{"id":"alj-H404248-2025-07-30","awcc_number":"H404248","decision_date":"2025-07-30","opinion_type":"alj","claimant_name":"Shundreka Richard","employer_name":"Kmj Management, LLC","title":"RICHARD VS. KMJ MANAGEMENT, LLC AWCC# H404248 July 30, 2025","outcome":"granted","outcome_keywords":["granted:5","denied:3"],"injury_keywords":["back","shoulder","cervical","lumbar","neck","strain","fracture","hip"],"pdf_url":"https://www.labor.arkansas.gov/wp-content/uploads/RICHARD_SHUNDREKA_H404248_20250730.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/","filename":"RICHARD_SHUNDREKA_H404248_20250730.pdf","text_length":58129,"full_text":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION \n \n WCC NO. H404248 \n \nSHUNDREKA RICHARD, Employee CLAIMANT \n \nKMJ MANAGEMENT, LLC, Employer RESPONDENT \n \nACCIDENT FUND INS., Carrier RESPONDENT \n \n \n OPINION FILED JULY 30, 2025 \n \nHearing  before  ADMINISTRATIVE  LAW  JUDGE  ERIC  PAUL  WELLS  in  Fort  Smith, \nSebastian County, Arkansas. \n \nClaimant represented by EDDIE H. WALKER, Attorney at Law, Fort Smith, Arkansas. \n \nRespondents represented by JAMES A. ARNOLD II, Attorney at Law, Fort Smith, Arkansas. \n \n STATEMENT OF THE CASE \n \n On May  1,  2025,  the  above  captioned  claim  came  on  for  a  hearing  at  Fort  Smith, \nArkansas.      A  pre-hearing  conference  was  conducted  on March  17,  2025,  and  a  Pre-hearing \nOrder  was  filed  on March  18,  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 February \n14, 2024. \n 3. The claimant sustained a compensable injury to her low back and left shoulder on or \nabout February 14, 2024. \n\nRichard – H404248 \n \n-2- \n 4. The claimant was earning sufficient wages to entitle her to compensation at the weekly \nrates  of  $420.00  for  temporary  total  disability  benefits  and  $315.00  for  permanent  partial \ndisability benefits. \n By agreement of the parties the issues to litigate are limited to the following: \n 1.  Whether  Claimant  sustained  a  compensable  injury  to  her  cervical  spine  on  or  about \nFebruary 14, 2024. \n 2.  Whether  Claimant  is  entitled  to  medical  treatment  for  her  cervical  spine  injury  in  the \nform of surgery as recommended by Dr. Blankenship. \n 3. Whether Claimant is entitled to additional medical treatment for her compensable low \nback injury in the form of surgery as recommended by Dr. Blankenship. \n 4.  Whether  Claimant  is  entitled  to  temporary  total  disability  benefits  from  March  26, \n2024, through September 22, 2024. \n 5. Whether Claimant’s attorney is entitled to an attorney’s fee. \n The claimant's contentions are as follows: \n“a.  The  Claimant  contends  that  she  is  entitled  to  temporary  total \ndisability  benefits  from  March  26,  2024  through  September  22, \n2024  and  temporary  disability  benefits  in  regard  to  the  surgeries \nthat her authorized treating physician is recommending. \n \nb.  The  Claimant  contends  that  the  surgeries  recommended  by  Dr. \nBlankenship    constitutes    reasonable    and    necessary    medical \ntreatment  and  therefore  the  respondents  should  be  held  liable  for \nthe same. \n \nc.  The  Claimant  contends  that  her  attorney  is  entitled  to  an \nattorney’s fee  regarding temporary total disability benefits from \nMarch  26,  2024  through  September  22,  2024  and  in  regard  to \ntemporary disability benefits associated with the surgeries that her \nauthorized  physician  is  recommending  and  that  the  respondents \ndeny liability for.” \n \n\nRichard – H404248 \n \n-3- \n The respondents’ contentions are as follows: \n“Respondents  contend  that  they  have  paid  and  continue  to  pay  all \nappropriate benefits to which the Claimant is entitled.” \n \nI  note  that  a  clerical  was  made  in  my  Prehearing  Order  issued  March  18,  2025,  which \nserved as a foundational document for this Opinion. That error occurs in Stipulation No. 3, which \nreads, “The claimant sustained a compensable injury to her low back and left shoulder on or \nabout February 14, 2025.” That has been corrected to reflect a date of February 14, 2024. That \nsame error occurs in Issue No. 1, which reads, “Whether Claimant sustained a compensable \ninjury to her cervical spine on or about February 14, 2025.” That now reflects a date of February \n14,  2024.  I  also  note  that  the  proper  date  is  reflected  in  Stipulation No.  2,  which  regards  the \nemployee/employer/carrier relationship that the parties agree existed on  February 14, 2024,  and \nthat  the  date  of  February  14,  2024,  is  recognized  by both  parties throughout  questioning  in  the \ncourse  of  the  hearing  and  documentary  evidence  submitted  by  both  parties.  There  is  no  dispute \nregarding the proper date of the claimant’s allegations of cervical spine injury and compensable \nlumbar spine and left shoulder injuries occurring on February 14, 2024. \n The claimant in this matter is a 34-year-old female who sustained compensable injuries to \nher  low  back  and  left  shoulder  on  or  about  February  14,  2024,  while  employed  by  the \nrespondent.  The  claimant  has  asked  the  Commission  to  determine  whether  she  also  sustained  a \ncompensable cervical spine injury in that same incident. Additionally, the claimant has requested \nmedical  treatment  for  her  cervical  spine  in  the  form  of  surgery  as  recommended  by  Dr.  James \nBlankenship. On direct examination the claimant testified about the incident and her reporting of \nit to the respondent as follows: \nQ Ms. Richard, we are here today in regard to an incident that \noccurred on February 14, 2024, while you were in the employment \n\nRichard – H404248 \n \n-4- \nof  Fianna  Nursing  &  Rehab.  Will  you  tell  us  what  happened  on \nthat day as far as your condition is concerned. \n \nA Yes, sir. I was working four halls. I was working 500, 600, \n100 and 200. 200 is the rehabilitation hall. I was helping a resident \nget  from  his  wheelchair  to  the  bed  and  he  fell  back  into  his \nwheelchair.  When  he  fell  back  into  his  wheelchair,  he  pulled  me \ndown  with  him  and  I  heard  my  back  pop,  so  I  left  him  in  the \nwheelchair until someone else got there to assist me getting him in \nthe bed. \n \nQ Did  you  report  that  incident  to  somebody  in  a  supervisory \ncapacity that day? \n \nA When I left, there was no supervisors. No nurses had made \nit. There was nobody there. \n \nQ So when did you first report it? \n \nA I  spoke  with  Jasmine  that  Friday  before  I  went  to  the \nemergency room. \n \nQ Now, who is Jasmine? \n \nA She was – she is – I think it’s the DON. \n \nQ And that is the Director of Nursing? \n \nA Yes, sir. \n \nQ Now,  you  saw  before  you  went  to  the  emergency  room. \nThe  records  indicate  that  you  went  to  the  emergency  room  on  the \n16\nth\n, which would have been two days later. \n \nA Yes, sir. \n \nOn  cross  examination  the  claimant  was  asked  about  her  direct  examination  testimony  and \ndeposition testimony regarding the February 14, 2024, incident and her reporting of it as follows: \nQ Ms.  