{"id":"full_commission-G807060-2024-08-21","awcc_number":"G807060","decision_date":"2024-08-21","opinion_type":"full_commission","claimant_name":"Tina Melius","employer_name":"Chapel Ridge Nursing Center","title":"MELIUS VS. CHAPEL RIDGE NURSING CENTER AWCC# G807060 August 21, 2024","outcome":"denied","outcome_keywords":["affirmed:1","dismissed:1","granted:3","denied:9"],"injury_keywords":["back","knee","hip","strain","lumbar","herniated"],"pdf_url":"https://labor.arkansas.gov/wp-content/uploads/Melius_Tina_G807060_20240821.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/full-commission-opinions/","filename":"Melius_Tina_G807060_20240821.pdf","text_length":41715,"full_text":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION \n \n \nCLAIM NO.  G807060 \n \nTINA MELIUS, \nEMPLOYEE \n \nCLAIMANT \nCHAPEL RIDGE NURSING CENTER,  \nEMPLOYER \n \nRESPONDENT \nAMTRUST NORTH AMERICA, \nINSURANCE CARRIER/TPA \nRESPONDENT \n  \n      \nOPINION FILED AUGUST 21, 2024  \n \nUpon review before the FULL COMMISSION in Little Rock, Pulaski County, \nArkansas. \n \nClaimant represented by the HONORABLE MATTHEW J. KETCHAM, \nAttorney at Law, Fort Smith, Arkansas. \n \nRespondents represented by the HONORABLE WILLIAM C. FRYE, \nAttorney at Law, North Little Rock, Arkansas. \n \nDecision of Administrative Law Judge:  Affirmed. \n \n \n OPINION AND ORDER \nThe claimant appeals an administrative law judge’s opinion filed \nFebruary 27, 2024.  The administrative law judge found that the claimant \nfailed to prove she sustained a compensable back injury.  The \nadministrative law judge found that the claimant failed to prove she was \nentitled to additional medical treatment provided in connection with “her \ncompensable piriformis and right thigh injuries.”  After reviewing the entire \nrecord de novo, the Full Commission affirms the administrative law judge’s \nopinion.     \nI.  HISTORY \n\nMELIUS - G807060  2\n  \n \n \n Tina Louise Melius, now age 54, testified that she had been \nemployed with the respondents as an LPN, Nurse Manager.  The parties \nstipulated that the employee-employer-carrier relationship existed on July \n11, 2018.  The claimant testified on direct examination: \nQ.  Were you working in your capacity as a Nurse Manager on \n7/11 of ’18? \n  A.  Yes. \n  Q.  What happened that day? \nA.  I was coming out of my office....I was told to go to a room \nand help EMS because they were coming through the \ndoor....We entered the room....I lowered the bed down and I \njust pushed it with my hand and when I went to step, it was – \nit’s like you could almost hear it, but feel it at the same time, a \npopping in my buttocks on my right side.  And when I went to \nstep, my calf drew up and the pain shot down my buttocks to \nbehind my knee.  So I stood there for a second and I rubbed \nmy bottom and then I reached down and felt my calf which \nwas rock hard.... \nQ.  When you mentioned what you have described as a pop \nsensation and sound, where exactly was that? \nA.  In my right glute.   \n \n The claimant testified that she informed a supervisor that a work-\nrelated incident had occurred, and that the employer directed her to seek \nmedical treatment.     \nAccording to the record, the claimant treated at Mercy Clinic on July \n11, 2018:  “Tina had just lifting (sic) a patient to the gurney from the bed \nand when she went to walk away afterwards she had a sharp pain in her \nright glute.”  Dr. Keith Holder reported on July 11, 2018, “This is the first \nexamination for this right hip strain.  She was provided a mild muscle \n\nMELIUS - G807060  3\n  \n \n \nrelaxer for night use.”  The diagnosis was “1.  Strain of muscle, fascia and \ntendon of right hip, initial encounter.”  The claimant was treated \nconservatively, and her Work Status was “Restricted Duty.”  The claimant \ntestified that she returned to work at light duty.     \nDr. Holder diagnosed the following on August 23, 2018:  “1.  Strain of \nmuscle, fascia and tendon of right hip, subsequent encounter.  2.  \nIntervertebral disc disorders with radiculopathy, lumbar region.”  Dr. Holder \ncontinued the Work Status “Restricted Duty.”  Dr. Holder instructed the \nclaimant, “Finish therapy.  Go for the MRI of the back and right thigh.”   \nDr. Holder reported on October 2, 2018, “This is the sixth \nexamination for this right hip strain.  She was provided a mild muscle \nrelaxer for night use and one for daytime.  I have recommended finishing \ntherapy for the last visit, I have requested [an] MRI of the lumbar and right \nthigh that was denied.  I will now try to refer her for a steroid injection of the \nischial bursae at pain management.  She will follow up in three weeks.” \nThe claimant signed a Form AR-C, CLAIM FOR COMPENSATION, \non October 16, 2018.  The ACCIDENT INFORMATION section of the Form \nAR-C indicated that the Date of Accident was July 11, 2018 and indicated, \n“Was helping lift a patient to move to another facility when felt twinge in \nbuttocks.  Buttocks and thigh.”       \n\nMELIUS - G807060  4\n  \n \n \nDr. Roy Sampson noted on November 1, 2018, “She injured herself \nat her job and has been dealing with hip and back pain from that....She \nsays she had an injury at work and her back and hip have been bothering \nher severely.  She is having trouble getting an MRI of her hip because of \nworkman’s comp.  