{"id":"alj-H302325-2024-12-17","awcc_number":"H302325","decision_date":"2024-12-17","opinion_type":"alj","claimant_name":"Alisha Berry","employer_name":"Home Helpers Of Nwa","title":"BERRY VS. HOME HELPERS OF NWA AWCC# H302325 December 17, 2024","outcome":"granted","outcome_keywords":["granted:4"],"injury_keywords":["knee","lumbar","back"],"pdf_url":"https://www.labor.arkansas.gov/wp-content/uploads/BERRY_ALISHA_H302325_20241217.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/","filename":"BERRY_ALISHA_H302325_20241217.pdf","text_length":32307,"full_text":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION \n \n WCC NO. H302325 \n \nALISHA BERRY, Employee CLAIMANT \n \nHOME HELPERS OF NWA, Employer RESPONDENT \n \nAMTRUST NORTH AMERICA, Carrier RESPONDENT \n \n OPINION FILED DECEMBER 17, 2024 \n \nHearing  before  ADMINISTRATIVE  LAW  JUDGE  ERIC  PAUL  WELLS  in  Fort  Smith, \nSebastian County, Arkansas. \n \nClaimant represented by MICHAEL L. ELLIG, Attorney at Law, Fort Smith, Arkansas. \n \nRespondents   represented   by WILLIAM   C.   FRYE,   Attorney   at   Law, North   Little   Rock, \nArkansas. \n \n STATEMENT OF THE CASE \n \n On September 26, 2024, the above captioned claim came on for a hearing at Fort Smith, \nArkansas.      A  pre-hearing  conference  was  conducted  on July  15,  2024,  and  an  Amended Pre-\nhearing  Order  was  filed  on September  25,  2024.      A  copy  of  the  Pre-hearing  Order  has  been \nmarked Commission'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 March 7, \n2023. \n 3. The claimant sustained a compensable injury to her right knee on or about March 7, \n2023. \n 4. All prior opinions are res judicata. \n By agreement of the parties the issue to litigate is limited to the following: \n\nBerry – H302325 \n \n-2- \n 1.  Whether  Claimant  is  entitled  to  additional  medical  treatment  in  the  form  of  a  trial \nspinal cord stimulator and prescription medications as recommended by Dr. Miedema. \n The claimant's contentions are as follows: \n“The   claimant   contends   that   the   respondents   have   repeatedly \nrefused  to  pay  the  benefits  awarded  to  her  under  the  December  5, \n2023,  Opinion  for  a  period  of  an  excess  of  20  days  after  the \nOpinion.  They  have  willfully  refused  to  pay  the  benefits  awarded \nand  are  entitled  to  the  36%  penalty  provided  by  Arkansas  Code \nAnn. §11-9-802 (e). In fact, the respondents have failed or refused \nto  pay  considerable  benefits  in  a  timely  manner.  The  medical \ntreatment   provided   and   recommended   by   Dr.   Miedema,   her \nauthorized  treating  physician  is  reasonably  necessary  under  the \nprovisions  of  Arkansas  Code  Ann  §11-9-508.  The  respondents \nhave controverted the claimant’s entitlement to all temporary total \ndisability benefits in excess of $208 per week.” \n \n The respondents’ contentions are as follows: \n“The   Respondents   contend   that   all   benefits   awarded   to   the \nClaimant have been paid and no penalty is warranted.” \n \n The  claimant  in  this  matter  is  a 44-year-old  female who  sustained  a  compensable  injury \nto  her  right  knee  on  March  7,  2023.  The  respondent  provided  the  claimant  with  medical \ntreatment  for  her  compensable  knee  injury  including  treatment  from  Dr.  Tom  Coker  on  June  5, \n2023.  Dr.  Coker  is  an  orthopedist,  and,  in  his  June  5,  2023,  medical  report  discussed  his  belief \nthat the claimant’s compensable right knee injury goes beyond a “simple fall and contusion” due \nto the development of RSD in the claimant’s right knee which Dr. Coker believed was related to \nher compensable right knee injury. Dr. Coker referred the claimant to a “physical medicine and \nrehab physician,” one of which was specifically Dr. Mark Miedema. The claimant was also \nordered to physical therapy and taken off work at that time.  \n\nBerry – H302325 \n \n-3- \n The  claimant  entered  physical  therapy  and  began  to  see  Dr.  