{"id":"alj-H109317-2023-04-06","awcc_number":"H109317","decision_date":"2023-04-06","opinion_type":"alj","claimant_name":"Timothyr Middleton","employer_name":"Lew Thompson & Son Trucking Inc","title":"MIDDLETON VS. LEW THOMPSON & SON TRUCKING INC. AWCC# H109317 APRIL 6, 2023","outcome":"denied","outcome_keywords":["dismissed:1","denied:2"],"injury_keywords":["neck","back","cervical","fracture","concussion","lumbar","tbi"],"pdf_url":"https://labor.arkansas.gov/wp-content/uploads/MIDDLETON_TIMOTHYR_H109317_20230406.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/","filename":"MIDDLETON_TIMOTHYR_H109317_20230406.pdf","text_length":31348,"full_text":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION \n   \n CLAIM NO. H109317 \n \nTIMOTHY R. MIDDLETON, Employee                                                           \nCLAIMANT \n \nLEW THOMPSON & SON TRUCKING INC., Employer        RESPONDENT \n \nCCMSI, Carrier                                RESPONDENT \n \n \n OPINION FILED APRIL 6, 2023 \n \nHearing before ADMINISTRATIVE LAW JUDGE JOSEPH C. SELF in Springdale, \nWashington County, Arkansas. \n \nClaimant represented by MARK ALAN PEOPLES, Attorney, Little Rock, Arkansas. \n \nRespondents represented by GUY ALTON WADE, Attorney, Little Rock, Arkansas. \n \n \n STATEMENT OF THE CASE \n  \n On January 23, 2023, the above captioned claim came on for hearing at Springdale, \nArkansas.    A  pre-hearing  conference  was  conducted  on  June  16,  2023,  and  a  pre-hearing \norder  was  filed  on  that  same  date.    A  copy  of  the  pre-hearing  order  has  been  marked  as \nCommission’s Exhibit #1 and made a part of the record without objection. \n At the hearing, the parties agreed to the following stipulations: \n1.         The Arkansas Workers' Compensation Commission has jurisdiction of this \nclaim. \n2.         The employee/employer/carrier relationship existed on November 4, 2021. \n 3. The compensation rates are $736.00 for temporary total disability and \n  $552.00 for permanent partial disability.  \n At the hearing, the parties agreed to litigate the following issues: \n\nMiddleton-H109317 \n2 \n \n \n            1. Compensability regarding claimant’s head, throat, neck, back and shoulders. \n            2. If  compensable,  whether  claimant  is  entitled  to  temporary  total  disability \nbenefits  and  medical  benefits  regarding  his  head,  throat,  neck,  back  and \nshoulders.  \n             3. Attorney fees. \n All other issues are reserved by the parties. \n The claimant contends that: \n “a. He  sustained  compensable  injuries  to  his  head,  throat,  neck,  back,  and \nshoulders as a result of his work motor vehicle accident. \n b. He  is  entitled  to  additional  medical  treatment  relative  to  his  work  motor \nvehicle accident. \n c. He is entitled to temporary total disability from November 5, 2021, through \nNovember  13,  2021,  and  from  January  14,  2022  until  a  yet-to-be-determined  date  in  the \nfuture.” \n The respondents contend that the claimant’s requested medical is not reasonably \nnecessary or related to the work incident. Claimant is not entitled to temporary total disability \nrelated to the accident. \n From a review of the entire record, including medical reports, documents, and other \nmatters  properly  before  the  Commission,  and  having  had  an  opportunity  to  hear  the \ntestimony of the witnesses and to observe their demeanor, the following findings of fact and \nconclusions of law are made in accordance with A.C.A. §11-9-704: \n \n \n\nMiddleton-H109317 \n3 \n \n \n  FINDINGS OF FACT & CONCLUSIONS OF LAW \n \n 1.   The stipulations agreed to by the parties at a pre-hearing conference conducted \non June 16, 2022, and contained in a pre-hearing order filed that same date, as modified at \nthe hearing, are hereby accepted as fact. \n 2.    Claimant has failed to prove by a preponderance of the evidence that he suffered \na compensable injury to his head which resulted in a physical or mental injury or illness, or \nto his throat, neck, back and shoulders on November 4, 2021. \n FACTUAL BACKGROUND \n Before the hearing began, the prehearing order was amended by claimant to add  a  \nhead injury to the list of other physical injuries which were at issue.  