{"id":"alj-H307207-2025-03-14","awcc_number":"H307207","decision_date":"2025-03-14","opinion_type":"alj","claimant_name":"Randy Munns","employer_name":"City Of North Little Rock","title":"MUNNS VS. CITY OF NORTH LITTLE ROCK AWCC# H307207 March 14, 2025","outcome":"granted","outcome_keywords":["granted:6"],"injury_keywords":["lumbar","back","thoracic","knee"],"pdf_url":"https://www.labor.arkansas.gov/wp-content/uploads/Munns_Randy_H307207_20250314.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/","filename":"Munns_Randy_H307207_20250314.pdf","text_length":37385,"full_text":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION \nWCC NO. H307207 \n \n \nRANDY D. MUNNS, EMPLOYEE CLAIMANT \n \nCITY OF NORTH LITTLE ROCK, \n SELF-INSURED EMPLOYER RESPONDENT \n \nARK. MUN. LEAGUE, \n THIRD-PARTY ADM’R RESPONDENT \n \n \nOPINION FILED MARCH 14, 2025 \n \nHearing before Chief Administrative Law Judge O. Milton Fine II on January 23, 2025, in \nLittle Rock, Pulaski County, Arkansas. \n \nClaimant represented by Mr. Neal L. Hart, Attorney at Law, Little Rock, Arkansas. \n \nRespondents represented by Ms. Mary K. Edwards, Attorney at Law, North Little Rock, \nArkansas. \n \n \nSTATEMENT OF THE CASE \n \n On January  23,  2025,  the  above-captioned  claim  was  heard  in Little  Rock, \nArkansas.  A prehearing conference took place on November 4, 2024.  The Prehearing \nOrder  entered  on  that  date  pursuant  to  the  conference  was  admitted  without  objection \nas  Commission  Exhibit  1.    At  the  hearing,  the  parties  confirmed  that  the  stipulations, \nissues, and respective contentions, as amended, were properly set forth in the order. \nStipulations \n At  the  hearing,  the  parties  discussed  the  stipulations set  forth  in  Commission \nExhibit  1.   With  an amendment  of  Stipulation  No.  3,  they  are the  following,  which  I \naccept: \n\nMUNNS – H307207 \n \n2 \n \n1. The Arkansas Workers’ Compensation Commission has jurisdiction over \nthis claim. \n2. The  employee/self-insured  employer/third-party  administrator  relationship \nexisted  among  the  parties  on  April  5,  2023,  when  Claimant  sustained  a \ncompensable  injury  to  his  lumbar  spine.    Respondents  also  paid  for \nmedical  treatment  in  the  form  of  a  peroneal  nerve  release  related  to  the \nwork injury. \n3. Respondents  accepted  this  claim  and  have  paid  medical  and  indemnity \nbenefits thereon, including permanent partial disability benefits pursuant to \nan impairment rating of twelve percent (12%) to the body as a whole that \nwas assigned by Dr. Justin Seale. \n4. Claimant’s  average  weekly  wage  of  $1,006.20  entitles  him  to \ncompensation rates of $671.00/$503.00. \nIssues \n At  the  hearing,  the parties  discussed the  issues set forth  in  Commission  Exhibit \n1.  The following were litigated: \n1. Whether   Claimant   is   entitled   to   additional   medical   treatment   of   his \nstipulated  compensable  injury  in the  form  of implantation  of  a  spinal  cord \nstimulator and related treatment of Dr. Jarna Shah. \n2. Whether   Claimant   is   entitled   to   additional   temporary   total   disability \nbenefits from the date last paid to a date yet to be determined. \n3. Whether Claimant is entitled to a controverted attorney’s fee. \n\nMUNNS – H307207 \n \n3 \n \n All other issues have been reserved. \nContentions \n The respective contentions of the parties, following amendments at the hearing, \nread as follows: \n Claimant: \n1. Claimant  contends  that  he  suffered  a  compensable  injury  to  his  lumbar \nspine  and  left  lower  extremity  while  working  for  Respondents  on  April  5, \n2023.    Surgeries  were  subsequently  performed  by  Dr.  Justin  Seale \n(lumbar fusion) and by Dr. Eric Gordon (peroneal nerve release). \n2. By  Commission  order  dated  July  3,  2024, Claimant  was  granted  a \nstatutory  change  of  physician  to  Dr.  Jarna  Shah.    She believes  that \nClaimant  suffers  from,  among  other  things,  post-laminectomy  syndrome, \nand  has  recommended  implantation  of  a  spinal  cord  stimulator.    This \nconstitutes  reasonable,  necessary,  and  related  medical  care  under  the \nAct; and Respondents should be required to provide it. \n3. Additional medical care designed to improve Claimant’s physical condition \nhas been recommended; and Claimant’s healing period has, therefore, not \nended.   As  a  consequence, he  is  entitled  to receive  additional  temporary \ntotal disability benefits from the date last paid, in February 2024, through a \ndate  yet  to  be  determined.  Throughout  that  period,  Claimant  remained \nincapable   of   working.      After   Claimant   last   received   temporary   total \ndisability benefits, he was returned to modified-duty employment.  