{"id":"full_commission-G905912-2025-03-05","awcc_number":"G905912","decision_date":"2025-03-05","opinion_type":"full_commission","claimant_name":"Gregory Patterson","employer_name":"City Of Monette","title":"PATTERSON VS. CITY OF MONETTE AWCC# G905912 March 05, 2025","outcome":"denied","outcome_keywords":["denied:2"],"injury_keywords":["fracture","neck","back","knee","concussion","tbi"],"pdf_url":"https://www.labor.arkansas.gov/wp-content/uploads/Patterson_Gregory_G905912_20250305.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/full-commission-opinions/","filename":"Patterson_Gregory_G905912_20250305.pdf","text_length":40568,"full_text":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION \n \n \nCLAIM NO.  G905912 \n \nGREGORY PATTERSON, \nEMPLOYEE \n \nCLAIMANT \nCITY OF MONETTE,  \nEMPLOYER \n \nRESPONDENT \nARKANSAS MUNICIPAL LEAGUE, \nINSURANCE CARRIER/TPA \nRESPONDENT \n  \n      \nOPINION FILED MARCH 5, 2025 \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 MARY K. EDWARDS, \nAttorney at Law, North Little Rock, Arkansas. \n \nDecision of Administrative Law Judge:  Affirmed as Modified. \n \n \n OPINION AND ORDER \nThe respondents appeal an administrative law judge’s opinion filed \nSeptember 5, 2024.  The administrative law judge found that the claimant \nproved he was entitled to reasonably necessary medical treatment “for his \nheadaches and seizures.”  The Full Commission finds that the medical \ntreatment of record provided to the claimant after January 25, 2022 was \nreasonably necessary in accordance with Ark. Code Ann. §11-9-\n508(a)(Repl. 2012).  The claimant proved that his headaches and seizures \nwere a natural consequence of the compensable head injury sustained by \nthe claimant.   \n\nPATTERSON - G905912  2\n  \n \n \nI.  HISTORY \n Gregory Patterson, II, now age 24, testified that he had been \nemployed with the respondents, City of Monette.  The parties stipulated that \nthe employment relationship existed on or about September 10, 2019.  The \nclaimant’s testimony indicated that he was a passenger in an All-Terrain \nVehicle being driven by a co-worker.  The claimant testified, “And then the \nnext thing I know I remember waking up in the hospital.\"  The parties \nstipulated that the claimant “sustained a compensable head injury.”  The \nclaimant testified on direct examination: \nQ.  What was your understanding of the injuries that you \nreceived when you were ejected from the ATV? \nA.  That I hit my head.  I had a couple of brain bleeds and \nfractured, some type of fracture on the temporal, temple lobe, \nwhatever that’s called up there.   \n \n According to the record, the claimant was admitted to Regional One \nHealth on September 10, 2019.  It was noted at that time, “18 yo M s/p ATV \naccident w/L T aSDH/ctx.”  A CT of the claimant’s brain and head was \ntaken on September 10, 2019 with the following impression: \n1. Multifocal intraparenchymal hemorrhage within the left \nlateral temporal lobe.   \n2. Subarachnoid hemorrhage within the left temporal lobe.   \n \nA CT Maxillofacial w/o Contrast was also taken on September 10, \n2019 with the impression, “1.  Suspected subtle nondepressed fracture of \nthe left temporal and parietal bone[.]”  \n\nPATTERSON - G905912  3\n  \n \n \nThe claimant was discharged from Regional One Health on \nSeptember 12, 2019: \n18 year-old gentleman s/p ATV accident on 9/10/19.  GCS9 \non arrival and intubated for combativeness.  Injuries on CTH \ninclude multifocal intraparenchymal hemorrhage within the left \nlateral temporal lobe and subarachnoid hemorrhage within the \nleft temporal lobe.  Non-operative per neurosurgery.  2\nnd\n \nrepeat CTH showed no evolution of injury.  Extubated on 9/11, \nGC15....Evaluated by PT, OT, Speech on 9/12.  All \nrecommended outpatient therapy.  Discharged to home with \ninstructions to follow-up in neurosurgery clinic in 1 month with \nnew CTH.   \n \n The Discharge Diagnosis on September 12, 2019 was “1.  Head \ninjury, 09/10/2019.  2.  Intraparenchymal hemorrhage of brain, 09/10/2019.”   \n An occupational therapist noted on September 30, 2019, “To whom it \nmay concern, Gregory Patterson, has attended a total of 5 occupational \ntherapy visits with his last visit being 9/26/19.  He reported 0/10 pain pre \nand post session last visit.  He has progressed very well while attending.  \nFunctional activities have been implemented to facilitate dynamic \nmovement, cognitive exercises, processing skills, attention to task, and fine \nmotor activities.  Gregory initially demonstrated slight difficulty completing \nwriting tasks, and maintaining attention to task but this has greatly improved \nsince start of care.  Gregory established a goal to return to school as soon \nas he can to resume his role as a high school student.” \n\nPATTERSON - G905912  4\n  \n \n \n A CT of the claimant’s head was taken on October 1, 2019 with the \nimpression, “Possible minimal residual left temporal lobe blood products.  \nNo mass effect, edema, or additional intracranial abnormalities noted.”   \n Dr. John D. Brophy reported on October 1, 2019: \nMr. Gregory Patterson is an 18-year-old white male seen in \nconsultation at the request of Workers’ Compensation for \nevaluation after sustaining a closed head injury with \nintracranial hemorrhage.  