Respondent understood \nthat a claim for an injury to claimant’s head was at issue and did not object to this addition.  \nClaimant  withdrew  his  claim  for  rehabilitation  benefits  under §11-9-505,  specifically \nreserving that issue.   \nHEARING TESTIMONY \n \n Claimant  testified  that  he  was  in  a  motor  vehicle  accident  on  November  4,  2021, \nwhen the truck he was driving flipped onto its side while he was hauling live turkeys from a \nfarm  to  the  processing  plant.  Claimant  was  taken  to  the  emergency  department  at  Mercy \nHospital in Berryville, Arkansas, where he was treated and released from the hospital without \nany restrictions. Claimant stated that he had a bump on his head and produced photographs \nthat  he  maintains  depicted  the  injury  to  his  head;  he  did  not  know  if  he  was  rendered \nunconscious.  His wife testified that when she saw claimant in the emergency room, he was \nincoherent and confused.  \n Both claimant and his wife testified about claimant’s mental condition before and \n\nMiddleton-H109317 \n4 \n \n \nafter the accident. Claimant’s wife went into great detail about claimant’s memory failure \nand his inability to drive without someone being with him. In her words, “His memory and \ncognitive issues have greatly declined. He cannot remember things he did, places, people. \nHe can’t remember appointments. Medicines,  he  has  to  have  constant  reminders  from \nmyself.” Ms. Middleton said that she now must make all the decisions that the two of them \nhave talked about during the thirty-nine years they have been together as a couple, as such \ndiscussions now cause him to become overwhelmed.  \n Claimant testified that a week or so after the accident, he was employed again as a \ndriver for ABC Block, driving a dump truck hauling gravel and materials. Claimant did not \nseek any other medical attention following the accident until January 24, 2022, when he was \nhospitalized  for  breathing  issues.  While  the  medical  records  from  that  hospitalization \nindicate  that  claimant  had  COVID-19, he  and  his  wife  both  denied  those  records  were \naccurate. Since that hospitalization, claimant stated he has not been able to work.  \nREVIEW OF THE EXHIBITS \n \n Claimant  was  examined  and  released  on  November  4,  2022,  following  his  visit  to \nMercy  Hospital in Berryville, Arkansas. The records contain no restrictions on claimant’s \nactivities. He had a CT-scan of his head, his cervical spine and chest/abdomen/pelvis. There \nwas no acute intercranial abnormality noted on the CT-scan of the head, no acute fracture \nor subluxation of the cervical spine and no acute solid organ or traumatic injury in the chest, \nabdomen, or pelvis.  \n When admitted to Cox Health in Branson, Missouri on January 24, 2022, claimant’s \nchief complaint was “shortness of breath, cough, and neck pain associated with cough.” The \nassessment and plan at Cox Health were that claimant had COVID-19 pneumonia and was \n\nMiddleton-H109317 \n5 \n \n \nstarted  on  a  treatment  plan  of  Remdesivir.  Nothing  about  that  treatment,  or  whether \nclaimant  truly  had  COVID-19  or  not,  appears  to  relate  to  the  motor  vehicle  accident  of \nNovember 4, 2021. \n On  March  1, 2022,  claimant  began  treatment  at  Baxter  Regional  Medical  Center, \nseeing Dr. Keith Jackson with complaints of several physical conditions, some unrelated to \nthe accident of November 4, 2021. In the relevant part of the assessment, Dr. Jackson noted \ncervical disc disorder and spasm of the cervical paraspinous muscle. Regarding the cervical \ndisc disorder, Dr. Jackson stated that it was a chronic condition; claimant denied neck pain \nat  the  time  of  examination.  