{"id":"full_commission-H109984-2024-16-16","awcc_number":"H109984","decision_date":"2024-16-16","opinion_type":"full_commission","claimant_name":"Shauna Torrence","employer_name":"Lafayette County School District","title":"TORRENCE VS. LAFAYETTE COUNTY SCHOOL DISTRICT AWCC# H109984 December 16, 2024","outcome":"granted","outcome_keywords":["granted:1"],"injury_keywords":["back","carpal tunnel","wrist","ankle","cervical","shoulder","neck","repetitive"],"pdf_url":"https://www.labor.arkansas.gov/wp-content/uploads/Torrence_Shauna_H109984_20241616.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/full-commission-opinions/","filename":"Torrence_Shauna_H109984_20241616.pdf","text_length":46462,"full_text":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION \n \n \nCLAIM NO.  H109984  \n \nSHAUNA D. TORRENCE, \nEMPLOYEE \n \nCLAIMANT \nLAFAYETTE COUNTY SCHOOL DISTRICT,  \nEMPLOYER \n \nRESPONDENT \nARKANSAS SCHOOL BOARDS ASS’N \nWORKERS’ COMPENSATION TRUST, \nINSURANCE CARRIER/TPA \nRESPONDENT \n  \n      \nOPINION FILED DECEMBER 16, 2024 \n \nUpon review before the FULL COMMISSION in Little Rock, Pulaski County, \nArkansas. \n \nClaimant represented by the HONORABLE GREGORY R. GILES, Attorney \nat Law, Texarkana, Arkansas. \n \nRespondents represented by the HONORABLE MELISSA WOOD, Attorney \nat Law, Little Rock, Arkansas. \n \nDecision of Administrative Law Judge:  Affirmed. \n \n \n OPINION AND ORDER \nThe claimant appeals an administrative law judge’s opinion filed July \n24, 2024.  The administrative law judge found that the claimant failed to \nprove she sustained a compensable injury.  After reviewing the entire \nrecord de novo, the Full Commission finds that the claimant did not prove \nshe sustained a compensable injury.     \nI.  HISTORY \n Shauna Dorice Torrence, now age 43, testified that she became \nemployed as a bus driver for the respondents in 2004.  Ms. Torrence \n\nTORRENCE - H109984  2\n  \n \n \ntestified that she later contracted to be a custodian for the respondent-\nemployer.  The claimant testified on direct examination: \nQ.  Before you got hurt, give us a picture of the typical day for \nyourself as you would manage the bus driving activities and \nthen take on your custodial responsibilities.  What was the \ntypical time for you to get there each day? \nA.  Each day it varied.  It’s depending on how many kids I had, \nso some days it would be 5:30, some days it would be 6:00 I \nwould get there.... \nQ.  So once you would get them picked up, what time would \nyou typically get them delivered to the school? \nA.  Around 8:00.... \nQ.  Would you start your custodial duties at that point? \nA.  Yes, sir, I would.   \nQ.  And at what point in the day would you stop your custodial \nduties and then take back on the responsibility of delivering \nthe children home? \nA.  Around 2:00, 2:15.   \nQ.  So once you would get the children delivered and you \nstarted your custodial duties, on a typical day, did you have a \ngeneral routine, typically, of how you would go through the \nday? \nA.  Yes, sir. \nQ.  Could you give us a picture of that? \nA.  Pulled up all of the trash out of the classrooms.  Sweeping \nthe classrooms.  Some classrooms needed to be mopped.  \nBathrooms.  Pulling the trash up in the bathrooms.  I went \nfrom one building to – I went from the main building to the \nkindergarten building, the same thing.  Pulling up trash, \nsweeping.  If they needed mopped, I mopped.  Pulling up \ntrash in the bathrooms, cleaning those bathrooms, until it was \ntime for my bus route.   \n \n The parties stipulated that the employment relationship existed at all \npertinent times, “including October 5, 2021, the date the claimant alleges \nshe became temporarily totally disabled due to alleged work-related bi-\n\nTORRENCE - H109984  3\n  \n \n \nlateral carpal tunnel syndrome (CTS), particularly CTS, most notably in her \nright wrist/hand.” \n The claimant testified on direct examination: \nQ.  And what time of day did the event that we’re talking about \non October 5\nth\n occur, do you recall? \nA.  I know it was before lunch.  I always go over there and \nclean the bathrooms before lunch, so I’m going to say around \nabout 9:00, maybe 9:30. \nQ.  And immediately before this happened, what area of the \ncampus were you on? \nA.  I was in the cafeteria in the foyer part... \nQ.  Tell us what happened. \nA.  As I was getting ready to enter out the door, I had the door \nopen with my left, and I was pushing the cart with my right \ntrying to get it over the – It’s a metal beam there but, also, it’s \na tile kind of missing in there, and my wheel got stuck in the \ntile as I’m trying to get it over the metal part in the doorway....I \nhad the cart pushing, you know, pushing out. \nQ.  All right.  So you were, in effect, using the cart to try and \npush the door open? \nA.  Yes.  I had my arm open with the left – Opened the door \nwith the left, and I had my right hand on the cart trying to push \nit through.... \nQ.  Describe for us how you fell.   \nA.  I had my hand, my right hand on the cart trying to hold on, \nbecause I didn’t want to, you know didn’t want – I seen what \nwas fixing to happen, but I didn’t want to fall hard, so I’m still \nhanging on, but I did hit the floor.... \nQ.  Did you think you needed medical attention at that time? \nA.  No, sir. \nQ.  Were you able to complete your day and go on and return \nthe children home on the bus? \nA.  Yes, sir.... \nQ.  Did you, at some point, decide to go see a doctor with \nregard to the problems that you were having? \nA.  Yes, sir. \nQ.  At that time, what doctor did you go see? \nA.  It was Dr. Saldino.   \nQ.  And that was for the foot? \n\nTORRENCE - H109984  4\n  \n \n \nA.  Yes, sir.   \n \n According to the record, the claimant treated at Texas Foot And \nAnkle Institute on or about October 12, 2021:  “40-year-old female has \ncomplaints of pain to her left dorsal foot.  She states it is from her toes to \nher ankle.  