{"id":"alj-H400203-2024-09-05","awcc_number":"H400203","decision_date":"2024-09-05","opinion_type":"alj","claimant_name":"Juan Cerrato","employer_name":"Dale Crampton Co. Inc","title":"CERRATO VS. DALE CRAMPTON CO. INC. AWCC# H400203 September 5, 2024","outcome":"unknown","outcome_keywords":[],"injury_keywords":["back","lumbar","hip","strain","repetitive","neck"],"pdf_url":"https://labor.arkansas.gov/wp-content/uploads/CERRATO_JUAN_H400203_20240905.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/","filename":"CERRATO_JUAN_H400203_20240905.pdf","text_length":16810,"full_text":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION \n   \n CLAIM NO. H400203 \n \n \nJUAN C. RAMIREZ-CERRATO, EMPLOYEE CLAIMANT \n \nDALE CRAMPTON CO. INC., EMPLOYER RESPONDENT \n \nSUMMIT CONSULTING LLC, CARRIER RESPONDENT \n \n \n OPINION FILED SEPTEMBER 5, 2024 \n \n \nHearing before ADMINISTRATIVE LAW JUDGE JOSEPH C. SELF in Fort Smith, Sebastian \nCounty, Arkansas. \n \nClaimant represented by MICHAEL L. ELLIG, Attorney, Fort Smith, Arkansas. \n \nRespondents represented by ZACHARY F. RYBURN, Attorney, Little Rock, Arkansas. \n \n \n STATEMENT OF THE CASE \n  \n \n On July 30, 2024, the above captioned claim came on for a hearing at Fort Smith, Arkansas. \nA pre-hearing conference was conducted on June 20, 2024, and a pre-hearing order was filed on that \nsame date. A copy of the pre-hearing order has been marked as Commission’s Exhibit #1 and made \na part of the record without objection. \n At the pre-hearing conference the parties agreed to the following stipulations: \n 1.   The Arkansas Workers’ Compensation Commission has jurisdiction of this claim.  \n 2.   The employee/employer/carrier relationship existed on or about June 5, 2023. \n            At the pre-hearing conference the parties agreed to litigate the following issues: \n            1.  Whether claimant is entitled to additional medical benefits. \n All other issues are reserved by the parties. \n\nRamirez-Cerrato-H400203 \n2 \n \nThe claimant contends that “Such services are reasonably necessary for his compensable back \ninjury of June 5, 2023.” \nThe respondents contend that “All  appropriate  benefits  have  been  paid. The  suggested \ntreatment is not reasonable, necessary, or related.”   \n From a review of the entire record including medical reports, documents, and other matters \nproperly before the Commission, and having had an opportunity to hear the testimony of the witness \nand  to  observe his demeanor,  the  following  findings  of  fact  and  conclusions  of  law  are  made  in \naccordance with A.C.A. §11-9-704: \n \n  FINDINGS OF FACT & CONCLUSIONS OF LAW \n \n 1.   The stipulations agreed to by the parties at a pre-hearing conference conducted on June \n20, 2024, and contained in a pre-hearing order filed that same date are hereby accepted as fact. \n 2.   Claimant has met his burden of proof by a preponderance of evidence that he is entitled \nto additional medical treatment from Dr. James Blankenship for his back injury. \n \n FACTUAL BACKGROUND \n At the hearing, the parties announced that the issue as recited in the prehearing order should \nbe amended to limit this claim solely to a lumbar back injury. I wrote that on the prehearing order. \nThe opening discussion before the testimony began clarified that claimant reserved any claim for other \npossible physical injuries.  \n The prehearing order did not specifically recite that the parties stipulated that claimant suffered \na compensable injury. However, because the respondents contended that all appropriate benefits had \nbeen  paid,  this  matter  was  tried to  determine  if  the recommended  treatment  was  reasonable  and \nnecessary, not whether claimant had suffered a compensable back injury on June 20, 2024. Therefore, \n\nRamirez-Cerrato-H400203 \n3 \n \n \nI did not believe it necessary for me to determine that claimant suffered a compensable injury on that \ndate. \nHEARING TESTIMONY  \n \n Claimant was the only witness at the hearing. He testified that on June 5, 2023, he was working \nfor Dale Crampton doing roofing work. Part of the job involved moving rolls of roofing material that \nweighed about ninety pounds each. Claimant said he had been doing that work for approximately one \nyear and three months and had no previous problems with his low back, hip, or leg before that date. \nOn June 5, 2023 claimant testified that the accident occurred as “we were installing rolls that were \napproximately ninety pounds.  