Her pain is located in her right hip, back, and hands.” \nThe claimant consulted with Dr. Brian Goodman on November 13, \n2018:  “Ms. Melius is a 48 y.o. female who presents to the pain clinic with \nback pain which has been gradually worsening over time.  Possible \naccident or event leading to this pain:  July nursing incident, lifting patient, \nfelt a pop, then had spasms in the R buttocks and hamstring.”  Dr. \nGoodman’s assessment was “1.  Muscle strain – likely gluteal.  2.  Possible \npiriformis syndrome.”  Dr. Goodman planned conservative treatment.  The \nclaimant testified that she received pain relief from an injection provided by \nDr. Goodman. \nThe claimant followed up with Dr. Holder on November 30, 2018:  \n“Tina’s primary problem is pain located in the right gluteal area....She has \nhad an injection by Dr. Goodman into the trigger point.  She returns to him \nin two weeks.  Mild decrease in the pain after the steroid shot.”  Dr. Holder \ndiagnosed “1.  Strain of muscle, fascia and tendon of right hip, subsequent \nencounter....Tina’s recommended work status is Restricted Duty.”         \n\nMELIUS - G807060  5\n  \n \n \n A pre-hearing order was filed on February 19, 2019.  According to \nthe pre-hearing order, the claimant contended, “1.  The claimant was \ninjured on July 11, 2018 while assisting with lifting a patient from the bed to \nthe wheelchair.  2.  The claimant reserves the right to amend and \nsupplement her contentions after additional discovery has been completed.  \nThe claimant reserves all other issues.”   \n The parties stipulated that the respondents “have controverted the \nclaim in its entirety.”  The respondents contended that “the claimant is \nalleging an injury on July 11, 2018, at which time she was helping to lift a \npatient, and felt pain in the right buttocks and hip.  The respondents sent \nthe claimant to Dr. Holder for an evaluation.  Dr. Holder found no swelling \nand released the claimant to light duty, which the respondents \naccommodated.  Dr. Holder opined that the claimant had piriformis \nsyndrome, and recommended physical therapy.  On October 2, 2018, Dr. \nHolder ordered an injection in the bursa, which did not provide the claimant \nwith any lasting relief.  On November 13, 2018, the claimant was evaluated \nby Dr. Brian Goodman on a referral from Dr. Holder.  Dr. Goodman opined \nthat the claimant had a right gluteal muscle strain, and recommended \ntrigger point injections.  It is the respondent’s contention that the claimant’s \ncurrent piriformis problems are not due to her work related incident, and \nthat there are no objective findings to support a compensable injury.”   \n\nMELIUS - G807060  6\n  \n \n \n The parties agreed to litigate the following issues: \n1.  Whether claimant suffered a compensable injury to her \nbuttocks and thigh on July 11, 2018. \n2.  Whether claimant is entitled to medical treatment. \n3.  Whether claimant is entitled to temporary partial disability \nbenefits.   \n4.  Attorney fees.   \n \n Dr. Goodman corresponded with a case manager on March 15, \n2019: \n  This is a letter of response to your questions regarding Tina. \n  1.  Diagnosis provided at my visit:  muscle strain. \n2.  Current medical status and prognosis:  I don’t know, I saw \nher one time, 4 months ago.  No follow up. \n3.  Objective findings and treatment plan:  Right buttocks \ntenderness to palpation.  Treatment plan was to follow up for \ntrigger point injection and reevaluation. \n4.  Further improvement or MMI?  Unknown at this time. \n5.  Future treatment recommended:  Unsure until I see her \nagain, if she ever comes back for a follow up.   \n \n A hearing was held on April 16, 2019.  The claimant testified on \ndirect examination: \n  Q.  Are you claiming today that you suffered a back injury? \n  A.  No.  No. \n  Q.  Okay. \n  A.  It is just soreness or stiffness.  I walk it out.   \n  Q.  All right.  Where does the pain radiate from? \n  A.  From my buttocks down to behind my knee.   \nQ.  Okay.  What is your understanding as to what the problem \nis? \n  A.  Piriformis syndrome.   \n  Q.  What is piriformis, do you know? \nA.  The piriformis is a muscle that runs like east to west under \nthe glutes and the sciatic nerve runs through there and it’s \ntwisting and pinching the sciatic nerve.   \n \n\nMELIUS - G807060  7\n  \n \n \n An administrative law judge filed an opinion on June 25, 2019.  The \nadministrative law judge found, among other things, that the claimant “has \nfailed to prove by a preponderance of the evidence that she suffered a \ncompensable injury to her right buttock and thigh on July 11, 2018.”  The \nclaimant filed a notice of appeal to the Full Commission.   \n Dr. Thomas E. Cheyne noted on July 18, 2019: \nMs. Melius is a 48-year-old who presents with chronic right hip \npain over the last year.  She states she injured it at work one \nyear ago on 7/11/18 whenever she was lifting a patient to a \nbed and was trying to reach forward and felt pain in her \nbuttock area.  She had a few physical therapy treatments.  \nShe had one injection at the pain clinic but then Workers’ \nCompensation insurance denied any further injections.... \nShe is nontender in the low back.... \nX-rays of the lumbar spine are within normal limits for her age \nas is an AP pelvis.   \n \n Dr. Cheyne’s impression was “Chronic right hip pain, probable \nhamstring injury.  PLAN:  I would recommend getting an MRI of the right hip \nand pelvis.  We will have her continue her naproxen.  