{"id":"alj-H402408-2025-07-09","awcc_number":"H402408","decision_date":"2025-07-09","opinion_type":"alj","claimant_name":"Debra Piatt","employer_name":"Edgewood Health & Rehab","title":"PIATT VS. EDGEWOOD HEALTH & REHAB AWCC# H402408 July 09, 2025","outcome":"granted","outcome_keywords":["granted:5"],"injury_keywords":["shoulder","back","sprain","fracture","rotator cuff","knee"],"pdf_url":"https://www.labor.arkansas.gov/wp-content/uploads/PIATT_DEBRA_H402408_20250709.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/","filename":"PIATT_DEBRA_H402408_20250709.pdf","text_length":20520,"full_text":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION \n \n WCC NO. H402408 \n \nDEBRA PIATT, Employee CLAIMANT \n \nEDGEWOOD HEALTH & REHAB, Employer RESPONDENT \n \nCCMSI, Carrier RESPONDENT \n \n \n \n OPINION FILED JULY 9, 2025 \n \nHearing   before   ADMINISTRATIVE   LAW   JUDGE   ERIC   PAUL   WELLS   in   Springdale, \nWashington County, Arkansas. \n \nClaimant represented by EVELYN E. BROOKS, Attorney at Law, Fayetteville, Arkansas. \n \nRespondents  represented  by CAROL  LOCKARD  WORLEY ,  Attorney  at  Law, Little  Rock, \nArkansas. \n \n STATEMENT OF THE CASE \n \n On April  29,  2025,  the  above  captioned  claim  came  on  for  a  hearing  at  Springdale, \nArkansas.    A pre-hearing conference was  conducted on December 30, 2024, and a Pre-hearing \nOrder  was  filed  on January  7,  2025.      A  copy  of  the  Pre-hearing  Order  has  been  marked \nCommission's Exhibit No. 1 and made a part of the record without objection. \n At the pre-hearing conference the parties agreed to the following stipulations: \n 1. The Arkansas Workers' Compensation Commission has jurisdiction of this claim. \n 2. The  relationship  of  employee-employer-carrier  existed  between  the  parties on  June \n20, 2023. \n 3. The  claimant  sustained  a  compensable  injury  to  her  right  shoulder  on  or  about  June \n20, 2023. \n 4. The claimant’s weekly compensation rates will be determined at a later date. \n\nPiatt – H402408 \n \n-2- \n 5.  The  respondents  have  accepted  a  2%  permanent  impairment  rating  to  the  right \nshoulder. \n By agreement of the parties the issues to litigate are limited to the following: \n 1. Whether Claimant is entitled to payment of a permanent impairment rating greater than \n2% for her compensable right shoulder injury. \n 2. Whether Claimant’s attorney is entitled to an attorney’s fee. \n The claimant's contentions are as follows: \n“Claimant  contends  she  is  entitled  to  payment  of  a  permanent \nimpairment  rating  for  her  compensable  injury.  Claimant  reserves \nall other issues.” \n \n The respondents’ contentions are as follows: \n“Respondents   contend   that   Claimant   has    received   an   8% \npermanent   partial   impairment.   That   rating   assigned   by   Dr. \nHeinzelmann  is  being  questioned  to  address  major  cause.  Once \nclarification is received, Respondents will pay permanent disability \nbenefits associated with the claimant’s acute injury.” \n \n The  claimant  in  this  matter  is  a 55-year-old  female who  sustained  a  compensable  injury \nto her right shoulder on June 20, 2023, while employed by the respondent as a CNA. On direct \nexamination  the  claimant  described  the  incident  in  which  she  sustained  a  compensable  right \nshoulder injury as follows: \nQ And what happened to you on June 20\nth\n of 2023? \n \nA I  was  taking  care  of  a  two-person  assist  on  my  hall  that  I \nwas   assigned   and   I   was   rolling   this   person  over   and   I   had \noverreached for the wipes and I felt a pull. \n \nQ And what is a two-person assist? \n \nA It is a person that needs two people in the room to assist on \nthe changing, dressing, and getting up of the resident. \n \n\nPiatt – H402408 \n \n-3- \nQ Any  why  would  a  person  be  a  two-person  assist  or  more \nspecifically, why was this person a two-person assist? \n \nA He had had a stroke and he was extremely heavy. He was – \ncould not stand. \n \nQ So I can’t remember if you said. What service were you \nproviding for him at this time? \n \nA I was doing my two-your nightly rounds changing him. \n \nQ Okay. And so you said you overreached. Could you explain \nwhy that happened? \n \nA I  went  and  rolled  the  resident  over  and  I  had  realized  that \nmy wipes that I needed to perform my duty was at that time too far \naway and I overreached so I wouldn’t have to pull him back and \nre-roll him. \n \nQ So  when  you  overreached,  what  happened?  