{"id":"alj-H304356-2025-11-10","awcc_number":"H304356","decision_date":"2025-11-10","opinion_type":"alj","claimant_name":"Candace Fletcher","employer_name":"International Paper Company","title":"FLETCHER VS. INTERNATIONAL PAPER COMPANY AWCC# H304356 November 10, 2025","outcome":"denied","outcome_keywords":["dismissed:1","denied:4"],"injury_keywords":["back","repetitive","thoracic","lumbar","shoulder","hip","neck","strain"],"pdf_url":"https://www.labor.arkansas.gov/wp-content/uploads/FLETCHER_CANDACE_H304346_20251110.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/","filename":"FLETCHER_CANDACE_H304346_20251110.pdf","text_length":39704,"full_text":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION \nAWCC FILE No H304356 \n \nCANDACE FLETCHER, EMPLOYEE       CLAIMANT \n \nINTERNATIONAL PAPER COMPANY,  \nEMPLOYER                     RESPONDENT \n \nOLD REPUBLIC INSURANCE COMPANY,  \nCARRIER                      RESPONDENT \n \nSEDGWICK CLAIMS MANAGEMENT, \nTHIRD PARTY ADMINISTRATOR           RESPONDENT \n  \n \nOPINION FILED 10 NOVEMBER 2025 \n \n \nHeard before Arkansas Workers’ Compensation Commission Administrative Law Judge \nJayO. Howe on 13 August 2025 in Little Rock, Arkansas. \n \nMr. Mark Alan Peoples appeared on behalf of the claimant. \n \nMitchell, Williams, Selig, Gates & Woodyard, PLLC, Mr. John P. Talbot and Ms. Abby \nHart, appeared on behalf of the respondents. \n \nSTATEMENT OF THE CASE \n \n A Prehearing Order was filed on 10 June 2025 and admitted to the record as \nCommission’s Exhibit No 1. For this litigation, and consistent with that Order, the parties \nagreed to the following: \nSTIPULATIONS \n \n 1. The Arkansas Workers' Compensation Commission (the Commission) has \n  jurisdiction over this claim. \n \n 2. The employee/employer/carrier-TPA relationship existed on 26 June   \n  2023 when the claimant allegedly sustained an injury by specific incident to  \n  her left arm. \n \n 3. The claimant’s average weekly wage of $780.58 would entitle her to weekly  \n  benefits of $520 for Temporary Total Disability (TTD) and $390 for Partial  \n  Permanent Disability (PPD). \n \n 4. The respondents have controverted this claim in its entirety. \n\nC. FLETCHER- H304356 \n2 \n \nISSUES TO BE LITIGATED \n \n 1. Whether the claimant suffered a compensable injury to her left arm by  \n  specific incident on 26 June 2023. \n \n 2. Whether the claimant is entitled to TTD benefits from 8 July 2023 to 1  \n  December 2023. \n \n 3. Whether the claimant is entitled to reasonable and necessary medical   \n  treatment of her alleged compensable injury. \n \n 4. Whether the claimant is entitled to an attorney’s fee. \n \n All other issues are reserved.\n1\n \n \nCONTENTIONS \n \nThe Prehearing Order incorporated the following contentions from the parties’ \nrespective prehearing questionnaire responses: \nClaimant \n The Claimant contends that she is entitled to TTD from on or about \n8 July 2023 to her return to work elsewhere beginning on or about 1 \nDecember 2023. Claimant also contends that she is entitled to medical \ntreatment. This claim is controverted, and counsel is entitled to a \nmaximum of statutory fee. All other issues are reserved. \n \n Respondent \n \n The respondents contend that the claimant did not sustain a \ncompensable injury while employed with the respondents on 26 June \n2023, or she cannot carry her burden of proving she sustained a \ncompensable injury on such date. Further, the respondents contend the \nclaimant’s claim may be barred, or her benefits may be limited, due to \nher involvement in an incident of workplace violence.\n2\n The respondents \nreserve the right to modify, supplement or amend these contentions as \ndiscovery and investigation continue. \n \n \n \n \n1\n At the beginning of the hearing, the claimant sought to additionally plead a gradual onset \nof her alleged injury as an alternative theory. The respondents objected, stating, “That’s got \nother elements to it that we might have brought a witness to address had we known that \nwas going to come up today.” [TR at 8.] I sustained the objection, noting that any additional \ntheories for sustaining her claim and any claims for additional benefits were reserved. \n2\n The respondents withdrew this contention at the hearing. \n\nC. FLETCHER- H304356 \n3 \n \nFINDINGS OF FACT AND CONCLUSIONS OF LAW \n \nHaving reviewed the record as a whole, including the evidence summarized below, \nand having heard testimony from the witness, observing her demeanor, I make the \nfollowing findings of fact and conclusions of law under Ark. Code Ann. § 11-9-704: \n1. The Commission has jurisdiction over this claim. \n \n2. The stipulations as set forth above are reasonable and are hereby accepted. \n \n3. The claimant has failed to prove by a preponderance of the evidence that she \nsuffered a compensable injury to her left arm by specific incident. \n \n4. Because the claimant has failed to prove a compensable injury, her other \nclaims are moot and will not be addressed in this Opinion. \n \n5. Because the claimant has failed to prevail on any claim for indemnity \nbenefits, she is not entitled to an attorney’s