He was doing well until 10 \nSeptember when he was ejected from a work ATV, striking his \nhead on a sidewalk.  He was apparently combative at the \nscene and sedated, intubated and evacuated by air to The \nMed.  A head CT demonstrated a left temporal intracranial \nhemorrhage and subarachnoid hemorrhage.  He was \nextubated and discharged after approximately 48 hours in \ngood condition.  Mr. Patterson has remained sedentary at \nhome since his discharge.  Currently, he reports that he is \ndoing quite well without headache, visual disturbance, \nweakness, paresthesias or memory difficulty.... \nHead CT dated 1 October, 2019 demonstrates resolution of \nthe left temporal intracranial hemorrhage and subarachnoid \nhemorrhage.  There is no masses effect or hydrocephalus.... \nThe results of the head CT from this afternoon and clinical \nsituation were reviewed in detail with Mr. Patterson and his \nmother.  He has requested clearance to return to school \ntomorrow.  He will undergo follow-up evaluation in \napproximately three weeks.  He is cleared to return to work at \nsedentary duties only.  He is cleared to drive a motor vehicle \nwhen cleared by his parents.  We discussed the option of \nnotifying our office if he is having problems tolerating his \nschool work.   \n \n Dr. Brophy’s impression was “Doing well status post closed head \ninjury with left temporal hemorrhage.\"     \n A speech therapist noted on October 6, 2019, “Mr. Gregory \nPatterson, 18 years old, has attended 2/12 therapy sessions for speech \n\nPATTERSON - G905912  5\n  \n \n \ntherapy services following traumatic brain injury and admit to Region One.  \nPt was released and referred to SBRMC outpatient for PT, OT, and ST.  Pt \nwas evaluated using the Scales of Cognitive Ability for Traumatic Brain \nInjury (SCATBI).  Pt was noted to be [having] most difficulty with Recall \nsubtest, demonstrating a mild deficit, evident by word generation, delayed \nrecall of word strings, and recall of oral paragraphs....Pt is recommended to \ncontinue with speech therapy at this time.” \n Dr. Brophy noted on October 22, 2019, “Mr. Patterson is an 18-year-\nold high school student six weeks status post closed head injury with \nsubarachnoid hemorrhage.  He has attempted to return to school where he \nis having increased headaches using his computer.  He is having no \ndifficulty driving or dating.”  Dr. Brophy’s impression was “Residual \nsymptoms status post closed head injury, slowly improving.” \n Dr. Brophy’s impression on November 19, 2019 was “Residual \nsymptoms status post closed head injury including headache and fatigue.”     \n The claimant sought emergency treatment on December 19, 2019 \nfor complaints of headaches.  A CT of the claimant’s head was taken on \nDecember 19, 2019 with the impression, “Noncontrast head CT without \nevidence of acute intracranial hemorrhage.”  It was noted, “We will give him \nToradol, Benadryl and Compazine....Headache has resolved.”   \n\nPATTERSON - G905912  6\n  \n \n \n Dr. Brophy gave the following impression on January 21, 2020:  \n“Headaches improved status post closed head injury.  Plan:  The clinical \nsituation and results of his recent testing were reviewed in detail with Mr. \nPatterson and his family.  We again discussed the potential for continued \ngradual improvement.  He is cleared to return to work at full duty without \nrestriction on 22 January.  He will undergo follow-up evaluation as needed.”   \n The claimant received emergency treatment at St. Bernards Medical \nCenter on August 22, 2020: \nPatient reports that he was in the passenger side of a single \ncab truck that was stopped on the side of the road due to car \ntrouble.  He reports that at approx. 1800 another vehicle going \napprox. 70 mph struck the driver’s side of his truck....He \ndenies LOC....He reports neck, upper to mid back, right \nforearm, and right knee pain.  C-collar placed in triage.... \nPatient did hit his head, has a sore spot to his left forehead.... \n \n The claimant was discharged from St. Bernards on August 23, 2020 \n“with concussion precautions.”  The Clinical Impression was “MVA (motor \nvehicle accident), Concussion.”  The claimant was informed, “Your head CT \nwas normal.”   \n A CT of the claimant’s head was taken on June 25, 2021: \n  Clinical History:  CEREBRAL ANEURYSM.... \nImpression:  Unremarkable noncontrast CT examination of the     \nhead. \n3.  Left sphenoid sinus disease.   \n \nA CT of the claimant’s head was taken on July 29, 2021: \n\nPATTERSON - G905912  7\n  \n \n \nClinical History:  HEADACHE, NAUSEA, VERTIGO, \nDEHYDRATION \n Comparison:  6/25/2021  \nImpression:  Unremarkable noncontrast CT examination of the \nhead.   \n \nThe claimant followed up with Dr. Brophy on September 28, 2021: \nMr. Patterson is a 20-year-old white male undergoing follow-\nup evaluation for recent complaints potentially related to his \nclosed head injury that occurred at work in September 2019.  \nHis CT at the time of injury demonstrated a left temporal \ncontusion and subarachnoid hemorrhage.  These findings \nresolved on follow-up head CT.  