{"id":"alj-H207643-2024-07-03","awcc_number":"H207643","decision_date":"2024-07-03","opinion_type":"alj","claimant_name":"Daraphone Saegsatheuane","employer_name":null,"title":"SAEGSATHEUANE VS. TRANE COMMERCIAL SYSTEMSAWCC# H207643July 3, 2024","outcome":"denied","outcome_keywords":["granted:1","denied:2"],"injury_keywords":["cervical","neck","shoulder"],"pdf_url":"https://www.labor.arkansas.gov/wp-content/uploads/SAEGSATHEUANE_DARAPHONE_H207643_20240703.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/","filename":"SAEGSATHEUANE_DARAPHONE_H207643_20240703.pdf","text_length":15445,"full_text":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION \n   \n CLAIM NO. H207643 \n \nDARAPHONE SAEGSATHEUANE, EMPLOYEE CLAIMANT \n \nTRANE COMMERCIAL SYSTEMS, EMPLOYER RESPONDENT \n \nTRAVELERS INDEMNITY COMPANY, CARRIER RESPONDENT \n \n \n OPINION FILED JULY 3, 2024 \n \nHearing before ADMINISTRATIVE LAW JUDGE JOSEPH C. SELF in Fort Smith, Sebastian \nCounty, Arkansas. \n \nClaimant represented by EDDIE H. WALKER, JR., Attorney, Fort Smith, Arkansas. \n \nRespondents represented by GUY ALTON WADE, Attorney, Little Rock, Arkansas. \n \n \n STATEMENT OF THE CASE \n  \n On June 18, 2024, the above captioned claim came on for a hearing at Fort Smith, Arkansas. \nA pre-hearing conference was conducted on April 4, 2024, and a pre-hearing order was filed on that \nsame date. A copy of the pre-hearing order has been marked as Commission’s Exhibit #1 and made \na 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.   All prior Opinions are res judicata. \n 3.   The employee/employer/carrier relationship existed on November 3, 2021. \n 4.   Compensation rates are not an issue.  \nBy agreement of the parties, the issues to be litigated and resolved at the forthcoming hearing \n were limited to the following: \n\nSaegsatheuane-H207643 \n2 \n \n1.  Whether claimant is entitled to medical benefits, specifically ESI injections, and \n prescriptions medications.  \n 2.  Whether claimant is entitled to temporary total disability benefits from August 10, 2023, to \n August 23, 2023, in the amount of $1,046.50. \n3.  Attorney’s fees on said temporary total disability benefits in the amount of $299.00. \nAll other issues are reserved by the parties. \nThe parties announced that issue #2 was resolved by the parties before the hearing, making \nissue #3 moot.  \nThe claimant contends that “That her authorized treating physician has recommended cervical \nepidural  steroid  injection  at  C5-6  and  the  respondents  have  refused  to  authorize  that  injection. \nClaimant’s attorney requested respondents’ attorney to reconsider the non-certification;  however, \nalthough the request was made more than 3 weeks ago, it is the claimant’s understanding that the \ninjection has still not been approved. The claimant contends entitlement to prescription medications \nprescribed by her authorized treating physician. Claimant was seen by her authorized treating physician \non February 19, 2024, and was prescribed pain medication and muscle relaxers to which the pharmacy \nhas been unable to obtain authorization for the prescribed medications.” \nThe respondents contend that “The ESI injections are not reasonable, necessary, or related to \nthe work injury. Respondents contend they are paying all reasonable, necessary, and related medical \ntreatment.”   \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 testimony \nof the witnesses and to observe their demeanor, the following findings of fact and conclusions \nof law are made in accordance with A.C.A. §11-9-704: \n\nSaegsatheuane-H207643 \n3 \n \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 on \nApril 4, 2024, and contained in a pre-hearing order filed that same date are hereby accepted as \nfact. \n 2.  Claimant has met her burden of proof by a preponderance of the evidence that she \nis  entitled  to  additional  medical  benefits  from  Dr.  