{"id":"alj-H107962-2023-08-29","awcc_number":"H107962","decision_date":"2023-08-29","opinion_type":"alj","claimant_name":"Charles Axsom","employer_name":"Baptist Health Systems","title":"AXSOM VS. BAPTIST HEALTH SYSTEMS AWCC# H107962 AUGUST 29, 2023","outcome":"granted","outcome_keywords":["granted:1"],"injury_keywords":["knee","back","ankle","sprain","lumbar","hip","thoracic"],"pdf_url":"https://labor.arkansas.gov/wp-content/uploads//AXSOM_CHARLES_H107962_20230829.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/","filename":"AXSOM_CHARLES_H107962_20230829.pdf","text_length":34810,"full_text":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION \nCLAIM NO. H107962 \n \nCHARLES W. AXSOM, EMPLOYEE        CLAIMANT \n \nv. \n \nBAPTIST HEALTH SYSTEMS,               \nSELF-INSURED EMPLOYER               RESPONDENT \n \nCLAIMS ADMINISTRATIVE SERVICES, TPA            RESPONDNET \n \nOPINION FILED AUGUST 29, 2023 \n \nHearing before Administrative Law Judge, James D. Kennedy, on the  18\nth\n day of July, \n2023, in Little Rock, Pulaski County, Arkansas. \n \nClaimant   is   represented   by   Ms.   Evelyn E.   Brooks,   Attorney-at-Law,   Fayetteville, \nArkansas. \n \nRespondents  are  represented  by  Mr.  Jarrod  S.  Parrish,  Attorney  at  Law,  Little  Rock, \nArkansas. \n \nSTATEMENT OF THE CASE \n  \n A  hearing  was  conducted  on  the  18th  day  of  July, 2023,  to  determine  the  \nclaimant’s  entitlement  to  additional  benefits,  specifically  additional  medical  treatment \nassociated with complex regional pain syndrome as a result of a right knee injury.  A copy \nof the Prehearing Order which was dated May 9, 2023, was marked “Commission Exhibit \n1” and made part  of  the  record  without  objection.    The  Order  provided  that the parties \nstipulated that the Arkansas Workers’ Compensation has jurisdiction of the case and that \nthere  was  an  employer/employee  relationship  which existed  on  or about  September 4, \n2021, when the claimant suffered a compensable, work-related injury to his right knee.   \nThe  respondents  accepted  the  claim  as  compensable  and  were  paying  a  ten  percent \n(10%)  permanent  partial  impairment  to  the  claimant  at  the  time  of  the  hearing.  \n\nAXSOM – H107962 \n \n2 \n \nAdditionally, it was stipulated that claimant’s prior attorney, Mr. Andy Caldwell had a lien \nin regard to this claim.  \n The  claimant’s  and  respondent’s  contentions  are  set  out  in  their  respective \nresponses  to  the  prehearing  questionnaire and  made  a  part  of  the  record  without \nobjection.  The sole witness to testify was the claimant, Charles M. Axsom.  The claimant \nsubmitted two (2) exhibits.  “Claimant’s Exhibit One” consisted of 198 pages of medical \nreports with an index that was admitted without objection.  “Claimant’s Exhibit Two” was \nfound to not be admissible due to the fact it was furnished to the respondents within the \nseven-day  cutoff  period  prior  to  the  hearing.    The  exhibit  was  allowed  to  be  proffered.  \nThe respondents submitted two (2) exhibits without objection, with “Respondents’ Exhibit \nOne”   consisting  of  medical   records   consisting   of 32   pages   with   an   index,   and \n“Respondents’ Exhibit Two” consisting of 5 pages of forms and correspondence with an \nindex.    From  a  review  of  the  record  as  a  whole,  to  include  medical  reports  and  other \nmatters properly before the Commission, and having had an opportunity to observe the \ntestimony and demeanor of the witness, the following findings of fact and conclusions of \nlaw are made in accordance with Ark. Code Ann. §11-9-704. \nFINDINGS OF FACT AND CONCLUSSIONS OF LAW \n1. The  Arkansas  Workers’  Compensation Commission  has  jurisdiction \nover this claim. \n \n2.  That an employer/employee relationship existed on September 4, 2021, \nthe  date  that  the  claimant  suffered  a  compensable  injury  to  his  right \nknee. \n  \n3.  Respondents  have  accepted  and  are  paying  a  ten  percent  (10%) \npermanent partial impairment to the claimant. \n \n4. The claimant’s prior attorney,  Mr.  Andy  L.  Caldwell,  has  filed  a  lien  in \nthis matter. \n\nAXSOM – H107962 \n \n3 \n \n  \n5.  That  the  claimant  has  proven,  by  a  preponderance  of  the  credible \nevidence,   that   the   additional   medical   treatment,   specifically   the \ntreatment for complex regional pain syndrome is both causally related \nand  reasonably  necessary  for  the  treatment  of  the  work-related  right \nknee injury. \n    \n6.  