Regarding  the  spasm  of  the  cervical  paraspinous  muscle,  the \nclinical note says “acute due to MVA, discussed that this should calm down over the next \nfew months. He would benefit from PT but does not have insurance and is not working.” \n Claimant followed up with Dr. Jackson on April 4, and there was no mention of a \ncervical  disorder  or  the  spasm  of  the  cervical  paraspinous  muscle.  At  this  visit,  claimant \ncomplained of back pain which he had since the motor vehicle accident and memory loss \nwith the following entry “Acute. Discussed he may have had a concussion that is causing his \nmemory  issues.  Encouraged  him  to  do  things  that  challenge  the  mind,  word  puzzles, \ncrossword puzzles, etc.” On April 6, Dr. Jackson wrote the following “To Whom it May \nConcern” letter:  \n“Mr.  Middleton  was  injured  in  a  rollover  semi-truck  accident  on \n11/4/21. He suffered multiple injuries as his seat belt failed to restrain \nhim as evidenced by truck camera footage. It is my medical opinion \nthat  he  suffered  a  concussed  head  injury  as  well,  from  which  he \ncontinues to have symptoms. He continues to experience problems \nwith memory loss. We will continue to monitor his condition closely.” \n \n During the May 3, 2022 visit, Dr. Jackson again mentioned the cervical disc disorder \nalong  with  the  lumbar  disc  disorder  with  myelopathy  and  memory  loss  or  impairment. \n\nMiddleton-H109317 \n6 \n \n \nClaimant was also referred to a speech pathologist, Julie Brandon. Ms. Brandon administered \na cognitive linguistic quick test and found that claimant’s memory was moderately impaired, \nand his executive functions and visuospatial skills were mildly impaired.  \n On June 7, 2022, claimant returned to Dr. Jackson and there was no mention of his \ncervical or lumbar difficulties, but the memory loss or impairment was noted as unchanged. \n On July 18, 2022, claimant saw Dr. Vernon Cooper at Ozark Health Medical Center. \nDr. Cooper recommended an MRI of claimant’s brain and a formal neuropsychic testing to \ndetermine  if  claimant  had  post-concussion  memory  problems  as  opposed  to  an  on-going \nprogressive dementia or pseudodementia relating to depression and anxiety. The impression \nfrom the MRI was “normal MRI of the brain.”  \n On  August  11,  2022,  claimant  was  seen  at  Arkansas  Neuropsychology  and \nBehavioral Health in Sherwood, Arkansas. It appears that the report was prepared by  Dr. \nKaitlyn  Gall,  a  neuropsychology  post  doctorate  fellow, with  Dr.  Gall’s  work  being \nsupervised by Dr. Garrett Andrews, a certified forensic examiner in the State of Arkansas. \nThe clinical impressions from that visit are set out below in its entirety:  \nMr. Middleton's neurocognitive profile is valid and mildly abnormal. \nHe demonstrates inefficiencies in his verbal processing speed, which \nis likely negatively impact his ability to efficiently encode new verbal \ninformation.  It  should  be  noted  his  delayed,  verbal  recall;  overall \ncomplexity working memory; visual processing speed; and judgment \nwere within normal limits. It should be noted his visual skills appear \nsuperior to his verbal ability.  \n \nMr. Middleton's psychosocial profile reveals amplification of somatic \nand cognitive symptoms which are likely the result of genuine mood \ndysfunction.  He  likely  feels  dejected,  exhibits  symptoms  of  PTSD, \nand  has  a  tendency  to  experience  physical  reactions  to  negative \nemotions. His reports of worsening memory loss months after the \nMVA  are  inconsistent  with  a  TBI  and  it  is  very  likely  his  mood \ndysfunction   that   negatively   impacts   his   cognitive   functioning. \nNevertheless,  Mr.  Middleton  is  within  the  window  of  recovery \n\nMiddleton-H109317 \n7 \n \n \nfollowing a mild brain injury and would be expected to continue to \nimprove,   especially   with   treatment   of   his   mood.   As   such, \ninterventions aimed at improving his behavioral disturbance should \nbe  the  focus  of  treatment.  It  is  recommended  he  return  for  an \nupdated neuropsychological examination in one year to monitor his \ncognitive and emotional status. See recommendations below.