{"id":"full_commission-G900538-2023-05-26","awcc_number":"G900538","decision_date":"2023-05-26","opinion_type":"full_commission","claimant_name":"Eldridge Howard","employer_name":"City Of Faith Prison Ministries","title":"HOWARD VS. CITY OF FAITH PRISON MINISTRIES AWCC# G900538 MAY 26, 2023","outcome":"granted","outcome_keywords":["granted:2","denied:1"],"injury_keywords":["fracture","wrist","shoulder","knee","back","neck","strain","sprain"],"pdf_url":"https://labor.arkansas.gov/wp-content/uploads/Howard_Eldridge_G900538_20230526.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/full-commission-opinions/","filename":"Howard_Eldridge_G900538_20230526.pdf","text_length":48148,"full_text":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION \n \n \nCLAIM NO.  G900538 \n \nELDRIDGE  HOWARD, III, \nEMPLOYEE \n \nCLAIMANT \nCITY OF FAITH PRISON MINISTRIES,  \nEMPLOYER \n \nRESPONDENT \nTECHNOLOGY INSURANCE CO., CARRIER \nAMTRUST NORTH AMERICA, TPA \nRESPONDENT \n  \n      \nOPINION FILED MAY 26, 2023  \n \nUpon review before the FULL COMMISSION in Little Rock, Pulaski County, \nArkansas. \n \nClaimant represented by the HONORABLE DARRELL F. BROWN, JR., \nAttorney at Law, Little Rock, Arkansas. \n \nRespondents represented by the HONORABLE WILLIAM C. FRYE, \nAttorney at Law, North Little Rock, Arkansas. \n \nDecision of Administrative Law Judge:  Reversed. \n \n \n OPINION AND ORDER \nThe claimant appeals an administrative law judge’s opinion filed \nSeptember 20, 2022.  The administrative law judge found that the claimant \ndid not prove he sustained a compensable injury.  After reviewing the entire \nrecord de novo, the Full Commission reverses the administrative law \njudge’s opinion.  The Full Commission finds that the claimant proved he \nsustained a compensable injury to his left elbow.     \nI.  HISTORY \n Eldridge Charles Howard, III, now age 40, testified that he was \ndiagnosed as having epileptic seizures beginning in 2005.  Dr. David M. \n\nHOWARD – G900538  2\n  \n \n \nRhodes treated Mr. Howard, and corresponded with Dr. Robin Jeffers-Perry \non May 26, 2005:   \nThe patient is a 22 year old right hand dominant male, \nstudent, who on 5/7/05 was involved in a motor vehicle \naccident.  He sustained an open left elbow dislocation \nwith brachial artery injury and open left distal radius and ulnar \nfracture.  He complains of pain in the arm that is exacerbated \nwith range of motion and alleviated with rest.... \nThere is an ex/fix across the elbow and across the left distal \nradius with decreased sensation to light touch in the radial \nand ulnar nerve distribution.... \nX-RAYS:  2 views of the left elbow were ordered, performed \nand interpreted by me with the following findings:  Show \nsubluxation of the radial head.  2 views of the left wrist show \nsegmental bone deformity of the distal radius.   \n \n Dr. Rhodes assessed “1.  Status post left elbow and distal radius \nopen fracture ex/fix with brachial artery graft....Schedule left elbow ex/fix \nremoval.”   \n Dr. Rhodes reported on May 27, 2005, “Mr. Eldridge Howard was \ntaken to the operating room today for removal of external fixator across his \nleft elbow under anesthesia....He was given a follow-up appointment that \nday with therapy to get placed in a hinged elbow brace.”   \n Dr. Rhodes informed Dr. Jeffers-Perry on June 17, 2005, “Mr. \nEldridge Howard was taken to the operating room today for removal of his \nex/fix of his left distal radius.”   \n Dr. Rhodes’ assessment on July 18, 2005 was “1.  Left distal radius \nfracture and brachial plexus injury and elbow fracture dislocation.”       \n\nHOWARD – G900538  3\n  \n \n \n Dr. Rhodes reported on July 22, 2005, “Mr. Eldridge Howard was \ntaken to the operating room today for treatment of his left distal radius non-\nunion.”   \nDr. David N. Collins evaluated the claimant on August 31, 2005: \nMr. Howard is a 22-year old patient seen in consultation for \nhis right shoulder at the request of David Rhodes, M.D.  His \nchief complaint is pain and dysfunction.  His primary care \nphysician is Dr. Perry. \nMr. Howard was involved in severe accident on 5/07/05.  He \napparently was treated in Memphis for an open, left elbow \ndislocation with brachial artery injury and a left open distal \nradius and ulna fracture.  He came to the care of Dr. Rhodes \non 5/26/05.  At that time, he had an ex-fix in place.  He had \nsome concerns regarding the injury relative to infection.  Over \nthe course of time, he was treated for nonunion and went on \nto have additional surgery with bone grafting.  It was \ndetermined at some point that he had a brachial plexus injury.  \nHe continues under Dr. Rhodes’ care for the upper extremity \nwith concerns regarding the elbow, forearm, and shoulder.   \n \n Dr. Collins gave the following impression:  “It appears that Mr. \nHoward sustained an injury of significant magnitude to the left upper \nextremity....There are no specific problems related to the shoulder, other \nthan weakness which should hopefully improve over time....The greatest \nconcern, I would think at this point, is his elbow....There are no specific \nindications for additional imaging studies or diagnostic tests regarding the \nleft shoulder.  I will follow him as needed.”     \n Dr. Michael M. Moore corresponded with Dr. Rhodes on September \n13, 2005: \n\nHOWARD – G900538  4\n  \n \n \nThank you very much for referring Eldridge Howard for \nconsultation.  He was seen at the Arkansas Hand Center on \n09/13/05 for Second Opinion Evaluation.  He is a pleasant, \n22-year-old, right-hand dominant student who was involved in \na motor vehicle accident on 05/07/05.  He sustained severe \ninjuries to the left wrist and elbow....Apparently, external \nfixation devices were placed on the wrist and elbow.  Mr. \nHoward required repair of the brachial artery.  In addition, skin \ngrafting was required to cover a wound over the anteromedial \naspect of the elbow.... \nIt is my opinion Mr. Howard has sustained a complex injury to \nthe left upper extremity....If Mr. Howard were my patient, it \nwould be my recommendation that a Zoom CT scan of the left \ndistal radius be performed.  