{"id":"alj-H404336-2025-02-10","awcc_number":"H404336","decision_date":"2025-02-10","opinion_type":"alj","claimant_name":"Nancy Valencia","employer_name":"Washington Regional Medical Center","title":"VALENCIA VS. WASHINGTON REGIONAL MEDICAL CENTER AWCC# H404336 February 10, 2025","outcome":"denied","outcome_keywords":["granted:1","denied:5"],"injury_keywords":["back","lumbar","strain","herniated","shoulder","knee","hip","cervical"],"pdf_url":"https://www.labor.arkansas.gov/wp-content/uploads/VALENCIA_NANCY_H404336_20250210.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/","filename":"VALENCIA_NANCY_H404336_20250210.pdf","text_length":31048,"full_text":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION \n \n WCC NO. H404336 \n \nNANCY VALENCIA, Employee CLAIMANT \n \nWASHINGTON REGIONAL MEDICAL CENTER, Employer RESPONDENT \n \nRISK MANAGEMENT RESOURCES, Carrier RESPONDENT \n \n OPINION FILED FEBRUARY 10, 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 MELISSA WOOD, Attorney at Law, Little Rock, Arkansas. \n \n STATEMENT OF THE CASE \n \n On November 12, 2024, the above captioned claim came on for a hearing at Springdale, \nArkansas.   A pre-hearing conference was conducted on September 16, 2024, and a Pre-hearing \nOrder  was  filed  on September  17,  2024.      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 \n21, 2024. \n 3. The respondents have controverted the claim in its entirety. \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 low back on or about June 21, \n2024. \n\nValencia – H404336 \n \n-2- \n 2.  Whether  Claimant  is  entitled  to  medical  treatment  for  her  compensable  low  back \ninjury. \n 3. Whether Claimant is entitled to temporary total disability benefits from June 22, 2024,  \nto October 1, 2024. Other temporary total disability periods are reserved. \n 4. Whether Claimant’s attorney is entitled to an attorney fee. \n 5. Respondents raise lack of notice as a defense in that June 24, 2024, was the first notice \nof the alleged work-related injury sustained on or about June 21, 2024. \n 6. The claimant’s weekly compensation rates. \n The claimant's contentions are as follows: \n“Claimant  contends  she  is  entitled  to  medical  treatment,  and  to \nTTD   from   6/22/2024   to   date   yet   to   be   determined,   for   her \ncompensable back injury. Claimant reserves all other issues.” \n \n The respondents’ contentions are as follows: \n“Respondents contend that Claimant did not sustain a compensable \ninjury  to  her  lower  back  on  6/21/24  or  at  any  other  time  while \nworking  for  Respondent/Employer.  Claimant  did  not  sustain  an \ninjury  in  the  course  and  scope  of  her  employment,  and  she  has \npreexisting  issues  with  regard  to  her  lower  back.  Respondents \ncontend  that  there  was  no  notice  of  the  alleged  injury  given  until \n6/24/24.” \n \n The  claimant  in  this  matter  is  a 43-year-old  female who  alleges  to  have  sustained  a \ncompensable  low  back  injury  on  or  about  June  21,  2024.  The  claimant  was  employed  by  the \nrespondent  at  that  time  as  a  CNA  working  with  elderly  adults.  On  direct  examination  the \nclaimant gave testimony about how the alleged injury occurred. \nQ Okay. So what happened on June 21\nst\n of 2024? \n \nA I  was  at  work  since  8:00  in  the  morning.  I  was  hurting – \nprior  to  that  I  had  some  pain,  but  that  day  I  did  my  normal  work \nduring  the  morning.  Then  we  got  this  patient,  Mr.  Parker,  who \n\nValencia – H404336 \n \n-3- \ncame in and I was assigned to help him change his brief. He was – \nbecause he is no longer alive. He passed away. He was wheelchair \nbound completely, so we had to use a Hoyer to help him. \n \n But that day his wife did not put the sling under him, so we \nhad  to  improvise.  