\n \n \nDiagnosis:  \nF43.10 Posttraumatic stress disorder \nF32.9   Depressive disorder \n \nRecommendations:  \n \n1. Cognitive Behavioral Therapy (CBT) to address mood and teach \nadaptive  coping  skills  (e.g.,  relaxation  training).  Trauma-related \ntherapy would also be beneficial...\n \n2.   Medication  to  address  mood.  SSRIs  (e.g.,  Lexapro)  have  been \nfound to be especially efficacious for treating depression. \n \n3.  Utilize  cognitive  Rehabilitation  strategies  to  Aid  attention  in \nmemory and everyday life:\n \na.   Address   anxiety-provoking   or   upsetting   situations   before \nbeginning a task. \nb.  Write down information and use a calendar/alarm to keep track \nof tasks. \nc.  Use mnemonic strategies to Aid in encoding and recall, such as \nrepetition, elaboration, personalization, and chunking. \nd.  Given  your  Superior  visual  abilities,  attempt  to  use  visual \nstrategies when learning new information.  \ne.  Break  larger  projects  into  smaller,  step-by-step  goals  to  make \nthem more manageable and reduce feeling overwhelmed.  \nf. Work in a low-stimulus environment free from distractions \n4. Repeat  neuropsychic  exam  in  1  year  to  monitor  cognitive  and \nfunctional status. \n \nAn addendum to that report was issued on September 27, 2022:  \n \n“For clarification, it should be noted that Mr. Middleton is referred \nfor  injury  sustained  in  a  MVA  in  November  2021.  He  currently \nexhibits mild cognitive deficits, depression, and PTSD. Given history \nand  reports,  he  did  likely  sustain  a  mild  traumatic  brain  injury. \nHowever,  the  current  cognitive  defects  are  grossly  impacted  by  his \nmood difficulties. These are all related to the MVA. He is still within \nthe  recovery  window  and  should  continue  to  be  monitored  during \ntreatment.  He  should  refrain  from  being  overstimulated  and  at  this \ntime, not return to work full time. With continued treatment as noted \nabove,  he  may  be  able  to  return  to  part-time  work  with  a  stepwise \n\nMiddleton-H109317 \n8 \n \n \nprogression  toward  full-time  work.  He  should  be  re-examined  at \napproximately 1 year post accident.” \n \n \nOn January 16, 2023, Dr. Andrews prepared the following:  \n \n“It  is  noted  that  Mr.  Middleton  was  examined  as  a  clinical  patient \nand the examination was to answer a clinical question.  The referral \nquestion was asked, does Mr. Middleton have \"early onset dementia \nversus pseudodementia” related to mood changes. The information \nobtained in the initial report and addendum regarding history related \nto  the  MVA  and  subsequent  reported  symptoms  following  were \nbased on subjective reports from Mr. Middleton and his wife. There \nwas  no corroborating  medical  evidence  reviewed  or  provided. \nObjective examination revealed mild variability in verbal processing \nspeed  that  was  deemed  below  expectations  with  grossly  intact \nmemory,   attention,   judgment,   and   visuospatial   abilities.   This \nvariability  was  attributed  to  subjective  mood  difficulties  reported \nsince  the  accident.  Again,  there  was  no corroborating  evidence \nreviewed  or  provided  with  regard  to  pre-accident  functioning  of \ncognition  or  mood.  In  short,  regarding  the  referral  question,  Mr. \nMiddleton did NOT meet the criteria for diagnosis of Dementia or \nneurocognitive  disorder.  Subsequent  recommendations  were  made \nbased  on  the  clinical  concerns  and  subjective  complaints  by  Mr. \nMiddleton and his wife.”\n1\n \n \n In addition to the medical records, claimant introduced the accident report prepared \nby the police working the scene, several photographs of both the accident and claimant at \nthe ER, and a video from the cab of the truck, showing a view of both the road and inside \nthe cab at the time of the accident.  \n \n \n \n \n \n1\n  In  his  post-hearing  brief,  claimant  argued  that  this  January  16,  2023,  report  should  not  be  given  any \nweight because  of  the  “dubious  circumstances”  under  which  it  was  prepared.    