He was \n\nMUNNS – H307207 \n \n4 \n \nfired  on  May  15,  2024,  because  Respondent  employer  could  no  longer \naccommodate his work restrictions. \n Respondents: \n1. Respondents contend that Claimant is not entitled to additional temporary \ntotal disability benefits.  He was placed at maximum medical improvement \non April 24, 2024, by Dr. Seale.  In addition, Dr. Seale assigned Claimant \na  twelve  percent  (12%)  impairment  rating.   Respondents  have  accepted \nand  are  currently  paying  this  rating.   Claimant  has  not  re-entered  his \nhealing  period  for  his  back;  therefore,  he  is  not  entitled  to  any  temporary \ntotal disability benefits past the date of April 24, 2024. \n2. Respondents further   contend   that   the   additional   medical   treatment \nrecommended by Dr. Shah is not reasonable, necessary, or related to his \ncompensable back injury. \nFINDINGS OF FACT AND CONCLUSIONS OF LAW \n After  reviewing  the  record  as  a  whole,  including  medical  reports,  deposition \ntranscripts, documents, and other matters properly before the Commission, and having \nhad  an  opportunity  to  hear  the  testimony  of  Claimant  and  to  observe  his demeanor,  I \nhereby  make  the  following  findings  of  fact  and  conclusions  of  law  in  accordance  with \nArk. Code Ann. § 11-9-704 (Repl. 2012): \n1. The Arkansas Workers’ Compensation Commission has jurisdiction over \nthis claim. \n2. The stipulations set forth above are reasonable and are hereby accepted. \n\nMUNNS – H307207 \n \n5 \n \n3. Claimant  has  proven  by  a  preponderance  of  the  evidence  that  he  is \nentitled to additional treatment of his stipulated compensable lumbar spine \ninjury in the form of a spinal cord stimulator and related treatment that has \nbeen recommended by Dr. Jarna Shah. \n4. Claimant  has  proven  by  a  preponderance  of  the  evidence  that  he  is \nentitled  to  additional  temporary  total  disability  benefits  for February  7, \n2024. \n5. Claimant has proven his entitlement to a controverted attorney’s fee on \nthe indemnity benefits awarded herein, pursuant to Ark. Code Ann. § 11-9-\n715 (Repl. 2012). \nADJUDICATION \nSummary of Evidence \n Claimant was the sole hearing witness. \n In  addition  to  the Prehearing Order  discussed  above,  the  exhibits  admitted  into \nevidence in this case were Claimant’s Exhibit 1, a compilation of his medical  records, \nconsisting  of  two index  pages  and 119 pages  thereafter;  Respondents’ Exhibit  1, \nanother compilation of Claimant’s medical records, consisting of two index  pages and \n19 numbered  pages  thereafter; and Respondents’  Exhibit  2, non-medical  records, \nconsisting of 37 numbered pages. \nA. Additional Treatment \n Claimant  has  asked  that  the  Commission to  find  that  he  is  entitled  to  additional \nmedical   treatment of   his   stipulated   compensable   lumbar   spine   injury—with   that \n\nMUNNS – H307207 \n \n6 \n \ntreatment consisting of the proposed procedure outlined by Dr. Shah of the University of \nArkansas for Medical Sciences (“UAMS”) that is contained in Claimant’s Exhibit 1.  The \nJuly 24, 2024, report of Claimant’s visit to her reads in pertinent part: \nImaging: \n3/2024 MRI L Spine: \nPostoperative  change L5-S1.    No  evidence  for  neural  impingement.   Soft \ntissue left L5-S1 neural foramen without displacement of neural structures, \nthis is likely granulation tissue. \n \n5/2023 MRI L Spine \nL5-S1  severe  ligamentum  flavum  thickening,  narrowing  the  left  greater \nthan  right  lateral  recess.    Potential  exists  for  symptomatic  impingement \nupon the left greater than right descending S1 nerve roots. \n \n12/2023:    EMG  consistent  with  left  peroneal  nerve  entrapment    causing \nneuropraxia. \n \nA/P: \nBriefly, Randall D. Munns is a 61 y.o. male with a past medical history of \nback  pain  radiating to left  lower  extremity.  Pain  first  started  4/4/23  when \npatient  was  on  duty  at  work  and  a  wrench  snapped,  causing  him  to  fall \nbackwards  onto  other  tools.  S/p   L5-S1 TLIF/PSIF  9/2023,  and  2024 \nperoneal   nerve   release   with   continued   neuropathic   pain   of   LLE.  \nConsistent  with  post  laminectomy  syndrome  of  the  lumbar  spine  with  left \nlower  extremity  pain.  Has  taken  gabapentin  30mg  TID,  ibuprofen,  OTC \nmedications, neuropathics, muscle relaxants, tramadol.  Rated 10/10 pain. \nPain is severely limiting quality of life.  Patient does not smoke, does not \ntake anticoagulants. \n \nI   believe   that   the   patient   has   failed   all   other   conservative \nmanagement  including  the  following:    injections,  physical  therapy, \nand medications.  Because he has failed these past therapies, patient \ncould benefit from neuromodulation for postlaminectomy pain of the \nlumbar  spine  and  is  a  candidate  for  spinal  cord  stimulation  due  to \npost laminectomy and chronic pain syndrome.  