Miedema  in  June  of  2023. \nDuring that time period the claimant’s right knee symptoms continued. At the hearing in this \nmatter the claimant described her right knee difficulties as follows: \nQ And why would you want that help? What is your problem \ncurrently? \n \nA Well,  I  am  on  crutches.  I  have  a  knee  that  all  the  way \naround,  all  the  way  to  the  bottom,  the  side,  everything,  it  hurts.  I \ncan’t bend it hardly. It feels like it is just tight, like a rubber band is \nwrapped around it just holding it there. I have burning pain. I have \na cold leg and foot. My foot is numb constantly. I have tingling. It \nthrobs. It aches. It’s painful. \n \nQ Do you have discoloration of the skin? \n \nA Do what? \n \nQ Do you have discoloration of your skin around your knee? \n \nA I  get  discoloration  all  the  way  down  my  leg.  Sometimes  it \nstays there longer than others. \n \n On October 16, 2023, the claimant was seen by Dr. Miedema.  Following is a portion of \nthat  medical  report  where  Dr.  Miedema  expresses  his  belief  that  the  claimant’s  current \ndifficulties are related to her compensable right knee injury and not related to her lumbar spine as \nfollows: \n1. Pain of the right knee joint- \nMs.  Berry  presents  for  follow-up  evaluation  of  several  months \nright  knee  pain.  She  had  a  fall  at  work  in  March  2023  which \nprecipitated her symptoms. She has been having to use crutches to \nget   around.   She   has   tried   physical   therapy   for   desensitizing \ntechniques  and  attempts  of  improving  range  of  motion  as  well  as \nexercises for her lumbar spine. She is here to review the results of \nher MRI and discuss treatment options. \n \nShe  had  an  MRI  of  the  right  knee  at  Ozark  on  5/22/2023  which \nshowed  a  contusion  of  the  anterior  medial  tibial  condyle.  On  my \nreview  of  her  lumbar  MRI  taken  at  Prime  Medical  Imaging  on \n\nBerry – H302325 \n \n-4- \n9/12/23  it  shows  mild  degenerative  changes  of  the  lumbar  spine. \nNo neural compression at any level. \nM25.561: Pain in right knee \n \n2. Lumbosacral radiculopathy- \nI  do  not  think  her  current  symptoms  are  referred  from  the  lumbar \nspine \n \nI  again  educated  the  patient  on  conservative  treatment  options \nincluding  physical  therapy,  home  exercise  program,  healthy  diet \nand lifestyle, acupuncture, massage, chiropractic care, \npharmacotherapy and injections. \n \nI encouraged the patient to continue with a home exercise program \npreviously taught by physical therapy. \nM54.17: radiculopathy, lumbosacral region \n \nIn  that  same  report  Dr.  Miedema  describes  his  opinion  as  to  the  source  of  the  claimant’s \nsymptoms and treatment for her right knee as follows: \n3. Chronic pain syndrome- \nChronic   pain   syndrome   secondary   to   complex   regional   pain \nsyndrome type 1 in the lower extremity. \nG89.4: Chronic pain syndrome \n \n4. Complex regional pain syndrome type 1- \nRight  lower  extremity  CRPS  type  1  after  a  fall  and  subsequent \nbony  contusion.  The  patient  qualifies  for  diagnosis  of  Complex \nRegional  Pain  Syndrome  (CRPS)  Type  1  based  on  the  Budapest \ncriteria  presenting  symptoms  of  allodynia  &  hyperalgesia,  with \nassociated  vasomotor/sudomotor  changes.  She  saw  Dr.  Coker  for \nthe  knee  and  there  is  no  surgical  indication  at  this  time.  She  has \nbeen doing   PT   with   significant   ongoing   pain   and   functional \nlimitation.  She  cannot  bear  weight  on  her  right  leg  and  has  been \nambulating using crutches. \n \nShe  is  s/p  lumbar  sympathetic  nerve  blocks  on  7/2/23  and  8/3/23 \nwith  temporary  relief  after  each  injection  which  is  helpful  for \ndiagnostic  purposes.  She  has  continued  working  with  physical \ntherapy   for   improving   range   of   motion   and   desensitization \ntechniques.  She  continues  to  utilize  pregabalin  100  mg  twice  per \nday,  Celebrex  200  mg  once  per  day,  and  baclofen  10  mg  3  times \nper  day  as  needed.  