{"id":"full_commission-H107908-2024-06-19","awcc_number":"H107908","decision_date":"2024-06-19","opinion_type":"full_commission","claimant_name":"Jessie Ellis","employer_name":"City Of Conway","title":"ELLIS VS. CITY OF CONWAY AWCC# H107908 JUNE 19, 2024","outcome":"denied","outcome_keywords":["denied:1"],"injury_keywords":["knee","neck","back","strain","fracture","tbi","concussion","repetitive"],"pdf_url":"https://labor.arkansas.gov/wp-content/uploads/Ellis_Jessie_H107908_20240619.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/full-commission-opinions/","filename":"Ellis_Jessie_H107908_20240619.pdf","text_length":49472,"full_text":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION \n \n \nCLAIM NO.  H107908 \n \nJESSIE D. ELLIS, \nEMPLOYEE \n \nCLAIMANT \nCITY OF CONWAY,  \nEMPLOYER \n \nRESPONDENT \nARKANSAS MUNICIPAL LEAGUE \nWORKERS’ COMPENSATION TRUST, \nINSURANCE CARRIER/TPA \nRESPONDENT \n  \n      \nOPINION FILED JUNE 19, 2024 \n \nUpon review before the FULL COMMISSION in Little Rock, Pulaski County, \nArkansas. \n \nClaimant represented by the HONORABLE EDDIE H. WALKER, JR., \nAttorney at Law, Fort Smith, Arkansas. \n \nRespondents represented by the HONORABLE JARROD S. PARRISH, \nAttorney at Law, 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 \nJanuary 2, 2024.  The administrative law judge found that the claimant \n“failed to establish a compensable closed head injury with medical evidence \nsupported by objective findings.”  After reviewing the entire record de novo, \nthe Full Commission reverses the administrative law judge’s opinion.  The \nFull Commission finds that the claimant proved he sustained a \ncompensable closed head injury.  We find that the claimant proved he was \nentitled to reasonably necessary medical treatment provided in connection \nwith the compensable injury.         \n\nELLIS - H107908  2\n  \n \n \nI.  HISTORY \n The record indicates that Jessie Ellis, now age 26, became \nemployed with the respondents, Conway Police Department, in December \n2019.  The parties stipulated that the employment relationship existed on \nJune 17, 2020.  The claimant testified on direct examination: \nQ.  Mr. Ellis, would you briefly explain to us how you got hurt \nworking for the Conway Police Department on June 16, 2020? \nA.  Yeah.  So it started off as a vehicle pursuit drill.  I was \nchasing a suspect, which was another officer, and we went \nthrough, right next to like a store in Conway, right around that \narea, and we proceeded then behind the St. Joseph High \nSchool, like we visited the high school.  And as we stopped \nthe suspect, the officer gets out of the car and starts running.  \nSo I’m giving chase and we’re running as hard as we can go, \nand as I catch up to him, I reached out to catch him, and you \nknow, I’m a big guy.  I’m 6’5”, I was 300 pounds at the time, \nand this officer is probably like 5’6” to 5’8”, and like 150 to \n180.  So I reached out to catch him and I overextend, and so I \nknow I’m going to fall so I let him go, because I didn’t want to \nfall on him, and that led to me hitting my head on the \nsidewalk. \nQ.  Now, when you say you hit your head on the sidewalk, \nsome of the medical records say that you hit your head on the \ncurb.  Did you hit on the sidewalk or on the curb? \nA.  I believe it was the curb.  Yeah, it was the curb.  I hit the \ncorner of my head on the curb of the sidewalk.   \nQ.  What material was that curb made out of? \nA.  I would say concrete.   \n \n The parties stipulated that the claimant “sustained a compensable \nwork-related injury abrasion to his head above the eye, and also his left \nknuckle, and left knee.”   \n\nELLIS - H107908  3\n  \n \n \n According to the record, the claimant received emergency treatment \non June 17, 2020: \nPatient fell while giving chase, landed on pavement, denies \nLOC or neck pain, has abrasion to left brow, abrasion and \nswelling to left hand, abrasion right lower leg.... \nPatient is a police officer; they were doing a pursuit drill \ntonight.  He was running, fell forward striking left hand, right \nleg and the left forehead on the ground.  Denies any loss of \nconsciousness.  Denies any neck pain.  States following was \nslightly sore, some nausea and did have emesis once on \narrival to the emergency room.  He reports his nausea has \nresolved following the emesis.  Denies any significant \nheadache.  No numbness or weakness.  No vision change. \n \n Dr. Robert M. Wycoff’s diagnosis on June 17, 2020 was “Mild closed \nhead injury, initial encounter.  Abrasion of left eyebrow, initial encounter.  \nAbrasion of left hand, initial encounter.  Abrasion of right lower extremity, \ninitial encounter.”   \n An EMT noted on June 20, 2020, “22 male c/o a lot of confusion after \na fall he had on Wednesday.  Pt states that he was seen here on \nWednesday.  Pt states that a few hours after leaving the hospital he started \nto have a dull headache.  Pt states that he worked a shift on Friday and was \nhaving a hard time concentrating and had some confusion throughout the \nshift.”     \n A CT of the claimant’s head was taken on June 20, 2020 with the \nimpression, “No acute intracranial findings.”   \n Dr. Gil E. Johnson examined the claimant on June 22, 2020: \n\nELLIS - H107908  4\n  \n \n \nJessie presents with closed head trauma.  He was injured \nwhen chasing a suspect on 6/16/20 close [to] the St. Joe \nschool here in Conway.  He fell when he lost his balance \nwhen he was apprehending the suspect and fell onto the \nconcrete striking his head – left side above the left eye on the \nfrontal and parietal skull.  He went to the emergency room \nfairly soon after the incident happened he was seen [and] \nreleased.  He was checked he states and then discharged.  \nAfter that he developed symptoms of a headache and \nfogginess and he went back to that same emergency room at \nBMC in Conway the next Saturday 6/20/20.  The event \nhappened on Tuesday 6/16/20.  The CT scan was done and \nhe was released.  He was given head trauma instructions he \nstates and discharge.... \nJessie is alert and oriented time person [and] place.  He has \nhad some recent memory issues since the accident \n[happened] he reports.  He appears to be in no acute distress \nat this time.  