{"id":"full_commission-H109939-2025-09-24","awcc_number":"H109939","decision_date":"2025-09-24","opinion_type":"full_commission","claimant_name":"Wendy Peacock","employer_name":"Conway Regional Medical Center","title":"PEACOCK VS. CONWAY REGIONAL MEDICAL CENTER AWCC# H109939 September 24, 2025","outcome":"unknown","outcome_keywords":[],"injury_keywords":["strain","fracture","back","lumbar","ankle","knee"],"pdf_url":"https://www.labor.arkansas.gov/wp-content/uploads/Peacock_Wendy_H109939_20250924.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/full-commission-opinions/","filename":"Peacock_Wendy_H109939_20250924.pdf","text_length":44895,"full_text":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION \n \n \nCLAIM NO. H109939 \n \nWENDY PEACOCK, \nEMPLOYEE \n \nCLAIMANT \nCONWAY REGIONAL MEDICAL CENTER,  \nEMPLOYER \n \nRESPONDENT \nRISK MANAGEMENT RESOURCES, \nINSURANCE CARRIER/TPA \nRESPONDENT \n  \n      \nOPINION FILED SEPTEMBER 24, 2025 \n \nUpon review before the FULL COMMISSION in Little Rock, Pulaski County, \nArkansas. \n \nClaimant represented by the HONORABLE DANIEL E. WREN, Attorney at \nLaw, Little Rock, Arkansas. \n \nRespondents represented by the HONORABLE MELISSA WOOD, Attorney \nat Law, Little Rock, Arkansas. \n \nDecision of Administrative Law Judge: Affirmed as Modified. \n \n \n OPINION AND ORDER \nThe respondents appeal an administrative law judge’s opinion filed \nMay 27, 2025.  The administrative law judge found that the claimant proved \nshe was entitled to additional medical treatment.  The Full Commission \nfinds that the claimant proved she was entitled to additional medical \ntreatment as recommended by Dr. Baskin.       \nI. HISTORY \n Wendy Peacock, now age 52, testified that she had previously been \nemployed with the respondents, Conway Regional Health System, for \napproximately 13 years.  The claimant testified that her employment \n\nPEACOCK - H109939  2\n  \n \n \nposition was “Direct Patient Care.”  The parties stipulated that the \nemployment relationship existed on March 1, 2021.  The claimant testified \non direct examination: \n  Q.  On March 1\nst\n, 2021, was there an incident with a bed? \n  A.  Yes. \n  Q.  Tell me what happened. \nA.  I was taking the bed to – from the room to the OR, and \nwhen I pushed it out in the hall, I had to get to the other end to \nturn it, and when I did, the wheel ran over my foot, like, right \nacross where my – I call them my toe knuckles, but it – and it \nrolled over the top of it and crushed it.   \n \n The parties stipulated that the claimant “sustained compensable \ninjuries to her left foot” on March 1, 2021.  According to the record, the \nclaimant treated with Dr. Gil E. Johnson on March 3, 2021: \nWendy works in labor and delivery at the hospital – CRMC.  \nShe was moving a bed and rolled over the top of her left foot.  \nSince that time it occurred on 3/1/21 she’s complained of soft \ntissue swelling and pain in the left foot.  It affects her gait.  \nShe reports no prior injury to this foot.... \nEvaluation of the left foot reveals noted soft tissue swelling \nand pain to palpate the distal and dorsal aspect of the foot.  \nThis is mostly over the distal metatarsal heads one – \nfour....Mild ecchymosis is present....Impression crush injury \nof soft tissue swelling of left foot, approximately 48 hours out \nfrom injury.   \n \n Dr. Johnson planned diagnostic testing and conservative treatment. \n The parties stipulated that the respondents “accepted the claim and \npaid benefits.”     \n An MRI of the claimant’s left foot was taken on March 23, 2021, with \nthe following impression: \n\nPEACOCK - H109939  3\n  \n \n \n1. Strain of the lateral head of the flexor hallucis brevis and \nadductor hallucis muscles with partial tear of the flexor \nhallucis brevis tendon at the attachment to the lateral \nsesamoid.   \n \n Dr. James Head performed surgery on December 14, 2021: \n1. Excision of fibular sesamoid to treat nonunited fibular \nsesamoid fracture.   \n2. Resection of a segment of a superficial peroneal nerve. \n3. Resection of a segment of the deep peroneal nerve with \ntransplantation of the nerve into the first metatarsal bone. \n4. Closed treatment of calcaneal stress fracture.   \n \nThe pre- and post-operative diagnosis was “1.  Left painful nonunited \nfibular sesamoid fracture.  2.  Painful neuroma to the deep peroneal and \npossibly superficial peroneal nerve to the dorsum of the forefoot.  3.  \nCalcaneal stress fracture.” \nThe claimant testified that the condition of her foot worsened \nfollowing surgery by Dr. Head.  Dr. Carlos Roman subsequently ordered a \nNuclear Medicine Three Phase Bone Scan, which was performed on April \n28, 2022 with the following impression: \nThere is no scintigraphic evidence of complex regional pain \nsyndrome.  Degenerative type activity along the bilateral first \nmetatarsophalangeal joints greater on the left than the right.   \n \n Dr. Roman noted on July 12, 2022: \nThe patient is a 49-year-old female.  She is a Workers’ \nCompensation patient.  She is a healthcare technician.  She \nworked for Labor and Delivery at Conway Regional when her \nfoot was run over by a hospital cart on March 1, 2021.  She \nhad a sesamoid fracture and ultimately underwent surgery on \nher left foot by Dr. Head for fibular sesamoid resection and \n\nPEACOCK - H109939  4\n  \n \n \nsuperficial peroneal nerve and tendon resection with \nreimplantation of the nerve.   \nShe continued to have pain in the left foot and was diagnosed \nwith calcaneal stress fracture.  She obtained a second opinion \nfrom Dr. Burks in April and was diagnosed with possible \nCRPS of the left lower extremity.  He suggested no further \nsurgeries until further workup in that regard.  Bone scan \nshowed no evidence of CRPS.  Her clinical exam does not \nmeet criteria for CRPS.  