{"id":"alj-H109939-2025-05-27","awcc_number":"H109939","decision_date":"2025-05-27","opinion_type":"alj","claimant_name":"Wendy Peacock","employer_name":"Conway Regional Med. Center","title":"PEACOCK VS. CONWAY REGIONAL MED. CENTER AWCC# H109939 May 27, 2025","outcome":"granted","outcome_keywords":["granted:8","denied:3"],"injury_keywords":["back","knee","fracture","strain","sprain","ankle","lumbar"],"pdf_url":"https://www.labor.arkansas.gov/wp-content/uploads/Peacock_Wendy_H109939_20250527.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/","filename":"Peacock_Wendy_H109939_20250527.pdf","text_length":46463,"full_text":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION \nCLAIM NO. H109939 \n \nWENDY PEACOCK, EMPLOYEE   CLAIMANT \n \nCONWAY REGIONAL MED. CENTER, SELF INS. EMPLOYER   RESPONDENT \n \nRISK MANAGEMENT RESOURCES, TPA   RESPONDENT \n \nOPINION FILED MAY  27, 2025 \n \nHearing  before  Administrative  Law  Judge,  Steven  Porch,  on April  1,  2025,  in Little  Rock, \nArkansas. \n \nClaimant was represented by Mr. Daniel E. Wren, Attorney at Law, Little Rock, Arkansas. \n \nRespondents were represented by Ms. Melissa Wood, Attorney at Law, Little Rock, Arkansas. \n \nSTATEMENT OF THE CASE \n \n A full hearing was held on this claim on April 1, 2025\n1\n. A prehearing telephone conference \ntook place on December 10, 2024. A prehearing order was entered on that date and subsequently \nentered into evidence as Commission Exhibit 1. The parties’ stipulations are set forth. \nSTIPULATIONS \n By agreement of the parties, the stipulations applicable to this claim are as follows: \n1. The Arkansas Workers’ Compensation Commission has jurisdiction of the \nwithin claim. \n \n2. The self-insured employer/employee/third-party administrator relationship \nexisted  among  the  parties  on March  1, 2021,  when  Claimant  sustained \ncompensable injuries to her left foot. \n \n3. Respondents accepted the claim and paid benefits. \n \n4. The Claimant’s temporary total disability  (TTD)  benefits  rate is $364.00 \nand permanent partial disability (PPD) benefits rate is $273.00, weekly. \n \n \n \n \n1\n The original hearing date was February 18, 2025. However, due to inclement weather, it was cancelled and \nrescheduled for April 1, 2025. \n\nPEACOCK H109939 \n \n2 \n \n \nThe parties have identified the following issues to be adjudicated: \n1. Whether Claimant is entitled to additional reasonable and necessary medical treatment \nand related expenses, including a three-phase bone scan, EMG, and nerve conduction \nstudy of the left lower extremity. \n \n2. Whether  Claimant sustained  an  injury  to  her  back  as  a  compensable  consequence  of \nher stipulated compensable left foot injury.\n2\n \n \n3. Whether Claimant is entitled to reasonable and necessary medical treatment for her low \nback as a compensable consequence of the compensable left foot injury.\n3\n \n \n4. Whether Claimant is entitled to temporary total disability (TTD) from August 29, 2023, \nto a date yet to be determined. \n \n5. Whether  Claimant  is  entitled  to temporary partial disability  (TPD)  from  August  29, \n2023, to a date yet to be determined.\n4\n \n \n6. Whether Claimant’s attorney is entitled to a controverted attorney’s fee. \n \n All other issues are reserved. \n \nCONTENTIONS \nClaimant contends: \n She sustained an injury to her left foot on March 1, 2021, while moving a bed in \nlabor and delivery when it rolled over the top of her left foot.  She treated with Dr. Robert \nMartin at UAMS Ortho Clinic on Shackleford.  She has undergone three different \nsurgeries on her foot. \n The first surgery was on December 14, 2021, with Dr. Adam Head.  The second \n \n2\n This issue must be established before the third issue could be addressed. Therefore, it is added as an issue to \nproperly address Claimant’s third issue. \n3\n Claimant’s counsel stated that Respondents did not pay any benefits for the alleged back injury. Thus, the word \n“additional” that is reflected on my prehearing order, for this issue, is now removed without objection from the \nparties. \n4\n Claimant motioned to add the issue of TPD benefits to the hearing, without objection from Respondents’ counsel, \nand I granted the motion. \n\nPEACOCK H109939 \n \n3 \n \nsurgery was on August 12, 2022, with Dr. Jesse Burks.  He kept her on non-weight \nbearing for a period of time.  She used a knee scooter due to swelling in her foot.  Dr. \nBurks noted on October 26, 2022\n5\n, that she may possibly have complex regional pain \nsyndrome (CRPS) and recommended her to see Dr. Carlos Roman.  Dr. Roman did an \nindependent medical evaluation (IME) on her on May 16, 2022.  He did not feel she had \nthe criteria for CRPS.  Dr. Roman referred her back to Dr. Burks for additional treatment.  \nDr. Burks\n6\n did a third surgery on February 13, 2023. She continued to have pain and was \nseen again by Dr. Roman who felt like she met all the criteria for reflex sympathetic \ndystrophy (RSD) at that time.  She underwent sympathetic blocks.  She was released \nfrom Dr. Martin and Dr. Roman and received impairment ratings.  She underwent a \nfunctional capacity evaluation (FCE) test on October 16, 2023, which reflected that she \nhad a combined impairment rating of five percent to the whole person. \n After continued pain, she was seen by Dr. Barry Baskin for a second \nopinion/IME.  Dr. Baskin opined that she clearly has some nerve problems in the left \nfoot.  He stated that because of the peripheral nerve issues that she has, it could easily be \nconfused with CRPS.  Dr. Baskin opined that he thinks she does have some low back \npain, and that the low back pain might well have resulted from her walking with altered \ngait mechanics because of left foot problems, the walker boot, and knee scooter.  Dr. \nBaskin has recommended a three-phase bone scan and EMG and nerve conduction \nstudies of the left lower extremity, which have not been approved by workers’ \ncompensation. \n \n5\n   My review of the file shows Dr. Burks referred Claimant to Dr. Roman on April 13, 2022. \n6\n   My review of the file shows Dr. Martin performed 3\nrd\n and final surgery.  