By January 2020, his \nheadaches had significantly improved and he was cleared to \nreturn to work at full duty....Currently, his chief complaint is \nfatigue.  He has difficulty sleeping at night.  His family has \nnoted increased issues with his temper, subjective memory \nproblems and judgment issues.  He does not report \nheadaches.   \n \n Dr. Brophy gave the following impression on September 28, 2021:  \n“Subjective cognitive/memory issues status post closed head injury with \nbrain contusion and subarachnoid hemorrhage.  Plan:  Based on the family \ncomplaints of personality changes and cognitive issues, I would suggest \nformal neuropsych evaluation.  He will undergo follow-up evaluation to \nreview these results and we will finalize a treatment plan at that time.”  \n Dr. A.J. Zolten provided a NEUROPSYCHOLOGICAL EVALUATION \non December 9, 2021: \nGreg Patterson is a 21-year-old Caucasian male, with a high \nschool education.  Greg sustained a traumatic brain injury in \nSept. 2019 while working as a landscaper, as a result of an \nATV accident.  Greg sustained a left temporal bone fracture, \nleft parietal bone fracture and both intraparenchymal and \n\nPATTERSON - G905912  8\n  \n \n \nsubarachnoid hemorrhages on the left side.  He was \ntransported to Med One Medical Ctr. In Memphis, where he \nwas evaluated, stabilized and discharged after five days of \ncare....He reports that he is able to perform his duties, but has \noccasional problems with the need to have instructions \nrepeated at times, and he reports occasional sick days \nbecause of headaches.   \nGreg has had headaches and dizziness as a result of his \ninjuries.  He reports that his headaches have generally \nimproved, but there was a period of time in July, 2021, when \nhe had several episodes of dizziness and blackouts when \ngetting out of bed.  This was frequently, and he reports a 15-\nday period when this occurred daily.  This frequency has \nresolved, but he continues to occasionally experience the \nsame positional vertigo.  He continues to have occasional \nheadaches, about once every 3-4 days.  He takes an OTC \nmedication most of the time and this type of medication is \neffective enough to continue and work, but he reports about \ntwo days per month when he will have to take the day off from \nwork.... \n \nImpressions:  1.  Greg Patterson is a 21-year-old male who \nis two years status-post Traumatic Brain Injury (S06.2) who \npresents for an evaluation of residual neurocognitive deficits \nand psychological adjustment.  Neuropsychological testing \nreveals subtle to mild residual auditory/verbal weaknesses \nincluding modestly lower-than-expected core auditory \ncognitive skills (WAIS-4 VCI=83 versus NAART=90), \nparaphasia noted during confrontational naming, and low \naverage FAS verbal fluency.  All of these findings indicate \nfunctional skills in the domains indicated, but all of these \nfindings are mildly weaker-than-expected.  As Greg is now \ntwo years post injury, these problems are likely to be chronic, \nbut I doubt that the problems will interfere with overall \nfunctioning when considering activities for daily living or his \nwork.   \n2.  Memory, motor, visual perceptual, and executive skills \nwere all entirely within the normal limits.   \n \n Dr. Brophy reported on January 25, 2022:   \n\nPATTERSON - G905912  9\n  \n \n \nMr. Patterson returns today to review the results of his recent \nneuropsychological evaluation.  He sustained a closed head \ninjury association with temporal contusion in 2019.  At two \nyears post injury, his family was complaining regarding his \ntemper, memory and judgment.  Mr. Patterson was reporting \nfatigue without headaches, visual disturbance, weakness or \nbalance difficulty.  He has returned to work at full duty.  He \nremains engaged to his long time girlfriend over the past two \nyears.  He specifically denies any problems with anxiety.... \nNeuropsychological evaluation by Dr. Zolten indicates that Mr. \nPatterson’s memory, motor, visual perceptual and executive \nskills were all entirely within normal limits.  Dr. Zolten indicates \nproblems with anxiety and discussed the option of initiating \nmedical management with Citalopram.... \nImpression:  1.  No significant cognitive problems are noted \nbased on neuropsychological evaluation two years status post \nclosed head injury. \n2.  Anxiety issues identified on neuropsychological testing are \nnot considered specifically relateed (sic) to his closed head \ninjury. \n \nRecommendations:  The results of the evaluation were \ndiscussed in detail with Mr. Patterson and his family.  He has \nno interest in initiating medical management for anxiety at this \ntime.  He plans to continue to progress his activities at home \nand will undergo follow-up evaluation as needed.  He is \ncleared to remain at work on full duty without restriction.  In \nmy opinion, no further treatment is indicated at this time.   \n \n The claimant testified that he began suffering from what he \ndescribed as “seizures” beginning in about July 2022.  Kirk A. Coward, \nAPRN examined the claimant at FC – Stadium on July 25, 2022: \nGregory L. Patterson II is a 21 year old Caucasian/White male \nwho is complaining of passed out which started today and \nThursday ago.  