Richard,  you  are  describing  an  incident  that  occurred \non February 14\nth\n, correct? \n \nA Yes, sir. \n \n\nRichard – H404248 \n \n-5- \nQ And it is my understanding that when this incident occurred \nwith  the  gentleman  you  were  assisting  from  the  wheelchair  to  the \nbed, that you felt a pop in your lower back? \n \nA Yes, sir. \n \nQ Not in your neck? \n \nA Not in my neck. \n \nQ And when that occurred, you experienced low back pain? \n \nA Yes, sir. I also had pain in my neck and my shoulder. \n \nQ Okay. As a matter of fact, you recall that Ms. Rambo here \ntook your deposition back on August 12, 2024, this last summer? \n \nA Yes, sir. \n \nQ She  asked  you  about  what  your  pain  was  and  she  said, \n“Okay. So you felt your back pop. Was it in your lower back?” \n \n You answered, “My lower back.” \n \n MR. ARNOLD: This is Page 19 \n \nQ [BY MR ARNOLD]: (Continued) “And I started to have \npains  like  in  my  neck,  my  right  neck,  the  right  side  of  my \nshoulder.” \n \nA Uh-huh. \n \nQ And she said, “Okay. Your right shoulder?” \n \n And you said, “Yes.” \n \n Is that your testimony? \n \nA It  is  the  left  side,  but  from  where  I  was  sitting,  it  might \nhave looked – seemed like right to me, but it is my left side. \n \nQ Okay.  She  asked  you  a  little  bit  later  about  this  report  to \nJasmine. \n \nA Uh-huh. \n\nRichard – H404248 \n \n-6- \n \nQ And you said that you told Jasmine that you were, “Having \npain in my neck and my shoulder on my right side.” \n \n So  in  August  you  were  explicit  that  the  pain  you  felt \ninitially was on the right side of your neck and shoulder. \n \nA I never told Jasmine that it was on  my right side. I did tell \nher  that  I  was  having  the  pain,  but  I  never  told  her  it  was  on  my \nright side. \n \nQ Okay. At Page 22 of your deposition taken by Ms. Rambo, \nshe asked, “Did you report that you had injured your shoulder to \nKim or Jasmine?” \n \n You said, “I did. I told her I was having pains in my neck \nand my shoulder on the right side.” \n \nA Again, I was in pain and it’s my left side. And it’s also in \nthe paperwork that it is is the left side. \n \nQ Okay. Let’s talk about that. \n \nA Yes. \n \nQ You  did  not  report  this  incident  to  anyone  at  the  nursing \nhome on February the 14\nth\n. \n \nA That’s true. \n \nQ Okay. You did not report it to anyone at the nursing home \non February the 15\nth\n. \n \nA That is true. \n \nQ You  did  not  report  it  to  anyone  at  the  nursing  home  until \nFebruary   the   16\nth\n after   you   had   been   to   seek   the   folks   in \nOklahoma? \n \nA You mean the hospital? \n \nQ Yes. \n \nA No. I talked to Jasmine before I went to the hospital. \n \n\nRichard – H404248 \n \n-7- \nQ Okay. Is that when you told her that it was your right side? \n \nA No. I didn’t tell her it was either side. I told her that I was \nhaving pain and that I was hurt and I think it was my back and my \nneck. \n \nQ Again, in your deposition you told us it was your right side. \n \nA And  I  understand  that.  And  again,  I  was  in  pain.  And  also \nfrom the way we were sitting, I was trying to see which way it was, \nbut I said right side, but I gestured my left side. \n \n On  February  16,  2024,  the  claimant  was  seen  at  Eastern  Oklahoma Medical  Center \nemergency  department  in  Poteau,  Oklahoma,  by  Dr.  Jeffrey  Johnson. The claimant’s medical \nrecord from that visit in part states: \nCHIEF COMPLAINT \nChief Complaint: LEFT SIDE NECK PAIN \n \nHPI \nPatient  Name:  RICHARD,  SHUNDREKA  M.  is  a  Age:  33  years \nwho presents with left sided neck pain that radiates down into left \narm. no trauma or known injury. she works as a CNA at a nursing \nhome  and  does  heavy  lifting.  no  numbness  or  weakness.  no  fever \nor chills. no n/v. no rash. no uri symptoms. no headache. \n \n*** \nPHYSICAL EXAM \n \n*** \nNeck:  Supple. left crivical  [sic] paraspinous  muscles  are  tender  to \npalp. no midline bony tenderness \n \n*** \nDiagnostic Considerations and Summary of Care: \nPt here with atraumatic neck pain. no red flags. normal exam \nI gave  dose  of  Toradol  here. will  dc  with  rx  for  meloxicam  and \nrobaxin. \nShe  will  call  her  pcp  in  one  week  if  not better.  I  told  her  that  she \nmay need an MRI of neck if not improving. \n \n*** \nNursing Note \n\nRichard – H404248 \n \n-8- \n33  year  old  female  presents  to  ER  from  home  with  primary \ncomplaint   of   left   neck   pain   which   has   been   present   since \nWednesday.  Patient  works  as  a  CNA  at  finna  nursing  home. \nPatient  reports  taking  home  nsaids  with  no  relief  reported.  Patient \nis  alert  and  oriented  times  4  with  clear  and  appropriate  speech. \nGCS is 15. Spontaneous unlabored respirations assessed with even \nchest rise and fall. Patient ambulated to ER 4 with a steady gait and \nwas triaged at bedside. \n \n*** \nPRESCRIPTIONS WRITTEN \nContinue    regular    medicines    unless    specified    below.    New \nmedications by the provide will also be stated below. \nRobaxin  (methocarbamol)  500  Mg.  Tablets,  Dispense:  40  (Forty) \n500 mg. How To Use; Take two (2) tablets by mouth every 6 hours \nas needed for muscle spasm, Refills: None (0). \n \nINSTRUCTIONS \n1. You have been given  a medicine or prescription for medication \ncalled Robaxin (Methocarbamol). \n- This medication is used to relieve muscle spasm. \n \n The  claimant’s  next  chronological  medical  record  in  evidence  is  from  Mercy  Clinic \nOccupational Medicine – Fort Smith dated February 23, 2024. I find no mention of the claimant \nhaving cervical difficulties or complaints in that medical record. That report reflects the claimant \nhaving lower back pain from lifting a resident. The claimant was given a diagnosis of “1. Strain \nof  muscle(s)  and  tendon(s)  of  the  rotator  cuff  of  left  shoulder,  initial  encounter  (S46.012A). 2. \nStrain of muscle, fascia and tendon of lower back, initial encounter (S39.012A)” by APN Tawni \nGlander. The claimant was also placed on restricted work duty at that time.  \n After the claimant’s February 16, 2024, initial visit where she complained of cervical \npain, there are 15 medical reports in evidence beginning with a February 23, 2024, visit to Mercy \nClinic  Occupational  Medicine – Fort  Smith  until  she  again  reports  cervical  difficulties  or \ncomplaints  to  a  medical  provider  on  July  24,  2024.  That  report  is  made  to  Eastern  Oklahoma \nMedical Center. Following is a portion of that medical report: \n\nRichard – H404248 \n \n-9- \nChief Complaint: Chief Complaint: Fall \n \nHistory of Present Illness: \nPatient Name: RICHARD, SHUNDREKA M is a Age: 33 years \nwho presents for evaluation of Chief Complaint: Fall \n \nPt reports walking out front door today and her “legs gave out” pt \nreports hx of bulging disc of L5, S1. Pt reports hitting her left side \nwhen she fell. \n \nTime of Symptom Onset: 6 hour(s) ago \n \n*** \nRISK: \nDrugs: Rx Medications considered but not prescribed OTC drugs \nTreatment:  Diagnosis  or  treatment  significant  risks  discussed. \nDiagnostic test considered but not performed \n \nPatient  was  seen  and  evaluated  by  myself.  History  and  physical \nexam is consistent with low back and cervical strain. There are no \nsigns or symptoms concerning for spinal cord compression, spinal, \ninfection, or any other neurosurgical emergency. I did consider CT \nor  x-ray  imaging,  however  I  do  not  believe  these  are  necessary  at \nthis  time.  