What  did  you \nfeel? \n \nA I felt a pull. \n \nQ And where was the pull? \n \nA On my shoulder. \n \nQ Which shoulder? \n \nA My right one. \n \nQ Okay. And did you get the wipes successfully? \n \nA I did, yes. \n \nQ Okay. And then what did you feel? \n \nA Pain. \n \n The  claimant  reported  her  injury  and  was  seen  at  Washington  Regional  Hospital’s \nemergency room. The claimant was later seen by APRN Dominque Carver on June 22, 2023. At \nthat  time,  APRN  Carver  diagnosed  the  claimant  with  a  right  shoulder  sprain  and  gave  the \n\nPiatt – H402408 \n \n-4- \nclaimant  instructions  to  ice  her  right  shoulder.  The  claimant  was  prescribed  ibuprofen  and \nDiclofenac gel. The claimant was returned to work with restrictions at that time. \n APRN Carver referred the claimant to physical therapy on July 6, 2023, as the claimant’s \nright shoulder failed to improve. On August 17, 2023, APRN Carver referred the claimant for a \nright shoulder MRI due to her minor improvement. \n On  August  30,  2023,  the  claimant  underwent  an  MRI  of  the  right  shoulder  at  MANA \nMedical  Associates.  Following  is  a  portion  of  that  diagnostic  report  authored  by  Dr.  Benjamin \nLowery: \nIMPRESSION: \n1.  Low-grade  partial-thickness  articular  surface  tear  involving  the \nconjoined tendon of the supraspinatus and infraspinatus. \n2. Tear of the interior labrum. \n \n On  September  13,  2023,  the  claimant  was  seen  by  Dr.  Andrew  Heinzelmann  at  Ozark \nOrthopedics. Following is a portion of the medical record from that visit: \nAssessment/Plan \nX-ray  three-view  right  shoulder  taken  here  today  no  fracture  no \ndislocation \n \nMRI  scan  right  shoulder  demonstrates  low-grade  partial  thickness \nrotator cuff tear. Tear of the inferior labrum. \n \nRight shoulder partial-thickness rotator cuff tear, labral tear \n \nWe  talked  about  the  pathology  and  the  treatment  strategies.  She \nreports  that  she  really  needs  to  keep  working  without  restrictions. \nIf there is a way to avoid the surgery that would be her preference. \nI  explained  to  her  that  we  certainly  can  treat  this  nonoperatively \nand  see  how  she  does.  I  would  recommend  maybe  a  steroid \ninjection  today  she  agrees  physical  therapy  once  a  week  for  6 \nweeks with a home program. No work restrictions come back in 6 \nweeks.  I  did  explain  as  well  that  it  is  possible  if  she  does  not \nimprove over time we could consider arthroscopic surgical options. \n \n1. Partial thickness rotator cuff tear – Right. \n\nPiatt – H402408 \n \n-5- \nM75.101: Unspecified rotator cuff tear or rupture of right shoulder, \nnot specified as traumatic. \n \n On April 15, 2024, the claimant was seen by Dr. Chad Songy at UAMS Orthopedics and \nSports Medicine. Following is a portion of that medical report: \nHistory of Present Illness: \nDebra Piatt is a 54 y.o. female who is here today for evaluation of \nher right shoulder. This is a workers’ Comp injury, date of injury \nwas 06/20/2023. The patient states she was moving a heavy patient \nand  sustained  an  injury  to  her  right  shoulder.  She  was  initially \ntreated with nonoperative management using oral medications and \nphysical therapy, she did not make improvements and had an MRI \nwhich   revealed   a   partial-thickness   articular   sided   tear   to   her \nsupraspinatus.  She  was  then  seen  by  Dr.  Heinzelman  who  did  a \nsubacromial    steroid    injection    and    more    physical    therapy. \nUnfortunately  the  patient  has  not  made  improvements.  