I, also, admonish the Claimant’s \ncounsel to ensure that his contentions are accurate concerning doctors and dates. \n\nPEACOCK H109939 \n \n4 \n \n \nRespondents contend: \n All appropriate benefits are being paid regarding Claimant’s left lower extremity \ninjury sustained on March 1, 2021.  Treatment recommended by Dr. Baskin is not \nreasonable and necessary associated with the same.  All appropriate temporary total \ndisability benefits have been paid. \nFINDINGS OF FACT AND CONCLUSIONS OF LAW \n Therefore,  after  thorough  consideration  of  the  facts,  issues,  the  applicable  law,  and  the \nevidentiary  record,  I  hereby  make  the  following  Findings  of  Fact  and  Conclusions  of  Law  in \naccordance with Ark. Code Ann. § 11-9-704 (Repl. 2012):   \n1. The Arkansas Workers’ Compensation Commission has jurisdiction over this claim. \n \n2. The stipulations set forth above are reasonable and are hereby accepted. \n \n3. The Claimant has proven by the preponderance of the evidence that she is entitled to \nadditional  reasonable  and  necessary  medical  treatment,  including  a three-phase  bone \nscan, an EMG, and a nerve conduction study of the left lower extremity.  \n \n4. The Claimant has proven by the preponderance of the evidence that she has sustained \nan injury to her low back as a compensable consequence of her stipulated compensable \nleft foot injuries. \n \n5. The Claimant has proven by the preponderance of the evidence that she is entitled to \nreasonable  and  necessary  medical  treatment  for her compensable  consequence low \nback injury. \n \n6. The Claimant has not proven by the preponderance of the evidence that she is entitled \nto TTD from August 29, 2023, to a date yet to be determined. \n \n7. The Claimant has not proven by the preponderance of the evidence that she is entitled \nto TPD from August 29, 2023, to a date yet to be determined. \n \n8. Claimant has not proven by the preponderance of the evidence that she is entitled to a \ncontroverted attorney’s fee. \n \n \n\nPEACOCK H109939 \n \n5 \n \n \n \nCASE IN CHIEF \nSummary of Evidence \n The record is made up of Claimant’s Exhibit 1, medical records, that consists of 156 pages, \nRespondents’ Exhibit 1, medical records, that consist of 30 pages, Respondents’ Exhibit 2, DFA \nemployment application, consisting of 6 pages, and Commission Exhibit 1, Pre-Hearing Order \nfiled December 10, 2024, that consists of 5 pages. The Claimant’s and Respondents’ post hearing \nbriefs are blue-backed and made a part of the record. The Claimant was the only witness testifying \nat the full hearing.  \nClaimant was employed as a Patient Care Tech for the Respondent employer. On March 1, \n2021, Claimant was moving a hospital bed when it rolled over the top of her left foot, resulting in \ninjury. On March 3, 2021, Claimant visited Dr. Gil Johnson at College Park Family Clinic and was \ndiagnosed with a “crush injury of soft tissue swelling of left foot...”. Claimant Ex. 1, pp. 4-5. \nClaimant did not have a fracture in her left foot. Id. Nevertheless, Claimant was placed on \nsedentary work. Claimant Ex. 1, p. 6. Respondents accepted the left foot injury as compensable. \nClaimant visited Dr. Johnson the next day, March 4, 2021, and complained that her pain \nwas worse. Claimant Ex. 1, pp. 8-9. Dr. Johnson’s progress note stated that most of her pain was \non the ventral aspect at the base of the left great toe over the metatarsal area. Id. Dr. Johnson also \nnoted soft tissue swelling and the potential of a deep hematoma. Id. The Claimant’s x-ray did not \nshow any fractures nor disruptions of the joint spaces, and her circulation was intact. Id.  Dr. \nJohnson recommended crutches and left Claimant on sedentary work restrictions. Id. On March 8, \n2021, Claimant continued to have pain and swelling in the left foot, primarily at the distal first and \nsecond metatarsal – phalangeal joint. Claimant Ex. 1, p. 10-11. Dr. Johnson ordered another x-ray \n\nPEACOCK H109939 \n \n6 \n \nof her left foot and placed her in an OCL fiberglass splint for support. Id. Dr. Johnson noted that \nClaimant had a significant crush injury and contusion to her left foot. Id. \nOn March 10, 2021, Claimant continued to have “soft tissue swelling at the base of the left \ngreat toe over the distal metatarsal ....” The second x-ray again confirmed there were no fractures. \nId. at 11. On March 18, 2021, Claimant had a follow-up visit with Dr. Johnson and complained \nabout continued discomfort at the base of her left second and third metatarsal/toes. Claimant Ex. \n1, p. 17. Dr. Johnson noted soft tissue swelling and pain with palpation and stated that this affects \nher gait. Id. Dr. Johnson recommended that Claimant get an MRI of her left foot to look for “occult \nfracture or other soft tissue or ligament or tendon damage....” Id. Claimant remained on sedentary \nwork restrictions. Id. Dr. Samuel Edwards authored the MRI report dated March 23, 2021, finding \nthat Claimant suffered from the “Strain of the lateral head of the flexor hallucis brevis and adductor \nhallucis muscles with partial tear of the flexor hallucis brevis tendon at the attachment to the lateral \nsesamoid.” Claimant Ex. 1, p. 21-22. On March 24, 2021, Dr. Johnson recommended the Claimant \nsee an orthopedist. Id.  \nOn April  7,  2021,  Claimant  saw  Dr.  