fee. \n \nADJUDICATION \nThe stipulated facts as outlined above are reasonable and accepted. It is settled that \nthe Commission, with the benefit of being in the presence of a witness and observing their \ndemeanor, determines a witness’ credibility and the appropriate weight to accord their \nstatements. Wal-Mart Stores, Inc. v. VanWagner, 337 Ark. 443, 990 S.W.2d 522 (1999). A \nclaimant'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 \nmuch weight to accord to that person's testimony are solely up to the Commission. White v. \nGregg Agricultural Ent., 72 Ark. App. 309, 37 S.W.3d 649 (2001). The Commission must \nsort through conflicting evidence and determine the true facts. Id. In so doing, the \nCommission is not required to believe the testimony of the claimant or any other witness \nbut may accept and translate into findings of fact only those portions of the testimony that \nit deems worthy of belief. Id. \n \n\nC. FLETCHER- H304356 \n4 \n \nSUMMARY OF THE EVIDENCE \nThe claimant was the only witness. The record consists of the hearing transcript and \nthe following exhibits: Commission’s Exhibit No 1 (the 10 June 2025 Prehearing Order); \nClaimant’s Exhibit No 1 (one index page and 20 pages of medical records); Claimant’s \nExhibit No 2 (one index page and five pages of non-medical records); Respondents’ Exhibit \nNo 1 (one index page and seven pages of non-medical records); and Respondents’ Exhibit No \n2 (three index pages and 93 pages of medical records). \nHearing Testimony \n The claimant was 40 years old at the time of the hearing. She testified that she had \nbeen working for the respondent-employer for six or seven weeks on the date of her alleged \ninjury. She worked as a palletizer, stacking packaged products onto shipping pallets.   \n The claimant stated that she “felt like a little pop” in her left arm while working on \n26 June 2023. [TR at 17.] She testified that her supervisor gave her some ibuprofen after \nshe reported the injury. She said that someone at work initiated a video chat with a doctor \nfor her after she returned for the start of her next shift still complaining of pain. According \nto the claimant, she then saw an orthopedic doctor on her own, via video chat at midnight, \nevery night, for the next seven nights. She did not recall any of those doctors’ names or \nprovide records from those visits. The claimant testified that she eventually saw a local \nprovider, Dr. Gil Johnson in July of 2023, around the same time that she was terminated \nfrom her employment.  \n The claimant eventually began working as a tax preparer with Jackson Hewitt on 1 \nDecember 2023. She testified that had she not been terminated, she could not have \nphysically performed her job with the respondent-employer during the time that she was \nnot employed.  \nQ:  ... eventually, you went back to work, right? \n\nC. FLETCHER- H304356 \n5 \n \nA:  Yes. \nQ:  I have December 1, 2023, does that sound right? \nA:  Yes. \nQ:  Okay. Where’d you go to work? \nA:  For Jackson Hewitt as a tax preparer. \nQ:  Okay. So a much less physically demanding job? \nA:  Yes. \nQ:  Are you physically able to do that job? \nA:  Yes. \nQ:  During that period from July the 8\nth\n of 2023, to December 1\nst\n, 2023, would \nyou have been able to do your job at International Paper? \nA:  No. \n \n[TR at 24.]  \n She denied any problems with her left elbow prior to 23 June 2023. The claimant \ndescribed the pain in her left arm as a “sharp shooting pain.” [TR at 26.] She said that at \ntimes the pain would get so bad that: \nA:  ...when my inflammation gets real high, I can’t even move it and it goes \nfrom one arm to the other. \nQ:  Okay. \nJudge:  The pain goes from one arm to the other? \nA:  Yes. \n \nId. She went on to state that she was still seeking treatment for her left elbow and forearm; \nand she claimed that a specialist diagnosed nerve damage in the elbow. \n On cross-examination, the claimant acknowledged that she had been diagnosed with \nchronic pain syndrome and that she was seeking treatment from Arkansas Pain Center \nbefore her alleged injury. On the nature of the onset of her injury, the claimant testified: \nQ:  And so the injury, I guess, I’m confused. You attribute it to this pop in \nyour arm, that’s when it started? \nA:  Yes. \nQ:  Okay. But you’re also reserving the right to say it was a gradual onset \ninjury of some kind? \nA:  Oh, no. It happened while I was working. \nQ:  It started with this pop? \nA:  Yes. \nQ:  It wasn’t bothering you before that? \nA:  I couldn’t work there if it was bothering me. \nQ:  And had—you had this pop, and that’s when it all started? \nA:  Yes. \n\nC. FLETCHER- H304356 \n6 \n \n \n[TR at 32-33.] She also testified that she reported an accurate past medical history and list \nof current medication to Dr. Gil Johnson when she saw him on 20 July 2023. \nQ:  ... When you first started seeing Dr. Johnson, did you tell him that you’d \nbeen in good health with no major problems? \nA:  Yes. \nQ:  Okay. \nA:  I took a physical. I took a physical. He also test[ed] me for diabetes and \nall—and urine specimen. So he also knew what medications I was on. \nQ:  Okay. So did you mention to him— \nA:  Uh-huh. \nQ:  -- about the pain doctor? \nA:  Yes. \nQ:  And the chronic pain syndrome and the Hydrocodone? \nA:  Uh— \nQ:  And the Gabapentin? \nA:  Yes. Chronic pain was from my lower back, yes. I’m having to— \nQ:  Did you ever tell Dr. Johnson that you had suffered more of a repetitive-\nmotion-type injury? \nA:  Prior or after? \nQ:  When you saw him in July or August of ’23? \nA:  I didn’t know exactly what, actually—what, actually, caused it, but I know \nit had happened. So once I seen Dr. Gil [Johnson], we were more trying to see \nwhat it was, not what caused it. \n \n[TR at 34.]   \n The claimant testified that she returned to work after the alleged injury and that \nshe continued working until 11 July 2023 when she was given notice of her termination. \nQ:  And what did you understand the reason for your termination to be? \nA:  Workhouse violence, which was a coverup for the accident. \nQ:  Okay. And why do you say that? \nA:  Because I reported that the machinist was speeding the machine up and \nworking me more than normal and no one did anything about it. So when I \nbecame injured, then, that’s when the HR Department and all that started \nreaching out. \n \n[TR at 35.] She went on to explain that she believed a machine operator was intentionally \nrunning her production line too quickly and that she participated in a verbal altercation of \nsome sort about it. That altercation was the stated basis for her termination. \n \n\nC. FLETCHER- H304356 \n7 \n \nMedical Evidence \n On 8 June 2023, before the date of the injury alleged in this claim, the claimant \nattended a follow-up visit at Arkansas Pain Centers. The note from that visit provided, in \npart: \nCHIEF COMPLAINT: Pain \n \nSUBJECTIVE COMPLAINTS (HPI): ... Ms. Fletcher is reporting pain \ntoday as high as 8.5/10, which stays at a 5/10 lasting 2-3 hours. \n... \n \nDIAGNOSIS/MEDICAL DECISION MAKING: \nM54.2 Cervicalgia \nM54.6 Pain in thoracic spine \nM54.16 Radiculopathy, lumbar spine \nM25.512 Pain in left shoulder \nG89.4 Chronic pain syndrome \nM25.511  Pain in right shoulder \nM54.50 Low back pain, unspecified \nM62.830 Muscle spasm of back \nM96.1 Postlaminectomy syndrome, not elsewhere classified \nZ79.891 Long term (current) use of opiate analgesic \nZ79.899 Other long term (current) drug therapy \n. . .  \n \nPLAN: \nRefill meds today—Ms. Fletcher has requested an increase in pain \nmedication several times. Considering her MRI findings, that she takes \nSoma 3 times daily, and physical presentation, she is not a good \ncandidate for an increase in medication at this time. A drug holiday \nmay be a better option for this patient. \nUDS [urine drug screen] and pill count will be performed periodically to \nmonitor medication usage. \nPMP [Arkansas’ Prescription Monitoring Program] was reviewed prior \nto today’s visit. No concerns. \nBowel program: adequate control with current regimen. Encouraged \nfiber and water intake for prevention. \n \n[Resp. Ex. No 2.] The note for that visit also shows that she was assessed for/with right \nshoulder pain, chronic low back pain, lumbar spondylosis, and myofascial pain syndrome \nalong the right hip and right shoulder, both anteriorly and posteriorly. \n\nC. FLETCHER- H304356 \n8 \n \n According to the claimant, she had a number of injury-related physician visits before \nbeing referred to Dr. Gil Johnson. But she did not introduce those records into evidence. On \n20 July 2023, the claimant presented to the College Park Family Clinic, where she was seen \nby Dr. Johnson. The note from that visit includes: \nPROGRESS NOTE: \nCandace comes in today for assessment of injuries here. She comes in \nwith the nurse case manager who was assigned. Candace works at \nInternational Paper. She complains of pain in her left arm that hurts \n[...]. The safety and health department referred Candace to a \ntelemedicine company: Ortho Live. She was given neck exercises and \npostural changes for exercises for her left arm. She subsequently saw \nher primary care doctor who prescribed steroid dose pack that was a 5-\nday prescription. He also gave her a muscle relaxant. She had a \nscheduled visit again with the Ortho Live physician—telemedicine who \nadvised her to stop the steroid dose pack after she had taken the first 2 \ndays of it. She talked to the telemedicine Dr. for the next several days \nwith the last telemedicine consult being July 7 at 1 AM. She was \nreferred to me for evaluation after that and present today for initial \nvisit. \n \nPAST MEDICAL HISTORY:  She is started working at International \nPaper in May of this year. She reports that she’s in good health with no \nmajor medical problems. \n \nPAST SURGICAL HISTORY: none reported. \n \nCURRENT MEDICATIONS: none reported. \n \nPHYSICAL EXAM: \n. . . \nExamination of the left upper extremity reveals discomfort at the \nantecubital fossa and proximal forearm. This is over the brachioradialis \nmuscle mostly. She has good grip strength. Tinel’s sign is negative. \nPhalen’s test is negative. She does not have pain in the axilla or her \nneck. She has a normal biceps reflex. \n \nIMPRESSION: \nLeft forearm strain. \n \n[Resp. Ex. No 2.] Dr. Johnson ordered X-rays of the claimant’s left arm. That imaging was \nperformed on 31 July 2023. According to the reports: \nPROCEDURE: 2 view left forearm \nFINDINGS: The left radius and ulna are unremarkable. \n\nC. FLETCHER- H304356 \n9 \n \n. . .  \nPROCEDURE: 2 view left elbow \nFINDINGS: Left elbow is unremarkable. \n \n The claimant then returned to Dr. Johnson’s clinic on 1 August 2023. The notes from \nthat visit include: \nShe continues to have pain when I palpate the brachioradialis muscle. \nTinel’s test is negative \nPhalen’s test: [blank space in original] Allens’s test is negative. There’s \ngood circulation to the hand. \nShe complains of pain when she extends her left forearm out to [150 \ndegrees]. She can extend all the way to 180 [degrees] although she \ncomplains of discomfort at the brachioradialis muscle on the left side. \nThere is no pain to palpate the lateral or medial epicondyle or the \nantecubital fossa today. I did not observe fasciculations when I palpated \nand observed the musculature of the left forearm. She has good CRM \n[cervical range of motion]. There’s no pain to palpate the spinous \nprocesses of the cervical spine. \nShe states she was putting boxes onto a pallet. Usually the boxes are \nbanded together she states. Each load consisted of 25 boxes. She was \nplacing each load onto a pallet and she was to stack the pallet 7 high \nwhich means 7 boxes of 25 box load high which was above the level of \nher head. She performed this task many times over her shift and she \nstates she noticed around 4:10 AM that she had pain in her left \nforearm. This was more of a repetitive motion type injury, not a sudden \nsort of pain or one particular load or movement that caused it. \n \nIMPRESSION: \nThis appears to be musculoligamentous- brachioradialis strain. \nI’m going to review her progress and plan of care with the nurse case \nmanager. I have advised that Candace continue range of motion \nexercises, heat and over-the-counter Aleve or ibuprofen. I’m going to \nrecheck her back in one week or sooner if needed. Continue current job \nrecommendations which are regular duty allowed with job modification \nto prevent further injury as reviewed with the nurse case manager \npreviously and the EHS coordinator at the plant. I completed a work \nstatus to the report indicating my plan of care. \n \n The claimant returned again to Dr. Johnson’s clinic on 8 August 2023. He noted \nthat, “Her treatment has consisted of conservative measures with range of motion, heat and \nover-the-counter ibuprofen. She has good grip strength. She has no cervical complaints. She \nhas not responded to conservative treatment and she continues to complain of pain. This \n\nC. FLETCHER- H304356 \n10 \n \nappears to be a soft tissue injury. I did not observe fasciculations.” Dr. Johson released the \nclaimant that day and referred her to an orthopedist for review. \n Also on 8 August 2023, the claimant returned to Arkansas Pain Centers. That note \nprovides, in part: \nInterval history- no change in medical or surgical history reported.  \nRates pain at 7/10, site and nature unchanged, reports relief on the \ncurrent regimen with improvements in ADLs and QOL. No new \nweakness or numbness was reported. \n. . .  \n \nMs. Fletcher is reporting pain today as high as 10/10 which stays at a \n6/10 lasting 2 hours. (-) Constipation. \n \nPatient states she was informed at her last visit to not continue PT \nuntil she received her cervical MRI. Reviewed normal MRI today \n12.08.22 and informed she would begin PT again. Asking for printout of \nher MRI in order to get a second opinion. (Previous visit) States she \ncompleted PT. \n \nToday c/o lumbar and LUE pain. States a month ago she injur[ed] it at \nwork and is seeing a workman’s comp MD. States X-ray was done and is \ngoing to be scheduled with ortho. States she will have imaging faxed to \nclinic. \n \nId. The assessment from that visit did not include any mention of her left arm. \n \n The claimant then saw Dr. Michael Hussey on 30 August 2023. The note from that \nvisit provides, in part: \nSUBJECTIVE: \nCandace Fletcher is a 39-year-old female who presents to discuss \nconcerns about their elbow that began on 06/20/2023. She is a very \npleasant left-hand-dominant lady here for evaluation of scalp (sic) arm \npain that began when working her job loading pallets. She said pain \nradiates from her elbow up into the arm and down the forearm. Pain \nlocated lateral increased rotation and lifting. She states she saw a \ncompany doctor who prescribed NSAIDs and gave home exercises and \nMedrol Dosepak. She also saw an orthopedic fellow Dr. She denies prior \ntrauma or surgery on the arm. \n. . . \n \nSHOULDER EXAM: \nThere is no obvious trauma or deformity noted. Nontender over the AC \njoint, subacromial space, bicipital groove, glenohumeral joint line. The \n\nC. FLETCHER- H304356 \n11 \n \nshoulder has a full active range of motion without crepitus or pain. \nMotor strength of the shoulder is 5/5 to rotator cuff and deltoid muscle \ntesting. There is no major atrophy noted of the shoulder girdle \nmusculature. The patient has a negative Neer, Hawkins, Jove, Lag \nsign, Horn blower, apprehension, and Yergason’s test. \n \nELBOW EXAM: \nNo obvious sign of trauma or deformity and no skin lesions present. \nTender to palpation over the lateral epicondyle and extensor muscle \norigin. Nontender to palpation over the medial epicondyle, distal biceps \ntendon, cubital tunnel, triceps tendon attachment, olecranon process, \nand elbow joint line. There is full active range of motion of the elbow \nwith no crepitus. 