{"id":"full_commission-H004171-2024-03-07","awcc_number":"H004171","decision_date":"2024-03-07","opinion_type":"full_commission","claimant_name":"Joshua Shelton","employer_name":"Nucor Yamato Steel Co","title":"SHELTON VS. NUCOR YAMATO STEEL CO. AWCC# H004171 MARCH 7, 2024","outcome":"unknown","outcome_keywords":[],"injury_keywords":["back","lumbar","knee","sprain","herniated"],"pdf_url":"https://labor.arkansas.gov/wp-content/uploads/Shelton_Joshua_H004171_20240307.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/full-commission-opinions/","filename":"Shelton_Joshua_H004171_20240307.pdf","text_length":34546,"full_text":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION \n \n \nCLAIM NO.  H004171 \n \nJOSHUA SHELTON, \nEMPLOYEE \n \nCLAIMANT \nNUCOR YAMATO STEEL CO.,  \nEMPLOYER \n \nRESPONDENT \nARCH INSURANCE COMPANY, CARRIER/ \nSEDGWICK CLAIMS MANAGEMENT, \nINSURANCE CARRIER/TPA \nRESPONDENT \n  \n      \nOPINION FILED MARCH 7, 2024 \n \nUpon review before the FULL COMMISSION in Little Rock, Pulaski County, \nArkansas. \n \nClaimant represented by the HONORABLE ANDY L. CALDWELL, Attorney \nat Law, Little Rock, Arkansas. \n \nRespondents represented by the HONORABLE MICHAEL E. RYBURN, \nAttorney at Law, Little Rock, Arkansas. \n \nDecision of Administrative Law Judge:  Affirmed as Modified. \n \n \nOPINION AND ORDER \n \nThe respondents appeal an administrative law judge’s opinion filed \nAugust 22, 2023.  The administrative law judge found that the claimant \nsustained a compensable back injury.  The administrative law judge \nawarded medical treatment and temporary total disability benefits.  After \nreviewing the entire record de novo, the Full Commission finds that the \nclaimant proved he sustained a compensable back injury.  We find that the \nmedical treatment of record, including the recommendation of a spinal cord \nstimulator, was reasonably necessary in accordance with Ark. Code Ann. \n\nSHELTON - H004171  2\n  \n \n \n§11-9-508(a)(Repl. 2012).  The Full Commission finds that the claimant did \nnot prove he was entitled to additional temporary total disability benefits.       \nI.  HISTORY \n The testimony of Joshua Wade Shelton, now age 52, indicated that \nhe became employed with the respondents, Nucor Yamato Steel Company, \nin about 2002.  The parties initially stipulated that Mr. Shelton “sustained a \ncompensable injury to his back” on June 25, 2020.  The claimant testified \nthat he slipped and fell while stepping over a “roll line.”  The claimant \ntestified that he reported the incident to his supervisor, and that the \nrespondent-employer arranged for the claimant to obtain medical treatment.     \nAccording to the record, the claimant treated with Dr. Robert Riley \nJones at OrthoSouth on June 26, 2020: \nThis is a 48 year old male who is being seen for a chief \ncomplaint of Acute Low Back Pain, involving the lumbar spine \nand spine.  This occurs in the context of tripped and fell at \nwork.  DOI 06/25/2020.  The pain has been present for 1 day.  \nThe lumbar spine and spine pain is aggravated by all \nmovement and is constant.... \nPatient presents today with complaint of pain primarily in his \nleft back and buttock.  This gentleman works for Nucor and \nwas injured on 6/25/2020 when he tripped and fell forward.  \nHe hit his right knee but that is doing relatively well right now \nbut about 20 minutes after he fell he began to have pain in his \nleft lower back.  Pain is primarily in the back but over the last \nseveral days it has radiated down into his posterior thigh on \nthe left.  No real numbness but he does have pain he has \ndifficulty with moving around changing positions.  He had \nprevious surgery at L5-S1 [laminectomy] of Semmes Murphy \non December 20, 2018.  He had [an] excellent result from \nthis.... \n\nSHELTON - H004171  3\n  \n \n \nL-Spine inspection:  left and right paraspinal musculature \ntender to palpation[.]... \nX-ray [shows] decreased disc space at L5-S1 and \nhemilaminectomy left.   \n \n Dr. Jones planned, “I am going to put the patient on a Medrol \nDosepak.  He is already taking Flexeril.  We have ordered an MRI of his \nlumbar spine with and without contrast.  He is off work.  Depending on what \nwe see on the MRI we will either do [an] epidural block or have him see a \nspine surgeon.”  Dr. Jones’ impression was “1.  Spondylosis, lumbar.”  Dr. \nJones also stated, “The injured worker is unable to return to work until \nfurther specified.”   \nAn MRI of the claimant’s lumbar spine was taken on June 26, 2020 \nwith the following pertinent findings:   \nL4/5:  No dural sac compression is apparent.  Mild bilateral \nforaminal narrowing is observed. \nL5/S1:  Postsurgical changes on the left are apparent.  \nEnhancing material most consistent with epidural fibrosis \ninvolves the left S1 nerve root.  Mild disc bulge and \nspondylosis is observed and appears chronic in nature.  There \nis no dural sac or S1 root impingement.  Mild bilateral \nforaminal narrowing is observed. \nImpressions:  1.  No disc herniation, dural sac compression or \nnerve root impingement. \n2.  Mild degenerative change at L5-S1.   \n \nThe parties stipulated that the respondents “accepted this claim as \ncompensable and paid some benefits.”   \n The claimant was provided physical therapy visits beginning June \n29, 2020.   \n\nSHELTON - H004171  4\n  \n \n \n Dr. Jones noted on or about July 24, 2020, “This is a 48 year old \nmale who is following up for Lumbar Sprain (Sprain of ligaments of lumbar \nspine, initial encounter) on the lumbar spine....Patient comes in having had \nto see my partner Dr. Ferguson.  He had spasms and Dr. Ferguson \nchanged his medications to Toradol and Robaxin this appeared to help him.  \nHe also kept him off work for a few days and that has helped.  He would like \nto try to go to therapy [as] many days as they will allow him and apparently \nthe therapist is at the plant 4 days a week.  He is having no real spasm this \ntime but he still has difficulty with flexion and extension....Patient has had \nsome mild improvement.  I think we will go let him continue to be off work.  \nWe will continue his present medications and let him go to therapy 4 times \na week for 1 week.”  Dr. Jones’ impression was “1.  Lumbar Sprain.”  Dr. \nJones stated, “The injured worker is unable to return to work until further \nspecified.” \n Dr. Jones noted on or about July 31, 2020, “The injured worker is \nunable to return to work until further specified.  OFF WORK, and he was \nprescribed Robaxin-750 750 mg tablet (1 po hs for muscle spasms)....He is \ndoing exercises and PT 4 days a week.”   \n Dr. Todd E. Fountain examined the claimant at Semmes-Murphey \nClinic on September 24, 2020: \nThe patient is a very pleasant 49-year-old gentleman \npreviously operated on for a left L5-S1 herniated nucleus \n\nSHELTON - H004171  5\n  \n \n \npulposus.  He did very well from that operative intervention in \n2018.  Unfortunately, while at work, he suffered a fall forward \nfrom a standing height, landing onto a metal crate with his \nright knee.  He states he felt pain initially in his right knee, but \nthat subsided, but it was a few hours later he felt a significant \nincrease in pain in the left back.  Unfortunately, that has been \nunrelenting since that initial injury.  He has been seeing \nOrthoSouth who have been treating him with physical therapy \nand medication, but he has not made a significant response, \nhas not been able to return back to work.  This led to MRI \nimaging of his lumbar spine.... \nFortunately, he does not have any new or recurrent disc \nherniations or residuals.  His foramen are patent and nerve \nelements are free.  His canal is widely patent.  There is no \nsignificant compression.  His x-ray imaging also reveals his \nalignment to be preserved with no overt motion changes on \nflexion-extension.  He does have some facet arthropathy at \nthe 4-5 and 5-1 facets.... \nPlan:  Possible facetogenic pain, L4-5/L5-S1.  I discussed \nwith the patient treatment options at this time.  We will have \nhim see one of our pain specialists for evaluation of facet test \nblock followed by ablative treatment as necessary.  As I see \nno overt structural abnormalities, I do not think I have an \noperative intervention that would be amenable to him at this \ntime.  He understands.  We will not change his work status; he \nremains off work.   \n \n Dr. Jones’ impression on November 10, 2020 was “1.  Lumbar \nSprain” and “Sprain of ligaments of lumbar spine, initial encounter.”  Dr. \nJones returned the claimant to full-duty work, “The patient is discharged \nfrom care.  DISCHARGED MMI.”   \n The impression of Dr. Jay McDonald on January 14, 2021 was “1.  \nLumbar spondylosis at L4 to S1 on the left.  2.  History of disc herniation, \nstable, no radiculopathy.”  