James  Head,  Orthopedic  Surgeon,  at  Conway \nOrthopaedic and Sports Medicine Center. Claimant Ex. 1, pp. 23-24. Dr. Head examined Claimant \nand her records and likewise concluded that she has a left lateral sesamoid fracture; and he told \nher to take over-the-counter pain medications, wear a rigid shoe insert, and get some rest. Id. On \nJuly 15, 2021, the Claimant complained about her pain worsening the longer she was on her feet. \nClaimant’s Ex. 1, pp. 25-26. Dr. Head discussed nonsurgical versus surgical treatment, explaining \nthat surgical treatment would likely require two months off work. Id. The patient declined surgery \ntreatment due to financial constraints. Id. However, on November 12, 2021, Claimant had a follow-\nup visit with Dr. Head and this time requested surgery since she had been in pain for the past \n\nPEACOCK H109939 \n \n7 \n \nseveral months. Claimant Ex. 1, pp. 29-30. Dr. Head explained that the surgery would include “a \nleft fibular sesamoid excision with possible neuroma excision of the peroneal nerve, and possible \nperoneal nerve excision. Id. Dr. Head gave Claimant an injection of 40mg of Depo-Medrol and \nscheduled her surgery for December 14, 2021. Id.  \nOn December 9, 2021, Claimant reported to Dr. Head that she had minimum improvement \nin pain, and that she could not put weight on her left foot, due to her favoring it, resulting in a trip \nto the emergency room. Claimant Ex. 1, pp. 33-34. She also informed Dr. Head that she recently \nhad an inversion sprain. Id. Dr. Head ordered an MRI of the left ankle to evaluate for a subtalar \nstress fracture. Id. The Claimant’s gait was altered due to the pain in her left foot. Id. Dr. Head \nbelieved this could have caused the Claimant to develop a stress fracture. Id. He noted that an MRI \nof her left ankle would be helpful prior to the surgery to ensure Claimant did not need a secondary \nprocedure after the initial surgery. Id. On December 13, 2021, the Claimant saw Dr. Head for \nanother follow-up where she reported aching and sharp pain in the outer side of her left ankle \nwhenever she walked. Claimant Ex. 1, pp. 35-36. Dr. Head discussed Claimant’s MRI of her left \nankle, noting that she had a calcaneal stress fracture that was caused by the way she was walking \ndue to the pain in her foot. Id.  This was treated non-operatively by her not putting any weight on \nit for two weeks. Id. The Claimant eventually underwent her surgery on December 14, 2021.  \nOn February 23, 2022, Claimant had a ten-week follow-up visit with Dr. Head. Claimant \nEx. 1, pp. 43-44. The Claimant reported that she was still experiencing some pain on the lateral \naspect of the hindfoot that radiated across the anterior aspect of her ankle. Id. Claimant described \nher pain as an intermittent aching pain with occasional sharp pains. Id. Dr. Head instructed \nClaimant to continue  “Vitamin  D  supplementation  and  bone  stimulator.” Id. Dr.  Head  also \nrecommended physical therapy for scar desensitization. Id.  \n\nPEACOCK H109939 \n \n8 \n \nOn March 23, 2022, Claimant had a 3.5-month surgical follow-up, where she was given a \nMedrol Dosepak for pain and swelling. Claimant Ex. 1, pp. 45-46. The Claimant reported swelling \nwhen she was on her left foot for prolonged periods of time, and that she still experienced a \nshooting pain starting on the lateral hindfoot that radiated down the lateral side of her foot. Id. Dr. \nHead discussed surgical options if Claimant continued to fail conservative treatment. Id.  \nOn April 13, 2022, the Claimant saw Dr. Jesse Burks, a podiatric doctor, at Bowen Hefley \nOrthopedics. Claimant Ex. 1, pp. 47-49. The Claimant rated her pain as an 8/10. Id. She described \nher pain as sharp, stabbing, throbbing, aching, and shooting. Id. She further stated that symptoms \ncome and go and are made worse with sitting, stairs, moving, walking, and standing. Id. She \nreported that her problem was unchanged, and she still experienced bruising, swelling, numbness, \nstiffness, limping, popping, tingling, and weakness. Id. Dr. Burks diagnosed her with possible \ncomplex regional pain syndrome, status post list from fracture dislocation, and peroneus brevis \ntendon tear. Id. Dr. Burks recommended an evaluation for possible RSD to confirm or exclude the \ndiagnosis. Id.  \nOn May 16, 2022, Claimant met with Dr. Carlos Roman for an IME. Claimant’s Ex. 1, pp. \n50-52. Dr. Roman reviewed Claimant’s bone scan of her left lower extremity, which showed no \nevidence of CRPS. Id. Dr. Roman noted the “flow, pooled, and delayed images demonstrated good \nsymmetric flow.” Id. The Claimant reported that she still had pain over the surgical incision and \n“left ankle on the lateral aspect with extension and flexion as well as prolonged weight-bearing.” \nId. Dr. Roman recommended compression therapy for her foot. Id.  \nOn June 14, 2022, the Claimant saw Dr. Burks described having significant pain through \nthe midfoot and over the course of her peroneal tendons. Claimant Ex. 1, pp. 53-55. Dr. Burks \ndiscussed Claimants surgical options, which included a peroneal debridement and repair, and \n\nPEACOCK H109939 \n \n9 \n \narthrodesis  of  the  medial  and  intermediate  cuneiform  and  the  immediate  cuneiform  second \nmetatarsal. Id. Dr. Burks advised Claimant that these treatments would include six weeks of \n“nonweightbearing with 3 to 4 weeks in a walking boot.” Id. Dr. Burks gave another option of pain \nmanagement under the care of Dr. Roman. Id. The Claimant chose the surgery recommended by \nDr. Burks, and that procedure was done on August 12, 2022. Claimant Ex. 1, pp. 61-64.  \nOn August 17, 2022, Claimant had a follow-up with Dr. Burks where she stated that she \nwas doing well, and that her pain was well-controlled. Claimant’s Ex. 1, pp. 63-66. She denied any \nsignificant discomfort in her calf or thigh. Id. On September 19, 2022, Dr. Burks initiated a \ntreatment plan that involved weightbearing on her left foot with the aid of a cam walker, as \ntolerated.  Claimant’s  Ex.  1,  pp.  70-71.  On  October  26,  2022, Claimant  saw  Dr.  Burks  and \ncomplained about severe pain in her left foot and ankle. Claimant Ex. 1, pp. 75-77.  Dr. Burks \nordered an MRI of the left ankle. Id. The MRI revealed extensive stress reaction throughout the \nfoot and ankle without fracture or signs of any full-thickness cartilage loss at the ankle, along with \na peroneus longus and brevis tendinopathy with split tear of the brevis. Claimant Ex. 1, p. 78.  \nOn  November  1,  2022,  the  Claimant  informed  Dr.  Burks  that her condition  had  not \nchanged. Claimant Ex. 1, pp. 79-81. Dr. Burks believed that Claimant had multiple signs consistent \nwith CRPS, but he deferred to Dr. Roman. Id. Dr. Burks felt that on the MRI the peroneal tendon \nrepair was fine, but she did have some fluid collection consistent with post-surgical changes. Id. \nDr. Burks also felt that the fracture mentioned was old and clinically not symptomatic. Id. On \nNovember 2, 2022, Dr. Roman wrote that he likewise believed that Claimant could possibly have \nCRPS. Claimant Ex. 1, pp. 82-83.  \nDue to Claimants altered gait from having the work-related injury and multiple surgeries, \nthe Claimant alleges that she suffers from back pain. On November 21, 2022, she saw Dr. Billy \n\nPEACOCK H109939 \n \n10 \n \nMcBay concerning left foot pain and right-sided back pain. Claimant Ex. 1, pp. 85-88. Dr. McBay \ndiagnosed her with acute right-sided low back pain with right-sided sciatica. Id. Dr. McBay also \ndiagnosed her with age-related osteoporosis without current pathological fracture. Id. Dr. Burks \nordered an x-ray of Claimant’s spine and referred her to Dr. Noha Mohamad for treatment of \nosteoporosis of both hips. Id. The x-ray report revealed only mild degenerative changes, most \npronounced in the lower lumbar spine, L4, L5, and S1. Id. Despite this, Dr. McBay still diagnosed \nClaimant with acute right-sided low back pain with right-sided sciatica. Claimant’s Ex. 1, pp. 91-\n92.  \nOn December 14, 2022, Claimant visited Dr. Burks again complaining about severe pain \nin her left foot. Claimant’s Ex. 1, pp. 94-96. Per the report of that appointment, Claimant could not \nidentify one particular area that hurt, however, the area that seemed to bother her the most was \naround the second and third metatarsal heads. Id. Nevertheless, Dr. Burks diagnosed her with \nchronic pain in her left foot, secondary to the injury. Id. He gave her an injection to help localize \nthe pain. Id.  \nOn January 6, 2023, Claimant visited Dr. Robert Martin at UAMS Orthopedic Clinic for \nan evaluation of her left foot. Claimant’s Ex. 1, pp. 97-105. Dr. Martin noted that her past surgeries \nhad failed, and her implants were not really even in the bone. Id. Dr. Martin further noted that the \nsite of the injury was not in the area where all her surgeries had been performed. Id. Dr. Martin \nwrote that he believed that Claimant would require a revision midfoot arthrodesis with removal of \nthe failed orthopedic implants. Id. He believed this would provide some improvement in pain. Id. \nDr. Martin also recommends exploration of the distal peroneal tendons in the site of previous \nsurgery because she  has  significant  symptoms  there. Id.  Dr.  Martin added: “the  nerve  type \nsymptoms from deep peroneal nerve irritation and numbness, hyperesthesias in the dorsal foot may \n\nPEACOCK H109939 \n \n11 \n \nbe permanent based on the chronicity of her problem.” Id. The Claimant agreed to have the surgery, \nand it was performed on February 13, 2023. Claimant Ex. 1, pp. 106-108. \nOn March 14, 2023, Claimant met with Dr. Lily Guastella at Conway Regional Health \nSystem concerning back pain. Claimant’s Ex. 1, pp. 112-120. Dr. Guastella ordered an MRI for \nher lumbar spine. Id. The MRI showed “Moderate facet arthropathy at L4-L5 with a right-sided \nfacet effusion and mild surrounding soft tissue edema and enhancement, indicating acute reactive \ninflammatory changes. There are small ganglion cyst formation extending posteriorly from the \nfacet.” Id. (emphasis added) The report also concluded that Claimant had a mild bilateral neural \nforamen stenosis at L4-L5, and no significant spinal canal stenosis at any level. Id. Dr. Guastella \nnoted that the Claimant had used a walking boot and rolling scooter, off and on, for the past two \nyears since her work-related injury. Claimant Ex. 1, pp. 131-133. Savanah Bradbury, Physician \nAssistant, noted that Claimant had “degenerative arthritis at L4-L5.” Id. Ms. Bradbury did note \nsome fluid signal in the right facet joint, but no spondylolisthesis. Id. She recommended physical \ntherapy for core low back stretching and strengthening exercises as well as gait training, along \nwith the continued use of a boot and scooter. Id.  \nOn April 27, 2023, Claimant had a 10-week follow-up visit with Dr. Martin and reported \nthat her pain had improved overall, but that she still had significant nerve type pain such as itching \nand burning. Claimant Ex. 1, pp. 134-136. Since Claimant was doing well overall, Dr. Martin \nscheduled another visit a month out. Id. \nOn May 25, 2023, Claimant returned to Dr. Martin for a follow-up, where she continued to \ncomplain about significant tenderness with light touch and palpation of her diffuse mid and \nforefoot. Claimant’s Ex. 1, pp. 137-139. Dr. Martin recommended that Claimant continue to be \ntreated by Dr. Roman and that she remains on light duty. Id. Dr. Roman saw Claimant again on \n\nPEACOCK H109939 \n \n12 \n \nJune 12, 2023, and noted that her left foot pain had a more indicative diagnosis of CRPS by \nBudapest criteria. Claimant Ex. 1, pp. 140-141. Dr. Roman decided to set Claimant up for a series \nof lumbar sympathetic blocks on the left side, since the initial cause of the foot pain has been \nresolved. Id. \n On July 20, 2023, Dr. Martin placed the patient at “maximum medical improvement, \npermanent work restrictions are limited ladder and stairs, no standing more than 30 minutes an \nhour, allowed breaks as needed.” Claimant Ex. 1, pp. 143-145. Dr. Martin gave the following \nimpairment rating of 4% to the whole person, 10% to the lower extremity, and 14% to the foot. Id. \nDr. Roman, on August 29, 2023, placed Claimant at maximum medical improvement and decided \nagainst the lumbar sympathetic blocks because the sympathetic tone had resolved sufficiently. \nClaimant Exhibit Ex. 1, pp. 146-147. Dr. Roman also opined that her CRPS, left lower extremity, \ntype 1, resolved. Id. Dr. Roman stated he would assist her with medication management; and he \nencouraged her to get back into the workforce. Id. On October 2, 2023, he gave her a 1% \nimpairment rating to the first and second metatarsal joint. Claimant Ex. 1, p. 150. Based on the \ndiscrepancy of ratings by Dr. Martin and Dr. Roman, an impairment evaluation was done by Casey \nGarretson and Rick Byrd at Functional Testing Centers, Inc., on October 16, 2023. Their report \nreflects that a combined rating of 5% to the body as a whole was appropriate. Id.  \nOn July 22, 2024, Dr. Barry Baskin was asked to give a second opinion on Claimant’s \ncondition. Claimant’s Ex. 1, pp. 152-156.  Per his report he reviewed Claimant’s medical history \nand personally examined her. Id. Dr. Baskin opined that the Claimant “may” have CRPS that has \ngone into remission and come back again. Id. He stated that “Frequently peripheral nerve lesions \nmanifest like CRPS.” Id. Dr. Baskin’s examination revealed that Claimant had “allodynia, some \nmild color changes in the skin over the course of the evaluation, and temperature changes.” Id. He \n\nPEACOCK H109939 \n \n13 \n \nstated that these symptoms could be from the effects of the nerve resections that were done in the \nfirst surgical procedure. Id. Ultimately, Dr. Baskin’s inclination was that the Claimant has chronic \nnerve pain that comes from the “nerve resections more than CRPS.” Id. He believed that a three-\nphase bone scan “might” give some useful information, and a nerve conduction study “could” \nproduce  valuable  information concerning CRPS. Id. However,  Dr.  Baskin  read  Dr. Head’s \noperative note concerning the nerve resections and admitted that they may not show up on an EMG \nor nerve conduction study. Id. Nevertheless, he believed the test would be helpful in looking for \n“objective findings.” Id. He further stated that the 3-phase bone scan would be diagnostically \nbeneficial. Id. \nAccording to Dr. Baskin’s report, he does believe that the Claimant has some low back pain \nand that the low back pain might well have resulted from her walking with an altered gait \nmechanics because of the left foot problems, the walker boot, and the knee scooter. Id. He stated \nthat she Claimant  has  minimal  degenerative  changes  in  her  lumbar  spine  and  some  facet \narthropathy at L4-L5. Id. Dr. Baskin stated that this low back injury is a “little more clear-cut than \nthe left foot.” Id. He wrote that he does not believe that the Claimant is at maximum medical \nimprovement for her low back, and that Claimant has a clear-cut facet arthropathy that is most \nlikely degenerative in nature but appears to be aggravated from her gait mechanic alterations and \nthe  scooter. Id.  Dr.  Baskin added  that an EMG  and  nerve  conduction  study  of  both  lower \nextremities would be useful, and that Claimant would benefit from a facet block in the right L4-5 \nfacet. Id.   \nAdjudication \nA. Whether Claimant is entitled to additional reasonable and necessary medical \ntreatment and related expenses, including a three-phase bone scan, EMG, and \nnerve conduction study of the left lower extremity. \n\nPEACOCK H109939 \n \n14 \n \nUnder Arkansas Code Annotated § 11-9-508(a) (Repl. 2012), which I find applies to this \nclaim, that an employer shall provide for an injured employee “such medical . . . services . . . as \nmay be reasonably necessary in connection with the injury received by the employee.”  See Wal-\nMart Stores, Inc. v. Brown, 82 Ark. App. 600, 120 S.W.3d 153 (2003).  The claimant must prove \nby a preponderance of the evidence that the subject medical treatment is reasonable and necessary.  \nId.; Geo Specialty Chem. v. Clingan, 69 Ark. App. 369, 13 S.W.3d 218 (2000).  The standard \n“preponderance of the evidence” means the evidence having greater weight or convincing force.  \nBarre v. Hoffman, 2009 Ark. 373, 326 S.W.3d 415; Smith v. Magnet Cove Barium Corp., 212 Ark. \n491, 206 S.W.2d 442 (1947).  What constitutes reasonable and necessary medical treatment is a \nquestion of fact for the Commission.  White Consolidated Indus. v. Galloway, 74 Ark. App. 13, 45 \nS.W.3d 396 (2001); Wackenhut Corp. v. Jones, 73 Ark. App. 158, 40 S.W.3d 333 (2001).  To prove \nher entitlement to the requested treatment, Claimant must also prove that it is causally related to \nher stipulated compensable left foot injuries of March 1, 2021.  See Pulaski Cty. Spec. Sch. Dist. \nv. Tenner, 2013 Ark. App. 569, 2013 Ark. App. LEXIS 601.  A claimant is not required to furnish \nobjective medical evidence of her continued need for medical treatment.  Castleberry v. Elite Lamp \nCo., 69 Ark. App. 359, 13 S.W.3d 211 (2000). \n A claimant’s testimony is never considered uncontroverted.  Nix v. Wilson World Hotel, 46 \nArk. App. 303, 879 S.W.2d 457 (1994).  The determination of a witness’ credibility and how much \nweight to accord to that person’s testimony are solely up to the Commission.  White v. Gregg \nAgricultural Ent., 72 Ark. App. 309, 37 S.W.3d 649 (2001).  The Commission must sort through \nconflicting evidence and determine the true facts.  Id.  In so doing, the Commission is not required \nto believe the testimony of the claimant or any other witness but may accept and translate into \nfindings of fact only those portions of the testimony that it deems worthy of belief.  Id. The \n\nPEACOCK H109939 \n \n15 \n \nCommission is authorized to accept or reject a medical opinion and is authorized to determine its \nmedical soundness and probative value.  