However,  those \ncircumstances  were  not  presented  as  part  of  the  record,  and although  I  am  aware  of  what  claimant  is \nreferring to, I cannot take judicial notice of the events leading up to the preparation of that report that are \nnot in the record. Ultimately, though, the January 16, 2023, report is not dispositive of the issues in this \ncase, as my decision on the merits of this claim would be the same without it.  \n\nMiddleton-H109317 \n9 \n \n \nADJUDICATION \n \nThe claimant maintains his motor vehicle accident of November 4, 2021, resulted in \nboth physical and mental injuries.  Because the standards for obtaining benefits  for these \ntypes of injuries are different, the physical injuries claim will be addressed before the claim \nfor mental injury.  \nA.  Claim for injury to the throat, neck, back and shoulders. \n In order to prove a compensable injury as the result of a specific incident that is \nidentifiable by time and place of occurrence, a claimant must establish by a preponderance \nof the evidence (1) an injury arising out of and in the course of employment; (2) the injury \ncaused internal or external harm to the body which required medical services or resulted in \ndisability  or  death;  (3)  medical  evidence  supported  by  objective  findings  establishing  an \ninjury; and (4) the injury was caused by a specific incident identifiable by time and place of \noccurrence. Odd Jobs and More v. Reid, 2011 Ark. App. 450, 384 S.W. 3d 630. \nWhile claimant identified the specific time and place of the motor vehicle accident \nthat occurred during his employment which resulted in him going to the emergency room \nfor  an  examination,  nothing  about  that  examination  revealed  an  objective  finding  that \nestablished claimant had an injury to his throat, neck, back and shoulders.  CT scans taken \nimmediately after the accident showed no abnormalities with his neck, chest, abdomen, and \npelvis.  He was released with no restrictions, and after he was fired for causing the accident, \nhe was working again the next week at full duty.   The issues claimant had with his throat in \nJanuary 2022 were not attributed to the motor vehicle accident by the treating physicians at \nthat time; his neck pain was deemed to be a result of coughing.  The only objective medical \nfinding as to one of the parts of his body that claimant alleged was injured was a spasm in \n\nMiddleton-H109317 \n10 \n \n \nhis  neck  noted  by  Dr.  Jackson  in  March  2022,  almost  five  months  after  the  accident; \nhowever,  this  spasm wasn’t noted during his hospitalization in January 2022 and was not \npresent during the April 2022 visit with Dr. Jackson.    \nIn reviewing all the records, I find claimant has failed to meet his burden of proof \nthat he sustained a compensable injury to his throat, neck, back or shoulders, as there was \nno medical evidence of objective findings to support this portion of his claim.  \nB.  Claim for mental injury or illness. \n While claimant’s contention was for an injury to his head, it was clear from the \ntestimony and the medical evidence that he was not referring to an external injury to that \nportion of his body, but rather a mental injury or illness.  Arkansas Code Annotated §11-9-\n113 provides the framework under which a mental injury may be deemed compensable for \npurposes of workers' compensation law: \n(a)(1) A mental injury or illness is not a compensable injury unless \nit is caused by physical injury to the employee's body and shall not \nbe  considered  an  injury  arising  out  of  and  in  the  course  of \nemployment  or  compensable  unless  it  is  demonstrated  by  a \npreponderance  of  the  evidence;  provided,  however,  that  this \nphysical injury limitation shall not apply to any victim of a crime of \nviolence. \n \n(2)   No   mental   injury   or   illness   under   this   section   shall   be \ncompensable unless it is also diagnosed by a licensed psychiatrist or \npsychologist  and  unless  the  diagnosis  of  the  condition  meets  the \ncriteria established in the most current issue of the Diagnostic and \nStatistical Manual of Mental Disorders. \n \n Finding claimant had not established that he suffered a compensable physical injury \nis likely dispositive of his claim for a mental injury.  