We will send her to \nphysical therapy, continue her work restrictions as a nurse, and we will see \nher back after the MRI.”  An MRI of the claimant’s hip was taken on July 26, \n2019 with the impression, “Essentially normal MRI of the bony pelvis and \nhips.”   \n Dr. Cheyne reported on July 31, 2019: \nMs. Melius returns for follow up of her chronic right hip pain.  \nShe had her MRI scan of her hip which was essentially normal \nother than an incidental finding of a left ovarian cyst.  She has \n\nMELIUS - G807060  8\n  \n \n \na history of ovarian polycystic disease so she is well aware of \nthat finding and is seeing her gynecologist in that regard.  I \ncontinue to believe that this is not a lower back issue.  I also \ndo not believe that this is a right hip joint issue but more likely \nmuscle or tendon injury.  Other than physical therapy and anti-\ninflammatories which have so far not helped, I would \nrecommend getting her in to see Dr. Jones just for a second \nopinion evaluation and get his ideas about the possible source \nof her pain.  We will schedule that appointment as soon as \ntime is available. \n \n Dr. Greg Jones noted on August 21, 2019: \nMs. Melius is a 49-year-old from Alma who presents at Dr. \nBishop’s request regarding right hip pain and back pain that \nhas been going on since she had a patient lifting incident on \n7/11/18.  She apparently has been denied as workman’s \ncomp.  She felt a pop and has had pain in the posterior aspect \nof her hip, states that she has had a “knot.”  She has been \ntreating with physical therapy for “piriformis syndrome.”  She \nhas been told by the therapist on multiple occasions that they \ncan feel the lump.  Physical therapy seems to have helped her \nget some motion back and she is not as tight as she was but \nshe comes in for complaints of her continued hip pain. \nOn exam, she has mild to moderate greater trochanteric \nbursitis.  The radicular pain symptoms are down the right leg \nand she has mild straight leg raise. \nI think that she has hurt her back.  This isn’t a piriformis \nlesion.  Certainly that can contribute to sciatic inflammation, \nbut I think we need to find out at this point, a year after the \nindex injury, if there is something more serious in terms of her \nback that could be addressed.  She was at Chapel Ridge \nHealth & Rehab when this occurred.  Dr. Bishop is her primary \nmedical physician.  They have an MRI of the hip.  I have \nreviewed it carefully.  There is no evidence of tendon avulsion, \nfemoral acetabular arthritis, avascular necrosis, or other \nintrinsic femoral acetabular issues in terms of the source of \nher present discomfort.  On external rotation, the hip did not \nreproduce her pain and while palpably she is tender \nposteriorly along the tract of the sciatic nerve, I do not feel an \nactual muscle avulsion where the “lump” that the therapist has \nbeen so prominent about.   \n\nMELIUS - G807060  9\n  \n \n \nWe will see her back when the lumbar MRI is completed and \nproceed with conservative care further.  Previous lumbar \nspine x-rays from July 18\nth\n were reviewed.  These are from \n2019.  She has straightening and loss of the lumbar lordosis.  \nThere is no obvious listhesis or scoliotic pattern.  There is \nspur-type lipping anteriorly at 4-5 and at T11-12.  Disc space \nheights are fairly well maintained but subchondral endplate \nsclerosis is noted.  On the foraminal outlet view there appears \nto be facet arthropathy, interference at 4-5 and at 5-1.  No \nfractures and no destruction lesion evident.  No new x-rays \nare made on today’s spine films.  We will see her when the \nMRI is completed.  No additional x-rays need to be made at \nthat time.  Previous hip x-rays were reviewed and although \nshe has some calcific density at the abductor insertion on the \nright hip, prominent trochanter changes, these are not \nconsistent with femoral acetabular arthritis.  No leg length \ninequality and these again are hip x-rays made in July and no \nnew films are made.   \n \n An MRI of the claimant’s lumbar spine was taken on August 28, 2019 \nwith the following impression: \n1.  Central/left paracentral disc protrusion L4-5 level, along \nwith hypertrophy the facets and ligamentum flavum causing at \nleast moderate central stenosis with probable mass effect left \nL5 nerve root lateral recess. \n2.  Broad-based central protrusion L5-S1 level mild central \nstenosis.  There may be some mild mass effect left S1 nerve \nroot lateral recess.   \n \n The claimant followed up with Dr. Jones on September 4, 2019: \nMs. Melius is a nurse at local Chapel Ridge Health & Rehab.  \nShe has been on limited duty pushing a cart.  She has not \nbeen engaged in lifting activities.  She comes back for \nfollowup of her MRI.  She has lumbar stenosis, facet \nhypertrophy and degenerative disc changes at L4-5 and L5-\nS1 with disc protrusion.  Her symptoms have improved \nconsiderably with the physiotherapy.  I do not think she has a \nherniated disc that requires surgery.  We have talked about \nthe implications of this level of back trouble.  At age 49 in \n\nMELIUS - G807060  10\n  \n \n \nterms of her body habitus, her lifting, etc., I recommended that \nshe not be lifting patients.  Physical therapy will be changed to \ninclude spinal flexibility and strengthening.  