Patient describes the symptoms as \nINTERMITTENT and rates the discomfort as 7/10.  Patient \nalso has stomach pain.... \n21 y/o presents with chest pain, SOB and syncope x 2-3 \nweeks.  Pt states that he passed out for the first time last \n\nPATTERSON - G905912  10\n  \n \n \nThursday and presented to the ER.  Pt states that the provider \nin the ER told him he had nodules in his lungs.  Pt reports \npain in his RUQ and passed out again this morning at \n9am....Hx of TBI x 3 years ago.   \n \n The APRN assessed “Chest pain,” “Shortness of breath,” “Syncope,” \n“RUQ pain,” “History of traumatic brain injury,” and “R/O Brain bleed.” \n A CT of the claimant’s head was taken on July 25, 2022 with the \nimpression, “No acute intracranial findings.  No significant change.”    \n The claimant sought treatment at Neurology Associates of Northeast \nArkansas PA on August 2, 2022.  Dr. Ronald E. South noted at that time, \n“21 year old right handed male presents with alteration of awareness.  He \nstates that sometimes he wakes up in the floor and doesn’t know how he \ngot there.  TBI in 2019 with several brain bleeds.”  Jessica S. Matthews, \nAPRN gave the following impressions:  “Problem #1:  SYNCOPE AND \nCOLLAPSE,” “Problem #2:  Alteration of consciousness,” “Problem #3:  \nNumbness and tingling sensation, skin,” “Problem #4:  Headache, \nunspecified,” and “Problem #5:  Neck spasm.”  Jessica Matthews reported: \nWe will order an MRI of his brain to evaluate and help with a \ndiagnosis for the patient.  The MRI will rule out infections, \nbrain tumors, stroke, bleeding in the brain, cyst, hormonal \ndisorders, spinal cord injuries, abnormalities in development \nand aneurysm, as well as any other reasoning for his syncope \nepisodes.  I will also order an EEG (electroencephalography) \nto monitor the electric sensitivity of the brain to detect any \ndisorders....Dr. South saw the patient with me and agreed to \nthe assessment and help formulate a plan for the patient. \nEEG Performed today:  Abnormal, awake and drowsy EEG.  \nAbnormal due to brief intermediate burst of sharp waves \n\nPATTERSON - G905912  11\n  \n \n \nactivity in the right temporal region exacerbated by photic \nstimulation and post hyperventilation 8 to 10 Hz.  Dr. South \nread:  Dr. South recommended starting the patient on Keppra \n500 mg twice a day.... \n \n An MRI of the claimant’s head was taken on August 8, 2022 with the \nimpression, “Negative MRI of the brain with contrast.\" \n Dr. Garrett Andrews, a Clinical Neuropsychologist, examined the \nclaimant on August 9, 2022: \nPatient is a 22-year-old, right-handed, Caucasian \nmale....Patient notes changes in behavior with \nlightheadedness, passing out, headaches, mood swings, \nanger spurts, and seizures occurring since September 9, \n2019.  Reports that he was thrown from an ATV with “multiple \nhead injuries and brain bleeds as well as a skull fracture.\"  He \nreports a daily headache in the left parietal area that is \ndescribed as stabbing pain.... \nPast medical history includes concussion, and seizures.  He \nreports that he had a petit mal/zoning out over the last 2 \nmonths following the loss of a friend.... \nMRI scan dated August 8, 2022 for syncope was interpreted \nas “negative MRI of the brain with contrast.”... \nOverall the current neurocognitive exam is grossly within \nnormal limits and does not suggest any gross cognitive \ndisorder.  Also, measures that are most sensitive to traumatic \nbrain injury and the effects of a brain injury are within normal \nlimits to superior range.  Suggesting there is no long-term \ncognitive sequela following a traumatic brain injury.  \nAdditionally, he reported significant neurobehavioral \nsymptoms that were deemed grossly amplified.  This may be \nrelated to a significant emotional disorder such as \nposttraumatic stress disorder; however, it may also indicate \namplification of symptoms.   \nGiven the evidence and data he would best be served by \npsychotherapy to address possible difficulties with adjustment \nand possible trauma response.  The current cognitive exam \ndoes support his ability to return to work at this time.  His \n\nPATTERSON - G905912  12\n  \n \n \nemotional abilities and mood may still be a hindrance and \nshould be addressed through medications and psychotherapy.   \n \n Dr. Andrews assessed “1.  Somatoform disorder” and “2.  \nPosttraumatic stress disorder – RULE OUT.”   \n The claimant continued to follow up with Jessica Matthews at \nNeurology Associates of Northeast Arkansas, PA.     \n The claimant treated at NEA Baptist on January 16, 2023.  Dr. \nAmanda Jo Watlington reported, “Patient is a 22-year-old male who \npresents today with seizures.  His significant other is with him, states he \nhad 4-5 seizures this morning.  Patient reports he [is] on Keppra and has \nbeen taking it as prescribed.”   \n An APRN noted at Buffalo Island Medical Clinic Leachville on March \n27, 2023, “Gregory L. Patterson, II presents complaining of seizure this \nmorning.  Patient also has headache and body aches right now, but states \nthis is common after he has a seizure....Patient states this is his first \nseizure in the past 3-4 months.”   \n A CT of the claimant’s head was taken on March 29, 2023 with the \nimpression, “No acute intracranial abnormality.  