The record indicates that Dr. McDonald \nperformed “Medial branch nerve blocks of L4-S1” on February 1, 2021.  Dr. \n\nSHELTON - H004171  6\n  \n \n \nMcDonald noted on June 3, 2021, “Mr. Shelton is a 49-year-old male with a \nhistory of low back pain.  He underwent a left L4 to S1 radiofrequency \nablation.  He says he is about 75% better.  He has been able to be more \nactive.  He does have usual typical soreness after a day of being active but \nat this point he thinks he is on the road to recovery and he is happy about \nthat.”   \n Dr. Jones noted on December 22, 2021, “We have had a long \ndiscussion with the patient gone through [his] records with him.  It appears \nthat some of this is still a radiculopathy possibly secondary to scar tissue.  \nThere is nothing really for of (sic) the neurosurgeons to operate on.  I do not \nsee anything from the orthopedic standpoint to be done.  I think it is \nreasonable to proceed with a trial of the spinal cord stimulator and see if \nthis gives him any improvement.  Even with a spinal cord stimulator I doubt \nthat he will return to full duty.”   \n Dr. Jones signed a Form AR-3, PHYSICIAN’S REPORT on or about \nDecember 24, 2021.  Dr. Jones reported that the diagnosis was \n“Spondylosis without myelopathy or radiculopathy, lumbar region.”  Dr. \nJones checked a box indicating, “The claimant has suffered no permanent \nimpairment due to his/her work-related injury.”  Dr. Jones also indicated that \nthe “maximum medical improvement date (end of healing period)” was \nDecember 22, 2021. \n\nSHELTON - H004171  7\n  \n \n \n The claimant testified that he did not receive any workers’ \ncompensation benefits after January 10, 2022.  Dr. Jones’ impression on \nJanuary 11, 2022 was “1.  Lumbar sprain,” “Sprain of ligaments of lumbar \nspine.”  Dr. Jones again returned the claimant to full-duty work, stating, \n“The following work restrictions were determined:  - none.  No functional \nlimitations or restrictions....The patient is discharged from care.  \nDISCHARGED MMI.”        \n Dr. Jones reported on or about January 24, 2022: \nThis is a 50 year old male who is following up for Lumbar \nSprain (Sprain of ligaments of lumbar spine, initial encounter).  \nHe was seen on December 22, 2021, at which time he was \ngiven the following activity guidelines:  “SEDENTARY DUTY-\nLIMITED WALKING.”  Return date:  12/22/2021.... \nPatient comes in today more for a conference than any \ntreatment or examination.  He apparently has been told that \nhe is at his maximum.  They did not allow him to try the spinal \ncord stimulator.  He is questioning me about possibility of \ngetting a repeat bone scan since his original bone scan \nshowed some increased uptake in the lower back.... \nWe have had a long discussion today concerning the fact that \nwe had discharged him in November 2020.  He then had a \nanother (sic) problem and really has been taken care of by Dr. \nMcDonnell who is the one who recommended a spinal cord \nstimulator.  In my last office visit I made a note that I thought \nthat it might be a reasonable thing to do considering his \ncomplaints of pain.  He is here on his private insurance he \nwould like for me to repeat his bone scan to see if anything \nhas changed.  I have no problem with that.  Arrangements will \nbe made for the bone scan under his private insurance.  We \nwill have it done at the same place he had his first bone scan \nso they can compare adequately.   \n \n Dr. McDonald reported on February 28, 2022: \n\nSHELTON - H004171  8\n  \n \n \nMr. Shelton is here for followup.  We had discussed the spinal \ncord stimulator, but apparently, all further medical care has \nbeen denied by Worker’s Comp.  He is looking into that \ncurrently.  In the meantime, he is asking for some medication.  \nHe says the Celebrex does not really cover him very well.  He \nsays this has really affected his whole life, and he is pretty \nupset about it.  He complains of the same pain across his \nback and down the left leg.  It sounds like his further care is \nbeing denied by Worker’s Comp because they feel that this is \nall related to his surgery in 2018 but not from the fall that he \nhad at work in 2020.... \nPlan:  1.  I would like to point out that I think that the pain that \nwe are dealing with currently is related to his fall in 2020.  \nBased on the timeline of his symptoms, I think he would be an \nexcellent candidate for a spinal cord stimulator, so hopefully, \nwe will be able to go down that route.   \n2.  He is telling me that in the meantime, he would need some \nmedication because he is so miserable, and we discussed \nthat we are not a chronic pain clinic, but if he is denied to have \nthe stimulator, then I need to refer him to a chronic pain clinic.  \nIn the meantime, I wrote Norco 7.5 q. 6 h. #60 with no refills, \nand he will follow up with me as needed based on how \neverything goes with Worker’s Comp and the getting the \nstimulator.   \nADDENDUM \nHe wanted me to clarify whether he was under his PCP’s care \nor my care.  I told him that even if he is released at maximum \nmedical improvement by his PCP/orthopedic surgeon, he is \nstill under my care, and I reinforced that the plan was to see if \nwe can get a stimulator trial done, but if not, then we will see \nhow he does with the medication, and if that works well for \nhim, then I would eventually need to refer him out to a chronic \npain clinic.  Also, I am keeping him at sedentary duty for work.   \n \n The record indicates that Dr. McDonald referred the claimant to Dr. \nMoacir Schnapp, who reported on March 28, 2022: \nThis is a 50-year-old white male who comes to us with a \nprimary complaint of bilateral low back and proximal left lower \nextremity pain for the past two years.   \n\nSHELTON - H004171  9\n  \n \n \nThis gentleman had an on-the-job injury in June 2020.  Since \nthen, he has had severe pain across his back and leg.  He \nwas treated at Semmes Murphey Clinic.  The story is, \nhowever, more complicated including:   \n1.  Lumbar laminectomy with an L5 discectomy in 2018, not \nwork-related. \n2.  On-the-job injury June 2020 followed by intensive \ntreatment with blocks, radiofrequency ablation.   \n3.  He has been offered spinal cord stimulator but his carrier \nhas denied it.   \nHe describes pain as being constant, aching, and throbbing \nacross his back but also with a moderate degree of sciatica \nproximal greater than distal.... \nHe has undergone extensive workup including an MRI of the \nlumbar spine and this was reviewed with the patient.  It shows \nepidural fibrosis on the left lateral canal around the left S1 \nnerve.  An EMG and nerve conduction performed by Dr. \nGraham shows a left lumbar radiculopathy.   \nRadiofrequency ablation between L4-S1 has provided partial \nrelief of his low back pain but still insufficiently.  He comes to \nus for evaluation and pain management.   \nSince Worker’s Compensation denied his spinal cord \nstimulator and he was told that he is not covered under \nWorker’s Compensation anymore, so he comes today on his \nregular insurance.   \nHe gets up with stiffness.  He walks with a limp on the left.  \nThere is flattening of the lumbar lordosis.  There is decreased \nrange of motion of the lumbar spine for flexion, extension and \nrotation.  No long tract signs.  No atrophy or fasciculations.... \nPsychologically he is stable without signs of depression or \nanxiety.... \nHe has a well-healed laminectomy scar. \nI reviewed his records, his EMG, surgery, and MRI.  Clearly, \nhe suffers from post laminectomy syndrome and he has failed \nmost other treatments.  It is clear, in my opinion, that a spinal \ncord stimulator is the next option.  We will obtain \npsychological evaluation for spinal cord stimulator.   \nIn the meantime, we need to think outside the box and we will \nallow him to use Marinol as an anti-neurogenic drug and keep \nhim on Percocet after fully advising him as to the potential for \ndependency, addiction, respiratory depression, etc.  We spent \nthe majority of our 50 minutes going over pain, pain \n\nSHELTON - H004171  10\n  \n \n \nmanagement, pathophysiology of the pain and alternatives for \nthe future.  He also understands that we are not primarily a \nmedication management facility. \n \n A pre-hearing order was filed on May 10, 2023.  According to the \npre-hearing order, the parties agreed to litigate the following issues: \n1.  Whether Claimant is entitled to additional reasonably \nnecessary medical treatment previously denied by \nRespondents.   \n2.  Whether Claimant is entitled to temporary total disability \nbenefits from January 9, 2022, to a date yet to be determined. \n3.  Attorney’s fee.   \n \n Dr. McDonald signed a prepared questionnaire on June 27, 2023 \nand indicated, among other things, that the claimant was “not at maximum \nmedical improvement.”   \nA hearing was held on July 28, 2023.  At that time, the claimant \ncontended, among other things, that he sustained “a compensable \naggravation of a pre-existing condition” on or about June 25, 2020.  The \nclaimant contended that a spinal cord stimulator was reasonably necessary.  \nThe claimant contended that he was entitled to temporary total disability \nbenefits “from the date that the respondents terminated benefits.”  The \nclaimant contended that he was entitled to temporary total disability benefits \n“from January 11, 2022 to a date yet to be determined.”   \n The respondents contended, among other things, that there were “no \nobjective medical findings to corroborate the compensable injury.”  The \n\nSHELTON - H004171  11\n  \n \n \nrespondents contended that there was “no proof that’s objective that the \nclaimant sustained a new injury in this case.”  \n An administrative law judge filed an opinion on August 22, 2023.  \nThe administrative law judge found, among other things, that the claimant \nsustained a compensable back injury.  The administrative law judge \nawarded medical treatment and temporary total disability benefits.  The \nrespondents appeal to the Full Commission. \nII.  ADJUDICATION \n A.  Compensability \n Ark. Code Ann. §11-9-102(4)(Repl. 2012) provides, in pertinent part: \n  (A)  “Compensable injury” means: \n(i)  An accidental injury causing internal or external physical \nharm to the body ... \narising out of and in the course of employment and which \nrequires medical services or results in disability or death.  An \ninjury is “accidental” only if it is caused by a specific incident \nand is identifiable by time and place of occurrence[.]   \n \n A compensable injury must also be established by medical evidence \nsupported by objective findings.  Ark. Code Ann. §11-9-102(4)(D)(Repl. \n2012).  “Objective findings” are those findings which cannot come under the \nvoluntary control of the patient.  Ark. Code Ann. §11-9-102(16)(A)(i)(Repl. \n2012).   \n The employee has the burden of proving by a preponderance of the \nevidence that he sustained a compensable injury.  Ark. Code Ann. §11-9-\n\nSHELTON - H004171  12\n  \n \n \n102(4)(E)(i)(Repl. 2012).  Preponderance of the evidence means the \nevidence having greater weight or convincing force.  Metropolitan Nat’l \nBank v. La Sher Oil Co., 81 Ark. App. 269, 101 S.W.3d 252 (2003).  \n An administrative law judge found in the present matter, “5.  \nClaimant did sustain a compensable back injury on June 25, 2020.”  The \nFull Commission affirms this finding.  The claimant’s testimony indicated \nthat he became employed with the respondents in about 2002.  The \nclaimant testified that he was working for the respondents as a Torch \nInspector on June 25, 2020.  The claimant testified that he slipped and fell \nthat day while stepping across a “roll line.”  The claimant testified that he at \nfirst felt pain in his right knee but afterward began suffering from back pain.  \nThe claimant testified that he reported the accidental injury to his \nsupervisor, and that the respondents arranged for him to treat with a \nphysician.  The claimant began treating with Dr. Jones on June 26, 2020, \nand the parties stipulated that the respondents “accepted this claim as \ncompensable and paid some benefits.”   \n Dr. Jones’ diagnosis on July 24, 2020 was “Lumbar Sprain (Sprain of \nligaments of lumbar spine, initial encounter) on the lumbar spine.”  Dr. \nJones noted that Dr. Ferguson had prescribed medications for the claimant \nto treat “spasms” following the accidental injury.  Dr. Jones reported on or \nabout July 31, 2020 that he had prescribed Robaxin “for muscle spasms.”   \n\nSHELTON - H004171  13\n  \n \n \n Muscle spasms can constitute objective medical findings to support \ncompensability.  Estridge v. Waste Management, 343 Ark. 276, 33 S.W.3d \n167 (2000), citing Continental Express, Inc. v. Freeman, 66 Ark. App. 102, \n989 S.W.2d 538 (1999).  In the present matter, Dr. Jones diagnosed \n“Lumbar Sprain” following the accidental injury, and he prescribed Robaxin \n“for muscle spasms.”  The Full Commission finds in the present matter that \nthe treating physician’s diagnosis of “Lumbar Sprain” accompanied by a \nprescribed treatment of medication for “muscle spasms” is sufficient to \nestablish objective findings of a compensable injury.  