The  patient  was  given  IM  Toradol  and  Norflex  in  the \nemergency  department.  I  do  believe  she  is  safe  for  outpatient \nfollow-up. I did consider prescription for narcotic pain medication, \nhowever  I  do  not  believe  this  is  necessary  at  this  time.  She  has  a \nfollow-up  appointment  tomorrow  with  pain  management  for  her \nchronic  pain.  I  recommend  over-the-counter  Tylenol  and  topical \nanalgesics.   She   was   given   return   precautions   and   follow-up \ninstructions. \n \nProblem List \nAcute COVID-19 \nLow back strain \nCervical strain \n \n The claimant begins to  report cervical pain to other medical providers  after her July 24, \n2024, Eastern Oklahoma Medical Center visit where she reported a fall and had a physical exam \nconsistent  with  cervical  strain.  The  claimant  was  seen  at  the  Mercy  Clinic  Department  of  Pain \nMedicine for a follow-up after she received a lumbar steroid injection. That report, dated July 25, \n\nRichard – H404248 \n \n-10- \n2024, in part states, “she does have shoulder and neck pain.” On July 30, 2024, the claimant was \nseen at Mercy Clinic Primary Care in Poteau and reports cervical and low back pain. That report \nalso states: \nASSESSMENT AND PLAN: \n1. Lumbar radiculopathy \nChronic issue, patient is scheduled to see neurosurgery on October \n17\nth\n. Prescribing tramadol today to help with stability. \n \n2. Chronic anemia \nChronic issue, currently on Ferralet. H&H and ferritin remains low \nCBC/ferritin now. Hematology appointment on 8/19 \n- CBC WITH DIFFERENTIAL; Future \n- FERRITIN; Future \n \n3. B12 deficiency \nChronic issue, stable at this time with B12 replacement. Continue 1 \ncc IM monthly. \n \n The  claimant  is  seen  by  Dr.  James  Blankenship  at  the  Neurosurgery  Spine  and  Pain \nManagement  Center  on  September  23,  2024.  That  medical  report  primarily  deals  with  the \nclaimant’s lumbar spine but does address her cervical spine in part as follows: \nHPI: \n \n*** \nThe  patient  also  had  and  is  still  having  neck  and  upper  left  arm \npain.  This has not  gotten  any  better  since  the  accident  but  has \nreally not been worked up. \n \n*** \nRecommendations: \n \n*** \nConcerning  her  neck,  we  are  going  to  get  an  MRI,  and  we  will \nreview  this.  Obviously,  if  it  shows  cord  compression,  we  will  get \nher back in here. If not, we will continue on with this conservative \ntreatment plan. The patient left with no further questions. \n \n\nRichard – H404248 \n \n-11- \n On  October  23,  2024,  the  claimant  underwent  an  MRI  of  the  cervical  spine  at  MANA \nMRI. Dr. Blankenship authored the diagnostic report. Following is a portion of that report: \nC2-3: Midline disc bulge is noted with no cord, canal or foraminal \ncompression. \nC3-4: No disc herniation, neural foraminal narrowing, or central or \nlateral recess stenosis is noted. \nC4-5:   Midline   disc   protrusion   with   the   AP   canal   diameter \nmeasuring in the axial plane 8 mm. \nC5-6: Midline disc protrusion with gross annular fissuring is noted. \nIn the midline where the disc has protruded, the AP canal diameter \nmeasures 7 mm. \nC6-7:  No  disc  herniations,  neural  foraminal  narrowing,  or  central \ncanal stenosis is noted. \nC7-T1: No disc herniations, neural foraminal narrowing, or central \ncanal stenosis is noted. \n \nIMPRESSION:   Midline   disc   protrusions   at   C4-5   and   C5-6 \nresulting  in  kyphotic  angulation  of  the  spine  with  the  spinal  canal \nAP diameter measuring 8 mm at C4-5 and 7 mm at C5-6. \n \n On October 31, 2024, Dr. Blankenship issued a note for the claimant’s chart regarding \nher cervical spine as follows: \nNOTE FOR CHART: I have reviewed the patient’s MRI in its \nentirety. The main purpose of this was to evaluate whether she has \nany cord compression. She did have some myelopathic findings on \nexamination.  The  patient  has  a  significantly  flat  neck  with  loss  of \nnormal  cervical  lordosis.  She  does  have  posterior  disc  bulging  at \nC5-6 and C6-7. Her midline disc protrusion at C4-5 does abut the \nanterior  horn  of  the  spinal  cord,  but  there  is  still  CSF  signal \ncircumferentially.  At  C5-6  she  has  the  same  thing  with  less  cord \nimpingement.  I  certainly  do  not  think  this  is  bad  enough  that  we \nneed to talk about surgical intervention at present. We need to stick \nwith  the  conservative  game  plan,  and  then  we  will  see  how  she  is \ndoing when she come back in to see us. \n \n On  November  21,  2024,  the  claimant  is  again  seen  by  Dr.  Blankenship.  Following  is  a \nportion of that medical record regarding the claimant’s cervical spine: \nChief Complaint: \nChief Complaint: LEFT SIDE LOW BACK PAIN; NECK PAIN. \n\nRichard – H404248 \n \n-12- \n \n*** \nDiagnosis: \nM54.2 Cervicalgia \nM50.20  Other  cervical  disc  displacement,  unspecified  cervical \nregion. \n \nImpression: \nThe  patient  returns  today  increasing  in  pain.  She  did  not  get  any \nrelief  with  her  SI  joint  injection.  She  is  still  complaining  of  neck \npain, left subscapular and left hand pain. The patient had posterior \ndisc protrusions at C4-5 and C5-6 that abut the anterior horn of the \nspinal  cord.  Her  degree  of  stenosis  is  borderline  with  CSF  signal \nnoted   posteriorly.   Certainly   her   disc   protrusion   and   kyphotic \nangulation  are  the  etiology  of  her  neck  pain  and  headaches.  I  do \nnot  think  there  is  enough  crowding  on  the  spinal  cord,  I  told  the \npatient,  that  she  needs  to  have  surgery,  although  her  increasing \nbalance  problems  are  a  little  bit  of  a  concern.  At  well  over  6 \nmonths   out   from   her   injury   and   having   failed   conservative \ntreatment,  a  discussion  about  surgical  intervention  on  her  neck  is \nnot unreasonable.  \n \n*** \nRecommendations: \nFrom   the   standpoint   of   pain,   I   have   offered   her   surgical \nintervention  on  both.  I  have  talked  to  her  about  a  C4-5,  C5-6 \nanterior    cervical    arthrodesis    and    fusion    with    spinal    cord \ndecompression and correction of alignment.  \n \n*** \nIn  summary,  the  rationale  for  offering  her  an  arthrodesis  in  her \nneck is due to her segmental spinal stenosis as well as her kyphotic \nangulation.  \n \n On  December  9,  2024,  the  claimant  was  seen by  Dr.  Wayne  Bruffett.  Following  is  a \nportion of that medical record regarding the claimant’s cervical spine: \nChief Complaint: \nNeck pain and low back pain \n \nHPI: Shundreka Richard is a 34 y.o. year old female who got hurt \nat  work  on  February  14\nth\n.  She  works  as  a  CNA.  She  was  lifting  a \nresident who became dead weight and the patient experienced pain \nin her neck and low back. She has had an MRI scan of her cervical \n\nRichard – H404248 \n \n-13- \nand  lumbar  spine  and  she  reports  that  she  has  had  extensive \ntreatments  with  medications  physical  therapy  and  spinal  cord \ninjections. Surgery has been recommended in both the cervical and \nlumbar spine. She is here for an IME. \n \n*** \nDiagnosis   cervical   degenerative   disc   disease   with   cervical \nstrain \nLumbar degenerative disc disease with lumbar strain \nDisc   herniation   L5-S1   on   the   left   without   specific   S1 \nradiculopathy \n \nAssessment: \nShundreka  Richard  is  a  34  y.o.  year  old  female  with  3  young \nchildren  who  had  a  work  related  injury  resulting  in  neck  and  low \nback pain. She is here for a 2\nnd\n opinion/IME. \n \nPlan: \nI was asked to assess whether the  proposed surgeries are indicated \nor  not.  