Specifically, no acute \nhemorrhage or acute infarct.” \n Dr. South’s impression on April 5, 2023 included “CONVULSIONS ... \nAssessment:  Deteriorated.”   \n\nPATTERSON - G905912  13\n  \n \n \n The claimant received emergency treatment at NEA Baptist on July \n26, 2023.  Dr. Kereem Monolito Marlow noted at that time, “Since he had \nthis possible head injury and seizure he has had right posterior headache \npain and right posterior neck pain.” \n The claimant received emergency medical treatment at St. Bernards \nMedical Center on August 7, 2023.  Dr. Amirtharaj Dhanaraja commented \nat that time: \nThe patient is a 22-year-old male who presents [to] the \nemergency department for evaluation of possible seizure.  He \nhas a seizure disorder secondary to remote traumatic brain \ninjury approximately 4 years ago.  He takes Keppra and has \nbeen taking as directed.  Did have a seizure approximate \nweek ago.  Prior to that it had been several months before he \nhad a seizure.   \n \n A CT of the claimant’s head was taken on August 7, 2023 with the \nimpression, “No acute intracranial findings.”  The results from an \nECG/Electrocardiogram dated August 7, 2023 were “Normal sinus rhythm.  \nNormal ECG.”    \n Under the attendance of Dr. Dhanaraja, Phillip W. Stokes, APN \nreported on or about August 8, 2023: \nA 22-year-old male with a past medical history of TBI, \nepilepsy on Keppra presents after being found to be \nunresponsive at home most likely secondary to a seizure.  \nArrival to SBMC, patient was hemodynamically stable, CT \nhead was negative for any acute intraconal (sic) pathology, \nlabs were unremarkable.  Patient was admitted for the \nmanagement of breakthrough seizures, neurology was \nconsulted and recommended increasing the Keppra to 1500 \n\nPATTERSON - G905912  14\n  \n \n \nmg twice daily from 1000mg however patient has already \nbeen on 1500 mg twice daily.  Will inform neurology and see if \nthey want to add more antiepileptics.  Patient has been \nseizure-free since admission.  Patient was noted to have \nbradycardia and therefore echocardiogram and carotid \nDopplers have been ordered we will follow.... \nRECOMMENDATIONS \n1) Continue Keppra to 1500 mg bid. \n2) Avoid alcohol consumption. \n3) Social work to report patient to Department of Motor \nVehicles. \n4) f/u outpatient PCP. \n5) signing off.   \n \n A pre-hearing order was filed on February 28, 2024.  The claimant \ncontended, “1.  The above listed proposed stipulations.  2.  The Claimant \nwas injured on September 10, 2019, when he was a passenger of an ATV \nin which the driver took a turn too fast causing the Claimant to be ejected \nfrom the vehicle which caused an injury to his head and brain.  The \nClaimant was life-flighted to Regional One Health Medical Center in \nMemphis, Tennessee for emergency treatment.  He was hospitalized for \ntwo (2) days due to his injuries and was discharged with a head injury and \nintraparenchymal hemorrhage of brain.  The Claimant was scheduled to \nfollow-up with neurosurgery within one (1) month.  The Claimant followed-\nup with therapy including speech therapy within a month of the injury.  On \nOctober 1, 2019, the Claimant was seen by Dr. John Brophy for follow-up \non the traumatic head injury.  On December 19, 2019, the Claimant was \nseen at St. Bernard’s Medical Center for increased headaches.  The \n\nPATTERSON - G905912  15\n  \n \n \nClaimant continued to follow-up with Dr. Brophy for continued increase in \nheadaches and was released on January 22, 2020.  The Claimant \ncontinued to get regular treatment and imaging of his head due to ongoing \nand continuous headaches.  The Claimant began to have seizures along \nwith numbness on the left side of his body and was seen at NEA Baptist \nHospital wherein testing and evaluations have been performed as well as \ncontinued follow-up with Semmes-Murphy Clinic.  3.  The Claimant reserves \nthe right to amend and supplement his contentions after additional \ndiscovery has been completed.”   \n The respondents contended, “Respondents contend that claimant’s \nhead injury was accepted as compensable, and he has received all \nreasonable and necessary medical treatment and indemnity benefits.  On \nSeptember 10, 2019, claimant jumped out of a mule and hit his head.  He \nwas med flighted to the Med in Memphis.  Claimant saw Dr. Brophy, who \nreleased him to full duty, placing him at MMI and no impairment rating on \nJanuary 22, 2020.  Claimant saw a neuropsychologist, Dr. Zolten on \nDecember 9, 2021.  Dr. Zolten noted his memory was normal and did not \nrecommend further treatment for the compensable injury.  Dr. Brophy \nconfirmed that Dr. Zolten’s neuropsychologist report was normal and \nreleased him from his care on January 25, 2022.  Respondents are not \naware of any further medical treatment or treatment recommendations.  \n\nPATTERSON - G905912  16\n  \n \n \nRespondents reserve the right to file an Amended Response to the \nPrehearing Questionnaire or other appropriate pleading and to allege any \nfurther affirmative defense(s) that might be available upon further \ndiscovery.”   \n The parties agreed to litigate the following issue:  “1.  