5/5 muscle strength testing to elbow flexion and \nextension, pronation and supination. Motor strength testing is 4/5 to \nwrist extension limited. 5/5 wrist flexion strength. Positive tennis elbow \nstress test to resisted wrist extension with the elbow in full extension. \nNegative Tinel’s test at the cubital tunnel. The elbow is stable to varus \nand valgus stress. Full active range of motion of the wrist and hand \nwithout pain or crepitus. Sensation is intact to light touch to all nerve \ndistributions. Brisk cap refill to all digits. \n \n3 view X-ray of the left elbow: There is no obvious sign of trauma, \ndeformity, or lesions around the elbow joint. The ulnohumeral and \nradiocapitellar joints are well aligned. There are no major signs of \nosteoarthritis. \n \nASSESSMENT/PLAN \n39-year-old female sustained occupational related injury on 6/23/2023 \nwith left elbow pain and dysfunction with differential diagnosis: \n1.  Extensor tendon strain/lateral epicondylitis \n \n1.  Recommend conservative treatment at the present time to include: \n2.  NSAID prescription given. \n3.  Handout given on tennis elbow with home exercises given to be \nperformed daily. \n4.  Physical therapy prescription given for elbow/forearm strengthening, \nstretching, and modalities as indicated. \n5.  Recommended activity modification. \n6.  Forearm counterforce brace and wrist splint immobilizer ordered for \npatient, with instructions given on use. \n7.  Follow-up in 6 weeks for reevaluation. \n \n1.  Pain of left elbow joint... \n2.  Overweight... \n3.  Lateral epicondylitis... \n \n[Cl. Ex. No 1.] She was given a note authorizing a return to work that day with restrictions. \n\nC. FLETCHER- H304356 \n12 \n \n The claimant then saw Dr. Hussey again on 17 January 2024. The note from that \nvisit provides, in part: \nSUBJECTIVE: \nCandace Fletcher is a 39-year-old female. Since their last visit, patient \nreports feeling same. She is a very pleasant lady who returns back to \nclinic this time for nonoccupation-related problems but still with left \nelbow and forearm pain radiating. She states her work comp claim was \ndenied and she is no longer working at her previous job. She states \nsince that time her pain improved and she got a job at Amazon doing \ntemporary seasonal work and did a lot of lifting and increased pain in \nthe arm she states now more located anterior volar forearm areas \nincreased with lifting. She has pain in the day as well as at night \naffecting her sleep. She states she has taken a leave of absence from \nwork due to severe pain in the arm. She denies prior trauma or surgery \non the arm. \n. . . \n \nELBOW EXAM: \nThere is no obvious sign of trauma or deformity to the arm. Tender to \npalpation over the antecubital fossa and radial tuberosity and lateral \ncondyle. Nontender to palpation over the medial epicondyle, lateral \nepicondyle, cubital tunnel, triceps tendon attachment, olecranon \nprocess, and elbow joint line. There is full active range of motion of the \nelbow with no crepitus. Motor strength testing is 4/5 to elbow flexion \nand 3/5 to forearm supination. 5/5 triceps and forearm pronation \nstrength testing. 5/5 wrist extension/flexion strength. Positive Yergason \nand Speed test. Negative tennis elbow and golfer’s elbow stress test. \nNegative Tinel’s test at the cubital tunnel. The elbow is stable to varus \nand valgus stress. Full active range of motion of the wrist and hand \nwithout pain or crepitus. Sensation is intact to light touch to all nerve \ndistributions distally. Brisk cap refill to all digits. \n. . .  \n \n1. Biceps tendinitis \n \nId.  \n The claimant’s next encounter note was from a 5 February 2024 visit with Dr. \nButchaiah Garlapati at the Arkansas Pain Center clinic. That note includes, in part: \nSUBJECTIVE: \n. . .  \nStates she was injured left arm at work. [sic] She has been seeing Ortho \nArkansas. Reports she tore the tendons in her arm. She wears an arm \nbrace today under her elbow. She reports she has another brace she \n\nC. FLETCHER- H304356 \n13 \n \nwears at night. She states she will wear this brace until March 15\nth\n, \n2024 when she sees ortho MD again. \n. . . \n \nDIAGNOSIS/MEDICAL DECISION MAKING: \nM54.2 Cervicalgia \nM54.6 Pain in thoracic spine \nM54.16 Radiculopathy, lumbar spine \nM25.512 Pain in left shoulder \nG89.4 Chronic pain syndrome \nZ79.899 Other long term (current) drug therapy \nZ79.891 Long term (current) use of opiate analgesic \nM62.830 Muscle spasm of back \nM25.511  Pain in right shoulder \nM54.50 Low back pain, unspecified \nM96.1 Postlaminectomy syndrome, not elsewhere classified \nM79.18 Myalgia, other site \nM51.36 Other intervertebral