In Dugan v. Jerry Sweetster, Inc., 54 Ark. \nApp. 401, 928 S.W.2d 341 (1996), the Court of Appeals examined what a claimant needed \nto show to demonstrate a mental condition was connected to a physical injury:  \n\nMiddleton-H109317 \n11 \n \n \nWe  note  that  Webster's  defines  injury  as  simply  \"harm  or \ndamage.\" Webster's New World Dictionary and Thesaurus 320 \n(1996). \"Bodily injury\" has been defined as \"physical pain, illness \nor   any   impairment   of   physical   condition.\"   Black's   Law \nDictionary  786  (6th  ed.  1990).  One  medical  dictionary  defines \ninjury  as  \"damage  or  wound  or  trauma.\"  Stedman's  Medical \nDictionary 786 (25th ed. 1990). Another calls it \"a disruption of \nthe integrity or function of a tissue or organ by external means, \nwhich are usually mechanical but can also be chemical, electrical, \nthermal,  or  radiant.\"  International  Dictionary  of  Medicine  and \nBiology, 1443, Vol. II. (1986). \n \n As mentioned above, the testing on claimant’s physical condition at the emergency \nroom showed none of the harms that are described above.  Still, after reviewing the video \nof  how  claimant  was  thrown  about  in  the  cab  of  his  truck  as  it  flipped  onto  its  side  and \nhaving heard the testimony of him and his wife as to the bump on his head following the \naccident, I determined that a closer examination of that portion of his claim on its merits \nwas warranted.   \n While several of the medical professionals that treated claimant gave an opinion that \nhe suffered a brain injury, only Arkansas Neuropsychology and Behavioral Health met the \nrequirements of §11-9-113 that the mental injury be diagnosed by a licensed psychologist or \npsychiatrist.  As such, I included a large portion of the narratives from those records in my \nreview  of  the  exhibits.    Nothing  from  the  Diagnostic  and  Statistical  Manual  of  Mental \nDisorders  (hereinafter  DSM-5)  on  post-traumatic  stress  disorder  (hereinafter  PTSD)  or \ndepression was submitted for me to consider, but Lincoln Pub. Sch. v. Secrist, 2016 Ark. App. \n315, holds “the  Commission  can,  and  indeed  should,  refer  to  a  manual  that  is  not  in  the \nrecord when by law the manual must be consulted to decide an issue in dispute.”  As such, \nI located the DSM-5 provisions on depression, which are set forth in Lincoln, and include: \nA. Five (or more) of the following symptoms have been present during \nthe  same  2-week  period  and  represent  a  change  from  previous \n\nMiddleton-H109317 \n12 \n \n \nfunctioning; at least one of the symptoms is either (1) depressed mood \nor (2) loss of interest or pleasure. \n  Note: Do not include symptoms that are clearly attributable to another \nmedical condition. \n \n1.  Depressed  mood  most  of  the  day,  nearly  every  day,  as \nindicated  by  either  a  subjective  report  (e.g.,  feels  sad,  empty, \nhopeless) or observation made by others (e.g., appears tearful).  \n2. Markedly diminished interest or pleasure in all, or almost all, \nactivities most of the day, nearly every day (as indicated by either \nsubjective account or observation). \n 3. Significant weight loss when not dieting or weight gain (e.g., \na  change  of  more  than  5%  of  body  weight  in  a  month)  or \ndecrease or increase in appetite nearly every day.  \n4. Insomnia or hypersomnia nearly every day. \n5.   Psychomotor   agitation   or   retardation   nearly   every   day \n(observable   by   others,   not   merely   subjective   feelings   of \nrestlessness or being slowed down). \n6. Fatigue or loss of energy nearly every day. \n7. Feelings of worthlessness or excessive or inappropriate guilt \n(which  may  be  delusional)  nearly  every  day  (not  merely  self-\nreproach or guilt about being sick). \n8. Diminished ability to think or concentrate, or indecisiveness, \nnearly every day (either by subjective account or as observed by \nothers). \n9. Recurrent thoughts of death (not just fear of dying), recurrent \nsuicidal ideation without a specific plan, or a suicide attempt or \na specific plan for committing suicide. \n \nB.  