The following research \ntrials have demonstrated the benefit of SCS in this condition:  Deer et al[.], \nNeuromodulation,  2018;  North  et  al.  2011  Neuromodulation;  Kapural  et \nal[.] 2015.  We will move forward with a trial.  We discussed the risks and \nbenefits  of  this  therapy  including  the  probabilities  of  successful  treatment \nof h[is] pain with current data available in the literature. \n\nMUNNS – H307207 \n \n7 \n \n \n(Emphasis added) \n Respondents  denied  the  recommended  treatment,  which  led  to  the  following \nletter being sent to them: \n8/8/2024 \n \nRe:  RANDALL D. MUNNS \nDOB:  6/26/1963 \n \nDear Arkansas Municipal League Worker[’]s Comp. \n \nI  am  writing on  behalf  of  Dr.  Jarna  Shah and  her  patient,  Randall  Munns \nDOB   6/26/1963   in   response   to   your   denial   of   a Thoracic   MRI, \nNeuropsychological  evaluation,  and  a Spinal Cord Stimulator Trial  CPT \n63650 for the diagnosis of Post laminectomy Syndrome of lumbar region, \nICD 10:  M 96.1, Causalgia of left lower extremity, ICD G57.72, and Low \nback  pain  ICD M54.50.  Your  denial  states  that  the  request  cannot  be \napproved because Mr. Munn‘s work injury is to his lumbar spine and not \nhis thoracic spine. \n \nPlease  consider  this  an  urgent  reconsideration  request.  This  letter \nprovides information about the patient’s medical history and diagnosis and \na statement summarizing the treatment rational[e]. \n \nPatient’s History and Diagnosis \nRANDALL  D.  MUNNS is  a  61-year-old  male  with  past  medical  history  of \nback  pain  radiating  to  the  left  lower  extremity  due  to  an  injury  sustained \nwhile  on  duty  at  work.  He  had  an  L5-S1  TLIF  and  PSIF  on  9/22/2023 \nfollowed  by  a  peroneal  nerve  release  in  2024.  He  has  continued \nneuropathic  pain  of  his  left  lower  extremity.  The  pain  is  described  as \nburning with radiation, rated as 7/10.  Symptoms have been present since \n2023  and  the  initial  inciting  event  was  a  fall.  Symptoms  are  worse  at \nnight.  Alleviating factors identifiable by the patient are none.  Aggravating \nfactors  identifiable  by  the  patient are recumbency,  sitting,  and  walking.  \nPatient  reports  recent  physical  therapy  and/or  home  exercise  program, \nwith no improvement. \n \nThe pain that Mr. Munns experiences is consistent with post laminectomy \nsyndrome of the lumbar spine with left lower extremity pain.  As shown in \nthe  research  articles  cited  below,  spinal  cord  stimulation  is  a  well-\n\nMUNNS – H307207 \n \n8 \n \nestablished   treatment   for   post-laminectomy   syndrome   that   is \nrefractory to conservative measures. \n \nFurthermore,   your   denial   letter   states   that   the   thoracic   MRI   and \nNeuropsychological  evaluation are denied  as  well.  Current  published \nguidelines recommend advanced imaging, specifically, thoracic MRI, prior \nto  the  stimulator  lead  to  placement  as  the  leads  are  placed  above  the \nlumbar   laminectomy   levels.  Preoperative   imaging   may   affect   the \napproach  and  minimize  the  risk  of  complications.  Without  advanced \nimaging  to  inform  surgical  planning,  unnecessary  risk  may  be  placed  on \nthe patient. \n \nNeuropsychological evaluations are necessary as part of the standards for \nidentifying  appropriate  patients  for  this  therapy.  To  improve  treatment \noutcomes of SCS, the evaluations help determine patient expectations as \nwell  as  emotional  and  behavioral  factors  that  may  be  affecting  the \npatient’s perception of pain.  There are specific emotional issues, ways of \nthinking, and behaviors that can specifically impede pain therapy.  These \ninclude depression, unrealistic pain expectations, the severity and location \nof  the  pain,  and  how  long  the  patient  has  suffered  from  the  condition.  \nOther elements, such as a history of substance abuse, trauma, or a lack of \na  social  support  system  can  also  have  an  impact.  As  confirmed  in  the \nresearch  article cited,  the  higher  the  anxiety  or  distress,  the  lower  the \nchance of improvement from spinal cord stimulation therapy. \n \nInterventions \nMr.  Munns  has  had  multiple  lumbar  epidural  steroid  injections  which \nhelped  mild  to  moderately  for  a  few  weeks.    Repeat  lumbar  epidural \nsteroid injections provided zero relief. \n \nConservative Treatment \nMr. Munns has tried and failed physical therapy, medications in the form of \nGabapentin, Tramadol, Ibuprofen, Naprosyn, Cyclobenzaprine, \nTizandidine, Hydrocodone, Acetaminiphen, heat, ice, and rest. \n \nImaging \nImaging reports are attached for your review. \n \nIn summary: \n3/2024 MRI L Spine \nPostoperative  change L5-S1.    No  evidence  for  neural  impingement.   