Whether \nClaimant is entitled to additional reasonable and necessary medical \ntreatment for his compensable injury.” \n A hearing was held on July 26, 2024.  The claimant testified on direct \nexamination: \nQ.  After you got back home and went through the treatment \nmodalities and all that, can you tell the judge what problems \nyou were having at that point from these injuries? \nA.  Constant headaches.  I guess you would call it vertigo.   \nQ.  Okay. \nA.  Dizzy spells.  And at times double vision.... \nQ.  Tell me what the folks at Buffalo Island Medical Clinic \nhave done for you since your injury? \nA.  They’ve helped me with, with my headaches.  They’ve \ntried different kind of medications to help me out, to try to \nprevent them or keep them away as long as I can.   \nQ.  Okay.  Do you continue to see them? \nA.  Yes, sir.... \nQ.  Prior to your head injury with the City of Monette, did you \nhave any of these issues of vertigo or syncope? \nA.  No, sir.   \nQ.  Okay.  And you still have them to this day? \nA.  Yes, sir.   \nQ.  How often do you have the vertigo or the syncope? \nA.  Once every couple of months.   \nQ.  Okay.  They’re not as often as the headaches? \nA.  Correct....   \n \n The respondents’ attorney cross-examined the claimant: \n\nPATTERSON - G905912  17\n  \n \n \nQ.  So far as your seizures go, you’re primarily receiving \nmedication called Keppra, right? \nA.  Correct. \nQ.  Other than that, you just do some follow-up visits.  Is that \ncorrect? \nA.  Yes, ma’am. \nQ.  There’s no other medical treatment that you’re receiving \nfor that, right? \nA.  Correct.   \n \n An administrative law judge filed an opinion on September 5, 2024.  \nThe administrative law judge found that the claimant proved he was \n“entitled to reasonable and necessary medical treatment for his headaches \nand seizures.”  The respondents appeal to the Full Commission.  \nII.  ADJUDICATION \n The employer shall promptly provide for an injured employee such \nmedical treatment as may be reasonably necessary in connection with the \ninjury received by the employee.  Ark. Code Ann. §11-9-508(a)(Repl. 2012).  \nThe 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).  Preponderance \nof the evidence means the evidence having greater weight or convincing \nforce.  Metropolitan Nat’l Bank v. La Sher Oil Co., 81 Ark. App. 269, 101 \nS.W.3d 252 (2003).  What constitutes reasonably necessary medical \ntreatment is a question of fact for the Commission.  Wright Contracting Co. \nv. Randall, 12 Ark. App. 358, 676 S.W.2d 70 (1984).     \n\nPATTERSON - G905912  18\n  \n \n \n An administrative law judge found in the present matter, “3.  The \nClaimant has proven by the preponderance of the evidence that he is \nentitled to reasonable and necessary medical treatment for his headaches \nand seizures.”  The Full Commission finds that the claimant proved that the \nmedical treatment of record after January 25, 2022, including follow-up \ntreatment at Buffalo Island Medical Clinic, was reasonably necessary in \naccordance with Ark. Code Ann. §11-9-508(a)(Repl. 2012).    \n As we have discussed, the parties stipulated that the claimant \n“sustained a compensable head injury” on September 10, 2019.  The record \nshows that the claimant was apparently thrown from an All-Terrain Vehicle \nwhile he was performing employment services.  As a result of the \ncompensable head injury, the claimant sustained hemorrhaging within the \nleft lateral lobe and a fracture of the left temporal/parietal bone.  The \nclaimant subsequently treated with various therapists and physicians, \nincluding Dr. Brophy.  Dr. Brophy noted in November 2019 that the claimant \nwas suffering from “headache” following the compensable closed head \ninjury.  The claimant sought emergency treatment for “headaches” in \nDecember 2019.   \n The claimant was involved in a nonwork-related motor vehicle \naccident in August 2020.  The claimant was sitting in a parked vehicle that \nwas hit by another vehicle.  The evidence does not demonstrate that the \n\nPATTERSON - G905912  19\n  \n \n \nclaimant sustained another closed head injury as a result of the accident \noccurring in August 2020.  The claimant complained of pain in his neck, \nback, right forearm, and right knee.  Although the claimant was given a \nconcussion protocol, a head CT was “normal.”  The claimant followed up \nwith Dr. Brophy in September 2021, and Dr. Brophy did not report that the \nclaimant was suffering from symptoms related to the accident occurring in \nAugust 2020.  Instead, Dr. Brophy noted that the claimant’s complaints \nwere “related to his closed head injury which occurred in September 2019.”   \n Dr. Brophy stated on January 25, 2022, “In my opinion, no further \ntreatment is indicated at this time.”  The healing period is that period for \nhealing of an accidental injury that continues until an employee is as far \nrestored as the permanent character of the injury will permit.  Hope Sch. \nDist. v. Wilson, 2011 Ark. App. 219, 382 S.W.3d 782.  Based on Dr. \nBrophy’s report, the Full Commission finds in the present matter that the \nclaimant reached the end of the healing period for his September 10, 2019 \ncompensable injury no later than January 25, 2022.  