We  had  to  transfer  him  manually.  So  it  took \nthree  of  us  to  help  him.  We  took  him  to  a  quiet  room,  which  we \nhad  a  bed  in  there  to  change  the  patients,  and  we  transfer  him.  I \nwas in the front; my coworker CNA, she was in the back; and the \nPT  occupational  therapist  was  on  the  left  of  him  helping.  And  we \ntried  to  transfer  him.  When  we  lift,  we  transfer  him  to  the  bed.  I \nimmediately felt something broke in my back. \n \nQ And what other symptoms did you have besides the feeling \nin your back? \n \nA Radiating  pain  from  my  back  all  the  way  down  to  my  leg. \nTingling, numbness. \n \nQ Which leg was it? \n \nA Right leg. \n \nQ And how far did the pain go down? \n \nA All the way to my toes. \n \n The claimant testified that she informed a coworker named “Patrice” at the moment of \nher  alleged  injury.  The  claimant  completed  her  work  with  the  patient  and  was  then  assigned  to \nwork at the front desk and did so for the remainder of her workday. Front desk work was not in \nthe claimant’s normal course of work duties but the employee who does that work was absent \nthat day. During cross examination the claimant admitted that she was not working the front desk \nbecause of her injury, but instead it was simply her turn to do so. The claimant testified on cross \nexamination about not reporting her alleged injury on June 21, 2024, as follows: \nQ I  asked  you  what  you  are  supposed  to  do  if  you  had  an \ninjury  and  you  said  you  guessed  you  would  need  to  report  it  to \nyour immediate supervisor; is that correct? \n \n\nValencia – H404336 \n \n-4- \nA That is correct. \n \nQ So on that day it would have been Lucy or Jason? \n \nA That is correct. \n \nQ But you did not do that that day; did you? \n \nA I did not. \n \nQ Why not? \n \nA I  was  hoping  that  I  was  going  to  feel  better.  I  was  hoping \nthat I will go home, take something for the pain, and the next day I \nwas going to be okay. \n \nQ And you already had pain medication at home? \n \nA No. I had some Tylenol. They didn’t give me – when  I \nwent  to  the  doctor  that  day,  they  gave  me  some – the  prior  week \nbefore,   they   gave   me   some   prednisone,   so   I   finished   that \nprednisone. I don’t remember if they gave me pain meds. I don’t \nbelieve so. \n \nQ So  you  are  saying  that  when  you  went  to  Mercy  Urgent \nCare is when you got medication? \n \nA The prednisone. \n \nQ Prior to June 21\nst\n, though? \n \nA Yes. Before. \n \n Late  in  the  night  on  June 21,  2024,  the  claimant  sought  medical  care  at  Northwest \nMedical  Center,  Bentonville,  emergency  department.  Following  is  a  portion  of  that  medical \nrecord: \nBasic Information \nTime seen: Date & time 06/22/2024 00:50:00, Initial Time Seen \nTime  Initially  Seen:  06/22/2024  00:51  by  GARIBALDI,  BYRON \nT MD \n \nHistory source: Patient \n\nValencia – H404336 \n \n-5- \nArrival mode: Private vehicle, walking. Private vehicle \nHistory limitation: None \nAdditional  Information:  Chief  Complaint  from  Nursing  Triage \nNote: Chief Complaint \n6/21/2024  22:22  CDT.  Chief  Complaint.  Pt  states  she  has  had \nsciatic pain x 2 weeks and it got worse today. Pain is in rt lg. \n \nHistory of Present Illness \nThe  patient  presents  with  lower  extremity  pain.  The  onset  was  2 \nweeks  ago.  The  course/duration  of  symptoms  is  constant.  Type  of \ninjury:  none.  The  character  of  symptoms  is  pain.  The  degree  at \npresent is moderate. The exacerbating factor is none. The relieving \nfactor is none. \n \nThe  patient  presents  with  back  pain  and  lumbar  pain.  The  onset \nwas 2 weeks ago and gradual. The course/duration of symptoms is \nconstant.  Type  of  injury:  none.  