I  would  say  with  a  reasonable  degree  of  medical  certainty \nthat  the  proposed  cervical  and  lumbar  fusion  surgeries  are  not \nindicated. In the cervical spine there is no evidence of nerve root or \nspinal  cord  compression  there  is  no  instability  or  fracture.  In  my \nopinion she does not have “segmental spinal stenosis” nor does she \nhave “kyphotic angulation in the cervical spine” as described by \nDr. Blankenship.  \n \n*** \nIt also appears that the patient will be given a cervical brace and a \nlumbar  brace  and  a  cervical  bone  stimulator  and  a  lumbar  bone \nstimulator  to  be  used  after  the  surgery.  The  cost  for  these  items \napparently  is  $1200  for  each  brace  and  $5000  for  each  stimulator \n“all to be given by Dr. Blankenship”. \n \n*** \n But she certainly does not need a 2 level cervical fusion nor does \nshe  need  an  anterior  lumbar  fusion.  I  would  not  recommend  any \nsurgery for her. \n \n On  January  30,  2025,  Dr.  Blankenship  authored  a  letter  to  the  claimant’s  attorney. \nFollowing are portions of that letter concerning the claimant’s cervical spine: \nI  have  received  Dr.  Bruffett’s  report  regarding  his  12-09-2024 \nevaluation  of  Ms.  Richard.  I  have  also  reviewed  my  previous \n\nRichard – H404248 \n \n-14- \nnotes.  First  of  all,  the  patient  has  certainly  failed  all  routine  and \nusually  conservative  measures.  I  respectfully  disagree  with  Dr. \nBruffett’s report. I have been following this patient for some time. \nShe does have significant pain.  \n \n*** \nConcerning  her  cervical  spine,  again,  as  I  have  indicated  in  my \nnotes, she has anterior disc protrusion with kyphotic angulation. In \nher  cervical  spine,  this  is  a  little  bit  more  difficult  diagnosis  and \noffering of treatment. She does have a narrowed spinal canal but is \nnot  myelopathic  on  examination.  Alignment  issues  have  become \nmore  and  more  apparent  thanks  to  our  orthopedic  brethren.  I  still \nthink  is  a  very  good  probability  that  correcting  her  alignment  will \nafford her long-term relief. \n \nI would also be reasonable to fix her back and then try to be more \nfocused on her neck after recovering from her back. \n \n*** \nAt present, given the description of her job, I do not feel she is able \nto return to work in her current job description. \n \nThis  narrative  has  been  based  on  a  reasonable  degree  of  medical \ncertainty. Any questions or concerns can be forwarded to me. \n \n On February 19, 2025, Dr Theodore Hronas authored a letter to the respondent’s attorney \nregarding a records review of the claimant’s case. Following are portions of that letter related to \nthe claimant’s cervical spine: \nThe  clinical  history  is  of  a  work-related  accidental  injury  that \noccurred  on  02/14/2024  and  described  as  “she  was  lifting  a \nresident  who  became  dead  weight  and  the  patient  experienced \npain.” MRI exams of the cervical and lumbar spine are presented \nfor  review.  The  studies  are  of  good  quality  and  sufficient  for \ndiagnostic   purposes.   I   am   a   board-certified   radiologist   with \nadditional training in body and musculoskeletal MRI, and therefore \nmy focus will be on the imaging studies provided. \n \n*** \nThe   MRI   of   the   cervical   spine,   10/23/2024,   demonstrates \nstraightening  but  normal  alignment  of  the  cervical  spine,  with  no \nevidence   of   fracture,   subluxation,   or   presence   of   a   kyphotic \ndeformity. The visualized posterior fossa and the cervical cord are \n\nRichard – H404248 \n \n-15- \nnormal. There is mild disc height loss and desiccation with diffuse \ndisc  bulging  at  C2/3,  C3/4,  C4/5,  and  C5/6,  with  superimposed \nsmall central disc protrusions at C2/3, C4/5, and C5/6 resulting in \nmild  central  canal  stenosis  without  cord  deformity  at  these  levels. \nThe  C6/7  and  C7/T1  disc  levels  are  normal.  The  foramina  are \npatent at all cervical levels. The posterior elements are intact. \n \n The   claimant   has   asked   the   Commission   to   determine   whether   she   sustained   a \ncompensable  cervical  spine  injury  on  February  14,  2024,  in  the  same  incident  in  which  she \nsustained a compensable lumbar spine and left shoulder injury. \nIn  order  to  prove  a  compensable  injury  as  the  result  of  a  specific  incident  that  is \nidentifiable by time and place of occurrence, a claimant must establish by a preponderance of the \nevidence  (1)  an  injury  arising  out  of  and  in  the  course  of  employment;  (2)  the  injury  caused \ninternal or external harm to the body which required medical services or resulted in disability or \ndeath;  (3)  medical  evidence  supported  by  objective  findings  establishing  an  injury;  and  (4)  the \ninjury was caused by a specific incident identifiable by time and place of occurrence. Odd Jobs \nand More v. Reid, 2011 Ark. App. 450, 384 S.W. 3d 630. \n The claimant was clear in her testimony that she experienced a “pop” in her low back but \nnot  her  neck.  However,  the  claimant  testified  that  she  felt  pain  in  her  cervical  spine  or  neck  at \nthat  time.  The  claimant  reported  her  incident  two  days  later  and  was  seen  at  the  Eastern \nOklahoma  Medical  Center  emergency  department  that  same  day.  During  that  visit  she  reported \ncervical  pain.  Her  physical  exam  from  that  visit  states, “Neck: Supple. left crivical  [sic] \nparaspinous  muscles  are  tender  to  palp.  No  midline  bony  tenderness.”  The  claimant  was \ndiagnosed with a cervical strain and prescribed Robaxin specifically “to alleviate muscle spasm.” \nDr.  Jeffrey  Johnson  was  the  physician  at  the  EOMC  emergency  department.  He  clearly  made \nobjective  findings  regarding  the  claimant’s  cervical  spine  in  the  physical  exam  noting “left \n\nRichard – H404248 \n \n-16- \ncrivical   [sic] paraspinous   muscles are  tender  to  palp.”  In  conjunction  with  specifically \nprescribing  Robaxin  for  muscle  spasm,  this  finding  is  consistent  with  the  Court  of  Appeals \ndecision in Melius vs Chapel Ridge Nursing Center, LLC, 2021 Ark. App. 61, 618 S.W.3d 410, \nregarding  objective  medical  findings.  The  claimant  is  also  able  establish  a  causal  connection \nbetween her objective medical findings and the incident in which she alleges the cervical injury. \nThat same incident resulted in compensable lumbar spine and left shoulder injuries. The claimant \nfirst  reported  her  cervical  pain  to  her  first  medical  provider,  Dr.  Johnson.  I  find  the  claimant  is \nable to prove she sustained a compensable cervical injury on February 14, 2024, in the form of a \ncervical strain. \n It appears that the claimant’s cervical strain resolved quickly as  the  claimant  did  not \nagain  make  medical  providers  aware  of  cervical difficulties until  a  fall  in  July  of  2024.  