{"id":"full_commission-H107962-2024-03-07","awcc_number":"H107962","decision_date":"2024-03-07","opinion_type":"full_commission","claimant_name":"Charles Axsom","employer_name":"Baptist Health","title":"AXSOM VS. BAPTIST HEALTH AWCC# H107962 MARCH 7, 2024","outcome":"denied","outcome_keywords":["granted:1","denied:2"],"injury_keywords":["knee","ankle","sprain","lumbar"],"pdf_url":"https://labor.arkansas.gov/wp-content/uploads/Axsom_Charles_H107962_20240307.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/full-commission-opinions/","filename":"Axsom_Charles_H107962_20240307.pdf","text_length":14269,"full_text":"NOT DESIGNATED FOR PUBLICATION \n \n \nBEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION \n \nCLAIM NO.  H107962 \n \nCHARLES W. AXSOM, EMPLOYEE  CLAIMANT \n \nBAPTIST HEALTH, EMPLOYER RESPONDENT \n \nCLAIMS ADMINISTRATIVE SERVICES,  RESPONDENT \nINSURANCE CARRIER/TPA  \n \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 EVELYN E. BROOKS, Attorney \nat Law, Fayetteville, Arkansas. \n \nRespondents represented by the HONORABLE JARROD S. PARRISH, \nAttorney at Law, Little Rock, Arkansas. \n \nDecision of Administrative Law Judge:  Affirmed and Adopted. \n \n OPINION AND ORDER \n Respondents appeal an opinion and order of the Administrative Law \nJudge filed August 29, 2023.  In said order, the Administrative Law Judge \nmade the following findings of fact and conclusions of law: \n1. The Arkansas Workers’ Compensation Commission has \njurisdiction over this claim.  \n \n2. That an employer/employee relationship existed on September 4, \n2021, the date  that the claimant suffered a compensable injury to \nhis right knee. \n \n\nAXSOM - H107962  2\n  \n \n \n3. Respondents have accepted and are paying a ten percent (10%) \npermanent partial impairment to the claimant.  \n \n4. The claimant’s prior attorney, Mr. Andy L. Caldwell, has filed a lien \nin this matter.  \n \n5. That the claimant has proven, by a preponderance of the credible \nevidence, that the additional medical treatment, specifically the \ntreatment for complex regional pain syndrome is both causally \nrelated and reasonably necessary for the treatment of the work-\nrelated right knee injury.  \n \n6. If not already paid, the respondents are ordered to pay for the \ncost of the transcript forthwith.  \n \n We have carefully conducted a de novo review of the entire record \nherein and it is our opinion that the Administrative Law Judge's decision is \nsupported by a preponderance of the credible evidence, correctly applies \nthe law, and should be affirmed.  Specifically, we find from a preponderance \nof the evidence that the findings made by the Administrative Law Judge are \ncorrect and they are, therefore, adopted by the Full Commission.  \n We therefore affirm the decision of the Administrative Law Judge, \nincluding all findings of fact and conclusions of law therein, and adopt the \nopinion as the decision of the Full Commission on appeal. \n All accrued benefits shall be paid in a lump sum without discount and \nwith interest thereon at the lawful rate from the date of the Administrative \nLaw Judge's decision in accordance with Ark. Code Ann. § 11-9-809 (Repl. \n2012). \n\nAXSOM - H107962  3\n  \n \n \n For prevailing on this appeal before the Full Commission, claimant’s \nattorney is entitled to fees for legal services in accordance with Ark. Code \nAnn. § 11-9-715(a)(Repl. 2012).  For prevailing on appeal to the Full \nCommission, the claimant’s attorney is entitled to an additional fee of five \nhundred dollars ($500), pursuant to Ark. Code Ann. § 11-9-715(b)(Repl. \n2012). \n  IT IS SO ORDERED. \n                                       _____________________ \n    SCOTTY DALE DOUTHIT, Chairman \n \n                                       _____________________ \n    M. SCOTT WILLHITE, Commissioner \n \n \n \nCommissioner Mayton dissents \n \nDISSENTING OPINION \n \nI respectfully dissent from the majority opinion.  