She has a history of diabetes but describes this is a \nhypoglycemia.  She works as a bus driver.”  Dr. Michael C. Saldino \ndiagnosed “Left degenerative midfoot changes are identified with posterior \ntibial tendinous pain....I recommend Custom Molded Orthotics.” \nThe claimant presented for treatment at Christus Health on October \n18, 2021.  The Reason for Visit was reported as “left foot problem, bilateral” \nand “swelling in hands.”   \nDr. Priyal Patel reported on October 18, 2021: \n Has been hurting for years.   \nHad xrays, was given three steroid shots in her feet, was \ngiven a mold for her shoe.  Her feet still hurt.  Does a lot of \nwalking and hurts when she is walking.   \nReports burning/stinging pain.  Hasn’t had [any] labwork in the \nlast year.... \nAbnormal BMI:  Diagnosis Obesity.  Goals and care plan \ndiscussed at this visit.  Discussed current nutrition and \nphysical activity behaviors. \n \n Dr. Patel wrote on October 18, 2021, “Due to patient’s medical \nconditions, she needs to be put on light duty where she isn’t walking long \ndistances and she has sufficient break to recover between job duties.”   \n\nTORRENCE - H109984  5\n  \n \n \nDr. Saldino continued to provide follow-up treatment for pain in the \nclaimant’s left lower extremity and noted on November 1, 2021, “Removed \nfrom work for an estimated 2 months.” \nRobert Edwards, Superintendent, Lafayette County School District, \nwrote the following on November 2, 2021: \n To Whom This May Concern, \nPlease accept this letter as evidence that there are no “light \nduty” options for Mrs. Torrence within the scope of her job \nduties as bus driver or custodian.   \nIn the event documentation is needed, please feel free to \ncontact me at your convenience.   \n \n The claimant followed up with Dr. Patel on November 30, 2021: \nShauna was seen today for wants (sic) to go over echo report \nand hands hurt bad right hand hurts worse, can’t hold \nanything with both of her hands and cannot even braid her \ndaughter’s hair.  Gabapentin is not helping the pain.  Also \ncomplains of dyspnea on minimal exertion.  Echo of the \npatient is normal.  Patient is wanting to see pulmonology.  \nReports that she used to clean and all the inhalation of the \nchemicals could have caused her lung issues.... \nAdvised patient to wear a wrist splint.  We will order her a \nnerve conduction study and start her on Lyrica for the pain.  \nWe will refer her to pulmonology for her shortness of breath \nand give her albuterol inhaler in the meantime.  We will start \nher on glimepiride for her diabetes and recheck back in 3 \nmonths.   \n \n Dr. Patel diagnosed “Type 2 diabetes mellitus without complication, \nwithout long-term current use of insulin (HC Category),” “Bilateral hand \nnumbness,” and “Dyspnea on minimal exertion.”   \nDr. Saldino reported on January 3, 2022: \n\nTORRENCE - H109984  6\n  \n \n \n[She] states that she is getting a neurological testing for her \nhands and feet as she is concerned that there may be a \ncarpal tunnel syndrome.  Both the feet and the hands are \npainful and are keeping her up at night.  She states her feet \nhave become so painful that she cannot do basic housework.  \nApparently there is some type of Worker’s Compensation \nclaim.  She indicates she is wearing the boot on a regular \nbasis.  As her pain has not improved.... \nHer clinical response has been very limited and not what I \nwould anticipate to date.  I am concerned that much of this \nmay be more of a neurological problem since it is occurring in \nher hands as well.  This may be related to her diabetes which \nshe says is well controlled.  For the time being we can \nmaintain the current treatment plan and had MRI imaging to \nsee if this changes the treatment plan at all.   \n \n The claimant signed a Form AR-N, EMPLOYEE’S NOTICE OF \nINJURY, on or about January 6, 2022.  The claimant appeared to write in \nthe ACCIDENT INFORMATION section of the Form AR-N that the Date of \nAccident was October 5, 2021, and that she injured her “left foot and right \nhand.”  The claimant described the cause of injury:  “trying to push the cart \nout of cafeteria door.\"   \n The claimant provided a recorded statement on January 7, 2022.  \nMelody Tipton with the Arkansas School Boards Association questioned the \nclaimant: \n  Q.  And you’re employed with what school district? \n  A.  Lafayette County School District. \n  Q.  Which campus or department do you work at? \n  A.  The lower elementary.... \n  Q.  What is your job title with the school district? \n  A.  I’m a bus driver and a custodian.... \nQ.  Alright, we’re going to talk about your incident now.  Do \nyou remember the date and the time?   \n\nTORRENCE - H109984  7\n  \n \n \nA.  The date was on the 5\nth\n, October the 5\nth\n. \nQ.  And what time? \nA.  Around between 9 to 9:30, I don’t remember.  I wasn’t \nlooking at the clock.  I don’t remember exactly what time it \nwas.  The only thing I can tell you, it was before lunch, \nbecause (inaudible).   \nQ.  Okay.  About what time had you started working that day? \nA.  At 5:30.   \nQ.  And where were you when this incident happened?  Be \nspecific, if you were in a hallway, tell me what hallway. \nA.  No I was in the foyer part over there in the cafeteria.   \nQ.  What were you doing at the time? \nA.  At the time, I was trying to get the car (sic) out of the, to \npush the cart out of the door.  I was leaving, I had finished \ncleaning up, and I had, had the door with my left one and I \nwas trying to push it with my right one, trying to get the door, \ntrying to get my cart out the door. \nQ.  And what happened? \nA.  It’s a metal part, between the two glass doors, and I was \ntrying to get it over there, trying to get the cart over that metal \npart.  And I don’t know what happened, only thing I can tell \nyou, I went to do that and that’s when I went down, and I had \nthe cart with my right one, trying to hold.  