See Bradford v. \nStracener Bros. Const., 2021 Ark. App. 316, citing Melius v. Chapel Ridge \nNursing Ctr., LLC, 2021 Ark. App. 61, 618 S.W.3d 410.    \n The 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 June 25, 2020.  The claimant also \nestablished a compensable injury by medical evidence supported by \nobjective findings, namely Dr. Jones’ prescription of medication for muscle \nspasm following the accidental injury.  We find that these objective medical \n\nSHELTON - H004171  14\n  \n \n \nfindings reported by Dr. Jones were causally related to the June 25, 2020 \ncompensable injury and were not caused by a prior injury or pre-existing \ncondition.   \n B.  Medical Treatment \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 must prove by a preponderance of the evidence that he is \nentitled to additional medical treatment.  Wal-Mart Stores, Inc. v. Brown, 82 \nArk. App. 600, 120 S.W.3d 153 (2003).  What constitutes reasonably \nnecessary medical treatment is a question of fact for the Commission.  \nHamilton v. Gregory Trucking, 90 Ark. App. 248, 205 S.W.3d 181 (2005).   \n An administrative law judge found in the present matter, “The \nClaimant is entitled to additional medical treatment for his back injury of \nJune 25, 2020.”  The Full Commission finds that the treatment of record on \nand after June 26, 2020 was reasonably necessary in connection with the \ncompensable injury.  Said reasonably necessary medical treatment \nincludes trial of a spinal stimulator.   \n The claimant proved by a preponderance of the evidence that he \nsustained a compensable injury on June 25, 2020.  Dr. Jones subsequently \ndiagnosed “Lumbar Sprain,” and the claimant was treated conservatively.  \n\nSHELTON - H004171  15\n  \n \n \nThe claimant was provided treatment to include physical therapy, but no \ntreating physician has recommended that the claimant is a candidate for \nsurgery.  Dr. Jones noted in December 2021, “I do not see anything from \nthe orthopedic standpoint to be done.  I think it is reasonable to proceed \nwith a trial of the spinal cord stimulator and see if this gives him any \nimprovement.”  Dr. McDonald stated in February 2022, “Based on the \ntimeline of his symptoms, I think he would be an excellent candidate for a \nspinal cord stimulator, so hopefully, we will be able to go down that route.”  \nDr. Schnapp reported in March 2022, “It is clear, in my opinion, that a spinal \ncord stimulator is the next option.  We will obtain psychological evaluation \nfor a spinal cord stimulator.”  The claimant testified that he had undergone a \npsychological evaluation, as a result of which he was “a prime candidate for \nthe spinal cord stimulator.”   \n It is within the Commission’s province to weigh all of the medical \nevidence and to determine what is most credible.  Minnesota Mining & Mfg. \nv. Baker, 337 Ark. 94, 989 S.W.2d 151 (1999).  In the present matter, the \nFull Commission finds that, with regard to trial of a spinal cord stimulator, \nthe opinions of treating physicians Dr. Jones, Dr. McDonald, and Dr. \nSchnapp are entitled to significant evidentiary weight.  We therefore find \nthat trial of a spinal cord stimulator is reasonably necessary in accordance \nwith Ark. Code Ann. §11-9-508(a)(Repl. 2012). \n\nSHELTON - H004171  16\n  \n \n \n C.  Temporary Disability \n Finally, temporary total disability is that period within the healing \nperiod in which the employee suffers a total incapacity to earn wages.  Ark. \nState Hwy. Dept. v. Breshears, 272 Ark. 244, 613 S.W.2d 392 (1981).  \n“Healing period” means “that period for healing of an injury resulting from an \naccident.”  Ark. Code Ann. §11-9-102(12)(Repl. 2012).  The healing period \ncontinues until the employee is as far restored as the permanent character \nof the injury will permit.  Mad Butcher, Inc. v. Parker, 4 Ark. App. 124, 628 \nS.W.2d 582 (1982).  If the underlying condition causing the disability has \nbecome more stable and nothing further in the way of treatment will \nimprove that condition, the healing period has ended.  Id.  The \ndetermination of when the healing period ends is a question of fact for the \nCommission.  K II Constr. Co. v. Crabtree, 78 Ark. App. 222, 79 S.W.3d 414 \n(2002).   \n An administrative law judge found in the present matter, “4.  The \nClaimant is entitled to additional temporary total disability benefits from \nJune 25, 2020, through a date to be determined.”  The Full Commission \ndoes not affirm this finding.  