If there appeared to be healing of \nthe distal radius, I would recommend removing the plate and \ndebriding the fracture site.   \n \n Dr. Rhodes performed a “debridement of dorsal complex of left distal \nradius for osteomyelitis” on October 4, 2005.  The post-operative diagnosis \nwas “Retained hardware, left distal radius fracture, with chronic distal radius \nosteomyelitis, with extensor carpi radialis brevis and tongus tendon \nadhesions and adhesions of the flexor carpi radialis.” \n Dr. Rhodes’ assessment on October 10, 2005 was “1.  Left distal \nradius hardware removal with osteomyelitis.”     \n The claimant testified, “After the ’05 injury I was placed on disability \nprobably in about 2007.”  An MRI of the claimant’s left knee on January 21, \n2008 showed, among other things, a “nondisplaced intra-articular fracture.”  \nThe assessment of Dr. Robert C. Matthias on December 3, 2008 was \n“Severe left elbow degenerative disease following a severe traumatic \ninjury.”     \n\nHOWARD – G900538  5\n  \n \n \n Dr. Jeanine Andersson evaluated the claimant on July 15, 2013:  \n“The patient is a 30-year-old right-hand dominant male who has a \ndebilitating seizure disorder.  He has no use of his left arm secondary to an \nMVA while having a seizure.  He comes in today for evaluation of masses \nover his right hand which have progressively enlarged and are severely \npainful.  Since this is his only useful hand, he wishes to have these \nsurgically excised....I discussed with the patient today both nonsurgical and \nsurgical treatment options.  The patient would like to proceed with surgical \nexcision of multiple hand masses.”   \n Dr. Andersson assessed “#1  right hand multiple soft tissue masses \n– worsening of progressively enlarging.  #2)  left hand paralysis following \nMVA.  #3  seizure disorder.”   \n Dr. Andersson performed a procedure on July 30, 2013 which \nincluded “Right hand mass excision.”  The post-operative diagnosis was \n“Right hand multiple masses, including three masses of right thumb, two \nmasses of right index finger and one mass in palm of hand.” \n Dr. Willis Courtney saw the claimant at Arkansas Neurology & \nEpilepsy Center on April 16, 2014: \nThe patient is a 31 year old male who presents with seizure \ndisorder.  The patient’s typical seizures are complex \npartial....The patient was referred by Dr. Robin Perry.  The \npatient was last evaluated by me on November 19, 2013.  At \nthat time, the patient reported recurrent episodes of seizures \nas well as paroxysmal episodes of involuntary nystagmus and \n\nHOWARD – G900538  6\n  \n \n \ngait ataxia.  The patient was scheduled for an EEG to assist in \ndetermining if additional or alternative anticonvulsant \nmedication were required.  The EEG study was \nunrevealing.... \n \n Dr. Courtney’s impression included “1.  Intractable partial complex \nepilepsy with and without secondary generalization, currently stable on \nphenobarbital, generic Trileptal, and generic Lamictal.  2.  Status post MVA \nwith fracture of the left forearm, requiring surgery.  3.  Left foot surgery.”  Dr. \nCourtney recommended continued medication and “2.  Seizure \nprecautions.\"   \n The claimant sustained a “left distal ulnar fracture” on September 6, \n2014 following a fall.  The claimant was treated conservatively.          \n Dr. Courtney’s impression on October 15, 2014 was “1.  Intractable \npartial complex epilepsy with secondary generalization, currently stable.”  \nDr. Courtney’s impression on May 11, 2015 was “1.  Intractable partial \ncomplex epilepsy with and without secondary generalization.  2.  Reports of \nrecurrent seizure described as nocturnal generalized tonic-clonic events as \nwell as intermittent staring episodes/loss of time during wakefulness.”   \n An RN noted on July 8, 2015, “Pt was walking down stairs last night \nand fell.  Unsure if he had seizure or what.  Hx seizure....Pt with small \nsuperficial lac to left side of forehead in scalp.”   \n Dr. Casey M. Smolarz assessed the following on October 23, 2015:  \n“1.  Closed head injury, initial encounter.  2.  Lip swelling.  3.  Forehead \n\nHOWARD – G900538  7\n  \n \n \nabrasion, initial encounter.  4.  Motor vehicle accident.  5.  History of \nseizure.” \n Dr. Zachary B. Lewis reported on October 23, 2015: \nMotor Vehicle Crash w/history of seizure disorder presenting \nto the ED after 4 block city speed MVC w/his vehicle striking \nmultiple poles, one house, and one vehicle.  Pt notes that he \nwoke up around 1:30 AM, took his phenobarbital, and went to \nthe strip club.  Pt denies drug or EtOH use tonight.  He left the \nclub because his phenobarbital “kicked in” because it “messes \nwith him sometimes.”  Pt notes remembering losing control \nand hitting the first few objects w/airbags being deployed....Pt \nunsure if he was knocked out.  Ambulatory on the scene.... \nPt was examined after traumatic event w/possible \ninjury....Patient wishes to leave against medical advice.   \n \n Dr. Lewis diagnosed “1.  Motor vehicle accident.  2.  Lip swelling.  3.  \nForehead abrasion, initial encounter.  4.  History of seizure.” \n Dr. Neil K. Masangkay noted on September 21, 2016, “Mr. Howard is \na patient with a history of epilepsy for several years.  He is on 3 AEDs \nincluding PHB.  He was taking 120mg/day but reduced this to 60mg per \nday.  He had been having good seizure control until earlier this week and \nhas had at least two seizures since then leading to a fracture and a \nhematoma affecting his left shoulder and arm.  On examination, his left arm \nhad some scarring and limited range of motion because of the injuries \nnoted above.  The rest of his examination was unremarkable.”         \n Dr. Shahryar Ahmadi performed a “left shoulder hemiarthroplasty” on \nSeptember 21, 2016.  The pre- and post-operative diagnosis was “Left \n\nHOWARD – G900538  8\n  \n \n \nproximal humerus fracture dislocation.”  The claimant was provided follow-\nup treatment after surgery.   \n Dr. Robin Perry noted on January 8, 2018, “Patient is here for his \nMedicare physical.  He does see neurology at UAMS every 6 months.  He \nis on 3 medications for his seizure disorder.  Seizures have been controlled.  \nHe was seeing ortho for shoulder injury and did have surgery.  He has been \nreleased by ortho.  He is not seeing any other physicians.”  Dr. Perry’s \nassessment included “2.  Epilepsy, unspecified, not intractable, without \nstatus epilepticus.”   \n Dr. Humaira M. Khan provided an assessment and plan on March \n12, 2018:  “35 yo M w/seizures first dx in 2005 after a seizure caused a \nMVA.  He was last seen in Nov 2016 and has not had seizures since.  Prior \nMRI brain and EEG normal.  He is on stable doses of Phenobarb 120 mg \nqhs, Lamictal 200 mg and Trileptal 1200 mg bid.  No side effects reported.  \nNo doses missed....Seizure precautions discussed.  RTC 9 months.”     \n Dr. Ethan Schock evaluated the claimant on March 29, 2018:  \n“Howard is here today for consideration of bilateral knee pain, left greater \nthan right.  He has a long history of seizure disorder and has had multiple \nmotor vehicle accidents over the years.  He has had no fractures about the \nknees but has had these injured with dashboard type injury several \ntimes....Examination today shows bilateral knee effusions.”   \n\nHOWARD – G900538  9\n  \n \n \n Dr. Schock reported on April 19, 2018, “Left knee MRI is reviewed \ntoday and this confirms a large intra-articular loose body likely from a \ntrochlear donor site....I think a knee arthroscopy with anticipated loose body \nremoval and possible microfracture could be helpful for him.”   \n Dr. Schock performed surgery on May 8, 2018:  “Left knee \narthroscopy with multicompartment chondroplasty and removal of multiple \nintra-articular loose bodies measuring greater than 5 mm.”  The post-\noperative diagnosis was “Degenerative arthritis with intra-articular loose \nbodies.”   \nThe claimant testified that he became employed with the \nrespondents, City of Faith Prison Ministries, in approximately September \n2018.  The claimant testified on direct examination: \nQ.  When you were employed by City of Faith, did you go \nthrough the application process? \nA.  Yes, sir.   \nQ.  You advised them of all your injuries? \nA.  Yes.   \nQ.  Did you advise them of all, any kind of work status that \nyou had? \nA.  I had to. \nQ.  They knew about social security at that time? \nA.  Yes.   \nQ.  And they approved you to do the work that you described \nearlier? \nA.  Yes. \nQ.  Working in the building and also driving the vehicle to and \nfrom the hospital with the food trays.   \nA.  Yes.... \nQ.  At the time in 2018, how long had it been since your last \nseizure? \n\nHOWARD – G900538  10\n  \n \n \nA.  2018.  What I came to learn about seizures through the \nyears, there’s several different types of seizures, you know.  \nYou can have a seizure where you fall out, when you shake \non the ground, or you can have a staring seizure, just me \nsitting here looking at you.  So I really couldn’t tell you how \nmany seizures I’ve had since then as far as like where I had to \ngo into the hospital or somebody around me noticing, I hadn’t \nhad a seizure.   \n \n The parties stipulated that the claimant “would provide services for \nthe respondent, and the services included operation of a vehicle.”   \nThe claimant testified on direct examination: \n  Q.  What was the primary purpose of City of Faith? \nA.  Basically security, checking people in and out in the \ncomputers, sometimes searching them, making sure they \ndidn’t have certain items, picking up their meals from Baptist \nHospital, taking the trays back to Baptist Hospital, sometimes \nwalking around just checking the facility, making sure \neverything is going like it’s supposed to.   \nQ.  And City of Faith has a number of residents that stay there \nat the facility, right? \nA.  Yes, men and women....   \nQ.  I think you said you had to go and pick up the meal trays \nand bring them back? \nA.  Yes, from the Baptist Hospital.   \nQ.  So explain to me what that would entail.  What would you \ndo? \nA.  Well, sometimes it would be one or two of the residents \nwith me in the van, and we would go, go to Baptist, we would \npick up the trays, load up the trays, and we would go directly \nback to City of Faith, unload the trays.  We would serve the \ntrays, make sure everybody ate, clean up everything, put the \ntrays back in the van, and I would take them back and unload \nthem, come back, clock out, and that’s it.   \n \n The parties stipulated, “The employer/employee/carrier relationship \nexisted on December 2, 2018, when the claimant was operating a vehicle \n\nHOWARD – G900538  11\n  \n \n \nowned by the respondent, City of Faith, and was involved in a motor vehicle \naccident, where he sustained a physical injury.” \n The claimant testified on direct examination: \nQ.  On December 2, 2018, which is the day you had your \naccident in this case, what occurred on that day? \nA.  Well, I came in and I got the trays, brought them back, \neverybody ate, everything was fine.  This particular night \nnobody rode back with me to drop the trays back off.   \nQ.  At Baptist?  Is that where you’re dropping them back off? \nA.  At Baptist.  So when I left the City of Faith to drop the trays \noff, nobody was with me.  It was probably like a stop sign, \nprobably not even a minute away from City of Faith.  It’s like \nby the Penick Boys Club.  It’s Penick Boys Club.  But if you’re \nfamiliar with that area, it’s like a short distance.  It’s a stop \nsign right there.  As I was coming there, a car came around, \nhit me.  I lost control.  It was like, kind of like a sidewalk.  So I \nhit really hard there, and after that it was just straight on into \nthe building, which the car caught fire.  I wasn’t able to get out \nof the car, and I had to get out of the van by the sliding door \non the side.  That was the way I was able to get out.  From \nthere, if I’m not mistaken, I called the police, and then I went \nto my supervisor, basically Mr. Seales, and he let me know \nbasically what I needed to do.  At that time I was in shock.  I \nreally didn’t want to go to the emergency room, but he made \nsure that I did....Mr. Seales, he told me he wanted me to go to \nthe emergency room, and that’s when he let me know I could \nuse the workers’ comp.... \n   \n According to the record, an RN entered an ED Triage Note at 11:55 \np.m. on December 2, 2018:  “Patient states he was involved in an MVC \nwhere his car was struck causing him to run into a building.  