If not already paid, the respondents  are ordered to pay for the cost of \nthe transcript forthwith. \n \nREVIEW OF TESTIMONY AND EVIDENCE \n \n The claimant, Charles Axsom, testified he would turn fifty-nine (59) years old on \nAugust 17 and had been working for the respondent since February of 2020 as a painter \nand  also  worked  on  wall-paper,  flooring,  sheet  rocking,  and  fire  proofing.    He  had  no \nproblem performing his work prior to September 4, 2021.  On that date, he went out “fixing \nto  head out for lunch, go back to the main hospital.  That’s where we clocked in and \nclocked out.”     “When I went in to get into the van, I put in, they were standing at the \ndoor and we’ve got that running board on the step side, and when I went up to get on it, \nwhen I put my foot on it, the running board fell.”  (Tr. 6, 7)  He went on to state when he \nfell,  his  right  knee  popped  and  that  he  reported  his  injury.    He  returned  to  work  that \nTuesday and continued to climb a ladder.  After the accident, he continued to work light \nduty from September 13\nth\n through October 19\nth\n, and then had surgery by Dr. Tucker at \nOrthoArkansas.  He suffered from “mild pain” in his right inner knee. (Tr. 8, 9)  He walked \non crutches for about eight (8) months which started before the surgery.  After the surgery, \nhe testified that his symptoms changed and that “my ankle started hurting, my blood in \nmy  foot,  it  started  out  at  my  big  toe  and  it  progressed.    It  went  from there  to,  and  you \nknow, it surged, you know, it just comes up my knee.  I can’t, it just does different things.  \nBut I mean, but it got worse by swelling.  It got worse by the pain.  It was horrible to deal \n\nAXSOM – H107962 \n \n4 \n \nwith.”  He hurt in regard to his right leg, his foot, calf, ankle, and from the bottom  of his \nfoot  to  his  knee  and  sometimes to his thigh.  When he sits down, it “aggravates that \nnerve.”  These symptoms have been present since the surgery.  He also admitted that he \nhad hurt his back in 2018, but he had not filed a workers’ compensation claim in regard \nto the injury, and was not having any back trouble.  He had received physical therapy and \ncurrently  was  seeing  Doctor  Christine  Wagner  and  Doctor  Robin.    He ended  his  direct \ntestimony by saying that he wanted to return to work and that sometimes the pain goes \naway for thirty (30) minutes to an hour but returns. (Tr. 10-13)    \n  Under  cross-examination,  the  claimant  was  questioned  about  testifying  in  his \ndeposition that he had never had any problem with his right knee and his response was \n“I tell you, sir, I didn’t remember any of that.”  He admitted that at the time of the deposition \nhe provided he never had any diagnostic studies of his right knee, but since that time, his \nlawyer had shown him “some stuff” that he did not remember.  He admitted seeing his \nmedical records and being shown an MRI for his knee.  The following questioning then \noccurred: \n Q:    You  had  pain  radiating  down  your  knee  in  2018  at  a  9  on  a  10  point \nscale? \n \n A:  Sir, I don’t remember, but if that’s what it says, yes, sir. \n \nQ:  The judge is going to see if it’s right knee pain requiring an MRI on page \n13 of your medical packet.  You’ve seen that with your lawyer, right? \n \n A:  Yes sir. \n \nQ:  So when you told me at your deposition that you’d never had any right \nknee  problems  or  never  had  any  diagnostic  tests,  that  wasn’t  a  true \nstatement, was it? \n \nA:  Sir, I didn’t remember it.  I did have a mask (sic) on it, but it wasn’t like \nthis right here.  I don’t remember. (Tr. 14) \n\nAXSOM – H107962 \n \n5 \n \nQ:    Okay.    And  we  know,  even  from  your  description  here  today,  the \naccident only involved your right knee, right?  You said you stepped on the \nrunning board you had a twisting and popping sensation with the right knee \nonly, right? \n \nA:  Right. \n \nQ:  There was no involvement involving you toes, your feet or your ankle or \nanything like that, is that right? \n \nA:  I still stepped on my foot, but what I actually injured was my knee. \n \nQ:  Yes sir.  So you had no injury or symptoms in your toes or your ankle \nright after the accident, right? \n \nA:  Right. \n \nQ:    I  went  through  your  medical  exhibits and I don’t see mention of the \nwords, foot, ankle, or toes or any of that until April of 2022.  