{"id":"full_commission-H203317-2024-01-09","awcc_number":"H203317","decision_date":"2024-01-09","opinion_type":"full_commission","claimant_name":"Mark Ausbrooks","employer_name":"Lexicon, Inc","title":"AUSBROOK VS. LEXICON, INC. AWCC# H203317 JANUARY 9, 2024","outcome":"granted","outcome_keywords":["granted:1"],"injury_keywords":["ankle","back","strain","fracture"],"pdf_url":"https://labor.arkansas.gov/wp-content/uploads/Ausbrooks_Mark_H203317_20240109.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/full-commission-opinions/","filename":"Ausbrooks_Mark_H203317_20240109.pdf","text_length":52563,"full_text":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION \n \n \nCLAIM NO.  H203317 \n \nMARK A. AUSBROOKS, \nEMPLOYEE \n \nCLAIMANT \nLEXICON, INC.,  \nEMPLOYER \n \nRESPONDENT \nTRISTAR CLAIMS MANAGEMENT SERVICES, \nINC., INSURANCE CARRIER/TPA \nRESPONDENT \n  \n      \nOPINION FILED JANUARY 9, 2024  \n \nUpon review before the FULL COMMISSION in Little Rock, Pulaski County, \nArkansas. \n \nClaimant represented by the HONORABLE GARY DAVIS, Attorney at Law, \nLittle 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 \nJune 6, 2023.  The administrative law judge found that the claimant proved \nhe was entitled to temporary total disability benefits and medical treatment.  \nAfter reviewing the entire record de novo, the Full Commission finds that \nthe claimant proved the medical treatment of record was reasonably \nnecessary in connection with the compensable injury.  The claimant proved \nthat he was entitled to temporary total disability benefits beginning April 8, \n2022 until a date yet to be determined.   \nI.  HISTORY \n\nAUSBROOKS - H203317   2\n  \n \n \n The record indicates that Mark Ausbrooks, now age 52, was hired by \nthe respondent-employer, Lexicon, Inc., on January 21, 2020.  Mr. \nAusbrooks testified that he had been employed with the respondents as a \nSheet Metal Mechanic.  The parties stipulated that the employee-employer \nrelationship existed on March 24, 2022, on which date the claimant \n“sustained a compensable injury.”  The claimant testified on direct \nexamination: \n Q.  What was Lexicon Holdings doing?  What’s the job? \nA.  We were puttin’ HVAC ductwork in the UCA Fine Arts \nbuilding....  \n Q.  Tell us what happened. \nA.  I was walkin’ with Joe Minton through the concert hall and \nthere was a board anchored to the floor coverin’ up a \nelectrical place.  I was carryin’ a box of cleats and was walkin’ \nthrough there and my left foot hit it, and when it did, all my \nweight came down on my right foot.  A loud pop occurred.  \nJoe told me to walk it off, and I looked at him and said, “Joe, \nthis is bad.”  He said, “Just walk it off.  You can do it.”   \nQ.  Okay.  Mr. Minton was your supervisor at the time? \nA.  Yes, sir.   \nQ.  Okay.  So this incident resulted in you needing medical \ntreatment.  Is that right? \nA.  Yes, sir.... \nQ.  Now, there’s a company nurse there at Lexicon, right? \nA.  Yes, sir. \nQ.  So you did see the company nurse at Lexicon. \nA.  Yes, sir.... \nQ.  So you went to the nurse and what did the nurse do for \nyou? \nA.  She put me on don’t work for a week, go to the office every \nday and put it on ice[.]... \nQ.  So did you, in fact, go to work and put ice on your foot? \nA.  Yes, sir.  Five days.   \nQ.  Okay.  Now the injury is an Achilles injury, the backside of \nyour right ankle calf area, right? \n\nAUSBROOKS - H203317   3\n  \n \n \nA.  Yes, sir.... \nQ.  You were there for about a week basically doing nothing \nbut icing your leg? \nA.  I just sat in a chair for eight hours and then they released \nme to go.... \n  Q.  So what happened for a work standpoint? \nA.  I went back to my work and there’s no way I could, you \nknow, do my job.   \n  Q.  So how many days did you work after that discussion? \n  A.  I believe it was three 10-hour days. \nQ.  Okay.  And when you were working on those days, what \nwere you doing? \nA.  The first day I was climbin’ up an extension ladder catchin’ \nduct as it came across the safety rail and carryin’ it down a \nhallway, which there was no concrete poured at the time, so it \nwas just raw roof and decking.... \nQ.  And are you carrying items up the ladder? \nA.  We’re not supposed to but yes, sir, I did.... \nQ.  How far do you have to walk?   \nA.  I mean, 50, 75 foot, maybe 100 yards, you know, to the \nfirst piece, and then we stage our way out like I said.   \nQ.  All right.  And so you did that for three days? \nA.  Yes, sir. \nQ.  All right.  How were you doing? \nA.  Not good.... \nQ.  And as far as being on your feet, are you having to be on \nyour feet all day to perform this work? \nA.  10 hours a day.   \n \n According to the record, the claimant treated at Carter Family \nMedicine Clinic on April 5, 2022: \nMark Ausbrooks is a 51 year old male who presents for \ncontinued right leg pain.  