Patient c/o left \narm pain and right knee pain.”   \n The claimant treated at Baptist Health on December 3, 2018: \n\nHOWARD – G900538  12\n  \n \n \n35 yo AAM presents to the ED with c/o L elbow pain and \nswelling that onset tonight due to a MVC.  Pt states he was a \nrestrained driver who was hit by another vehicle on the L front \nside of his vehicle and had positive airbag deployment.  Pt \nalso reports having upper lip pain due to the airbags.  Pt \ndenies having any neck pain.  Pt states he had a previous \ninjury to his L arm before from another accident and he has \nhad several procedures performed on his L arm, but he has \nnoticed that he has some new swelling since the incident.  Pt \nstates his PCP is Dr. Robin Perry and his orthopedist is Dr. \nMoore.... \nMouth:  Pt has swelling to his upper lip.... \nLeft elbow:  He exhibits swelling (to medial aspect) and \ndeformity (chronic).... \n \n An x-ray of the claimant’s left elbow showed “Chronic deformity, \nSTS, nothing acute.”  An emergency physician diagnosed “Strain of left \nelbow, initial encounter....I see nothing acute on his x-ray.  He did request a \nsling.  We will treat with Toradol and encouraged him to follow-up with his \northopedist.”    \n An RN reported on December 3, 2018, “Called patient, who states \nthat he was having ‘warning symptoms’ last night, that may lead to a \nseizure.  Reminded patient that he has an appointment for 12/12/18.”  An \nRN further noted on December 3, 2018, “Mrs. Tonya Kelley [patient’s] \nmother called to requesting (sic) an urgent appointment and a call back \nfrom the nurse.  Mrs. Kelley called to schedule patient for a follow up \nappointment to see Dr. Shihabuddin stating patient was seen in the ER last \nnight after having a really bad seizure.”     \n Dr. Perry examined the claimant on December 4, 2018: \n\nHOWARD – G900538  13\n  \n \n \nPatient is here for follow up after MVA.  He was on the \nrestrained driver of a van that was hit and he lost control and \nhit a storage building.  Building and van both burned.  Airbag \ndeployed when he hit the curb.  He injured his left knee.  Also \ninjured his chronically deformed left elbow.  He had to wear \nknee braces.  He did have drivers license.  Has been seizure \nfree for years.  He is seeing neurologist at UAMS and just \ncompleted arthroscopic left [knee] surgery with Ortho \nspecialist.   \n \n Dr. Perry assessed “1.  Bursitis of left elbow, unspecified bursa.  2.  \nBrachial plexus injury, left sequela.”  The record indicates that Dr. Perry \ntook the claimant off work beginning December 4, 2018.  The parties \nstipulated that the claim “was initially accepted as compensable.” \n An x-ray of the claimant’s left upper extremity was taken on \nDecember 11, 2018 with the following findings and impression: \nMalunited distal radius and ulna fractures are seen.  A \nnonunited ulnar styloid fracture is noted.  Limited view of the \nelbow demonstrates significant heterotopic ossification.  \nElbow joint is grossly aligned.  There is mild osteopenia.  No \nsignificant soft tissue abnormality.   \n \n Dr. Ahmadi took the claimant off work on December 11, 2018.  \n Dr. Michael M. Hussey provided an Independent Medical Exam on \nFebruary 20, 2019: \nEldridge Howard is a 36-year-old African-American right-hand \ndominant male who presents to my clinic today for an \nindependent medical examination regarding an injury that the \nclaimant states occurred on 12/2/2018.  Mr. Howard states \nthat he was driving the company van of his employer City of \nFaith performing a food delivery when he states another \nvehicle struck his vehicle and caused him to hit a building.  \nMr. Howard states he had been working for City of Faith as a \n\nHOWARD – G900538  14\n  \n \n \nsecurity personnel for about 1-2 months prior to his motor \nvehicle collision.  According to the fire department report \npresented to me, the van caught on fire.  The fire department \nreport also documents that he questioned Mr. Howard if he \nwas injured, and Mr. Howard told him he was “fine” and that \nthe MEMS unit had already checked him out and released \nhim.  Patient denies seeing the other vehicle that struck his \nvan.  He states that he did not have any significant immediate \nonset of pain after the collision but later noticed increased \npain in the shoulder and elbow region.  He states he does not \nremember having a seizure during the accident.  He states he \nwas taking seizure medication daily before and after his motor \nvehicle collision.  He states his last seizure occurred around \n2015.... \nAssessment:  36-year-old right-hand dominant male with \nseizure disorder, status post occupation related injury on \n12/2/2018 due to motor vehicle collision with post-injury \ncomplaint of left shoulder/elbow pain that appears secondary \nto shoulder and elbow joint sprain.   \nIn regards to the left shoulder, it is my opinion that the majority \nof Mr. Howard’s pain and dysfunction is related to his pre-\nexisting traumatic injury he sustained to the shoulder in 2016 \nthat was related to a seizure.  At that time Mr. Howard had a \nsevere comminuted proximal humerus fracture that required a \npartial shoulder replacement by Dr. Ahmadi, which I believe \nwas a reasonable treatment for his injury....There is no \ndocumentation in the medical record that he ever achieved \nsignificant improvement in his shoulder function or pain level.   \nAfter his occupation related injury on 12/2/2018, the Fire \nDepartment report states that Mr. Howard did not complain of \nany pain in his left shoulder or elbow.  It is my opinion, if Mr. \nHoward had that severe of new injury to his left arm that he \nwould have complained of some arm pain at that time.... \nSpecific questions to address presented by William C. \nFrye: \nQuestion 1:  I did find objective findings during my \nexamination of the claimant’s left shoulder which showed \ndiffuse mild muscle atrophy compared to the contralateral \nuninjured right shoulder.  