Did you speak \nthat? \n \nA:  Yes, sir.  2022. \n  \nThe  claimant  also  agreed  there  was  no  mention  of  chronic  regional  pain  syndrome, \n(CRPS), until May 31 of 2022, which was nine (9) months after the accident. (Tr. 16, 17)  \nHe admitted his right foot was not injured in the accident and that he had no reason to \ndispute the records that Dr. Tucker placed him at MMI and released him for his right knee. \n(Tr. 18, 19)    \n On re-direct, the claimant testified that in his deposition he did not recall an MRI of \nhis right knee.  He did recall volunteering he had an injury while working for Century.  In \nregard  to  his  surgeries,  his  first  one  was  November  1\nst\n,  and  the  second  one  was \nDecember 6\nth\n. (Tr. 24, 25) \n “Claimant’s Exhibit Ones” initial medical consisted of a clinic note dated September \n7, 2021, which provided the claimant presented to discuss concerns about his right knee \nwhich  had  begun  on  September  4,  2021.    An  x-ray  provided  for  no  fractures  or \n\nAXSOM – H107962 \n \n6 \n \ndislocations with mild degenerative changes.  The assessment provided for a decreased \nrange of motion and mentioned that  an MRI was going to be ordered.  It also provided \nthat  the  claimant  could  return  to  work  the  following  day on  light  duty.    Crutches  were \nprescribed. (Cl. Ex. 1, PP. 1-7)   \n Claimant  presented  to  Dr.  James  Tucker  on  September  21,  2021.   The  report \nprovided  the  claimant  was  to  stay  on  crutches  and  that  the  MRI  provided  for  a  medial \nmeniscal    radial    type    tear,    and  a   Velcro   hinged   knee   brace   for    the    MCL    was \nordered.  (Cl. Ex. 1, PP. 8-16)   A  return  to  work  slip  for  sedentary  duty  was  provided. \n(Cl. Ex. 1, P. 17)  The claimant returned to OrthoArkansas on September 26, 2021, and \nsurgery was later performed by Dr. Tucker on November 2, 2021, for repair of the medial \nmeniscus. (Cl. Ex. 1, PP. 18-31)  An MRI dated November 17, 2021, provided for findings \nsuspicious of a re-tear involving the inferior meniscal surface. (Cl. Ex. 1, PP. 32-33)  The \nclaimant then returned to Dr. Tucker on November 23, 2021, for a follow-up after a fall \ndue  to  his  crutches  and  the  report  confirmed  a  showing  of  a  re-tear  of  his medial  and \nlateral meniscus with a sprain of his MCL. (Cl. Ex. 1, PP. 34-37) \n A  second  surgery  involving the claimant’s  right  knee  occurred  on  December  6, \n2021. (Cl. Ex. 1, PP. 38-41)  The claimant then returned to Dr. Tucker for a follow-up on \nDecember 22, 2021, after an initial physical therapy treatment. The report provided that \nthe claimant was doing okay but had an increase in pain since surgery.  A new knee brace \nwas  ordered.  (Cl.  Ex.  1,  PP.  44-50)    The  claimant  continued  to  present  for  multiple \nphysical  therapy  sessions  and  returned  to  Dr.  Tucker  on  February  8,  2022.  The  major \ncomplaint  at  the  time  of  the  visit  was  continued  and  increasing  pain  down  the  L4 \ndermatome/saphenous nerve distribution and the claimant indicated this comes on when \n\nAXSOM – H107962 \n \n7 \n \nhe  had  something  press  against  his  posterior  thigh.    An  EMG  nerve  study  was \nrecommended, as well as continued therapy. (Cl. Ex. 1, PP. 55-58) \n The claimant continued to receive physical therapy and presented to Dr. Cayme \nat  OrthoArkansas  on  February 21, 2022, for  a  nerve  conduction  study.  The  initial \nstudy  provided  for  a  normal  study  with  no  electrodiagnostic  evidence  of  a  focal \nnerve  entrapment,  generalized  peripheral  neuropathy,  or  right  lumbar  radiculopathy. \n(Cl.  Ex.  1,  PP.  60-64)    However,  a  revised  report  of  the  same  date  provided  for  an \nabnormal  electrodiagnostic  study  with  electrodiagnostic  evidence  of  a  right  axonal \nsaphenous  neuropathy.    There  was  no  electrodiagnostic  evidence  of  a  generalized \nperipheral  neuropathy,  other  focal  nerve  entrapment, or right lumbar radiculopathy. \n(Cl. Ex. 1, PP. 65-66) \n The claimant returned to Dr. Tucker on February 23, 2022, and also on March 16, \n2022,  after  physical  therapy.  The  report  from  March  16,  2022,  provided  that  the EMG \nnerve conduction study provided no signs of nerve compression and was felt to be normal, \nbut  that  the  claimant  continued  to  have  dysesthesias  along  the  saphenous  nerve \ndistribution which was aggravated by sitting in a chair. (Cl. Ex. 1, PP. 67-71) \n Physical  therapy  regarding  the  right  knee  continued  and  the  claimant  was \ninstructed to remain off work until further notice. (Cl. Ex. 1, PP. 74-75)  The claimant was \nthen referred to Dr. Paulus on March 28, 2022.  