In  the  setting  of  CRPS  and  failure  to  improve \nwith  conservative  treatments  over  the  past  7  months  I  think \n\nBerry – H302325 \n \n-5- \nneuromodulation   is   the   appropriate   next   step   in   her   care.   I \nexplained the mechanism of action of spinal  cord stimulation. We \ndiscussed the trial procedure and permanent implant. We discussed \nthe risk, benefits and alternatives. Given the focal pain in her right \nknee  in  the  absence  of  back  pain  I  think  a  dorsal  root  ganglion \nstimulation is the most appropriate. We will target the right L4 and \nL5  nerve  roots.  We  will  get  her  set  up  with  neuropsychology \nevaluation for preoperative clearance. \n \nI do not yet think she has reached maximal medical improvement. I \ndo not think she can return to work at this time. \n \n It  is during the  claimant’s  October  16,  2023,  visit  with  Dr.  Miedema  that  he  first \nrecommends  a  trial  spinal  cord  stimulator  for  the  claimant.  Dr.  Miedema  also  recommends \nprescription  medications  for  her  right  knee  at  that  time.  This  is  the  central  issue  in  the  matter \nbefore the Commission as to whether the  claimant is entitled to additional medical treatment in \nthe  form  of  a  trial  spinal  cord  stimulator  and  prescription  medications  recommended  by  Dr. \nMiedema. \n The  respondent  sent  the  claimant  to  see  Dr.  Chris  Dougherty  for  a  second  opinion.  On \nJanuary 16, 2024, Dr. Dougherty authored a letter to the respondent. In that letter Dr. Dougherty \nanswered  several  questions  posed  to  him  by  the  respondent  in  regard  to  his  examination  of  the \nclaimant. Following is a portion of the questions posed, and answers given by Dr. Dougherty: \n3.  In  your  expert  opinion,  is  the  treatment  of  RSD  and  proposed \ntreatment of spinal cord stimulator related to the 03/07/2023 work \ninjury?  Do  you  believe  the  Spinal  Cord  Stimulator  is  needed  for \nthe treatment of RSD? Please explain in detail. \n \nIn    my   expert  opinion,  the  treatment  of  the  RSD  has  been \nappropriate   and   within   the   guidelines   and   standards   of   care. \nImprovement  after  lumbar  injection  correlates  directly  with  the \npatient’s diagnosis. Improvements also indicates the patient is an \nexcellent spinal cord stimulator candidate. \n \n*** \n\nBerry – H302325 \n \n-6- \n6. Has all treatment for the 03/07/2023 injury been appropriate and \nnecessary,  or  do  you  feel  it  has  been  excessive?  Please  explain  in \ndetail. \n \nThe record is reviewed in great detail. The treatment appears to be \nmedically  necessary,  appropriate  and  within  the  guidelines  of \ntreatment for RSD. No treatment is noted to be excessive. \n \n7.  What  further  treatment,  if  any,  is  necessary  and  appropriate  as \ndirectly related to the 03/07/2023 injury? Please provide a specific \ntreatment   plan   and   duration   that   this   treatment   should   be \nimplemented. \n \nSpecifically,  treatment  up  to  date  has  been  medically  necessary, \nappropriate   and   meets   guidelines.   Improvements   in   pain   as \ndocumented  by  the  lumbar  injections  indicates  the  patient  is  an \nexcellent  candidate  for  a  spinal  cord  stimulator  as  is  noted  in  the \nrecord. The specific treatment plan would be the implementation of \nthe  spinal  cord  stimulator  first  through  a  trial  and  if  the  trial  is \nsuccessful implantation of a permanent spinal cord stimulator. The \ntreatment of duration is a lifetime. \n \n*** \n11.  In  your  medical  opinion,  has  claimant  reached  Maximum \nMedical Improvement, as directly related to the 03/07/2023 injury? \nPlease  explain  in  detail.  If  the  claimant  is  not  yet  at  Maximum \nMedical Improvement, when will this status be reached? \n \nThe claimant has not reached maximum medical improvement as it \nrelated to the 3/7/2023 injury. She currently suffers from RSD also \nknow  as  chronic  regional  pain  syndrome.  The  request  to  estimate \nwhen  MMI  is   achieved  will  not  be  known until  the  patient \nundergoes installation of the spinal cord stimulator trial and in the \nevent this is successful, a permanent spinal cord stimulator. \n \n The  respondent  sent  the  claimant  to  see  Dr.  