Was at work helping supervisor \nmove equipment on March 28, 2022 when he tripped and felt \npop and searing leg pain in his calf.   \nPain worse when he tried to put weight on leg or trying to \ndorsiflex foot.   \nWas seen at company Health Center by Nurse Practitioner \nand cleared to return to light-duty.  There is no light duty \npositions at his company. \n\nAUSBROOKS - H203317   4\n  \n \n \nSince accident his pain is worse, he has to use crutches to \nambulate, calf remains tender.... \nExtremities:  normal except for tenderness to palpate right \ncalf, bruise below right calf, swelling of leg.   \n \n Dr. Inge Carter diagnosed “Calf injury.”  Dr. Carter planned an x-ray \nof the claimant’s right lower leg and referral to an orthopedist.  Dr. Carter \nalso stated, “Continue to use crutches when ambulating.”   \n The claimant testified that his employment was terminated by his \nsupervisor, Joe Minton, on or about April 6, 2022.  Joe Minton testified that \nhe was a Project Manager/Estimator for the respondent-employer, and that \nhe had been the claimant’s main supervisor.  Joe Minton agreed that the \nclaimant’s employment was terminated on or about April 8, 2022.  The \nrespondents’ attorney examined Mr. Minton at hearing: \nQ.  Did Mr. Ausbrooks receive any verbal warnings leading up \nto that termination? \nA.  He had previously, yes.  Several. \nQ.  For what types of things? \nA.  Several verbal warnings.  Verbal warnings about bein’ late, \nabout not comin’ in, about the quality of his work, about doin’ \nthings right, about conflicts on the jobsite, arguin’ with people, \nstirrin’ up trouble on the jobsite[.]... \nQ.  What made you wait until April 8\nth\n to terminate him? \nA.  Because we were – ‘cause we needed help.  We were \nbusy and I kept him until I just got to a point where I – I didn’t \nneed any more help and I couldn’t afford to – to not keep the \nhelp.   \n \n The claimant’s attorney cross-examined Joe Minton: \nQ.  Would you agree he had at least a week where the nurse \nhad him with the ice just being sedentary, not doing anything? \n\nAUSBROOKS - H203317   5\n  \n \n \nA.  I don’t know for sure what she had him doin’, but yeah, it \nwas about a week that I know he was under her care. \nQ.  All right.  So after that, he got released by her and he went \nback to work and worked three days before he got fired, right? \nA.  Yes, I believe that’s about right.   \nQ.  What was he doing on those three days? \nA.  Tryin’ to install ductwork.  Not a lot, to be honest.   \nQ.  Well, was he performing – maybe he wasn’t performing \nvery well, okay?  But to be performing his regular duties, isn’t \nthat what he was supposed to be doing? \nA.  That’s correct. \nQ.  Okay.  So he was not being given light duty, and he was \nnot being given sedentary duty, and he was fired without a \nwritten warning, right? \nA.  That’s correct.   \n \n The record contains a Lexicon Separation Notice indicating that the \nrespondents terminated the claimant’s employment effective April 8, 2022.  \nThe Lexicon Separation Notice indicated that the respondents terminated \nthe claimant because of “Performance” and “Attendance.”  The following \nremarks were written on the Separation Notice:  “Mark has a repeated \nhistory of tardiness and absences, to the point he could no longer be \ncounted on.  Despite being given over two years he still doesn’t have all the \ntools necessary to perform his job and had to borrow from others to be able \nto perform a task.  His production was very slow and his quality was \nunacceptable.  Constant problems with him on the site as well, including \nconflicts with others, parking issues and lack of respect.”  The Separation \nNotice included a Final Employee Evaluation which indicated that the \nfollowing areas were “Unacceptable”:  Quality of Work, Productivity, \n\nAUSBROOKS - H203317   6\n  \n \n \nDependability, Safety, and Initiative.  The claimant’s supervisor, Joe K. \nMinton, Jr., signed the Separation Notice on April 11, 2022. \n A Nurse Practitioner’s diagnosis on April 18, 2022 was “Rupture of \nright Achilles tendon.”     \n Joe Minton corresponded with Danna Gaunt and other individuals via \ne-mail on May 18, 2022: \n1)  Did he complain about anything related to his injury \nbetween the date of the injury and the date of separation? \nMarked (sic) was cleared and returned to the job site on \nMonday, April 4\nth\n.  On Wednesday he told me his leg was \nswollen the night before but he knew it was because he \ndidn’t wear the bandage as instructed and that it was fine \nthat day because he had the bandage on.  On Friday he \ncomes to me and says he knows he has been cleared but \nhis leg still hurt.  Then he stated that he called Mike \nPerkins on Thursday and said his leg was still hurt and \nMike told him to tough it out until Sunday and if it still hurt \nhe could go to the ER.  When I mentioned this to Mike he \nimmediately says that wasn’t true.  