Dr. Paulus agreed with Dr. Tucker that \nmuch of the radiating leg symptoms of the medial knee to the medial ankle fit with the \nsaphenous  nerve  distribution,  but  by  continuing  to  the  dorsum  of  the  foot,  it   was \natypical  for  saphenous  neuropathy  and  could  represent  an  L5  radicular  pattern.  \n(Cl. Ex. 1, PP. 76-81)  \n\nAXSOM – H107962 \n \n8 \n \n After additional physical therapy, the claimant returned to Dr. Tucker on April 12, \n2022.    The  report  provided  the  claimant had  a  saphenous  nerve  injury  with  a  positive \nTinel’s, with pressure against the posterior.  An MRI was recommended and the claimant \nwas again instructed to remain off of work. (Cl. Ex. 1, PP. 83-87)  Two weeks later, the \nclaimant returned to Dr. Paulus.  The report provided that the claimant had presented with \nthree (3) months of “dull, aching, throbbing” low back pain with “sharp, shooting, stabbing, \ntingling, numb” referral into the right leg that began after a knee surgery.  The bilateral \nsaphenous  nerve  conduction  studies  performed  on  March  28,  2022,  revealed a \nsignificantly  lower  right-sided nerve  amplitude  in  comparison to  the  left  and  Dr. Paulus \nopined  that  this  was  “confirmatory  for  saphenous  neuropathy,”  axonal  in  nature. \n(Cl. Ex. 1, PP. 88-92)  A clinic note from Dr. Tucker on the same date of April 26, 2022, \nprovided the claimant had marked quad atrophy and was going to be placed back into \ntherapy.  (Cl.  Ex.  1,  PP.  93-96)    An  MRI  of  the  right  lower  extremity  provided  for  an \nunremarkable evaluation of the right thigh and showed no abnormality that could cause \nsaphenous nerve compression. (Cl. Ex. 1, P. 97) \n The claimant returned to Dr. Paulus on May 31, 2022, who opined the claimant’s \npresentation had changed over the last month, with pain now extending into the dorsum \nof his foot with a new onset of vasomotor and sudomotor changes.  He opined that the \nclaimant had developed Type 2 Chronic Regional Pain Syndrome. (Cl. Ex. 1, PP. 98-102)  \nDr.  Tucker  also  issued  a  clinic  note  of  the  same  date  which  provided  the  claimant \ncontinued to suffer from saphenous neuropathy. (Cl. Ex. 1, PP. 103-106)  \n On June 15, 2022, the claimant was  referred by Dr. Paulus to Dr. Brent Walker, \nfor  possible  complex  regional  pain  syndrome  of  his  lower  extremity.    Dr.  Walker  noted \n\nAXSOM – H107962 \n \n9 \n \nthat the claimant’s right knee was reddened and swollen and that there was a temperature \nasymmetry and consequently, he ordered a triple phase bone scan in regard to possible \ncomplex regional pain syndrome of the right lower extremity. (Cl. Ex. 1, PP. 107-112)  The \nbone scan was performed on June 21, 2022, and it provided that there was decreased \nactivity on all three (3) phases within the right foot which could be related to the disuse of \nthe right leg.  It also noted that although rare, this pattern had also been described with \ncomplex  regional  pain  syndrome.  (Cl.  Ex.  1,  PP.  113-114)    The  claimant received  a \nsympathetic nerve block administered by Dr. Walker on June 28, 2022, on July 5, 2022, \nand also on July 12, 2022. (Cl. Ex. 1, PP. 115-120)  Claimant then returned to Dr. Walker \non July 15, 2022,  who assessed him  with complex regional pain syndrome of the right \nlower  extremity.    Complex  regional  pain  syndrome  has  an  uncertain  progress  and  can \npossibly reactivate months and even years after the initial insult. (Cl. Ex. 1, PP. 121-127)  \nThe claimant received additional right lumbar sympathetic blocks by Dr. Walker, based \nupon the diagnosis of complex regional pain syndrome of the lower extremity on August \n4, 9, and the 16, of 2022. (Cl. Ex. 1, PP. 128-133)  Dr. Walker issued a clinical note on \nAugust  25,  2022,  which  provided  the  claimant was  returning  after  six  (6)  lumbar \nsympathetic  nerve  blocks  and  was  seeing  an  improvement  over  the  last  three  (3) \ninjections and no longer had a generalized pain, but had a more specific pain into the web \nof  his  toes  and  dorsum  of  his  foot,  with  continued  pain  in  his  right  knee  and  with a \ndecreased range of motion. (Cl. Ex. 1, PP. 134-140) \n The  claimant  returned  for  additional  sympathetic  nerve  blocks  on  August  30, \nSeptember 6 and the 13, of 2022.  (Cl. Ex. 1, P. 141-146)  On September 23, 2022, Dr. \nWalker  issued  an  additional  clinic  note  which  provided  the  claimant  might  be  a  good \n\nAXSOM – H107962 \n \n10 \n \ncandidate  for  a  referral  to  UAMS  and  their  CRPS  program.    He  opined  that  it  was  his \nopinion that the claimant would not respond to any additional sympathetic nerve blocks.   \n(Cl. Ex. 1, PP. 147-154)  Another clinic note was issued by Dr. Walker on October 21, \n2022, which again provided under assessment for the diagnosis of complex regional pain \nsyndrome of the right lower extremity. (Cl. Ex. 1, PP. 155-163) \n The claimant was then seen by Dr. Ethan Schock on November 17, 2022, with a \nclinic addendum issued on February 27, 2023, which provided that the opinion he issued \nwas limited to the orthopedic related issues of the right knee and the neurologic/complex \nregional pain syndrome involving the right knee and the lower extremity diagnosis.  He \nopined the claimant had reached MMI with respect to his right knee work-related injury \nand  found  a  twelve  percent  (12%)  whole  person  permanent  partial  impairment.    On \nFebruary 27, 2023, Dr. Schock issued an addendum which provided he saw no way to \nmodify  his November  17,  2022,  assessment  based  upon  the  question  of  “chronic \nchondromalacia.” (Cl. Ex. 1, PP. 163a-168) \n On  December  15,  2022,  Dr.  Wagner  issued  a  clinic  note  which  provided  the \nclaimant  was  seen  for  management  of  his  right  lower  extremity  complex  regional  pain \nsyndrome.    Unfortunately,  he was  in  the  chronic  phase.    Symptoms were  starting  to \nradiate to the mid-thigh level and he had not heard about a second opinion with UAMS.  \nHe had been assessed with complex regional pain syndrome of the right lower extremity \nand  his  work  restrictions  were  continued.  (Cl.  Ex.  1,  PP.  169-180)    An  OrthoArkansas \nclinic note dated December 15, 2022, again made an assessment of complex regional \npain syndrome of the right lower extremity. (Cl. Ex. 1, PP. 181-189) \n\nAXSOM – H107962 \n \n11 \n \n Finally, claimant was seen by Dr. Cale White and Dr. Jonathan Goree on April 25, \n2023.  The report provided that the right lower extremity pain was consistent with complex \nregional  pain  syndrome  and  the  plan  called  for  a  DRG stimulator assessment, a \npre-operative  neuropsych  evaluation,  a  preoperative  MRI,  and  counseling  on  smoking \ncessation. (Cl. Ex. 1, PP. 190-195) \n The respondents submitted  two (2) exhibits which were admitted into the record \nwithout objection.  The first exhibit consisted of 32 pages of medical reports with an index. \nAn MRI of the lumbar spine dated June 21, 2012, provided the claimant had narrowed \ndisc spaces at the L3-4 and at the L4-5 disc space with a right paracentral disc herniation \nslightly indenting the thecal sac and abutting the right S1 nerve root. (Resp. Ex. 1, P. 1)  \nA second lumbar spine MRI was taken on April 9, 2014, which provided for development \nof disc degeneration with left paracentral disc protrusion at the L2-3, with no change of \nthe left disc protrusion at L3-4.  Additionally, there was no change in the right paracentral \ndisc protrusion at L5-S1 with minimal mass affect on the right S1 nerve root.  There was \nno  change  in  the  right  posterolateral  annual  tear  with  a  small  protrusion   at   L4-5.  \n(Resp. Ex. 1, PP. 2-3) \n A  chart  note  dated  April  21,  2014, by  Dr  Regan  Gallaher  provided  for  right  hip \narthropathy and lumbar radiculopathy. (Resp. Ex. 1, P. 4)  A myelogram dated June 6, \n2014,  provided  for  a  L2-3  left  subarticular  disc  protrusion  contracting  and  posterior \ndeviating  the  descending  left  L3  nerve  roots.   An L2-3  left  foraminal  disc  protrusion \ncontacted the exiting left L3 nerve roots with mild left neural foraminal narrowing.  L3-4 \nforaminal  disc  protrusions  contacted  the  exiting  left  L3  nerve  roots  without  neural \nforaminal narrowing. (Resp. Ex. 1, PP. 5-7) \n\nAXSOM – H107962 \n \n12 \n \n The records also provided that on December 31, 2014, the claimant presented to \nthe ER at Baptist Medical Center for alcohol detoxification and had presented to the ER \nintoxicated with elevated liver enzymes and back pain. (Resp. Ex. 1, PP. 8-10).  A report \nby  Dr.  Jacob  Abraham  dated  August  18,  2015,  provided  the  claimant  had  lumbar \nspondylosis, lumbosacral and thoracic radiculitis, and lumbar disc disruption.  In addition, \na  letter  from  Dr.  Jack  Cates  addressed  to  Dr.  