Location:  Right  lumbar  sacral. \nRadiating  pain:  right  lower  extremity.  To  the  right  foot.  Right \nbuttock. The character of symptoms is sharp and achy. The degree \nat  onset  was  moderate.  The  degree  at  present  is  moderate.  There \nare  exacerbating  factors  including  movement  and  bending  over. \nThe relieving factor is none. Risk factors consist of none. Therapy \ntoday:  see  nurses  notes.  Associated  symptoms:  none.  See  na. \nPatient reports that she started having low back pain rating down to \nthe  right  foot  2  weeks  ago.  She  states  she  has  been  to Mercy \nHospital twice for the same problem. She was placed on tramadol, \nMedrol  Dosepak  and  cyclobenzaprine.  She  states  none  of  these \nmedications  have  helped.  She  continues  having  pain  in  the  lower \nback  rating  down  to  her  right  foot.  She  states  she  went  to  work \nyesterday  and  seem  to  make  the  pain  worse.  Patient  denies  any \nfever  or  rash.  She  denies  any  abdominal  pain.  She  denies  any \nincontinence.  She  denies  any  other  neurological  changes.  She \ndenies   any   previous   medical   problems.   She   still   has   some \ncyclobenzaprine  at  home.  She  states  she  finished  her  Medrol \nDosepak already. \n \n*** \nImpression and Plan \nDiagnosis \nAcute right sciatica; low back pain. \n \nPlan \nCondition: Stable. \nDisposition: Discharged: Time 06/22/2024 01:02:00, to home. \nPrescriptions: Prescriptions \n\nValencia – H404336 \n \n-6- \nPharmacy: \nNarcan 4 mg/0.1 mL nasal spray (Prescribe): 4 mg Nasal, Once use \nas directed; may repeat every 2 to 3 minutes until patient responds, \n2 EA, 1 Refill(s) \nIndomethacin  25  mg  oral  capsule  (Prescribe):  1-2  cap(s),  Oral, \nTID, PRN PAIN, TAKE with food or milk, 15 cap(s), 1 Refill(s). \noxycodone  5  mg  oral  tablet  (Prescribe):  See  instructions,  ½  tab(s) \nOral q6H SEVERE PAIN, PRN, for pain, 20 tab(s), 0 Refill(s). \nLimitations: No work for 5 days. \nFollow  up  with:  CHRISTOPHER  HARDIN  Within  1  to  2  days; \nSCOTT   MUSICK   Within   2   to   4   days.   Call   for   follow   up \nappointment.  \nCounseled:   Patient,   Family,   Regarding   diagnosis,   Regarding \ndiagnostic     results,     Regarding     treatment     plan,     Regarding \nprescription, Patient indicated understanding of instructions. \nOrders: ADT Order \nAdmit/Transfer/Discharge: \nDischarge  patient  (Order):  6/22/2024  01:10,  CDT,  to  Home/Self \nCare. \n \n On  June  23,  2024,  the  claimant  returned  to  Northwest  Medical  Center,  Bentonville, \nemergency department. Following is a portion of that medical record: \nAdditional  information:  Chief  Complaint  from  Nursing  Triage \nNote: Chief Complaint \n6/23/2024  00:23  CDT.  Chief  Complaint:  right  sciatic  pain  seen \nhere last night for same, also seen at Mercy 3 times. \n \nHistory of Present Illness \nPatient is a 43-year-old female who presents with right sciatic pain. \nPatient was seen here last evening  for the same  and also has been \nseen at Mercy Urgent Care several times over the last 2 weeks. She \ndescribes  constant,  aching,  severe  pain  radiating  down  her  right \nlower  extremity.  She  notes  some  numbness  and  tingling  to  her \nright lower extremity. She denies loss of bowel or bladder control. \nPain  is  worse  with  walking.  She  has  not  been  to  see  her  primary \ncare  physician  during  the  several  weeks.  Patient  notes  a  similar \nepisode about 4 years prior which resolved spontaneously. \n \n*** \nDifferential  Diagnosis:  Back  pain,  lumbar  strain,  disc  herniation, \nsciatica, spinal stenosis. \n \n*** \n\nValencia – H404336 \n \n-7- \nReexamination/Reevaluation \nPatient  was  treated  with  IM  pain  medication  and  given  another \nDecadron   shot   IM.   She   noted   some   relief   from   her   pain.   