There’s a small abrasion and soft tissue swelling \njust above the laptop.  This is quite tender to touch.  I cannot \npalpitate crepitus.  Cranial nerve exam II – XII are intact.  \nFinger nose finger and [heel] knee shin test are within normal \nlimits.  There’s no sign of dysmetria and no tremor.... \nImpression:    \n1.  Closed head trauma with contusion to frontal/parietal skull. \n2.  Posttraumatic headache. \n3.  Nausea and vomiting, related to head trauma. \n4.  Slightly altered mental status related to head trauma, \ncurrently stable.   \n \n Dr. Johnson treated the claimant conservatively, and noted on June \n24, 2020, “Jessie returns for follow-up for head trauma.  He has improved \nfrom the initial visit.  He’s noticed that he is not as groggy and feels better \nalthough he still has some posttraumatic headache....If his condition [gets] \nworse before the recheck I’ve [advised] him to contact me immediately [or] \ngo to the emergency room.”  Dr. Johnson continued to provide follow-up \ntreatment and noted on July 7, 2020, “This was a fairly significant injury.”  \n\nELLIS - H107908  5\n  \n \n \nDr. Johnson reported on July 27, 2020, “He states that his headaches have \nreturned and he’s noticed a change in his memory....I discussed my \nfindings with the radiologist and an MRI is indicated.\"  An MRI of the \nclaimant’s brain was taken on July 30, 2020 with the impression, “Normal \nbrain.”   \n The claimant followed up with Dr. Johnson on July 31, 2020: \nThe MRI procedure was done on 7/30/20.  The results \nshowed no acute abnormality....Interpretation was normal \nbrain.... \nJessie has not reached maximum medical benefit and still is \nexperiencing symptoms most likely related to postconcussive \nsyndrome with posttraumatic headaches.  At this point \nevaluation by a neurologist would be helpful and I’m going to \ncontact the Workmen’s Comp. case manager and get \napproval for referral to a network specialist.... \n \n Dr. Barry D. Baskin evaluated the claimant on September 3, 2020: \nMr. Ellis is a 22-year-old gentleman from Conway who is a \npolice officer for the Conway City Police.  He fell and hit [his] \nleft forehead doing a pursuit training drill.  He reached out to \ngrab another officer by the collar to try to bring him down and \nfell.  He had a left eyebrow laceration that did not require any \nstaples or stitches.  He has had a CT of his head that was \nnormal.  He later saw Dr. Gil Johnson, several visits, and Dr. \nJohnson did an MRI of his brain on 7/30/2020 that was \nnegative.  He has seen Dr. Johnson seven visits.  He has a \nhistory of preexisting Bell’s palsy on the right that never \ncompletely resolved and he has had some mild residual ptosis \non the right.  He has been diagnosed with a questionable post \nconcussive syndrome.  He has been released to light duty and \ncurrently is doing computer work.  He has tried ibuprofen and \nover the counter medications without much benefit with his \nheadaches.  He states that his girlfriend has noted that he just \nseems to be a little foggy.  He states he is slow to respond to \nquestions.  He is fatigued....He states he has some emotional \n\nELLIS - H107908  6\n  \n \n \nlability and a short fuse and he is quick to anger.  He states \nthat was not the case prior.  His records have been reviewed.  \nDr. Gil Johnson’s records are reviewed as are emergency \nmedicine notes from his initial treatment.  CT of the head that \nwas normal.  Next, MRI of the head which was normal.  Mr. \nEllis has had no therapy....He has a small residual scar from \nwhen he had the laceration over his left lateral eyebrow.   \n \n Dr. Baskin referred the claimant to other physicians for additional \nevaluation and diagnostic testing.  Dr. Baskin also returned the claimant to \nrestricted work duty.   \n Dr. Baskin gave the following impression on October 6, 2020:  “Mr. \nEllis has had a mild closed head injury on 6/17/2020.  He has residual \nheadaches, memory loss and some blurring of his vision.  Speech therapy \nhas noted some loss of executive function and memory deficits.  I think he \nshould be seen by a neuropsychologist for formal neuropsych testing.  We \nare going to send him to Dr. Renee Mageira-Planey for a neuropsych \nassessment.  I reviewed his eye evaluation which was negative.  I will see \nhim back after his neuropsych assessment in about 4 weeks.”   \n Dr. Renee Magiera-Planey provided a Neuropsychological \nEvaluation on November 13, 2020 and diagnosed the following: \nMr. Ellis’s medical records, behavioral presentation and best \nresults meet the diagnostic criteria for an acquired Cognitive \ndisorder f09, mild.  Mr. Ellis displayed mild impairments in his \nprogressive language skills and mild impairments in his \ncomprehension.  He displayed mild impairments in his brief \nattention span and mild-to-moderate impairments in sustained \nand divided attention.  There were mild impairments in his \nimmediate visual short-term memory functions and mild \n\nELLIS - H107908  7\n  \n \n \nimpairments in his perceptual reasoning skills for visually \npresented information.   \nMr. Ellis also described changes in his mood and level of \npatience and tolerance after the accident.   \nAt this time, Mr. Ellis’s level of performance indicates he will \nhave difficulty returning to many of his previous duties as a \npolice officer.   \nMr. Ellis is receiving therapies at Baptist Health Rehabilitation \nInstitute to address the residual deficits in his cognitive and \nlanguage functions.   \nA review of those records indicates he is making progress.  It \nis recommended he continue with those therapies.   \nMr. Ellis may be an appropriate candidate for the use of a \nmood stabilizer to help with the reported anxiety and mood \nswings.... \n \n The claimant continued to follow up with Dr. Baskin, who stated in \npart on December 17, 2020, “I still feel that further neuropsych testing \nwould be of value in this case.  Mr. Ellis does not have any objective \nfindings with regards to imaging studies or neurologic pathology....Our plan \nis to pursue a neuropsych assessment with Dr. Zolten.”   \n An occupational therapist noted on January 7, 2021, “Jessie Ellis \ndemonstrated the fitness to operate a vehicle....Mr. Ellis is recommended \nfor approval by physician to resume driving independently.”   \n Dr. Jennifer I. Doyle summarized for Dr. Baskin on January 27, 2021, \n“A 22-year-old male with closed head injury in June of 2020 with \nheadaches, blurred vision and disorientation.  From an ocular standpoint I \ndo not see any permanent damage to the afferent pathway.  His exam is \ncompletely normal today, and I am hoping that with time his symptoms will \n\nELLIS - H107908  8\n  \n \n \nalso improve.  The only suggestion that I have would be to maybe try some \nsunglasses, discuss increasing his dose of Lexapro, complete the sleep \nstudy and see Dr. Zolten.” \n An EEG was done on February 24, 2021 with the impression, “This \nis a normal EEG.”   \n Dr. A.J. Zolten provided a Neuropsychological Evaluation on April 2, \n2021 and gave the following impressions: \n1.  Jessie Ellis is a 23-year-old male with recent history of a \nmild Traumatic Brain Injury (S06.2), with post-concussive \nsymptoms and complaints of neurocognitive deficits.  Current \ntest results were not entirely reliable, with evidence of both \ninconsistent effort, and over-reporting of psychological \nsymptoms.  In general, there are no overt deficits noted in \nJessie’s neurocognitive profile with the exception of poor \nvisual constructions skills and the related incidental visual \nmemory after the visual construction task.  Visual spatial \nrelations have improved when compared to the previous test \nresults as apparently have Jessie’s language skills.  To the \ndegree that Jessie still demonstrates some problems with \nvisual construction, this may reflect some very mild residual \nneurocognitive deficit, but the lack of reliability obscures this.  \nIf present, this mild weakness does not interfere with Jessie’s \noverall adaptive functioning.   \n2.  Jessie’s inconsistent effort is most likely a function of \npsychological overlay.... \n3.  Much more troubling is the clear presence of Post \nTraumatic Stress Disorder, with symptoms of de-\nrealization/de-personalization as part of this clinical picture.  \nThese symptoms are a serious variant of interpersonal \nnumbness often seen with PTSD patients, and indicate a \nloosening or strain on reality testing.  Jessie is in clear need of \ncounseling to help him cope with his PTSD symptoms.  He \ncan be referred to Chenal Family Therapy, which has a \nConway office[.]   \n\nELLIS - H107908  9\n  \n \n \n4.  Jessie’s MMPI-2 results are certainly problematic from the \nstandpoint of his return to full duty as a police officer.  As a \ncurrent picture of psychological functioning, Jessie’s results \nare much too unstable for return to active duty with a side \narm.  I would recommend that he undergo a full course of \nPTSD therapy, and if this is successful in quelling his \nsymptoms, he be re-evaluated for fitness.   \n \n The claimant began treating with Tobi Taylor, LPC on or about May \n10, 2021.  Ms.Taylor noted that the claimant’s treatment plan included \n“cognitive behavioral therapy, mindfulness/meditation, and EMDR to \naddress anxiety, depression, and possible PTSD.”       \nDr. Baskin provided an Impairment Rating on September 14, 2021 \nand reported in part: \nMr. Ellis initially was seen by me 9/3/2020 on referral from Dr. \nJohnson and Stacy Mathis, RN for closed head injury.  He fell \non the job working on pursuit training and hit his head on a \nconcrete curb.  He had residual memory loss, blurred vision, \nirritability, anger, fatigue and generalized weakness.... \nMy overall impression at this point 9/14/2021 is that Mr. Ellis \ndid in fact sustain a closed head injury and to some extent a \ntraumatic brain injury without any significant bleeding or skull \nfracture or objective findings on his CT of the head or MRI of \nthe head.  He clearly has symptoms of PTSD versus \nadjustment disorder.  He is not able to go back to work as a \npolice officer.  All parties involved in his care are in agreement \non that.  I had suggested that we have him see a psychiatrist \nand referred him to Mary Paal for help with medication \nmanagement but Workers’ Comp would not approve that.  He \nstill has intrusive thoughts and dreams and is sleeping poorly \nand tired during the day.   \nUsing the AMA Guides to the Evaluation of Permanent \nImpairment 4\nth\n Edition and turning to the chapter on the \nnervous system on page 142 and reviewing table 2 mental \nstatus impairments and table 3 emotional and behavioral \nimpairments, Jessie presents with mild limitation of some but \n\nELLIS - H107908  10\n  \n \n \nnot all social and interpersonal daily functioning....He would \nhave a 14% whole person impairment which is mild limitation \nof some but not all social and interpersonal daily living \nfunctions....I think he still needs follow up with Tobi Taylor and \nI would recommend continued counseling sessions with her \nfor now.  He needs to see me about every 3-4 months for now \nbut eventually I will probably see him only once or twice a \nyear.  I am hoping that he will continue to improve.  He seems \nfairly dejected about the fact that he is still dealing with issues \nof his head injury....He will still be covered through Workers’ \nComp I hope for his counseling and his visits back to see \nme....He still may need medical management as far as his \ndepression and anxiety medicines and his sleep medicine.... \n \n The respondents terminated the claimant’s employment effective \nSeptember 29, 2021. \n Dr. Baskin corresponded with counsel for the respondents on \nFebruary 5, 2022:   \nI am in receipt of a letter from you dated January 27, 2022 \nrequesting information on Mr. Ellis. \nI have gone back through my records in order the answer the \nquestions you proposed.  First of all, this is a complicated \ncase.  Mr. Ellis sustained a closed head injury on the job as a \nrookie Conway Police Department Officer on June 17, 2020.  \nHe had a closed head injury without any significant \nhemorrhages, skull fracture, or significant objective findings \non his imaging studies.  He was referred to me by Stacy \nMathis, RN, case manager with JMS Consulting, and Dr. Gil \nJohnson, a primary care physician in Conway, on September \n3, 2020.  From the first time I saw Mr. Ellis, I had concerns \nthat he was a bit addled.  