  that  the  Claimant  has  proven  by  a  preponderance  of  the  evidence  all  of  the \nrequirements  necessary  for  establishing  that  she  sustained  a  compensable  injury  to  her  neck  on \nOctober 6, 2020.    \nB. Medical Treatment \nThe employer shall promptly provide for an injured employee such medical treatment as \nmay be reasonably necessary in connection with the injury received by the employee.  Ark. Code \n\nMacon- H107091 \n \n22 \n \nAnn.  §11-9-508(a)  (Repl.  2012).      The  Claimant  must  meet  her  burden  of  proving  by  a \npreponderance  of  the  evidence  that  medical  treatment  of  record  is  reasonably  necessary  in \nconnection with the injury received by the employee.  Stone v. Dollar General Stores, 91 Ark. \nApp. 260, 209 S.W.3d 445 (2002).  Our courts have quantified the preponderance of the evidence \nto mean the evidence having greater weight or convincing force.  Metropolitan Nat’l Bank v. La \nSher Oil Co., 81 Ark. App. 269, 101 S.W.3d 252 (2003). \nHere, the Claimant sustained compensable injuries to her neck and back when a table she \nwas leaning on collapsed, causing her to fall on her buttocks, on October 6, 2020.  The Claimant \nunderwent  conservative  care  with  her  PCP,  Dr.  Bowman,  at  the  Texas  Back  Institute,  and \nPrecision Spine for her neck and back injuries.  I find all of the treatment of record is reasonably \nnecessary treatment for diagnosing and treating the Claimant’s back and neck injuries.  Despite \nthis  conservative  treatment  including  steroid  injections,  the  Claimant  has  continued  with \ncomplaints  of  pain  and  discomfort,  particularly  in  her  neck.    The  Claimant  was  diagnosed  as \nhaving significant herniations, by Dr. Arakal, a spine specialist, who has recommended surgical \nintervention.  Considering the Claimant failed conservative treatment modalities, I am persuaded \nthat  surgical  intervention  is  warranted  and  recommended  follow-up  management  treatment \ndeemed appropriate by her treating physician. \nI  realize  that  the  Claimant  is  reluctant  to  undergo  surgery  at  this  time  and  wishes  to \ncontinue with conservative treatment modalities.  However, given the nature and severity of the \nrisks involved with neck surgery, I find this course of action of putting the surgery off for as long \nas possible is quite reasonable and most prudent.   \n \n\nMacon- H107091 \n \n23 \n \n                                                  AWARD \n The Respondents are ordered and directed to pay benefits in accordance with the \nfindings of fact and conclusions of law set forth above.  All other issues are reserved under \nthe Arkansas Workers’ Compensation Act.  \n      IT IS SO ORDERED. \n \n \n          ______________________________ \n          HON. CHANDRA L. BLACK \n                 ADMINISTRATIVE LAW JUDGE","preview":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION CLAIM NO.:H107091 MARGARET A. MACON, EMPLOYEE CLAIMANT MINERAL SPRINGS, SARATOGA SCHOOL DISTRICT, EMPLOYER RESPONDENT ARKANSAS SCHOOL BOARDS ASSOCIATION, WCT RESPONDENT OPINION FILED JUNE 12, 2023 Hearing held before ADMINISTRATIVE LAW J UDGE CHANDRA L. BLACK in Texa...","fetched_at":"2026-05-19T23:06:17.264Z","links":{"html":"/opinions/alj-H107091-2023-06-12","pdf":"https://labor.arkansas.gov/wp-content/uploads/MACON_MARGARET_H107091_20230612.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/"}}