{"id":"alj-H407536-2026-03-05","awcc_number":"H407536","decision_date":"2026-03-05","opinion_type":"alj","claimant_name":"Laura Walker","employer_name":"Ark. Heart Hosp","title":"WALKER VS. ARK. HEART HOSP. AWCC# H407536 March 05, 2026","outcome":"granted","outcome_keywords":["granted:1"],"injury_keywords":["hip","knee","back","wrist","repetitive"],"pdf_url":"https://www.labor.arkansas.gov/wp-content/uploads/Walker_Laura_H407536_20260305.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/","filename":"Walker_Laura_H407536_20260305.pdf","text_length":19447,"full_text":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION \nWCC NO. H407536 \n \n \nLAURA WALKER, EMPLOYEE CLAIMANT \n \nARK. HEART HOSP., \n EMPLOYER RESPONDENT \n \nLUBA CASUALTY INS. CO., \n CARRIER RESPONDENT \n \n \nOPINION FILED MARCH 5, 2026 \n \nHearing before Administrative Law Judge O. Milton Fine II on January 22, 2026, in Little \nRock, Pulaski County, Arkansas. \n \nClaimant represented by Mr. Richard L. Mays, Attorney at Law, Little Rock, Arkansas. \n \nRespondents  represented  by  Mr. Jarrod  S.  Parrish,  Attorney  at  Law,  Little  Rock, \nArkansas. \n \n \nSTATEMENT OF THE CASE \n On January  22,  2026,  the  above-captioned  claim  was  heard  in Little  Rock, \nArkansas.  A prehearing conference took place on December 1, 2025.  The Prehearing \nOrder  entered that  day pursuant  to  the  conference  was  admitted  without  objection  as \nCommission  Exhibit  1.    At  the  hearing,  the  parties  confirmed  that  the  stipulations, \nissues, and respective contentions were properly set forth in the order. \nStipulations \n At  the  hearing,  the  parties  discussed  the  stipulations  set  forth  in  Commission \nExhibit 1.  They are the following, which I accept: \n1. The Arkansas Workers’ Compensation Commission has jurisdiction over \nthis claim. \n\nWALKER – H407536 \n \n2 \n2. The  employee/employer/carrier  relationship existed  among  the  parties  on \nOctober  29,  2024,  when  Claimant  sustained  compensable  injuries  to  her \nleft  hip  and  knee,  to  her  low  back,  and  to  her  right  hand  by  specific \nincident. \n3. Respondents accepted  the  above  injuries  as  compensable  and  paid \nbenefits pursuant thereto. \nIssues \n At  the  hearing,  the parties  discussed the  issues  set forth  in  Commission  Exhibit \n1.  The following were litigated: \n1. Whether Claimant  sustained  an  injury  to  her  left  wrist  as  a  compensable \nconsequence of her stipulated compensable injuries. \n2. Whether   Claimant   is   entitled   to   reasonable   and   necessary   medical \ntreatment of her alleged compensable consequence left wrist injury. \n All other issues have been reserved. \nContentions \n The respective contentions of the parties read as follows: \n Claimant: \n1. Claimant contends that her medical records document that she sustained \nan injury to her left wrist as a compensable consequence of her stipulated \ncompensable   injuries,   along   with   her  entitlement   to   reasonable   and \nnecessary treatment thereof. \n\nWALKER – H407536 \n \n3 \n Respondents: \n1. Respondents  contend  that all  appropriate  benefits  have  been  paid  with \nregard  to  this  matter.    She  was  released  as  having  reached  maximum \nmedical  improvement  by  Dr. Brian Norton  with  regard  to  her  right  wrist \ninjury  on  May  2,  2025.    Claimant  was  released  as  having  reached \nmaximum medical improvement with respect to her low back by Dr. Victor \nVargas on May 12, 2025.  Temporary total disability benefits were paid to \nClaimant  through  July 11, 2025.    