The  symptoms  cause  clinically  significant  distress  or  impairment  in  social, \noccupational, or other important areas of functioning. \n \nC. The episode is not attributable to the physiological effects of a substance or to \nanother medical condition. \n \nDiagnostic and Statistical Manual of Mental Disorders, 160-61 (5th ed. 2013). \n \n The  entries  of  Dr.  Andrews  (either  his  own  or  those  of  Dr.  Gall,  whom  he  was \nsupervising) did not specify five elements of depression that are necessary to establish that \ncondition under the DSM-5 guidelines.  In Lincoln, supra, an award of benefits from the Full \nCommission was overturned by the Court of Appeals because the evidence supported only \nfour of the five necessary criteria.  Here, the report simply says that he likely feels dejected.  \n\nMiddleton-H109317 \n13 \n \n \nIt  does  not  provide  enough  information  for  me  to  extrapolate  from  it  the  information \nneeded to determine if the DSM-5 criteria are met.  Contrast this with the medical report in \nHope  Livestock  Auction  Co.  v.  Knighton,  67  Ark.  App.  165,  992  S.W.2d  826  (1999),  which \ncontained more than a conclusionary finding, and allowed the Commission to make a finding \npursuant to the DSM in effect at the time:  \nWhile   a   bare   diagnosis,   without   an   explanation   of   the \ncharacteristics of the mental illness, might not be sufficient to meet \nthe requirements of section 11-9-113(a)(2), here Dr. Tobey, in both \nhis deposition and progress notes, described Knighton's Bipolar I  \nDisorder in such detail that the Commission could easily make the \nfinding  that  the  diagnosis  met  the  DSM-IV  criteria.  Although  it \nwould  be  preferable  in  cases  of  mental  injury  or  illness  for  a \npsychiatrist or psychologist to correlate the basis of his opinion to \nthe  DSM  criteria,  we  recognize  the  Commission's  expertise  and \nability  to  translate  medical  testimony  into  findings  of  fact.  We \ncannot say that the Commission's finding that Knighton's Bipolar \nI Disorder was a compensable work-related injury is not supported \nby substantial evidence. \n \n In sum, claimant did not meet his burden of proof of a depression  that meets the \nDSM-5 criteria, as there was not sufficient medical evidence that he met at least five of the \nrequired elements for that diagnosis.  \nI then did a similar analysis of the PTSD diagnosis after locating the DSM-5 \ncriteria for that condition at: \nhttps://www.ptsd.va.gov/professional/treat/essentials/dsm5_ptsd.asp: \nDSM-5 Criteria for PTSD \n All  of  the  criteria  are  required  for  the  diagnosis  of  PTSD.  The  following  text \nsummarizes the diagnostic criteria: \n \nCriterion A (one required): The person was exposed to: death, threatened death, actual or \nthreatened serious injury, or actual or threatened sexual violence, in the following way(s): \n• Direct exposure \n• Witnessing the trauma \n• Learning that a relative or close friend was exposed to a trauma \n\nMiddleton-H109317 \n14 \n \n \n• Indirect  exposure  to  aversive  details  of  the  trauma,  usually  in  the  course  of \nprofessional duties (e.g., first responders, medics) \nCriterion  B  (one  required): The  traumatic  event  is  persistently  re-experienced,  in  the \nfollowing way(s): \n• Unwanted upsetting memories \n• Nightmares \n• Flashbacks \n• Emotional distress after exposure to traumatic reminders \n• Physical reactivity after exposure to traumatic reminders \nCriterion C (one required): Avoidance of trauma-related stimuli after the trauma, in the \nfollowing way(s): \n• Trauma-related thoughts or feelings \n• Trauma-related reminders \nCriterion  D  (two  required): Negative  thoughts  or  feelings  that  began  or  worsened  after \nthe trauma, in the following way(s): \n• Inability to recall key features of the trauma \n• Overly negative thoughts and assumptions about oneself or