He seemed a bit confused and \nunable to think clearly.  I sent him to Michelle Cox, a speech \nand language pathologist at Baptist Health Rehabilitation \nInstitution, for a speech and language evaluation and \ncognitive assessment for problem solving, memory, and \nexecutive function.  Ms. Cox felt like that he had moderate \ncognitive deficits.  I spoke with Ms. Cox about Mr. Ellis in the \nlast 3 days prior to dictating this note to you and reviewed his \n\nELLIS - H107908  11\n  \n \n \ncase, and she feels strongly that he was impaired from his \nclosed head injury.  I referred him to Renee Magiera-Planey, \nPhD, neuropsychologist at Baptist Health Rehabilitation for \nfurther evaluation.  This report was done back in November \n2020.  Dr. Magiera-Planey felt that Mr. Ellis’ diagnosis was \nconsistent with an acquired cognitive disorder that was mild.... \nMr. Ellis remains, as of my last appointment, a little better than \nwhen I first saw him.... \nAs you know, surveillance was undertaken.  I did not really \nrecommend that this be done, but it was suggested through \nWorker’s Compensation, and I approved it.  It did not prove \nanything one way or the other with regards to Mr. Ellis’ \ncondition.   \nIn your letter you have addressed several concerns, and I will \ntry to respond to them at this point.  First, you have addressed \nthat he saw a psychological counselor, Tobi Taylor, in \nConway.  You noted that she cannot state with reasonable \ncertainty whether Mr. Ellis’ diagnosis stems specifically from \nhis accident.  It is noted in his history that he had a step-father \nwho was abusive to Jessie’s mother.  It is clearly speculation \nthat that has anything to do with his current symptoms.  More \nimportantly, it should be noted that Mr. Ellis was never \nreported to have had any problems with memory, problem \nsolving, visuoperceptual deficit, visual problems, driving, etc. \nprior to his date of injury.  I think it is clearly more likely than \nnot that his symptoms stem from his work injury and not from \nsome obscure pre-existing condition growing up.  Dr. Zolten \nfelt like that Mr. Ellis may have gone back to work too soon \nand been threatened by that and developed PTSD symptoms.  \nThe onset of these symptoms, in my opinion, are related to his \nwork injury.   \nYou noted in your letter that his neuro exam was normal.  \nThat is not uncommon with a patient with a traumatic brain \ninjury, postconcussion syndrome, or disorders of \nconsciousness (DOI).  You further indicated his neurologist \nindicated his exam was completely normal and an EEG \nindicated no evidence of seizures or any clearcut \nabnormalities.  We did have him see a neurologist and an \nEEG was done and it was negative for evidence of seizure \ndisorder.... \nYou questioned what objective findings I relied upon in regard \nto his diagnosis of traumatic brain injury or closed head injury.  \n\nELLIS - H107908  12\n  \n \n \nMr. Ellis had a definable work injury in which he hit his head.  \nHe was running and fell and hit his head on the concrete curb.  \nHe was dazed from that.  He has continued to be somewhat \ndazed and mildly confused over the last year and a half, \nalthough he has clearly improved.... \nI believe based on my extensive amount of time with Mr. Ellis \nin the office face-to-face that this gentleman sustained a mild \nclosed head injury with residual cognitive deficits and \nemotional and behavioral deficits.  Based upon my evaluation \nof Mr. Ellis over the last year as well as my training \nexperience, I feel like I have given him a fairly minimal \nimpairment rating using table 3 on page 142 of the AMA \nGuides to the Evaluation of Permanent Impairment 4\nth\n Edition.  \nThis is mild limitation of daily social and interpersonal \nfunctioning.  That rating scale goes from 0% to 14% on the \nmild rating.  I rated him at 9%.   \nYou have further mentioned that I recommend ongoing \ncounseling in addition to additional prescription medication for \nMr. Ellis.  I have felt that Mr. Ellis would benefit from \nprescription medications for his depression and anxiety.  I \nhave also felt that counseling was necessary for his PTSD.  In \nparticular, I felt that he needed cognitive behavioral therapy \n(CBT) or EMDR, which is an eye movement desensitization \ntype therapy for PTSD.  Both of these are currently in vogue \nand are useful for patients with PTSD.  I have not set a stop \ndate on Mr. Ellis’ therapy.  If we can get him in for therapy for \nanother few months I would be pleased.  I believe I have an \nappointment to see Mr. Ellis back in follow-up on March 16, \n2022.  Depending on how he is doing then, we may be able to \ndiscontinue further therapies.... \n \n The claimant’s attorney examined Dr. Baskin during a deposition \ntaken March 9, 2022: \nQ.  Now, there’s some terms that are used throughout the \nmedical records, and I’d like for you to kind of clarify them for \nme if you can.  It talks about closed head injuries, it talks \nabout TBI, traumatic brain injury, and it talks about \nconcussion.  What’s the difference between those three \nthings, or is there a difference between those three things? \n\nELLIS - H107908  13\n  \n \n \nA.  Well, a closed head injury is when somebody’s had trauma \nto their head, usually blunt trauma.  It’s not penetrating \ntrauma, and they have a – they don’t have – you don’t have – \nwith a closed head injury, you don’t have to have loss of \nconsciousness.  You could.  But a closed head injury could be \nme going to sleep and hitting my head on the table and having \nsome pain or headaches or maybe dizziness after that.  A \ntraumatic brain injury is when you have had trauma to the \nhead, and you have findings on the imaging studies where \nyou might see a skull fracture again or a subdural or epidural \nbleed, things like that inside the skull, intracranial pathology.  \nAnd then now they use another term, “disorders of \nconsciousness,” frequently to address people that have had a \nclosed head injury and/or a traumatic brain injury.  It’s all kind \nof – it’s all just terminology for the most part, but a closed \nhead injury is essentially not as bad, typically, as somebody \nwho’s had a traumatic brain injury as far as the findings.   \nQ.  And what about a concussion? \nA.  A concussion would – is essentially when people have had \na blow to their head.  They may have some alteration of their \nlevel of consciousness, they may be knocked out, and they – \ntheir mental status is altered in some way.  Those can be \nrepetitive trauma, like the football players, the, you know, the \nrepetitive head injuries.  People have been hit and hit and hit, \nand they began to have post-concussion syndrome, but in this \ncase, I think he fell – it looked – it sounded like he fell, hit his \nhead, and had a closed head injury without any positive \nfindings on his imaging studies.... \nQ.  What are some of the symptoms that are commonly \nassociated with a closed head injury? \nA.  Well, it – there’s lots of them.  I mean, a closed head injury \ncould cause somebody to have – commonly, we see people \nthat have headaches.  They have – they’ve had a head injury.  \nI see lots of people that have been hurt with a blow to their \nhead, and they have headaches.  Sometimes they do have, \noccasionally, blurred vision.  They have – sometimes they \nhave memory loss.  Sometimes they have loss of \nconcentration, focus, inability to do things that they could do \nbefore any difficulty, having trouble with those now.  Those \nare some of the more common things I see with people that \nhave had a closed head injury.... \n \n\nELLIS - H107908  14\n  \n \n \n On January 25, 2023, the claimant began treating at HonorHealth in \nPeoria, Arizona.  The assessment at that time included “Closed traumatic \nbrain injury, with loss of consciousness of 30 minutes or less, sequela.”   \nA pre-hearing order was filed on April 18, 2023.  The claimant \ncontended, “a.  The Claimant contends that as the result of the \ncompensable trauma to his head he is entitled to additional medical \ntreatment.  b.  The Claimant contends that his authorized treating physician, \nDr. Barry Baskins (sic), recommended additional professional counseling \nand a psychiatric evaluation for the claimant and both of those \nrecommendations have been rejected by the respondents.  c.  The claimant \ncontends that he has sustained some degree of permanent injury regarding \nhis job related accident; however, assessment of the extent of that \npermanent injury is premature and he therefore reserves that issue for \nfuture determination after the recommended medical treatment has been \nconcluded.” \n The respondents contended, “Respondents contend that there are \nno objective findings to support permanent impairment associated with the \nclaimant’s 6/17/20 injury.  Respondents assert that the work-related injury is \nnot the major cause of any permanency the claimant has.  Respondents \nfurther contend that Claimant is at maximum medical improvement and that \nadditional medical and/or psychological treatment is not reasonable and \n\nELLIS - H107908  15\n  \n \n \nnecessary.  Respondents contend that without the permanent impairment, \nwage loss disability is not applicable.  Lastly, Respondents contend they \nare entitled to a credit for overpayment of PPD in the amount of $3,208.00.”   \n The parties agreed to litigate the following issues: \n1.  The claimant’s entitlement to an assessment by a \nvocational rehabilitation professional in order to determine an \nappropriate program of vocational training. \n2.  The claimant’s entitlement to additional medical treatment. \n3.  Compensability of a brain injury.   \n4.  All other issues are reserved.   \n \n Dr. Harpreet Kaur Sandhu examined the claimant at HonorHealth \nNeurology on May 31, 2023: \nPatient has a past history of a head injury associated with \nwork in 2020.  Patient has 260+ pages of records which have \nbeen reviewed.  Patient had a worker’s compensation case in \nregards to this and has undergone extensive workup including \nhead CT, MRI of the brain, EEG and neuropsychological \nevaluation.  Patient’s neuropsychological assessment had \nfindings of an acquired cognitive disorder.  There [were] also \nsome concerns for possible PTSD.  Patient has recently been \nseen by behavioral health and has a history of generalized \nanxiety disorder.... \n25-year-old male past medical history of a head injury in 2020 \nwith a reported history of postconcussion syndrome presents \nto establish care.  Patient has undergone extensive \nneurological workup including a Neuro-Ophthalmology \nevaluation which was reported to be within normal limits.  \nPatient’s neurological workup has been nondiagnostic and \npatient’s chief complaint continues to be his behavioral and \npsychological issues.  Discussed the importance of \nestablishing with behavioral health including Psychology and \nPsychiatry to help with both cognitive therapy and/or \nmedication.  Discussed the option of a repeat \nneuropsychological assessment and patient would like to \ncontinue with repeat testing.  Discussed the importance of \n\nELLIS - H107908  16\n  \n \n \ncontinuing with a healthy diet and exercise regimen, working \non modifiable comorbidities, adequate sleep as well as stress \nmanagement.   \n \n Dr. Sandhu instructed the claimant to “Return after neuropsych \ntesting.”   \n Dr. Danny Rosenbaum, a clinical neuropsychologist, evaluated the \nclaimant on July 21, 2023 and recommended the following: \n1).  Should the patient choose to continue in rehab, cognitive \nretraining activities such as computer and board games \ntargeting processing speed and attention may help the patient \nin those areas of need. \n2).  Given the patient’s admitted significant negative mood, \npsychotherapeutic intervention is recommended. \n3).  Further, monitoring the patient’s psychotropic medication \nis suggested especially since it is a relatively new prescription. \n4).  The patient stated that he has recently suffered from Bell’s \nPalsy with noted hand weakness.  A follow up with a \nneurologist [may] prove beneficial.   \n \n A hearing was held on September 26, 2023.  At that time, the \nclaimant contended that he sustained a closed head injury, and that he was \nentitled to reasonably necessary medical treatment.  All other issues were \nreserved.     \n An administrative law judge filed an opinion on January 2, 2024.  