{"id":"alj-H204217-2024-11-19","awcc_number":"H204217","decision_date":"2024-11-19","opinion_type":"alj","claimant_name":"Terri Sparks","employer_name":"North Ark. College","title":"SPARKS VS. NORTH ARK. COLLEGE AWCC# H204217 November 19, 2024","outcome":"denied","outcome_keywords":["denied:1"],"injury_keywords":["ankle","sprain","back","knee"],"pdf_url":"https://www.labor.arkansas.gov/wp-content/uploads/SPARKS_TERRI_H204217_20241119.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/","filename":"SPARKS_TERRI_H204217_20241119.pdf","text_length":27220,"full_text":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION \n \n WCC NO. H204217 \n \nTERRI SPARKS, Employee CLAIMANT \n \nNORTH ARK. COLLEGE, Employer RESPONDENT \n \nPUBLIC EMPLOYEE CLAIMS DIVISION, Carrier RESPONDENT \n \n \n OPINION FILED NOVEMBER 19, 2024 \n \nHearing  before  ADMINISTRATIVE  LAW  JUDGE  ERIC  PAUL  WELLS  in Harrison, Boone \nCounty, Arkansas. \n \nClaimant  represented  by FREDERICK  S.  SPENCER,  Attorney  at  Law, Mountain  Home \nArkansas. \n \nRespondents  represented  by CHARLES  H.  MCLEMORE,  Attorney  at  Law, Little  Rock, \nArkansas. \n \n STATEMENT OF THE CASE \n \n On August  21,  2024,  the  above  captioned  claim  came  on  for  a  hearing  at Harrison, \nArkansas.      A  pre-hearing  conference  was  conducted  on February  5,  2024,  and  a  Pre-hearing \nOrder  was  filed  on February  6,  2024.      A  copy  of  the  Pre-hearing  Order  has  been  marked \nCommission's Exhibit No. 1 and made a part of the record without objection. \n At the pre-hearing conference the parties agreed to the following stipulations: \n 1. The Arkansas Workers' Compensation Commission has jurisdiction of this claim. \n 2. The relationship of employee-employer-carrier existed between the parties on January \n12, 2022. \n 3. The claimant sustained a compensable injury to her right foot  and ankle on or about \nJanuary 12, 2022. \n 4. The claimant’s weekly compensation rates will be determined at a later date. \n\nSparks – H204217 \n \n-2- \n By agreement of the parties the issue to litigate is limited to the following: \n 1. Whether Claimant is entitled to additional medical treatment for her compensable right \nfoot and ankle injury in the form of surgery as recommended by Dr. Kevin Steffen. \n The claimant's contentions are as follows: \n“The Claimant contends that she sustained a compensable injury to \nher right foot and ankle in the course and scope of her employment \non January 12, 2022. \n \nThe Claimant did a Change of Physician to Dr. Kevin Steffen. She \ncontends  that  she  is  entitled  to  reasonable  and  necessary  medical \ntreatment under his direction. \n \nThe  Claimant  contends  that  she  is  entitled  to  TTD  benefits  (dates \nto be determined). \n \nThe Claimant contends that she is entitled to an impairment rating \nby Dr. Steffen and related permanent partial disability benefits.” \n \n The respondents’ contentions are as follows: \n“The  Respondent  contends  that  the  claimant  reported  having  an \naccident  occurring  January  12,  2022  when  she  stumbled  on  a  mat \nand  injured  her  right  ankle.  The  claimant  was  diagnosed  with  a \nsprain  following  this  date.  Respondent  accepted  as  compensable \nthis   sprain   injury   the   claimant   sustained.   The   claimant   was \nprovided   reasonable   and   necessary   medical   treatment   for   her \ninjury,   including   MRI   study   and   treatment   with   Dr.   Jason \nPleimann.  The  claimant  had  a  preexisting  condition  in  her  right \nankle,  and  had  undergone  arthroscopic  surgery  on  her  right  ankle \nby  Dr. Pleimann  on  December  8,  2020.  The  claimant  had  arthritis \nfollowing her surgery. Dr. Pleimann wrote that the claimant’s need \nfor a surgery at this time is due to her preexisting condition, not a \nwork  injury,  and  released  the  claimant  at Maximum  Medical \nImprovement  on  September  12,  2022  with  0%  impairment  rating. \nThe claimant was paid TTD benefits until October 5, 2022, and has \nbeen  overpaid  TTD  benefits  for  which  Respondent  is  entitled  to  a \ncredit. The claimant used her one-time Change of Physician to see \nDr.  