I referred her back to Dr. Burks and \nshe is now scheduled for surgical intervention.  I will follow her \nabout three to four weeks after surgery.... \n \n Dr. Roman diagnosed “1.  Left foot pain.  2.  Arthrosis of the left \ncuneiform bones of the foot.  3.  Previous fracture of the metatarsal bone.” \n Dr. Jesse Burks performed surgery on August 12, 2022:  “1.  \nArthrodesis tarsometatarsal joint, left.  2.  Intermediate lateral cuneiform \narthrodesis, left.  3.  Peroneus brevis tendon tear, left.”  The pre- and post-\noperative diagnosis was “1.  Arthrosis, second tarsometatarsal joint.  2.  \nArthrosis, lateral intermediate cuneiform joint.  3.  Peroneus brevis tendon \ntear, left.” \n The claimant testified that she did not “respond well” to surgery \nperformed by Dr. Burks. \n An x-ray of the claimant’s lumbar spine was taken on November 21, \n2022 with the following findings and impression: \nVertebral body heights are preserved.  Alignment is within \nnormal limits.  There is mild intervertebral disc height loss \nnoted at L4-L5 and L5-S1.  Mild facet arthropathy most \npronounced in the lower lumbar spine.  Overall, mild \ndegenerative changes, most pronounced in the lower lumbar \nspine.   \n\nPEACOCK - H109939  5\n  \n \n \n \n Dr. Billy McBay reported in part on December 1, 2022: \nShe comes in today to discuss her back pain and left foot.  \nShe has a history of left foot injury that is being evaluated by \nWorker’s Compensation.  She states her left foot started \nhurting on 03/01/2021.  Her left foot injury affected her walking \nand ambulation and aggravated her back pain.   \nShe also comes in to discuss the result of her lumbar spine x-\nray, which showed mild intervertebral disc loss on the L4, L5, \nand S1 and some facet arthropathy.  The patient had low back \npain with right-sided radiculopathy, which is aggravated by a \nrecent foot injury and prolonged walking in a walker boot or \nscooter.   \n \n Dr. McBay assessed “1.  Acute right-sided low back pain with right-\nsided sciatica[.]...Continue present care measures.”   \n Dr. Robert Daniel Martin noted on January 6, 2023: \nThe patient is seen today for evaluation of her left foot.  Back \nin March of 2021 she had a crush type injury of the left foot.  \nShe has had a very long and drawn out course thereafter with \nmultiple surgeries performed by another orthopedic surgeon, \nand also podiatrist....She has also been seen by pain \nmanagement for evaluation regarding the possibility of \ncomplex regional pain syndrome, this also been (sic) seen by \npain management for evaluation regarding the possibility of \ncomplex regional pain syndrome, this was felt to be less likely.  \nCurrently the patient is unable to work full duty because of left \nfoot pain, she has pain and swelling on a regular basis, she is \nunable to walk or stand for any prolonged period of time \nbecause of pain and swelling mostly on the dorsal foot.  She \nalso continues to complain of significant pain over the \nprevious incision over the distal peroneal tendons....She \nwalks with an antalgic gait.... \nThis is a complicated problem, she has had multiple surgeries \nincluding attempted midfoot fusion but this has failed, her \nimplants are not really even in the bone.  She has persistent \npain over where her peroneal tendons were either explored \n[or] repaired.  She has 1\nst\n webspace numbness from previous \n\nPEACOCK - H109939  6\n  \n \n \nnerve excision.  The site of injury is really not even in the area \nwhere all of her surgeries have been performed [and] the \npatient is understandably perplexed by this, as am I.   \n \n Dr. Martin planned, “At this point I think the patient will require \nrevision midfoot arthrodesis with removal of the failed orthopedic implants, \nthis should provide some improvement in pain.  Also would recommend \nexploration of the distal peroneal tendons in the site of previous surgery as \nshe has significant symptoms here.  Unfortunately I think the nerve type \nsymptoms from deep peroneal nerve irritation and numbness, \nhyperesthesias in the dorsal foot may be permanent based on the chronicity \nof her problem.”   \nDr. Martin performed surgery on February 13, 2023:  “1.  28730, \nmidfoot arthrodesis of 1\nst\n and 2\nnd\n tarsometatarsal joints, left foot.  2.  20900, \nharvesting of calcaneal autograft, left foot, separate incision.  3.  27675, \nopen repair of peroneus brevis tendon, left ankle.”  The pre- and post-\noperative diagnosis was “1.  Posttraumatic arthropathy of left foot.  2.  \nNonunion and midfoot arthrodesis, left foot.  3.  Peroneus brevis tear, left \nankle.  4.  Retained failed orthopedic implants, left foot.”   \nDr. Martin provided follow-up treatment after surgery.  The claimant \ntestified on direct examination: \nQ.  During this period of time, were you able to be weight-\nbearing on that foot? \n\nPEACOCK - H109939  7\n  \n \n \nA.  It was off and on.  Sometimes I was, sometimes I wasn’t.  I \nwas in a walking boot and on a knee scooter almost the entire \ntime.   \nQ.  Did that –  \nA.  Until after Dr. Martin done my last surgery.  I, eventually, \ncame off of my scooter.   \nQ.  Did that change the way you walk at all? \nA.  Oh, most definitely. \nQ.  And at some point, did you develop pain in your back? \nA.  As a matter of fact, yes.... \nQ.  At some point, did your foot swell, change colors, get hot? \nA.  Yes, it was doing that before I saw Dr. Burks, and that’s \none of the reasons I went to see Dr. Burks, because it was not \nhealing up and it was just – the color had changed and it was \nitching and burning, and I had all kinds of issues going on.   \n \n Dr. Lily F. Guastella examined the claimant on March 14, 2023 and \nnoted in part, “I do suspect that her back pain is related to walking in a \ncast/boot with scooter for nearly 2 years.” \nAn MRI of the claimant’s lumbar spine was taken on March 24, 2023, \nwith the following conclusion: \n1. Moderate facet arthropathy at L4-L5 with a right-sided \nfacet effusion and mild surrounding soft tissue edema and \nenhancement, indicating acute reactive or inflammatory \nchanges.  There are small ganglion cyst formation \nextending posteriorly from the facet. \n2. Mild bilateral neural foramen stenosis at L4-L5.  No \nsignificant spinal canal stenosis at any level. \n \nDr. Guastella’s assessment on April 3, 2023 was “(1)  Abnormal MRI, \nlumbar spine:  Status:  Acute....Patient does appear to have acute \nenhancement and inflammatory changes noted on MRI of the lumbar spine.  \n\nPEACOCK - H109939  8\n  \n \n \nLikely secondary to compensation from foot injury, does not appear \nchronic.\"    \n An x-ray of the claimant’s lumbar spine was taken on April 3, 2023 \nand was compared with the x-ray taken November 21, 2022.  The following \nfindings and conclusions resulted: \nLumbar spinal alignment is within normal limits.  No displaced \nfracture or other acute osseous abnormality identified.  \nMultilevel bilateral facet joint arthropathy is noted, worse in the \nlower lumbar spine.  Mild discogenic DJD at L5-S1.  SI joints \nintact.   \n \n Savannah Bradbury, PA-C reported on April 4, 2023: \nVery pleasant 49-year-old female using a knee scooter for her \nleft knee to be nonweightbearing in clinic.  She describes \nworsening right-sided low back pain after having to walk with \nthe boot and using a knee scooter.  She has degenerative \narthritis at L4-5.  There is some fluid signal in the right facet \njoint but there is no spondylolisthesis.  I am recommending \nphysical therapy for core low back stretching and \nstrengthening exercises as well as any possible gait training \nthat can help while she is continuing to wear a boot and use a \nknee scooter.  She may also benefit from traction.  She is also \ninterested in seeing pain management to discuss facet blocks.  \nAt this time surgical intervention is not warranted.  I do not \nhave a great explanation for numbness and tingling as well as \npain down into her right leg.  I suspect is likely more related to \nspasms and pain in her low back.  If her low back pain \nimproved but she continues to have right leg pain with \nnumbness the [next] step would be getting a nerve conduction \nstudy.  She will call us with any concerns or questions \notherwise follow-up as needed.   \n \n The claimant followed up with Dr. Roman on June 12, 2023.  Dr. \nRoman noted in part, “We will now proceed on with treatment of CRPS and \n\nPEACOCK - H109939  9\n  \n \n \nlumbar sympathectomies to be done by two block technique and ketamine \nprotocol will be utilized.”  Dr. Roman diagnosed “1.  Complex regional pain \ndown the left lower extremity, type 1.  2.  Left foot pain.  3.  She had a left \nfoot fracture.  4.  Left ankle fracture.  5.  Other long term use of medication.”     \n Dr. Roman performed a procedure on July 6, 2023:  “Lumbar \nsympathetic block, #3 of 3, on the left side, ketamine protocol utilized.”  The \npre- and post-operative diagnosis was “Complex regional pain syndrome, \nleft lower extremity, type 1.”   \n Dr. Martin reported on July 20, 2023: \nPatient is seen today in follow-up, overall she reports \ncontinued improvement but she [is] still having occasional \nnerve pain and swelling and does limit her ability to stand for \nprolonged periods of time.... \nX-rays demonstrate healed midfoot fusion of 1\nst\n and 2\nnd\n \ntarsometatarsal joints, no other acute findings are noted.  \nStable implant position.... \nThe patient is placed at maximum medical improvement, \npermanent work restrictions are limited ladders and stairs, no \nstanding more than 30 minutes an hour, allowed breaks as \nneeded.  Based on 4\nth\n edition AMA guidelines, her permanent \npartial impairment rating chapter 3, page 81, midfoot ankylosis \nneutral position, 4% whole person, 10% lower extremity, 14% \nfoot.   \n \n Dr. Roman assessed maximum medical improvement on August 29, \n2023. \n Dr. Roman noted on October 2, 2023: \nThe patient is a 50-year-old female, is a Workers \nCompensation patient.  She had a left foot injury in March of \n2021....A cart ran over her foot.  She had a sesamoid \n\nPEACOCK - H109939  10\n  \n \n \nfracture, ended up with traumatic osteoarthritis of the \nmetatarsal  joints.  Ultimately she had a nonunion and mid-\nfoot arthrodesis of the first and second metatarsal joints of the \nleft foot.  She developed complex regional pain syndrome, we \nhave resolved. \nThe question is the impairment rating as it pertains to foot \nfractures.  By the AMA Guidelines, the only ratable \nimpairment on page 78, table 45 for toe impairments, that the \nfirst metatarsophalangeal joint and second \nmetatarsophalangeal joint were fused, it would lead to a mild \nimpairment at a 1% whole person impairment for the lower \nextremity.  Her total impairment, again, is 1% for the first and \nsecond metatarsal joint.  She has some mild impairment \nthere.  No other impairments would be applicable.   \n \n On October 16, 2023, Casey Garretson and Rick Byrd with \nFunctional Testing Centers, Inc. assessed the claimant as having a 5% \nwhole-person impairment. \n An orthotic specialist noted on November 10, 2023, “Patient was \nseen in the office to be measured for a left foot insert due to pain.  Patient \nhad an injury to the left foot and has had multiple surgeries and hardware \ninstalled.  She had a hospital bed run over her forefoot.  She has tried other \ninserts, walking boots and carbon footplates that did not work.  Patient has \nbruising and edema in the foot.  She has obvious gait abnormalities due to \nlimping.”     \n Dr. Roman noted on January 3, 2024: \nThe patient is a 50-year-old female, is a Workers \nCompensation patient.  She had a foot injury when she \nworked at Conway Regional and a cart rolled over her foot.  \nShe had a foot surgery, had a sesamoid fracture, calcaneal \nstress fracture.  Dr. Head did surgery and another surgery by \n\nPEACOCK - H109939  11\n  \n \n \nDr. Burks.  She was diagnosed with complex regional pain \nsyndrome and had another surgery by Dr. Martin.  I did a \nseries of sympathetic blocks on the left lower extremity.  The \nsympathetic tone has normalized.  She comes in today with \nincreasing pain in the foot, complaining of swelling, and she \nwas afraid she had a return of complex regional pain \nsyndrome symptoms.  She does have pain there, but the \ntemperature, tone and color are all symmetric, and there is no \nexcess swelling.  She has hypersensitivity over the foot and \nburning pain in the foot.  I tried to explain to the patient that \nthat does not constitute a complex regional pain syndrome \ndiagnosis.  It is a sympathetic dysfunction of the nervous \nsystem, which currently is resolved.  I do not recommend \nfurther interventional procedures again, sympathetic blocks, \nspinal cord stimulators, etc.  I think it would be an \nunnecessary risk to the patient.  She had a Medrol Dosepak \nthat did resolve a lot of the symptoms.  I would continue to \ngive her access to gabapentin and diclofenac as needed, but I \ndo not recommend further interventions.  I think she is at \nmaximum medical improvement as far as interventional \nprocedures, surgeries, etc.... \nThe left foot tone, color and temperature are symmetric.  The \nvasculature is normal.  There are two incision lines on the top \nof the foot.  There is a little bit of skin disruption there, but the \nskin is mobile.  Skin breakdown issues.  Peripheral pulses are \npalpable.  By Budapest Criteria, she has complained of pain \nand hypersensitivity, but that would be the only symptom.  \nShe does not have sympathetic dysfunction.  She does not \nhave complex regional pain syndrome of the left lower \nextremity.   \nFINAL DIAGNOSES: \n1. History of complex regional pain syndrome, left lower \nextremity, resolved. \n2. Left foot pain. \n3. Sequela of a left foot fracture.   \n4. Sesamoid bone fracture.   \n5. Calcaneal fracture. \n6. Ankle pain. \n7. Long-term use of medications. \n8. Post-incisional neuropathy.   \n \nDr. Roman planned, “Follow up as indicated.” \n\nPEACOCK - H109939  12\n  \n \n \nThe claimant’s attorney corresponded with Dr. Barry D. Baskin on \nJuly 17, 2024.  The claimant’s attorney queried Dr. Baskin with regard to \nissues such as complex regional pain syndrome, altered gait, and maximum \nmedical improvement.       \n Dr. Baskin provided a lengthy Second Opinion on July 22, 2024 and \nreported in part: \nMs. Peacock is referred for a second opinion.  This is more \nakin to an IME based on the records and time allotted for this \nevaluation, approaching an hour and a half face-to-face.  My \nimpression is that Ms. Peacock had a crush injury to her left \nfoot.  She has had 3 surgeries as outlined.  The first surgery \nresulted in some resection of some of her superficial peroneal \nbranches in the left foot and some resection of the deep \nperoneal nerve in the left foot with burying of the nerve into \nthe bone.  She has had some symptoms that have been felt \nby her providers, including Dr. Roman, to represent complex \nregional pain syndrome.  She does have, by her record and \nher examination, clearly some nerve problems in the left foot.  \nMy inclination is that she has neuropathic pain as a result of \nthe superficial and deep peroneal nerve resection.  Her \nexamination is a little perplexing because the peripheral nerve \nissues that she has could easily be confused with reflex \nsympathetic dystrophy or CRPS.  I explained to her in great \ndetail that CRPS can result from very minimal trauma such as \na hangnail or an ingrown toenail or some minimal problem \nwith the foot or ankle or it can be due to a more serious issue \nsuch as surgeries like she has had.  Frequently peripheral \nnerve lesions manifest like CRPS.  She does have allodynia, \nsome mild color changes in the skin over the course of our \nevaluation, and temperature changes.  This could very well be \ncoming from the effects of the nerve resections that were \ndone in the first surgical procedure.  I think she does have \nsome low back pain and the low back pain might well have \nresulted from her walking with altered gait mechanics because \nof the left foot problems, the walker boot, and the knee \nscooter.  She has minimal degenerative changes in her \n\nPEACOCK - H109939  13\n  \n \n \nlumbar spine and some facet arthropathy at L4-5.  That \nproblem is a little more clear-cut than the left foot.  My \nrecommendation would be to get a 3-phase bone scan and I \nwould recommend EMG and nerve conduction studies of the \nleft lower extremity.  From Dr. Head’s operative note the nerve \nresections were branches of the superficial peroneal and deep \nperoneal very distally down into the forefoot area.  These may \nnot show up on EMG or nerve conduction studies, but I still \nthink the studies would be helpful in looking for objective \nfindings.  As well, I think she would benefit diagnostically from \na 3-phase bone scan.   \nMr. Wren has asked some questions regarding my evaluation. \n1. Do I believe that Ms. Peacock has CRPS from this injury \nand surgeries to her left foot?   \nAnswer:  That has been addressed previously.  She \ncertainly may have now and may have had previously \nCRPS that has gone into remission and come back again.  \nI am inclined to believe that this is more related to chronic \nnerve pain as a result of the nerve resections more than \nCRPS.  