Richard    Back,  a  neuropsychologist,  at \nNorthwest Arkansas Psychological Group for a “pre-surgical evaluation.” That report is found at \nRespondents’ Exhibit 1, pages 1-3. From a review of the report, it appears Dr. Back administered \nthe  Minnesota  Multiphasic  Personality  Inventory-2  to  the  claimant.  Following  is  the  “Test \nResults and Interpretation” portion of that report: \n\nBerry – H302325 \n \n-7- \nThe MMPI-2 was completed. An examination of the validity scales \nindicates that this individual produced an interpretable profile. Her \nscore  on  the  F  scale  was  elevated  moderately.  These  patients  are \nacknowledging  unusual  experiences  represented  in  these  scales \nmore than the typical person. The elevation reflects the extent and \nseverity of their psychopathology, and how the patient has adjusted \nto  his  or  her  psychopathology.  This  individual  also  produced \nelevations on scales 2 and 3. Individuals who test high on these are \nlikely  to  be  experiencing  a  mild  to  moderate  level  of  emotional \ndistress   characterized   by   dysphoria,   worrying,   and   anhedonia. \nThey  frequently  worry  about  something.  They  feel  inadequate, \nhelpless, and insecure. They are easily hurt by criticism or scolding \nand   have   difficulty   expressing   their   feelings.   They   are   over \ncontrolled   and   fearful   of   losing   control.   They   are   likely   to \nexperience increases in depression, fatigue, and physical symptoms \nin response to stress. They are likely to express their anger overtly. \nThey  have  concentration  difficulties  and  memory  problems.  They \nhave  low  self-esteem,  lack  self-confidence,  and  are  self-doubting. \nTheir  judgment  is  not  as  good  now  as  it  was  in  the  past.  They \nsometimes think they are about to “go to pieces.” \n \nThe  Paindex  was  calculated  on  this  patient,  from  her  MMPI-2 \nscores.  Her  total,  19,  exceeds  the  cut  off  associated  with  good \nprognosis  (13).  Patients  scoring  in  this  elevated  range  are  poor \ncandidates for pain reduction after a “surgical” intervention. The \nPaindex  accurately  identifies  87%  of  patients  who  are  likely  to \nshow a significant reduction in pain complaints after surgery. \n \n The  claimant  was  seen  for  a  “behavioral  assessment”  on  May  28,  2024,  by  Juan \nValenzuela,  LCSW,  at  Advantage  Point  Behavioral.  The  claimant  testified  that  this  evaluation \nwas recommended by Dr. Miedema. Following is a portion from the report of that assessment: \nPATIENT BEHAVIORAL ASSESSMENT SCORES \n \nNIDA  SCREEN:  This  screening  is  composed  of  four  distinct \ncategories:   Alcohol   use,   Tobacco   use,   Illegal   Drugs   use   and \nPrescription Drugs for non-medical reasons use over the past year. \nThe  patient  reports  NO  to  use  of  any  substances  or  prescription \ndrug  use  for  non-medical  reasons  which  reinforces abstinence. \nThere  are  no  known  addictions  reported.  I  do  not  see  any  factors \nthat would hinder the success of a spinal cord stimulator. \n \n\nBerry – H302325 \n \n-8- \nCHRONIC    PAIN    ASSESSMENT    QUESTIONNAIRE:    This \nquestionnaire  assesses  the  two  parts  of  chronic  pain  that  change \nover  time:  Persistent  Baseline  Pain  and  Breakthrough  Pain.  The \npatient rated their  baseline  pain  as:  8,  Severe  pain.  The  patient \nreports  feeling  this  pain  in  the  following  areas:  right  knee.  The \npatient  reports  that  the  pain  feels  like:  burning  and  hurting.  The \npatient  rates  their  breakthrough  pain  as:  0.  The  patient  reports \nfeeling  this  pain  in  the  following  areas:  N/A.  The  patient  reports \nthat  the  pain  feels  like:  N/A.  I  do  not  see  any  factors  that  would \nhinder the success of a spinal cord stimulator. \n \nPHQ-9 ASSESSMENT: The patient’s PHQ-9  score  is:  eighteen \nwhich indicates the level of the patient’s depression severity. The \nlevel  of  depression  severity  of  this  patient  is  moderately  severe.  