Steffen,  and  has  been  provided  a  visit  with  her  choice  of \nphysician by the Respondent. \n \n\nSparks – H204217 \n \n-3- \nRespondent   contends   that   the   claimant   has   been   provided \nreasonable   and   necessary   medical   treatment   and   appropriate \nindemnity benefits for her compensable sprain injury, and that the \nclaimant  cannot  meet  her  burden  of  proving  that  she  is  entitled  to \nadditional   medical   treatment   reasonable   and   necessary   for   or \ncausally  related  to  her  work  injury,  nor  is  the  claimant  entitled  to \nadditional  indemnity  benefits  for  her  work  injury.  Respondent \nfurther   contends   that   the   claimant   cannot   establish   that   a \ncompensable   injury   is   the   major   cause   of   any   permanent \nimpairment she contends to be entitled to. \n \nThe  Respondents  reserve  the  right  to  raise  additional  contentions, \nor  to  modify  those  stated  herein,  pending  the  completion  of \ndiscovery.” \n \n The  claimant  in  this  matter  is  a 58-year-old  female who  sustained  a  compensable  injury \nto  her  right  ankle/foot  on  or  about  January  12,  2022.  The  sole  issue  before  the  Commission  is \nwhether  the  claimant  is  entitled  to  additional  medical  treatment  for  her  right  ankle/foot  in  the \nform  of  surgery  as  recommended  by  Dr.  Kevin  Steffen.  I  note  that  prior  to  the  hearing  in  this \nmatter  the  claimant  underwent  that  surgical  intervention  at  the  hands  of  Dr.  Steffen  on \nSeptember 1, 2023, at Baxter Regional Medical Center. The claimant has previously had surgical \nintervention  on  her  right  ankle/foot  on  December  8,  2020.  Dr.  Jason Pleimann performed  an \narthroscopic  debridement  and  microfracture  at  that  time.  On  direct  examination  the  claimant \ndescribed  her  symptoms  before  and  after  her  January  12,  2022,  compensable  right  ankle/foot \ninjury as follows: \nQ Okay. And I want you to tell the Judge what has been going \non.  What  were  the  symptoms  before  you  had  the  injury  and  what \nwere  the  symptoms  after  you  had  the  injury  up  until  the  present? \nJust give him a history of that. Tell the Judge that. \n \nA I can say, honestly, my  ankle was bothering me  before the \nsecond  fall.  I  mean  I  was  still  able  to  drive  and  do  whatever  I \nwanted to do, but after the fall, it swells – basically, I mean I don’t \nknow how to say it, three to four times the size. I would have to go \n\nSparks – H204217 \n \n-4- \nget  groceries,  but  I  have  to  go  to  Walmart  and  do  the  call-in  and \nthey bring it out to you because I couldn’t walk through Walmart. \n \n Just  the  pain.  And  still  to  this  day,  even  after  the  surgery \nand the brace that I am in, I am in an AFO that is supposed to keep \nme non-weightbearing, and it still swells up. And it will only swell \nup – I don’t know how to explain it. Where the boot is, and let’s \nsay  this  is  my  foot,  the  boot  comes  to  here  (indicating).  It  starts \nhere  and  both  sides  and  then  comes  up  to  about  here  (indicating). \nWhen   it   swells,   it   comes   out   the   top   and   out   the   bottom \n(indicating). And as soon as you take it off, then the rest of the foot \nis swollen. \n \n On  direct  examination  the  claimant  was  asked  about  her  January  12,  2022,  admittedly \ncompensable right ankle/foot injury as follows: \nQ Okay.  Tell  the  Judge   what  happened  so  he   just  kind \nunderstands the degree and extent of the injury. \n \nA Okay.  When  you  walk  into  the  library  where  I  worked, \nthere  is  two  sets  of  doors.  I  had  unlocked  the  first  set  and  was \nwalking towards the second set when I tripped and fell on the black \nmat. \n \nQ Okay. And how did you fall? \n \nA Honestly,  it  happened  so  fast,  I  don’t  know.  