A 3-phase bone scan might give us some good \ninformation in answering that question and nerve \nconduction studies could also be helpful. \n2. Do I believe that if Ms. Peacock has CRPS has it \npermanently been resolved and Ms. Peacock is at \nmaximum medical improvement in regard to CRPS?   \nAnswer:  I do not think her pain is resolved.  I think she is \nstill symptomatic, but again, I do not think that I can clearly \nsay with reasonable medical certainty that her pain \nsyndrome is CRPS versus peripheral nerve injuries from \nsurgery. \n3. Do you believe that Ms. Peacock is currently having \nsymptoms of CRPS? \nAnswer:  Again, answer previously discussed above. \n4. Do I believe that Ms. Peacock has lumbar pain that was \ncaused by long-term altered gait? \nAnswer:  Yes. \n5. Do I believe that Ms. Peacock is at maximum medical \nimprovement in regards to her lumbar pain?   \nAnswer:  No.   \n6. If Ms. Peacock is not at maximum medical improvement in \nregards to her lumbar pain, what further testing or \ntreatment would you recommend for Ms. Peacock? \n\nPEACOCK - H109939  14\n  \n \n \nAnswer:  She does have some referred pain down into her \nright leg and thigh, mostly in the thigh.  She does have \nclear-cut facet arthropathy that is most likely degenerative \nin nature, but appears to have been an aggravation from \nher gait mechanic alterations and the scooter.  EMG and \nnerve conduction studies would be useful on the right \nlower extremity as well.  If she is allowed to have EMG and \nnerve conduction studies through Worker’s Compensation \nI would suggest that we get them done with Dr. Mike \nChesser and that both lower extremities be evaluated for \ndifferent etiologies.  Also she might benefit from a facet \nblock in the right L4-5 facet.  She did appear to be \nneurologically intact in the right lower extremity completely, \nbut she does still have subjective symptoms that could be \ncoming from sciatica.  Her pain problem is more consistent \nwith facet arthropathy, however. \nThis concludes my Independent Medical Evaluation of Ms. \nPeacock.  Greater than 3 hours was spent in performing this \nexam, reviewing the record, and dictating this note.  If there \nare any questions regarding this evaluation I would be happy \nto address them if they are forwarded to me.  I appreciate the \nopportunity to assist in this nice lady’s care. \n \n A pre-hearing order was filed on December 10, 2024.  The claimant \ncontended, “Claimant sustained an injury to her left foot on March 1, 2021, \nwhile moving a bed in labor and delivery it rolled over the top of her left foot.  \nShe treated with Dr. Robert Martin @ UAMS Ortho Clinic on Shackleford.  \nShe has undergone 3 different surgeries on her left foot.  The 1\nst\n surgery \nwas on 12/14/2021 with Dr. Adam Head.  The second surgery was on \n8/12/2022 with Dr. Burks.  He kept her on non-weight bearing for a period of \ntime.  She used a knee scooter due to swelling in her foot.  Dr. Burks noted \non 10/26/2022 that she possible (sic) have complex regional pain syndrome \nand recommended her to see Dr. Roman.  Dr. Roman did an Independent \n\nPEACOCK - H109939  15\n  \n \n \nMedical Evaluation on her on (sic)[.]  He did not feel she had the criteria for \nCRPS.  Dr. Roman referred he (sic) back to Dr. Burks for additional \ntreatment.  Dr. Burks did a 3\nrd\n surgery on 02/13/2023.  She continued to \nhave pain and was seen again by Dr. Roman who felt like she met all the \ncriteria for RSD at that time.  She underwent sympathetic blocks.  She was \nreleased from Dr. Martin and Dr. Roman and received impairment ratings.  \nShe had an FCE test on 10-16-23 which stated she had a combined IR of \n5% whole person.”   \n The claimant contended, “After continued pain, she was seen by Dr. \nBarry Baskin for a second opinion/IME.  Dr. Baskin opined that she clearly \nhas some nerve problems in the left foot.  He stated that because of the the \n(sic) peripheral nerve issues that she has could easily be confused with \nCRPS (sic).  Dr. Baskin opined that he thinks she does have some low back \npain and the low back pain might well have resulted from her walking with \naltered gait mechanics because of left foot problems, the walker boot and \nknee scooter.  Dr. Baskin has recommended a 3-phase bone scan and \nEMG and nerve conduction studies of the left lower extremity which have \nnot been approved by Workers Compensation.” \n The respondents contended, “Respondents contend that all \nappropriate benefits are being paid with regard to Claimant’s left lower \nextremity injury sustained on 3/1/21.  Treatment recommended by Dr. Barry \n\nPEACOCK - H109939  16\n  \n \n \nBaskin is not reasonable and necessary associated with the same.  All \nappropriate temporary total disability benefits have been paid.”   \n The parties agreed to litigate the following issues: \n1. Whether claimant is entitled to reasonable and necessary \nmedical treatment and related expenses, including a 3-\nphase bone scan, EMG and nerve conduction study of the \nleft lower extremity.   \n2. Whether Claimant is entitled to additional reasonable and \nnecessary medical treatment to her lower back as a \ncompensable consequence of the compensable left foot \ninjury. \n3. Whether Claimant is entitled to Temporary Total Disability \n(TTD) benefits from August 29, 2023 to a date yet to be \ndetermined.   \n4. Whether Claimant’s attorney is entitled to a controverted \nattorney’s fee. \n5. All other issues are reserved. \n \nA hearing was held on April 1, 2025.  The claimant testified that she \ncontinued to suffer from pain, and that she wanted to undergo the \ndiagnostic testing recommended by Dr. Baskin.   \nAn administrative law judge filed an opinion on May 27, 2025.  