After my de novo \nreview of the file, I find that the claimant has failed to prove by a \npreponderance of the credible evidence that the medical treatment \nassociated with complex regional pain syndrome is both causally related \nand reasonably necessary for the treatment of the compensable work-\nrelated right knee injury.  \n The claimant suffered an admittedly compensable injury to his right \nknee on September 4, 2021, when the running board to a work van \n\nAXSOM - H107962  4\n  \n \n \ncollapsed beneath him.  (Hrng. Tr, Pp. 6-7).  Dr. James Tucker performed a \ndiagnostic arthroscopy with medial meniscal repair and partial lateral \nmeniscectomy on November 1, 2021.  (Cl. Ex. 1, P. 28).  The claimant \nasserts that his symptoms changed after surgery, leading to right foot, toe, \nand ankle pain.  (Hrng. Tr, P. 16).  \nAt an appointment with Dr. Tucker on November 17, 2021, the \nclaimant advised Dr. Tucker that earlier that week he twisted his knee and \nfelt a pop when his crutches got twisted up with a dog, and an MRI dated \nNovember 17, 2021, showed findings suspicious of a re-tear involving the \ninferior meniscal surface of the posterior horn.  (Cl. Ex. 1, Pp. 31-33)  \nThe claimant returned to Dr. Tucker on November 23, 2021, for a \nfollow-up after a fall, and Dr. Tucker’s report confirmed a showing of a re-\ntear of his medial and lateral meniscus with a sprain of his MCL.  (Cl. Ex. 1, \nPp. 34-37).  Dr. Tucker performed a second surgery on the claimant’s knee \non December 6, 2021.  (Cl. Ex. 1, Pp. 38-41).  \nThe claimant continued to complain of ongoing pain, and on \nFebruary 8, 2022, reported increasing pain down the L4 \ndermatome/saphenous nerve distribution when something pressed against \nhis posterior thigh.  (Cl. Ex. 1, Pp. 55-58).  Dr. Tucker ordered an EMG \nnerve study.  Id.  \n\nAXSOM - H107962  5\n  \n \n \nDr. Rodrigo Cayme performed a nerve study on February 21, 2022, \nwhich resulted in a report of “1. Normal electrodiagnostic study.  2. There is \nno electrodiagnostic evidence of a focal nerve entrapment, generalized \nperipheral neuropathy, or right lumbar radiculopathy.”  (Cl. Ex. 1, P. 63). \nThis study was later revised to include an electrodiagnostic finding of right \naxonal saphenous neuropathy, but no evidence of CRPS.  (Cl. Ex. 1, P. \n65).  \nOn March 16, 2022, Dr. Tucker reported that the EMG nerve \nconduction study showed no signs of nerve compression and was felt to be \nnormal, but that the claimant continued to have dysesthesias along the \nsaphenous nerve distribution which was aggravated by sitting in a chair. \n(Cl. Ex. 1, Pp. 67-71). \nThe claimant was examined by Dr. Stephen Paulus on May 31, \n2022, who opined that the claimant’s presentation had changed over the \nlast month, with pain now extending into the dorsum of his foot with a new \nonset of vasomotor and sudomotor changes.  He believed that the claimant \nwas developing Type 2 Chronic Regional Pain Syndrome.  (Cl. Ex. 1, Pp. \n98-102).  \nDr. Tucker issued a clinic note of the same date which provided the \nclaimant continued to suffer from saphenous neuropathy and the MRI of his \n\nAXSOM - H107962  6\n  \n \n \nthigh showed no signs of a lesion which would increase his saphenous \nnerve symptoms with sitting.  (Cl. Ex. 1, Pp. 103-106). \n Dr. Paulus referred the claimant to Dr. Brent Walker for possible \nCRPS, and upon examination, Dr. Walker noted that the claimant’s right \nknee was reddened and swollen and there was temperature asymmetry. \n(Cl. Ex. 1, Pp. 107-112).  Dr. Walker ordered a three-phase bone scan, \nwhich revealed “relatively decreased activity on all three phases within the \nright foot, which may be related to disuse of the right leg.”  (Cl. Ex. 1, P. \n113).  The claimant underwent a series of lumbar sympathetic nerve blocks \nfor the treatment of his symptoms, but they offered no relief.  (Hrng. Tr, P. \n19; See Cl. Ex. 1, Pp. 115, 117, 119, 128, 130, 132, 141, 143, 145; Resp. \nEx. 1, P. 29).  Dr. Walker opined that the claimant may be a good candidate \nfor the UAMS CRPS program.  (Cl. Ex. 1, Pp. 147-154).  \nOn November 17, 2022, Dr. Ethan Schock assigned a 12% whole \nperson impairment rating (30% lower extremity permanent partial \nimpairment).  (Cl. 1, P. 168).  \nThe claimant ultimately underwent an evaluation on April 25, 2023 by \nDr. Cale White and Dr. Johnathan Goree who diagnosed the claimant with \nCRPS of the claimant’s foot per Budapest Criteria.  (Cl. Ex. 1, Pp. 190-195).  \nDr. Carlos Roman performed an independent medical examination \non January 30, 2023, and determined: \n\nAXSOM - H107962  7\n  \n \n \nIt is my assessment per Budapest \nCriteria, he does not have \nComplex Regional Pain \nSyndrome...By Budapest Criteria, \nthe tone, color and temperature \nwas not compatible with complex \nregional pain syndrome of the right \nlower extremity. This bone scan, \nagain, indicates the foot, not the \nknee, again an atypical and \nunusual pattern, but not correlative \nwith complex regional pain \nsyndrome and the location of the \npooling was not relative to the \nknee where the pain is. The bone \nscan does not in any way conclude \ncomplex regional pain syndrome. It \nis quite contrary.  Obviously the \nradiologist reading the scan would \nnot be aware if it was a knee or a \nfoot, but the bone scan does not \nindicate complex regional pain \nsyndrome.  (Resp. Ex. 1, Pp. 26-\n30). \n \nThere was no mention of chronic regional pain syndrome (CRPS) \nuntil May 31 of 2022, which was ten (10) months after the claimant’s \naccident.  (Hrng. Tr, Pp. 16-17).  \nThe respondents have accepted and are paying a ten percent (whole \nbody) impairment rating.  An administrative law judge determined that the \nclaimant met his burden of proving that he is entitled to additional medical \ntreatment for CRPS related to his September 2021 compensable injury. \nRespondents appeal. \n\nAXSOM - H107962  8\n  \n \n \nArkansas Code Annotated section 11-9-508(a) (Repl. 2012) requires \nan employer to provide an employee with medical and surgical treatment \n\"as may be reasonably necessary in connection with the injury received by \nthe employee.\"  The claimant has the burden of proving by a \npreponderance of the evidence that the additional treatment is reasonable \nand necessary. Nichols v. Omaha Sch. Dist., 2010 Ark. App. 194, 374 \nS.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 and the respondent is only responsible for treatment \ncausally related to the compensable injury.  Walker v. United Cerebral \nPalsy of Ark., 2013 Ark. App. 153, 426 S.W.3d 539 (2013).  Treatments to \nreduce or alleviate symptoms resulting from the compensable injury to \nmaintain the level of healing achieved; or to prevent further deterioration of \nthe damage produced by the compensable injury are considered \nreasonable medical services.  Foster v. Kann Enterprises, 2009 Ark. App. \n746, 350 S.W.2d 796 (2009). \n\nAXSOM - H107962  9\n  \n \n \nThe Commission has authority to accept or reject medical opinion \nand to determine its medical soundness and probative force.  Gant v. First \nStep, Inc., 2023 Ark. App. 393, 675 S.W.3d 445 (2023).  Furthermore, it is \nthe Commission's duty to use its experience and expertise in translating the \ntestimony of medical experts into findings of fact and to draw inferences \nwhen testimony is open to more than a single interpretation.  Id. \nThe claimant alleges that he is entitled to additional medical \ntreatment for complex regional pain syndrome (CRPS).  \n Dr. Carlos Roman conducted an IME on January 30, 2023, and \nopined that, “[b]y Budapest Criteria, he does not fit criteria for complex \nregional pain syndrome, again, also been refractory to sympathetic blocks, \nthose are both therapeutic and diagnostic in scope.\"  (Resp. Ex. 1, P. 28). \nDr. Roman’s report included the findings that: \n• Sympathetic tone is normal and \nsymmetric. \n \n• No excess swelling in the right \nleg compared to the left. \n \n• No gross temperature \ndifferential. \n \n• Color is appropriate. \n \n• No skin breakdown issues. \n \n(Resp. Ex. 1, Pp. 26-30).  \n\nAXSOM - H107962  10\n  \n \n \nOn February 21, 2022, the claimant underwent a nerve conduction \nstudy which resulted in a report of “1. Normal electrodiagnostic study.  2. \nThere is no electrodiagnostic evidence of a focal nerve entrapment, \ngeneralized peripheral neuropathy, or right lumbar radiculopathy.”  (Cl. Ex. \n1, P. 63).  This study was later revised to include an electrodiagnostic \nfinding of right axonal saphenous neuropathy, but no evidence of CRPS. \n(Cl. Ex. 1, P. 65).  \nA June 21, 2022, three-phase bone scan revealed “relatively \ndecreased activity on all three phases within the right foot, which may be \nrelated to disuse of the right leg.”  (Cl. Ex. 1, P. 113).  “Typical pattern for \ncomplex regional pain syndrome is going to be increased activity in all three \nphases, the flow, the pool, and the delay.”  (Resp. Ex. 1, P. 29).  Decreased \nactivity as seen in the claimant’s scan would be a “rare atypical pattern.”  Id. \nBy Budapest Criteria, the tone, \ncolor and temperature was not \ncompatible with complex regional \npain syndrome of the right lower \nextremity.  This bone scan, again, \nindicates the foot, not the knee, \nagain an atypical and unusual \npattern, but not correlative with \ncomplex regional pain syndrome \nand the location of the pooling was \nnot relative to the knee where the \npain is.  The bone scan does not in \nany way conclude complex \nregional pain syndrome.  It is quite \ncontrary.  Obviously the radiologist \nreading the scan would not be \n\nAXSOM - H107962  11\n  \n \n \naware if it was a knee or a foot, but \nthe bone scan does not indicate \ncomplex regional pain syndrome. \nId. \n \nThe claimant did not respond to the typical treatments for CRPS. \n(Hrng. Tr, P. 19; See Cl. Ex. 1, Pp. 115, 117, 119, 128, 130, 132, 141, 143, \n145; Resp. Ex. 1, P. 29).  No fewer than nine lumbar block injections which \nprovided no long-term relief.  Id. \nThe medical records are clear that the claimant has failed to prove by \na preponderance of the evidence that he suffers from CRPS.  The claimant’s \nbone scan was negative for any indication of CRPS, and the results of the \nclaimant’s nerve conduction study showed no evidence of CRPS.  \nDr. Ramon was unequivocal in his medical opinion that despite years \nof investigation by OrthoArkansas, there is no evidence of CRPS by the \nBudapest Standard and the claimant is not entitled to additional medical \ntreatment for this claim. \nAccordingly, for the reasons set forth above, I must dissent. \n \n                                       _____________________ \n    MICHAEL R. MAYTON, Commissioner","preview":"NOT DESIGNATED FOR PUBLICATION BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. H107962 CHARLES W. AXSOM, EMPLOYEE CLAIMANT BAPTIST HEALTH, EMPLOYER RESPONDENT CLAIMS ADMINISTRATIVE SERVICES, RESPONDENT INSURANCE CARRIER/TPA OPINION FILED MARCH 7, 2024 Upon review before the FULL COMMISSION in Little Rock...","fetched_at":"2026-05-19T22:29:45.831Z","links":{"html":"/opinions/full_commission-H107962-2024-03-07","pdf":"https://labor.arkansas.gov/wp-content/uploads/Axsom_Charles_H107962_20240307.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/full-commission-opinions/"}}