The  only \nreason I didn’t hit the floor was because I did – I face-planted the \nglass door. \n \nQ Okay. And immediately  did you sense  any sensations with \nregard to that injury and where you were hurt, if anywhere? \n \nA Immediately, yes. I hurt immediately. \n \nQ Where? \n \nA My ankle. \n \nQ Which ankle? \n \nA My right ankle. \n \n\nSparks – H204217 \n \n-5- \nOn that same day, the  claimant was seen at  Washington Regional Urgent Care with complaints \nof ankle pain and swelling. The claimant was simply diagnosed with ankle pain upon findings of \nswelling and tenderness to the right ankle. The claimant was referred to an “ortho” at that time. \nOn February 9, 2022, the claimant was seen at Ozark Orthopedics by APRN Hannah Patterson. \nFollowing is a portion of that medical record: \nAssessment/Plan \nImpression: Right ankle sprain, date of injury 1/12/2022. She has a \npre-existing   medial   osteochondral   lesion   of   the   talus   that \nunderwent    arthroscopic    debridement    and    microfracture    on \n12/8/2020. \n \nPlan: She has been in the boot weightbearing as tolerated, she still \nhas  pretty  considerable  swelling  today  on  exam.  She  has  been  off \nwork  quite  a  bit  due  to  the  weather,  but  is  still  doing  her  normal \nwork duty with the use of the boot. I told her I think she can stay in \nthe  boot  for  another  2  weeks,  then  transition  back  to  her  lace  up \nankle boots if she feels able before her next appointment. We have \ndiscussed that with her history of surgery on this ankle, this could \ntake a while before it comes around fully. I want her to continue to \nice, take ibuprofen as needed, and give this some relative rest. We \nwill get her into some physical therapy to work on range of motion \nand strengthening. Follow-up in 3 weeks for reevaluation. I expect \nMMI in 6 to 8 weeks. \n \n The  claimant  continued  to  treat  with  APRN  Patterson  until  she  last  saw  her  on  May  2, \n2022. Following is a portion of that medical record: \nAssessment/Plan \nImpression: Right ankle sprain, date of injury 1/12/2022. She has a \npre-existing   medial   osteochondral   lesion   of   the   talus   that \nunderwent    arthroscopic    debridement    and    microfracture    on \n12/8/2020. \n \nPlan: Clinically her swelling looks much better today, but she says \nshe  is  still  having  pain.  She  has  been  doing  physical  therapy, \ntaking anti-inflammatories, at this point she has failed conservative \nmeasures.  At  this  point  we  need  to  proceed  forward  with  an  MRI \nto  further  evaluate  the  ankle  to  ensure  nothing  else  is  going  on \n\nSparks – H204217 \n \n-6- \nhere.  She  will  follow-up  with  Dr.  Pleimann  go  over  those  results \nand determine next steps. \n \n On  May  9,  2022,  the  claimant  underwent  an  MRI  of  the  right  ankle.  Following  is  the \nImpressions section from that diagnostic test: \nIMPRESSION: \n1. Progressive cystic changes are seen in the talar dome with joint \nspace   narrowing   of   the   tibiotalar   joint.   The   tibiotalar   joint \ndemonstrates a moderate joint effusion and changes consistent with \nsynovitis. \n2.  Reactive  edema  is  seen  involving  the  posterior  subtalar  joint, \ntalonavicular joint, and calcaneocuboid joint. \n3.  Edema  in  the  sinus  Tarsi  which  could  represent  sinus  Tarsi \nsyndrome in the right clinical setting. \n4. Split tear of the peroneal brevis tendon. \n \nThat  same  day,  the  claimant  was  seen  by  Dr.  Jason Pleimann,  an  orthopedic  surgeon  at  Ozark \nOrthopedics. Following is a portion of that medical record: \nAssessment/Plan \nRadiographs:  MRI  of  the  right  ankle  done  here  today  reviewed. \nThese demonstrate significant cystic change in the talar dome more \ndiffusely  than  the  area  of  her  previous  OLT.  There  is  significant \nbony edema throughout the talus and calcaneus. \n \nImpression:  Right  ankle  sprain  with  history  of  prior  arthroscopic \ndebridement OLT, date of injury 1/12/2022. Her MRI today shows \ndiffuse edema throughout the talus and into the calcaneus. I am not \nsure if this represents stress reaction or exacerbation of developing \narthritis.  