I \ndo  not  see  any  factors  that  would  hinder  the  success  of  a  spinal \ncord stimulator. \n \nDepression, Anxiety and Stress Scale (DASS-21): the DASS-21 is \ncomposed   of   21   questions.   The   patient   scored   a   20   on   the \ndepression scale. This is in the moderate range. The patient scored \na  4  on  the  anxiety  scale.  This  is  in  the  normal  range.  The  patient \nscored  a  16  on  the  stress  scale.  This  is  in  the  mild  range.  I  do  not \nsee  any  factors  that  would  hinder  the  success  of  a  spinal  cord \nstimulator. \n \nPAIN  CATASTROPHIZING  SCALE:  This  scale  consists  of  13 \nitems  across  through  subscales.  The  patient  scored  a:  31  which \ndoes indicate a clinically relevant level of catastrophizing. \n \n*** \nRecommendations: Alisha Berry’s mental health history suggests \nthat  she  is  a  good  spinal  cord  stimulator  candidate.  The  patient \nindicates that she has been adequately informed regarding the risks \nof,   the   benefits   of,   the   alternatives   to,   and   the   potential \ncomplications  of  the  procedure.  The  patient  asserts  that  she  has \nmade an informed decision. The patient professes reasonable post-\nprocedural  expectations  and  describes  reliable  relationships  that \nwill   support   her   in   her   journey   to   reduce   chronic   pain. \nArrangements  for  post-operative  care  and  assistance  have  been \nmade. \n \nI SEE NO SIGNIFICANT PSYCHOLOGICAL FACTORS THAT \nWOULD   HINDER   THE   SUCCESS   OF   A   SPINAL   CORD \nSTIMULATOR. I AFFIRM THAT ALISHA BERRY IS A GOOD \nCANDIDATE FOR A SPINAL CORD STIMULATOR. \n\nBerry – H302325 \n \n-9- \n \n On July 11, 2024, the claimant was again seen by Dr. Miedema. Following is a portion of \nthat report: \n3. Complex regional pain syndrome type 1 –  \nRight  lower  extremity  CRPS  type  1  after  a  fall  and  subsequent \nbony  contusion.  The  patient  qualifies  for  diagnosis  of  Complex \nRegional  Pain  Syndrome  (CRPS)  Type  1  based  on  the  Budapest \ncriteria  presenting  symptoms  of  allodynia  &  hyperalgesia,  with \nassociated  vasomotor/sudomotor  changes.  She  saw  Dr.  Coker  for \nthe  knee  and  there  is  no  surgical  indication  at  this  time.  She  has \nbeen   doing   PT   with   significant   ongoing   pain   and   functional \nlimitation.  She  cannot  bear  weight  on  her  right  leg  and  has \ncontinued to ambulate with crutches. \n \nShe  is  s/p  lumbar  sympathetic  nerve  blocks  on  7/3/23  and  8/3/23 \nwith  temporary  relief  after  each  injection  which  is  helpful  for \ndiagnosis purposes to confirm the diagnosis of CRPS. \n \nShe  can  continue  pregabalin  100  mg  twice  per  day.  Celebrex  200 \nmg  once  per  day,  and  baclofen  10  mg  3  times  per  day  as  needed. \nAll  of  these  medications  are  specifically to  treat neuropathic  pain \nfrom complex regional pain syndrome. \n \nIn  the  setting  of  CRPS  and  failure  to  improve  with  appropriate \nconservative   treatments   I still think   neuromodulation   is   the \nappropriate next step in her care. She had an Independent Medical \nEvaluation that was done with Dr. Chris Dougherty. Unfortunately \nher  insurance  denied  the  spinal  cord  stimulator.  This  is  certainly \nfrustrating  since  she  has  ongoing  symptoms  of  CRPS  and  has  not \nimproved  with  appropriate  conservative  treatments.  I  am  not  sure \nwhy  they  denied  the  spinal  cord  stimulator.  I  therefore  think  it  is \nreasonable to try repeat lumbar sympathetic block to see if we can \nreinstate some pain relief. \n \nIn the meantime, I also think it is reasonable for her to try aquatic \ntherapy  for  strengthening,  stabilization  and  desensitization  in  the \nsetting of complex regional pain syndrome. \n \nShe  is  approaching  maximum  medical  improvement.  She  will \ncertainly  have  a  permanent  impairment  as  a  result  of  this  injury \nhowever    and    will    require    ongoing    treatment    including – \npharmacotherapy  with  Celebrex,  baclofen  and  Lyrica.  