I didn’t want to fall \nand hurt myself.   \nQ.  So you said you fell? \nA.  No, I tried to keep from falling....my left feet (sic) gave out \non me. \nQ.  So the part of your body that was injured was your left \nfoot? \nA.  My left foot and my right hand.... \nGG:  Explain to us how you hurt your right hand.  What is you \nthink you did on your right hand? \nA. I was trying to keep myself....I had my right hand trying to \npush the buggy out.  I don’t know if I put a lot of weight, I don’t \nknow what I done, ma’am, but I was pushing the cart with my \nright hand.... \nGG:  So you were grabbing with your right hand to your cart to \nhold on to keep from falling? \nA.  Yes, to keep from hurting myself real bad.  That’s \nconcrete.  And I kept just, trying to keep myself from just \nfalling.   \n \n\nTORRENCE - H109984  8\n  \n \n \n The record contains a report from Wadley Regional Medical Center \nNeurophysiology Laboratory dated January 18, 2022: \nPatient c/o pain, numbness and tingling in her hands, right \nhand being worse.  Patient has PMH of diabetes.  No PMH of \nhypothyroidism or B12 deficiency.... \nBilateral median, ulnar and radial sensory nerve conduction \nstudies were normal.   \nBilateral ulnar digital sensory nerve conduction studies \nshowed no response.   \nRight medial digital sensory nerve conduction study showed \nprolonged latency. \nLeft median digital sensory nerve conduction study showed no \nresponse.   \nBilateral median and ulnar motor nerve conduction studies \nwere normal. \nBilateral median F-wave studies were normal.   \n \n Dr. Khalid Malik gave the following impression on January 18, 2022:  \n“Bilateral ulnar digital and median digital nerve lesions.”   \n Sara Moreno, CCMA, a representative of Christus Health, stated on \nJanuary 18, 2022: \nDue to patient’s medical conditions and since there is not \n“light duty” offered in scope of job duties.  She needs to be off \nof work due to not being able to walk long distances, and \nneeding to have sufficient breaks to recover between job \nduties.   \n \n An MRI of the claimant’s left foot was taken on January 20, 2022 \nwith the impression, “Mild degenerative changes and small adjacent \nganglion noted at the level of the third and fourth TMT joints.  Otherwise, \nthere is negative without posttraumatic pathology noted.”  \n Dr. John Camp examined the claimant on February 14, 2022: \n\nTORRENCE - H109984  9\n  \n \n \nThis is a 40-year-old right-hand dominant female who is a \npatient of Dr. Patel, as well as a Dr. Malik.  Ms. Torrence \nrelates she took a fall back sometime in October of this past \nyear onto her outstretched right hand.  She has had some \npain, swelling, numbness, and tingling dating back to that \nincident.  She has tried bracing both day and night and anti-\ninflammatories including some Lyrica and gabapentin for \nnerve type symptoms.  She also does use [an] asthma inhaler \nas necessary.   \nMs. Torrence did have a nerve study accomplished by Dr. \nMalik after being seen by her primary care provider, Dr. Patel.  \nThis did show evidence of a right-sided carpal tunnel \nsyndrome.... \nX-rays of her right wrist taken today are within normal \nparameters.  No significant arthrosis.  Carpal alignment is \nsatisfactory.   \n \n Dr. Camp assessed “Right carpal tunnel syndrome, significant.  Rule \nout cervical radiculopathy.  PLAN:  My recommendation is to consider a \nsurgical course for right carpal tunnel release when she is so inclined.”   \n Dr. Gregory Ardoin noted on March 28, 2022, “Shauna Torrence is a \n40 year old Female who presents to discuss concerns about their Foot/toe, \nthat began on 10/05/2021.  Patient has pain on the top of the foot primarily \non the left side.  She states she somehow slipped and caused a problem \nback in October 2021 she did not remember exactly what she did their foot \n(sic).”  Dr. Ardoin examined the claimant’s upper extremities and reported, \n“Full range of motion of shoulder elbow, wrist, and digits \nbilaterally....Impression:  Left foot pain and likely early midfoot arthritis.”  Dr. \nArdoin assessed “1.  Pain in left foot” and “2.  Body mass index 46+ - \nseverely obese.”      \n\nTORRENCE - H109984  10\n  \n \n \n Dr. Camp performed a procedure on April 7, 2022:  “Right carpal \ntunnel release.”  The pre- and post-operative diagnosis was “1.  Right \ncarpal tunnel syndrome, severe.  2.  Morbid obesity.”  The claimant testified \nwith regard to surgery performed by Dr. Camp, “It helped a little bit,” that \nsurgery relieved the numbness in her right hand.     \n The record indicates that the respondents terminated the claimant’s \nemployment contract effective April 30, 2022. \n Dr. Gregory Smolarz noted on January 10, 2023: \nThis is a 41 y.o. female who presents for left hand pain.  \nPatient reports that she has a history of a carpal tunnel \nrelease of her right hand after patient developed carpal tunnel \nsyndrome after a fall in which she landed on her right hand \nabout a year ago.  Patient says that she has been having left \nhand pain most recently with numbness and tingling that is \nsimilar to how her right hand (sic).  She mentions the left hand \npain and numbness started some time after her right hand.  \nHer right hand is no longer having numbness or tingling.  It \nstill has pain and swelling at times.  Patient says that her left \nhand has numbness and tingling that wakes her up at night at \ntimes.... \nThe Nerve Conduction Study of the bilateral hand was \nreviewed and the findings indicate bilateral ulnar and digital \nand median digital lesions.   \n \n Dr. Smolarz assessed “1.  Carpal tunnel syndrome of left wrist.  2.  \nCarpal tunnel syndrome of right wrist.”  Dr. Smolarz recommended \nconservative treatment.   \n Dr. Patrick O’Brien examined the claimant at UAMS on June 29, \n2023 and diagnosed the following:  “42 y.o. female with possible right hand \n\nTORRENCE - H109984  11\n  \n \n \ncomplex regional pain syndrome following carpal tunnel release by outside \nsurgeon, untreated left carpal tunnel syndrome.”  