the world \n• Exaggerated blame of self or others for causing the trauma \n• Negative affect \n• Decreased interest in activities \n• Feeling isolated \n• Difficulty experiencing positive affect \nCriterion E (two required): Trauma-related arousal and reactivity that began or worsened \nafter the trauma, in the following way(s): \n• Irritability or aggression \n• Risky or destructive behavior \n• Hypervigilance \n• Heightened startle reaction \n• Difficulty concentrating \n• Difficulty sleeping \nCriterion F (required): Symptoms last for more than 1 month. \nCriterion  G  (required): Symptoms  create  distress  or  functional  impairment  (e.g.,  social, \noccupational). \nCriterion  H  (required): Symptoms  are  not  due  to  medication,  substance  use,  or  other \nillness. \nTwo specifications: \n1. Dissociative  Specification. In  addition  to  meeting  criteria  for  diagnosis,  an \nindividual experiences high levels of either of the following in reaction to trauma-\nrelated stimuli: \n• Depersonalization. Experience of being an outside observer of or detached \nfrom oneself (e.g., feeling as if \"this is not happening to me\" or one were in \na dream). \n• Derealization. Experience of unreality, distance, or distortion (e.g., \"things \nare not real\"). \n2. Delayed Specification. Full diagnostic criteria are not met until at least six months \nafter the trauma(s), although onset of symptoms may occur immediately. \n\nMiddleton-H109317 \n15 \n \n \n \nIn reading the reports of Dr. Andrews, as well as reviewing the testimony of claimant \nand his wife and comparing that with the criteria for a PTSD diagnosis, I can find the first \ncriteria  was  met,  in  that  a  motor  vehicle  accident  can  be  an  exposure  to  death  or  serious \nphysical injury, or the threat thereof.  There was some evidence presented on Criterion F, \nG, and H, at least in the testimony of claimant and his wife.  From there, however, claimant \ndid not relate that he was re-experiencing the event.  He was avoiding driving a large truck \nfor  the  same  reason  he  was  avoiding  driving  an  automobile—memory  and  concentration \nissues, not because he was reliving the accident.  Failing to establish any one of the Criterion \nB through E would be fatal to this claim, and I find that none of those four were established.\n2\n  \nAs with the claim of depression, the competent medical evidence under §11-9-113 \ndoes not support a finding of a diagnosis of PTSD under the DSM-5 criteria. \nORDER \n \nClaimant failed to meet his burden of proving by a preponderance of the evidence \nthat he suffered a compensable injury to his head, resulting in a mental injury or illness, or a \ncompensable physical injury to his throat, neck, back and shoulders on November 4, 2021. \nTherefore, his claim for compensation benefits is hereby denied and dismissed. \nRespondent is responsible for paying the court reporter her charges for preparation \nof the hearing transcript in the amount of $ 837.9 5. \n \n \n \n2\n To be clear, I am not finding that claimant’s testimony alone could provide sufficient proof of a PTSD \ndiagnosis.  My observations are based on a “best case scenario” for claimant, pairing his testimony with \nthe conclusionary finding of PTSD by Dr. Andrews in August 2022. Even with that approach, his proof \nwas still lacking on several of the required criteria.   \n\nMiddleton-H109317 \n16 \n \n \n IT IS SO ORDERED. \n  \n \n                           ______________ \n        JOSEPH C. SELF \n       ADMINISTRATIVE LAW JUDGE","preview":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION CLAIM NO. H109317 TIMOTHY R. MIDDLETON, Employee CLAIMANT LEW THOMPSON & SON TRUCKING INC., Employer RESPONDENT CCMSI, Carrier RESPONDENT OPINION FILED APRIL 6, 2023 Hearing before ADMINISTRATIVE LAW JUDGE JOSEPH C. SELF in Springdale, Washington County, Arkansas. Cl...","fetched_at":"2026-05-19T23:08:20.659Z","links":{"html":"/opinions/alj-H109317-2023-04-06","pdf":"https://labor.arkansas.gov/wp-content/uploads/MIDDLETON_TIMOTHYR_H109317_20230406.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/"}}