6  weeks  of \nphysical  therapy  per  year  and  up  to  4  lumbar  sympathetic  blocks \n\nBerry – H302325 \n \n-10- \nper  year.  These  treatments  would  be  indefinite  since  complex \nregional  pain  syndrome  is  not  curable.  This  is  one  reason  why \nthink spinal cord stimulation would also be a good alternative. \n \nWe will get her set up with a lumbar sympathetic block. \n \nI will follow-up with her after this procedure reassess her progress \nG90.521: Complex regional pain syndrome 1 of right lower limb \n \n On August 7, 2024, the claimant was again seen by Dr. Miedema. Following is a portion \nof that report: \nAssessment/Plan \nODI 37 Completely Disabled \n \n1. Pain of the right knee joint –  \nMrs. Berry presents for follow-up evaluation of over a 1 year right \nknee pain. To review she had a fall at work in March 2023 which \nprecipitated   her   symptoms.   She   has   tried   physical   therapy, \nexercising   at   home,   pharmacotherapy   and   injections   without \nsustained  relief.  She  is  here  to  review  treatment  options.  She  has \nhad worsening pain. \n \nTo review MRI of the right knee at Ozark on 5/22/2023 showed a \ncontusion of the anterior medial tibial condyle. Lumbar MRI taken \nat  Prime  Medical  Imaging  on  9/12/23  showed  mild  degenerative \nchanges of the lumbar spine. No neural compression at any level. \nM25.561: Pain in right knee \n \n2. Chronic pain syndrome –  \nChronic   pain   syndrome   secondary   to   complex   regional   pain \nsyndrome type 1 in the right lower extremity. \nG89.4: Chronic pain syndrome \n \n3. Complex regional pain syndrome type 1 –  \nRight  lower  extremity  CRPS  type  1  after  a  fall  and  subsequent \nbony  contusion.  She  had  a  work  injury  as  a  direct  result  of  her \ncurrent symptoms. \n \nShe  qualifies  for  diagnosis  of  Complex  Regional  Pain  Syndrome \n(CRPS)   Type   1   based   on   the   Budapest   criteria   presenting \nsymptoms    of    allodynia    &    hyperalgesia,    with    associated \nvasomotor/sudomotor  changes.  She  saw  Dr.  Coker  for  the  knee \nand there is no surgical indication at this time. She has been doing \n\nBerry – H302325 \n \n-11- \nPT  with  significant  ongoing  pain  and  functional  limitation.  She \ncannot bear weight on the right leg and has continued to ambulate \nwith crutches. \n \nShe  is  s/p  lumbar  sympathetic  nerve  blocks  on  7/3/23  and  8/3/23 \nwith  temporary  relief  after  each  injection  with  is  helpful  for \ndiagnostic purposes to confirm the diagnosis for CRPS. \n \nI would recommend she continue pregabalin 100 mg twice per day \nfor  neuropathic  pain,  Celebrex  200  mg  one  per  day  as  an  anti-\ninflammatory, and baclofen 10 mg 3 times per day as needed. All \nof these medications are specifically to treat neuropathic pain from \ncomplex regional pain syndrome. \n \nIn  the  setting  of  CRPS  and  failure  to  improve  with  appropriate \nconservation   treatments   I   still   think   neuromodulation   is   the \nappropriate next step in her care. She had an Independent Medical \nEvaluation  that  was  done  with  Dr.  Chris  Dougherty – he  agreed \nwith  the  diagnosis  of  CRPS  and  recommendation  for  spinal  cord \nstimulation. \n \nUnfortunately her insurance denied the spinal cord stimulator. Her \ninsurance  also  denied  ongoing  therapy,  aquatic  therapy  and  a  trial \nof   a   repeat   lumbar   sympathetic   block.   The   therapy   is   for \ndesensitization  in  the  setting  of  CRPS.  The  lumbar  sympathetic \nblock is for the treatment of pain. \n \nDenial  of  care  certainly  delays  treatment  and  perpetuates  pain  in \nthe setting of complex regional pain syndrome. \n \nShe is approaching maximum medical improvement. As mentioned \npreviously  she  have  a  permanent  impairment  as  a  result  of  this \ninjury and require ongoing treatments including – \npharmacotherapy  with  Celebrex,  baclofen  and  Lyrica.  6  weeks  of \nphysical  therapy  per  year  and  up  to  4  lumbar  sympathetic  blocks \nper  year.  