Dr. O’Brien planned \nadditional electrodiagnostic testing.   \n The claimant followed up at UAMS with Dr. John Bracey on August \n30, 2023: \nPatient is a 42-year-old who returns today for follow-up \nevaluation of her bilateral upper extremities.  She has a \nhistory of numbness and tingling in both upper extremities.  \nShe had previously undergone treatment for carpal tunnel \nsyndrome with a carpal tunnel release [in] 2021.  She again \nreports that that did not really help any of her symptoms.  She \ncontinues to have numbness in both hands which is worse in \nthe right side.  Involves all 5 fingers on the right and just the \nmiddle, index, and thumb of the left.  She also says she has \ntrouble with numbness and pain in the legs which is actually \nworse on the left side.  She complains of neck and back \npain.... \nNerve test:  Today we reviewed and personally interpreted the \nrecent nerve test done by Dr. Chesser.  On the motor nerve \nconduction study appears to be normal conduction of both the \nmedian and ulnar nerves bilaterally.  On sensory nerve \nconduction there is very mildly increased or prolonged distal \nlatency in the median nerves across the wrist.  The EMG is \nnormal.  Study is consistent with some very mild to minimal \ncarpal tunnel syndrome.... \nToday I had a long discussion with the patient.  We did review \nthe nerve test in detail together.  I explained that I do believe \nsome of her symptoms are likely secondary to some \nperipheral nerve compression at the carpal tunnel and cubital \ntunnel but this appears to be very mild.  I explained that I do \nnot think it would fully explain the type of pain that she is \nhaving.  I explained [it’s] possible she has a double crush \nphenomenon with additional irritation of the cervical spine \nlevel which could cause similar symptoms.  I recommend that \nshe be evaluated by one of our nonoperative partners for \nevaluation of her neck and they can also evaluate her back \n\nTORRENCE - H109984  12\n  \n \n \nwhich may be contributing to her lower back pain and lower \nextremity numbness.     \n \n Dr. Bracey’s impression was “Bilateral upper extremity numbness \nand pain.” \n The claimant’s attorney corresponded with a representative of the \nCommission on October 3, 2023: \nThis letter is to advise you that I have agreed to represent and \nassist Ms. Torrence as a result of bilateral carpal tunnel \ninjuries sustained on October 5, 2021, or in the alternative, as \na result of the rapid repetitive nature of her work with the \nLafayette County School District during the course of her \nemployment.  I am attaching the Form AR-C on her behalf.   \n \n The claimant signed a Form AR-C, CLAIM FOR COMPENSATION, \non October 3, 2023.  The ACCIDENT INFORMATION section of the Form \nAR-C indicated that the Date of Accident was October 5, 2021.  The cause \nof injury was “Carpal Tunnel Syndrome – Bilateral.”       \n A pre-hearing order was filed on December 11, 2023.  According to \nthe text of the pre-hearing order, the claimant contended, “The claimant \ncontends she sustained bilateral CTS injuries which culminated in disability \non or about October 5, 2021, or alternatively, as a result of her rapid, \nrepetitive work-related activities performed at the school district since 2004.  \nShe contends the applicable S/L does not barr (sic) her claim for CTS in her \nleft wrist/hand.  The claimant further contends she is entitled to TTD \nbenefits from on or about January 18, 2022, through on or about June 30, \n\nTORRENCE - H109984  13\n  \n \n \n2022, for treatment associated with her right wrist/hand.  Furthermore, the \nclaimant contends she is entitled to TTD benefits for treatment associated \nwith the left wrist/hand beginning on or about January 10, 2023, until she \nwas seen by Dr. Cassatt for evaluation on a date certain in 2023 (the \nclaimant has requested these related records).  The claimant contends the \nrespondents are responsible for payment of her medical treatment and \nrelated out-of-pocket expenses for her bilateral CTS, as such treatment is \nrelated to and reasonably necessary in light of the work-related bilateral \nCTS injuries.  The claimant contends she has sustained permanent \nanatomical impairment to both her left and right wrist/hand as a result of \nthese bilateral CTS injuries; however, she specifically reserves this issue \npending the Commission’s decision of the threshold compensability issue.  \nThe claimant reserves any and all other issues for future determination \nand/or litigation.”   \n The parties stipulated that the respondents “controvert this claim in \nits entirety.”  The respondents contended, “The respondents contend the \napplicable S/L barrs (sic) her CTS claim in her left wrist/hand.  Furthermore, \nthe respondents contend the claimant cannot meet her burden of proof \npursuant to the Act in demonstrating she sustained CTS in either her right \nwrist/hand and/or her left wrist/hand, which culminated in alleged disability \non or about October 5, 2021, or at any other time while she was working \n\nTORRENCE - H109984  14\n  \n \n \nwith the respondents.  Significantly, the respondents contend the claimant \ndid not provide them the statutorily required notice of any alleged right \nwrist/hand CTS injury until the the (sic) Form AR-C was filed on her behalf \non January 5, 2022.  In addition, the respondents contend the claimant also \nfailed and/or refused to provide them the legally required notice of any \nalleged left wrist/hand CTS injury until October 26, 2023, the date she filed \nher initial Response to Prehearing Questionnaire.  If the claimant’s \ninjury(ies) is (are) deemed compensable, the respondents contend the \nclaimant received both short and long-term disability (STD, and LTD, \nrespectively) benefits and, therefore, pursuant to Ark. Code Ann. Section \n11-9-411 (2023 Lexis Replacement), they are entitled to a dollar-for-dollar \noffset/credit.  