Timothy  English  dated  October  1, \n2015,  provided  the  claimant  suffered  from  a  right  hand  that  was  dry  and  flakey.  \n(Resp. Ex. 1, P. 12) \n An MRI of the claimant’s right knee dated May 12, 2016, provided for mild medical \nosteoarthritis with no evidence of acute internal derangement. (Resp. Ex. 1, P. 13)  The \nrespondents also provided a chart note from Dr. Joshua Garner dated November 7, 2018.  \nThe note provided for vertebral subluxation complex. (Resp. Ex. 1, PP. 14-18)  An EMG \nnerve  conduction  study  dated  February  21,  2022,  was  previously  reviewed  in  the \nclaimant’s documentary evidence. (Resp. Ex. 1, PP. 19-20) \n An Impairment Evaluation Summary dated January 11, 2023, was also made part \nof the record which provided the claimant had a “4% Whole Person, 10% Lower Extremity \nimpairment due to a loss of motion and also a 4% Whole Person, 10% Lower Extremity \nimpairment when rated using a diagnosis based impairment approach.”  The report also \nprovided  that  the  claimant  had  a  documented  surgical  and/or  medical  history  which \nindicated a diagnosis-based impairment was applicable. (Resp. 1, PP. 21-25) \n Finally,  an  IME  from  Dr.  Carlos  Roman  discussed  the  various  treatments  and \ndiagnoses  the  claimant  received  from  multiple  doctors,  as  well  as  his  past  history  of \nneuropathy and general and severe osteoarthritis.  He opined that the claimant did not fit \n\nAXSOM – H107962 \n \n13 \n \nthe criteria for complex regional pain syndrome. (Resp. Ex. 1, PP. 26-28)  Additionally, in \na clinic note for the claimant dated April 5. 2023, Dr.  Roman opined that the bone scan \nwould not in any way conclude complex regional pain syndrome.  He also opined that the \nIovera procedure for the right knee pain was indicated for severe osteoarthritic patients \ncontemplating a right total knee arthroplasty and/or post arthroplasty surgeries and the \nclaimant did not fit the criteria for an Iovera knee procedure. (Resp. Ex. 1, PP. 29-30)     \n The respondents second exhibit consisted of an AR-C Form filed on September \n30, 2021, which provided the claimant had suffered injuries to his right knee and other \nbody  parts.  (Resp.  Ex.  2,  P.  1)    The  AR-2  form  filed  by  the  respondents  provided  the \nrespondents had accepted the compensability of the right knee and that all benefits due \nhad been or were in the process of being paid. (Resp. Ex. 2, P. 2)  Additionally, attorney \nAndy  Caldwell,  claimant’s  previous  attorney,  asserted  a  lien  pursuant  to  Ark. Code \nAnn.  §  16-22-304  after  the  claimant  informed  him  he  no  long  wanted  Mr.  Caldwell  to \nrepresent him.  (Resp. Ex. 2, P. 3)  Finally, the respondents provided a list of available \njobs that were forwarded to the claimant.  (Resp. 2, P. 4)          \n      DISCUSSION AND ADJUDICATION OF ISSUES \nIn the present matter, the parties stipulated the claimant sustained a compensable \ninjury on September 4, 2021.  The claimant is therefore not required to establish “objective \nmedical findings” in order to prove that he is entitled to additional benefits. Chamber Door \nIndus., Inc. v Graham, 59 Ark. App. 224, 956 S.W.2d 196 (1997) \nHowever, when assessing whether medical treatment is reasonably necessary for \nthe treatment of a compensable injury, we must analyze the proposed procedure and the \ncondition  that  it  is  sought  to  remedy.   Deborah  Jones  v.  Seba,  Inc., Full  Workers’ \n\nAXSOM – H107962 \n \n14 \n \nCompensation filed December 13, 1989. (Claim No. D512553).  The respondent is only \nresponsible  for  medical  services  which  are  causally  related  to  the  compensable  injury.  \nTreatments  to  reduce  or  alleviate  symptoms  resulting  from  a  compensable  injury,  to \nmaintain the level of healing achieved, or to prevent further deterioration of the damage \nproduced by the compensable injury are considered reasonable medical services.  Foster \nv. Kann Enterprises, 2009 Ark. App. 746, 350 S.W.2d 796 (2009).  Liability for additional \nmedical  treatment  may  extend  beyond  the  treatment  healing  period as  long  as  the \ntreatment is geared toward management of the compensable injury. Patchell v. Wal-Mart \nStores, Inc., 86 Ark. App. 230, 180 S.W.3d 31 (2004). \nThe claimant bears the burden of proof in establishing entitlement to benefits under \nthe  Arkansas  Workers’  Compensation  Act   and   must   sustain   that   burden   by   a \npreponderance of the evidence.  