I think the \npiriformis syndrome is not the answer but rather the stenotic \nphenomenon, and given that she is this much better with \ntherapy, surgery is a last resort.  Lumbar epidural steroids \nmay be of benefit. \nShe has asked that I opine as to its onset.  Certainly, the story \nshe provided historically that she felt a pop, had swelling and \npresented immediately, this represents an exacerbation of an \nunderlying degenerative disc phenomenon and at least by the \nhistorical information stated, she is thankfully better and I do \nnot think will require any surgical intervention at this juncture, \nbut it has lifelong implications which we discussed at length.  \nWe will change physical therapy.  I asked her to do that twice \ndaily.  Her injury was in July 2018 so she is making it pretty \ndecent.  I think she should remain with a limited duty status in \nterms of avoidance of patient lifting and we will leave her \nfollowup here open ended.   \n \n The claimant agreed on cross-examination that she did not treat with \nDr. Jones after September 4, 2019.  The claimant testified that she worked \nfor the respondent-employer through September 19, 2019.  The claimant \ntestified, “I could no longer do the patient-lifting portion of my job.”  The \nclaimant testified that she became employed with a nursing home on \nSeptember 20, 2019.     \n Meanwhile, a majority of the Full Commission affirmed and adopted \nthe administrative law judge’s June 25, 2019 decision in an opinion filed \nDecember 19, 2019.  In an opinion delivered February 10, 2021, the \nArkansas Court of Appeals reversed and remanded for further proceedings.  \nMelius v. Chapel Ridge Nursing Center, 2021 Ark. App. 61, 618 S.W.3d \n\nMELIUS - G807060  11\n  \n \n \n410.  The Court determined:  “[W]e reinstate Melius’s case and remand for \nfurther determinations of whether she suffered a compensable injury to her \nbuttock and thigh on July 11, 2018, whether she is entitled to medical \ntreatment, and whether she is entitled to temporary partial-disability \nbenefits.”         \n The Full Commission filed an opinion on September 28, 2021 and \nremanded to the administrative law judge “for proceedings consistent with \nthis order and the mandate from the Court of Appeals.”  The parties \nthereafter stipulated that the claimant “sustained a compensable piriformis \ninjury to the buttock and thigh” on July 11, 2018. \n Dr. Cheyne noted on November 23, 2021: \nMs. Melius is seen back for the first time since I last saw her \nin July 2019 with right buttock pain.  She eventually saw Dr. \nJones who thought that this was likely related to her back.  \nShe had an MRI scan done and had a left paracentral disk \nprotrusion at L4-5 and a central disk protrusion at L5-S1.  She \ngot better to a point with physical therapy and anti-\ninflammatory medications.  She also got some relief from a \ngluteal injection which was done by Dr. Goodman; however, \nshe has persistent pain.  I have looked at her MRI scan and \nstill believe that this is likely related to her back, although it is \ncertainly possible since she got relief from the injection by Dr. \nGoodman.  We will get her back in to see him for another \ninjection or 2.  If gluteal injections do not work, then we will \nconsider LESIs.   \n \n A pre-hearing order was filed on July 21, 2022.  The claimant \ncontended, “1.  The above listed proposed stipulations.  2.  The Claimant \nwas injured on July 11, 2018, while assisting EMS personnel who were \n\nMELIUS - G807060  12\n  \n \n \nmoving a patient from a bed to a gurney.  The Claimant was grabbed by the \npatient while lowering the patient onto the gurney which caused the \nclaimant to come up onto her right tiptoes.  The Claimant felt a pop in her \nglute and a muscle spasm in her thigh and calf.  On July 11, 2018, the \nClaimant was instructed to see Dr. Keith Holder at Mercy Clinic \nOccupational Medicine with complaints of sharp pain in the right glute.  Dr. \nHolder diagnosed the claimant with strain of muscle, fascia and tendon of \nright hip.  Dr. Holder also restricted the Claimant to light duty with a follow-\nup in seven (7) to ten (10) days as well as hip exercises and a cane to \nambulate with.  On July 19, 2018, the Claimant returned to Dr. Holder for a \nfollow-up where she stated that the pain is worse at night as well as with \nsitting.  Dr. Holder kept the Claimant restricted to light duty and referred her \nto therapy.  The Claimant continued to follow-up with Dr. Holder who \ncontinued to refer the Claimant for therapy as well as her restriction to light \nduty.  On August 13, 2018, the Claimant attended physical therapy for \nstrain of muscle, fascia and tendon of right hip where it was noted that she \nhas decreased range of motion and strength as well as gait and postural \ndeficits.  The Claimant was approved for six (6) visits.  On August 23, 2018, \nthe Claimant was seen by Dr. Holder where he recommended the Claimant \nto finish therapy and that he would request an MRI of the Claimant’s lumbar \nspine and right thigh which was denied.”   \n\nMELIUS - G807060  13\n  \n \n \n The claimant contended, “On October 2, 2018, the Claimant once \nagain seen (sic) by Dr. Holder where he referred the Claimant for steroid \ninjection by pain management.  Dr. Holder kept the Claimant on light duty.  \nOn November 23, 2018, the Claimant was seen by Dr. Brian Goodman for \npain management where it (sic) he recommended the Claimant getting \nstretching exercises and to follow-up in one (1) month.  