Surgery \nwas then recommended, patient is here today for a 2\nnd\n opinion. \n \n*** \nImaging: \nMRI  from  outside  facility  was  reviewed  and  does  show  a  partial \narticular sided tear to her supraspinatus. \n \nAssessment \n1. Traumatic incomplete tear of right rotator cuff, initial encounter \n2. Activity involving caregiving involving lifting. \n \nPlan \nDebra  Piatt is  a  54  y.o.  female  here  today  for  evaluation  of  her \nright shoulder, this is a 2\nnd\n opinion for a workers’ Comp injury. \n \nIn  my  professional  opinion,  the  patient’s  current  diagnosis  is  a \npartial articular sided rotator cuff tear to the supraspinatus. \n \nIn my professional opinion, the mechanism of injury does correlate \nwith her continued complaints and MRI findings. \n \nAcute objective findings would be the partial articular sided tear of \nher supraspinatus on MRI. \n \nI do think an injury like to patient had could lead to finding similar \nto her MRI. \n \n\nPiatt – H402408 \n \n-6- \nSince  the  patient  has  failed  nonoperative  management  including \nsteroid   injections   and   extended   physical   therapy,   I   would \nrecommend  surgical  intervention  for  a  right  shoulder  arthroscopy \nwith possible rotator cuff repair and other indicated procedures. \n \nAt  this  time  I  would  keep  the  patient  limited  at  work  to  no  lifting \ngreater than 5 lb. and no overhead activities. \n \nOutside  hospital  records  were  reviewed,  including  notes  from  the \nworkers’ comp team, outside orthopedic, MRI, and report from the \nradiologist. \n \n The  claimant  underwent  surgical  intervention  for  her  compensable  right  shoulder  injury \non  June  21,  2024,  at  the  hands  of  Dr.  Heinzelmann.  Following  is  a  portion  of  that  operative \nreport: \nPREOPERATIVE  DIAGNOSES:  Right  shoulder  rotator  cuff  tear, \nimpingement, AC joint arthritis, possible labral tear. \n \nPOSTOPERATIVE   DIAGNOSES:   Right   shoulder   high-grade \npartial  thickness  rotator  cuff  tear,  labral  tear  with  glenohumeral \narthrosis, impingement, and AC joint arthrosis. \n \nPROCEDURES PERFORMED: \n1. Right shoulder arthroscopic rotator cuff repair. \n2. Right shoulder arthroscopic labral repair, anterior. \n3. Right     shoulder     arthroscopic     distal     clavicle     excision \napproximately 1 cm in size. \n4. Right shoulder arthroscopic debridement to include subacromial \ndecompression,    glenohumeral    debridement,    and    bursectomy \nanteriorly, posteriorly, and laterally. \n \n On September 20, 2024, Dr. Heinzelmann again saw the claimant. At that time, he found \nthe  claimant  to  be  at  maximum  medical  improvement  and  referred  the  claimant  for  an \nimpairment  rating  of  her  right  shoulder.  The  claimant  was  assessed  and  rated  by  Casey \nGarretson,  OTD,  OTR/L,  CFE,  CEAS  of  Functional  Testing  Centers,  Inc.,  on  September  23, \n2024. That “Impairment Evaluation Summary” can be found Claimant’s Exhibit 1, pages 43-47. \n\nPiatt – H402408 \n \n-7- \nIt  was  determined  at  that  time  that  the  claimant  had  a  13%  upper  extremity  impairment  which \nconverts to an 8% whole body rating. \n On  November  16,  2024,  the  respondent  authored  a  letter  to  Dr.  Heinzelmann  regarding \nthe impairment rating stated in the Functional Testing Centers, Inc. report. Following is the body \nof that letter authored by Ms. Jackie Cooper, BSN, RN, CCM with Integrity Consulting Services, \nLLC: \nThank  you  for  treating  Ms.  Debra  Piatt  for  her  injury  of  6/20/23. \nThis  is  an  Arkansas  Work  Comp  Claim.  As  you  are  aware, Ms. \nPiatt reported  an injury to her  right shoulder on 6/20/23 when she \nwas holding a resident on their side with her left arm and reached \nfor  a  wet  wipe  with  her  right  arm  and  felt  a  pull  in  her  right \nshoulder.  Ms.  Piatt  underwent  an  MRI  of  the  right  shoulder  on \n8/30/23  which  revealed  a  low-grade  partial-thickness  articular \nsurface  tear  involving  the  conjoined  tendon  of  the  supraspinatus \nand infraspinatus and tear of the inferior labrum as well as mild to \nmoderate  degenerative  changes  in  the  AC  joint.  She  underwent  a \nright shoulder arthroscopic RTC repair, labral repair anterior, distal \nclavicle  excision  approximately  1  cm  in  size  and  debridement  to \ninclude  subacromial  decompression,  glenohumeral  debridement, \nand  bursectomy  anteriorly,  posteriorly  and  laterally  performed  by \nyou on 6/21/24. \n \nThe  Functional  Testing  Center  performed  the  impairment  rating \nand assigned 13 percent to the upper extremity which equated to 8 \npercent to the body  as a  whole.  