Soft \ntissue left L5-S1 neural foramen without displacement of neural structures, \nthis is likely granulation tissue. \n\nMUNNS – H307207 \n \n9 \n \n \n5/2023 MRI L Spine \nL5-S1  severe  ligamentum  flavum  thickening,  narrowing  the  left  greater \nthan  right  lateral  recess.    Potential  exists  for  symptomatic  impingement \nupon the left greater than the right descending S1 nerve roots. \n \n12/2023:    EMG  consistent  with  left  peroneal  nerve  entrapment  causing \nneuropraxia. \n \nThe  following  articles  support  Spinal  Cord  Stimulation  as  an  effective \ntherapy  for  post  laminectomy  syndrome  as  well  as  the  necessity  of  a \nneuropsychological screening and a pre-procedural thoracic MRI. \n \n. . . \n \nTherefore,  it  is  the  provider’s  medical  opinion  that  a \nneuropsychological   screening,   thoracic   MRI,   and   spinal   cord \nstimulator trial is medically necessary as it could lead to a significant \nimprovement  in  his  functionality  and  quality  of  life.  Please  do  not \nhesitate to contact me if additional information is needed to approve CPT \n63650,  Spinal  Cord  Stimulator  Trial  preceded  by  a  neuropsychological \nscreening and Thoracic MRI. \n \nSincerely, \n \nVickie Carlton, RN \nInterventional Pain Prior Authorizations \nUniversity of Arkansas for Medical Sciences \n \n(Emphasis added) \n Claimant’s  counsel  wrote  Dr.  Shah  on  December  6,  2024,  asking  her  the \nfollowing three questions: \n(1) Is the additional medical treatment you’ve recommended, including \nthe  spinal  cord  stimulator,  designed  to  improve  Munns’  current \nphysical condition? \n \n(2) Would it be reasonable to place Munns in an “off work” capacity, at \nleast  until  such  time  as  the  spinal  cord  stimulator  you’ve \nrecommended is authorized and implanted? \n \n\nMUNNS – H307207 \n \n10 \n \n(3) Have  your  answers  to  the  above  questions  been  stated  within  a \nreasonable degree of medical certainty? \nShah answered “Yes” to all three questions. \n \n In  his hearing testimony,  Claimant  stated  that he  is  61  years  old  and  has  a \ngraduate equivalency degree.  He went to work for Respondent City of North Little Rock \non  July  15,  2019.    When  asked  to  recount  how  his  injury  occurred  on  April  25,  2023, \nClaimant stated: \nI was working on a backhoe that had—he had run over a tree and busted \nthe  fuel  lines  going  to  the  fuel  injector,  and  I  was  replacing  it.    And  I \nneeded a short wrench and I didn’t have one, and I was trying to bend a \nwrench.  So I went in the shop, and the shop’s not much bigger than this \ndown here at the soccer [sic], and they had all the equipment for it.  They \nhad reel mowers, John Deere gators and everything that they use for it in \nthe  shop, and  I  was  trying  to  bend  a—a  wrench,  like  I  said,  to  tighten up \nthe line, the fuel line.  And I jumped up on it and I was pushing down on it \nand it snapped and, when it did, I spun around and landed on top of a reel \nmower,  landed  on  my  back  and  my  leg  on  top  of  a  reel  mower,  and  I \nknocked the breath out of me and then hurt bad. \n \n Afterward,  Claimant  felt  pain  in  his  lower  back  and  left  leg.    Respondents  sent \nhim to Concentra Clinic the next day.  Initially, he underwent x-rays and was prescribed \nphysical  therapy  and  medication.    After  continuing  to  treat  a  Concentra,  he  eventually \nunderwent a lumbar MRI.  Thereafter, he was referred to OrthoArkansas.  At that time, \nhe  was  still  experiencing  back  and  leg  pain.    At  first,  he  was  given  more  physical \ntherapy along   with   two   epidural   steroid   injections—on   August   4   and   16,   2023, \nrespectively.  Per Claimant, the first helped “somewhat,” while the second provided no \nrelief. \n Thereafter,  on  September  22,  2023,  Dr.  Jared  Seale  operated  on  Claimant, \nperforming the following procedures: \n\nMUNNS – H307207 \n \n11 \n \n(1) Minimally   invasive   decompression   facetectomy   and   laminotomy   with \nthorough foraminotomy, left, L5-S1 \n(2) Minimally  invasive  transforaminal  lumbar  interbody  fusion,  left,  with  right \nfacet/posterior fusion, L5-S1 \n(3) Minimally invasive instrumentation, segmental, L5-S1 posterior \n(4) Insertion of machined PEEK interbody spacer, left, L5-S1 \n(5) Aspiration of bone marrow, left iliac wing \n(6) Placement of morselized autograft from decompression \n(7) Use of computer navigation, application of percutaneous instrumentation \nThe pre and post-operative diagnoses that Seale assigned Claimant were: \n1.  Foraminal disc protrusion right sustained from work injury; \n2.  Degenerative spondylolisthesis spinal instability L5-S1; and \n3.  Degenerative disc disease and foraminal stenosis L5-S1. \n At  the  hearing,  Claimant  was  asked  if  the  surgery  had  helped.    