When I told Mark that \nMike said it wasn’t true, he just shook his head and walked \noff. \n2)  Did he miss a lot of work and was it documented? \nMark missed a lot of time at work and that was one of the \nprimary reasons for his separation, along with the poor \nquality of his work and lack of production.  I’ve attached \ncopies of his timecard that show 14 tardys, 3 early outs \nand 2 absences since January.  And these didn’t show all \nthe times he was late returning from either our morning \nbreak or our lunch break.   \n3)  Help me justify the reason on the separation for his \nattendance and performance. \nBesides the attendance mentioned above, his production \nand quality were unacceptable.  He would show up one \nday with just a few of the required tools to perform his job \nand then the next day not have any and say oh I left them \nat home.  On the occasions where we let him make small \n\nAUSBROOKS - H203317   7\n  \n \n \ndecisions about the project he was working on, more time \nthan not we would have to go back and redo the work due \nto poor quality and bad decisions.  Mark has over 20 \nyears’ experience and it got to the point were I had two or \nthree year guys leading the projects because Marks work \nwas unacceptable.  Numerous complaints from both the \nmechanical contractor and the general contractor about \nMarks attitude and treatment towards others, and lack of \nrespect for the work of the other trades on the job.  It was \nmentioned more than once that if he kept on that way, he \nwould be asked to leave the job.  As I’ve mentioned to \nSteve and Renee, the only reason I did not terminate him \nsooner was because of our work load and lack of \nmanpower.  We had a spell for about two plus months \nwhere we had all crews working 7 days a week and 10 \nhours a day and I needed as many men on the job as \npossible.  We are just now getting back to our regular 40 \nhour work weeks for the most part although we haven’t \nhad any layoffs in manpower, we did get to a point where I \ncould live without him.   \n \n Dr. Robert Daniel Martin noted on May 26, 2022: \nPatient to follow-up.  States minimal improved since last office \nvisit 2 weeks ago.  He reports he has been ambulating in the \ntall walking boot, however, reports some physical therapy \nstates he has no showed that appointment and showed up to \nanother 1 without his boot on.  He continues to endorse \nsignificant pain from the gastrocnemius muscle down his \nAchilles tendon and cannot push off with his right foot.... \nRight ankle examination demonstrates muscle contracture \nproximally at the myotendinous junction of the gastrocnemius \nwith significant tenderness to palpation, moderate edema, \ntender to palpate the length of the Achilles tendon as well, \npain with resisted plantar flexion, distal neurovascular intact, \npain out of proportion on examination.... \n \n Dr. Martin assessed “51-year-old male partial thickness Achilles \ntendon rupture right side, worker’s compensation, intermittent \nnoncompliance.”  Dr. Martin planned, “Went over ports of continue with the \n\nAUSBROOKS - H203317   8\n  \n \n \nregular physical therapy and tall boot use, we will keep him on sedentary \nwork duty, he is not at MMI currently, follow-up in 1 month.  We will possibly \ntransition him out of the walking boot at that time.”  The diagnosis was \n“Achilles rupture, right[.]”  \n The claimant treated at Baptist Health Therapy Centers on July 19, \n2022, where the claimant was diagnosed with “Strain of right Achilles \ntendon, initial encounter.”  It was also noted at that time, “Pt states he is \nhurting a lot today and states when he got up from a chair on Saturday he \nheard and felt a pop in his Achilles even with his boot on.  Pt states he is \nnot able to do everything today but is icing at home.”    \n Dr. Justin H. Long corresponded with a Medical Case Manager on \nAugust 15, 2022: \n  I have reviewed the MRI of the right ankle dated 4/21/2022. \nThere is no evidence of acute fracture at the right ankle.  \nThere is no mass like abnormal marrow replacement.  There \nis patchy subchondral marrow edema at multiple \ntarsometatarsal articulations.... \nThere is marked thickening of the Achilles tendon extending \nfrom the myotendinous junction distally.... \nI have reviewed the MRI of the right ankle dated 8/1/2022. \nThere is no acute fracture at the ankle.... \nIn my professional opinion, the patient’s partial thickness \nAchilles tendon tear could certainly be acute given the history \nof tripping at work.  However, this undoubtably occurs on a \nbackground of chronic Achilles tendinopathy present previous \nto the acute traumatic event.  On the follow-up MRI in August, \nthe partial thickness Achilles tear has largely healed although \nthe features of Achilles tendinopathy remain.  With regards to \nthe need for surgery, the imaging findings discussed above \ncould support surgical treatment as an option due to \n\nAUSBROOKS - H203317   9\n  \n \n \npersistent, chronic tendinopathy and previous tearing.  