Dalton v. Allen Engineering Co., 66 Ark. App 260, 635 \nS.W.2d 543.  Injured employees have the burden of proving by a preponderance of the \nevidence  that  the  medical  treatment  is  reasonably  necessary  for  the  treatment  of  the \ncompensable injury. Owens Plating Co. v. Graham, 102 Ark. App 299, 284 S.W. 3d 537 \n(2008).  What constitutes reasonable and necessary treatment is a question of fact for \nthe Commission. Anaya v. Newberry’s 3N Mill, 102 Ark. App. 119, 282 S.W.3d 269 (2008).  \nThe claimant was injured when he stepped on the running board of a vehicle and \nthe  running  board  collapsed.    The  testimony  provided  he  worked  the  remainder of \nSeptember 4, 2021, and worked light duty from September 13 through October 19, 2021. \nThe claimant was treated by Dr. James Tucker who ordered an MRI and who diagnosed \na  medial  meniscal  radial  tear  and  performed  the  initial  surgery  to  repair  the medial \nmeniscal  tear  on  November  2,  2021.    After  the  surgery,  the  claimant  was  placed  on \n\nAXSOM – H107962 \n \n15 \n \ncrutches and fell due to the crutches, which caused a reinjury of his medial meniscus and \nlateral meniscus and also a sprain of his MCL.  Dr. Tucker performed a second surgery \nto  repair  the  additional  injuries  on  December  6,  2021.    The  follow-up  by  Dr. Tucker \nprovided  that  the  claimant  was  doing “okay”  but  was  having  increased  pain  after  the \nsurgery, with increased pain down the L4 dermatome/saphenous nerve distribution, and \nthe claimant indicated that the pain came on if something pressed on his exterior thigh.  \nAn  EMG  nerve  study by  Dr.  Cayme  provided  in  a  revised  report  an  abnormal \nelectrodiagnostic  study  with  electrodiagnostic  evidence  of  a  generalized  peripheral \nneuropathy, other focal nerve entrapment, or right lumbar radiculopathy.  The claimant \ncontinued  with  physical  therapy  and  continued  with  dysesthesias along  the saphenous \nnerve distribution, which was aggravated by sitting in a chair. \nThe claimant continued to complain and was eventually referred to Dr. Paulus who \nagreed with Dr. Tucker that much of the radiating leg symptoms of the medial knee to the \nmedial ankle fit with the saphenous nerve distribution, but by continuing to the dorsum of \nthe foot was atypical for saphenous neuropathy.  A bilateral saphenous nerve conduction \nwas performed on March 28, 2022, which revealed a significantly lower right-sided nerve \namplitude in comparison to the left and Dr. Paulus opined that this was “confirmatory for \nsaphenous neuropathy.”  He also noted quad atrophy.  On May 31, 2022, Dr. Paulus \nopined that the claimant had developed Type 2 Chronic Regional Pain Syndrome.  Dr. \nTucker  also  issued  a  clinic  note  on  the  same  date  which  provided  that  the claimant \ncontinued to suffer from saphenous neuropathy. \nDr.  Paulus  then  referred  the  claimant  to  Dr.  Brent  Walker,  who  noted  that  the \nclaimant’s right knee was reddened  and  swollen  and  who ordered  a  triple  phase  bone \n\nAXSOM – H107962 \n \n16 \n \nscan in regard to possible complex regional pain syndrome of the right lower extremity.  \nOn July 15, 2022, Dr. Walker assessed the claimant with complex regional pain syndrome \nof  the  right  lower  extremity.    The  report  also  provided  that  complex  regional  pain \nsyndrome had an uncertain progress and could reactivate months and even years after \nthe  initial  insult.    Dr.  Walker  recommended  that  the  claimant  was  a  candidate  for  the \nUAMS program for chronic regional pain syndrome. \nThe claimant was also seen by Dr. Cale White and Dr. Jonathan Gores on April \n25, 2023, and their report also provided that the right lower extremity pain was consistent \nwith  complex  regional  pain  syndrome  and  their  plan  called  for  a  DRG  stimulator \nassessment.  \nAn IME by Dr. Carlos Roman discussed the various treatments and diagnoses that \nhad  been  provided  by  the  above  doctors  and  he  opined  that  the  claimant  had  a  past \nhistory of neuropathy with general and severe osteoarthritis and  the claimant did not fit \nthe criteria for complex regional pain syndrome and further, the bone scan would not in \nany way conclude complex regional pain syndrome.  He also opined that the claimant did \nnot fit the criteria for the initial right knee surgery. (Iovera procedure per Dr. Roman)       \nQuestions  concerning  the  credibility  of  witnesses  and  the  weight  to  be  given  to \ntheir testimony are within the exclusive province of the Commission.  