However, it is well-\nsettled that a claimant may be entitled to ongoing medical treatment after \nthe healing period has ended, if the medical treatment is geared toward \nmanagement of the claimant’s compensable injury.  Patchell v. Wal-Mart \nStores, Inc., 86 Ark. App. 230, 184 S.W.3d 31 (2004).   \n\nPATTERSON - G905912  20\n  \n \n \n The Full Commission finds in the present matter that the medical \ntreatment of record provided after January 25, 2022 was geared toward \nmanagement of the claimant’s injury and was reasonably necessary in \nconnection with the compensable injury.  If an injury is compensable, then \nevery natural consequence of that injury is also compensable.  Hubley v. \nBest Western Governor’s Inn, 52 Ark. App. 226, 916 S.W.2d 143 (1996).  \nThe basic test is whether there is a causal connection between the two \nepisodes.  Jeter v. B.R. McGinty Mechanical, 62 Ark. App. 53, 968 S.W.2d \n645 (1998).  The burden is on the claimant to establish the necessary \ncausal connection.  Nichols v. Omaha Sch. Dist., 2010 Ark. App. 194, 374 \nS.W.3d 148.  Whether there is a causal connection is a question of fact for \nthe Commission.  Jeter, supra.  In workers’ compensation cases, the \nCommission functions as the trier of fact.  Blevins v. Safeway Stores, 25 \nArk. App. 297, 757 S.W.2d 569 (1988).  The Commission is not required to \nbelieve the testimony of the claimant or any other witness but may accept \nand translate into findings of fact only those portions of the testimony it \ndeems worthy of belief.  Farmers Co-op v. Biles, 77 Ark. App. 1, 69 S.W.3d \n899 (2002). \n The Full Commission finds in the present matter that the claimant \nwas a credible witness.  The claimant proved that the chronic headaches \nfrom which he has suffered were a natural consequence of the September \n\nPATTERSON - G905912  21\n  \n \n \n10, 2019 compensable head injury.  Dr. Brophy reported as early as \nNovember 2019 that the claimant was suffering from headaches following \nthe compensable injury.  The record does not show that the claimant \nsuffered from chronic headaches, which were sometimes debilitating, prior \nto the compensable injury.  The claimant testified that he began suffering \nfrom seizures in about July 2022, and the report from FC – Stadium \ncorroborated the claimant’s testimony.  Dr. South noted “alteration of \nawareness” in August 2022.  An EEG on August 2, 2022 was “Abnormal \ndue to brief intermediate burst of sharp waves activity in the right temporal \nregion[.]”  The Full Commission finds that this diagnostic abnormality was \ncausally related to the September 10, 2019 compensable closed head \ninjury.  Dr. Andrews reported on August 9, 2022 that the claimant had been \nsuffering from seizures since the date of the compensable injury.   \n Finally, Dr. Dhanaraja reported on August 7, 2023, “He has a seizure \ndisorder secondary to remote traumatic brain injury approximately 4 years \nago [emphasis supplied].  It is within the Commission’s province to weigh all \nof the medical evidence and to determine what is most credible.  Minnesota \nMining & Mfg. v. Baker, 337 Ark. 94, 989 S.W.2d 151 (1999).  The Full \nCommission finds in the present matter that Dr. Dhanaraja’s opinion is \ncorroborated by the record and is entitled to significant evidentiary weight.  \nThe claimant proved that both his chronic headaches and his occasional \n\nPATTERSON - G905912  22\n  \n \n \nseizures were a natural consequence of the September 10, 2019 \ncompensable head injury.   \n After performing a de novo review of the entire record currently \nbefore us, the Full Commission finds that the claimant proved the medical \ntreatment of record provided after January 25, 2022 was reasonably \nnecessary in accordance with Ark. Code Ann. §11-9-508(a)(Repl. 2012).  \nSaid reasonably necessary medical treatment includes follow-up visits at \nBuffalo Island Medical Clinic.  For prevailing on appeal to the Full \nCommission, the claimant’s attorney is entitled to a fee of five hundred \ndollars ($500), pursuant to Ark. Code Ann. §11-9-715(b)(Repl. 2012). \n IT IS SO ORDERED.   \n \n    ___________________________________ \n    SCOTTY DALE DOUTHIT, Chairman \n \n    ___________________________________ \n    M. SCOTT WILLHITE, Commissioner \n \n \n \nCommissioner Mayton dissents. \n \n \nDISSENTING OPINION \n \n I respectfully dissent from the majority opinion finding the medical \ntreatment provided to the claimant after January 25, 2022, was reasonable \nand necessary, and the claimant’s headaches and seizures were a natural \nconsequence of his compensable head injury.  \n\nPATTERSON - G905912  23\n  \n \n \nThe claimant was injured in September of 2019 when he suffered a \nhead injury in an ATV accident.  The respondents accepted the claim as \ncompensable and paid all appropriate benefits.  \nThe claimant was released at maximum medical improvement with \nno permanent impairment or work restrictions on January 22, 2020, by Dr. \nJohn Brophy, a neurosurgeon in Memphis, Tennessee.  The claimant was \nlater in a car accident on August 22, 2020, in which he sustained an injury \nto his neck as well as other areas of his body. \nOn September 28, 2021, Dr. John Brophy recommended the \nclaimant undergo a neuropsychological evaluation.  