This is \nassuming the patient was adherent to the nonoperative \ntreatment regimen/rehabilitation but has failed to improve to a \nsufficient degree clinically.  However, by imaging, the acute \nAchilles tendon partial-thickness intrasubstance and \nmyotendinous tear has undergone significant healing in the \ninterval between the MRI exams suggesting that the surgery \nwould be treating the continued tendinopathy and reducing \nrisk for recurrent tear.  Ultimately, the need for surgery should \nbe largely clinical and related to persistent symptomatology in \nthe setting of chronic Achilles tendinopathy and the resultant \nlifestyle limitations.   \n \n On August 19, 2022, the Medical Case Manager queried Dr. James \nL. Head in part, “After reviewing the second MRI dated 8/1/2022 of M. \nAusbrooks right ankle and Dr. Long’s comparison of the two MRIs; is it still \nyour professional opinion that Mr. Ausbrooks requires surgical intervention \nof the right ankle?  If so, please opine if your recommendation for surgery is \ngreater than 51% directly related to the acute injury from 3/24/2022?”  Dr. \nHead answered with a question mark and commented, “Exacerbation of \npre-existing condition, I can’t put a % on that.”   \n The Medical Case Manager corresponded with Dr. Martin on August \n25, 2022: \nMr. Ausbrooks requested a change of physician.  He saw Dr. \nHead at Conway Orthopedics on two separate occasions.  On \n7/27/2022 Dr. Head requested to proceed with surgical \nintervention, non-insertional Achilles tendinopathy \ndebridement and FHL transfer.  The insurance carrier \nrequested a second MRI which was done on 8/1/2022.  The \ninsurance carrier requested Dr. Justin Long to compare the \ntwo MRIs and then asked Dr. Head’s opinion on relatedness \nof the surgery that he requested. \n\nAUSBROOKS - H203317   10\n  \n \n \nThe insurance has requested your expert opinion as well.  I \nhave attached all the medical records since his last visit with \nyou.  Would you kindly review and provide your opinion if Mr. \nAusbrooks requires surgical intervention of the right ankle?  If \nso, please opine if the surgery is greater than 51% directly \nrelated to the acute injury from 3/24/2022? \n \n Dr. Martin answered “No” and commented, “Pt primary c/o pain and \nIMO this is related to his chronic pre-existing Achilles tendinopathy, his \npartial Achilles tear has healed on his most recent MRI.  The recommended \nsurgery is NOT > 51% directly related to acute 3/24/2022 injury.”   \n The claimant followed up with Dr. Head on October 28, 2022: \nMark presents for his right Achilles.  He reports that he is here \nfor to discuss surgery options.  He is ambulating without \nassistance wearing normal footwear.  He was able to \ntransition from the boot but is still experiencing pain when \nwalking.  The pain usually occurs while weightbearing.  He \nreports that he has pain with walking on uneven ground.  She \nstates that he has not improved in pain since his last visit.... \nMRI on the Right Ankle on 4/21/22:  Tendinosis of the Achilles \ntendon with medium grade intra-substance partial tear.   \n \n Dr. Head’s impression was “Noninsertional Achilles tendinopathy \nw/partial tear/rupture, right foot....I recommended proceeding with the \npreviously discussed surgery.”   \n Dr. Head performed surgery on December 6, 2022:  “Right \ndebridement of the Achilles tendon with secondary repair and flexor hallucis \nlongus tendon transfer to the calcaneus.”  The pre- and post-operative \ndiagnosis was “R Achilles tendinopathy.”  Dr. Head planned following \nsurgery, “Nonweightbearing.  Follow up in two weeks.  Once his wound is \n\nAUSBROOKS - H203317   11\n  \n \n \nhealed, he can begin weightbearing as tolerated in a boot and begin \nphysical therapy.”     \n Dr. Jason G. Stewart corresponded with Integrity Consulting \nServices on January 10, 2023: \nThe following is a narrative report of the medical file review in \nthe specialty of orthopedic surgery regarding Mark Ausbrooks.  \nI have reviewed the attached the statement of accepted facts \nand the following medical records.  I have been asked by the \ninsurer for my opinion on relatedness.... \n1.  Are the objective findings on the imaging related to an \nacute work injury or preexisting chronic issues? \nI reviewed radiologic imaging studies provided on CD, \nincluding MRIs of the right ankle from 4/21/2022 and \n8/1/2022.  Both MRIs depict evidence of chronic Achilles \ntendinosis.  Achilles tendinosis is an often-misunderstood \ndiagnosis.  It is distinct from Achilles tendonitis, insertional \nAchilles tendonitis, Achilles strain and Achilles rupture.  A \npartial tear of the Achilles tendon, also known as a strain, \nis an acute, traumatic injury to the tendon, often caused by \nsudden force or impact.  