Finally, the respondents contend the claimant’s need for \nmedical treatment, if any, is related to her diabetes mellitus and not any \nacute or gradual injury.  The respondents reserve the right to supplement \ntheir contentions and assert any and all other applicable defenses and \narguments upon the completion of necessary investigation and discovery.  \nThe respondents reserve any and all other issues for future determination \nand/or litigation.”   \n The parties agreed to litigate the following issues: \n1. Whether the claim for the claimant’s left wrist CTS is \nbarred by the applicable statute of limitations (S/L). \n2. Whether the claimant sustained compensable bilateral \nCTS injuries, particularly in her right wrist/hand, within the \n\nTORRENCE - H109984  15\n  \n \n \nmeaning of the Arkansas Workers’ Compensation Act (the \nAct) which allegedly culminated in disability on or about \nOctober 5, 2021. \n3. If the claimant’s alleged bilateral CTS is deemed \ncompensable, the extent to which she is entitled to medical \nand indemnity benefits, specifically TTD benefits from on \nor about January 18, 2022, through on or about June 30, \n2022, for treat (sic) related to her right wrist/hand; and \nfrom on or about January 10, 2023, until at least March 7, \n2023, with respect to her left wrist/hand.   \n4. Whether the claimant’s attorney is entitled to a \ncontroverted fee on these facts.   \n5. The parties specifically reserve any and all other issues for \nfuture determination and/or litigation.   \n \nA hearing was held on April 25, 2024.  At that time, the respondents \nwithdrew their statute of limitations defense.  The claimant testified on direct \nexamination: \nQ.  So we’re here today because you are alleging the \nsymptoms with regard to your hands, the right that you’ve had \nsurgery on and the left that you didn’t, you believe occurred as \na result of your work-related activities there at the school \ndistrict.  Why do you think the school should be responsible \nfor your hand problems? \nA.  Yes, sir.  The reason why I think is if it wasn’t from the fall, \nit was the day-to-day activity I had to do, the repetitive on my \njob.   \nQ.  When you say repetitive activities, what are you talking \nabout? \nA.  The sweeping, the mopping, the dusting, the everyday \nthings that I did, vacuuming.   \nQ.  What was the pace of the performance of those activities \nas you would do those from day to day and as you went from \nbathroom to bathroom and building to building? \nA.  I tried to do them as quickly as possible.   \nQ.  Had you had any problems with your hands before \nOctober 5\nth\n? \nA.  No, sir.   \n \n\nTORRENCE - H109984  16\n  \n \n \n An administrative law judge filed an opinion on July 24, 2024.  The \nadministrative law judge found that the statute of limitations did not bar the \nclaim.  The respondents do not appeal that finding.  The administrative law \njudge found that the claimant failed to prove she sustained a compensable \ninjury.  The administrative law judge therefore denied and dismissed the \nclaim.  The claimant appeals to the Full Commission. \nII.  ADJUDICATION \nA.  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(ii)  An injury causing internal or external physical harm to the \nbody and arising out of and in the course of employment if it is \nnot caused by a specific incident or is not identifiable by time \nand place of occurrence, if the injury is: \n(a) Caused by rapid repetitive motion.  Carpal tunnel \nsyndrome is specifically categorized as a compensable \ninjury falling within this definition[.]... \n \nA compensable injury must also be established by medical evidence \nsupported by objective findings.  Ark. Code Ann. §11-9-102(4)(D)(Repl. \n2012).  “Objective findings” are those findings which cannot come under the \nvoluntary control of the patient.  Ark. Code Ann. §11-9-102(16)(A)(i)(Repl. \n2012).   \n\nTORRENCE - H109984  17\n  \n \n \nArk. Code Ann. §11-9-102(4)(Repl. 2012) further provides, in \npertinent part: \n(E)  BURDEN OF PROOF.  The burden of proof of a \ncompensable injury shall be on the employee and shall be as \nfollows: \n(i)  For injuries falling within the definition of compensable \ninjury under subdivision (4)(A)(i) of this section, the burden of \nproof shall be a preponderance of the evidence; or  \n(ii)  For injuries falling within the definition of compensable \ninjury under subdivision (4)(A)(ii) of this section, the burden of \nproof shall be by a preponderance of the evidence, and the \nresultant condition is compensable only if the alleged \ncompensable injury is the major cause of the disability or need \nfor treatment.   \n \n Preponderance of the evidence means the evidence having greater \nweight or convincing force.  Metropolitan Nat’l Bank v. La Sher Oil Co., 81 \nArk. App. 269, 101 S.W.3d 252 (2003).  “Major cause” means “more than \nfifty percent (50%) of the cause,” and a finding of major cause shall be \nestablished according to the preponderance of the evidence.  Ark. Code \nAnn. §11-9-102(14)(Repl. 2012).      \n1.  Alleged Specific Incident \n An administrative law judge found in the present matter, “3.  The \nclaimant has failed to meet her burden of proof that she has sustained \neither a specific incident or a gradual onset compensable injury to either or \nboth her right or left wrist.”  It is the duty of the Full Commission conduct our \nown fact-finding independent of that done by an administrative law judge.  \nCrawford v. Pace Indus., 55 Ark. App. 60, 929 S.W.2d 727 (1996).  The Full \n\nTORRENCE - H109984  18\n  \n \n \nCommission enters its own findings in accordance with the preponderance \nof the evidence.  Tyson Foods, Inc. v. Watkins, 31 Ark. App. 230, 792 \nS.W.2d 348 (1990).   \n In the present matter, the Full Commission finds that the claimant did \nnot prove she sustained a compensable injury to her left upper extremity or \nright upper extremity in accordance with Ark. Code Ann. §11-9-\n102(4)(A)(i)(Repl. 2012).  