In looking at the  operative report, \nyou   noted   she   had   mild   to   moderate   pre-existing   AC   joint \narthrosis, for which a distal clavicle excision was done. \n \nWould  you  agree  the  10%  upper  extremity  rating  for  the  distal \nclavicle excision (arthroplasty) is 51% or greater related to her pre-\nexisting AC joint arthritis versus the work injury? \n \nDr. Heinzelmann responded on December 6, 2024, by indicating “Yes” to the question, \n“Would you agree the 10% upper extremity rating for the distal clavicle excision (arthroscopy) is \n51% or greater related to her pre-existing AC joint arthritis versus the work injury?” \n\nPiatt – H402408 \n \n-8- \n The respondent in this matter has accepted a 2% impairment rating to the claimant’s right \nshoulder.  The  claimant  has  asked  the  Commission  to  determine  whether  she  is  entitled  to  an \nimpairment rating greater than 2% for compensable right shoulder injury. \nPermanent impairment, which is usually a medical condition, is any permanent functional \nor  anatomical  loss  remaining  after  the  healing  period  has  been  reached.   Ouachita  Marine  v. \nMorrison, 246 Ark. 882, 440 S.W.2d 216 (1969).  Also, in Wilson & Co. v. Christman, 244 Ark. \n132, 424 S.W.2d 863 (1968), the Arkansas Supreme Court held that physical functional loss may \nbest   be   measured   through   physical   examination   by   competent   medical   specialists.   The \nCommission must first evaluate the medical evidence and determine if the permanent impairment \nis  supported  by  objective  and  measurable  findings.   Reader  v.  Rheem  Mfg.  Co.,  38  Ark.  App. \n248,  832  S.W.2d  505  (1992).    Ark.  Code  Ann.  §11-9-704(c)(1)(B)(Repl.  1996)  states  that  any \ndetermination of the  existence or extent of  physical impairment shall be supported by objective \nand  measurable  physical  or  mental  findings.    In  addition,  permanent  benefits  may  only  be \nawarded  upon  a  determination  that  the  compensable  injury  was  the  major  cause  of  the \nimpairment, Ark. Code Ann. §11-9-102(5)(F)(ii)(Repl. 1996). \n The claimant’s compensable right shoulder injury’s healing period came to an end on \nSeptember   20,   2024,   when   Dr.   Heinzelmann   declared   her   to   be   at   maximum   medical \nimprovement. Dr. Heinzelmann then referred the claimant for an impairment rating assessment, \nand  one  was  performed  by  Casey  Garretson,  whom  is  an  occupational  therapist.  His  report  in \nsome detail explains his rating procedure, which appears to be in line with the AMA Guidelines \nto   the   Evaluation   of   Permanent   Impairment,   4\nth\n Edition and  the  Arkansas  Workers’ \nCompensation  Act.  The  impairment  rating  of  8%  to  the  body  as  a  whole  is  supported  by \nsubjective measurable findings, specifically the claimant’s right shoulder MRI performed on \n\nPiatt – H402408 \n \n-9- \nAugust 30, 2023, and the claimant’s operative report from her June 21, 2024, right shoulder \nsurgery.  However,  the  claimant  is  only  entitled  to  an  award  of  permanent benefits  upon  a \ndetermination that her compensable right shoulder injury was the major cause of her impairment. \nDr.  Heinzelmann’s  response  of  “Yes”  to  the  question, “Would  you  agree  the  10%  upper \nextremity rating for the distal clavicle excision (arthroscopy) is 51% or greater related to her pre-\nexisting AC joint arthritis versus the work injury?” appears to be the basis of the respondent’s \nbelief that only 2% of the claimant’s whole body impairment’s major cause stemmed from her \ncompensable  right  shoulder  injury;  associating  the  balance  of  the  8%  whole  body  impairment \nassessed by occupational therapist Garretson with a major cause that stemmed from pre-existing \nAC joint arthritis. \n I disagree with this position and find the claimant’s compensable right shoulder injury \nwas  the  major  cause  of  the  8%  whole  body  impairment  assessed  by  occupational  therapist \nGarretson. The claimant gave credible testimony that she had never previously had right shoulder \ndifficulties on direct examination as follows: \nQ Now, before this incident, had you ever had any problem at \nall with your right shoulder? \n \nA No. \n \nQ Before June 20\nth\n of 2023, had you had any aches or pains in \nyour right shoulder? \n \nA No. \n \nQ Before that time, had you had any restrictions of movement \nin your right shoulder? \n \nA No. \n \nQ Had  you  ever  seen  a  doctor  for  your  right  shoulder  before \nthat date? \n\nPiatt – H402408 \n \n-10- \n \nA No. \n \nQ Had  you  ever  missed  work  because  of  your  right  shoulder \nbefore that date? \n \nA No. \n*** \nQ And prior to this injury, had you had any trouble using your \narm with a full range of motion? \n \nA No. \n \n The  claimant’s  testimony  regarding  having  no  prior  right  shoulder  difficulties  is \nsupported  by  the  medical  evidence.  