Respondents  will  have  an overpayment \ncredit entitlement once an impairment rating is assigned for Claimant’s \nright wrist. \n2. Respondents deny that Claimant sustained an injury to her left wrist as a \nconsequence of her stipulated compensable injuries. \nFINDINGS OF FACT AND CONCLUSIONS OF LAW \n After  reviewing  the  record  as  a  whole,  including  medical  reports, non-medical \nrecords,  and  other  matters  properly  before  the  Commission,  and  having  had  an \nopportunity  to  hear  the  testimony  of Claimant and  to  observe her demeanor,  I  hereby \nmake the following findings of fact and conclusions of law in accordance with Ark. Code \nAnn. § 11-9-704 (Repl. 2012): \n1. The Arkansas Workers’ Compensation Commission has jurisdiction over \nthis claim. \n2. The stipulations set forth above are reasonable and are hereby accepted. \n\nWALKER – H407536 \n \n4 \n3. Claimant  has  proven  by  a  preponderance  of  the  evidence  that  she \nsuffered  an  injury  to  her  left  wrist  that  is  a  compensable  consequence  of \nher stipulated compensable right hand injury. \n4. Claimant has  proven  by  a  preponderance  of  the  evidence  that  she is \nentitled    to    reasonable    and    necessary   medical    treatment   of    her \ncompensable consequence left wrist injury.  This includes the surgical left \nwrist release performed by Dr. Brian Norton and related treatment. \nCASE IN CHIEF \nSummary of Evidence \n Claimant was the sole witness at the hearing. \n In  addition  to  the Prehearing Order  discussed  above,  exhibits  admitted  into \nevidence  in  this  case  were  Claimant’s  Exhibit 1,  medical  records,  consisting  of two \npages;  Respondents’  Exhibit  1,  another  compilation  of  Claimant’s  medical  records, \nconsisting  of one  index page and  60  numbered  pages  thereafter;  and  Respondents’ \nExhibit  2,  nonmedical  records,  consisting  of  one  index  page  and  12  numbered  pages \nthereafter. \nAnalysis of Issues \nA. Compensable Consequence-Left Wrist \n Introduction.  As the parties have stipulated, Claimant sustained a compensable \ninjury  to her  left  hip  and  knee,  to  her  low  back,  and  to  her  right  hand on October  29, \n2024, while  working  for  Respondent Arkansas  Heart  Hospital.    In  this  action, she  is \n\nWALKER – H407536 \n \n5 \nseeking treatment of a left wrist injury that she claims is a compensable consequence of \nher stipulated compensable injuries. \n Evidence.  Claimant testified that she worked for Arkansas Heart Hospital as an \ninstrument  technician.  At  the time of  the October  29,  2024, work-related incident,  she \nhad been employed by the hospital for two to three months.  She described the incident \nin question: \nAs   an   instrument  technician,   I  prepare   instruments   for  the   doctors.  \nThere’s a wash cart that comes out of the washer where the instruments \ncome to the other side, they are supposed to the dried.  They were pulled \nout.  When they were pulled out, I got a set to process to put it together.  I \nset  it  on  the  working  area.    Once  I  set  it  on  the  working  area,  I  turned \naround to get a stool; and when I turned around, I slipped in water. \n \nClaimant related that while she felt pain in her right wrist that “was very noticeable,” the \npain she felt in the left wrist was less noticeable. \n The  treatment  that  Claimant  underwent  for  her  right hand  injury  included  a \nsteroid  injection.    But  when  conservative  measures  failed,  the  hand  was  surgically \nrepaired. \n The following exchange occurred on direct examination: \nQ. When you went back to work, did you use your left hand— \n \nA.  I never went back to work. \n \nQ. Pardon? \n \nA.  I never went back to work. \n \nQ. Never went back to work? \n \nA. No. \n \n\nWALKER – H407536 \n \n6 \nQ. So  your—your—your wrist,  you  then  relied more  on  your  left  hand \nfor whatever you had to manage? \n \nA. Yes, I did. \n \nQ. And—and that’s—and  so  when  did  you  become  really  focusing—\nstart focusing on your left wrist? \n \nA. Right  after  the  surgery  or  right  before  the  surgery,  I  was  talking  to \nDr. Norton about this hand hurting also. \n \nJUDGE FINE:  Which hand is this? \n \nA. The left hand. \n \n. . . \n \nQ. So what did he do—what did you tell him about your left hand? \n \nA. I told him it was hurting. \n \nQ. It was hurting? \n \nA. Yes. \n \nQ. And—did—what did he do to the left hand? \n \nA. He did a test on my left hand, and it’s a certain test that they do so \nfar as pushing a certain area on your wrist.  And the same problem \nwas over here.  