There was no further objective \nfindings found, as I was unable to obtain a reliable exam due \nto his extreme pain behavior exhibited during the left shoulder \nexam.  In my opinion, the findings of diffuse muscle atrophy in \n\nHOWARD – G900538  15\n  \n \n \nthe left shoulder are not related to the claimant’s December 2, \n2018 motor vehicle accident, and are more likely related to his \npre-existing left shoulder injury and surgery.   \nQuestion 2:  In my opinion, there has been no significant \nchange in the claimant’s left shoulder x-rays before and after \nthe 12/2/2018 accident.  In my opinion, and in the \ndocumented opinion of Dr. Ahmadi, the x-rays show a stable \nhemiarthroplasty prosthesis with no sign of failure.   \nQuestion 3:  Not applicable. \nQuestion 4:  Based on the objective evidence available to me, \nit is my opinion that the claimant does not need a reverse total \nshoulder replacement.   \nQuestion 5:  In regards to future treatment for Mr. Howard’s \nleft shoulder occupation related injury, I would recommend \nconservative treatment.  The objective clinical, physical exam, \nand imaging evidence available to me at most, points to a \nsimple strain of the left shoulder.  In my opinion, I do not see \nany significant objective derangement sustained on the \n12/2/2018 accident to Mr. Howard’s left shoulder that would \nwarrant further surgical intervention.   \nQuestion 6:  During my examination of Mr. Howard’s left \nelbow, I did find objective findings.  These findings included \nlimited passive and active range of motion of the elbow joint \nas well as a soft tissue contracture of the skin and connective \ntissue in the area of the previously placed skin graft.  There \nwas noted to be significant soft tissue and skin deformity in \nthe area of his prior injury that occurred in 2005.  There were \nold well-healed skin incisions from previous surgery and \nexternal fixator placement, with no new soft tissue wounds \npresent.  There are multiple reports in his previous past \nmedical history from multiple orthopedic surgeons prior to his \n12/2/2018 accident, that document significant derangement of \nthe left elbow with loss of motion and function.  Therefore, it is \nmy opinion that all of the objective findings that were noted on \nhis left elbow were pre-existing prior to his 12/2/2018 motor \nvehicle accident.   \nQuestion 7:  Based on imaging available to me, it is my \nopinion that the claimant’s left elbow x-rays show no new \nsignificant changes from the time period before the 12/2/2018 \naccident, to after the accident.  The x-rays and CT scan \nperformed after the 12/2/2018 accident, are in my opinion of \nsimilar appearance to the x-rays that were taken prior to his \n\nHOWARD – G900538  16\n  \n \n \n12/2/2018 accident.  It is my opinion that all of the objective \nfindings that were noted on his left elbow were pre-existing \nprior to his 12/2/2018 motor vehicle accident.   \nQuestion 8:  In my opinion, I do not believe the claimant \nrequires a debridement of the left elbow based on the injury \nhe sustained on 12/2/2018.  It is obvious in his prior medical \nhistory that other upper extremity orthopedic surgeons had \nrecommended either a debridement procedure or a total \nelbow arthroplasty of his left elbow many years [preceding] \nthe 12/2/2018 accident.   \nQuestion 9:  In regards to future treatment for Mr. Howard’s \nleft elbow occupation related injury, I would recommend \nconservative treatment.  The objective clinical, physical exam, \nand imaging evidence available to me at most, points to a \nsimple strain of the left elbow.  In my opinion, I do not see any \nsignificant objective derangement sustained on the 12/2/2018 \naccident to Mr. Howard’s left elbow that would warrant further \nsurgical intervention.  The conservative treatment I would \nrecommend if Mr. Howard were my patient would include rest, \nice, topical analgesia creams, anti-inflammatory medication, \nand physical therapy to decrease pain and inflammation \nrelated to the joint sprains.  The duration of treatment and \nrecovery period for an injury of this nature in my experience \nwith a joint sprain is typically 2-3 months with resumption of \nfull duties at the end of 3 months.   \nQuestion 10:  The opinions that I have presented are based \non a reasonable degree of medical certainty.   \n  \nThe parties stipulated that the respondents paid temporary total \ndisability benefits through May 19, 2019.  The claimant testified that he \nnever returned to work for the respondent-employer.      \nDr. Ahmadi performed surgery on August 16, 2019:  “Revision of the \nleft failed shoulder arthroplasty to reverse shoulder arthroplasty[.]”  The pre- \nand post-operative diagnosis was “Failed left shoulder arthroplasty.”  Dr. \nAhmadi performed left elbow surgery on January 23, 2020:  “Radical \n\nHOWARD – G900538  17\n  \n \n \nresection of the capsule, soft tissue, and heterotopic bone of the left elbow \nwith contracture release.”  The pre- and post-operative diagnosis was “Left \nelbow stiffness.”   \nDr. William Bowen performed a right knee arthroscopy on May 13, \n2020.  The post-operative diagnosis was \"1.  Pigmented villonodular \nsynovitis.  2.  Grade 3 chondromalacia, patellofemoral joint and trochlea.”  \nDr. Bowen performed a left knee arthroscopy on October 2, 2020.  The \npost-operative diagnosis was “1.  Pigmented villonodular synovitis, left \nknee.  2.  Extensive grade 3 chondromalacia medial femoral condyle and \npatellofemoral joint.\"   \n A pre-hearing order was filed on June 7, 2022.  The claimant \ncontended, “Mr. Howard contends that he sustained injuries to his shoulder, \nelbow and knees as a result of the automobile accident which occurred on \nDecember 2, 2018 and further that though he had sustained injuries to his \nshoulder, elbow and knees previously, the injuries sustained in the present \naccident and surgeries and other medical issues were not exacerbated by \nthe previous injuries as contended by the Respondent, as a result the \nRespondent should pay for the Claimant (sic) entire healing period in \nTemporary Disability payments and pay appropriately for any surgeries, \nmedical bills and the appropriate sum for any disability that exist (sic) now \ndue to that accident.” \n\nHOWARD – G900538  18\n  \n \n \n The parties stipulated that the claim “has now been controverted in \nits entirety.”  