As we have discussed, the claimant proved \nthat he sustained a compensable back injury on June 25, 2020.  Dr. Jones \nsubsequently diagnosed \"Lumbar Sprain (Sprain of ligaments of lumbar \nspine, initial encounter)” on the lumbar spine.”  The parties stipulated that \n\nSHELTON - H004171  17\n  \n \n \nthe respondents initially accepted the claim as compensable and paid \nbenefits.  The claimant was provided physical therapy and treatment in the \nform of “radiofrequency ablation.”   \n Dr. Jones signed a Form AR-3, PHYSICIAN’S REPORT on or about \nDecember 24, 2021.  Dr. Jones opined, among other things that the \n“maximum medical improvement date (end of healing period)” was \nDecember 22, 2021.  Based on Dr. Jones’ credible report, the Full \nCommission finds that the claimant reached the end of his healing period \nfor the compensable lumbar sprain no later than December 22, 2021.  \nTemporary total disability benefits cannot be awarded after a claimant’s \nhealing period has ended.  Milligan v. West Tree Serv., 57 Ark. App. 14, \n946 S.W.2d 697 (1997).   The claimant on appeal contends that he is \nentitled to temporary total disability benefits beginning January 10, 2022 to \na date yet to be determined.  The Full Commission finds that the claimant \ndid not re-enter a healing period at any time after December 22, 2021; \ntherefore, the claimant did not prove he was entitled to temporary total \ndisability benefits beginning January 10, 2022.  We recognize that Dr. \nMcDonald signed a prepared questionnaire on June 27, 2023 which \nindicated that the claimant was “not at maximum medical improvement.”  \nThe Full Commission finds that the questionnaire on June 27, 2023 is \nentitled to minimal evidentiary weight when compared to Dr. Jones’ \n\nSHELTON - H004171  18\n  \n \n \ndetermination that the claimant reached maximum medical improvement \nand the end of his healing period no later than December 22, 2021.  The \nFull Commission’s award of a spinal cord stimulator trial does not extend \nthe claimant’s healing period.  We find that a spinal cord stimulator in the \npresent matter is geared toward management of the claimant’s injury \nbeyond the end of the healing period.  See Patchell v. Wal-Mart Stores, \nInc., 86 Ark. App. 230, 184 S.W.3d 31 (2004).   \n   After reviewing the entire record de novo, the Full Commission finds \nthat the claimant proved he sustained a compensable back injury.  We find \nthat the medical treatment of record following the compensable injury, \nincluding the recommendation of a spinal cord stimulator, was reasonably \nnecessary in accordance with Ark. Code Ann. §11-9-508(a)(Repl. 2012).  \nThe Full Commission finds that the claimant did not prove he was entitled to \nadditional temporary total disability benefits.  For prevailing in part on \nappeal, the claimant’s attorney is entitled to a fee of five hundred dollars \n($500), pursuant to Ark. Code Ann. §11-9-715(b)(Repl. 2012). \n \n \n \n \n \n\nSHELTON - H004171  19\n  \n \n \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. \nDISSENTING OPINION      \n I must respectfully dissent from the Majority’s finding that the \nclaimant met his burden of proving that he sustained a compensable back \ninjury on June 25, 2020. \nA compensable injury is an accidental injury arising out of the course \nof employment caused by a specific incident identifiable by time and place \nof occurrence.  Ark. Code Ann. § 11-9-102(4)(A)(i).  This requires that a \nclaimant establish by a preponderance of the evidence:  (1) an injury arising \nout of and in the course of employment; (2) that the injury caused internal or \nexternal harm to the body which required medical services or resulted in \ndisability or death; (3) medical evidence supported by objective findings \nestablishing an injury; and (4) that the injury was caused by a specific \nincident identifiable by time and place of occurrence.  Ark. Code Ann. § 11-\n9-102(4)(A)(i) and Ark. Code Ann. § 11-9-102(4)(E)(i).  A compensable \ninjury must be established by medical evidence supported by objective \n\nSHELTON - H004171  20\n  \n \n \nfindings.  Ark. Code Ann. § 11-9-102(4)(D).  \"Objective findings\" are those \nfindings that cannot come under the voluntary control of the patient.  Ark. \nCode Ann. § 11-9-102(16)(A)(i).  