I \nexplained  to  the  patient  she  needs  to  go  see  her  primary  care \nphysician who will decide upon MRI versus physical therapy. She \nmay need a recommendation to the pain clinic. At this time there is \nno evidence of impending neurologic compromise. \n \nImpression and Plan \nDiagnosis \nRight sciatica \nPlan \nCondition: Improved. \nDisposition: Discharged: to home. \n \n The  claimant  was  seen  at  Advanced  Orthopedic  on  June  24,  2024.  The  medical  visit \nrepresents the first time the claimant’s medical records make any mention of a work-related \ninjury. \nNote: \nHPI: \nPain started 3 weeks ago the significantly worse with acute RIGHT \nL5 radio after lifting patient at work. \nSeen in wheelchair due to severe pain today. \nInitially managed with prednisone (no relief). \nER visit 1 week later, prescribed tramadol (no relief). \nUnable to put pressure on leg, feels like needles in foot. \nNumbness and weakness RIGHT L5 pattern. \n \n*** \nChief Complaint: back pain \nHPI: This is a 43 year old female who is being seen for evaluation \nof back pain. Onset or Duration: 6/5/2024. The patient reports back \nand   leg   symptoms   of   equal   intensity.   Symptoms   began   after \nambulating a patient at work. At their worst, symptoms are rated as \n10  out  of  10.  Symptoms  include  numbness  or  tingling  and  pain, \nand  in  the  right  leg.  Symptoms  are  aggravated  by  all  activities. \nSymptoms  improved  with:  prescription  pain  medication,  steroid \ninjection, and 6/21/2024. She has had no diagnostic studies. \n \n*** \nImpression/Plan: \n1. Lumbar Radiculopathy \n\nValencia – H404336 \n \n-8- \nRadiculopathy, lumbar region (M54.15) \nAssociated  diagnoses:  Low  Back  Pain  and  Intervertebral  Disc \nDegeneration, Lumbar \n \nPlan: Counseling – Sciatica \nMuscoskeletal  Care:  Most  patients  get  better  with  conservative \ncare  and  no  surgery.  NSAIDS,  hot  or  cold  therapy,  physical \ntherapy,  and  spine  injections  are  typically  recommended.  Surgical \nintervention   is   reserved   for   patients   that   fail   conservative \ntreatment. The surgery entails decompression and possible removal \nof some bone from around the spinal canal. Most patients are able \nto resume a normal, active lifestyle after appropriate treatment for \nsciatica. \nExpectations:  Sciatica  is  a  condition  where  the  sciatic  nerve  is \nirritated. It is a nerve that travels from the lower part of your spine \nto  your  feet.  Patients  typically  feel  cramps,  pins  and  needles,  or \nshooting  paints  in  their  legs.  An  increase  in  intrathoracic  pressure \nfrom  coughing  or  sneezing  may  aggravate  the  nerve  further.  A \nherniated  disc  caused  by  degeneration  of  the  spine  is  a  common \ncause  of  this  condition.  In  addition  to  the  pain,  there  may  be \nweakness  or  loss  of  bowel  or  bladder  control.  While  sciatica  is  a \nvery  common  condition,  a  minority  of  people  actually  experience \nsymptoms for longer than 6 weeks. \nContact  Office  if  pain  worsens.  If  numbness  and  tingling  become \nmore severe, or if you notice any change in your bowel or bladder \ncontrol. Patient has failed healthcare provider directed conservative \ncare (PT, medications) for over 6 weeks without significant change \nin pain and symptoms. \n \nThe claimant was also ordered an MRI of the lumbar spine at that time. It is the same day, June \n24, 2024, as the claimant’s first mention of a work-related  injury  to  her  medical  providers  that \nshe first reports a work-related injury to her employer. A document found at Claimant’s Exhibit \n2, pages 3-4, records her reporting of the incident and injury she alleges to have occurred on June \n21,  2024.  