The \nadministrative law judge found, among other things, that the claimant “failed \nto establish a compensable closed head injury.”  The administrative law \njudge found that the claimant was “not entitled to additional medical and \nattorney fees at this time.”  The claimant appeals to the Full Commission. \n\nELLIS - H107908  17\n  \n \n \nII.  ADJUDICATION \n A.  Compensability \nArk. Code Ann. §11-9-102(4)(Repl. 2012) provides, in pertinent part: \n  (A)  “Compensable injury” means: \n(i)  An accidental injury causing internal or external physical \nharm to the body ... arising out of and in the course of \nemployment and which requires medical services or results in \ndisability or death.  An injury is “accidental” only if it is caused \nby a specific incident and is identifiable by time and place of \noccurrence[.]   \n \n A 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).   \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-\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, “3.  That the \nclaimant has failed to establish a compensable closed head injury with \nmedical evidence supported by objective findings.”  In workers’ \ncompensation cases, the Commission functions as the trier of fact.  Blevins \n\nELLIS - H107908  18\n  \n \n \nv. Safeway Stores, 25 Ark. App. 297, 757 S.W.2d 569 (1988).  The \nCommission is not required to believe the testimony of the claimant or any \nother witness but may accept and translate into findings of fact only those \nportions of the testimony it deems worthy of belief.  Farmers Co-op v. Biles, \n77 Ark. App. 1, 69 S.W.3d 899 (2002).  The Full Commission finds in the \npresent matter that that the claimant was a credible witness, and that the \nclaimant proved by a preponderance of the evidence that he sustained a \ncompensable closed head injury.   \n The claimant became employed as a probationary Patrolman for the \nrespondents in December 2019.  The parties stipulated that the \nemployment relationship existed on June 17, 2020.  The claimant \ncontended that he sustained an accidental injury while performing a training \nexercise with the respondent-employer on June 16, 2020.  The claimant \ntestified that, while giving chase to another officer, he fell and struck his \nhead on a concrete curb.  The parties stipulated that the claimant \n“sustained a compensable work-related injury abrasion to his head above \nthe eye, and also his left knuckle, and left knee.”   \n The evidence demonstrates that the claimant sustained a \ncompensable closed head injury on or about June 16, 2020 as a result of \nthe accidental fall.  The medical records corroborated the claimant’s \ntestimony that he fell and struck his head.  Dr. Wycoff examined the \n\nELLIS - H107908  19\n  \n \n \nclaimant on June 17, 2020 and diagnosed “Mild closed head injury, initial \nencounter.”  Dr. Johnson noted on June 22, 2020, “Jessie presents with \nclosed head trauma.”  Dr. Johnson examined the claimant’s forehead and \nnoted “a small abrasion and soft tissue swelling[.]”  Swelling can be an \nobjective medical finding establishing a compensable injury.  White Cnty. \nMed. Ctr. v. Johnson, 2022 Ark. App. 262, 646 S.W.3d 245.  Dr. Johnson’s \nimpression included “1.  Closed head trauma with contusion to \nfrontal/parietal skull.”  The Full Commission finds that Dr. Johnson’s \nimpression of closed head trauma was supported by objective medical \nfindings, namely “soft tissue swelling” in the claimant’s forehead.  Dr. \nJohnson noted on July 7, 2020, “This was a fairly significant injury.”   \n Dr. Baskin began treating the claimant on September 3, 2020 and \nsubsequently gave the impression, “Mr. Ellis has had a mild closed head \ninjury on 6/17/2020.  He has residual headaches, memory loss and some \nblurring of his vision.”  The claimant thereafter treated with Dr. Magiera-\nPlaney and Dr. Zolten.  Dr. Doyle’s impression on January 27, 2021 was “A \n22-year-old male with closed head injury in June of 2020 with headaches, \nblurred vision and disorientation.”  Dr. Baskin informed counsel for the \nrespondents on February 5, 2022, “I believe based on my extensive amount \nof time with Mr. Ellis in the office face-to-face that this gentleman sustained \na mild closed head injury with residual cognitive deficits and emotional and \n\nELLIS - H107908  20\n  \n \n \nbehavioral deficits.”  During a a deposition taken March 9, 2022, Dr. Baskin \nexpertly testified with regard to the distinction between a “closed head \ninjury” and “traumatic brain injury.”   It is within the Commission’s province \nto weigh all of the medical evidence and to determine what is most credible.  \nMinnesota Mining & Mfg. v. Baker, 337 Ark. 94, 989 S.W.2d 151 (1999).  In \nthe present matter, the Full Commission finds that Dr. Baskin’s opinion is \nsupported by the record and is entitled to significant evidentiary weight.  Dr. \nBaskin’s diagnosis of a closed head injury was supported by Dr. Wycoff, Dr. \nJohnson, Dr. Doyle, and Dr. Sandhu. \n The Full Commission finds that the claimant proved by a \npreponderance of the evidence that he sustained a “compensable injury” in \naccordance with Ark. Code Ann. §11-9-102(4)(A)(i)(Repl. 2012).  The \nclaimant proved that he sustained an accidental injury causing physical \nharm to the body, viz., a “closed head injury.”  The claimant proved that the \ninjury arose out of and in the course of employment and required medical \nservices.  The injury was caused by a specific incident and was identifiable \nby time and place of occurrence on or about June 16, 2020.  In addition, the \nclaimant established a compensable injury by medical evidence supported \nby objective findings, namely Dr. Johnson’s report of “soft tissue swelling” in \nthe claimant’s forehead.  We find that this objective finding was causally \n\nELLIS - H107908  21\n  \n \n \nrelated to the compensable injury and was not the result of a prior injury or \npre-existing condition.              \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 has the burden of proving by a preponderance of the \nevidence that medical treatment is reasonably necessary.  Stone v. Dollar \nGeneral Stores, 91 Ark. App. 260, 209 S.W.3d 445 (2005).  What \nconstitutes reasonably necessary medical treatment is a question of fact for \nthe Commission.  