When determining physical or anatomical \nimpairment, complaints of pain may not be considered by the physician or \nany other medical provider, an administrative law judge, the Workers' \nCompensation Commission, or the courts. Ark. Code Ann. § 11-9-\n102(16)(A)(ii).  \nHere, the ALJ opines that, under our rules, muscle spasms constitute \nobjective medical findings.  See Kimbrell v. Arkansas Department of Health, \n66 Ark.App. 245, 989 S.W.2d 570 (1999).  This, however, requires that \ncertain elements be met, including the “observation of ‘an involuntary \nmuscular contraction’ or ‘increased muscular tension and shortness which \ncannot be released voluntarily’” to constitute an objective finding. University \nof Arkansas Medical Sciences v. Hart, 60 Ark. App. 13, 958 S.W.2d 546 \n(1997). \nAt the claimant’s initial visit with OrthoSouth in Germantown, \nTennessee, Dr. Riley Jones reported that the claimant presented with acute \nlow back pain.  (Cl. Ex. 1, P. 1).  There were no complaints or findings of \nmuscle spasms at that time.  (Cl. Ex. 1, Pp. 1-4).  Dr. Jones referred the \nclaimant for an MRI, and there were no radiographic findings beyond mild \ndegenerative changes at L5-S1.  (Cl. Ex. 1, P. 5).  On June 29, 2020, \n\nSHELTON - H004171  21\n  \n \n \nclaimant began physical therapy at the Nucor-Yamato Health Clinic to \naddress non-work-related lumbar spondylosis and was issued a TENS unit \nto address this issue at home.  (Cl. Ex. 1, P. 7).  On July 2, 2020, the \nclaimant presented to physical therapy complaining of “left paraspinal \nmuscle tension and pain,” but there is no indication that the claimant \nmentioned muscle spasms at that point, and there were no findings of \nmuscle spasms.  (Cl. Ex. 1, P. 9).  Claimant reported “achy” pain in his \ncentral lumbar spine on July 6 and July 7, 2020, but did not begin to \ncomplain of “spasms” until July 9, 2020.  (Cl. Ex. 1, Pp. 10-12).  The \nphysical therapist never observed or diagnosed these purported spasms. \nAlthough the claimant informed the physical therapist that his back spasms \nstarted immediately after getting up from his fall at work on June 25, 2020, \nthese spasms were never observed.  (Cl. Ex 1, P. 28).  In fact, Dr. Jones \nreported on July 24, 2020 that claimant “is having no real spasm at this \ntime.”  (Cl. Ex. 1, P. 30).  A thorough examination of the medical records \nreflects that this pattern continues through the claimant reaching maximum \nmedical improvement (MMI) on January 11, 2022.  No practitioner ever \nobserved or felt the claimant’s purported muscle spasms, and any mention \nof muscle spasms in the claimant’s records are based solely upon the \nclaimant’s own statements.  The only diagnoses the claimant ever received \n\nSHELTON - H004171  22\n  \n \n \nwas lumbar spondylosis and post laminectomy syndrome resulting from a \n2018, non-work-related, laminectomy.  (See Resp. Ex. 1, Pp. 62-64). \n“When there was no other evidence introduced to the contrary,” \nfindings of tenderness, prescriptions for muscle spasms, and physical \ntherapy and pain management may constitute objective findings.  Melius v. \nChapel Ridge Nursing Center, 2021 Ark. App. 61, 618 S.W.3d 410 (2021); \nFred’s, Inc. v. Jefferson, 361 Ark. 258, 206 S.W.3d 238 (2005).  These two \ncases rely on a lack of objective testing.  In the case before the \nCommission, there was objective testing.  The claimant had two separate \nnormal MRIs, a normal EMG, and normal x-rays showing no objective \nproblems that were not degenerative in nature.  Coupled with the absence \nof any medical professional either witnessing or diagnosing the claimant’s \nmuscle spasms, this case is distinct from Melius and Fred’s.  There were no \nobjective findings of muscle spasms or, indeed, any work-related injury \nresulting from the claimant’s June 25, 2020 fall. \nAccordingly, for the reasons stated above, I respectfully dissent. \n  \n    ___________________________________ \n    MICHAEL R. MAYTON, Commissioner","preview":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. H004171 JOSHUA SHELTON, EMPLOYEE CLAIMANT NUCOR YAMATO STEEL CO., EMPLOYER RESPONDENT ARCH INSURANCE COMPANY, CARRIER/ SEDGWICK CLAIMS MANAGEMENT, INSURANCE CARRIER/TPA RESPONDENT","fetched_at":"2026-05-19T22:29:45.856Z","links":{"html":"/opinions/full_commission-H004171-2024-03-07","pdf":"https://labor.arkansas.gov/wp-content/uploads/Shelton_Joshua_H004171_20240307.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/full-commission-opinions/"}}