I had it over on my left, also. \n \nQ. The  same  problem  you  had—complained  you  had  on  your  right, \nyou had with your left? \n \nA. Yes, sir. \n \n According to Claimant, she eventually underwent the same surgical procedure on \nher left wrist that Dr. Norton had previously performed on the right.  Unlike following her \nright  wrist  surgery,  Claimant  did  not  receive  physical  therapy  following  the  surgery  on \nher left wrist.  Her left wrist treatment was paid out of her own pocket. \n\nWALKER – H407536 \n \n7 \n On cross-examination, Claimant acknowledged that she did not make a claim for \nan  alleged  left  wrist  injury  until  after  she  had  been  released  to  return  to  work  in \nconnection  with  her  stipulated  right  upper  extremity  injury.    Claimant  also  agreed  that \nher testimony on direct that she had left wrist symptoms at the time of her work-related \nfall  differed  from  her  deposition  testimony  that  those  symptoms  did  not  manifest  until \nthree  to  five  days  thereafter.   Neither  the  initial  accident  report  nor  the  Form  AR-N \nreference the left wrist. \n With respect to her contention that her alleged left wrist injury is a compensable \nconsequence, Claimant confirmed that she was not working during the three to five-day \nperiod between the accident in question and the onset of her left wrist symptoms.  She \nrepeated her earlier testimony that she does not know if she suffered trauma to her left \nwrist in the fall; she only knows that she landed on her left side.  The condition in her left \nwrist is known as de Quervain’s.  It is her testimony that this condition is work-related.  \nDuring  the  period  of  time  that  she  was  using  her  left  upper  extremity,  she  did  not  do \nanything strenuous, rapid, repetitive, or work-like. \n Under  questioning  from  the  Commission,  Claimant  testified  that  there  was  a \nperiod following her stipulated accident in October 2024 that she was using only her left \nwrist  and  not  her  right.    Asked  what  those  activities  consisted  of,  she  responded:  \n“Mopping, mopping sometimes, sweeping.”  Later, she stated that those activities also \nincluded  “[c]ooking  .  .  .  [d]riving  sometimes”  and  added:    “Basically  everything  and \nanything that I couldn’t use this one [the  right  wrist], I’d use this [the  left].   She  denied \n\nWALKER – H407536 \n \n8 \nlifting  anything  heavy  exclusively  with  her  left  upper  extremity.   While  the  left  wrist \nsymptoms were not initially “major,” they worsened over a period of two months. \n During a May 2, 2025, visit, Dr. Norton examined both of Claimant’s wrists.  He \nperformed a  de Quervain’s release on February 14, 2025.  Claimant related to him that \nshe was suffering from “severe left wrist pain.”  The doctor added:  “[s]he believes this \nwas also related to the fall.”  He diagnosed her as having bilateral de Quervain’s (i.e., \nradial styloid tenosynovitis in both wrists) and recommended a release be performed on \nthe left wrist as well. \n In a follow-up report dated June 17, 2025, Norton wrote: \nOverall the patient is doing well from a left de Quervain’s release.  The \npatient is having difficulty as this was not covered under Worker’s Comp.  I \ndid state in my previous dictations that I believe this directly related to her \nfall  even  though  she  did  not  initially  complain  of  much  left  wrist  pain.    Of \nnote  I  also  believe  that  this  was  exacerbated  by  the  fact  that  she  was \nlimited to only using her left hand while her right de Quervain’s recovered.  \nThis is [has] exacerbated the de Quervain’s on the left side. \n \n Standards.  If an injury is compensable, every natural consequence of that injury \nis  likewise  compensable.   Air  Compressor  Equip.  Co.  v.  Sword,  69  Ark.  App.  162,  11 \nS.W.3d 1  (2000); Hubley v. Best West. Governor’s Inn,  52  Ark. App. 226,  916  S.W.2d \n143  (1996).    The  test  is  whether  a  causal  connection  between  the  two  (2)  episodes \nexists.  Sword, supra; Jeter v. McGinty Mech., 62 Ark. App. 53, 968 S.W.2d 645 (1998).  \nThe existence of a causal connection is a question of fact for the Commission.  