Brent  Whatcott  for  her  neck  and  left \nshoulder injury. \n FACTUAL BACKGROUND \n This  matter  was  previously  before  this  court for  a  hearing  on March  21,  2023. An \nopinion was rendered on June 15, 2023, in which I found, among other things, that claimant \nhad  met  her  burden  of  proof  that  she  was  entitled  to additional  medical  benefits  from  Dr. \nBrett Whatcott for her neck and left shoulder injury. That opinion was not appealed to the \nFull Commission, and the parties have stipulated that it is res judicata for this hearing.  \nHEARING TESTIMONY \n \n Claimant says she has been under Dr. Brett Whatcott’s treatment since the last hearing \nin this case.  She testified that her left shoulder was still very painful and that sometimes it gets \nnumb. She believes her condition is getting worse. Claimant denied receiving any injections \nfor  her  shoulder  and  is  currently  taking  painkillers  and  muscle  relaxers  (Hydrocodone, \nAcetaminophens, and Tizanidine, HCL 4mlg.). She said she was having to use Medicaid to get \nthe painkiller filled because workers’ compensation had not been paying for it. Claimant denied \nany new injury since the job-related accident. \n On  cross-examination,  claimant  said  that  she  spends  her  day  now  driving  her  kids \naround  to  games,  church,  and  practice. She  cooks  dinner  but does  not lift  anything  heavy \n\nSaegsatheuane-H207643 \n4 \n \n \nbecause  her  hand  is  very  numb  and  painful. She  stated  that  she  did  physical  therapy  until \nworkers’ compensation denied the claim. She wanted to do more but it was denied. Claimant \nrecalled that she had an injection which initially did not help but after a while it did. Her doctor \nrequested some more, and it was denied. Claimant was shown the report from Dr. Whatcott \nfrom July 18, 2023, which showed normal findings, including no tenderness or spasms, normal \nlordosis, and a normal range of motion for her age. Claimant said during that visit, she was \nonly feeling pain in her shoulder but not as painful throughout her arm.  Claimant first denied \nthat the doctor had done an examination but when questioned further, she conceded that he \ndid physically touch her in July 2023. \n Claimant  says  that  she  does  not  do  long  drives  but  is  able  to  do  short  ones  to  go \ngrocery shopping. She cleans around the house, washing dishes, and clothes. She sometimes \nvacuums but when she cannot her son does the vacuuming. Claimant has not looked for work \nbecause of the pain she has at night and when she sits for very long, her neck is very painful.   \n On redirect-examination, claimant confirmed that her main problem is on her left side, \nwhich is where there is a disc herniation at C5-6. She said again that the pain interferes with \nher ability to sleep and that she treats it by heating a towel to put on her neck and shoulders. \nShe said the pain starts in her shoulder and goes down her arm.  \nREVIEW OF THE EXHIBITS \n Claimant submitted a few records from her treating physician, Dr. Whatcott, which \nwere  prepared since  the  last  hearing  in  this  matter. On  June  19,  2023,  he saw  claimant  and \nrecorded what she told him. Among other things, claimant reported that her current course \nof treatment had caused her to sleep better and do routine activities. An occipital nerve block \nwas mentioned.  \n\nSaegsatheuane-H207643 \n5 \n \n \n She returned to see Dr. Whatcott on July 18, 2023, and his record of that visit included \nmore history than the previous one. The most notable entries are as follows:  \n1. Cervical radiculopathy- \n07/18/2023 We are reordering PT as she has not heard from them \nyet. Her attorney is trying to help so we can get her the CESI that she \nneeds. Of note, it is well documented in medicine that the longer there \nis pressure from a disc on a spinal nerve root, the greater the chance \nof permanent nerve damage. \n \n06/19/23 PT notes received dated 05/16/23. However, I don’t know \nwhat else really to do as worker’s comp is denying every treatment. \nApparently, they are requiring more PT, I will order this. \n \nHas received her TENS unit, already. \n \nHer insurance is denying CESI yet again. This is after failing PT which \nthey  requested. She would like TENS unit.  