It  could  also  potentially  be  consistent  with  early  onset \navascular necrosis of the talus. \n \nPlan: She has not been improving with measures tried previously. I \nam   going   to   have   her   go   back   into   her   boot   and   go \nnonweightbearing on a knee scooter. She needs to be a sitting work \nonly  nonweightbearing.  Return  in  4  weeks  with  a  standing  three-\nview right ankle. \n \n\nSparks – H204217 \n \n-7- \n On  July  18,  2022,  the  claimant  was  again  seen  by  Dr. Pleimann who, in  the  medical \nrecords,  acknowledges  her  past  right  ankle  difficulties,  which  include  surgical  intervention  and \ntreatment he provided. Following is a portion of that medical record: \nAssessment/Plan \nRadiographs:  Standing  3  view  of  the  right  ankle  were  done  here \ntoday. These again show some cystic change to the talus and some \nmild sclerosis. No obvious collapse. \n \nImpression:  Right  ankle  sprain  with  history  of  prior  arthroscopic \ndebridement OLT, date of injury 1/12/2022. Her MRI today shows \ndiffuse edema throughout the talus and into the calcaneus. I am not \nsure if this represents stress reaction or exacerbation of developing \narthritis.  It  could  also  potentially  be  consistent  with  early  onset \navascular necrosis of the talus. \n \nPlan:  She  has  had  less  pain  since  using  the  knee  scooter  and \nkeeping weight off of her foot. Her x-rays look stable. At the very \nleast  she  is  got  severe  arthritis,  and  certainly  it  is  possible  she \ncould  have  avascular  necrosis  here.  I  am  going  to  keep  her \nnonweightbearing  for  another  6  weeks  and  repeat  x-rays  then.  As \nlong  as  there  is  no  change  we  will  repeat  her  MRI  after  that  visit. \nShe needs to remain in sitting work only nonweightbearing on this \nextremity.  She  tells  me  that  she  was  fired  from  her  job  after  she \nwas  placed  on  limitations.  Ultimately,  we  may  try  a  tall  Arizona \ntype  brace  after  the  next  visit  an  MRI  to  see  if  it  would  let  her \nweight-bear with less pain. \n \n On  September  12,  2022,  the  claimant  underwent  another  right  ankle  MRI.  Following  is \nthe Impression section of that diagnostic report: \nIMPRESSION: \n1. Degenerative  changes  of  the  tibiotalar  joint  posterior  subtalar \njoint,  talonavicular  joint,  and  calcaneocuboid  joint.  Overall  this  is \nstable slightly progressed since the previous exam. \n2.  Moderate  tibiotalar  joint  effusion  with  changes  consistent  with \nsynovitis. \n3.  Split  tear  of  the  personal  brevis  tendon  in  the  retromalleolar \nregion. \n \n\nSparks – H204217 \n \n-8- \nOn  that  same  day,  the  claimant  was  again  seen  by  Dr. Pleimann.  Following  is  a  portion  of  that \nmedical record: \nAssessment/Plan \nRadiographs: An MRI of this ankle done here today is reviewed. It \ndemonstrates    moderately    worsened    tibiotalar    subtalar    and \ntalonavicular  arthritis  with  subchondral  cystic  change.  The  ankle \njoint looks the worst. \n \nImpression: Right  ankle  sprain  with  history  of  prior  arthroscopic \ndebridement  OLT,  date  of  injury  1/12/2022.  Her  MRI  shows \ndiffuse   edema   throughout   the   talus   and   into   the   calcaneus \nconsistent  with  developing  arthritis.  It  could  also  potentially  be \nconsistent with early onset avascular necrosis of the talus. \n \nPlan:  Her  pain  has  not  improved.  She  still  unable  to  bear  weight. \nHer MRI shows progressive arthritic change primarily in the ankle \nand subtalar joint but to a lesser extent the talonavicular joint. We \ndiscussed   various   treatment   options,   including   various   fusion \noptions,  total  talus  replacement,  ankle  replacement.  I  think  given \nconcerns over possible vascularity of the talus I think she would do \nbest  with  a  tibiotalar  calcaneal  arthrodesis.  This  would  still  leave \nher   talonavicular   joint   arthritic,   but   hopefully   this   could   be \nmanaged  with  cortisone  injections  etc.  