The Claimant \nreturned once more to Dr. Holder for a follow-up.  However, any further \ntreatment was denied by Respondents.  While the Claimant was going \nthrough the workers’ compensation process, she continued to seek \ntreatment using her own private health insurance.  On July 18, 2019, the \nClaimant present (sic) to Dr. Thomas Cheyne for continued right hip pain.  \nDr. Cheyne’s diagnosed (sic) was chronic right hip pain, probable hamstring \ntendon injury.  He recommended an MRI of right hip and pelvis as well as \nreferred the Claimant for physical therapy.  The Claimant had an MRI \ncompleted which was normal.  However, Dr. Cheyne referred the Claimant \nfor a second opinion to try to locate the source of the pain.  In the \nmeantime, the Claimant continued to attend physical therapy for a right \nhamstring injury.”   \n The claimant contended, “On August 12, 2019, the Claimant was \nseen by Dr. Greg Jones for a second opinion.  Dr. Jones notes the \nClaimant’s radicular pain symptoms down the right leg.  Dr. Jones states \n\nMELIUS - G807060  14\n  \n \n \nthat he believes that the Claimant has suffered a low back injury and has \nrequested a lumbar MRI.  The Claimant returns to Dr. Jones post-MRI on \nSeptember 4, 2019, and it was found that the Claimant has lumbar \nstenosis, facet  hypertrophy and degenerative disc changes at L4-5 and L5-\nS1 disc protrusion.  Dr. Jones changed the Claimant’s physical therapy to \nfocus on the Claimant’s lumbar spine but that she is to continue on light \nduty work restrictions.  The Claimant continued with physical therapy \ntreatment.  On November 23, 2021, the Claimant returned to Dr. Cheyne for \ncontinued pain where Dr. Cheyne opined his opinion that they (sic) right \nglute pain comes from the Claimant’s low back and referred the Claimant \nfor additional trigger point injections.  3.  Claimant reserves the right to \nsupplement and amend her contentions after additional discovery has been \ncompleted.”   \n The parties stipulated, “The respondents have agreed to pay for all \nmedical treatment from July 11, 2018, to April 16, 2019, regarding the \ncompensable piriformis injury to the buttock and thigh.”  The respondents \ncontended, “Respondents contend that the Claimant did have a piriformis \ninjury that the Court of Appeals said was in the right buttocks.  The \nClaimant apparently is now having problems in the low back, which was not \nlitigated at the prior hearing and is not subject to this remand.  Respondents \nhave paid the medical bills that were subject of the initial hearing related to \n\nMELIUS - G807060  15\n  \n \n \nthe piriformis syndrome.  A copy of the payment history is attached.  The \nClaimant has not outlined what medical are outstanding nor have any \nmedical bills been submitted.  Claimant is also contending that she is \nentitled to temporary total disability benefits.  However, the Claimant did not \nlose any time from work, but did make a claim for temporary partial \ndisability.  It is possible that issue will need to be litigated, though it is \nunclear what benefits and time frame the Claimant is asking for benefits.  \nThe Claimant has not provided any off work slips.  In addition, she \nvoluntarily quit working for the Respondent-Employer and went to work for \nanother facility.  Therefore, Respondents are unaware of any missed time.  \nNext, the Claimant went from 2019 to 2021 with no medical treatment.  It is \nRespondents position that the healing period has long since ended.  \nClaimant has also requested permanent partial disability and wage loss.  \nRespondents are unaware of any impairment rating being assigned for the \npiriformis syndrome.”   \n The parties agreed to litigate the following issues: \n1.  Whether Claimant is entitled to temporary partial disability \nbenefits.   \n  2.  Whether Claimant’s attorney is entitled to an attorney fee.   \n \n After a hearing, an administrative law judge filed an opinion on \nOctober 18, 2022.  The administrative law judge found, “2.  That the \nclaimant has proven by a preponderance of the evidence that she is entitled \n\nMELIUS - G807060  16\n  \n \n \nto temporary partial disability benefits from July 12, 2018, until she began \nher new position with the respondents sometime between September of \n2018 and December of 2018.”  The parties have stipulated, “All prior \nopinions are res judicata and the law of this case.” \n A pre-hearing order was filed on October 31, 2023.  According to the \npre-hearing order, the claimant contended:  “1.  The above-listed proposed \nstipulations.  2.  The Claimant was injured on July 11, 2018 while assisting \nEMS personnel who were moving a patient from a bed to a gurney.  The \nClaimant was grabbed by the patient while lowering the patient onto the \ngurney which caused the claimant to come up onto her right tiptoes.  The \nClaimant felt a pop in her glute and a muscle spasm in her thigh and calf.  \nOn July 11, 2018, the Claimant was instructed to see Dr. Keith Holder at \nMercy Clinic Occupational Medicine with complaints of sharp pain in right \nglute.  Dr. Holder diagnosed the claimant with strain of muscle, fascia and \ntendon of right hip.  Dr. Holder also restricted the Claimant to light duty with \na follow-up in seven (7) to ten (10) days as well as hip exercises and a cane \nto ambulate with.  