I had to pick it up and then straighten it out towards the back to be \nable to lay it out. And at the moment when we were doing that, that is when the pain on my back \nstarted.”  Immediately after that, claimant had difficulty crouching and walking upright.  If he bent \nover, he could not straighten himself, and his back felt like he had a sting in it. The pain went down \nhis left side into his left leg. As claimant was not paid on his days off, he tried to work through the \npain until his foot was falling asleep.  \n At that point, respondent sent him to a doctor, and it was discovered that claimant had two \ndiscs  bulging  in  his  back. Claimant  was  put  on a  course  of physical  therapy,  having to work  in  the \nmorning  and  then  go  to  therapy  in  the  afternoon  so  he  would  not  lose  any  pay. Claimant  said  the \ntreatment from Dr. Cheyne did not help.  He now works at a job where he lifts less weight but is still \nhaving problems with his back and his hip and his leg. Claimant testified that Dr. Cheyne released him \nand advised him to find different types of work because his back was not fine. Claimant then saw Dr. \nBlankenship in Fayetteville, who recommended an MRI.   \n On cross-examination, claimant agreed that Dr. Cheyne sent him to physical therapy and gave \nhim some prescriptions. He said he refused the injection that Dr. Cheyne suggested because at that \n\nRamirez-Cerrato-H400203 \n4 \n \n \ntime,  the  pain  had  diminished  a  bit. Dr.  Cheyne  then  referred  claimant  for  a  functional  capacity \nevaluation.  \n Claimant said  he  gave a  good  effort  at  the  evaluation  and  received a  7%  impairment  rating \nbased on the existence of his L4-5 disc bulge. Claimant said he was in moderate pain while performing \nthe FCE. Claimant said he continues to have problems with his back. He disagreed with Dr. Cheyne’s \nlast report that said he was improving. Claimant insisted that he told him everything was still the same; \nthe leg was still painful and felt like little ants were crawling all over it. He also denied that he told the \nperson conducting the functional capacity evaluation this pain has subsided, because he still had pain.  \n Claimant was  surprised  that  he  had  been  fired  from  his  employment  with  respondent  Dale \nCrampton. He called his doctor and found that he had been discharged from Dr. Cheyne’s treatment. \nHe asked to see a different doctor and had his initial visit with Dr. Blankenship. While Dr. Blankenship \nhas not yet recommended surgery, claimant understood there could be a bad result but if he does not \nreceive treatment, his back is still in bad shape. \n On  re-direct  examination,  claimant  said  he is still  having a  lot  of  difficulties  with  his  back. \nWhen he sits, such as traveling in a car and gets up, it feels very numb. He conceded that his back is \nbetter some days than others, but he always has a significant level of difficulties. Claimant understood \nthe difference between Dr. Blankenship, an experienced neurosurgeon and Dr. Cheyne, who practices \nat  an  Occupational  Medicine  Clinic  that  specializes  in  conservative  care.  He  has  more  faith in Dr. \nBlankenship’s opinion. Claimant wants something done about his continuing difficulties be it surgery \nor not.  \n On re-cross examination, claimant said he didn’t feel Dr. Cheyne helped him much.  He always \ntold Dr. Cheyne he had pain and what worried him most was the numbing and tingling in his leg. He \nfelt they just wanted to discharge him from care. \n\nRamirez-Cerrato-H400203 \n5 \n \n \n On re-direct examination, claimant clarified that he did not go to see Dr. Cheyne after he was \ndischarged because he did not know that he would be able to see him again since he had been fired \nfrom his job.  \n Having the opportunity to observe the claimant’s testimony and compare what he said with \nthe medical records, I found him to be a credible witness. \nREVIEW OF THE MEDICAL RECORDS \n \n The  records  revealed  little  that  was not  brought  out  in  testimony. On  September  27,  2023, \nclaimant began conservative care which included a steroid pack, Tylenol, hot showers, and physical \ntherapy. During that examination, Dr. Cheyne recorded: “SLR positive on the left. 4/5 strength b/l, \nLLES,  DTRs,  one  plus  b/l  le  again, ROM is  slightly  limited  with  flexion. Pain  is  noted  with \nmovement.”  In his “Visit Summary for Employer,” Dr. Cheyne diagnosed the claimant with “1. Low \nback pain, 2.  Strain  of  muscle, facia, and  tendon of lower back,  3.  