Powers v. City of \nFayetteville, 97 Ark. App. 251, 248 S.W.3d 516 (2007).  Where there are contradictions \nin the evidence, it is within the Commissions’ province to reconcile conflicting evidence \nand to determine the true facts.  Cedar Chem. Co. v. Knight, 99 Ark. App. 162, 258 S.W.3d \n394 (2007).  The Commission has authority to accept or reject a medical opinion and to \ndetermine its medical soundness and probative force.  Oak Grove Lumber Co. v. Highfill, \n\nAXSOM – H107962 \n \n17 \n \n62 Ark. App. 42, 968 S.W.2d 637 (1998).  However, the Commission may not arbitrarily \ndisregard the testimony of any witness.  Patchell v. Wal-Mart Stores, Inc., 86 Ark. App. \n230, 184 S.W.3d 31 (2004). \nIn workers’ compensation law, the employer takes the employee as he finds him \nand employment circumstances that aggravate pre-existing conditions are compensable. \nHeritage Baptist Temple v. Robinson, 82 Ark. App. 460, 120 S.W. 3d 150 (2003).  The \nparties  agreed  the  claimant  suffered   a compensable  injury  to  his  right  knee  from \na work-related injury.  The claimant clearly suffered from some arthritic issues prior to the \nwork-related accident, as do most people who are approximately fifty-five (55) years of \nage.    It is also noted that the testimony of the claimant had various discrepancies between \nstatements during his deposition and later testimony.  However, with that said, there were \nvarious  objective  findings  regarding  the  right  knee,  which  included  a  nerve  conduction \nstudy that provided electrodiagnostic evidence of right saphenous neuropathy, a positive \nTinel’s,  quad  atrophy,  findings  of  a  reddened  and  swollen  right  knee  with  temperature \nasymmetry, and a triple phased bone scan that provided for decreased activity in all three \nphases of the right foot which could be caused by lack of use but also by a rare pattern \nof complex regional pain syndrome. \nHere  it  is  clear  that  the  medical  opinions by  treating  physicians  Dr.  Paulus,  Dr. \nWalker, Dr. White, and Dr. Gore, and the referral to complex regional pain syndrome by \nDr. Schock and Dr. Wagner, are in direct opposition to the opinion issued by Dr. Roman.  \nIt is also noted that Dr. Roman’s opinion is apparently  also  in  direct  opposition  to  Dr. \nTucker’s original treatment  of  the  claimant  in  regard  to  his  surgeries.  It  is  within  the \nCommission’s province to reconcile conflicting evidence, including the medical evidence.  \n\nAXSOM – H107962 \n \n18 \n \nWilliams v. Ark. Dept. of Community Corrections, 2016 Ark. App. 427, 502 S.W.3d 534.  \nThe  Commission  has  the  duty  of  weighing  medical  evidence,  and  the  resolution  of \nconflicting evidence  is  a  question of  fact for the  commission.    It  is  well  settled  that  the \nCommission has the authority to accept or reject medical opinions and the authority to \ndetermine their medical soundness and probative force.  Considering the Commission’s \nfact-finding  authority,  and  weighing  the  findings  of  multiple  doctors,  many  who  are \nspecialized in their area of practice, there is no alternative but to find that the opinions of \nDr. Paulus, Dr. Walker, Dr. White, and Dr. Goree are found to be controlling.    \nAfter reviewing all of the evidence, without giving the benefit of the doubt to either \nparty, there is no alternative but to find that the claimant has satisfied his burden of proof \nto  prove,  by  a  preponderance  of  the  credible  evidence,  that  the  medical  treatment he \nrequested, specifically treatment associated with complex regional pain syndrome is both \ncausally related and reasonably necessary for the treatment of the compensable work-\nrelated right knee injury and that he is entitled to the same. \n IT IS SO ORDERED. \n     \n      ___________________________ \n      JAMES D. KENNEDY  \n      Administrative Law Judge","preview":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION CLAIM NO. H107962 CHARLES W. AXSOM, EMPLOYEE CLAIMANT v. BAPTIST HEALTH SYSTEMS, SELF-INSURED EMPLOYER RESPONDENT CLAIMS ADMINISTRATIVE SERVICES, TPA RESPONDNET OPINION FILED AUGUST 29, 2023 Hearing before Administrative Law Judge, James D. Kennedy, on the 18 th day ...","fetched_at":"2026-05-19T23:04:24.392Z","links":{"html":"/opinions/alj-H107962-2023-08-29","pdf":"https://labor.arkansas.gov/wp-content/uploads//AXSOM_CHARLES_H107962_20230829.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/"}}