An acute traumatic partial tear of \nthe Achilles tendon typically presents with immediate pain, \nswelling, and stiffness at the site of the injury, and can \nmake it difficult to walk or stand on the affected foot.   \nOn the other hand, tendinosis is a degenerative condition \nthat develops over time, and it is not caused by a specific \ntraumatic event.  It is usually caused by overuse or aging \nand characterized by pain, weakness and stiffness of the \naffected joint.... \nThe claimant reports that he was “a lot” better with a pain \nlevel of 1/10, which led to release from medical care on \n4/1/2022.  This course of recovery would be appropriate \nand expected considering the mechanism and nature of \ninjury.  The provided records have a 17-day period from \nthe claimant’s recover and release from medical treatment \nto a visit with a new provider, new claims of worsened \nswelling, bruising, pain escalation from 1/10 to 7/10 and \ninability to put weight on the leg and acknowledgement of \nbeing fired from his job.  Typically, the further one is \n\nAUSBROOKS - H203317   12\n  \n \n \ntemporally removed from the traumatic incident the quality \nof pain diminishes as recovery occurs, which is what was \nseen initially.  There was no query by the subsequent \nprovider nor the insurer for an explanation of how and why \nthe recovery reversed course so dramatically.  An MRI had \nnot been done at this point and neither provider (but nurse \npractitioners) was aware of a chronic, underlying condition \nthat should have been considered as part of establishing a \ndifferential diagnosis.   \nThe ability to compare MRI studies from 1 month and 5 \nmonths after the injury is invaluable in this case.  The initial \nMRI findings showing some increased signal intensity of \nthe Achilles tendon which suggested partial tearing \napproximately one month later would be consistent within \nthis time frame of still having evidence of an injury but also \nacknowledging there are significant surrounding changes \nclearly much older than 1 month.  The follow-up MRI \nrepresents an improvement, the changes initially \npresumed to be acute are no longer present, while the \nchronic findings appear to be still present and unchanged \nin nature.  I would interpret this as a recovery to a baseline \nchronic diagnosis with clear evidence of resolution of the \nacute injury. \n2.  Within a medical degree of certainty do you believe the \nrecommended surgery is appropriate and medically \nnecessary for Mr. Ausbrooks’ status as reflected on the \n8/1/2022 MRI related to the work injury? \nI believe withing (sic) a reasonable degree of medical \ncertainty, based on the evidence provided in this medical \nrecord, the surgery was not appropriate or necessary to \ntreat the injury on 3/24/2022.  The surgical procedures Dr. \nHead performed were appropriate for the treatment of a \nchronic condition (Achilles tendinosis).  The record \nindicates an acute aggravation of a chronic problem \nsubjective clinical improvement and objective radiologic \nevidence of improvement.  The progress note immediately \nbefore the surgical procedure does not acknowledge the \nmore recent MRI which shows improvement of the \nappearance of the Achilles tendon.  Dr. Head makes no \nmention of seeing any evidence of an acute or subacute \ninjury, nor the consequence of an injury at the time of \nsurgery.  The initial claim is for a strain or low-grade partial \n\nAUSBROOKS - H203317   13\n  \n \n \ntear of the Achilles tendon, but no mention of tearing \nappears in the operative note.  In fact, the operative note \nindicates the surgeon debrided (surgically removed) nearly \n50% of the Achilles tendon substance.  This procedure \nwhen combined with a flexor hallucis longus (FHL) transfer \nis intended to remove degenerative changes in the \nAchilles tendon, transfer the FHL muscle belly with its rich \nblood supply to the anterior surface of the Achilles tendon \nto improve local blood flow and augment the debrided and \nweakened Achilles tendon.  The surgical treatment for an \nacute Achilles tear is to repair the tear with sutures, not \nremove half the tendon.   \nThe second MRI confirms resolution of the acute injury.  \nThe third medical record from 4/1/2022 indicates an \nimproved and nearly resolved injury.  The claimant’s own \nadmission of a quick recovery and release from medical \ncare only to reappear 3 weeks later at another medical \nclinic with symptoms appearing more severe than upon \ninitial presentation lacks a credible/logical premise.  There \nare records from Dr. Martin indicating the claimant not \nwearing the boot to the visit, which could be interpreted as \neither noncompliance or symptom resolution.  Dr. Martin \nnotes which appeared to be an out-of-proportion pain \nresponse to physical exam at approximately 2 months \nafter the injury.  Again, this would be considered unusual \ngiven the elapsed time from injury and the previous visits \nwhere this was not present.  