On July 19, 2018, the Claimant returned to Dr. Holder for \na follow-up where she stated that the pain is worse at night as well as with \nsitting.  Dr. Holder kept the Claimant restricted to light duty and referred her \nfor therapy.  The Claimant continued to follow-up with Dr. Holder who \ncontinued to refer the Claimant for therapy as well as her restriction to light \n\nMELIUS - G807060  17\n  \n \n \nduty.  On August 13, 2018, the Claimant attended physical therapy for \nstrain of muscle, fascia and tendon of right hip where it is noted she has \ndecreased range of motion and strength as well as gait and postural \ndeficits.  The Claimant was approved for six (6) visits.  On August 23, 2018, \nthe Claimant was seen by Dr. Holder where he recommended the Claimant \nto finish therapy and that he would request an MRI of the Claimant’s lumbar \nspine and right thigh which was denied.  On October 2, 2018, the Claimant \nonce again seen (sic) by Dr. Holder where he referred the Claimant for \nsteroid injection by pain management.  Dr. Holder kept the Claimant on light \nduty.  On November 13, 2018, the Claimant was seen by Dr. Brian \nGoodman for pain management where it (sic) he recommended the \nClaimant getting trigger point injection in the right gluteal muscle as well as \nstretching exercises and to follow-up in one (1) month.  The Claimant \nreturned once more to Dr. Holder for a follow-up.  However, any further \ntreatment was denied by the Respondents.  While the Claimant was going \nthrough the workers’ compensation process, she continued to seek \ntreatment using her own private health insurance.  On July 18, 2019, the \nClaimant present (sic) to Dr. Thomas Cheyne for continued right hip pain.  \nDr. Cheyne’s diagnosed (sic) was chronic right hip pain, probable hamstring \ninjury.  He recommended an MRI of right hip and pelvis as well as referred \nthe Claimant for physical therapy.  The Claimant had an MRI completed \n\nMELIUS - G807060  18\n  \n \n \nwhich was normal.  However, Dr. Cheyne referred the Claimant for a \nsecond opinion to try to locate the source of the pain.  In the meantime, the \nClaimant continued to attend physical therapy for a right hamstring injury.  \nOn August 21, 2019, the Claimant was seen by Dr. Greg Jones for a \nsecond opinion.  Dr. Jones notes the Claimant’s radicular pain symptoms \ndown the right leg.  Dr. Jones states that he believes that the Claimant has \nsuffered a low back injury and has requested a lumbar MRI.  The Claimant \nreturns to Dr. Jones post-MRI on September 4, 2019 and it was found that \nthe Claimant has lumbar stenosis, facet hypertrophy and degenerative disc \nchanges at L4-5 and L5-S1 disc protrusion.  Dr. Jones changes the \nClaimant’s physical therapy to focus on the Claimant’s lumbar spine but that \nshe is to continue on light duty work restrictions.  The Claimant continued \nwith physical therapy treatment.  On November 23, 2021, the Claimant \nreturned to Dr. Cheyne for continued pain where Dr. Cheyne opined his \nopinion that they (sic) right glute pain comes from the Claimant’s low back \nand referred the Claimant for additional trigger point injections.  3.  Claimant \nreserves the right to supplement and amend her contentions after additional \ndiscover (sic) has been completed.”   \n The respondents contended, “Respondents contend that the \nclaimant did have a piriformis injury that the Court of Appeals said was in \nthe right buttocks but not the low back.  The Claimant is apparently now \n\nMELIUS - G807060  19\n  \n \n \nhaving problems in the low back.  The Claimant testified at the previous \nhearing that her low back was not injured in July 11, 2018.  The Court of \nappeals found the Claimant sustained a piriformis injury and a claim for the \nlow back was not filed until the statute of limitations had run on this case.  \nThe Claimant is also contending that she is entitled to temporary total \ndisability benefits.  The Commission found that the Claimant was entitled to \nTemporary Partial Disability until sometime between September of 2018 \nand December of 2018 when she began a new position with the \nRespondents.  The Claimant has not provided any off work slips.  In \naddition, she voluntarily quit working for the Respondent-employer and \nwent to work for another facility.  Therefore, Respondents are unaware of \nany missed time.  Next, the Claimant went from 2019 to 2021 with no \nmedical treatment.  It is Respondents position that the healing period has \nlong since ended.  Claimant has also requested permanent partial disability \nand wage loss.  Respondents are unaware of any impairment rating being \nassigned for the piriformis syndrome.”   \n The parties agreed to litigate the following issues: \n1.  Whether Claimant is entitled to additional medical \ntreatment for her compensable piriformis and right thigh \ninjuries that occurred on July 11, 2018, or alternatively, \nwhether Claimant sustained a compensable injury to her low \nback on or about July 11, 2018.   \n2.  Whether Claimant is entitled to additional medical \ntreatment for compensable low back injury. \n\nMELIUS - G807060  20\n  \n \n \n3.  Whether Claimant is entitled to temporary partial disability \nbenefits from September 19, 2019 to a date yet to be \ndetermined. \n4.  Respondents raise the Statute of Limitations defense.   \n5.  Whether Claimant’s attorney is entitled to an attorney fee.  \n \n A hearing was held on November 30, 2023.  