These  treatments  would  be  indefinite  since  complex \nregional pain syndrome is not curable. \n \nI  think  a  functional  capacity  evaluation  would  be  helpful  to \ndetermine her permanent work restrictions. For now I do not think \nshe  has  reached  maximum  medical  improvement.  She  may  not \nreturn to work. \n \nI will follow-up with her after the functional capacity evaluation. \nG80.521: Complex regional pain syndrome 1 of right lower limb \n\nBerry – H302325 \n \n-12- \n \n Dr. Miedema authored a letter to “To Whom It May Concern” regarding the claimant’s \ncourse  of  treatment  and  his  recommendations.  Dr.  Miedema  also, in  part, discussed  the \npsychological evaluations of the claimant. The letter is undated but given the content and context \nof the letter it was clearly written sometime after the claimant’s August 2024 visit with Dr. \nMiedema. The body of that letter follows: \nAs  you  may  know  Mrs.  Berry  has  been  under  my  care  since  our \ninitial  evaluation  on  6/14/2023.  She  has  documented  complex \nregional pain syndrome (CRPS) type 1 of the right lower extremity \nfollowing a work related injury. \n \nWhen   she   failed   to   improve   with   appropriate   conservative \ntreatments (physical therapy, home directed exercises, \npharmacotherapy and lumbar sympathetic blocks) over the past 12 \nmonths  I  recommended  a  trial  of  spinal  cord  stimulation  as  the \nappropriate next step in her care. \n \nUnfortunately this modality was denied by her insurance. She had \nan  Independent  Medical  Evaluation  in  which  the  Independent \nphysician   also   recommended   spinal   cord   stimulation   for   the \ntreatment  of  CRPS.  As  you  mentioned,  she  had  neuropsychology \nevaluation  in  preparation  for  a  trial  spinal  cord  stimulation.  She \nhad an evaluation on 5/28/24 which indicated she would be a good \ncandidate  for  spinal  cord  stimulation.  She  had  an  evaluation  on \n4/22/24  which  indicated  she  would  not  be  a  good  candidate.  This \nevaluation seemed to be more focused on surgery rather than spinal \ncord stimulation specifically. \n \nWhen  we  use  spinal  cord  stimulation  in  the  treatment  of  chronic \npain   and   in   this   case   CRPS   specifically   we   first   do   a   trial \nprocedure.  The  trial  procedure  is  not  a  surgery  but  rather  an \noutpatient   procedure   done   under   local   anesthetic   and   mild \nintravenous  sedation. It  involves  percutaneously  inserting  spinal \ncord  stimulator  leads  within  the  epidural  space  to  help  modulate \npain  in  the  setting  of  CRPS.  The  trial  procedure  lasts  for  1  week. \nDuring this time the patient wears the devise externally to see if it \nis   helpful.   One   week   after   the   trial   procedure   the   leads   are \nremoved.  If  the  trial  procedure  is  successful  then  they  undergo \npermanent placement of the system. This is a surgery to internalize \nthe  system.  It  is  not  a  surgery  to  treat  an  anatomic  problem  but \n\nBerry – H302325 \n \n-13- \nrather  a  pain  problem.  It  is  an  outpatient  surgery  which  involves \nimplanting  the  leads  underneath  the  skin  and  tunneling  them  to \nconnect with a battery. \n \nI hope this helps clarify some of your questions. Do not hesitate to \ncontact me with any further questions. Thank you for allowing me \nto participate in the care of this patient. \n \n The claimant has asked the Commission to determine whether she is entitled to additional \nmedical treatment in the  form of  a trial spinal  cord stimulator and prescription medications and \nrecommended by Dr. Miedema. In order to prove her entitlement to additional medical treatment \nthe claimant must prove that the treatment is reasonable and necessary medical treatment for her \ncompensable right knee injury.  \nEmployers  must  promptly  provide  medical  services  which  are  reasonably  necessary  in \nconnection  with  the  compensable  injuries,  Ark.  Code  Ann.  §11-9-508(a).    However,  injured \nemployees have the burden of proving by a preponderance of the evidence that medical treatment \nis  reasonably  necessary.   