disc degeneration, lumbar region \nM47.896 Other spondylosis, lumbar region \nM25.551 Pain in right hip \n \n Then, on 18 September 2024, the claimant saw Dr. Mark Tait at a UAMS orthopedic \nclinic for a visit identified in the provider’s note as an independent medical evaluation. That \nnote included: \nREASON FOR VISIT: Elbow pain \n \nDOCUMENT REVIEW: \n06/08/2023: Arkansas Pain Center progress report patient unable to \nattend therapy secondary to change in employment. Patient was \nscheduled 2 times a week for therapy and neuromuscular reeducation \nand gait training. Patient was given a home exercise plan. Medications \nincluding hydrocodone, naloxone, and gabapentin. She is also on Soma. \nThey recommended a drug holiday. \n10/09/2023: Arkansas Pain Center progress report. Pain medication \ncontinued as well as therapy. Medications include Voltaren at this time. \nHe mentions include Norco. Recommeded referral for neurodiagnostic \ntesting. \n. . .  \n \nCHIEF COMPLAINT: Elbow Pain, Left \n \nHISTORY OF PRESENT ILLNESS: \nCandace Latoya Fletcher is a 40 y.o. female patient. This is a new \npatient today who sustained a work injury on 06/26/2023. She worked \nat International Paper at the time of her injury. She complained of left \narm pain at presentation her initial visit was with telemedicine and she \n\nC. FLETCHER- H304356 \n14 \n \nwas given range-of-motion exercises. She also has tried a Medrol \nDosepak initially. She was also given a muscle relaxer. She injured this \nwhile stacking large boxes of paper. She states that the pain has \nimproved some but she has persistent pain diffusely throughout the \nelbow. She states that this can hurt at any time and is not necessarily \nassociated with activity but does seem to get worse with activity. \n. . .  \n \nExamination today shows diffuse tenderness throughout the \nantecubital fossa of the elbow. There is no significant swelling noted. No \nevidence of atrophy. I am unable to solicit point tenderness at the area \nof the lateral epicondyle. She has minimal tenderness with resisted \nwrist extension. She has full elbow range of motion. There is no mid arc \npain. She has no pain with tunnel flexion and extension. The biceps is \nexam[ined] today and there is a intact biceps tendon. She has good \nstrength of resisted supination. \n. . .  \n \nIMPRESSION:  \nImproved but continued left elbow pain of uncertain etiology without \nevidence of lateral epicondylitis or distal biceps tendinitis today. \n \nDISCUSSION/PLAN: \nI discussed with the patient at length in regards to her left elbow. She \nhas some diffuse tenderness in the antecubital fossa not consistent with \nbiceps tendinosis or distal biceps tendinitis. She has no evidence of \ninstability of the elbow consistent with posterior lateral instability. She \nhas no instability with varus and valgus stressing. There is no signs of \nperipheral compression in the arm no significant evidence of atrophy or \nswelling throughout the arm and today her exam is inconsistent with \nlateral epicondylitis. Although she is having some continued pain she \ndoes seem to have gone through the appropriate interventions and I see \nno indication for surgical intervention. She had a previous MRI which \nshowed no evidence of injury. You could consider repeating this MRI \nbecause of the persistent pain, but the initial normal MRI is reassuring \nas it is reported as normal. I reassured the patient today that I do not \nthink she has harming the elbow by using the arm although she may \nhave some persistent pain. \n \nIME QUESTIONS: \n1.  With greater than 51% medical degree of certainty that the \npreviously diagnosed left elbow sprain versus lateral epicondylitis did \nresult from her work injury on June 26\nth\n 2023, but there is no indication \nof current lateral epicondylitis today. \n2.  I have reviewed the video and [it] does show that she is moving the \nelbow and using the arm but a left elbow sprain or lateral epicondylitis \ncould still exist with the activity shown in the video. \n3.  The patient has reached maximum medical improvement. \n4.  The patient has no permanent restrictions or impairment. \n\nC. FLETCHER- H304356 \n15 \n \n. . .  \n \nADDENDUM 1/17/25: \nSecondary to MRI findings patient was unlikely to have lateral \nepicondylitis because of negative findings on the report. This was likely \na mild elbow sprain without current evidence of residual injury. \n \n On 15 March 2024, the claimant presented to the Little Rock Family Practice Clinic \nWest, where she was seen by Dr. Harold Hedges. She complained of needing her pain \nmedication refilled. She then returned to that clinic about two weeks later. The notes from \nthat visit include: \nCHIEF COMPLAINTS:  \nBlood work for anemia and Vitamin D due to deficiency.   \nc/o LUE nerve pain- wants referral \nHISTORY OF PRESENT ILLNESS: \nL arm pain. No inciting injury. Evaluation by Orthopedist. \nRecommended evaluation by neurologist. Requesting labs to follow up \non deficiencies. \n. . .  \nPLAN: \nReferral to: Neurology \nReason: Eval and treat- Pt already had MRI with Ortho to rule out \northopedic concerns. \n \n[Resp. Ex. No 2] \nDISCUSSION \n The claimant alleges that her injury occurred by specific incident. The claimant \nmust establish four (4) factors by a preponderance of the evidence to prove a specific \nincident injury: (1) an injury occurred that arose out of and in the course of her \nemployment; (2) the injury caused internal or external harm to the body that required \nmedical services or resulted in disability or death; (3) the injury is established by medical \nevidence supported by objective findings, which are those findings which cannot come under \nthe voluntary control of the patient; and (4) the injury was caused by a specific incident and \nis identifiable by time and place of occurrence. Mikel v. Engineered Specialty Plastics, 56 \nArk. App. 126, 938 S.W.2d 876 (1997). If a claimant fails to establish by a preponderance of \n\nC. FLETCHER- H304356 \n16 \n \nthe evidence any of the above elements, compensation must be denied. Id. As explained \nbelow, she has failed to meet this burden. \n The claimant has a history of being treated for pain across multiple body parts \nbefore the alleged work incident related to this claim. She was already an established \nchronic pain patient whose records from just before the alleged work incident noted that \nshe had “requested an increase in pain medication several times” and was “not a good \ncandidate for an increase in medication.” A “drug holiday” was suggested for her instead. \n A couple of weeks following that visit, she reported the alleged injury at issue in this \nclaim. Notably, she testified that she heard and felt a sudden “pop” in her left arm while \nworking and knew that was when she hurt her arm. Her report of a “pop,” which could be \nclinically relevant for diagnosing an injury is, however, not mentioned in any of the medical \nrecords relating to her alleged injury. \n A month after the alleged injury, Dr. Johnson saw the claimant and performed an \nexam that suggested a possible muscle strain. He ordered over-the-counter Aleve and \ndeclined to take her off work. About two weeks later, the claimant returned to Dr. \nJohnson’s clinic after negative X-ray studies. He again performed an exam with essentially \nno relevant findings. He noted, however, that “This was more of a repetitive motion type \ninjury, not a sudden onset of pain or one particular load or movement that caused it.” Dr. \nJohnson recommended that she continue over-the-counter medication for what appeared to \nhave possibly been a strained muscle. When the claimant returned again the following \nweek still complaining of ongoing pain and additional pain in another part of her arm, he \nreleased her to an orthopedist’s care, noting, “she continues to complain of pain. This \nappears to be a soft tissue injury. I did not observe fasciculations.” \n Interestingly, on the same day that Dr. Johnson released her and documented that \nshe “had no cervical complaints,” she presented for a follow-up visit at the pain clinic where \n\nC. FLETCHER- H304356 \n17 \n \nher complaints included ongoing thoracic and cervical pain. (It also appears that she had \nrecently refused physical therapy due to concerns with her cervical spine. She was assured \nthat the MRI had no findings; but it was documented that she wanted to look for a second \nopinion regarding the same.) As the respondents’ counsel pointed out, Dr. Johnson’s initial \nvisit note indicates that she reported being in good health with no current medications. \nInconsistent with that note, she seemed to testify, however, that she either told Dr. \nJohnson that she was already seeing a pain doctor for many complaints not related to her \narm and that she was taking hydrocodone and gabapentin OR that he would have known \nabout her medication anyway because he “took a physical. He also test[ed] me for diabetes \nand all—and urine specimen. So and he also knew what medications I was on.” It is \npossible that the claimant was misattributing to Dr. Johnson the urine drug screens \nperformed by the pain clinic to test for any substances besides what they knew to be \nprescribed; but there is nothing in the medical record to suggest that Dr. Johnson ordered a \ndrug screen, tested her for diabetes, or had any information about her relevant medical \nhistory or then-current drug regimen besides what she chose to report or not report to him \nthat day in the clinic. To the extent that she reported to Dr. Johnson that she was in good \noverall health, her pain clinic treatment records clearly contradict that assertion. To the \nextent that she claims that she did report those conditions, the record clearly reflects \notherwise. Either way, her credibility in this regard is wanting. \n Also, without any medical evidence supporting her assertion, the claimant testified \nthat she was physically unable to perform her work duties (or what had been her work \nduties) between the date of her termination and eventually starting a new job months later. \nThe record, however, does not show that she was taken off work at any time during her \ncourse of treatment; and she made no effort to establish any actual change in her physical \ncondition at the time of her