He  responded, \n“[n]ot a whole lot,” explaining: \nWell, I  was—before I had the surgery, I couldn’t take a deep breath.  My \nback hurt so bad I couldn’t take a deep breath.  After my surgery, I could \ntake a deep breath, but, I mean, that’s about all the good it did for me. \n \n Per  the  medical  records, Claimant  reported  to  Seale  on  October  25,  2023,  that \nthe  surgery  did  not  result  in  any  improvement  in  his  left  lower  extremity  pain.  \nThereafter, on December 18, 2023, Claimant underwent an electrodiagnostic study that \nwas abnormal, “suggestive of a left deep peroneal neuropathy with active denervation \nseen in the left tibialis anterior and EHL muscles.”  Dr. Rodrigo Cayme, the reading \n\nMUNNS – H307207 \n \n12 \n \nradiologist, added in his report:  “An acute on chronic left L5 radiculopathy cannot be \ncompletely ruled out.”  While  Dr.  Eric  Gordon  had  Claimant  evaluated  for  a  peroneal \nnerve release, Dr. Seale warned Claimant that the procedure “may not help him.”  In his \nDecember 27, 2023, report, Seale added: \nI  also  had  a  long  discussion  with  [Claimant]  over  causation.    He  reports \nthat  he  has  never  had  the  symptoms  prior  to  his  work  injury.    Most  likely \nhe  took  a  direct  traumatic  hit  to  the  knee  during  his  fall  causing  this \nperoneal entrapment.  The patient has an objective finding consistent with \nperoneal  nerve  entrapment  causing  a  neuropraxia.    The  patient  reports \nhaving a direct insult or trauma to the left knee during his work-related fall.  \nThe  patient’s  symptoms  began  on  and  after  the  work  injury.    Patient \nreports no previous leg symptoms prior to the work injury.  Therefore it is \nwithin  a  certain  degree  of  medical  certainty  that  at  least  51%  of  the \npatient’s  current  symptoms  in  the  left  foot  resulting  from  peroneal \nentrapment are directly related to their work injury. \n \n Dr. Gordon performed the peroneal nerve release on Claimant’s left knee on \nJanuary  29,  2024.    Unfortunately,  Claimant  reported  to  Gordon  on  February  7,  2024, \nthat  his  left  lower  extremity  pain  had  not  changed.   In  his  testimony,  Claimant  related \nthat  this  is  still  true  today;  he  is  still  suffering  from  numbness  and  burning  in  his  leg.  \nAsked if the release did any good at all, Claimant replied:  “Well, it took care of the \nproblem in my heel, it seems like, but now it’s—it goes plumb to my toes.” \n On July 3, 2024, Commission granted Claimant a one-time change of physician \nfrom Dr. Gary Frankowski to Dr. Shah and scheduled an appointment for him with Shah \non  July  24, 2024.    The  report of  that  visit  is  quoted extensively  above.  Asked  how  he \nwas feeling the day of his appointment, Claimant replied:  “I was hurting.”  He  added \nthat he was having the same type of problem that he is suffering from at present:  “I \ndoesn’t go away.”  It was Claimant’s testimony that he desires the spinal cord stimulator \n\nMUNNS – H307207 \n \n13 \n \nthat Dr. Shah has recommended.  He wants it “to get rid of the pain and to get on with \n[his]  life.”   The  initial  visit  Claimant  had  with  Shah  has  also  been  the  only  one; \nRespondents have refused to cover any treatment or follow-up with her. \n The following exchange took place: \nQ. I  want  you  to  tell  the  judge,  Randy,  exactly  how  your  back  feels \nright now, your back. \n \nA. Man, it feels like a toothache.  It’s a[n] aching, burning, throbbing \nsensation,  and  it—it—it don’t get better.  I mean, I’m in—my—my \nleg hurts from—from—from my belt to my boot.  I mean, you know, \nthat’s about the easiest way to put it, you know, and it just burns.  I \nmean, man, my—my leg’s burning and throbbing right now. \n \nAsked to rate his pain on a scale of one (1) to ten (10), with a ten constituting the worst \npain  that  one  could  imagine,  Claimant  initially  responded  that  the  pain  in  his  left  leg \nrated  twelve  (12)  and his  back,  ten  (10).    Later  in  the  hearing,  he revised  the  leg  pain \nrating to ten (10).  He stated that he experiences “bad days” ninety-nine percent (99%) \nof  the  time.    Claimant  states  that  he  walks  to  help  his  back,  when  the  weather  is  fair.  \nHis back condition makes it hard for him to sleep. \n Arkansas  Code  Annotated  Section  11-9-508(a)  (Repl.  2012)  states  that  an \nemployer  shall  provide  for  an  injured  employee  such  medical  treatment  as  may  be \nnecessary  in  connection  with  the  injury  received  by  the  employee.   Wal-Mart  Stores, \nInc. v. Brown, 82 Ark. App. 600, 120 S.W.3d 153 (2003).  But employers are liable only \nfor  such  treatment  and  services  as  are  deemed  necessary  for  the  treatment  of  the \nclaimant’s injuries.  