The \nclaimant’s medical records do not indicate cervical pain or difficulties after  her  February  16, \n2024, emergency department visit until her fall in July of 2024. The claimant then begins to often \ncomplain of cervical pain.  \n It  is  at  that  time  that  the  medical  records  show  she  begins  to  seek  treatment  which  has \nultimately brought Dr. Blankenship to the conclusion that the claimant needs cervical surgery. I \nnote both Dr. Bruffett and Dr. Hronas disagree with Dr. Blankenship’s recommendation for \nsurgery. The claimant must prove that the medical treatment in the form of surgical intervention \nis reasonable and necessary treatment for her compensable cervical spine injury. \nEmployers  must  promptly  provide  medical  services  which  are  reasonably  necessary  in \nconnection  with  the  compensable  injuries,  Ark.  Code  Ann.  §11-9-508(a).    However,  injured \nemployees have the burden of proving by a preponderance of the evidence that medical treatment \nis  reasonably  necessary.   Patchell  v.  Wal-Mart  Stores,  Inc.,  86  Ark.  App.  230,  184  S.W.3d  31 \n\nRichard – H404248 \n \n-17- \n(2004).    What  constitutes  reasonable  and  necessary  medical  treatment  is  a  fact  question  for  the \nCommission,  and  the  resolution  of  this  issue  depends  upon  the  sufficiency  of  the  evidence.  \nGansky v. Hi-Tech Engineering, 325 Ark. 163, 924 S.W.2d 790 (1996). \n While   I   recognize   the   medical   opinions   of   Dr.   Blankenship   differ   regarding   the \nclaimant’s cervical spine on the course of treatment, they also differ on how the claimant’s MRI \nresults  are read.  I  agree  with  the  position  of  Dr. Bruffett  and  Dr.  Hronas  that  the  claimant  does \nnot  need  the  recommended  cervical  spine  surgery.  Furthermore,  I  find  that  any  cervical  spine \ntreatment the claimant is in current need of is the result of her July 2024 fall when she begins to \ncomplain of cervical spine pain again or some other condition. The claimant has failed to prove \nby a preponderance of the evidence that the cervical surgery recommended by Dr. Blankenship is \nreasonable and necessary treatment for her compensable cervical strain of February 14, 2024. \n The  claimant  has  also  asked the  Commission  to  determine  whether  she  is  entitled  to \nadditional  medical  treatment  for  her  compensable  low  back  injury  of  February  14,  2024.  I  note \nthat  several  of  the  later  dated  medical  records  admitted  into  evidence  deal  with  both  the \nclaimant’s lumbar and cervical spine. I have attempted above to isolate the portions of those \nmedical records that deal with the cervical spine. I will attempt to do the same here regarding the \nclaimant’s lumbar spine. \n The  claimant’s  medical  records  clearly  indicate  that  she  has  continuously  sought \ntreatment  for  her  lumbar  spine  beginning  with  her  February  23,  2024,  visit  to  Mercy  Clinic \nOccupational  Medicine – Fort  Smith,  including  a  lumbar  MRI  performed  on  March  22,  2024. \nThe diagnostic report was done by Dr. Alan Richard  at Mercy  Hospital and gave the  following \nImpression: \nImpression: \n\nRichard – H404248 \n \n-18- \nIMPRESSION: \nMild  degenerative  change  throughout  the  lumbar  spine.  The  most \nsignificant finding is a broad-based disc bulge eccentric to the left \nat L5-S1 which abuts the proximal S1 nerve root. \n \n The  claimant  has  undergone  conservative  treatment  including  prescription  medications, \nlumbar  epidural  steroid  injections,  and  physical  therapy.  The  claimant  eventually  finds  herself \nunder  the  care  of  Dr.  Blankenship  on  September  23,  2024.  Following  is  a  portion  of  that  visit \nnote regarding the claimant’s lumbar spine: \nHPI: \nThe patient has lower back pain, bilateral hip and buttock pain left \ngreater  than  right,  posterior  lower  extremity  pain  left  greater  than \nright,  and  decreased  strength  in  both  legs  left  greater  than  right. \nShe  has  fallen  a  couple  of  times.  She  denies  any  incontinence  or \nretention.  Standing,  walking,  and  bending  increase  her  pain.  She \nwas  injured  in  2/2024  lifting  a  resident  and  turned  and  her  back \npopped with progressive increase in her pain. She was given some \nhome  exercises  but  has  had  no  significant  conservative  treatment \nother   than   an   LESI   that   was   done   in   6/2024   that   actually \nexacerbated  her  pain.  She  is  currently  only  taking  gabapentin  300 \nmg 3 times a day. The patient also had and is still having neck and \nupper  left  arm  pain.  This has not  gotten  any  better  since  the \naccident but has really not been worked up. \n \nChief Complaint: \nChief Complaint: LEFT SIDE LOW BACK PAIN. \n \n*** \nDiagnosis: \nM51.26 Other intervertebral disc displacement, lumbar region \nM54.50 Low Back Pain \n \nImpression: \nHer   general   neurological   examination   reveals   the   patient   has \ndecreased  sensation  in  the  L5  and  S1  dermatomes  on  the  left. \nInterestingly,  she  has  some  myelopathic  findings  on  exam  with \nmostly  brisk  reflexes  throughout  the  upper  and  lower  extremities \nwith a positive Hoffmann’s on the right. Her SI joint examination \nis   markedly   positive   on   the   left-hand   side.   Her   piriformis \nexamination is also positive. \n \n\nRichard – H404248 \n \n-19- \nHer  MRI  demonstrates  a  gross  annular  fissure  off  to  the  left-hand \nside  consistent  with  her  back  pain  on  that  side  as  well  as  her  leg \npain.  She  has  significant  foraminal  narrowing  due  to  disc  space \nsettling  and  a  posterior  disc  protrusion  along  with  a  caudally \nmigrated  disc  fragment  on  the  left.  I  told  her  concerning  this  we \nneed to treat this conservatively. \n \n*** \nRecommendations: \n \n*** \nI  would  recommend  that  we  have  Dr.  David  Cannon  evaluate  her \nfor a left-sided SI joint injection at the lumbosacrum on the left. If \nshe  does  not  get  any  significant  relief  with  this,  I  do  want  to  go \nahead  with  the  transforaminal  ESI  at  L5-S1  on  the  left  if  Dr. \nCannon  agrees.  It  is  complicated  is  the  as  we  get  her  back  in  to \nwork with Velvet’s folks, I do not want to start doing anything \nwith her neck until we get the MRI. Once I see it, if it is okay, we \nwill  add  that  to  her  treatment  regimen.  I  have  recommended  we \nstart her on meloxicam and have her continue on her gabapentin. I \ntold  her  most  importantly  we  need  to  get  her  started  with  an \naggressive  active  physical  therapy  program.  She  lives  in  Podo.  I \ntold  her  my  preference  would  be  to  have  this  done  in  Fort  Smith, \nbut I realize that is 30 minutes away. We will coordinate that with \nher before she leaves today. I do want to go ahead and get her set \nup  to  see  Dr.  Cannon.  Unfortunately  for  her,  there  is  nobody  here \ntoday, and we will have to get it authorized. \n \n*** \nIn summary, she does have a posterior disc protrusion eccentric off \nto  the  left.  I  do  think  this  is  the  probable  culprit  of  her  pain, \nalthough  she  certainly  does have  some  S1   findings,  and  the \nmechanism of injury would be consistent with either. I would like \nto get her SI joint injected first and if that does not bear fruit do a \ntransforaminal  ESI  at  the  lumbosacrum  on  the  left-hand  side.  