Poulan Weed Eater v. Marshall, 79 Ark. App. 129, 84 \nS.W.3d 878 (2002); Green Bay Packing v. Bartlett, 67 Ark. App. 332, 999 S.W.2d 692 (1999). \nThe Claimant is seeking a three-phase bone scan, an EMG, and a nerve conduction study \non her left foot based on Dr. Baskin’s second opinion report. Claimant Ex. 1, pp. 152-156. Dr. \nBaskin in his report struggles as to whether the Claimant has neuropathic pain or CRPS. Id. Dr. \nBaskin admitted that his examination of Claimant was “a little perplexing because the peripheral \nnerve issues that she has could easily be confused with reflex sympathetic dystrophy or CRPS.” \nId. He further noted that frequently peripheral nerve lesions manifest like CRPS. Id. Dr. Baskin \ndid find that the Claimant did have “allodynia, some mild color changes in the skin over the course \nof our evaluation, and temperature changes.” Id. But he further admitted that these findings could \nbe the “effects of the nerve resections that were done in the first surgical procedure.” Id. Dr. Baskin \ndid not have a diagnosis for Claimant’s left foot pain; rather, he recommended a three-phase bone \nscan, an EMG, and a nerve conduction study on her left foot. However, based on Dr. Head’s \noperative note stating the nerve resections were branches of the superficial peroneal and deep \nperoneal very distally down into the forefoot area, Dr. Baskin admitted that these surgical changes \n“may not show up on an EMG or nerve conduction studies...”. Id. at 155. Despite that, Dr. Baskin \nthought the studies would be helpful in looking for “objective findings.” Id.  \nConsidering Dr. Baskin’s recommendation, it cannot be ignored that a bone scan was done \non April 28, 2022, showing no evidence of CRPS. Claimant Ex. 1, p. 51. There Dr. Roman noted: \n“The flow, pooled, and delayed images demonstrated good symmetric flow.” Id.  However, months \nafter this bone scan was done, both Dr. Roman and Dr. Burks believed that Claimant could possibly \nhave CRPS. Claimant Ex. 1, pp. 79-83. In fact, on June 12, 2023, over one year after Claimant’s \n\nPEACOCK H109939 \n \n16 \n \nbone scan, Dr. Roman noted that Claimant’s left foot pain has a “more indicative diagnosis of \nCRPS by Budapest criteria.” Claimant Ex. 1, pp. 140-141. I credit Dr. Roman’s June 12, 2023, \nmedical note. Poulan Weed Eater v. Marshall, 79 Ark. App. 129, 84 S.W.3d 878 (2002). \nMoreover, it is true that Dr. Roman on August 29, 2023, also found that the CRPS of the \nleft lower extremity, type 1, had resolved, and that Claimant was at maximum medical recovery. \nClaimant Ex. 1, pp. 146-147. I also credit this finding. But the law is clear that a claimant may be \nentitled to additional treatment, even after the healing period has ended, if said treatment is geared \ntoward management of the injury.  See Patchell v. Wal-Mart Stores, Inc., 86 Ark. App. 230, 184 \nS.W.3d 31 (2004); Artex Hydrophonics, Inc. v. Pippin, 8 Ark. App. 200, 649 S.W.2d 845 (1983).  \nThese medical services can include those for the purpose of diagnosing the nature and extent of \nthe compensable injury; reducing or alleviating symptoms resulting from the compensable injury; \nmaintaining the level of healing achieved; or preventing further deterioration of the damage \nproduced by the compensable injury.  Jordan v. Tyson Foods, Inc., 51 Ark. App. 100, 911 S.W.2d \n593 (1995); Artex, supra.  \nClaimant continues  to physically  suffer because  of her  work-related  injury; and Dr. \nBaskin’s recommended tests would assist in diagnosing the nature and extent of the compensable \ninjury thus creating a clearer focus on how to medically treat the Claimant’s symptoms. Dr. \nBaskin’s report also noted that Claimant’s CRPS could go into remission and come back again. \nClaimant’s Ex. 1, p. 155. The Claimant has not received any such diagnosis for CRPS before her \nMarch 1, 2021, work-related injury. Thus, the CRPS diagnosis is related and connected to the \ncompensable work-related injury and is entitled to symptom management. These recommended \ntests will assist with treatment. Therefore, based on Dr. Roman’s June 12, 2023, note and Dr. \nBaskin’s recommendation, I do find that the Claimant has proven by the preponderance of the \n\nPEACOCK H109939 \n \n17 \n \nevidence that Dr. Baskin’s recommendations for a three-phase bone scan, an EMG, and nerve \nconduction study are reasonable and necessary medical treatment that is tied to the crush injury \nClaimant sustained on March 1, 2021. Such examination is clearly a “medical service,” falling \nwithin the purview of § 11-9-508(a).   \nB. Whether Claimant sustained an injury to her back as a compensable consequence \nof her stipulated compensable left foot injury. \n \n If  an  injury  is  compensable,  every  natural  consequence  of  that  injury  is  likewise \ncompensable.  Air Compressor Equip. Co. v. Sword, 69 Ark. App. 162, 11 S.W.3d 1 (2000); Hubley \nv. Best West. Governor’s Inn, 52 Ark. App. 226, 916 S.W.2d 143 (1996).  The test is whether a \ncausal connection between the two (2) episodes exists.  Sword, supra; Jeter v. McGinty Mech., 62 \nArk. App. 53, 968 S.W.2d 645 (1998).  The existence of a causal connection is a question of fact \nfor the Commission.  Koster v. Custom Pak & Trissel, 2009 Ark. App. 780, 2009 Ark. App. LEXIS \n947.  It is generally a matter of inference, and possibilities may play a proper and important role \nin establishing that relationship.  Osmose Wood Preserving v. Jones, 40 Ark. App. 190, 843 S.W.2d \n875 (1992).  A finding of causation need not be expressed in terms of a reasonable medical certainty \nwhere  supplemental  evidence  supports  the  causal  connection.   Koster,  supra; Heptinstall  v. \nAsplundh Tree Expert Co., 84 Ark. App. 215, 137 S.W.3d 421 (2003). \n Under Ark. Code Ann. § 11-9-705(a)(3) (Repl. 2012), Claimant has the burden of proving \nby a preponderance of the evidence that she sustained a compensable injury.  