DeBoard v. Colson Co., 20 Ark. App. 166, 725 S.W.2d 857 (1987).  \nThe claimant must prove by a preponderance of the evidence that medical treatment is \n\nMUNNS – H307207 \n \n14 \n \nreasonable  and  necessary  for  the  treatment  of  a  compensable  injury.   Brown, supra; \nGeo  Specialty  Chem.  v.  Clingan,  69  Ark.  App.  369,  13  S.W.3d  218  (2000).    The \nstandard “preponderance of the evidence” means the evidence having greater weight or \nconvincing force.  Barre v. Hoffman, 2009 Ark. 373, 326 S.W.3d 415; Smith v. Magnet \nCove   Barium   Corp.,   212   Ark.   491,   206   S.W.2d   442   (1947).      What   constitutes \nreasonable and necessary medical treatment is a question of fact for the Commission.  \nWhite  Consolidated  Indus.  v.  Galloway,  74  Ark.  App.  13,  45  S.W.3d  396  (2001); \nWackenhut Corp. v. Jones, 73 Ark. App. 158, 40 S.W.3d 333 (2001).  In order to prove \nhis entitlement to the requested treatment, Claimant must also prove that it is causally \nrelated to his compensable injuries of July 6, 2007.  See Pulaski Cty. Spec. Sch. Dist. v. \nTenner, 2013 Ark. App. 569, 2013 Ark. App. LEXIS 601. \n As  the  Arkansas  Court  of  Appeals  has  held,  a  claimant  may  be  entitled  to \nadditional  treatment,  even  after  the  healing  period  has  ended,  if  said  treatment  is \ngeared toward management of the injury.  See Patchell v. Wal-Mart Stores, Inc., 86 Ark. \nApp.  230,  184  S.W.3d  31  (2004); Artex  Hydrophonics,  Inc.  v.  Pippin,  8  Ark.  App.  200, \n649 S.W.2d 845 (1983).  Such services can include those for the purpose of diagnosing \nthe  nature  and  extent  of  the  compensable  injury; reducing  or  alleviating  symptoms \nresulting from the compensable injury; maintaining the level of healing achieved; or \npreventing  further  deterioration  of  the  damage  produced  by  the  compensable  injury.  \nJordan v. Tyson Foods, Inc., 51 Ark. App. 100, 911 S.W.2d 593 (1995); Artex, supra.  A \nclaimant is not required to furnish objective medical evidence of his continued need for \n\nMUNNS – H307207 \n \n15 \n \nmedical  treatment.   Castleberry  v.  Elite  Lamp  Co.,  69  Ark.  App.  359,  13  S.W.3d  211 \n(2000). \n A claimant’s testimony is never considered uncontroverted.  Nix v. Wilson World \nHotel,  46  Ark.  App.  303,  879 S.W.2d  457 (1994).    The determination  of a  witness’ \ncredibility and how much weight to accord to that person’s testimony are solely up to the \nCommission.  White v. Gregg Agricultural Ent., 72 Ark. App. 309, 37 S.W.3d 649 (2001).  \nThe  Commission  must  sort  through  conflicting  evidence  and  determine  the  true  facts.  \nId.  In so doing, the Commission is not required to believe the testimony of the claimant \nor  any  other  witness,  but  may  accept  and  translate  into  findings  of  fact  only  those \nportions of the testimony that it deems worthy of belief.  Id. \n Claimant’s  testimony  is  that  the  treatment  he  is  seeking—and   which   he \nunderstands that Dr. Shah is recommending—consists of a spinal cord stimulator.  The \ntreatment  of  his  stipulated  compensable  lumbar  spine  injury  that  he  has  undergone \nincludes the surgery that Dr. Seale performed on September 22, 2023.  This operation \nconsisted of, inter alia, a fusion and laminotomy at L5-S1.  I credit Claimant’s testimony \nthat the surgery only partially alleviated his symptoms, and that the pain in his back and \ninto his lower extremity is extremely severe. \n Dr.  Shah,  who  is  now  Claimant’s  authorized  treating  physician,  has \nrecommended that he undergo a spinal cord stimulator trial, with a neuropsychological \nscreening and a thoracic MRI as precursors thereto.  She has opined that the purpose \nof the course of treatment is “neuromodulation” of the pain that he is suffering as a \nresult of “post laminectomy and chronic pain syndrome.”  As discussed above, Claimant \n\nMUNNS – H307207 \n \n16 \n \ndid  not  undergo  a  laminectomy,  which  is  the  “excision  of  the  posterior  arch  of  a \nvertebra.”  DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 996 (30\nth\n ed. 2003).  Instead, \nhis procedure was a laminotomy, which involves removal of only a portion of the lamina, \nor  arch.   Id.    This  is  a  difference  only  as  to  degree,  and  thus  is  not  substantive;  Shah \nhas rendered the opinion that Claimant is suffering from pain not only related to his work \nrelated injury, but as a consequence of the treatment thereof; and she is recommending \nthe stimulator trial and related treatment to address it.  The Commission is authorized to \naccept or reject a medical opinion and is authorized to determine its medical soundness \nand probative value.  Poulan Weed Eater v. Marshall, 79 Ark. App. 129, 84 S.W.3d 878 \n(2002); Green  Bay  Packing  v.  Bartlett,  67  Ark.  