The \nadministrative law judge found that the claimant did not prove she was \nentitled to additional temporary total disability or temporary partial disability \nbenefits.  The claimant does not appeal those findings.  The administrative \nlaw judge found that the claimant proved she sustained a compensable \nback injury as a compensable consequence of the claimant’s compensable \nleft foot injury.  The administrative law judge found that the claimant proved \n\nPEACOCK - H109939  17\n  \n \n \nshe was entitled to additional medical treatment.  The respondents appeal \nto the Full Commission.   \nII.  ADJUDICATION \n The employer shall promptly provide for an injured employee such \nmedical treatment as may be reasonably necessary in connection with the \ninjury sustained by the employee.  Ark. Code Ann. §11-9-508(a)(Repl. \n2012).  The employee has the burden of proving by a preponderance of the \nevidence that medical treatment is reasonably necessary.  Stone v. Dollar \nGeneral Stores, 91 Ark. App. 260, 209 S.W.3d 445 (2005).  Preponderance \nof the evidence means the evidence having greater weight or convincing \nforce.  Metropolitan Nat’l Bank v. La Sher Oil Co., 81 Ark. App. 269, 101 \nS.W.3d 252 (2003).  What constitutes reasonably necessary medical \ntreatment is a question of fact for the Commission.  Wright Contracting Co. \nv. Randall, 12 Ark. App. 358, 676 S.W.2d 750 (1984).   \n An administrative law judge found in the present matter, “3.  The \nClaimant has proven by the preponderance of the evidence that she is \nentitled to additional reasonable and necessary medical treatment, \nincluding a three-phase bone scan, an EMG, and a nerve conduction study \nof the left lower extremity.”  The Full Commission finds that the claimant \nproved she was entitled to additional medical treatment as currently \nrecommended by Dr. Baskin. \n\nPEACOCK - H109939  18\n  \n \n \n The parties stipulated that the claimant, who the Full Commission \nfinds was a credible witness, sustained a compensable injury to her left foot \non March 1, 2021.  The respondents initially accepted the claim and paid \nbenefits.  Dr. Johnson’s impression on March 3, 2021 was “crush injury” of \nthe left foot.  Dr. Head performed surgery in December 2021.  The claimant \nthereafter began treating with Dr. Roman.  Dr. Burks performed surgery in \nAugust 2022.  Dr. McBay reported in December 2022, “Her left foot injury \naffected her walking and ambulation and aggravated her back pain.”  Dr. \nMartin noted in January 2023 that the claimant “walks with an antalgic gait.”  \nDr. Martin performed surgery in February 2023.   \n Dr. Guastella noted in March 2023, “I do suspect that her back pain \nis related to walking in a cast/boot with scooter for nearly 2 years.”  The \nrecommendation of Savannah Bradbury, PA-C in April 2023 included a \nnerve conduction study.  An orthotic specialist in November 2023 reported \nthat the claimant “has obvious gait abnormalities due to limping.”   \n The claimant was assigned varying anatomical impairment ratings on \nJuly 20, 2023, October 2, 2023, and October 16, 2023.  The record does \nnot clearly show which rating the respondent-carrier accepted and paid.  \nPermanent impairment, which is a medical condition, is any permanent or \nanatomical loss remaining after an employee’s healing period has ended.  \nJohnson v. General Dynamics, 46 Ark. App. 188, 878 S.W.2d 411 (1994).  \n\nPEACOCK - H109939  19\n  \n \n \nThe evidence in the present matter demonstrates that the claimant reached \nthe end of a healing period no later than October 16, 2023, the latest date \nthe claimant was assessed as having a permanent anatomical impairment \nresulting from the compensable injury.  Nevertheless, it is well-settled that a \nclaimant may be entitled to ongoing medical treatment after the healing \nperiod has ended, if the medical treatment is geared toward management of \nthe claimant’s injury.  Patchell v. Wal-Mart Stores, Inc., 86 Ark. App. 230, \n184 S.W.3d 31 (2004), citing Hydrophonics, Inc. v. Pippin, 8 Ark. App. 200, \n649 S.W.2d 845 (1983).   \n In the present matter, the Full Commission finds that the claimant \nproved she was entitled to additional medical treatment as currently \nrecommended by Dr. Baskin.  Dr. Baskin opined that additional medical \ntreatment was necessary in part to treat the claimant’s chronic pain \nresulting from her compensable injury.  Reasonably necessary medical \ntreatment can include an effort to reduce symptoms of pain which result \nfrom a compensable injury.  University of Central Arkansas v. Srite, 2019 \nArk. App. 511, 588 S.W.3d 849.  Dr. Baskin’s recommendations, as stated \nin his July 22, 2024 Second Opinion, include a three-phase bone scan, an \nEMG, nerve conduction studies, and a facet block.  The Full Commission \nfinds that these treatment recommendations are reasonably necessary in \naccordance with Ark. Code Ann. §11-9-508(a)(Repl. 2012).  It is within the \n\nPEACOCK - H109939  20\n  \n \n \nCommission’s province to weigh all of the medical evidence and to \ndetermine what is most credible.  Minnesota Mining & Mfg. v. Baker, 337 \nArk. 94, 989 S.W.2d 151 (1999).  The Full Commission finds in the present \nmatter that Dr. Baskin’s treatment recommendations are sound and are \nentitled to more evidentiary weight than Dr. Roman’s conclusion that \nadditional treatment is not reasonably necessary.   \n The Full Commission also finds that the claimant’s low back \ncomplaints are causally related to the compensable injury to the claimant’s \nleft foot.  If an injury is compensable, then every natural consequence of \nthat injury is also compensable.  Hubley v. Best Western Governor’s Inn, 52 \nArk. App. 226, 916 S.W.2d 143 (1996).  The basic test is whether there is a \ncausal connection between the two episodes.  Jeter v. B.R. McGinty \nMechanical, 62 Ark. App. 53, 968 S.W.2d 645 (1998).  