We \nare going to start working the Velvet’s folks. I will plan on seeing \nher  back  in  about  8  weeks.  Since  her  work  cannot  accommodate \nrestrictions,   she   is   off   work   until   she   sees   me   back.   She \nunderstands and agrees with the game plan. \n \n The claimant again saw Dr. Blankenship on November 21, 2024. Following is a portion \nof that visit note regarding the claimant’s lumbar spine: \nHPI: \n\nRichard – H404248 \n \n-20- \nThe  patient  is  in  today  with  a  new  cervical  MRI.  She  has  been \ndoing  her  physical  therapy  for  her  neck  and  her  low  back.  She \nstates  it  does  not  afford  any  relief;  if  anything,  it  aggravates  her \npain.  She  is  still  taking  her  meloxicam  and  rates  her  pain  about \n80%   toward   the   worst   pain   imaginable.   Her   greatest   pain \ncomplaint is her left-sided low back pain that radiates into the left \nhip, left buttock, and goes down the posterior aspect of the bilateral \nlower  extremities  to  her  feet  with  her  left  greater  than  right.  She \nhas decreased strength in both legs, left greater than right. She did \nget her left SI joint injection but had no relief.  \n \n*** \nChief Complaint: \nChief Complaint: LEFT SIDE LOW BACK PAIN; NECK PAIN. \n \n*** \nDiagnosis: \nM54.2 Cervicalgia \nM50.20  Other  cervical  disc  displacement,  unspecified  cervical \nregion. \n \nImpression: \nThe  patient  returns  today  increasing  in  pain.  She  did  not  get  any \nrelief with her SI joint injection.  \n \n*** \nConcerning  her  lumbar  spine,  she  has  marked  disc  space  settling \nand  foraminal  stenosis  at  the  lumbosacrum.  She  does  have  some \nmild bilateral lateral recess stenosis at L4-5, and she has a midline \ndisc  protrusion  with  several  bilateral  foraminal  stenosis  at  the \nlumbosacrum.  I  do  not  have  any  doubt  that  that  is  the  etiology  of \nher back pain and leg pain. \n \nRecommendations: \n \n*** \nAt  the  lumbosacrum,  she  would  need  to  undergo  an  anterior \nlumbar interbody arthrodesis with ENZA-A stabilization. I told her \ninitially   I   would   rely   on   indirect   decompression   rather   than \nopening her back up to openly decompress the nerve roots. After a \nvery lengthy discussion, she does want to proceed on with cervical \nand  lumbar  arthrodesis.  I  have  told  her  we  would  do  the  cervical \nfirst   and   then   a   week   or   2   later   do   her   lumbar   standalone \narthrodesis. She left with no further questions.  \n \n\nRichard – H404248 \n \n-21- \n*** \nThe  rationale  for  the  lumbar  spine  is  failure  of  conservative \ntreatment  with  a  midline  disc  herniation  with  retrolisthesis  and \nsagittal plane malalignment. \n \n On  December  9,  2024,  the  claimant  was  seen  by  Dr.  Wayne  Bruffett.  Following  is  a \nportion of that medical record regarding her lumbar spine: \nChief Complaint: \nNeck pain and low back pain \n \nHPI: Shundreka Richard is a 34 y.o. year old female who got hurt \nat  work  on  February  14\nth\n.  She  works  as  a  CNA.  She  was  lifting  a \nresident who became dead weight and the patient experienced pain \nin her neck and low back. She has had an MRI scan of her cervical \nand  lumbar  spine  and  she  reports  that  she  has  had  extensive \ntreatments  with  medications  physical  therapy  and  spinal  cord \ninjections. Surgery has been recommended in both the cervical and \nlumbar spine. She is here for an IME. \n \n*** \nDiagnosis   cervical   degenerative   disc   disease   with   cervical \nstrain \nLumbar degenerative disc disease with lumbar strain \nDisc   herniation   L5-S1   on   the   left   without   specific   S1 \nradiculopathy \n \nAssessment: \nShundreka  Richard  is  a  34  y.o.  year  old  female  with  3  young \nchildren  who  had  a  work  related  injury  resulting  in  neck  and  low \nback pain. She is here for a 2\nnd\n opinion/IME. \n \nPlan: \nI was asked to assess whether the  proposed surgeries are indicated \nor  not.  I  would  say  with  a  reasonable  degree  of  medical  certainty \nthat  the  proposed  cervical  and  lumbar  fusion  surgeries  are  not \nindicated.  \n \n*** \nApparently  his  indication  for  the  lumbar  fusion  is  “failure  of \nconservative   treatment   with   a   midline   disc   herniation   with \nretrolisthesis and sagittal plane malalignment”. It also appears that \nthe patient will be given a cervical brace and a lumbar brace and a \ncervical  bone  stimulator  and  a  lumbar  bone  stimulator  to  be  used \n\nRichard – H404248 \n \n-22- \nafter  the  surgery.  The  cost  for  these  items  apparently  is  $1200  for \neach brace and $5000 for each stimulator “all to be given by Dr. \nBlankenship”. \n \nThe  patient  has  positive  Waddell  signs.  Today  she  is  using  a \nrolling type walker. Her description of her pain is in excess of any \nobjective findings on her imaging. She does have a disc herniation \nat  L5-S1  on  the  left.  If  she  had  a  specific  S1  radiculopathy  down \nher left leg and failed specific treatments directed towards this then \na  microscopic  partial  diskectomy  at  L5-S1  on  the  left  in  my \nopinion   would   be   a   reasonable   surgical   procedure   for   her. \nHowever,   she   does   not   really   complain   of   a   specific   S1 \nradiculopathy  down  her  left  leg  and  does  not  have  any  type  of \nneurological deficit associated with this so in my opinion a surgery \nsuch  as  that  would  even  have  risks  that  would  outweigh  the \nbenefit.  \n \n*** \nI would not recommend any surgery for her. \n \n On  January  30,  2025,  Dr.  Blankenship  authored  a  letter  to  the  claimant’s  attorney \nregarding Dr. Bruffett’s medical report pertaining to the claimant’s lumbar spine. Those portions \nfollow: \nI  have  received  Dr.  Bruffett’s  report  regarding  his  12-09-2024 \nevaluation  of  Ms.  Richard.  I  have  also  reviewed  my  previous \nnotes.  First  of  all,  the  patient  has  certainly  failed  all  routine  and \nusually  conservative  measures.  I  respectfully  disagree  with  Dr. \nBruffett’s report. I have been following this patient for some time. \nShe  does  have  significant  pain.  She  does  have  lower  back  pain \nalong with her left posterolateral leg pain. I think that her leg pain \nis probably coming from the severe foraminal stenosis that she has \nbilaterally.  The  disc  protrusion  with  caudal  migration  and  annular \nfissuring   is   noted.   A   simple   discectomy   that   Dr.   Bruffett \nmentioned is not going to treat her foraminal stenosis at all. It is for \nthat  reason  I  offered  her  an  anterior  lumbar  interbody  arthrodesis \nas a standalone procedure to avoid operating  and cutting open her \nback,  which  will  lead  to  increased  morbidity.  As  far  as  the \nrisk/benefit  ration,  anterior  lumbar  interbody  arthrodesis  in  young \nand healthy people has a very low risk of morbidity, which I have \ngone  over  with  her,  and  she  has  accepted  those  risks  for  surgical \nintervention.  At  the  lumbosacrum,  we  are  working  between  the \nvessels. The incident of vascular injury is not significantly higher.  \n\nRichard – H404248 \n \n-23- \n \nIn  summary,  it  is  my  opinion  based  on  a  reasonable  degree  of \nmedical certainty that the offering of an anterior lumbar interbody \narthrodesis  as  a  standalone  procedure  to  decrease  morbidity  in \npostoperative recovery is a very reasonable thing to offer a patient \nwho has railed routine and usual conservative measures. \n \n*** \nI would also be reasonable to fix her back and then try to be more \nfocused on her neck after recovering from her back. \n \nAgain,  concerning  her  lumbar  spine,  in  my  clinical  practice  and \nyears  of  experience,  this  is  a  very  reasonable  offering  of  surgical \nintervention, and I respectfully disagree with Dr. Bruffett. \n \nAt present, given the description of her job, I do not feel she is able \nto return to work in her current job description. \n \nThis  narrative  has  been  based  on  a  reasonable  degree  of  medical \ncertainty. Any questions or concerns can be forwarded to me. \n \n On February 19, 2025, Dr. Theodore Hronas authors a letter to the respondent’s attorney \nregarding his review of a portion of the claimant’s medical records. Following is a portion of that \nletter regarding the claimant’s lumbar spine: \nThe  clinical  history  is  of  a  work-related  accidental  injury  that \noccurred  on  02/14/2024  and  described  as  “she  was  lifting  a \nresident  who  became  dead  weight  and  the  patient  experienced \npain.” MRI exams of the cervical and lumbar spine are presented \nfor  review.  The  studies  are  of  good  quality  and  sufficient  for \ndiagnostic   purposes.   I   am   a   board-certified   radiologist   with \nadditional training in body and musculoskeletal MRI, and therefore \nmy focus will be on the imaging studies provided. \n \nRadiographs  of  the  lumbar  spine  02/23/2024,  demonstrate  normal \nvertebral   body   alignment   with   no   evidence   of   fracture   or \nsubluxation.   The   posterior   elements   are   intact.   There   are   no \nradiographic findings of an acute lumbar spine injury. \n \nThe  MRI  exam  of  the  lumbar  spine,  03/22/2024,  was  performed \napproximately  five  weeks  after  the  date  of  injury.  This  exam \ndemonstrates   normal   alignment   of   the   lumbar   spine   with   no \nevidence  of  fracture  or  subluxation.  The  conus  medullaris  is \n\nRichard – H404248 \n \n-24- \nnormal.  Sagittal  STIR  images  demonstrate  no  evidence  of  bone, \ndisc space, or soft tissue edema. The T12/L1, L1/2, L2/3, and L3/4, \ndisc   spaces   are   preserved,   but   there   is   bilateral   mild   facet \narthropathy   at   these   levels,   with   no   associated   central   canal \nstenosis or foraminal narrowing. At L4/5, there is mild diffuse disc \nbulging,  bilateral  mild  facet  arthropathy,  and  ligamentum  flavum \nthickening  resulting  in  mild  to  moderate  central  and  lateral  recess \nstenosis  and  bilateral  mild  to  moderate  foraminal  narrowing.  At \nL5/S1,  there  is  disc  desiccation,  diffuse  disc  bulging,  with  a \nsuperimposed  broad-based  left  paracentral  disc  protrusion  causing \nnarrowing  of  the  left  lateral  recess  with  mild  mass  effect  on  the \nadjacent  S1  nerve  root.  There  is  bilateral  mild  facet  arthropathy \nand   mild   ligamentum  flavum   thickening   resulting   in   mild   to \nmoderate  foraminal  narrowing  at  the  L5/S1  level.  The  posterior \nelements are intact. There are no paraspinal abnormalities. \n \n*** \nIn  summary,  the  MRI  of  the  lumbar  spine  demonstrates  chronic \ndegenerative  changes  at  L4/5  and  L5/S1  with  a  broad-based  left \nparacentral  disc  protrusion  at  L5/S1  resulting  in  mild  mass  effect \non  the  adjacent  S1  nerve  root.  I  defer  to  the  clinical  evaluation  of \nDr.  Blankenship  and  Dr.  Bruffett  in  regard  to  whether  there  is  a \nsymptomatic left S1 radiculopathy. In regard to Dr. Blankenship’s \ncomment, “I think that her leg pain is probably coming from the \nsevere foraminal stenosis that she has bilaterally,” I see only mild \nto  moderate  bilateral  foraminal  narrowing,  not  severe  foraminal \nnarrowing,  at  L4/5   and  L5/S1  with  no  objective  findings  of \nforaminal  nerve  root  impingement  within  the  lumbar  spine  at  any \nlevel.  The  MRI  of  the  cervical  spine  demonstrates  multi-level \ndegenerative  changes,  and  multiple  small  central  disc  protrusions \nwithout cord deformity or foraminal narrowing at any level within \nthe cervical spine. In regard to Dr. Blankenship’s comment, “she \nhas anterior disc protrusion with kyphotic angulation,” I see no \nevidence   of   an   anterior   disc   protrusion   and   no   evidence   of \nkyphosis.  \n \nEmployers  must  promptly  provide  medical  services  which  are  reasonably  necessary  in \nconnection  with  the  compensable  injuries,  Ark.  Code  Ann.  §11-9-508(a).    However,  injured \nemployees have the burden of proving by a preponderance of the evidence that medical treatment \nis  reasonably  necessary.   Patchell  v.  Wal-Mart  Stores,  Inc.,  86  Ark.  App.  230,  184  S.W.3d  31 \n(2004).    What  constitutes  reasonable  and  necessary  medical  treatment  is  a  fact  question  for  the \n\nRichard – H404248 \n \n-25- \nCommission,  and  the  resolution  of  this  issue  depends  upon  the  sufficiency  of  the  evidence.  \nGansky v. Hi-Tech Engineering, 325 Ark. 163, 924 S.W.2d 790 (1996). \n The  claimant  has  continually  complained  of  lumbar  spine  difficulties  as  a  result  of  her \nFebruary 14, 2024, compensable lumbar spine injury. The claimant has undergone conservative \ntreatment and Dr. Blankenship, her treating physician, has recommended “At the lumbosacrum, \nshe would need to undergo an anterior lumbar interbody arthrodesis with ENZA-A stabilization. \nI  told  her  initially  I  would  rely  on  indirect  decompression  rather  than  opening  her  back  up  to \nopenly decompress the nerve roots.” \n Here,  clearly  Dr.  Blankenship  and  Dr.  Bruffett  disagree.  Dr.  Bruffett  says  he  ultimately \nwould  not  recommend  any  surgery  for  the  claimant, but  if  he  did,  it  would  be  a  microscopic \npartial  discectomy  at  L5-S1  on  the  left.  It  appears  Dr.  Bruffett  is  basing  his  opinion,  at  least  in \npart,  on  his  clinical  findings  including  positive  Waddell  signs  and  “pain  in  excess  of  any \nobjective findings.” As to Dr. Hronas, he does differ on the review of the claimant’s lumbar \nMRI.  Dr.  Hronas  finds  only  mild  to  moderate  bilateral  foraminal  narrowing.  Dr. Blankenship \nfinds there to be severe foraminal stenosis bilaterally. However, Dr. Hronas does state, “I defer \nto  the  clinical  evaluations  of  Dr.  Blankenship  and  Dr.  Bruffett  in  regard  to  whether  there  is  a \nsymptomatic left S1 radiculopathy.” \n I  find  Dr. Blankenship  to  be  in  the  best  position  to  clinically diagnose and  recommend \ntreatment for the claimant. Given the consistency of the claimant’s lumbar spine complaints, her \ntreating physician’s clinical observations of her, and the failed conservative treatment, I find Dr. \nBlankenship’s surgical recommendations for the claimant’s lumbar spine to be reasonable and \nnecessary treatment for the claimant’s compensable lumbar spine injury. \n\nRichard – H404248 \n \n-26- \n The  claimant  has  asked  the  Commission  to  determine  whether  she  is  entitled  to \ntemporary total disability benefits from March 26, 2024, through September 22, 2024.  \nIn order to be  entitled to temporary total disability benefits, the claimant  has the burden \nof proving by a preponderance of the evidence that he remains within his healing period and that \nhe suffers a total incapacity to earn wages as a result of his compensable injury. Arkansas State \nHighway  &  Transportation  Department  v.  Breshears, 272  Ark.  244,  613  S.W.  2d  392  (1981).\n The claimant gave direct examination testimony regarding her last treatment with Mercy \nClinic  Occupational  Medicine – Fort  Smith,  her  work  restrictions  and  discontinuing  work  as \nfollows: \nQ At  some  point  did  Occupational  Medicine  stop  providing \nyou treatment? \n \nA Yes. \n \nQ Do you know when, approximately? \n \nA I honestly don’t remember the date. \n \nQ What is your understanding of why Occupational Medicine \nstopped providing you treatment? \n \nA I was told that she didn’t know why they sent me. There \nwas  nothing  else  that  she  could  do  for  me.  And  that  I  should \ncontinue to follow up with my primary care physician. \n \nQ And   your   primary   care   physician   was   another   Mercy \ndoctor, but over in Oklahoma, I believe; is that right? \n \nA Yes, sir. \n \nQ So when did you start missing work? \n \nA When  I  went  to  work  and  I  had  a  conversation  with \nJasmine about my restrictions not being followed. They wanted me \nto help put residents in the bed and run meal trays. Anything aside \nfrom sitting work and vitals is what they wanted me to do. \n\nRichard – H404248 \n \n-27- \n \n And that day I told – I had a conversation with Jasmine and \nI  told  her  that  that  was  outside  of  my  restrictions.  She  never \nmessaged me back, but I left that day. \n \nQ So was that on or about March 26\nth\n of 2024? \n \nA Yes, sir. \n \nQ Have you been back to work since then? \n \nA Yes, I did. \n \nQ Now, my records show that that was on or about September \n23\nrd\n of  2024  and  the  workers’  compensation  insurance  carrier \nstarted your benefits as of that date; is that correct? \n \nA Yes, sir. \n \nQ Between   March   26\nth\n of  ’24  and  when  you  saw  Dr. \nBlankenship,  did  our  condition  stay  the  same,  get  better  or  get \nworse? \n \nA It got worse. \n \nQ If   you   were   unable   to   perform   your   job   duties   on \nSeptember  23\nrd\n of  2024,  would  you  have  also  been  unable  to \nperform  your  job  duties  during  the  period  of  time  between  March \n26\nth\n and September 23\nrd\n? \n \nA Yes, sir. \n \nQ What was there about your condition that caused you not to \nbe able to work? \n \nA Walking.  I  was  having  muscle  spasms.  Well,  I  still  have \nmuscle spasms when I walk. I have a pain in my legs, my butt, my \nback,  and  my  neck.  Bending  hurts.  Looking  up  or  looking  down \nfor too long, I get headaches in my head and I have to lay down. It \nmakes me nauseous. It makes me feel like I am going to pass out. \n \n The  work  restrictions  placed  on  the  claimant  were  from  Mercy  Clinic  Occupational \nMedicine – Fort  Smith  in  a  report  dated  March  25,  2024.  Those  restrictions  were  as  follows, \n\nRichard – H404248 \n \n-28- \n“Recommended Activity Restrictions Alternate sit/stand/walk as tolerated. Primarily sedentary \nduty.” The  next  medical  record  removing  the  claimant  from  work  or  restricting  the  claimant  is \nfrom  Dr.  Blankenship  on  September  23,  2024,  when  he  removes  the  claimant  from  work  until \nNovember 21, 2024. \n I find the claimant to have still been in her healing period from March 26, 2024, through \nSeptember 22, 2024. However, the claimant must also prove by a preponderance of the evidence \nthat  she  suffers  a  total  incapacity  to  earn  wages  as  a  result  of  her  compensable  injuries.  The \nclaimant cannot meet that proof regarding total incapacity. In fact, she was able to sit/stand/walk \nas tolerated and perform sedentary duties. At one point in testimony, the claimant complains of \ntaking  meal  trays  as  she  believes  it  to  be  outside  of  her  restrictions.  I  do  not  find  that  to  be  so. \nThe claimant was asked, “What was there about your condition that caused you not to be able to \nwork?” The first part of her response is “Walking,” which is clearly allowed at least in part under \nher  restrictions  during  that  period.  I  also  note  that  the  claimant  saw  several  other  medical \nproviders between March 26, 2024, and September 22, 2024, and to my knowledge, no provider \nplaced  restrictions  or  removed  the  claimant  from  work.  The  claimant  is  unable  to  prove  her \nentitlement  to  temporary  total  disability  benefits  from  March  26,  2024,  through  September  22, \n2024. \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 \n \n\nRichard – H404248 \n \n-29- \n FINDINGS OF FACT & CONCLUSIONS OF LAW \n 1.  The  stipulations  agreed  to  by  the  parties  at  the  pre-hearing  conference  conducted  on \nMarch 17, 2025, and contained in a Pre-hearing Order filed March 18, 2025, are hereby accepted \nas fact. \n 2. The  claimant  has  proven  by  a  preponderance  of  the  evidence  that  she  sustained  a \ncompensable injury to her cervical spine on or about February 14, 2024. \n 3. The claimant has failed to prove by a preponderance of the evidence that she is entitled \nto  medical  treatment  for  her  compensable  cervical  spine  injury  in  the  form  of  surgery  as \nrecommended by Dr. Blankenship. \n 4.  The  claimant  has  proven  by  a  preponderance  of  the  evidence that  she  is  entitled  to \nadditional  medical  treatment  for  her  compensable  low  back  injury  in  the  form  of  surgical \nintervention as recommended by Dr. Blankenship. \n 5. The claimant has failed to prove by a preponderance of the evidence that she is entitled \nto temporary total disability benefits form March 26, 2024, through September 22, 2024. \n 6. The claimant has failed to prove by a preponderance of the evidence that her attorney \nis entitled to an attorney’s fee in this matter. \n ORDER \nThe  respondent  shall  pay  the  cost  associated  with  the  surgical  recommendations  of  Dr. \nBlankenship for the claimant’s compensable lumbar spine injury, including its aftercare. \nPursuant  to  A.C.A.  §11-9-715(a)(1)(B)(ii),  attorney  fees  are  awarded  “only  on  the \namount of compensation for indemnity benefits controverted and awarded.” Here, no indemnity \nbenefits were awarded; therefore, no attorney fee has been awarded. Instead, claimant’s attorney \nis free to voluntarily contract with the medical providers pursuant to A.C.A. §11-9-715(a)(4). \n\nRichard – H404248 \n \n-30- \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. H404248 SHUNDREKA RICHARD, Employee CLAIMANT KMJ MANAGEMENT, LLC, Employer RESPONDENT ACCIDENT FUND INS., Carrier RESPONDENT OPINION FILED JULY 30, 2025 Hearing before ADMINISTRATIVE LAW JUDGE ERIC PAUL WELLS in Fort Smith, Sebastian County, Arkansas. Claiman...","fetched_at":"2026-05-19T22:39:11.567Z","links":{"html":"/opinions/alj-H404248-2025-07-30","pdf":"https://www.labor.arkansas.gov/wp-content/uploads/RICHARD_SHUNDREKA_H404248_20250730.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/"}}