Pain behavior out-of-\nproportion to expected norms could be interpreted as a \nworsening of the injury process or symptom magnification.  \nThe claimant mentions a reinjury at home getting out of his \nshower with an audible “pop” but there is no evidence of \nconsideration of what role this may have had in leading up \nto a surgical intervention.  These particular medical \nfindings should be examined with a prudent amount of \nprofessional skepticism in order to thoroughly understand \na logical chain of events from injury to treatment.     \n \nA pre-hearing order was filed on March 1, 2023.  According to the \ntext of the pre-hearing order, the claimant contended, “Claimant contends \nthat he sustained compensable injuries to his right leg, ankle, and foot on \n\nAUSBROOKS - H203317   14\n  \n \n \nMarch 24, 2022.  Claimant further contends that he is entitled to payment of \ntemporary total disability (TTD) benefits for the period of March 24, 2022, \nthrough a date yet to be determined.  That payment of these benefits has \nbeen controverted for purposes of attorney’s fees.  Claimant also contends \nthat he is entitled to payment of medical treatment for December 6, 2022, \nsurgery.” \n The respondents contended, “Respondents contend that all \nappropriate benefits are being paid with regard to this matter.  The claimant \nhas been accepted at this time as medical only.  Respondents provided \nlight duty for claimant and would have continued to do so but for his \ntermination on April 8, 2022, for cause.  Respondents further contend that \nthe surgery performed by Dr. Head was not reasonable and necessary \nassociated with the March 24, 2022, injury.”   \n The parties agreed to litigate the following issue:  “1.  Temporary \ntotal disability (TTD).”   \n A hearing was held on May 4, 2023.  Upon examination by an \nadministrative law judge, the claimant testified that he was still “under a \ndoctor’s care” and was not working for any employer.    \n An administrative law judge filed an opinion on June 6, 2023.  The \nadministrative law judge found that the claimant proved he was entitled to \nadditional temporary total disability benefits beginning April 7, 2022 until a \n\nAUSBROOKS - H203317   15\n  \n \n \ndate to be determined.  The administrative law judge found that the surgery \nundergone by the claimant on December 6, 2022 was “directly related” to \nthe compensable injury “and shall be paid by the Respondents.”   \n The respondents appeal to the Full Commission. \nII.  ADJUDICATION \nA.   Medical Treatment \nThe employer shall promptly provide for an injured employee such \nmedical treatment as may be reasonably necessary in connection with the \ninjury received by the employee.  Ark. Code Ann. §11-9-508(a)(Repl. 2012).  \nThe employee has the burden of proving by a preponderance of the \nevidence that medical treatment is reasonably necessary.  Stone v. Dollar \nGeneral Stores, 91 Ark. App. 260, 209 S.W.3d 445 (2005).  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).   \nAn administrative law judge found in the present matter, “4.  \nClaimant’s December 6, 2022, ankle surgery is directly related to his March \n24, 2022 injury and shall be paid by the Respondents.”  The Full \nCommission finds that the medical treatment of record following the \n\nAUSBROOKS - H203317   16\n  \n \n \ncompensable injury was reasonably necessary.  Said reasonably necessary \nmedical treatment included surgery performed by Dr. Head on December 6, \n2022. \nThe parties stipulated that the claimant sustained a compensable \ninjury on March 24, 2022.  The claimant’s testimony indicated that he \ntripped and injured his right lower extremity as the result of a work-related \nspecific incident occurring March 24, 2022.  A claimant who has sustained a \ncompensable injury is not required to offer “objective medical evidence” to \nprove he is entitled to additional benefits.  Chamber Door Industries, Inc. v. \nGraham, 59 Ark. App. 224, 956 S.W.2d 196 (1997).  Nevertheless, there \nwere objective medical findings of record following the compensable injury.  \nIt was noted at Carter Family Medicine Clinic on April 5, 2022 that there \nwas a bruise below the claimant’s right calf and swelling of the claimant’s \nleg.  Dr. Carter diagnosed “Calf injury.”  A Nurse Practitioner’s diagnosis on \nApril 18, 2022 was “Rupture of right Achilles tendon.”  The Full Commission \nfinds that the ruptured right Achilles tendon was causally related to the \nMarch 24, 2022 compensable injury and was not the result of a prior injury \nor pre-existing condition.   \nDr. Martin examined the claimant on May 26, 2022 and reported \n“muscle contracture” in the claimant’s right lower extremity as well as \n“moderate edema.”  These were additional objective medical findings.  Dr. \n\nAUSBROOKS - H203317   17\n  \n \n \nMartin also reported that the claimant had sustained a “partial thickness \nAchilles tendon rupture.”  