Claimant received \nan x-ray on July 20, 2020, at Conway Regional Health System. Resp. Ex. 1, p. 1. The x-ray \nrevealed disc space narrowing at L4-5 that was compatible with degenerative changes. Id. The \nClaimant’s first mention of back pain after her March 1, 2021, work-related incident was on \nNovember 21, 2022, almost nine months later, when she visited Dr. Billy McBay of Noydeen \n\nPEACOCK H109939 \n \n18 \n \nMedical Group. Claimant Ex. 1, pp. 85-88. Dr. McBay ordered an x-ray of Claimant’s lumbar \nspine that revealed “mild intervertebral disc height loss noted at L4-L5 and L5-S1.” Id. The x-ray \nreport also revealed a “Mild facet arthropathy most pronounced in the lower lumbar spine.” Id. Dr. \nMcBay diagnosed Claimant with acute right-sided low back pain with right-sided sciatica. Id. \nClaimant received an MRI on March 24, 2023, that revealed facet arthropathy and stenosis at L4-\n5, as well as “right-sided facet effusion and mild surrounding soft tissue edema and enhancement, \nindicating acute reactive or inflammatory changes.” Claimant Ex. 1, p. 120.  \nDr. Baskin wrote, in his second opinion dated July 22, 2024, that his examination of \nClaimant’s low back reflected no muscle spasms, and normal lumbar lordosis. Claimant’s Ex. 1, \npp. 152-156. Despite Dr. Baskin’s physical examination, the Claimant still complains of “some \nlow back pain and numbness down to about the level of the knee in the right thigh and pain in the \nleft  leg  below  the  knee  that  is  a  combination  of burning,  numbness,  pins  and  needles,  and \nstabbing.” Id. Ultimately, Dr. Baskin thinks the Claimant does have some low back pain that may \nhave resulted from her walking with altered gait mechanics due to “left foot problems, the walker \nboot, and the knee scooter.” Claimant testified that she has been in a boot or scooter more than \n75% of the time since the date of her injury, March 1, 2021, and after her third surgery performed \non February 13, 2023. Trans. p. 63, lines 18-25 through p. 64, lines 1-2. I credit Claimant’s \ntestimony. I find that due to her altered gait, she continues to suffer low back pain. After months \nof walking with an altered gait, Claimant visited with Dr. Guastella at Conway Regional Health \nSystem concerning back pain. Claimant’s Ex. 1, pp. 112-120. Dr. Guastella ordered an MRI for \nher lumbar spine. Id. The MRI showed “Moderate facet arthropathy at L4-L5 with a right-sided \nfacet effusion and mild surrounding soft tissue edema and enhancement, indicating acute reactive \ninflammatory changes. There are small ganglion cyst formation extending posteriorly from the \n\nPEACOCK H109939 \n \n19 \n \nfacet.” Id. (emphasis added) The Claimant continues to have pain in her left foot. Trans. p. 28, \nlines 15-24. Therefore, it stands to reason that Claimant has not returned to a normal gait when she \nwalks. Thus, the preponderance of the credible evidence, highlighted above, establishes that \nClaimant’s low back injury was a natural consequence of her stipulated compensable left foot \ninjury. Accordingly, she had met her burden of proving that her low back injury is a compensable \nconsequence.  \nC. Whether Claimant is entitled to reasonable and necessary medical treatment for \nher alleged lower back injury as a compensable consequence of the compensable \nleft foot injury. \n \n I find that Claimant has proven by a preponderance of the evidence that she is entitled to \nreasonable and necessary medical treatment for her back injury, which includes an EMG and nerve \nconduction studies for the left and right lower extremities that have been recommended by Dr. \nBaskins. For clarity, I have reviewed Dr. Baskin’s treatment recommendations in his second \nopinion for her low back that are in evidence, and I find that she has proven by a preponderance \nof the evidence that all of it reflected therein is reasonable and necessary. Moreover, all prior back \ntreatment subsequent to the compensable work-related injury was reasonable and necessary and \nshall be paid or reimbursed by the Respondents. \nD. Whether Claimant is entitled to Temporary Total Disability (TTD) benefits from \nAugust 29, 2023, to a date yet to be determined. \n \nWhen it comes to TTD as part of the instant claim, Claimant is seeking temporary total \ndisability benefits from August 29, 2023, to a date to be determined.  Respondents deny that she \nis entitled to these benefits. Nevertheless, the law is clear. \n Claimant’s compensable injury to her left foot is a scheduled one.  See Ark. Code Ann. § \n11-9-521(a)(11) (Repl. 2012).  An employee who suffers a compensable scheduled injury is \n\nPEACOCK H109939 \n \n20 \n \nentitled to temporary total disability compensation “during the healing period or until the employee \nreturns to work, whichever occurs first . . . .”  Id. § 11-9-521(a).  See Wheeler Const. Co. v. \nArmstrong, 73 Ark. App. 146, 41 S.W.3d 822 (2001). \n Dr. Martin stated that Claimant had reached maximum medical improvement on July 20, \n2023. Claimant Ex. 1, p. 143. Dr. Roman saw Claimant on August 29, 2023, and concluded that \nshe had reached maximum medical improvement as of that date. Claimant Ex. 1, p. 146. I credit \nDr. Roman’s opinion and find that her healing period concerning her left foot had ended on August \n29, 2023. Claimant has thus failed to prove by the preponderance of the evidence that she is entitled \nto additional temporary total disability benefits. \n As to the back injury, the result of a compensable consequence of the left foot, the evidence \nabove is unclear whether the Claimant has not reached maximum medical improvement. The \nClaimant is entitled to medical treatment of her back so a determination can eventually be made \nconcerning maximum medical improvement. This issue is not ripe. Nevertheless, this injury is an \nunscheduled  one. See Ark.  Code Ann §11-9-521. An  employee  who  suffers  a  compensable \nunscheduled injury is entitled to temporary total disability compensation for that period within the \nhealing period in which she has suffered a total incapacity to earn wages. Ark. State Hwy. & Transp. \nDept. v. Breshears, 272 Ark. 244, 613 S.W.2d 392 (1981). The healing period ends when the \nunderlying condition causing the disability has become stable and nothing further in the way of \ntreatment will improve that condition. Mad Butcher, Inc. v. Parker, 4 Ark. App. 124, 628 S.W.2d \n582 (1982). Also, a claimant must demonstrate that the disability lasted more than seven days. Id. \n§11-9-501(a)(1).  