App.  332,  999  S.W.2d  692  (1999).  \nBased on the foregoing, I credit her opinion. \n Claimant  has also  proven  under Tenner, supra,  that  this  treatment  is  causally \nrelated  to  his  stipulated  compensable  injury.    Therefore,  he  has  met his  burden  of \nestablishing that it is reasonable and necessary. \nB. Temporary Total Disability \n As  part  of  this  claim,  Claimant  has  asked  that  he  be  awarded  additional \ntemporary total disability benefits from the date last paid to a date yet to be determined.  \nRespondents,  on  the  other  hand,  have  asserted  that  Claimant  is  not  entitled  to  any \nmore benefits of this type. \n The compensable injury to Claimant’s lumbar spine is unscheduled.  See Ark. \nCode  Ann.  §  11-9-521  (Repl.  2012).    An  employee  who  suffers  a  compensable \nunscheduled  injury  is  entitled  to  temporary  total  disability  compensation  for  that  period \n\nMUNNS – H307207 \n \n17 \n \nwithin the healing period in which he has suffered a total incapacity to earn wages.  Ark. \nState Hwy. & Transp. Dept. v. Breshears, 272 Ark. 244, 613 S.W.2d 392 (1981).  Also, \na claimant must demonstrate that the disability lasted more than seven days.  Id. § 11-\n9-501(a)(1). \n According  to  Claimant,  his  entire  career  has  been  spent  as  a  mechanic.    He \nnever went to college.  Claimant has never had a desk job.  To the contrary, all of the \npositions that he has held have required that he be able to lift at least 50 pounds.  His \nposition as a “heavy duty mechanic” with Respondent City of North Little Rock was no \nexception.    In  fact,  in  some  instances  he  has  had  to  lift  more  than  100  pounds  while \nworking there.  His job was physically demanding in other ways.  He had to stoop and \ncrouch at times. \n Claimant’s testimony was that he was off work for four weeks after his fusion \nprocedure.  Thereafter, he returned to work at modified duty.  He continued to treat with \nDr. Seale while he was seeing Dr. Gordon. \n The February 7, 2024, report of Claimant’s return visit to Gordon reflects that the \ndoctor  released  him  to  return  to  work  on  February  8,  2024,  with  restrictions  of  no \nbending or lifting, and no lifting of more than 20 pounds.  On April 24, 2024, Seale found \nthat he was at maximum medical improvement and assigned him an impairment rating \nof twelve percent (12%) to the body as a whole.  Respondents accepted this rating and \nhave been paying Claimant permanent partial disability benefits pursuant thereto. \n On May 2, 2024, Claimant underwent a functional capacity evaluation.  He gave \na reliable effort, with 51/51 consistency measures within expected limits.  Claimant was \n\nMUNNS – H307207 \n \n18 \n \nfound  to  have  demonstrated  the  ability  to  work  in  the  Medium  classification,  with \noccasional  bi-manual  lifting/carrying  of  up  to  50  pounds,  lifting/carrying  of  up  to  25 \npounds  on  a  frequent  basis,  and  an  occasional  lifting/carrying  of  up  to  25  pounds  by \neach upper extremity separately.  Moreover, he was assessed as being able to engage \nin  the  following  activities  constantly:    walking,  reaching  (immediate  and  with  a  five-\npound  weight),  handling,  fingering,  standing  and  sitting.    Claimant  was  also  found  to \nkneel  frequently,  and  to  perform  the  following  occasionally:    stooping,  crouching, \nclimbing stairs, pushing/pulling cart, and reaching overhead.  Based on these findings, \nRespondents determined that Claimant could no longer do his job for the City of North \nLittle  Rock  and  terminated  him.   He  has  not  filed  for  unemployment  benefits.    Asked \nwhy, he replied:  “I ain’t going to lie to nobody, tell them that I can work when I can’t.”  \nNotwithstanding  this,  it  was  also  his  testimony  that  he  has  not  applied  for  Social \nSecurity disability benefits.  He explained:  “I don’t believe in getting disability.  I want to \nhave a job.  I want to work.  I’ve worked all my life.” \n The following exchange took place: \nQ. Can you work currently? \n \nA. No, sir. \n \nQ. Why not? \n \nA. I can’t do the physical part of it.  My job demands that you pick \nthings up, that you bend over, you lay down, you crawl under stuff, \nyou crawl in stuff, so it’s—it’s no longer—I’m no longer physically \nable to do it. \n \nQ. Okay.    Is  your  physical  condition  now  better,  the  same,  or  worse \nthan when they terminated you? \n\nMUNNS – H307207 \n \n19 \n \n \nA. Worse. \n \nQ. And how is it worse, Randy? \n \nA. I’m getting fat ‘cause I can’t work.  I don’t have—I’m not doing the \nthings that I’m supposed to be doing . . . as far as physically taking \ncare of myself because I can’t—my back hurts, my leg hurts, so I’m \nnot able to do it. \n \n The   evidence   shows   that   Claimant   last  received  temporary   total  disability \nbenefits  for  the  period  ending  February  6,  2024.    