The claimant testified \nthat she was working for another employer, Mercy Neurosurgery.     \n An administrative law judge filed an opinion on February 27, 2024.  \nThe administrative law judge found, among other things, that the claimant \ndid not prove she sustained a compensable back injury.  The administrative \nlaw judge found that the claimant did not prove she was entitled to \nadditional medical treatment, and that the claimant did not prove she was \nentitled to additional temporary partial disability benefits.  The administrative \nlaw judge therefore denied the claim.  The claimant appeals to the Full \nCommission.   \nII.  ADJUDICATION \n A.  Compensability \n Ark. Code Ann. §11-9-102(4)(Repl. 2012) provides, in pertinent part: \n  (A)  “Compensable injury” means: \n(i)  An accidental injury causing internal or external physical \nharm to the body ... arising out of and in the course of \nemployment and which requires medical services or results in \ndisability or death.  An injury is “accidental” only if it is caused \nby a specific incident and is identifiable by time and place of \noccurrence[.] \n \n\nMELIUS - G807060  21\n  \n \n \n A compensable injury must also be established by medical evidence \nsupported by objective findings.  Ark. Code Ann. §11-9-102(4)(D)(Repl. \n2012).  “Objective findings” are those findings which cannot come under the \nvoluntary control of the patient.  Ark. Code Ann. §11-9-102(16)(A)(i)(Repl. \n2012).   \n The employee has the burden of proving by a preponderance of the \nevidence that she sustained a compensable injury.  Ark. Code Ann. §11-9-\n102(4)(E)(i)(Repl. 2012).  Preponderance of the evidence means the \nevidence having greater weight or convincing force.  Metropolitan Nat’l \nBank v. La Sher Oil Co., 81 Ark. App. 269, 101 S.W.3d 252 (2003).   \n An administrative law judge found in the present matter, “4.  The \nclaimant has failed to prove by a preponderance of the evidence that she \nsustained a compensable injury to her low back on or about July 11, 2018.”  \nThe Full Commission affirms this finding.  The parties stipulated that the \nemployment relationship existed on July 11, 2018.  The claimant testified \nthat she “felt a popping in my buttocks on my right side” while lowering and \npushing a resident’s bed.  The claimant testified that the pain was “in my \nright glute.”  The parties have stipulated that the claimant “sustained a \ncompensable piriformis injury to the buttock and thigh” on July 11, 2018.   \n The claimant did not prove by a preponderance of the evidence that \nshe also sustained a compensable injury to her low back on July 11, 2018.  \n\nMELIUS - G807060  22\n  \n \n \nDr. Holder reported on July 11, 2018 that the claimant had sustained a \n“right hip strain.”  Dr. Holder diagnosed “Strain of muscle, fascia and tendon \nof right hip[.]”  Dr. Holder did not opine that the claimant had sustained a \nback injury.  The claimant signed a Form AR-C, CLAIM FOR \nCOMPENSATION, on October 16, 2018.  The claimant reported on the \nForm AR-C that she had injured her buttocks and thigh.  The claimant did \nnot report that she had also injured her back on July 11, 2018.  As the Full \nCommission has noted, the claimant expressly testified on April 16, 2019 \nthat she had not suffered a back injury.  The claimant testified that she was \nsuffering from “piriformis syndrome.”  Dr. Cheyne reported on July 18, 2019 \nthat the claimant was “nontender in the low back.”  We also note Dr. \nCheyne’s report on July 31, 2019, “I continue to believe that this is not a \nlower back issue.”   \n The Full Commission recognizes Dr. Jones’ opinion stated August \n21, 2019, “I think she has hurt her back.”  It is within the Commission’s \nprovince to weigh all of the medical evidence and to determine what is most \ncredible.  Minnesota Mining & Mfg. v. Baker, 337 Ark. 94, 989 S.W.2d 151 \n(1999).  In the present matter, we assign minimal weight to Dr. Jones’ \nopinion that the claimant injured her back.  Neither the medical evidence of \nrecord nor the claimant’s testimony indicates that the claimant injured her \nback on July 11, 2018.  Moreover, the claimant reported on the Form AR-C \n\nMELIUS - G807060  23\n  \n \n \ndated October 16, 2018 that she had injured only her buttocks and thigh on \nJuly 11, 2018.  The claimant did not report a back injury.   \n In accordance with the applicable elements of Ark. Code Ann. §11-9-\n102(4)(Repl. 2012), the Full Commission finds that the claimant did not \nprove by a preponderance of the evidence that she sustained a \n“compensable injury” to her back on July 11, 2018.  The claimant did not \nprove that she sustained an accidental injury causing internal or external \nphysical harm to her back.  The claimant did not prove that she sustained \nan injury to her back which arose out of and in the course of employment, \nrequired medical services, or resulted in disability.  The claimant did not \nprove that she sustained an injury to her back which was caused by a \nspecific incident or was identifiable by time and place of occurrence on July \n11, 2018.  In addition, the claimant did not establish a compensable injury \nto her back by medical evidence supported by objective findings.  We find \nthat none of the abnormalities shown in the claimant’s lumbar spine \nbeginning July 18, 2019 were causally related to the “compensable \npiriformis injury to the buttock and thigh” which the claimant sustained on \nJuly 11, 2018, or that the claimant established a compensable injury to her \nlumbar spine by medical evidence supported by objective findings.  