She  understands  she  had  a \nvery   stiff   ankle   and   hindfoot.   She   understands   is   a   risk   of \nnonunion,  wound  healing  problems,  infection  among  others.  She \nwishes  to  proceed.  She  is  going  to  call  and  let  me  know  when  in \nthe  near  future  would  be  best  for  her.  In  the  interim  she  could \nreturn to sitting work only. She should not drive. \n \n On September 14, 2022, the respondent authored a letter to Dr. Pleimann concerning the \nclaimant’s condition regarding her compensable right ankle/foot injury. The respondent asked \nDr. Pleimann to  respond  to  several  questions.  Following  are  the  questions  and  Dr. Pleimann’s \nhandwritten responses: \n1. What pathology identified on the enclosed MRIs are considered \nacute 01/12/22 injury related? \n None \n \n\nSparks – H204217 \n \n-9- \n2. Would the reported mechanics of tripping, but not falling, have \nresulted  in  her  current  symptoms  and  pathology?  Please  explain \nand provide supporting rationale. \n NA \n \n3. Which of Ms. Sparks’ current symptoms are the direct result of \nthe  01/12/22  injury,  versus  progressive  degenerative  joint  disease \nor  from  the  pre-existing  osteochondritis  dissecans  lesions  and \nsurgery? Please explain and provide supporting rationale. \n The  majority,  if  not  all,  of  her  symptoms  are  related  to \nprogressive [illegible]. \n \n4.  Is  the  proposed  right  ankle  arthrodesis  indicated  and  medically \nappropriate, especially based on her weight (five feet, seven inches \nand   300   pounds)   and   reported   tobacco   dependency?   Please \nexplain. \n Yes \n \n5. Can you state, with a reasonable degree of medical certainty, the \nmajor  cause  (greater  than  50%)  for  the  proposed  right  ankle \narthrodesis is the direct result of the 01/12/22 injury versus her pre-\nexisting pathology? Please provide supporting rationale. \n NA \n \n6. If the ankle arthrodesis is indicated for pre-existing pathology, is \nthere   any   additional   treatment   indicated   as   the   result   of   the \n01/12/22 injury? \n NA \n \n7.  If  the  ankle  arthrodesis  is  indicated,  medically  appropriate,  and \nthe  direct  result  of  the  01/12/22  injury  what  is  the  potential \noutcome   based   on   her   pre-existing   and   co-existing   medical \nconditions? \n NA \n \n A  second  letter  was  sent  as  a  follow-up  letter  to  Dr. Pleimann on  September  27,  2022, \nwith  two  follow-up  questions.  Those  two  questions  and  Dr. Pleimann’s handwritten responses \nfollow: \n1. Since  the  proposed  surgery  is  not  considered  01/12/22  injury \nrelated, has Ms. Sparks achieved MMI as the result of the 01/12/22 \nwork injury? If so, what date was MMI achieved? \n Yes. 9/12/22 \n\nSparks – H204217 \n \n-10- \n \n2.  If  MMI  has  been  achieved,  is  there  any  assignment  of  a \npermanent  partial  physical  impairment  rating  as  the  result  of  the \n01/12/22  work  injury?  If  so,  please  document  the  percentage  of \nimpairment  and  the  objective  finding  this  is  based  in  accordance \nwith  the  enclosed  Arkansas  Workers’  Compensation  Rule  34. \nPlease include edition, page, table, and chart number. \n 0% impairment rating. \n \n The claimant requested a change of physician from the Commission on January 6, 2023. \nThat  change  of  physician  request  was  granted  to  the  claimant  changing  her  physician  from  Dr. \nPleimann to Dr. Kevin Steffen on January 18, 2023. \n The  claimant  was  seen  by  Dr.  Kevin  Steffen  on  February  7,  2023,  at  Foot  and  Ankle \nSpecialty in Mountain Home, Arkansas. Following is a portion of that medical report: \nObjective: \nModerate  edema  with  varicosities  noted  bilaterally  with  increased \nedema  to  the  right  foot  and  ankle.  There  is  significant  pain  with \npalpation  to  the  right  foot  and  ankle  and  with  ROM  of  the  ankle \nand  SJP.  