We find that Dr. Martin’s diagnosis of “Achilles \nrupture, right” was causally related to the March 24, 2022 compensable \ninjury and was not the result of a prior injury or pre-existing condition.  It \nwas also noted at Baptist Health Therapy Centers on July 19, 2022 that the \nclaimant had suffered a “Strain of right Achilles tendon, initial encounter.”  \nWe find that the report of a strained right Achilles tendon on July 19, 2022 \nwas causally related to the March 24, 2022 compensable injury and was \nlikewise not the result of a prior injury or pre-existing condition.   \nDr. Long opined on August 15, 2022 that “the partial thickness \nAchilles tear has largely healed although the features of Achilles \ntendinopathy remain.”  Dr. Martin agreed with Dr. Long and opined on \nAugust 25, 2022 that surgery proposed by Dr. Head was not reasonably \nnecessary.  Dr. Stewart stated on January 10, 2023 that surgery \nrecommended by Dr. Head was not reasonably necessary.       \nThe Commission has the authority to accept or reject a medical \nopinion and the authority to determine its probative value.  Poulan Weed \nEater v. Marshall, 79 Ark. App. 129, 84 S.W.3d 878 (2002).  It is within the \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).  In the present matter, the Full \n\nAUSBROOKS - H203317   18\n  \n \n \nCommission finds that the opinion stated by treating surgeon Dr. Head was \nmost credible.  Dr. Head opined on August 19, 2022 that the claimant had \nsustained an “Exacerbation of pre-existing condition, I can’t put a % on \nthat.”  The claimant need only prove that the compensable injury was “a \nfactor” in his need for surgery recommended by Dr. Head.  See Williams v. \nL&W Janitorial, Inc., 85 Ark. App. 1, 145 S.W.3d 383 (2004).  The evidence \nin the present matter demonstrates that the compensable injury was at least \n“a factor” in Dr. Head’s recommendation for surgery.  We find that Dr. \nHead’s treatment recommendations are supported by the record and are \nentitled to more evidentiary weight than the opinions of Dr. Long, Dr. Martin, \nor Dr. Stewart.  The Full Commission therefore finds that the medical \ntreatment of record, including surgery performed by Dr. Head, was \nreasonably necessary in accordance with Ark. Code Ann. §11-9-\n508(a)(Repl. 2012).     \nB.   Temporary Total Disability \nThe parties stipulated that the claimant sustained a compensable \ninjury on March 24, 2022.  The evidence demonstrates that the \ncompensable injury resulted, among other things, in a rupture of the \nclaimant’s right Achilles tendon and was therefore a “scheduled injury” in \naccordance with Ark. Code Ann. §11-9-521(a)(4)(Repl. 2012).  Act 796 of \n\nAUSBROOKS - H203317   19\n  \n \n \n1993, as codified at Ark. Code Ann. §11-9-521(Repl. 2012), provides, in \npertinent part: \n(a) An employee who sustains a permanent compensable \ninjury scheduled in this section shall receive, in addition to \ncompensation for temporary total and temporary partial \ndisability benefits during the healing period or until the \nemployee returns to work, whichever occurs first, weekly \nbenefits in the amount of the permanent partial disability \nrate attributable to the injury[.]    \n \nThe Arkansas General Assembly requires that administrative law \njudges and the Full Commission shall strictly construe the provisions of Act \n796.  See Ark. Code Ann. §11-9-704(c)(3)(Repl. 2012).  The doctrine of \nstrict construction is to use the plain meaning of the language employed.  \nHoladay v. Fraker, 323 Ark. 522, 915 S.W.2d 280 (1996). \nIn the present matter, the administrative law judge decided the case \nin accordance with the appellate standard for adjudicating nonscheduled \ninjuries, viz., Ark. State Hwy. Dept. v. Breshears, 272 Ark. 244, 613 S.W.2d \n392 (1981).  The administrative law judge erred as a matter of law.  For \nscheduled injuries the injured employee is to receive compensation for \ntemporary total or temporary partial disability during the healing period or \nuntil the employee returns to work, whichever occurs first.  Ark. Code Ann. \n§11-9-521(a)(Repl. 2012), supra; Wheeler Constr. Co. v. Armstrong, 73 \nArk. App. 146, 41 S.W.3d 822 (2001).  The healing period is that period for \nhealing of the injury which continues until the employee is as far restored as \n\nAUSBROOKS - H203317   20\n  \n \n \nthe permanent character of the injury will permit.  Nix v. Wilson World Hotel, \n46 Ark. App. 303, 879 S.W.2d 457 (1994).  If the underlying condition \ncausing the disability has become more stable and if nothing further in the \nway of treatment will improve that condition, the healing period has ended.  \nId.  Whether an employee’s healing period has ended is a question of fact \nfor the Commission.  