The burden is on the \nclaimant to establish the necessary causal connection.  Nichols v. Omaha \nSch. Dist., 2010 Ark. App. 194, 374 S.W.3d 148.  Whether there is a causal \nconnection is a question of fact for the Commission.  Jeter, supra.  In \nworkers’ compensation cases, the Commission functions as the trier of fact.  \nBlevins v. 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 \n\nPEACOCK - H109939  21\n  \n \n \nportions of the testimony it deems worthy of belief.  Farmers Co-op v. Biles, \n77 Ark. App. 1, 69 S.W.3d 899 (2002).   \n The claimant sustained a compensable crush injury to her left foot on \nMarch 3, 2021.  The claimant credibly testified that she developed low back \npain as a result of her compensable injury.  The medical evidence \ncorroborated the claimant’s testimony.  Dr. McBay noted in December \n2022, “Her left foot injury affected her walking and ambulation and \naggravated her back pain.” Dr. Martin reported in January 2023 that the \nclaimant “walks with an antalgic gait.”  Dr. Guastella stated in March 2023, \n“I do suspect that her back pain is related to walking in a cast/boot with \nscooter for nearly 2 years.”  A physician’s assistant reported in April 2023, \n“She describes worsening right-sided low back pain after having to walk \nwith the boot and using a knee scooter.”  An orthotic specialist noted in \nNovember 2023, “She has obvious gait abnormalities due to limping.”  \nFinally, Dr. Baskin expressly opined on July 22, 2024 that the claimant’s \nlumbar pain was caused by “long-term altered gait.”  The claimant in the \npresent matter proved by a preponderance of the evidence that her low \nback pain was a natural consequence of the stipulated compensable injury.  \nHubley, supra.   \n After reviewing the entire record de novo, the Full Commission finds \nthat the claimant proved she was entitled to additional medical treatment.  \n\nPEACOCK - H109939  22\n  \n \n \nThe claimant proved that Dr. Baskin’s current treatment recommendations \nwere reasonably necessary in accordance with Ark. Code Ann. §11-9-\n508(a)(Repl. 2012).  For prevailing on appeal, the claimant’s attorney is \nentitled to a fee of five hundred dollars ($500), pursuant to Ark. Code Ann. \n§11-9-715(b)(Repl. 2012).   \n IT IS SO ORDERED.   \n \n    ___________________________________ \n    SCOTTY DALE DOUTHIT, Chairman \n \n    ___________________________________ \n    M. SCOTT WILLHITE, Commissioner \n \n \n \nCommissioner Mayton dissents. \n \nDISSENTING OPINION \n \nI must respectfully dissent from the majority opinion.  In my de novo \nreview of the record, I find the claimant has not proven by a preponderance \nof the credible evidence that her purported low-back pain is a result of her \ncompensable left foot injury or met her burden of proving that she is entitled \nto additional medical treatment for the injury to her left foot. \nThe claimant suffered an admittedly compensable injury to her left foot on \nMarch 1, 2021.  The claimant contends that she sustained compensable back \ninjury as a result of her foot injury and is entitled to additional medical treatment \nfor the injury to her left foot.  After a hearing, an administrative law judge (ALJ) \n\nPEACOCK - H109939  23\n  \n \n \ndetermined that the claimant is entitled to additional medical treatment for her \nfoot injury and that she has sustained a compensable low-back injury. \nArk. Code Ann. § 11-9-508(a) requires an employer to provide an injured \nemployee with medical and surgical treatment \"as may be reasonably necessary \nin connection with the injury received by the employee.\" The claimant has the \nburden of proving by a preponderance of the evidence the additional treatment is \nreasonable and necessary.  Nichols v. Omaha Sch. Dist., 2010 Ark. App. 194, \n374 S.W.3d 148 (2010). \nWhat constitutes reasonably necessary treatment is a question of fact for \nthe Commission.  Gant v. First Step, Inc., 2023 Ark. App. 393, 675 S.W.3d 445 \n(2023).  In assessing whether a given medical procedure is reasonably \nnecessary for treatment of the compensable injury, the Commission analyzes \nboth the proposed procedure and the condition it sought to remedy.  Walker v. \nUnited Cerebral Palsy of Ark., 2013 Ark. App. 153, 426 S.W.3d 539 (2013).  \nIt is within the Commission's province to weigh all the medical evidence to \ndetermine what is most credible and to determine its medical soundness and \nprobative force.  Sheridan Sch. Dist. v. Wise, 2021 Ark. App. 459, 637 S.W.3d \n280 (2021).  \nIn weighing the evidence, the Commission may not arbitrarily disregard \nmedical evidence or the testimony of any witness.  Id.  However, the \nCommission has the authority to accept or reject medical opinions.  Williams v. \n\nPEACOCK - H109939  24\n  \n \n \nArk. Dept. of Community Corrections, 2016 Ark. App. 427, 502 S.W. 3d 530 \n(2016).  Furthermore, it is the Commission's duty to use its experience and \nexpertise in translating the testimony of medical experts into findings of fact and \nto draw inferences when testimony is open to more than a single interpretation. \nId. \nIn the present case, the claimant has undergone three surgeries \nthroughout the course of her treatment, conducted by Dr. Adam Head, Dr. Jesse \nBurks, and Dr. Robert Martin.  \nThe claimant ultimately obtained an opinion from Dr. Barry Baskin \nregarding further treatment on July 22, 2024.  In his four-page report, Dr. Baskin \noutlines the claimant’s treatment history, focusing largely on nerve pain observed \nin Dr. Head’s 2021 operative notes.  Dr. Baskin noted: \n[f]rom Dr. Head’s operative note the nerve resections \nwere branches of the superficial peroneal and deep \nperoneal very distally down into the forefoot area.  