I  note  the  claimant’s  testimony  indicates  that  she  did  not  report  the  injury  to  a \nrespondent supervisor until June 25, 2024, but the documentation indicates it was done on June \n24, 2024. \n\nValencia – H404336 \n \n-9- \n On June 26, 2024, the claimant underwent an MRI of the lumbar spine without contrast at \nNorthwest Health Physicians Specialty Hospital. Following is a portion of that diagnostic report: \nIMPRESSION: \nProminent  right  foraminal  disc  extrusion  at  L5-S1  causing  severe \nright foraminal stenosis. \n \n On  July  1,  2024,  the  claimant  was  seen  by  Dr.  Larry  Armstrong,  a  neurosurgeon. \nFollowing is a portion of that medical record: \nHistory of Present Illness \nLumbar Spine Intake (Brief): the patient is being seen for an initial \nlumbar  spine  evaluation  and  is  referred  by  a  physiatrist  and  Dr. \nKent Hagen referred this 43-year-old female who is a Washington \nRegional  employed  as  a  CNA  who  was  lifting  a  patient  last  week \nand  had  a  severe  onset  of  pain  in  her  back,  gluteal  area  with \nparesthesias  down  the  right  leg.  By  that  evening  the  pain  was \nintolerable.  She  has  actually  been  to  the  ER  2  times  and  has  seen \nDr.  Hagen  in  consultation  for  the  severity  for  pain  as  well  as  the \nweakness  in  his  right  leg.  She  is  unable  to  dorsiflex  the  right  foot \nhas footdrop on the right side and can not walk without assistance. \nShe is in a wheelchair for evaluation today. Her pain and weakness \nthe  most  bothersome  things  for  her  as  well  as  severe  paresthesias \nin the right L5 distribution. Her pain follows L5 classically and the \nbig  toe  was  completely  numb  with  painful  dysesthesias.  She  is \nunable  to  dorsiflex  the  right  foot.  She  cannot  walk  again  without \nassistance. Her lumbar spine MRI scan reveals intra foraminal disc \nherniation L5-S1 with severe  compression of the  exiting L6 nerve \nroot on the right side with severe foraminal stenosis creating severe \nL5  nerve  root  compression.  There  is  some  disc  space  collapse  at \nL5-S1.  The  indication  for  this  visit  is  low  back  pain,  herniated \nlumbar  disc,  lumbar  degenerative  disc  disease,  sciatica  and  spinal \nstenosis,  back  pain,  buttock  pain,  lower  extremity  pain,  back \nstiffness, weakness, numbness, paresthesia, no bladder \ndysfunction,   no   bowel   dysfunction,   depressed   mood,   sleeping \nproblems  and  difficulty  concentrating.  The  patient  is  currently \nexperiencing symptoms. \n \n*** \nAssessment \n1. Depression (311) (F32A) \n2. Endometriosis (617.9) (N80.9) \n3. Fibromyalgia (729.1) (M79.7) \n\nValencia – H404336 \n \n-10- \n4. Prolactinoma (227.3) (D35.2) \n5. Herniated nucleus pulposus, L5-S1, right (722.0) M51.27) \n6. Lumbar radiculopathy (724.4) (M54.16) \n7. Nural foraminal stenosis of lumbar spine (724.02) (M46.061) \n8. Right foot drop (736.79) (M21.371) \n9. Low back pain (724.2) (M54.50) \n \nPlan \n1. Posterior  Lumbar  Lateral  Fusion  w/Instrumentation;  Status: \nComplete. Done: 28 June 2024. \n2.  Start:  oxycodone  HCI;  5  MG  Oral  Tablet;  TAKE  1  TO  2 \nTABLETS EVERY 4 HOURS AS NEEDED FOR PAIN. \n3. XR Spine Lumbosacral 2 Or 3 Views; Status: Hold for – Manual \nActivation; Exact Date: Requested for: Before next appointment. \n \n On  that  same  day,  Dr.  Armstrong  performed  surgical  intervention  on  the  claimant’s \nlumbar spine. Following is a portion of that operative report: \nProcedure:  TLIF  L5-S1  utilizing  Zimmer  10x22  mm  interbody \nexpandable  cage  filled  with  allograft  between  L5  and  S1.  