The respondents contended, “The Claimant in this matter has \nbeen on Social Security for years due to seizures, and shoulder and elbow \nproblems.  He did not divulge the seizure problem to his insured causing \nthem to put him behind the wheel of a van when he should not have been \ndriving.  HE (sic) was involved in a motor vehicle accident in 2005 and \nsustained an injury to his elbow.  He had a subluxation and underwent \nsurgery with Dr. Rhoades (sic).  He was then seen by Dr. David Collins for \nhis left shoulder.  It was noted that he had a non-union of the elbow and \nshoulder problems.  He also had problems with his left knee popping and \nwas seen by Dr. Ethan Schock.  In 2008 he underwent shoulder surgery.  \nHe was also seen for severe elbow contracture and severe degenerative \nchanges.  He had another motor vehicle accident in 2013 due to a seizure.  \nIn 2014, he again injured his left arm in a fall.  In 2015, he had another \nseizure and fell down 12 stairs and his history was seizures 5 times a week.  \nHe then had a motor vehicle accident taking out numerous poles due to \nanother seizure.  In 2016, he had another seizure and broke his shoulder.  \nThe Claimant thought he had a seizure in the night.  Dr. Ahmadi did a total \nshoulder on the Claimant on September 21, 2016.  He continued to have \nproblems with the shoulder.  He was then seen on March 29, 2017 with a \nhistory of numerous accidents hitting the dash and was having pain and \n\nHOWARD – G900538  19\n  \n \n \nswelling of the knees.  He was found to have a large loss of cartilage.  He \nunderwent surgery on his knee with Dr. Schock on May 8, 2018.  The \nClaimant was involved in a motor vehicle accidents (sic) in which he drove \nhis van into a building.  His X-ray of the elbow showed the same severe \ndegenerative changes.  The X-ray showed no new fractures or failure of the \ntotal shoulder.  The X-ray of the elbow showed an old injury and nothing \nnew.  The history he gave to OrthoArkansas was that the seizure was part \nof the accident.  The Claimant then saw Dr. Hussey on February 20, 2019.  \nHe noted that the Claimant reported continued shoulder pain after his \nshoulder surgery.  He opined that the problems in the shoulder was (sic) \nrelated to the 2016 injury since he did not have significant improvement \nfrom the surgery.  The PT noted (sic) indicated that the Claimant had dismal \nfunction in the shoulder and could not raise his arm above his shoulder.  He \nalso said that there was no failure of the total shoulder so no reason to do \nanother surgery.  He also notes extreme pain behavior.  On the elbow, he \nnoted that the Claimant had already been told he needed the debridement \nbefore the December accident.  He also said there was no new objective \nfinding due to the accident.  Dr. Schock in May of 2019 felt the Claimant did \nnot need surgery and had a long history of recurrent effusions of both \nknees.  He did undergo a revision of the shoulder and surgery of the elbow.  \nIn October of 2019, he was six weeks out from the surgery.  The surgery for \n\nHOWARD – G900538  20\n  \n \n \nthe shoulder was performed on August 16 and the elbow surgery on \nJanuary 23, 2020.  He was then seen by Dr. Bowen on April 14, 2020 with a \nhistory of gradual onset of knee problems.  He underwent right knee \nsurgery and the pathology report said he had a diffuse-type tenosynovial \ngiant cell tumor.  He underwent surgery for left knee on October 2, 2020.  \nThe Respondents have no further medical treatment.”   \n The respondents contended, “A.  The Respondents contend that the \naccident was caused by the Claimant’s failure to disclose his seizure and \naccident history which resulted in him being allowed to drive the company \nvan that he wrecked due to a seizure.  B.  The Claimant’s shoulder, knee, \nand elbow problems are not related to the accident but to continued \npreexisting conditions.”       \n The parties agreed to litigate the following issues: \n1.  Compensability. \n2.  Temporary total disability. \n3.  Permanent partial disability. \n4.  Medical treatment. \n5. Attorney’s fees.   \n \nA hearing was held on August 16, 2022.  At that time, the parties \nreserved the issue of permanent partial disability.  An administrative law \njudge filed an opinion on September 20, 2022 and found that the claimant \nfailed to prove he sustained a compensable injury.  The claimant appeals to \nthe Full Commission.   \n\nHOWARD – G900538  21\n  \n \n \nII.  ADJUDICATION \n Act 796 of 1993, as codified at Ark. Code Ann. §11-9-102(4)(Repl. \n2012) provides, in pertinent part: \n(A)  “Compensable injury” means: \n(i) An accidental injury causing internal or external \nphysical harm to the body ... arising out of and in the \ncourse of employment and which requires medical \nservices or results in disability or death.  An injury is \n“accidental” only if it is caused by a specific incident \nand is identifiable by time and place of occurrence[.]   \n \nA compensable injury must 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).   \nThe employee has the burden of proving by a preponderance of the \nevidence that he 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). \nAn administrative law judge found in the present matter, “4.  That \nthere is no alternative but to find that the preponderance of the evidence \nshows that the claimant suffered a non-compensable, idiopathic injury on \nDecember 2, 2018, and consequently the claimant has failed to satisfy the \n\nHOWARD – G900538  22\n  \n \n \nrequired burden of proof that the claim is compensable.”  The Full \nCommission does not affirm this finding.     \nAn idiopathic injury is one whose cause is personal in nature, or \npeculiar to the individual.  Crawford v. Single Source Transp., 87 Ark. App. \n216, 189 S.W.3d 507 (2004), citing Kuhn v. Majestic Hotel, 324 Ark. 21, 918 \nS.W.2d 158 (1996).  Injuries sustained due to an unexplained cause are \ndifferent from injuries where the cause is idiopathic.  