These \nmay not show up on EMG or nerve conduction studies, \nbut I still think the studies would be helpful in looking for \nobjective findings.  As well, I think she would benefit \ndiagnostically from a 3-phase bone scan.  \n \nThe claimant’s second surgery was by Dr. Burks, which included \n“peroneus brevis tendon repair to the left” as noted by Dr. Baskin in his report. \nThe third surgery performed by Dr. Martin on February 13, 2023, addressed “left \nmidfoot arthrodesis of the 1\nst\n and 2\nnd\n tarsometatarsal joints of the left foot, \nharvesting of the calcaneal autograft left foot through a separate incision, and \nopen repair of the peroneus brevis tendon left ankle.”  \n\nPEACOCK - H109939  25\n  \n \n \nIn short, the nerve issues Dr. Baskin wants to address have been treated \nover the course of this claim, and Dr. Baskin’s report does nothing to explain the \nreason to readdress these issues which have been fully explored.  Further, Dr. \nBaskin states in his report that any findings “may not show up on EMG or nerve \nconduction studies.”  \nDr. Baskin also recommends a three-phase bone scan; however, the \nclaimant has previously undergone this exact test on April 28, 2022.  This \nrevealed “no scintigraphic evidence of complex regional pain syndrome. \nDegenerative type activity along the bilateral first metasophalangeal joints \ngreater in the left than the right.”  \nNone of the claimant’s treating physicians have recommended an \nadditional bone scan, including her pain management specialist Dr. Carlos \nRoman.  In fact, Dr. Roman has opined that the claimant’s complex regional pain \nsyndrome had resolved by January 3, 2024.  Even Dr. Baskin himself believes \nthat the claimant’s pain is “more related to chronic nerve pain as a result of the \nnerve resections more than CRPS.”  \nThe studies recommended by Dr. Baskin are clearly not reasonable and \nnecessary.  The issues they seek to identify have either resolved or have been \naddressed by the claimant’s treating physicians.  Dr. Baskin is not confident that \nthese studies will result in any findings that will aid in the claimant’s treatment \n\nPEACOCK - H109939  26\n  \n \n \nand will do nothing to further the claimant’s care.  For these reasons, the \nclaimant has failed to meet her burden of proof.  \nGenerally, a specific incident injury is an accidental injury arising out of \nthe course and scope of employment caused by a specific incident identifiable by \ntime and place of an occurrence.  Ark. Code Ann. § 11-9-102(4)(A)(i).  This, \ntherefore, requires that a claimant establish by a preponderance of the evidence: \n(1) an injury arising out of and in the course of employment; (2) that the injury \ncaused internal or external physical harm to the body which required medical \nservices or resulted in disability or death; (3) medical evidence supported by \nobjective findings establishing an injury as defined in Ark. Code Ann. §11-9-\n102(16) and; (4) that the injury was caused by a specific incident identifiable by \ntime and place of occurrence.  Ark. Code Ann. § 11-9-102(4)(A)(i). \nHowever, a compensable injury may also arise as a compensable, or \nnatural, consequence of a prior specific incident injury.  If an injury is \ncompensable, then every natural consequence of that injury is also \ncompensable.  Martin Charcoal, Inc. v. Britt, 102 Ark. App. 252, 284 S.W.3d 91 \n(2008).  The basic test is whether there is a causal connection between the two \nepisodes.  Walker v. Fresenius Med. Care Holding, Inc., 2014 Ark. App. 322, 436 \nS.W.3d 164 (2014). \nThe claimant suffers from common degenerative changes to her spine.  A \nJuly 2020 X-ray of the claimant’s lumbar spine revealed narrowing at L4-5.  An \n\nPEACOCK - H109939  27\n  \n \n \nX-ray conducted on November 21, 2022, showed mild disc height loss at L4-5 \nand L5-S1.  A March 24, 2023 MRI showed mild facet arthropathy and no \nsignificant stenosis at L5-S1.  \nUpon examining the claimant, Dr. Regan Gallaher, a neurosurgeon, noted \nmild degenerative changes, no significant central canal or foraminal narrowing, \nand degenerative arthritis at L4-5.   \nDr. Baskin’s findings agree with previous assessments, finding “minimal \ndegenerative changes in her lumbar spine.”  Dr. Baskin conducted a physical \nexamination of the claimant’s lumbar spine and found no muscle spasms and \nnormal lumbar lordosis.  \nThe claimant’s statements concerning the origin of her back pain have \nbeen inconsistent.  On March 14, 2023, the claimant stated in her history to \nConway Regional Health System that her back pain began in June of 2022, well \nafter her compensable injury.  However, at the hearing, she testified that her \nback pain began in March of 2021.  \n There is no evidence in the record to support a finding that the claimant’s \nback pain has any causal connection to her compensable left foot injury.  The \nclaimant’s pain is a clear result of degenerative problems as outlined by her \ntreating physicians.  Not one of the physicians who treated the claimant has \nstated with a reasonable degree of medical certainty that her back problems are \nrelated to her compensable foot injury.  \n\nPEACOCK - H109939  28\n  \n \n \nAccordingly, for the reasons set forth above, I must dissent. \n \n \n \n    ___________________________________ \n    MICHAEL R. MAYTON, Commissioner","preview":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. H109939 WENDY PEACOCK, EMPLOYEE CLAIMANT CONWAY REGIONAL MEDICAL CENTER, EMPLOYER RESPONDENT RISK MANAGEMENT RESOURCES, INSURANCE CARRIER/TPA RESPONDENT OPINION FILED SEPTEMBER 24, 2025","fetched_at":"2026-05-19T22:29:44.015Z","links":{"html":"/opinions/full_commission-H109939-2025-09-24","pdf":"https://www.labor.arkansas.gov/wp-content/uploads/Peacock_Wendy_H109939_20250924.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/full-commission-opinions/"}}