Furthermore, worker’s \ncomp will not pay for pain medication. \n \nA cervical epidural is indicated and considered medically necessary for \nthis patient based on the following: \n \n• Radiculopathy \n• Disc displacement \n• Spinal stenosis \n• Pain level of >=5 \n• Pain lasting longer than 3 months \n• Inadequate  pain  relief  from  NSAID,  physical  therapy,  exercises, \ntopical, lifestyle changes etc. \n \nRepeat  MIR  reviewed with  same  findings  as CT. Disc  herniation  at \nC5-C6,  but  now  with  bilateral  foraminal  stenosis,  left  greater  than \nright. This  suggests  that  the  disc  herniation  has  progressed. Started \nPT on 02/14. It is not helping. She wants to be off of opiates for now \nso I will add muscle relaxers. \n \nHaving  worsening  neck  pain,  we  need  to  proceed  with  CESI. Still \nfighting  worker’s  comp  over  this. Pain   continues   to   worsen. \nApparently, they are requiring outpatient physical therapy.  I will order \nthis through Mercy and will get a new MRI to evaluate any changes. \nNo refills needed today. \n \nCT reviewed. Left sided disc herniation at C5-C6. Based on failure of \n\nSaegsatheuane-H207643 \n6 \n \n \nshoulder  treatments,  this  must  be  the  source  of  pain  as  it  is  on  the \nsame side.  \nM54.12: radiculopathy, cervical region \n• Tizanidine  4  mg  tablet- Take  1  tablet(s)  every  day  by  oral  route  at \nbedtime for 30 days. Qty (30) tablet refills: 5 Pharmacy CVS 17357 \nIN TARGET \n• PHYSICAL    THERAPIST    REFERRAL – Schedule Within: \nprovider’s discretion \nReason for Referral: Evaluate and treat \n \n2. Long-term drug therapy – \nShe  was  able  to  get  at  least  a  seven-day  script  of  tramadol  from  her \nPCP. I am ok with this as we are not having any luck getting her some \nmedicine. UDS and PMP as expected. \nZ79.899: Other long-term (current) drug therapy.\n1\n \n \n   \n Respondent  submitted an  internal  Utilization  Review  Determination by  Dr.  Edrick \nLopez. The relevant parts of it are reproduced below:      \nCervical epidural steroid injection C5-6 is Non-Certified \nODG by MCG(www.mcg.com/odg), Evidence-based Medical treatment Guidelines, Section: \nPain: Epidural Corticosteroid Injection \nReviewer’s Conclusion & Comments \nThis is a 50-year-old who sustained an industrial injury on 11/3/2021. \nThe individual was working full-time. Per the office visit by Kristina \nDean, APRN-FNP, on 01/03/2024, there was documentation of neck \npain,  related  8/10  radiating  to  the  bilateral  shoulders  down  to  the \nfingers. The   individual   was   taking   hydrocodone   currently. The \nindividual had an injection in 2015 which helped somewhat. The PT \ndid not help with the pain. With the current treatment, the individual \nwas able to do routine activities, and the pain level, ability to sleep, and \noverall  function  had  improved  significantly. The  cervical  spine  MRI \ndated 01/30/2023 revealed degenerative changes most pronounced at \nC5-C6  with  grade  1  retrolistheses,  mild-to-moderate spinal  stenosis, \nand  mild  bilateral  neuroforaminal  stenosis. The  neck  exam  revealed \ntenderness. The  left  upper  extremity  exam  revealed  tenderness  and \n \n1\n In this one chart entry, I count at least five references to difficulties claimant was having getting respondents \nto provide her with the benefits I had previously awarded. \n\nSaegsatheuane-H207643 \n7 \n \n \npainful and restricted ROM. The diagnosis was cervical radiculopathy. \nPer the UR decision dated 05/03/2023, the request was non-certified. \n \nThe request is for cervical epidural steroid injection C5-C6. Per the \nODG, it is recommended for cervical radiculopathy when there is a \nfailure to respond > 1 weeks of conservative care. Cervical ESI is not \nrecommended at levels above C6-C7 or C7-T1. In this case, per prior \nUR Determination dated 05/03/2023, the request for cervical ES at \nC5-6 was non-certified as there were no abnormal neurologic findings \non  the  exam  and  no  indication  of  exhaustion  of  conservative  care. \nThe  updated  records still lack evidence  of  objective  findings of  any \nmyo-comal    or    derma-comal    deficits    suggesting    nerve    root \ncompression  or  neurological  deficits. Further,  records  indicate  the \nindividual’s overall function and pain level had improved with the \ncurrent  treatment  regimen  thus  questioning  the  need  for  additional \ntreatment. Also, the guidelines do not recommend cervical ESI above \nC6-7 or C7-T1. Hence considering these facts the request for Cervical \nepidural steroid injection C5-C6 is non-certified.  \n \nADJUDICATION \n \n I had a sense of déjà vu as I read the record in this matter. In my previous opinion on \nthis issue of additional medical care, I said:  \n“It  was  stipulated  that  claimant  had  a  compensable  injury  on \nNovember 3, 2021. Once it has been established that a claimant has \nsustained a compensable injury, she is not required to offer objective \nmedical  evidence  to  prove  entitlement  to  additional  benefits, Ark. \nHealth Ctr. v. Burnett, 2018 Ark. App. 427, at 9, 558 S.W.3d 408, 414. \n \nThe evidence on this point boils down to whether the testimony of \nthe  claimant  and  the  opinion  of  her  treating  physician  is  more \npersuasive  than  the  report  of  a  doctor  who only  reviewed  records \nprovided  to  him.  I  find  Dr.  Whatcott's  recommendation  is  more \ncredible in light of the conservative care claimant has received to this \npoint  in  her  course  of  treatment,  and  therefore  claimant's  proof  is \nsufficient to support her request for continued medical treatment for \nher compensable injury.”  \n \n Nothing in the current record has changed my mind. The Utilization Review cited a \nprevious review that denied benefits which was relevant mainly to show yet another instance \nwhere respondent had denied claimant treatment that had been recommended by her treating \n\nSaegsatheuane-H207643 \n8 \n \n \nphysician. It  also  used  the Official  Disability  Guidelines  instead  of  the proper  standard  in \nArkansas, The AMA Guides To The Evaluation Of Permanent Impairment, 4\nth\n Edition. I again find \nclaimant to be a credible witness and that the report of Dr. Whatcott is more persuasive than \nan  opinion  of  a  physician  that  (a)  has  not seen  the  claimant and  (b)  used a criterion that  is \nirrelevant to making a decision under Arkansas law.   I find Dr. Whatcott’s remark from almost \na year ago to be most concerning:  “...it is well documented in medicine that the longer there \nis  pressure  from  a  disc  on  a  spinal  nerve  root,  the  greater  the  chance  of  permanent  nerve \ndamage.”    \n Respondents’ continued denial of treatment as recommended by her treating physician \nand  as  previously  awarded  in  this  case  is  inexcusable.  Such may  well  end  up  costing  them \nmore money in the long run, but more importantly, it may cause a permanent injury to claimant \nthat could be avoided with appropriate and timely care.  \nORDER \n \n Claimant has met her burden of proving by a preponderance of the evidence that she \nis  entitled  to  additional  medical  treatment  as  recommended  by  Dr. Whatcott for her \ncompensable injury, including ESI injections and prescription medications.  \n Respondent is responsible for paying the court reporter her charges for preparation of \nthe transcript. \n IT IS SO ORDERED. \n \n \n                                                                                               \n_______     \n        JOSEPH C. SELF \n       ADMINISTRATIVE LAW JUDGE","preview":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION CLAIM NO. H207643 DARAPHONE SAEGSATHEUANE, EMPLOYEE CLAIMANT TRANE COMMERCIAL SYSTEMS, EMPLOYER RESPONDENT TRAVELERS INDEMNITY COMPANY, CARRIER RESPONDENT OPINION FILED JULY 3, 2024 Hearing before ADMINISTRATIVE LAW JUDGE JOSEPH C. SELF in Fort Smith, Sebastian Count...","fetched_at":"2026-05-19T22:50:53.203Z","links":{"html":"/opinions/alj-H207643-2024-07-03","pdf":"https://www.labor.arkansas.gov/wp-content/uploads/SAEGSATHEUANE_DARAPHONE_H207643_20240703.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/"}}