Claimant  must  likewise  prove  her  entitlement  to  these  benefits  by  the \npreponderance of the evidence. Ark. Code Ann. §11-9-705(a)(3). \n\nPEACOCK H109939 \n \n21 \n \nHowever, the credible evidence, assuming the Claimant is currently under the healing \nperiod, does not show that Claimant suffered a total incapacity to earn wages as a direct result of \nher back injury. This issue was not fully developed. Therefore, the Claimant failed to prove by the \npreponderance of the evidence that the Claimant is entitled to TTD benefits. \nE. Whether Claimant is entitled to Temporary Partial Disability (TPD) benefits from \nAugust 29, 2023, to a date yet to be determined. \n \nThe Claimant is also requesting temporary partial disability benefits. Temporary partial \ndisability is the period within the claimant’s healing period in which she suffers only a decrease in \nthe capacity to earn the wages she was receiving at the time of the injury.  Ark. State Hwy. & \nTransp. Dept. v. Breshears, 272 Ark. 244, 613 S.W.2d 392 (1981).  Per Ark. Code Ann. § 11-9-520 \n(Repl. 2012): \n“there shall be paid to the employee sixty-six and two-thirds percent (66 2/3%) of \nthe difference between the employee’s average weekly wage prior to the accident \nand his or her wage earning capacity after the injury.” \n \nClaimant’s compensable left foot injury is a scheduled one.  Ark. Code Ann. § 11-9-\n521(a)(1) (Repl. 2012). This section reads that a claimant suffering from a scheduled injury “shall \nreceive . . . compensation for temporary total and temporary partial benefits during the healing \nperiod or until the employee returns to work, whichever occurs first . . . .”  (emphasis added) In \npassing Act 796 of 1993, the General Assembly made it plain that the provisions of the Arkansas \nWorkers’ Compensation Act are to be strictly construed by the Commission and the courts.  See \nid. § 11-9-704(c)(3); Duke v. Regis Hairstylists, 55 Ark. App. 327, 935 S.W.2d 600 (1996).  “Strict \nconstruction means narrow construction and requires that nothing be taken as intended that is not \nclearly expressed.”  Hapney v. Rheem Mfg. Co., 341 Ark. 548, 26 S.W.3d 771 (2000). \n\nPEACOCK H109939 \n \n22 \n \n In discussing § 11-9-521(a), the Arkansas Court of Appeals in Wheeler v. Armstrong, 73 \nArk. App. 146, 41 S.W.3d 822 (2001) wrote that: \n“the plain meaning of the language employed indicates that an employee who has \nsuffered  a  scheduled  injury is  to  receive  temporary total  or temporary  partial \ndisability benefits during his healing period or until he returns to work regardless \nof whether he has demonstrated that he is actually incapacitated from earning \nwages.” \n \nId. (Emphasis added) The law is clear that a Claimant who has suffered a compensable scheduled \ninjury is no longer eligible to receive temporary partial disability benefits once he has reached his \nhealing period.  Id.   \n As stated previously, Dr. Martin stated that Claimant had reached maximum medical \nimprovement on July 20, 2023. Claimant Ex. 1, p. 143. Dr. Roman saw Claimant on August 29, \n2023, and concluded that she had reached maximum medical improvement on that date. Claimant \nEx. 1, p. 146. I credit Dr. Roman’s opinion and find that her healing period concerning her left foot \nhad ended on August 29, 2023. Claimant has thus failed to prove by the preponderance of the \nevidence that she is entitled to additional temporary partial disability benefits. \n Again, in reference to the back injury, and assuming the Claimant continues to be in the \nhealing period, the credible evidence does not show that Claimant suffered a decrease in the \ncapacity to earn the wages as a direct result of her back injury. This particular issue was not \ndeveloped in the evidentiary record. Thus, the Claimant has failed to prove by the preponderance \nof the evidence that she is entitled to TPD benefits. \nATTORNEY FEES \n Claimant has argued that her counsel should be entitled to a fee under Ark. Code Ann. § \n11-9-715 (Repl. 2012) for indemnity benefits awarded herein.  This provision reads in pertinent \npart: \n\nPEACOCK H109939 \n \n23 \n \n(B) Attorney’s  fees  shall  be  twenty-five  percent  (25%)  of  compensation  for \nindemnity benefits payable to the injured employee or dependents of a deceased \nemployee . . . In all other cases whenever the commission finds that a claim has \nbeen controverted, in whole or in part, the commission shall direct that fees for legal \nservices be paid to the attorney for the claimant as follows:  One-half (½) by the \nemployer or carrier in addition to compensation awarded; and one-half (½) by the \ninjured employee or dependents of a deceased employee out of compensation \npayable to them. \n \n (ii) The fees shall be allowed only on the amount of compensation for \nindemnity benefits controverted and awarded. \n \nId. § 11-9-715(a)(1)(B) & (a)(2)(B)(i)-(ii). \n The Claimant has not been awarded any indemnity benefits. Thus, Claimant’s counsel is \nnot entitled to a controverted attorney’s fee.  \nCONCLUSION \n In accordance with the Findings of Fact and Conclusions of Law set forth above, the parties \nshall act consistent with this opinion.  \n IT IS SO ORDERED. \n \n       ___________________________________ \n       Hon. Steven Porch \n                                                                                    Administrative Law Judge","preview":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION CLAIM NO. H109939 WENDY PEACOCK, EMPLOYEE CLAIMANT CONWAY REGIONAL MED. CENTER, SELF INS. EMPLOYER RESPONDENT RISK MANAGEMENT RESOURCES, TPA RESPONDENT OPINION FILED MAY 27, 2025 Hearing before Administrative Law Judge, Steven Porch, on April 1, 2025, in Little Rock,...","fetched_at":"2026-05-19T22:41:19.953Z","links":{"html":"/opinions/alj-H109939-2025-05-27","pdf":"https://www.labor.arkansas.gov/wp-content/uploads/Peacock_Wendy_H109939_20250527.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/"}}