Radiculopathy,  lumbar  region. \nClaimant was put on restrictive duty of lifting no more than twenty pounds, with a ten-pound limit \nfor repetitive lifting.  \n Claimant had an X-ray on September 27, 2023. The findings were: \n“There is a normal alignment positioning of the lumbar spine. Vertebral body \nheights well maintained. No definite fractures are noted. Disc heights overall \nmaintained. Mild  interior  end plates spurring  at  L2-3  L3-4  and  L4-5. Facet \njoints grossly unremarkable. SI joints symmetric.”   \n \n  The impression was, “mild multilevel discogenic degeneration. No radiographic fractures or \ntraumatic malalignment.” \n After a month, claimant had an MRI to his lumbar spine on October 31, 2023.  The impression \nwas recorded as:  \n1. L4-L5  moderate  to large  left  paracentral  disc  protrusion  with  probable \nseparate  sequestered/extruded  fragment  and  narrowing  of  subarachnoid \nspace to 5.8mm.  \n\nRamirez-Cerrato-H400203 \n6 \n \n \n2.  L3-4 broad based moderate disc bulge with central small protrusion, mild \nnarrowing subarachnoid space facet arthropathy.  \n \n  Claimant  continued  with  office  visits  with  Dr.  Cheyne  throughout  the  rest  of  2023. On \nDecember 6, 2023, Dr. Cheyne recorded the following:  \n“Juan’s primary problem is pain located in the left side of the posterior neck, \nlower lumbar region. He describes it as sharp. The problem began on June 27, \n2023. Juan says it seems to be variable-- depending on the activity level. He has \nnoticed that it is made worse by lifting. He also notes that it is accompanied by \nstiffness. He feels he is improving slightly. His pain level is 0. Patient continues \nto have pain with lifting rolls that are 90 lbs.”   \n \n On January 3, 2024, claimant was given a functional capacity evaluation (FCE) in which he \nput  forth  a  reliable  effort. The  evaluator  recorded claimant demonstrated the  ability  to  perform an \noccasional bimanual lift carry of up to eighty pounds and could lift and carry up to forty pounds on a \nfrequent basis. The examiner concluded that the claimant had a 7% whole person impairment as a \nresult of his work-related injury. I will return to this in more detail in the adjudication section of this \nopinion.  \n  On January 11, 2024, Dr. Cheyne saw claimant for the last time.  His diagnosis was:  \n1. Low back pain \n2. Strain of muscle, fascia and tendon of lower back, subsequent encounter \n3. Radiculopathy, lumbar region. \n4. Other intervertebral disc displacement.  \n \n  Dr. Cheyne then accepted the findings of the FCE and discharged claimant, saying “treatment \ncompleted.”  \n On May 6, 2024, claimant saw Dr. James Blankenship. Dr. Blankenship noted that “five visits \nto  physical  therapy  is  certainly  not  consistent  with  an  adequate  routine  and  usual  conservative \ntreatment.”  After his examination, Dr. Blankenship had this impression:  \n“His  general  neurological  examination  revealed  the  patient  has  an  S1 \nradiculopathy on examination. Again, I do not have a hard copy of his MRI, \nwhich  does  not  really  matter  because  it  was done over  six months  ago. The \n\nRamirez-Cerrato-H400203 \n7 \n \n \nreport  does  show  a  very  large  disc  herniation  of  the left-hand side  at  L4-5, \nwhich would certainly correspond with his pain. He is having this significant \namount of left sided lower back pain.” \n \n Dr. Blankenship stated that he needed an MRI to determine, “what is going on now and what \nit looked like seven months ago.”  The records conclude with the request for the MRI and a denial \nfrom respondent Summit two days later. \n \nADJUDICATION \n \n It is the employer's responsibility to provide for an injured employee such medical treatment \nas may be reasonably necessary in connection with the injury received by the employee, Ark. Code \nAnn. 11-9-508(a). A claimant bears the burden of proving entitlement to additional medical treatment \nfor a compensable injury. LVL, Inc. v. Ragsdale, 2011 Ark. App. 144, 381 S.W.3d 869. What constitutes \nreasonably  necessary  treatment  is  a  question  of  fact  for  the  Commission. Id.  The  Commission  has \nauthority to accept or reject medical opinion and to determine its medical soundness and probative \nforce. Id. Respondents relied on the results of the FCE and the subsequent discharge from care by \nDr. Cheyne as their basis for denying Dr. Blankenship’s request for an MRI. After reviewing those \nreports, I find this reliance to be misplaced.  \n The FCE in this case is virtually useless. On each of the lifting tests, claimant failed to complete \nthe  test,  complaining  of  back  pain  caused  by  the  lifting. Since  the  examiner  found  claimant  gave  a \nreliable effort, there was no indication that claimant was exaggerating his discomfort in performing \npart of the tasks he was asked to do. Further, those lifting exercises were only a small portion of the \nentire evaluation, which took less than four hours; I would not expect the results over an 8-hour day \nto improve as the workday continued.\n1\n  The test also does not account for what type of problems—\n \n1\n Claimant testified that  he  was only examined for three hours. While I question the accuracy of the results of this \nFCE, I accept that claimant was there from 7:58 until 11:49 AM.  \n\nRamirez-Cerrato-H400203 \n8 \n \n \nif any—claimant would have later that day or the next after putting forth the reliable effort on the \nrequested tasks.  \n I cannot say with certainty that Dr. Cheyne did not read the entire FCE, as he quoted only \nfrom the summary. My reading of his report is that on December 6, 2023, claimant was reluctant to \nhave  a  steroid  injection, which caused Dr.  Cheyne  to order  the  FCE. There  were  no  reports  from \nphysical therapy introduced into the records, but Dr. Blankenship’s report of May 6, 2024, mentions \nthat claimant did “5 visits with very transient relief... Five visits to physical therapy is certainly not \nconsistent  with  an  adequate  care  routine  and  usual  conservative  treatment.”  I  agree  with  that \nassessment of the lack of care provided.  \nFurther, I quoted Dr. Cheyne’s December 6, 2023, report above. To illustrate how inconsistent \nit was, here it is again, with emphasis added:  \n“Juan’s primary problem is pain  located  in  the  left  side  of  the  posterior \nneck, lower lumbar region. He describes it as sharp. The problem began on \nJune 27, 2023. Juan says it seems to be variable-- depending on the activity \nlevel. He has noticed that it is made worse by lifting. He also notes that it is \naccompanied by stiffness. He feels he is improving slightly. His pain level \nis 0. Patient continues to have pain with lifting rolls that are 90 lbs.” \n \nThere is either a typographical error or a failure to  communicate, as Dr. Cheyne repeatedly \ndocumented claimant’s complaints of pain, and then said the “pain level is 0.”  I cannot square  the \ncontradictions in this paragraph. Dr. Cheyne had the results of the MRI on December 6, 2023, and \nheard  claimant  reporting  symptoms  that  are  entirely  consistent  with  bulging  discs. Nonetheless, he \nordered an FCE and then discharged claimant on January 11, 2024, under restricted duty, but in the \nheavy classification of work, closing with the advice that claimant might want to find employment that \ndoesn’t require such heavy lifting.    \nFrankly, even without Dr. Blankenship’s notes from May 6, 2024, I would have found claimant \nhad a reason to seek additional medical treatment for his back injury. With that report, this is not even \n\nRamirez-Cerrato-H400203 \n9 \n \n \na close call. The MRI Dr. Blankenship requested is reasonable and appears to be necessary to afford \nthis claimant the medical care to which he is entitled for this compensable injury.   \nORDER \n \nClaimant has met his burden of proving by a preponderance of the evidence that he is entitled \nto  additional  medical  treatment  as  recommended  by  Dr.  Blankenship  for  his  compensable  injury, \nbeginning with but not limited to the recommended MRI on his lumbar spine.  \nRespondent  is  responsible  for  paying  the  court  reporter  her  charges  for  preparation  of  the \ntranscript the sum of $352.95. \n IT IS SO ORDERED. \n \n                                                                                              \n_______     \n JOSEPH C. SELF \nADMINISTRATIVE LAW JUDGE","preview":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION CLAIM NO. H400203 JUAN C. RAMIREZ-CERRATO, EMPLOYEE CLAIMANT DALE CRAMPTON CO. INC., EMPLOYER RESPONDENT SUMMIT CONSULTING LLC, CARRIER RESPONDENT OPINION FILED SEPTEMBER 5, 2024 Hearing before ADMINISTRATIVE LAW JUDGE JOSEPH C. SELF in Fort Smith, Sebastian County, ...","fetched_at":"2026-05-19T22:48:29.826Z","links":{"html":"/opinions/alj-H400203-2024-09-05","pdf":"https://labor.arkansas.gov/wp-content/uploads/CERRATO_JUAN_H400203_20240905.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/"}}