DP  and  PT  palpable,  temperature  tone  turgor  within \nnormal limits, neurological sensation intact, hair  growth adequate, \nmuscular skeletal strength is +5 over 5 bilateral lower extremities. \nRadiographs,  3  views  right  foot,  AP,  MO  and  lateral  and  2  views \nright ankle, AP and mortise, do not reveal acute changes, there are \nsignificant  degenerative  changes  noted  to  the  ankle  and  subtalar \njoint with cystic changes to the talus with sclerosis of the talus and \nSTJ, there are also degenerative changes to the TN joint. \nMRIs  and  CTs  from  2020  and  2022  were  evaluated,  CT  in  2020 \nsuggested  osteochondral  lesion  to  the  talar  dome,  2022  MRIs \nsuggested  significant  bone  marrow  edema  to  rearfoot  and  ankle \nwith  degenerative  changes  to  the  ankle,  STJ  and  TN  and  cystic \nchanges to the talus. \n \nAssessment: \nPost traumatic arthritis right foot and ankle \nAVN talus right \nPain \n \nPlan: \nDiscussed treatment, risks and complications \nRadiographs taken, evaluated and discussed with the patient \n\nSparks – H204217 \n \n-11- \nEvaluated and discussed the MRIs and CTs with the patient \nDiscussed   treatment   and   diagnosis   in   detail   with   the   patient \nincluding  immobilization,  elevation,  rest,  non  weight  bearing  and \nsurgery. \nDiscussed  risks,  complications  and  post  operative  care  of  surgery, \nwhich would be tibiotalar and subtalar joint fusion. \nDiscussed length of time required for non weight bearing and risk \nof non healing. Discussed that if the patient does not heal, it could \npossibly result in loss of limb. \nDiscussed   that   both   sudden   injury   and   chronic   degenerative \nchanges from an old injury could cause the AVN of the talus. \nRx for topical pain cream \nRx for oral supplements to aid in bone healing \nFollow up in 1 month \n \n On  August  24,  2023,  the  claimant  was  again  seen  by  Dr.  Steffen.  At  that  time,  the \nclaimant  was  seen  for  pre-op  of  her  scheduled  right  ankle  scope  and  subchondroplasty.  On \nSeptember  1,  2023,  the  claimant  underwent  surgical  intervention  at  the  hands  of  Dr.  Steffen. \nFollowing are portions of that operative note: \nPREOPERATIVE DIAGNOSES: \n1. Osteochondritis dissecans of the right ankle. \n2. Arthritis, right ankle. \n \nPOSTOPERATIVE DIAGNOSES: \n1. Osteochondritis dissecans of the right ankle. \n2. Arthritis, right ankle. \n \nPROCEDURE: Ankle arthroscopy with significant debridement as \nwell as repair of the osteochondritis dissecans in the right talus. \n*** \nSURGICAL  INDICATIONS:  This  is  a  57-year-old  female  patient \nwell known to my practice with increasing pain to the right ankle. \nThe  patient  has  had  a  few  different  injuries  in  the  last  year  or  so \nresulting  in  significant  pain  and  has  had  several  MRIs  and  CT \nconfirming  significant  degenerative  changes  to  the  ankle  joint  as \nwell as cystic and osteochondral defects in the talus and the distal \ntibia. \n \n The  claimant  has  asked  the  Commission  to  determine  whether  surgical  intervention \nperformed by Dr. Steffen on September 1, 2023, was reasonable and necessary medical treatment \n\nSparks – H204217 \n \n-12- \nfor her compensable right ankle/foot injury. Employers must promptly provide medical services \nwhich  are  reasonably  necessary  in  connection  with  the  compensable  injuries,  Ark.  Code  Ann. \n§11-9-508(a).    However,  injured  employees  have  the  burden  of  proving  by  a  preponderance  of \nthe evidence that medical treatment is reasonably necessary.  Patchell v.  Wal-Mart Stores, Inc., \n86  Ark.  App.  230,  184  S.W.3d  31  (2004).    What  constitutes  reasonable  and  necessary  medical \ntreatment is a fact question for the Commission, and the resolution of this issue depends upon the \nsufficiency  of  the  evidence.   Gansky  v.  Hi-Tech  Engineering,  325  Ark.  163,  924  S.W.2d  790 \n(1996). \n The  claimant  was  consistently  diagnosed  with  a  right  ankle  sprain  as  a  result  of  her \nJanuary 12, 2022, fall which gave rise to her compensable right ankle/foot injury. Dr. Pleimann \nwas well aware of the claimant’s prior right ankle/foot difficulties as he was the surgeon who \ntreated  and  performed  surgery  on  the  claimant  in  December  of  2020.  