There  are  no  medical  records  in  evidence  that  mention  any \nissues  or  difficulties  regarding  the  claimant’s  right  shoulder  prior  to  her  compensable  right \nshoulder  injury  on  June  20,  2023.  There  are  four  medical  records  introduced  by  the  claimant \nfrom the years 2015 and 2016 that primarily discuss knee pain, but no mention of the claimant’s \nright  shoulder,  including  portions  of  those  records  that  discuss  the  claimant’s  past  medical \nhistory. \n Given Dr. Heinzelmann’s response to the respondent’s singular question in the November \n16, 2024, letter authored to him, it is clear that he believes the claimant had pre-existing AC joint \narthritis.  That  very  well  may  be  the  case,  but  if  that  pre-existing  condition  existed  it  was  most \ncertainly  asymptomatic  prior  to  the  accident  and  then  symptomatic  thereafter,  satisfying  the \nmajor cause requirement as it did in Leach v. Cooper Tire and Rubber, Co., 2011, Ark. App 571 \n(2011). The claimant is able to prove that she is entitled to a whole body impairment of 8% due \nto  her  compensable  right  shoulder  injury.  I  note  the  respondent has  previously  accepted  2%  of \nthat whole body impairment leaving a balance of 6% whole body impairment. \n\nPiatt – H402408 \n \n-11- \n From a review of the record as a whole, to include medical reports, documents, and other \nmatters properly before the Commission, and having had an opportunity to hear the testimony of \nthe witness and to observe her demeanor, the following findings of fact  and conclusions of law \nare made in accordance with A.C.A. §11-9-704: \n FINDINGS OF FACT & CONCLUSIONS OF LAW \n 1.  The  stipulations  agreed  to  by  the  parties  at  the  pre-hearing  conference  conducted  on \nDecember  30,  2024,  and  contained  in  a  Pre-hearing  Order  filed January  7,  2025,  are  hereby \naccepted as fact. \n 2. The  claimant  is  entitled  to  an  additional  6%  whole  body  impairment  due  to  her \ncompensable  right  shoulder  injury.  This, in  combination  with  the  2%  whole  body  impairment \nstipulated  to  by  the  respondents,  gives  the  claimant  a  total  whole  body  impairment  of  8% \nregarding her compensable right shoulder injury. \n 3. The claimant’s attorney is entitled to an attorney’s fee in this matter. \n ORDER \nRespondent shall pay the claimant a total of 8% whole body impairment, which is made \nup  of  the  2%  previously  accepted  and  stipulated  to  by  the  respondent  and  the  6%  whole  body \nimpairment awarded herein. \nRespondents shall pay to the claimant's attorney the maximum statutory attorney's fee on \nthe benefits awarded herein, with one half of said attorney's fee to be paid by the respondents in \naddition  to  such  benefits  and  one  half  of  said  attorney's  fee  to  be  withheld  by  the  respondents \nfrom such benefits pursuant to Ark. Code Ann. §11-9-715. \n All  benefits  herein  awarded  which  have  heretofore  accrued  are  payable  in  a  lump  sum \nwithout discount. \n\nPiatt – H402408 \n \n-12- \n This award shall bear the maximum legal rate of interest until paid. \nIf  they  have  not  already  done  so,  the  respondents  are  directed  to  pay  the  court  reporter, \nVeronica Lane, fees and expenses within thirty (30) days of receipt of the invoice. \n IT IS SO ORDERED. \n \n                                ____________________________                                               \n       HONORABLE ERIC PAUL WELLS \n       ADMINISTRATIVE LAW JUDGE","preview":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION WCC NO. H402408 DEBRA PIATT, Employee CLAIMANT EDGEWOOD HEALTH & REHAB, Employer RESPONDENT CCMSI, Carrier RESPONDENT OPINION FILED JULY 9, 2025 Hearing before ADMINISTRATIVE LAW JUDGE ERIC PAUL WELLS in Springdale, Washington County, Arkansas. Claimant represented b...","fetched_at":"2026-05-19T22:38:25.386Z","links":{"html":"/opinions/alj-H402408-2025-07-09","pdf":"https://www.labor.arkansas.gov/wp-content/uploads/PIATT_DEBRA_H402408_20250709.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/"}}