The claimant testified that she became employed \nwith the respondents, Lafayette County School District, in 2004.  The \nclaimant testified that she worked for the respondents as a bus driver and \ncustodian.  The parties stipulated that the employment relationship existed \non October 5, 2021.  The claimant testified that she was pushing a cart that \nday in the respondent-employer’s cafeteria.  The claimant testified that, \nwhile attempting to push the cart through a door, she fell and injured her \nright hand. \n The Commission may accept only those portions of the testimony \nthat it determines are worthy of belief.  Tucker v. Roberts-McNutt, Inc., 342 \nArk. 511, 29 S.W.3d 706 (2000).  Based on the record in the present \nmatter, the Full Commission finds that the claimant was not a credible \nwitness.  The evidence of record does not corroborate the claimant’s \ntestimony that she injured either her right hand or left hand on October 5, \n2021.  The claimant first sought medical treatment on October 12, 2021.  \n\nTORRENCE - H109984  19\n  \n \n \nThe claimant reported pain in her left dorsal foot but did not inform the \nmedical provider that she had injured her right hand or left hand.  The \nclaimant treated at Christus Health on October 18, 2021.  The claimant \nreported swelling in her hands but did not report an accidental injury \ncausing physical harm to the her right or left hand.  Dr. Patel diagnosed \n“Obesity” at that time but did not report a work-related injury allegedly \noccurring on October 5, 2021.  Dr. Patel instead noted that the claimant \n“Has been hurting for years.”     \n Dr. Saldino first noted a possible diagnosis of carpal tunnel \nsyndrome on January 3, 2022.  Dr. Saldino did not causally relate this \ndiagnosis to an accidental injury allegedly occurring on October 5, 2021.  \nThe evidence of record does not corroborate the claimant’s assertion on the \nJanuary 6, 2022 Form AR-N that she injured her right hand while “trying to \npush the cart out of cafeteria door.”  Nor does the evidence corroborate the \nclaimant’s recorded statement given on January 7, 2022 that she injured \nher right hand while “pushing a cart.”  The claimant informed Dr. Camp on \nFebruary 14, 2022 that she had fallen “onto her outstretched right hand” in \nOctober 2021.  Dr. Camp assessed “Right carpal tunnel syndrome, \nsignificant” and subsequently performed a right carpal tunnel release.  \nNevertheless, the Commission is entitled to review the basis for a doctor’s \nopinion in deciding the weight and credibility of the opinion and medical \n\nTORRENCE - H109984  20\n  \n \n \nevidence.  Swift-Eckrich, Inc. v. Brock, 63 Ark. App. 118, 975 S.W.2d 857 \n(1998).  In the present matter, there is no probative evidence demonstrating \nthat Dr. Camp’s assessment of “Right carpal tunnel syndrome” was causally \nrelated to an accidental injury allegedly occurring on October 5, 2021.   \n The Full Commission finds that the claimant did not prove by a \npreponderance of the evidence that she sustained a “compensable injury” \nin accordance with Ark. Code Ann. §11-9-102(4)(A)(i)(Repl. 2012).  The \nclaimant did not prove that she sustained an accidental injury causing \ninternal or external physical harm to the right hand or left hand.  The \nclaimant did not prove that she sustained an injury which arose out of and \nin the course of employment, required medical services, or resulted in \ndisability.  The claimant did not prove that she sustained an injury which \nwas caused by a specific incident or was identifiable by time and place of \noccurrence on or about October 5, 2021.  We therefore affirm the \nadministrative law judge’s finding that the claimant failed to prove she \nsustained a compensable injury. \n2.  Alleged Gradual Onset     \nAn administrative law judge found, “3.  The claimant has failed to \nmeet her burden of proof that she has sustained either a specific incident or \na gradual onset compensable injury to either or both her right or left wrist.”  \nThe Full Commission affirms this finding.  Carpal tunnel syndrome is \n\nTORRENCE - H109984  21\n  \n \n \nspecifically categorized as a compensable injury falling within the definition \nof rapid repetitive motion.  Ark. Code Ann. §11-9-102(4)(A)(ii)(a)(Repl. \n2012).  Therefore, the claimant is not required to prove that her bilateral \ncarpal tunnel condition was caused by rapid repetitive motion.  See Kildow \nv. Baldwin Piano & Organ, 333 Ark. 335, 969 S.W.2d 190 (1998).  The \nclaimant is, however, required to prove by a preponderance of the evidence \nthat the bilateral carpal tunnel condition arose out of and in the course of \nemployment, and that the alleged compensable injury was the major cause \nof the disability or need for treatment.  Ark. Code Ann. §11-9-\n102(4)(A)(ii)(Repl. 2012); Ark. Code Ann. §11-9-102(4)(E)(ii)(Repl. 2012).  \nIn the present matter, the claimant did not prove that the diagnosed \ncondition of bilateral carpal tunnel syndrome arose out of and in the course \nof the claimant’s employment with the respondents.  The evidence does not \ndemonstrate that the claimant sustained bilateral carpal tunnel syndrome as \na result of her custodial duties with the respondents.  The record does not \nshow that the duties described by the claimant, which including cleaning, \nsweeping, and mopping, caused bilateral carpal tunnel syndrome.  Nor \ndoes the evidence demonstrate that the alleged compensable injury was \nthe major cause of the claimant’s disability or need for treatment.  Dr. Patel \nreported in October 2021 that the claimant had been “hurting for years,” but \nDr. Patel diagnosed “Obesity” rather than an alleged compensable gradual \n\nTORRENCE - H109984  22\n  \n \n \ninjury causing harm to the claimant’s hands.  Dr. Patel noted in November \n2021 that the claimant was experiencing “bilateral hand numbness,” but he \ndiagnosed “Type 2 diabetes mellitus” rather than a compensable injury.  