Zimmer \n5.5 x 40 mm screws in L5 and 6.5 x 40 mm in S1 bilaterally, rods, \ncrosslink, lumbar decompressive laminectomy with full right-sided \nfacetectomy  L5-S1  excision  of  large  intra  and  extraforaminal  disc \nherniation   L5-S1   on   the   right,   posterior   spinal   fusion   L5-S1 \nutilizing  autograft  and  allograft,  C-arm  fluoroscopic  guidance  1g \nvancomycin powder, drain, SSEP. \n \n The  claimant  was  asked  on  direct  examination  about  prior  lumbar  spine  difficulties  as \nfollows: \nQ Okay.  And  before  this  accident  on  June  21\nst\n,  had  you  ever \ncontemplated or thought about having back surgery? \n \nA Never. I never thought that I was going to be going through \nsomething like this. \n \nQ So  prior  to  this  accident  on  June  21\nst\n of  this  year,  had  you \nhad back problems? \n \nA I  have  back  problems,  yes.  Also  shoulder  problems  and \nhips. I have fibromyalgia, so, yes, I have pain. \n \nQ And had you always been able to work with that? \n\nValencia – H404336 \n \n-11- \n \nA Yes. \n \nQ It  looks  like  from  some  of  the  evidence  that  has  been \nintroduced  that  a  week  or  two  before  this  accident  happened  you \nhad to leave work early one day. Do you recall that? \n \nA I did, yes. \n \nQ And why did you need to leave? \n \nA Like I said, I was having pain, sciatic pain those two weeks \nprior, so I wanted to go and see the doctor. \n \nQ And did you return to work the next day? \n \nA Yes, I did. \n \nQ And were you able to continue working? \n \nA Yes, I was able to continue working. I was actually feeling \nrelief  with – when   I   went  that  day,   I  was   prescribed  some \nprednisone and I was taking Tylenol, pain meds, and I was – \n \nQ So  prior  to  the  day  of  this  accident,  had  you  been  able  to \ncontinue to work? \n \nA Yes. \n \nQ Okay.  Now,  when  you  would  have  the  issues  with  the \nfibromyalgia,  the  shoulder,  the  knee  or  the  back,  did  you  see  a \nchiropractor? \n \nA I have, yes. \n \nQ Okay.  And  would  you  only  see  the  chiropractor  when  you \nwere having pain? \n \nA Not necessarily. I like going to the chiropractor for general \nwellness, also. For pain, yes, it helps me a lot. \n \nQ And you had had a couple of car accidents. Is that true? \n \nA Yes. I have had car accidents. \n \n\nValencia – H404336 \n \n-12- \nQ Okay.   And   after   those   car   accidents,   had   you   ever \nexperienced symptoms like you did when this incident occurred on \nJune 21\nst\n? \n \nA Never. \n \nQ Were you able to continue working through those times? \n \nA Yes, I was able to continue working. The chiropractor was \nmy treatment after the car accidents. \n \nQ Okay.  Do  you  recall  ever  having – when  you  would  have \nleg  pain  prior  to  this  accident,  do  you  ever  recall  it  going  all  the \nway to your toes? \n \nA No. Never. \n \nQ How far would it go down? \n \nA Just  sciatic  pain  down  behind  my  leg,  but  never  numbness \nor tingling all the way to my toes. \n \nQ At what part of your leg would it stop? \n \nA Probably  in  the  back  part  of  my – how  do  you  call  this \n(indicating). \n \nQ Calf? \n \nA Yes. \n \n The claimant’s testimony regarding lumbar spine difficulties affecting her right leg only \nto  her  calf  but  never  to  her  toes  is  directly  contrary  to  the  medical  evidence  submitted  into  the \nrecord.  In  fact,  the  claimant had been  seen  at  Mercy  GoHealth  Urgent  Care  on  June  9,  2024, \ntwelve  days  prior  to  her  allegations  of  suffering  a  compensable  low  back  injury  on  June  21, \n2024. The medical report from that visit states: \nBack Exam: \nSymmetric hip hight, normal curvature. NO CVA tenderness. Pain \nis  reproducible  with  palpation  over  the  right  sciatic  nerve  root. \nPain  radiates  down  the  posterior  right  leg.  Pain  is  exacerbated  by \n\nValencia – H404336 \n \n-13- \nwalking – standing does not cause increased pain. Reports transient \nnumbness and tingling in the toes of the right foot. \n \nThe report also states, “Reports she has been applying ice and been taking ibuprofen without \nimprovement.  