See \nFord v. Chemipulp Process, Inc., 63 Ark. App. 260, 977 S.W.2d 5 (1998).   \n B.  Temporary Disability \n\nMELIUS - G807060  24\n  \n \n \n Temporary total disability is that period within the healing period in \nwhich the employee suffers a total incapacity to earn wages, whereas \ntemporary partial disability is that period within the healing period in which \nthe employee suffers only a decrease in her capacity to earn the wages she \nwas receiving at the time of the injury.  Ark. State Hwy. Dept. v. Breshears, \n272 Ark. 244, 613 S.W.2d 392 (1981).  “Healing period” means “that period \nfor healing of an injury resulting from an accident.”  Ark. Code Ann. §11-9-\n102(12)(Repl. 2012).  A healing period has not ended so long as treatment \nis administered for the healing and alleviation of a condition.  Milligan v. \nWest Tree Serv., 57 Ark. App. 14, 946 S.W.2d 697 (1997). \n An administrative law judge found in the present matter, “5.  The \nclaimant has failed to prove by a preponderance of the evidence that she is \nentitled to temporary partial disability benefits from September 19, 2019, to \na date yet to be determined.\"  The Full Commission affirms this finding.  \nThe parties have stipulated that the claimant “sustained a compensable \npiriformis injury to the buttock and thigh” on July 11, 2018.  The claimant \ntestified that she returned to light-duty work following the compensable \ninjury.  An administrative law judge found that the claimant proved she was \n“entitled to temporary partial disability benefits from July 12, 2018, until she \nbegan her new position with the respondents somewhere between \n\nMELIUS - G807060  25\n  \n \n \nSeptember of 2018 and December of 2018.”  The parties have stipulated, \n“All prior opinions are res judicata and the law of this case.”   \n The claimant testified that she continued to work for the respondent-\nemployer through September 19, 2019.  The claimant testified that she \nbecame a full-time employee with Legacy, a nursing home, on September \n20, 2019.  The Full Commission finds that the claimant did not prove she \nwas entitled to additional temporary partial disability benefits after \nSeptember 19, 2019.  We find that the claimant did not prove she was \npartially incapacitated from earning wages at any time after September 19, \n2019. \n C.  Medical Treatment \n Finally, the employer shall promptly provide for an injured employee \nsuch medical treatment as may be reasonably necessary in connection with \nthe injury received by the employee.  Ark. Code Ann. §11-9-508(a)(Repl. \n2012).  The employee has the burden of proving by a preponderance of the \nevidence that medical treatment is reasonably necessary.  Stone v. Dollar \nGeneral Stores, 91 Ark. App. 260, 209 S.W.3d 445 (2005).  What \nconstitutes reasonably necessary medical treatment is a question of fact for \nthe Commission.  Wright Contracting Co. v. Randall, 12 Ark. App. 358, 676 \nS.W.2d 70 (1984).   \n\nMELIUS - G807060  26\n  \n \n \n An administrative law judge found in the present matter, “2.  The \nclaimant has failed to prove by a preponderance of the evidence that she is \nentitled to additional medical treatment for her compensable piriformis and \nright thigh injuries that occurred on July 11, 2018.”  The Full Commission \nfinds that the claimant did not prove additional medical treatment was \nreasonably necessary in connection with her compensable injuries.  As we \nhave discussed, the parties stipulated that the claimant “sustained a \ncompensable piriformis injury to the buttock and thigh” on July 11, 2018.  \nThe claimant treated with physicians including Dr. Holder, Dr. Sampson, \nand Dr. Goodman following her compensable injury.  There are currently no \ntreatment recommendations of record related to the compensable piriformis \ninjury.  We therefore find that the claimant did not prove additional medical \ntreatment was reasonably necessary.   \n After reviewing the entire record de novo, the Full Commission finds \nthat the claimant did not prove by a preponderance of the evidence that she \nsustained a compensable back injury.  The claimant did not prove that she \nwas entitled to additional temporary partial disability benefits, and the \nclaimant did not prove that additional medical treatment was reasonably \nnecessary in connection with her compensable piriformis injury.  The \nadministrative law judge’s opinion is affirmed, and this claim is respectfully \ndenied and dismissed.   \n\nMELIUS - G807060  27\n  \n \n \n IT IS SO ORDERED.               \n \n    ___________________________________ \n    SCOTTY DALE DOUTHIT, Chairman \n \n    \n    ___________________________________ \n    MICHAEL R. MAYTON, Commissioner \n \n \nCommissioner Willhite dissents.","preview":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. G807060 TINA MELIUS, EMPLOYEE CLAIMANT CHAPEL RIDGE NURSING CENTER, EMPLOYER RESPONDENT AMTRUST NORTH AMERICA, INSURANCE CARRIER/TPA RESPONDENT OPINION FILED AUGUST 21, 2024","fetched_at":"2026-05-19T22:29:45.171Z","links":{"html":"/opinions/full_commission-G807060-2024-08-21","pdf":"https://labor.arkansas.gov/wp-content/uploads/Melius_Tina_G807060_20240821.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/full-commission-opinions/"}}