In \naddition, Dr. Ardoin’s assessment in March 2022 included “2.  Body mass \nindex 46+ - severely obese.”   \nThe Full Commission finds that the claimant did not prove by a \npreponderance of the evidence that she sustained a “compensable injury” \nin accordance with Ark. Code Ann. §11-9-102(4)(A)(ii)(Repl. 2012).  The \nclaimant did not prove that she sustained an injury causing internal or \nexternal physical harm to the body which arose out of and in the course of \nemployment.  Nor did the claimant prove that the alleged compensable \ninjury was the major cause of the disability or need for treatment.         \nAfter reviewing the entire record de novo, the Full Commission finds \nthat the claimant did not prove by a preponderance of the evidence that she \nsustained a compensable injury in accordance with Ark. Code Ann. §11-9-\n102(4)(A)(i)(Repl. 2012).  The claimant did not prove by a preponderance of \nthe evidence that she sustained a compensable injury in accordance with \nArk. Code Ann. §11-9-102(4)(A)(ii)(Repl. 2012).  We therefore affirm the \nadministrative law judge’s finding that the claimant failed to prove she \nsustained a compensable injury, and this claim is respectfully denied and \ndismissed.   \n\nTORRENCE - H109984  23\n  \n \n \nIT IS SO ORDERED. \n \n    ___________________________________ \n    SCOTTY DALE DOUTHIT, Chairman \n \n    ___________________________________ \n    MICHAEL R. MAYTON, Commissioner \n \n \nCommissioner Willhite dissents. \n \nDISSENTING OPINION \n  The Administrative Law Judge (hereinafter referred to as “ALJ”) \nfound that the Claimant failed to prove she sustained a compensable carpal \ntunnel injury.  After conducting a thorough review of the record, I disagree.  \nI would rule in favor of the Claimant as she has proved by a preponderance \nof the evidence that she sustained a compensable carpal tunnel injury to \nboth of her wrists and is entitled to reasonable and necessary medical \ntreatment for her compensable wrist injuries and temporary total disability \nfrom January 18, 2022, until May 20, 2022. \nA. Claimant sustained a compensable carpal tunnel injury to both of \nher wrists.  \n \nTo establish a compensable injury by a preponderance of the \nevidence the Claimant must prove: (1) an injury arising out of and in the \ncourse of employment; (2) that the injury caused internal or external harm \nto the body which required medical services or resulted in disability or \n\nTORRENCE - H109984  24\n  \n \n \ndeath; (3) medical evidence supported by objective findings, as defined in \nArk. Code Ann. §11-9-102(16), establishing the injury; and (4) that the injury \nwas caused by a specific and identifiable time and place of occurrence. \nAlternatively, a compensable injury can develop over a period of time or \nresult from rapid repetitive motion.  Ark. Code Ann. § 11-9-102(4)(A)(ii)(a).  \nCarpal tunnel syndrome is specifically categorized as a compensable injury \nfalling within this definition.  Id.  Proof of rapid and repetitive motion by a \nClaimant is not required as carpal tunnel syndrome is both compensable \nand falls within the definition of rapid repetitive movement.  Kildow v. \nBaldwin Piano & Organ, 333 Ark. 35, 969 S.W.2d 190 (1998).  A \ncompensable injury must be established by medical evidence supported by \nobjective findings and medical opinions addressing compensability must be \nstated within a degree of medical certainty. Smith-Blair, Inc. v. Jones, 77 \nArk. App. 273, 72 S.W.3d 560 (2002).  Further, an injury resulting from \nsomething other than a specific incident must be shown to be the major \ncause of the disability or need for treatment.  Ark. Code Ann. § 11-9-\n102(4)(E)(ii).  Although objective medical findings are required to establish \nthe existence and extent of an injury, objective medical findings are not \nrequired to establish causation. Springfield Grocer Co. v. Chaulsett, 2023 \nArk. App. 53, 659 S.W.3d 731 (2023).  Causation often comes down to a \n\nTORRENCE - H109984  25\n  \n \n \ndecision on the credibility of the Claimant; medical evidence on causation is \nnot required in every case.  Id.  \n The Claimant began working as a bus driver for the Respondent in \n2004, and later took on additional contract duties as a custodian.  According \nto her testimony, Claimant cleaned approximately twenty classrooms a day.  \nHer duties included wiping down the desks and sweeping and mopping the \nfloor of each of her assigned classrooms.  Further, Claimant cleaned \napproximately fifteen bathrooms a day which included wiping down the \nbathroom and sweeping and mopping the floors.  On October 5, 2021, \nClaimant tripped and fell while working for the Respondent when she was \npushing her janitorial cart into the school.  Claimant landed on her right arm \nand left leg. Claimant was initially seen by Dr. Priyal Patel who diagnosed \nClaimant with a left foot problem and bilateral swelling in her hands.  On \nNovember 30, 2021, Dr. Patel ordered a nerve conduction study for \nClaimant’s hands.  The nerve conduction study was performed on January \n18, 2022 and showed bilateral ulnar digital and median digital nerve lesions. \nFrom these results, Claimant was diagnosed with right-sided carpal tunnel \nsyndrome by Dr. John Camp on February 14, 2022.  Dr. Camp \nrecommended a right carpal tunnel release surgery for Claimant which was \nperformed on April 7, 2022. On January 10, 2023, the Claimant was also \n\nTORRENCE - H109984  26\n  \n \n \ndiagnosed with carpal tunnel syndrome of the left wrist for which \nconservative treatment was recommended.  \n Claimant was employed with the Respondent for approximately \nseventeen years, and worked in a capacity where she regularly used her \nupper extremities during the majority of her job duties.  The credible \nevidence suggests that she was physically able to perform those duties \nwithout significant difficulties until the work accident on October 5, 2021.  \nFollowing this work accident the Claimant began to experience swelling and \npain in both of her hands, with more symptoms in the right hand.  The \nrecord contains no reasonable explanation for these symptoms other than \nthe Claimant’s work duties and the October 5, 2021 work incident.  \nCarpal  tunnel  syndrome  is  specifically  defined  as  a  compensable \ninjury, regardless of whether it was caused by specific injury or gradually over \ntime.  In this situation, I find that the work accident of October 5, 2021 may \nhave played some part in the process, but that the Claimant’s duties of \nconstantly using her arms and hands at work over seventeen years resulted \nin the development of carpal tunnel in both of her wrists.  Further, I find that \nClaimant’s employment duties were the major cause of her disability  and \nneed for medical treatment.  Therefore, based upon the credible evidence in \nthe  record  I  would  rule  that  the  Claimant  sustained  compensable  gradual \nonset injuries to both of her wrists.  \n\nTORRENCE - H109984  27\n  \n \n \nB. Claimant   is   entitled   to   additional   medical   treatment   for   her \ncompensable wrist injuries.  \n \nAn 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).  The \nclaimant bears the burden of proving that she is entitled to additional \nmedical treatment.  Dalton v. Allen Eng’g Co., 66 Ark. App. 201, 989 \nS.W.2d 543 (1999).   What constitutes reasonable and necessary medical \ntreatment is a question of fact for the Commission.  White Consolidated \nIndus. v. Galloway, 74 Ark. App. 13, 45 S.W.3d 396 (2001); Wackenhut \nCorp. v. Jones, 73 Ark. App. 158, 40 S.W.3d 333 (2001).  \nIn the present case, the Claimant has a compensable injury to both \nof her wrists in the form of carpal tunnel syndrome.  I find this treatment is \nreasonable and necessary for the Claimant’s compensable right wrist injury.  \nClaimant has had her right wrist treated in the form of carpal tunnel release \nsurgery.  Claimant’s physician, Dr. Gregory Smolarz, diagnosed the \nClaimant with left-sided carpal tunnel syndrome and recommended \nconservative treatment.  \nI  further  find  that  the  Claimant  is  entitled  to  treatment  for  her \ncompensable left-wrist carpal tunnel syndrome and that this recommended \ntreatment is reasonably necessary in connection with the injury received by \nthe Claimant.  \n\nTORRENCE - H109984  28\n  \n \n \nC. Claimant is entitled to temporary total disability from January 18, \n2022, until May 20, 2022.  \n \nTemporary   total   disability   benefits   are   appropriate   where   the \nemployee  remains  in  the  healing  period  and  is  totally  incapacitated  from \nearning wages.  Ark. State Highway Dep’t v. Breshears, 272 Ark. 244, 613 \nS.W.2d 392 (1981).  \nOn  October  18,  2021,  Dr.  Patel  placed  Claimant  on  light-duty  work \nrestrictions.  The note mentions the need to avoid walking long distances and \ncould have a connection to the Claimant’s left foot complaints.  Following this, \nSuperintendent  Robert  Edwards  of  the  Lafayette  County  School  District \nwrote a letter stating that there “are no ‘light duty’ options for Mrs. Torrence \nwithin the scope of her job duties as bus driver or custodian.” On January 18, \n2022, an EMG test was conducted which demonstrated abnormalities in both \nof the Claimant’s wrists.  On this same day, Claimant’s off work status was \nreiterated by Sara Moreno, CCMA due to the Claimant’s “medical conditions” \nand   because   light   duty   was   not   available   to   the   Claimant   with   the \nRespondents.  Claimant  then  underwent  a  right  carpal  tunnel  release \nperformed  by  Dr.  Camp  on  April  7,  2022.  Dr.  Camp  released  Claimant  to \nreturn to normal use of her right hand on May 20, 2022.  \nBased upon the credible evidence in the record, I would rule that the \nClaimant  is  entitled  to  temporary  total  disability  benefits  from  January  18, \n2022, until May 20, 2022.  \n\nTORRENCE - H109984  29\n  \n \n \nD. The claim for benefits for the injury to Claimant’s left wrist is not \nbound by the statute of limitations.  \n \nThe Respondent’s argue that they lacked appropriate notice in \naccordance with Ark. Code Ann. § 11-9-701 and that the claim is barred by \nthe statute of limitations under Ark. Code Ann. § 11-9-702.  However, both \nof these arguments lack merit.  Claimant was injured on October 5, 2021.  \nThe Claimant testified that she informed her supervisor, Mr. Crank, and Mr. \nCranks’ secretary, Ms. Roxanne, immediately after the work incident. \nClaimant then filed an AR-C on October 21, 2021, informing the \nRespondent that the injury occurred on October 5, 2021.  The Claimant also \ntestified that she provided her employer with a copy of her work restrictions.  \nAfter discovering the full extent of the Claimant’s injuries in 2023, the \nClaimant then re-filed another AR-C amending the previous AR-C in the \ntwo-year period required by Ark. Code Ann. § 11-9-702.  Therefore, I find \nthat the Claimant is not barred by the statute of limitations, or alleged lack \nof notice in seeking Arkansas Workers' Compensation Commission benefits \nfor the work incident that occurred on October 5, 2021.  \nFor the reasons stated above, I respectfully dissent. \n \n    ___________________________________ \n    M. SCOTT WILLHITE, Commissioner","preview":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. H109984 SHAUNA D. TORRENCE, EMPLOYEE CLAIMANT LAFAYETTE COUNTY SCHOOL DISTRICT, EMPLOYER RESPONDENT ARKANSAS SCHOOL BOARDS ASS’N WORKERS’ COMPENSATION TRUST, INSURANCE CARRIER/TPA RESPONDENT","fetched_at":"2026-05-19T22:29:44.778Z","links":{"html":"/opinions/full_commission-H109984-2024-16-16","pdf":"https://www.labor.arkansas.gov/wp-content/uploads/Torrence_Shauna_H109984_20241616.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/full-commission-opinions/"}}