She  has  had  this  before  and  requires  a  steroid  for  resolution.  Is  having  difficulty \nsleeping at night due to the pain. Has missed some work due to pain also.” The claimant was \nprescribed prednisone during that visit. \n Medical  records  introduced  by  the  respondent  certainly  show  the  claimant  to  have  had \nlong-standing, chronic lumbar spine difficulties. A July 7, 2017, record from MANA Fayetteville \nDiagnostic Clinic discusses the claimant’s chronic low back pain but does note “no radiation.” A \nWashington Regional emergency department record dated September 18, 2020, states: \nChief Complaint \nCo right sided low back pain, saw back doctor “only gave my \nmeloxicam...not  helping”  pain  ongoing  for  months,  this  week \n“constant pain.” Denies known injury or urinary issues. \n \nHistory of Present Illness \nChief complaint: Back pain. \nHistorian:  History  provided  by  patient.  Patient  is  a  39-year-old \nfemale in today for evaluation of back pain. Patient states she has a \nhistory  of  sciatica  as  well  as  fibromyalgia  is  states  for  last  month \nshe  has  had  constant  pain.  She  has  seen  and  evaluated  by  her \northopedic surgeon who is a back specialist inserted meloxicam as \nwell  as  started  physical  therapy  2  days  ago.  She  states  physical \ntherapy she has had difficulty with the pain. She  has had no  fever \nor  shills.  Denies  nausea  vomiting.  Denies  any  loss  of  bowel  or \nbladder  and  denies  any  unilateral  pain  or  weakness.  Movement \nmakes  his  symptoms  worse  and  nothing  seems  to  make  better. \nPatient is a nondiabetic. \nMechanism of injury: No injury. \nLocation: Right back. \n \n The claimant was examined on April 6, 2021, at Fir Chiropractic as a result of an April 1, \n2021,  motor  vehicle  accident.  The  medical  records  show  complaints  of  cervical  pain  and \n\nValencia – H404336 \n \n-14- \nlumbosacral  pain/spasms.  The  claimant  treated  with  Fir  Chiropractic  more  than  ten  times \nbetween April 6, 2021, and June 4, 2021.  \n On June 16, 2021, the claimant was again seen at Fir Chiropractic as a result of another \nmotor vehicle accident that occurred on June 9,  2021. The claimant complained of cervical and \nlower lumbar pain. The claimant treated at least ten times with Fir Chiropractic between August \n16, 2021, and September 14, 2021. \n The claimant, for a third time, began to treat with Fir Chiropractic on March 27, 2023, for \na  motor  vehicle  accident  that  occurred  on  March  23,  2023.  The  claimant  complained  of  lower \nlumbar   pain   and   right   lumbosacral   pain/spasms.   The   claimant   received   treatment   at   Fir \nChiropractic at least 22 times between March 27, 2023, and July 7, 2023.  \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 It  is  without  question  that  the  claimant  does  have  objective  findings  of  derangement  in \nher lumbar spine.  Both  the  June  26,  2024,  MRI  results  and  Dr.  Armstrong’s  July  1,  2024, \noperative  report  bear  that  issue  out.  However,  in  review  of  the  evidence  in  its  totality,  I  do  not \nbelieve that the claimant’s current condition is the result of any event or incident that occurred on \nor about June 21, 2024, while performing employment services for the respondent.  \nThe  credibility  of  witnesses  and  the  weight  to  be  given  to  their  testimony  are  matters \n\nValencia – H404336 \n \n-15- \nsolely within the province of the Commission.  Ringier America v. Combs, 41 Ark. App. 47, 849 \nS.W.2d 1 (1993). \n The  claimant,  who  clearly  has  long-standing,  chronic  back  problems,  did  not  report  the \nincident  when  or  shortly  after  it  occurred,  even  though  she  had  the  opportunity  to  do  so  as  she \nremained  at  work  the  rest  of  that  day.  