Koster \nv. Custom Pak & Trissel, 2009 Ark. App. 780, 2009 Ark. App. LEXIS 947.  It is generally \na  matter  of  inference,  and  possibilities  may  play  a  proper  and  important  role  in \nestablishing  that  relationship.   Osmose  Wood  Preserving  v.  Jones,  40  Ark.  App.  190, \n\nWALKER – H407536 \n \n9 \n843  S.W.2d  875  (1992).    A  finding  of  causation  need  not  be  expressed  in  terms  of  a \nreasonable   medical   certainty   where   supplemental   evidence   supports   the   causal \nconnection.  Koster, supra; Heptinstall v. Asplundh Tree Expert Co., 84 Ark. App. 215, \n137 S.W.3d 421 (2003). \n Under Ark. Code Ann. § 11-9-705(a)(3) (Repl. 2012), Claimant has the burden of \nproving by  a preponderance  of  the  evidence that  she  sustained a  compensable  injury.  \nThis standard means the evidence having greater weight or convincing force.  Barre v. \nHoffman,  2009  Ark.  373,  326  S.W.3d  415; Smith  v.  Magnet  Cove  Barium  Corp.,  212 \nArk. 491, 206 S.W.2d 442 (1947). \n A claimant’s testimony is never considered uncontroverted.  Nix v. Wilson World \nHotel,  46  Ark.  App.  303,  879 S.W.2d  457 (1994).    The determination  of a  witness’ \ncredibility and how much weight to accord to that person’s testimony are solely up to the \nCommission.  White v. Gregg Agricultural Ent., 72 Ark. App. 309, 37 S.W.3d 649 (2001).  \nThe  Commission  must  sort  through  conflicting  evidence  and  determine  the  true  facts.  \nId.  In so doing, the Commission is not required to believe the testimony of the claimant \nor  any  other  witness,  but  may  accept  and  translate  into  findings  of  fact  only  those \nportions of the testimony that it deems worthy of belief.  Id. \n Claimant’s testimony—which I credit—was that while she landed on her left side \nin  the  stipulated  work-related  fall  and  only  had  mild  left  wrist  symptoms at  first,  those \nworsened later when she began using her left hand exclusively for tasks. \n Dr.  Norton  diagnosed  and  treated  her  for de Quervain’s.    Per  DORLAND’S \nILLUSTRATED MEDICAL DICTIONARY 531  (30\nth\n ed.  2003),“de Quervain’s  disease”  is \n\nWALKER – H407536 \n \n10 \n“painful tenosynovitis due to relative narrowness of the common tendon sheath of the \nabductor  pollicis  longus  and  the  extensor  pollicis  brevis.”    In  turn,  “tenosynovitis”  is \n“inflammation of a tendon sheath.”  Id. at 1865. \n To the extent that Claimant’s left de Quervain’s was pre-existing,  the  Arkansas \nWorkers’  Compensation  Act  provides  that  the  employer  takes  the  employee  as  the \nemployer   finds   her,   and   employment   circumstances   that   aggravate   pre-existing \nconditions  are  compensable.   Nashville  Livestock  Comm.  v.  Cox,  302  Ark.  69,  787 \nS.W.2d 64 (1990).  A pre-existing infirmity does not disqualify a claim if the employment \naggravated,  accelerated,  or  combined  with  the  infirmity  to  produce  the  disability  for \nwhich  compensation  is  sought.   St.  Vincent  Med.  Ctr.  v.  Brown,  53  Ark.  App.  30,  917 \nS.W.2d 550 (1996). \n Again, Dr. Norton opined that her left de Quervain’s “was exacerbated by the fact \nthat she was limited to only using her left hand while her right de Quervain’s recovered.”  \nI  credit  this causation  opinion.   Medical  evidence  is  not  ordinarily  required  to  prove \ncausation.   Wal-Mart  v.  Van  Wagner,  337  Ark.  443,  990  S.W.2d  522  (1999).    But  if  a \nmedical opinion is offered on causation, the opinion must be stated within a reasonable \ndegree of medical certainty.  Ark. Code Ann. § 11-9-102(16)(B) (Repl. 2012).  It should \nalso  be  noted  that  in  interpreting  this  provision,  the  Arkansas  Supreme  Court  in \nFreeman v. Con-Agra Frozen Foods, 344 Ark. 296, 40 S.W.3d 760 (2001) stated:  “This \ncourt  has  never  required  .  .  .  that  the  magic  words  ‘within  a  reasonable  degree of \nmedical certainty’ even be used by the doctor.”  