Patchell  v.  Wal-Mart  Stores,  Inc.,  86  Ark.  App.  230,  184  S.W.3d  31 \n(2004).    What  constitutes  reasonable  and  necessary  medical  treatment  is  a  fact  question  for  the \nCommission,  and  the  resolution  of  this  issue  depends  upon  the  sufficiency  of  the  evidence.  \nGansky v. Hi-Tech Engineering, 325 Ark. 163, 924 S.W.2d 790 (1996). \n Dr.  Miedema  clearly  believes  the  claimant  should  undergo  a  trial  spinal  cord  stimulator \nand have the medications he prescribed. Dr. Miedema’s opinion is supported by Dr. Dougherty \nto whom the respondent sent the claimant for a second opinion. Dr. Back, who administered the \nMMPI-2 test to the claimant, did not recommend the spinal cord stimulator, stating in his report \n“A spinal chord stimulator is not recommended for this patient.” I note that Dr. Back’s report \nrecommendations   do   not   seem   to   distinguish   the   fact   that   the   claimant   has   not   been \nrecommended for a spinal cord stimulator, only a trial of a spinal cord stimulator. That trial will \n\nBerry – H302325 \n \n-14- \ndetermine if a spinal cord stimulator can provide the claimant relief from her compensable right \nknee injury symptomology. Dr. Miedema, in his undated letter, addresses Dr. Back’s evaluation \nas follows, “This evaluation seemed to be more focused on surgery rather than spinal cord \nstimulation specifically.” \n The claimant’s second psychological evaluation, which appears to have been done via \nvideo by a state licensed counselor, found the claimant to be a good candidate. That report also \nfails to consider the trial nature of the requested treatment.  \n Given  all  the  evidence  before  the  Commission,  I  find  that  the  medical  evidence  and \nopinions  from  Dr.  Miedema,  Dr.  Dougherty,  and  the  state  licensed  counselor  outweigh  the \nconcerns  and  opinion  of  Dr.  Back.  The  claimant  is  able  to  prove  by  a preponderance  of  the \nevidence  the  trial  spinal  cord  stimulator  and  medications  prescribed  by  Dr.  Miedema  are \nreasonable and necessary medical treatment for her compensable right knee 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 \nJuly  15,  2024,  and  contained  in  an  Amended Pre-hearing  Order  filed September  25,  2024,  are \nhereby accepted as fact. \n 2. The  claimant  has  proven  by  a  preponderance  of  the  evidence  that  she  is  entitled  to \nadditional  medical  treatment  in  the  form  of  a  trial  spinal  cord  stimulator  and  prescription \nmedications as recommended by Dr. Miedema. \n\nBerry – H302325 \n \n-15- \n \n \n ORDER \nThe  respondents  shall  pay  the  cost  associated  with  the  claimant’s  trial  spinal  cord \nstimulator  and  the  cost  of  the  prescription  medications  recommended  by  Dr.  Miedema  for  her \ncompensable right knee injury. \nPursuant  to  A.C.A.  §11-9-715(a)(1)(B)(ii),  attorney  fees  are  awarded  “only  on  the \namount of compensation for indemnity benefits controverted and awarded.”   Here, no indemnity \nbenefits were controverted and awarded; therefore, no attorney fee has been awarded.   Instead, \nclaimant’s attorney is free to voluntarily contract with the medical providers pursuant to A.C.A. \n§11-9-715(a)(4). \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                                ____________________________                                               \n       HONORABLE ERIC PAUL WELLS \n       ADMINISTRATIVE LAW JUDGE","preview":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION WCC NO. H302325 ALISHA BERRY, Employee CLAIMANT HOME HELPERS OF NWA, Employer RESPONDENT AMTRUST NORTH AMERICA, Carrier RESPONDENT OPINION FILED DECEMBER 17, 2024 Hearing before ADMINISTRATIVE LAW JUDGE ERIC PAUL WELLS in Fort Smith, Sebastian County, Arkansas. Claim...","fetched_at":"2026-05-19T22:45:35.402Z","links":{"html":"/opinions/alj-H302325-2024-12-17","pdf":"https://www.labor.arkansas.gov/wp-content/uploads/BERRY_ALISHA_H302325_20241217.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/"}}