Wright Contracting Co. v. Randall, 12 Ark. App. 358, 676 \nS.W.2d 750 (1984).   \n In the present matter, the Full Commission has found that the \nclaimant proved he sustained a compensable closed head injury on or \nabout June 16, 2020.  We find that the claimant proved by a preponderance \nof the evidence that the medical treatment of record thereafter was \nreasonably necessary in connection with the compensable injury.  Dr. \nBaskin assigned a 14% permanent impairment rating on September 14, \n2021.  Permanent impairment is any functional or anatomical loss \nremaining after the healing period has been reached.  Johnson v. Gen. \nDynamics, 46 Ark. App. 188, 878 S.W.2d 411 (1994).  We therefore find \n\nELLIS - H107908  22\n  \n \n \nthat the claimant reached the end of his healing period for the compensable \ninjury no later than September 14, 2021.  Nevertheless, it is well-settled that \na claimant may be entitled to ongoing medical treatment after the healing \nperiod has ended, if said treatment is geared toward management of the \ncompensable injury.  Patchell v. Wal-Mart Stores, Inc., 86 Ark. App. 230, \n184 S.W.3d 31 (2004).     \n The Full Commission finds that the treatment of record provided \nfollowing Dr. Baskin’s assessment of permanent anatomical impairment \nwas reasonably necessary in connection with the compensable injury.  We \nfind that the current treatment recommendations of Dr. Sandhu, which \ninclude additional neuropsychological testing, are reasonably necessary. \n After reviewing the entire record de novo, the Full Commission finds \nthat the claimant proved by a preponderance of the evidence that he \nsustained a compensable closed head injury.  The Full Commission finds \nthat the medical treatment of record provided on and after June 17, 2020 \nwas reasonably necessary in accordance with Ark. Code Ann. §11-9-\n508(a)(Repl. 2012).  The claimant proved that Dr. Sandhu’s current \ntreatment recommendations are reasonably necessary in connection with \nthe compensable injury.  For prevailing on appeal to the Full Commission, \nthe claimant’s attorney is entitled to a fee of five hundred dollars ($500), \npursuant to Ark. Code Ann. §11-9-715(b)(Repl. 2012). \n\nELLIS - H107908  23\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. \n \nDISSENTING OPINION \n \n I must respectfully dissent from the Majority’s finding that the \nclaimant proved by a preponderance of the evidence that he sustained a \ncompensable closed head injury on or about June 16, 2020, and is entitled \nto medical treatment for said injury. \nA compensable injury must be established by medical evidence \nsupported by \"objective findings.\" Ark. Code Ann. § 11-9-102(4)(D). \nObjective findings cannot come under the voluntary control of the patient. \nArk. Code Ann. § 11-9-102(16).  \nIt is within the Commission's province to weigh all the medical \nevidence, to determine what is most credible, and to determine its medical \nsoundness and probative force.  Sheridan Sch. Dist. v. Wise, 2021 Ark. \nApp. 459, 637 S.W.3d 280 (2021).  In weighing the evidence, the \nCommission may not arbitrarily disregard medical evidence or the testimony \nof any witness.  Id.  The Commission is not required to believe the \n\nELLIS - H107908  24\n  \n \n \ntestimony of the claimant or any other witness but may accept and translate \ninto findings of fact only those portions of the testimony that it deems worthy \nof belief.  White v. Gregg Agricultural Enterprises, 72 Ark. App. 309, 37 \nS.W.3d 649 (2001). \nTo date, there have been no objective findings that claimant suffered \na closed head brain injury on June 17, 2020, despite numerous evaluations \nand diagnostic testing including a head CT scan on June 20, 2020, a brain \nMRI on July 30, 2020, and an EEG on February 24, 2021.  (Resp. Ex. 1, \nPp. 1-9).  None of these tests or any in-person examinations revealed any \nobjective findings of a traumatic brain injury. \nDr. Barry Baskin, the claimant’s primary treating physician on this \nissue, testified unequivocally at his March 9, 2022 deposition that there \nwere no objective findings on the claimant’s diagnostic studies to prove a \nclosed injury and that his in-person examinations were unimpressive.  In \nfact, Dr. Baskin testified he could not identify any objective evidence \nsupporting the existence of a brain injury or the existence of a mental or \npsychological or emotional disorder.  (Depo. of Dr. Barry Baskin, Pp. 8, 10, \n13, 35, 53-54).  Dr. Baskin opined that there was no objective basis to \nexplain the alleged  complaints, fears, and phobias the claimant developed \nafter his injury, explaining that the claimant had a negative work-up and: \ndidn’t really have any significant \nobjective findings, and his exam \n\nELLIS - H107908  25\n  \n \n \nwas not really particularly \nimpressive either.  I mean, he had \n– I guess he was – his ability to \ngive a history and stay on track \nwas – he was kind of all over the \nplace, and – but again, his neuro \nexam was normal.  He had a \nnormal gait; he had normal \nmovements, and I just felt like we – \nthat based on what I saw, which \nagain, there weren’t a lot of hard \nobjective findings. \n \n(Id. at Pp. 8, 43-44). \n \nWhen asked directly, Dr. Baskin testified that there are, “[n]one – not \nany measurable objective findings” of a traumatic brain or closed-head \ninjury.  (Id. at P. 35). \nThe claimant underwent a battery of neuropsychological tests by Dr. \nA.J. Zolten on April 2, 2021.  (Resp. Ex. 1, Pp. 10-14).  These tests \nrevealed normal to above average cognition and no evidence of \nneurocognitive deficit.  Dr. Zolten noted the claimant’s symptom reporting \nindicated clear over-reporting of symptoms, both psychological and \nsomatic.  There was evidence of inconsistent effort and over-reporting of \npsychological symptoms.  Id.   \nDr. Baskin testified that it was hard for him to know how much of the \nclaimant’s problems were pre-morbid as opposed to post-traumatic.  (Depo. \nof Dr. Barry Baskin, Pp. 44-45) \nAt his deposition, Dr. Baskin had the following exchange: \n\nELLIS - H107908  26\n  \n \n \nQ: (by Mr. Parrish) If someone \ntruly had a traumatic brain \ninjury or closed head injury, \nwould you expect them to \nhave no evidence of any \ndamage to their brain \nacross the spectrum of all \nthose tests and \nexaminations? \n \nA: It would be unusual to have \nsomebody have all those \ntests and evaluations and \nnot have any positive \nobjective findings. Again, I \nhave seen people that had \nno findings on scans, and \nthey were clearly - had had \na head injury and had \nalteration of their level of \nconsciousness, but more \ntimes than not, I would say \nsome of those would be \npositive. You would expect, \nmore times than not, some \nof those things to be \npositive than for all of them \nto be negative.  \n \n(Id. at Pp. 45-46). \n \nIn short, Dr. Baskin could not state within a reasonable degree of \nmedical certainty that there was movement of the claimant’s brain at the \ntime of his fall, that the claimant sustained bruising to his brain, or that the \nclaimant’s emotional or behavioral complaints were related to the accident. \n(Id. at Pp. 60-63). \n\nELLIS - H107908  27\n  \n \n \nAs further evidence of the claimant’s exaggeration or manipulation of \nhis injuries, the sole indication that the claimant may be suffering from an \nongoing “adjustment disorder with mixed anxiety and depressed mood,” \ncomes from the opinion of LPC (Licensed Professional Counselor) Tobi \nTaylor, who was deposed on April 4, 2023.  (see Depo. of Tobi Taylor).  \nThe claimant’s diagnosis of adjustment disorder with mixed anxiety and \ndepressed mood by Tobi Taylor was based entirely on the claimant’s own \nreporting of symptoms.  \nWhen asked if the claimant could manipulate his treatment, Ms. \nTaylor responded, “I mean I guess everything could be manipulated.” \n(Depo. of Tobi Taylor, Pp. 11).  Ms. Taylor testified that she treats a lot of \ntrauma induced conditions, but when asked if there were any type of validity \nprocessing to measure whether somebody is just making this stuff up, she \nresponded that the client was the only source of information for her.  (Id. at \nPp.12-13).  She also stated that she had reviewed some psychological \ntesting on the claimant, and that testing would include validity checks, “[b]ut \nif somebody was telling me, ‘I’m having these symptoms,’ I don’t have a \nway to refute that they’re having those symptoms.”  (Id. at P.14).  \nMs. Taylor went on to testify, the physical manifestations that are \ntypically associated with closed head injuries, again, would be outside of \nher scope.  (Id. at P.16).  Specifically, Ms. Taylor stated she could not give \n\nELLIS - H107908  28\n  \n \n \nan opinion as to whether the fall in question was the triggering event of the \nissues in which she was treating the claimant. She testified she was treating \nwhat -- how [a symptom] shows up in his daily life, “because I am not the \nmedical doctor.”  (Id. at Pp. 17,18).  \nUnder questioning by the respondent’s attorney, Ms. Taylor testified \nthat she was not providing an opinion the claimant had suffered a traumatic \nbrain injury, “because I am not qualified to do so.”  (Id. at P.34).  She further \nstated that her opinions and treatment model for the claimant were based \non the subjective reporting the claimant decided to share with her.  (Id. at \nPp. 50, 51).  She also had no evidence to rebut the statement by Dr. Zolten \nthat the claimant had no cognitive deficits, stating, “I don’t test for a \ncognitive deficit, nor am I qualified to do so.”  She admitted her opinions \nand diagnoses were not based on objective findings, and she does not do \nany testing on her own.  (Id. at Pp. 53-54).  \nThe following exchange is illustrative of Ms. Taylor’s limitations:  \nQ: (by Mr. Parrish) Okay.  This \nadjustment disorder with \ndepression, anxiety, panic \nattacks, you are not \nproviding an opinion that \nthis is causally related to \nhim tripping and falling, with \na reasonable degree of \ncertainty, are you? \n \nA: I can only respond to what \nhe -- the information that he \n\nELLIS - H107908  29\n  \n \n \ngave me and the \ninformation that I have in his \nrecord.  \n \nQ: Okay.  \n \nA: And can say that the time of \nthe intake he met the \ndiagnostic criteria for \nadjustment disorder mixed.  \n \nQ: Okay. But you’re not \nproviding a causation \nopinion as to what has \ncaused --  \n \nA: My only opinion is that he \nreports to me that all of \nthese symptoms were either \nstarted or magnified post-\naccident.  \n \nQ: Okay. And that’s not really \nan opinion; it’s a --  \n \nA: It’s a reporting of what he – \n \nQ: -- repetition of what he said. \nRight? \n  \nA: Yes. Uh-huh. \n \nQ: Okay. So, ultimately he’s in \ncontrol as far as what the \ndiagnosis is based on what \nhe reports to you as a \nclinical professional.  \n \nA: Yeah.  \n  \n(Id. at Pp. 63 - 64). \n\nELLIS - H107908  30\n  \n \n \n Since the testing and opinions of Tobi Taylor are based solely on the \nself-serving, subjective complaints of the claimant and not on any \nmeasurable objective findings, her testimony should be disregarded.  \n The record is clear that Dr. Baskin is the physician best suited to \ndetermine the history and causes of the claimant’s injury.  There is clearly \nnothing in the record that reflects any objective finding of an acute injury to \nthe claimant’s brain.  The claimant underwent a battery of testing to \ndetermine if there is a medical source of his complaints and each revealed \nthat there was no physical injury.  The sole findings that would indicate an \ninjury are based on the claimant’s own reporting which, is clear from the \nrecord, is undisputedly unreliable.  There has been no evidence submitted \nby the claimant to controvert Dr. Baskin’s opinion, and he has therefore \nfailed to meet his burden of proving that he suffered a compensable closed-\nhead injury. \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. H107908 JESSIE D. ELLIS, EMPLOYEE CLAIMANT CITY OF CONWAY, EMPLOYER RESPONDENT ARKANSAS MUNICIPAL LEAGUE WORKERS’ COMPENSATION TRUST, INSURANCE CARRIER/TPA RESPONDENT","fetched_at":"2026-05-19T22:29:45.331Z","links":{"html":"/opinions/full_commission-H107908-2024-06-19","pdf":"https://labor.arkansas.gov/wp-content/uploads/Ellis_Jessie_H107908_20240619.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/full-commission-opinions/"}}