termination to support a finding that she was, indeed, unable to \n\nC. FLETCHER- H304356 \n18 \n \nwork around that time. Lastly, she testified incredulously that the pain in her left arm was \nso bad at times that it jumped from her left arm over to her right arm. Taking these \nstatements together with her demeanor on the stand, I again do not find her to be a credible \nwitness. \n More than two months after her alleged injury, on 30 August 2023, the claimant saw \nDr. Michael Hussey. She complained of pain and tenderness. His exam suggested that the \nclaimant might have tennis elbow. She was, again, not taken off work. When the claimant \nreturned to Dr. Hussey’s clinic on 1 January 2024, the exam from that visit revealed a \nnegative test for possible tennis elbow, but possible bicep tendonitis.  \n When the claimant eventually saw Dr. Mark Tait on 18 September 2024, his \nimpression was “continued left elbow pain of uncertain etiology without evidence of lateral \nepicondylitis or distal biceps tendinitis today.” In response to questions apparently posed to \nhim as a reviewer on the case, Dr. Tait noted, “greater than 51% medical degree of certainty \nthat the previously diagnosed left elbow sprain versus lateral epicondylitis did result from \nher work injury on June 26\nth\n 2023, but there is no indication of current lateral epicondylitis \ntoday.” Basically, he acknowledged that she had ongoing subjective complaints of pain in \nher left elbow; but he found no objective support for a diagnosis beyond that. \n And it is on those subjective claims of pain, unsupported by credible objective \nfindings, that this claim turns and fails. The record shows that as her reports of pain \ncontinued, the doctors suggested different possible diagnoses or causes, but those varying \ndifferential diagnoses did not prove out. All of the imaging reports that were ordered \nreturned with negative or unremarkable findings. And Dr. Johnson specifically noted that \nhe did not observe any fasciculations during his examinations. Additionally, he at one point \nsurmised that whatever could be causing her pain could be of a chronic nature, but “not a \nsudden onset.” \n\nC. FLETCHER- H304356 \n19 \n \n The claim must fail for the lack of objective findings in support of a compensable \ninjury. Importantly, this claim can be distinguished from Nucor Yamato Steel Co. v. \nShelton, 2025 Ark. App. 249, 713 S.W.3d 494, in that Nucor (reaffirming its precedent in \nMelius v. Chapel Ridge Nursing Ctr., LLC, 2021 Ark. App. 61, 618 S.W.3d 410) supports the \nproposition that a compensable injury may exist where a physician prescribed a muscle \nrelaxer for reported pain and unobserved spasms. That is, in the absence of other clear \nobjective findings, a provider prescribing medication for muscle spasms, physical therapy, \nand pain management can be sufficient to establish an objective finding. Here, the records \ndo not show a level of clinical decision making in line with that in the Nucor case. Instead, \nthe claimant simply reported pain that was attributed, inconsistently, to either a mild \nmuscle strain or a ligamentous condition usually attributed to overuse. And the records of \nthe treating physicians\n3\n show only recommendations for over-the-counter medications for \nthe claimant’s otherwise unsupported subjective complaints of pain. \n In short, because the medical records in evidence are devoid of objective findings of \nan injury, the claimant cannot, and has not, proven by a preponderance of the evidence that \nshe sustained a compensable injury. Her other claims for benefits are therefore moot and \nare not being addressed in this Opinion.  \nAttorney’s Fee \n Because the claimant has failed to prove by a preponderance of the evidence that she \nsustained a compensable injury, her claim for an attorney’s fee must also fail. \n \n \n \n3\n I note that the claimant stated that she was prescribed a steroid by one doctor (and that \nanother doctor told her to stop taking the steroids) and that Dr. Tait’s report shows that she \nwas given a muscle relaxer at some point. The records admitted into evidence, however, do \nnot reflect actual orders or prescriptions for those medications. \n\nC. FLETCHER- H304356 \n20 \n \nCONCLUSION \n The claimant has failed to prove by a preponderance of the evidence that she \nsuffered a compensable injury by specific incident to her left arm. Accordingly, this claim \nfor initial benefits is DENIED and DISMISSED. \nSO ORDERED. \n________________________________ \n       JAYO. HOWE \n       ADMINISTRATIVE LAW JUDGE","preview":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION AWCC FILE No H304356 CANDACE FLETCHER, EMPLOYEE CLAIMANT INTERNATIONAL PAPER COMPANY, EMPLOYER RESPONDENT OLD REPUBLIC INSURANCE COMPANY, CARRIER RESPONDENT SEDGWICK CLAIMS MANAGEMENT, THIRD PARTY ADMINISTRATOR RESPONDENT OPINION FILED 10 NOVEMBER 2025 Heard before A...","fetched_at":"2026-05-19T22:34:22.939Z","links":{"html":"/opinions/alj-H304356-2025-11-10","pdf":"https://www.labor.arkansas.gov/wp-content/uploads/FLETCHER_CANDACE_H304346_20251110.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/"}}