Dr. Pleimann,  in  his \nresponse  to  questions  submitted  to  him  by  the  respondent  on  September  14,  2022,  made  his \nopinion  clear.  Dr. Pleimann is of the opinion that none of the pathology in the claimant’s two \nMRIs  are  related  to  her  January  12,  2022; fall,  that  the  injury  the  claimant  had  on  January  12, \n2022, would not result in her current symptoms or pathology; and that no treatment was needed \nat this time for the claimant’s January 12, 2022, fall which was the cause of her compensable \nright ankle/foot injury. Given Dr. Pleimann’s history with the claimant, I give much weight to his \nopinions about the claimant’s need for treatment. \n Dr. Steffen, who the claimant saw through a change of physician, stated in his February \n7, 2023, medical report regarding the claimant, “Discussed  that  both  sudden  injury  and  chronic \ndegenerative changes from an old injury could cause the AVN of the talus.” In the claimant’s \nSeptember 1, 2023, operative note, Dr. Steffen stated, “This is a 57-year-old female patient well \n\nSparks – H204217 \n \n-13- \nknown to my practice with increasing pain to the right ankle. The patient has had a few different \ninjuries  in  the  last  year  or  so  resulting  in  significant  pain  and  has  had  several  MRIs  and  CT \nconfirming   significant   degenerative   changes   to   the   ankle   joint   as   well   as   cystic   and \nosteochondral defects in the talus and the distal tibia.” Dr. Steffen also appears to be under  the \nbelief that the claimant’s current issues are a result of degenerative changes. At least I find no \nindication from Dr. Steffen that the claimant’s surgical need was brought about by the claimant’s \nJanuary 12, 2022, fall. \n The  claimant  has  failed  to  prove  by  a  preponderance  of  the  evidence  that  the  surgical \nintervention  performed  by  Dr.  Steffen  on  September  1,  2023,  is  reasonable  and  necessary \nmedical treatment for her compensable right ankle/foot injury. \n From a review of the record as a whole, to include medical reports, documents, and other \nmatters properly before the Commission, and having had an opportunity to hear the testimony of \nthe witness and to observe her demeanor, the following findings of fact  and conclusions of law \nare made in accordance with A.C.A. §11-9-704: \n FINDINGS OF FACT & CONCLUSIONS OF LAW \n 1.  The  stipulations  agreed  to  by  the  parties  at  the  pre-hearing  conference  conducted  on \nFebruary  5,  2024,  and  contained  in  a  Pre-hearing  Order  filed February  6,  2024,  are  hereby \naccepted as fact. \n 2. The claimant has failed to prove by a preponderance of the evidence that she is entitled \nto additional medical treatment for her compensable right ankle/foot injury in the form of surgery \nas recommended by Dr. Steffen. \n  \n \n\nSparks – H204217 \n \n-14- \nORDER \nPursuant  to  the  above  findings  and  conclusions,  I  have  no  alternative  but  to  deny  this \nclaim in its entirety. \nIf  they  have  not  already  done  so,  the  respondents  are  directed  to  pay  the  court  reporter, \nVeronica Lane, fees and expenses within thirty (30) days of receipt of the invoice. \n IT IS SO ORDERED. \n                                ____________________________                                               \n       HONORABLE ERIC PAUL WELLS \n       ADMINISTRATIVE LAW JUDGE","preview":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION WCC NO. H204217 TERRI SPARKS, Employee CLAIMANT NORTH ARK. COLLEGE, Employer RESPONDENT PUBLIC EMPLOYEE CLAIMS DIVISION, Carrier RESPONDENT OPINION FILED NOVEMBER 19, 2024 Hearing before ADMINISTRATIVE LAW JUDGE ERIC PAUL WELLS in Harrison, Boone County, Arkansas. Cl...","fetched_at":"2026-05-19T22:46:34.267Z","links":{"html":"/opinions/alj-H204217-2024-11-19","pdf":"https://www.labor.arkansas.gov/wp-content/uploads/SPARKS_TERRI_H204217_20241119.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/"}}