The neuropsychological \nevaluation was performed by Dr. A.J. Zolten on December 9, 2021, and the \nresults were within the range of normal.  Dr. Brophy cleared the claimant to \nremain at work full duty without restrictions and did not recommend any \nfurther medical treatment. \n In August 2022, the claimant began complaining of seizures and \nheadaches for which he requests additional medical treatment.  An \nadministrative law judge ruled the claimant proved by a preponderance of \nthe evidence he is entitled to additional medical treatment.  After a review of \nthe entire record, I find the claimant is not entitled to additional medical \ntreatment, because his complaints of seizures and headaches are not \nrelated to his compensable injury on September 10, 2019. \n\nPATTERSON - G905912  24\n  \n \n \nArk. Code Ann. § 11-9-508(a) requires an employer to provide an \nemployee with medical and surgical treatment \"as may be reasonably \nnecessary in connection with the injury received by the employee.\"   The \nclaimant has the burden of proving by a preponderance of the evidence the \nadditional treatment is reasonable and necessary.  Nichols v. Omaha Sch. \nDist., 2010 Ark. App. 194, 374 S.W.3d 148 (2010). \nWhat constitutes reasonably necessary treatment is a question of \nfact for the Commission.  Gant v. First Step, Inc., 2023 Ark. App. 393, 675 \nS.W.3d 445 (2023).  In assessing whether a given medical procedure is \nreasonably necessary for treatment of the compensable injury, the \nCommission analyzes both the proposed procedure and the condition it \nsought to remedy.  Walker v. United Cerebral Palsy of Ark., 2013 Ark. App. \n153, 426 S.W.3d 539 (2013).  \nHere, the claimant has failed to prove his alleged headaches and \nseizures are causally related to his compensable injury.  Records from \nSemmes-Murphy Clinic dated October 1, 2019, reflect the claimant stated \nhe was “doing quite well, without headache, visual disturbance, weakness, \nparesthesias or memory difficulty.”  \nThe claimant did not complain of headaches until he returned to \nschool and began using a computer to complete his schoolwork at night \nafter working throughout the day.  \n\nPATTERSON - G905912  25\n  \n \n \nBy January 21, 2020, the claimant’s symptoms had definitely \nimproved.  By September 28, 2021, the claimant no longer reported \nheadaches.  Two years post-injury, the claimant reported “fatigue without \nheadaches, visual disturbance, weakness or balance difficulty.”  The \nclaimant did not report severe headaches until August of 2022, which, along \nwith “passing out episodes” had begun two months prior.  \nThe claimant has undergone seven head CTs since his injury, all of \nwhich have shown normal results without acute findings.  An MRI \nconducted on August 8, 2022, revealed the same results. \nThere is no evidence the claimant has suffered from “continuous” \nheadaches from January 2020 through August 2022.  The record reflects \nhis injury-related headaches had resolved for years before he began \nsuffering from headaches in 2022, simultaneous to when his seizures \nbegan.  No doctor has related the claimant’s current headaches to his 2019 \ninjury and there are no findings to show they are related. \nThe claimant has failed to prove by the preponderance of the \nevidence his headaches are the result of his 2019 injury. \nThe claimant further alleges he began suffering from seizures as a \nresult of his injury.  However, by his own admission, no doctor has ever \nrelated the claimant’s seizures to his work injury.  In fact, the claimant \n\nPATTERSON - G905912  26\n  \n \n \ninformed doctors “he has also been told the symptoms might be related to a \npinched nerve in his neck.\"  \nThese seizures did not begin until June or July of 2022, nearly three \nyears after the claimant’s injury.  All objective tests have been normal with \nno findings to link the complaints of headaches and seizures to the \ncompensable injury.  \nThere is simply no objective evidence to relate the headaches or \nseizures to the claimant’s compensable injury.  All these complaints \noriginated in 2022, nearly three years after the compensable injury and two \nand a half years after he had been released to full-duty work.  In addition, \nthe claimant was involved in a car accident subsequent to the compensable \ninjury and prior to his complaints of headaches and seizures.   \nNo doctor who has treated the claimant has found any objective \nmedical findings to relate the complaints of headaches and seizures to the \ncompensable injury.   \nAccordingly, for the reasons set forth above, I must dissent. \n \n    ___________________________________ \n    MICHAEL R. MAYTON, Commissioner","preview":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. G905912 GREGORY PATTERSON, EMPLOYEE CLAIMANT CITY OF MONETTE, EMPLOYER RESPONDENT ARKANSAS MUNICIPAL LEAGUE, INSURANCE CARRIER/TPA RESPONDENT OPINION FILED MARCH 5, 2025","fetched_at":"2026-05-19T22:29:44.476Z","links":{"html":"/opinions/full_commission-G905912-2025-03-05","pdf":"https://www.labor.arkansas.gov/wp-content/uploads/Patterson_Gregory_G905912_20250305.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/full-commission-opinions/"}}