The  claimant  then  reports  late  that  same  night  to  the \nemergency  department  for  sciatic  pain  and  reported  an  onset  of  that  pain  two  weeks  prior  and \ndenied any injury. The claimant then returns the next day to the emergency department and still \nfails  to  report  any  injury  as  the  source  of  her  problems,  much  less  a  work  injury.  Instead,  she \nstates: \nPatient is a 43-year-old female who presents with right sciatic pain. \nPatient was seen here last evening  for the same  and also has been \nseen at Mercy Urgent Care several times over the last 2 weeks. \n \n*** \nShe  has  not  been  to  see  her  primary  care  physician  during  the \nseveral  weeks.  Patient  notes  a  similar  episode  about  4  years  prior \nwhich resolved spontaneously. \n \nOn  June  24,  2024,  the  claimant  does  mention  a  work  lifting  incident  but  says  the  pain  started \nthree weeks ago. \n The claimant’s testimony regarding her history of “back problems” is concerning. The \nclaimant does admit prior back problems which she certainly had but downplays the seriousness \nof her condition prior to her alleged June 21, 2024, injury. Specifically, the claimant denies any \nhistory  of  her  back  pain  causing  her  difficulties  that  radiate  to  her  toes,  testifying  on  direct \nexamination  that  she  did  have  sciatic  pain  but  that  would  only  go  to  her  calf.  However,  just \ntwelve days prior to her allegations of a compensable back injury, which causes radiation down \nher  right  leg  and  to  her  toes,  the  claimant  reported  to  Mercy  Urgent  with  back  pain  with \n\nValencia – H404336 \n \n-16- \n“transient numbness and tingling in the toes of the right foot.” The claimant is unable to prove \nthat she sustained a compensable low back injury on or about June 21, 2024. The claimant’s \ncurrent condition appears to be a continuation of her long-standing, chronic low back difficulties \nand  not  the  result  of  any  work-related  incident  on  or  about  June  21,  2024,  as  the  claimant  is \nunable to prove that that incident occurred. \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 \nSeptember 16, 2024, and contained in a Pre-hearing Order filed September 17, 2024, are hereby \naccepted as fact. \n 2. The claimant has failed to prove by a preponderance of the evidence that she sustained \na compensable injury to her low back on or about June 21, 2024. \n 3. The claimant has failed to prove by a preponderance of the evidence that she is entitled \nto medical treatment. \n 4. The claimant has failed to prove by a preponderance of the evidence that she is entitled \nto temporary total disability benefits. \n 5. 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 6. The respondent’s lack of notice defense is moot. \n 7. The issue of the claimant’s weekly compensation rates is moot. \n\nValencia – H404336 \n \n-17- \n ORDER \nPursuant  to  the  above  findings  and  conclusions,  I  have  no  alternative  but  to  deny  this \nclaim in its entirety. \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       HONORABLE ERIC PAUL WELLS \n       ADMINISTRATIVE LAW JUDGE","preview":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION WCC NO. H404336 NANCY VALENCIA, Employee CLAIMANT WASHINGTON REGIONAL MEDICAL CENTER, Employer RESPONDENT RISK MANAGEMENT RESOURCES, Carrier RESPONDENT OPINION FILED FEBRUARY 10, 2025 Hearing before ADMINISTRATIVE LAW JUDGE ERIC PAUL WELLS in Springdale, Washington C...","fetched_at":"2026-05-19T22:43:31.431Z","links":{"html":"/opinions/alj-H404336-2025-02-10","pdf":"https://www.labor.arkansas.gov/wp-content/uploads/VALENCIA_NANCY_H404336_20250210.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/"}}