Thus,  he  is  asking  to  be  awarded \nadditional  benefits  of  this  type  on  and  after  February  7,  2024.  But  as  of  February  8, \n2024,  he  was placed back  on  modified  duty by  Dr.  Gordon—which are  the same \nrestrictions  that  Seale  had  assigned  him (and  Respondents  had  accommodated)—on \nOctober 25, 2023. \n Respondents  terminated  Claimant  because  they  could  not  meet  his  permanent \nrestrictions  as  documented  in  the  functional  capacity  evaluation.    But  his  termination \ncame after Dr. Seale had released him for being at maximum medical improvement on \nApril 24, 2024, when the doctor also assigned him the permanent impairment rating of \ntwelve  percent  (12%)  to  the  body  as  a  whole.  I  credit  these  findings  under Poulan, \nsupra. \n The healing period ends when the underlying condition causing the disability has \nbecome  stable  and  nothing  further  in  the  way  of  treatment  will  improve  that  condition.  \nMad  Butcher,  Inc.  v.  Parker,  4  Ark.  App.  124,  628  S.W.2d  582  (1982).    Claimant  has \nargued that  Claimant did not  reach the  end of his healing period  on  April  24, 2024,  by \nsoliciting  from  Dr.  Shah an answer of “yes” to the question of whether the trial  spinal \n\nMUNNS – H307207 \n \n20 \n \ncord  stimulator—which  I  awarded  above—is “designed to improve [Claimant’s] current \nphysical condition.”  But I cannot and do not credit this.  The evidence is clear that the \nstimulator’s purpose is purely palliative in nature.  As Carlton explained in her letter, \nquoted above:  “it is the provider’s medical opinion that a neuropsychological screening, \nthoracic MRI, and spinal cord stimulator trial is medically necessary as it could lead to a \nsignificant  improvement  in  [Claimant’s]  functionality  and  quality  of  life.”    Thus,  this \ntreatment  strictly geared  to  management  of  his  condition  after  the  end  of  the  healing \nperiod,  per Patchell, supra.  The  preponderance  of  the  evidence  establishes  that  he \nreached the end of his healing period on April 24, 2024. \n That  said,  based  on  the  foregoing, I  find  that Claimant  has met  his  burden  of \nproof  concerning his  entitlement  to  additional  temporary  total  disability  benefits  for  an \nadditional one-day period:  February 7, 2024. \nC. Attorneys’ Fee \n Claimant has asserted that he is entitled to a controverted attorney’s fee in this \nmatter.  One of the purposes of the attorney's fee statute is to put the economic burden \nof litigation on the party who makes litigation necessary.  Brass v. Weller, 23 Ark. App. \n193, 745 S.W.2d 647 (1998).  In this case, the fee would be twenty-five percent (25%) \nof any indemnity benefits awarded herein, one-half of which would be paid by Claimant \nand one-half to be paid by Respondents in accordance with See Ark. Code Ann. § 11-9-\n715  (Repl.  2012).   See Death  &  Permanent  Total  Disability  Trust  Fund  v.  Brewer,  76 \nArk. App. 348, 65 S.W.3d 463 (2002). \n\nMUNNS – H307207 \n \n21 \n \n The  evidence  before  me  clearly  shows  that  Respondents have  controverted \nClaimant’s entitlement to additional indemnity benefits—including  the  temporary  total \ndisability  benefit  awarded  above.    Thus,  the  evidence  preponderates  that  his counsel, \nthe Hon. Neal Hart, is entitled to the fee as set out above. \nCONCLUSION AND AWARD \n Respondents are directed to furnish/pay benefits in accordance with the findings \nof fact and conclusions of law set forth above.  All accrued sums shall be paid in a lump \nsum  without  discount,  and  this  award  shall  earn  interest  at  the  legal  rate  until  paid, \npursuant to Ark. Code Ann. § 11-9-809 (Repl. 2012).  See Couch v. First State Bank of \nNewport, 49 Ark. App. 102, 898 S.W.2d 57 (1995). \n Claimant’s  attorney  is  entitled  to  a twenty-five percent  (25%)  attorney’s  fee \nawarded herein, one-half of which is to be paid by Claimant and one-half to be paid by \nRespondents in accordance with Ark. Code Ann. § 11-9-715 (Repl. 2012). \n IT IS SO ORDERED. \n       ________________________________ \n       Hon. O. Milton Fine II \n       Chief Administrative Law Judge","preview":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION WCC NO. H307207 RANDY D. MUNNS, EMPLOYEE CLAIMANT CITY OF NORTH LITTLE ROCK, SELF-INSURED EMPLOYER RESPONDENT ARK. MUN. LEAGUE, THIRD-PARTY ADM’R RESPONDENT OPINION FILED MARCH 14, 2025 Hearing before Chief Administrative Law Judge O. Milton Fine II on January 23, 20...","fetched_at":"2026-05-19T22:42:36.999Z","links":{"html":"/opinions/alj-H307207-2025-03-14","pdf":"https://www.labor.arkansas.gov/wp-content/uploads/Munns_Randy_H307207_20250314.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/"}}