ERC Contractor Yard \n& Sales v. Robertson, 335 Ark. 63, 977 S.W.2d 212 (1998).  Where a \nclaimant suffers an unexplained injury at work, it is generally compensable.  \nLittle Rock Convention & Visitors Bur. v. Pack, 60 Ark. App. 82, 959 S.W.2d \n415 (1997).  Because an idiopathic injury is not related to employment, it is \ngenerally not compensable unless conditions related to the employment \ncontribute to the risk.  Id.  Employment conditions can contribute to the risk \nor aggravate the injury by, for example, placing the employee in a position \nwhich increases the dangerous effect of a fall, such as on a height, near \nmachinery or sharp corners, or in a moving vehicle.  Id.  See also \nDelaplaine Farm Center v. Crafton, 2011 Ark. App. 202, 382 S.W.2d 689. \nIn the present matter, the claimant testified that he has suffered from \nseizures since 2005.  The evidence shows that the claimant was involved in \na motor vehicle accident in 2005, and that the accident was caused by the \nclaimant having a seizure.  As a result of the motor vehicle accident on or \n\nHOWARD – G900538  23\n  \n \n \nabout May 7, 2005, the claimant sustained a traumatic injury to his left \nupper extremity.  The injury required several surgical procedures to the \nclaimant’s left upper extremity.  The claimant testified that he began \nreceiving Social Security disability benefits in about 2007, which benefits \nwere related to his epileptic condition.  Dr. Andersson stated in July 2013 \nthat the claimant suffered from “a debilitating seizure disorder.”  Dr. \nCourtney treated the claimant in April 2014 for a “seizure disorder.”  The \nclaimant was involved in a motor vehicle accident in October 2015, at which \ntime Dr. Lewis noted in part “4.  History of seizure.”  Dr. Perry, Dr. Khan, \nand Dr. Schock all noted in 2018, prior to the claimant’s employment with \nthe respondents, that the claimant was prescribed several anti-convulsant \nmedications and had “a long history” of a seizure disorder. \nAs we have noted, the claimant testified that he became employed \nwith the respondents in approximately September 2018.  The claimant \ntestified that one of his employment duties for the respondents was driving \na vehicle in which he picked up meals and returned them to Baptist \nHospital.  The parties stipulated that the claimant “would provide services \nfor the respondent, and the services included operation of a vehicle.”  The \nparties also stipulated that on December 2, 2018 the claimant “was \noperating a vehicle owned by the respondent, City of Faith, and was \ninvolved in a motor vehicle accident, where he sustained a physical injury.”   \n\nHOWARD – G900538  24\n  \n \n \nThe claimant testified that he was driving the company vehicle to \nBaptist Hospital on December 2, 2018 in order to drop off trays.  The \nclaimant testified, “As I was coming there, a car came around, hit me.  I lost \ncontrol....So I hit really hard there, and after that it was just straight on into \nthe building, which the car caught fire.”  In workers’ compensation cases, \nthe Commission functions as the trier of fact.  Blevins v. Safeway Stores, 25 \nArk. App. 297, 757 S.W.2d 569 (1988).  The determination of the credibility \nand weight to be given a witness’s testimony is within the sole province of \nthe Commission.  Murphy v. Forsgren, Inc., 99 Ark. App. 223, 258 S.W.3d \n794 (2007).  The Commission is not required to believe the testimony of the \nclaimant or any other witness but may accept and translate into findings of \nfact only those portions of the testimony it deems worthy of belief.  Farmers \nCo-op v. Biles, 77 Ark. App. 1, 69 S.W.3d 899 (2002).   \nIn the present matter, the Full Commission finds that the claimant \nwas not a credible witness with regard to the circumstances of the \nDecember 2, 2018 motor vehicle accident.  There is no evidence of record \ncorroborating the claimant’s assertion that the vehicle in which he was \ndriving was struck by another vehicle.  The evidence instead demonstrates \nthat the claimant suffered from a seizure on December 2, 2018, which \ncondition was idiopathic to the claimant.  An RN plainly noted on December \n3, 2018 that the claimant reported having “warning symptoms last night, \n\nHOWARD – G900538  25\n  \n \n \nthat may lead to a seizure.”  An RN also noted on December 3, 2018, “Mrs. \nTonya Kelley [patient’s] mother called to [request] an urgent appointment \nand a call back from the nurse.  Mrs. Kelley called to schedule patient for a \nfollow up appointment to see Dr. Shihabuddin stating patient was seen in \nthe ER last night after having a really bad seizure [emphasis supplied].”   \nThe probative evidence before the Commission does not reflect that \nthe vehicle in which the claimant was driving on December 2, 2018 was \nstruck by another vehicle.  Instead, the evidence demonstrates that the \nclaimant suffered from a seizure on December 2, 2018, which idiopathic \ncondition led to the motor vehicle accident.  The evidence therefore shows \nthat the claimant suffered from an idiopathic injury on December 2, 2018.  \nBecause an idiopathic injury is not related to employment, it is generally not \ncompensable unless conditions related to the employment contribute to the \nrisk.  Little Rock Convention & Visitors Bur., supra.  Employment conditions \ncan contribute to the risk or aggravate the injury by, for example, placing \nthe employee in dangerous position which increases the dangerous effect \nof the injury, such as “in a moving vehicle.”  Id.  See also Crawford, supra.   \nThe parties stipulated that the claimant in the present matter “was \noperating a vehicle owned by the respondent, City of Faith,” at the time of \nthe December 2, 2018 motor vehicle accident.  The evidence demonstrates \nthat the claimant sustained injuries as the result of an idiopathic condition, \n\nHOWARD – G900538  26\n  \n \n \nbut that the employment circumstances contributed to the injury, that is, the \nclaimant was in a moving vehicle, performing employment services, at the \ntime of the idiopathic event.  The claimant’s injuries on December 2, 2018 \nwere therefore compensable.           \nThe respondents argue on appeal that the claimant is barred from \nreceiving benefits in accordance with cited provisions of “Larson’s Workers’ \nCompensation Law.”  Indeed, in accordance with “Larson’s,” an employee \nmay be precluded from benefits under the Workers’ Compensation Act for \nan otherwise compensable injury if it is shown that the employee knowingly \nand willfully made a false representation as to his physical condition; the \nemployer relied upon the false representation, which reliance was a \nsubstantial factor in the employment; and there was a causal connection \nbetween the false representation and the injury.  Johnson v. PAM \nTransport, Inc., 2017 Ark. App. 514, 529 S.W.3d 678, citing Shippers \nTransport of Georgia v. Stepp, 265 Ark. 365, 578 S.W.2d 232 (1979).  \nIn the present matter, the evidence does not demonstrate that the \nclaimant knowingly and willfully made a false representation as to his \nphysical condition.  The claimant testified that, when he applied for \nemployment with the respondents, he advised them of his pre-existing \ninjuries, and that he informed the respondents that he was receiving Social \nSecurity disability benefits.  The Full Commission recognizes the credible \n\nHOWARD – G900538  27\n  \n \n \ntestimony of Philip Seales, a security officer with the respondents.  Philip \nSeales testified that he was unaware of the claimant’s prior history of \nseizures.  Mr. Seales testified that the claimant would not have been \nallowed to drive a vehicle for the respondents if they had known of the \nclaimant’s pre-existing condition. \nHowever, Philip Seales agreed on cross-examination that he was not \nthe individual who hired the claimant.  Philip Seales testified that the \nclaimant was interviewed and hired by a Mr. Pettus.  Philip Seales testified, \n“Mr. Pettus was very thorough.”  Mr. Pettus was deceased as of the time of \nthe August 16, 2022 hearing and of course did not testify.  There is simply \nno probative evidence demonstrating that the claimant knowingly and \nwillingly made a false representation to the respondents at the time of his \nhiring.  The Full Commission notes that there are no documents in the \nrecord such as an employment application or pre-employment physical \nexamination.  The claimant testified with regard to Philip Seales, “he let me \nknow I could use the workers’ comp” following the accidental injury.  We \ntherefore find that the respondents did not prove the claim should be barred \nin accordance with Johnson and Shippers, supra.  Because the evidence \ndoes not demonstrate that the claimant knowingly and willfully made a false \nrepresentation at the time of his hiring, we need not adjudicate whether the \n\nHOWARD – G900538  28\n  \n \n \nemployer relied upon a “false representation” or whether there was a causal \nconnection between the alleged false representation and the injury.   \nThe Full Commission finds that the claimant proved by a \npreponderance of the evidence that he sustained a compensable injury.  \nThe claimant proved that he sustained an accidental injury causing physical \nharm to the body.  The claimant proved that the injury arose out of and in \nthe course of employment, required medical services, and resulted in \ndisability.  The injury was caused by a specific incident and was identifiable \nby time and place of occurrence on December 2, 2018.  The claimant also \nestablished a compensable injury by medical evidence supported by \nobjective findings.  Namely, the objective findings established a \ncompensable injury to the claimant’s upper lip (swelling) and a \ncompensable injury to the claimant’s left elbow (swelling).  The claimant \ndoes not contend that he is entitled to benefits related to the swelling in his \nupper lip.  The evidence otherwise demonstrates that the claimant \nsustained a compensable “strain of left elbow” as assessed on December 3, \n2018.  The evidence does not demonstrate that the claimant proved he \nsustained a compensable injury to any other anatomic region or body part \nas a result of the specific incident occurring December 2, 2018.   \nAfter reviewing the entire record de novo, the Full Commission finds \nthat the claimant proved by a preponderance of the evidence that he \n\nHOWARD – G900538  29\n  \n \n \nsustained a compensable injury on December 2, 2018.  The evidence \ndemonstrates that the claimant sustained an idiopathic seizure, but that \nemployment conditions aggravated the injury.  The respondents did not \nprove that the claimant made a false representation as to his physical \ncondition at the time of the claimant’s hiring.  The claimant proved that the \nmedical treatment of record was reasonably necessary until the time of Dr. \nHussey’s Independent Medical Exam on February 20, 2019.  The claimant \ndid not prove that medical treatment beyond that time was reasonably \nnecessary in accordance with Ark. Code Ann. §11-9-508(a)(Repl. 2012).  \nNor did the claimant prove that he continued within a healing period for his \ncompensable left elbow strain at any time beyond February 20, 2019.  See \nKetcher Roofing Co. v. Johnson, 50 Ark. App. 63, 901 S.W.2d 25 (1995).  \nFor prevailing in part on appeal to the Full Commission, the claimant’s \nattorney is entitled to a fee of five hundred dollars ($500), pursuant to Ark. \nCode Ann. §11-9-715(b)(2)(Repl. 2012). \nIT IS SO ORDERED.   \n    ___________________________________ \n    SCOTTY DALE DOUTHIT, Chairman \n \n    ___________________________________ \n    M. SCOTT WILLHITE, Commissioner \n \n    ___________________________________ \n    MICHAEL R. MAYTON, Commissioner","preview":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. G900538 ELDRIDGE HOWARD, III, EMPLOYEE CLAIMANT CITY OF FAITH PRISON MINISTRIES, EMPLOYER RESPONDENT TECHNOLOGY INSURANCE CO., CARRIER AMTRUST NORTH AMERICA, TPA RESPONDENT OPINION FILED MAY 26, 2023","fetched_at":"2026-05-19T22:29:46.427Z","links":{"html":"/opinions/full_commission-G900538-2023-05-26","pdf":"https://labor.arkansas.gov/wp-content/uploads/Howard_Eldridge_G900538_20230526.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/full-commission-opinions/"}}