Norton’s language—the straightforward, \n\nWALKER – H407536 \n \n11 \nunqualified  statement  that  her  condition  “was exacerbated”—passes  muster  under \nFreeman. \n Claimant  has  thus  established  the  requisite  causal  connection  between  her \nstipulated compensable right hand injury and the exacerbation of her left de Quervain’s.  \nShe has proven by a preponderance of the evidence that she suffered an injury to her \nleft wrist that is a compensable consequence of her compensable right hand injury. \nB. Reasonable and Necessary Treatment \n Introduction.  In this proceeding, Claimant is seeking reasonable and necessary \ntreatment  of  her  alleged  left  wrist  injury.    Respondents  have  denied  responsibility  for \nthis. \n Standards.    Arkansas  Code  Annotated  Section  11-9-508(a)  (Repl.  2012)  states \nthat an employer shall provide for an injured employee such medical treatment as may \nbe necessary in connection with the injury received by the employee.  Wal-Mart Stores, \nInc. v. Brown, 82 Ark. App. 600, 120 S.W.3d 153 (2003).  But employers are liable only \nfor  such  treatment  and  services  as  are  deemed  necessary  for  the  treatment  of  the \nclaimant’s injuries.  DeBoard v. Colson Co., 20 Ark. App. 166, 725 S.W.2d 857 (1987).  \nThe claimant must prove by a preponderance of the evidence that medical treatment is \nreasonable  and  necessary  for  the  treatment  of  a  compensable  injury.   Brown, supra; \nGeo  Specialty  Chem.  v.  Clingan,  69  Ark.  App.  369,  13  S.W.3d  218  (2000).    What \nconstitutes  reasonable  and  necessary  medical  treatment  is  a  question  of  fact  for  the \nCommission.  White Consolidated Indus. v. Galloway, 74 Ark. App. 13, 45 S.W.3d 396 \n(2001); Wackenhut Corp. v. Jones, 73 Ark. App. 158, 40 S.W.3d 333 (2001). \n\nWALKER – H407536 \n \n12 \n As  the  Arkansas  Court  of  Appeals  has  held,  a  claimant  may  be  entitled  to \nadditional treatment even after the healing period has ended, if said treatment is geared \ntoward management of  the  injury.  See Patchell  v.  Wal-Mart  Stores,  Inc., 86  Ark.  App. \n230,  184  S.W.3d  31  (2004); Artex  Hydrophonics,  Inc.  v.  Pippin,  8  Ark.  App.  200,  649 \nS.W.2d 845 (1983).  Such services can include those for the purpose of diagnosing the \nnature and extent of the compensable injury; reducing or alleviating symptoms resulting \nfrom  the  compensable  injury;  maintaining  the  level  of  healing  achieved;  or  preventing \nfurther  deterioration  of  the  damage  produced  by  the  compensable  injury.   Jordan  v. \nTyson Foods, Inc., 51 Ark. App. 100, 911 S.W.2d 593 (1995); Artex, supra. \n Discussion.  I find that Claimant has proven by a preponderance of the evidence \nthat she is entitled to reasonable and necessary medical treatment of her compensable \nleft  wrist  injury,  including  her  left  de  Quervain’s  release  by  Dr.  Norton  and  related \ntreatment.  Moreover, I have reviewed his treatment records that are in evidence, and I \nfind that she has proven by a preponderance of the evidence that all of the treatment of \nher compensable left wrist injury that is in evidence was reasonable and necessary. \nCONCLUSION AND AWARD \n Respondents are directed to pay/furnish benefits in accordance with the findings \nof fact set forth above.  All accrued sums shall be paid in a lump sum without discount, \nand this award shall earn interest at the legal rate until paid, pursuant to Ark. Code Ann. \n§ 11-9-809 (Repl. 2002).  See Couch v. First State Bank of Newport, 49 Ark. App. 102, \n898 S.W.2d 57 (1995). \n\nWALKER – H407536 \n \n13 \n IT IS SO ORDERED. \n       ________________________________ \n       Hon. O. Milton Fine II \n       Chief Administrative Law Judge","preview":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION WCC NO. H407536 LAURA WALKER, EMPLOYEE CLAIMANT ARK. HEART HOSP., EMPLOYER RESPONDENT LUBA CASUALTY INS. CO., CARRIER RESPONDENT OPINION FILED MARCH 5, 2026 Hearing before Administrative Law Judge O. Milton Fine II on January 22, 2026, in Little Rock, Pulaski County,...","fetched_at":"2026-05-19T22:30:38.923Z","links":{"html":"/opinions/alj-H407536-2026-03-05","pdf":"https://www.labor.arkansas.gov/wp-content/uploads/Walker_Laura_H407536_20260305.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/"}}