Ketcher Roofing Co. v. Johnson, 50 Ark. App. 63, 901 \nS.W.2d 25 (1995). \nIn any event, it is the duty of the Full Commission to enter findings in \naccordance with the preponderance of the evidence and not on whether \nthere is substantial evidence to support the administrative law judge’s \nfindings.  Roberts v. Leo Levi Hospital, 8 Ark. App. 184, 649 S.W.2d 402 \n(1983), citing Jones v. Scheduled Skyways, Inc., 1 Ark. App. 44, 612 \nS.W.2d 333 (1981).  The Full Commission reviews an administrative law \njudge’s decision de novo, and it is the duty of the Full Commission to \nconduct its own fact-finding independent of that done by an administrative \nlaw judge.  Crawford v. Pace Indus., 55 Ark. App. 60, 929 S.W.2d 727 \n(1996).  The Full Commission makes its own findings in accordance with \nthe preponderance of the evidence.  Tyson Foods, Inc. v. Watkins, 31 Ark. \nApp. 230, 792 S.W.2d 348 (1990).  Moreover, the appellate court reviews \nthe decision of the Full Commission and not that of the administrative law \njudge.  Powers v. City of Fayetteville, 97 Ark. App. 251, 254, 248 S.W.3d \n\nAUSBROOKS - H203317   21\n  \n \n \n516, 519 (2007), citing High Capacity Prods. v. Moore, 61 Ark. App. 1, 962 \nS.W.2d 831 (1998).   \nIt is the Commission’s duty to weigh the evidence, to resolve any \nconflicts in the evidence, and to assess each witness’s credibility.  Walker v. \nCooper Standard Auto., 104 Ark. App. 175, 289 S.W.3d 184 (2008).  The \nCommission is not required to believe the testimony of the claimant or any \nother witness but may accept and translate into findings of fact only those \nportions of the testimony it deems worthy of belief.  American Greetings \nCorp. v. Garey, 61 Ark. App. 19, 963 S.W.2d 613 (1998). \nIn the present matter, the Full Commission finds that the claimant \nproved he was entitled to temporary total disability benefits beginning April \n8, 2022 until a date yet to be determined.  The claimant sustained a \ncompensable scheduled injury on March 24, 2022.  The claimant testified \nthat he “iced” his right lower extremity at work, elevating his leg, for \napproximately a week following the compensable scheduled injury.  The \nclaimant testified that he subsequently attempted to return to work but \n“there’s no way I could, you know, do my job.”  We note that Dr. Carter \ninstructed the claimant on April 5, 2022 to “use crutches while ambulating.”  \nThe record does not show that that claimant was able to competently \nperform his job as a Sheet Metal Mechanic while using crutches as advised \nby a treating physician.   \n\nAUSBROOKS - H203317   22\n  \n \n \nThe claimant’s supervisor, Joe Minton, terminated the claimant’s \nemployment effective April 8, 2022.  Mr. Minton asserted on a Separation \nNotice that the claimant was an “Unacceptable” employee.  Yet the \nevidence plainly demonstrates that the claimant remained within a healing \nperiod at the time of his termination on April 8, 2022.  A Nurse Practitioner’s \ndiagnosis on April 18, 2022 was “Rupture of right Achilles tendon.”  If, \nduring the period while the body is healing, the employee is unable to \nperform remunerative labor with reasonable consistency and without pain \nand discomfort, his temporary disability is deemed total.  Farmers \nCooperative v. Biles, 77 Ark. App. 1, 69 S.W.3d 899 (2002).  Ark. Code \nAnn. §11-9-521(a)(Repl. 2012) was not intended to bar additional \ntemporary total disability benefits following an unsuccessful attempt to \nreturn to the workforce.  Id, citing Roberson v. Waste Management, 58 Ark. \nApp. 11, 944 S.W.2d 858 (1997). \nThe evidence in the present matter does not demonstrate that the \nclaimant could effectively perform his employment duties for the \nrespondents while the claimant remained in a healing period for his \ncompensable scheduled injury.  Along with the diagnosis of a ruptured \nAchilles tendon, which diagnosis was causally related to the compensable \ninjury, Dr. Martin reported on May 26, 2022 that the claimant “cannot push \noff with his right foot....Right ankle examination demonstrates muscle \n\nAUSBROOKS - H203317   23\n  \n \n \ncontracture proximally[.]”  Dr. Martin agreed that the claimant had sustained \nan Achilles tendon rupture.  Dr. Martin assigned sedentary work and \nopined, “he is not at MMI currently, follow-up in 1 month.”  Dr. Head \nperformed reasonably necessary surgery on December 6, 2022.  There is \nno indication of record that Dr. Head has released the claimant to return to \nwork or has opined that the claimant reached the end of the healing period \nfor the compensable injury.   \nThe respondents cite as authority Robertson v. Pork Group, Inc., \n2011 Ark. App. 448, 384 S.W.3d 639 (2011).  In Robertson, the Arkansas \nCourt of Appeals affirmed the Full Commission’s finding that the claimant \ndid not prove she was entitled to temporary total disability benefits after her \nemployment was terminated.  The Court of Appeals agreed that the \nclaimant “unjustifiably refused employment suitable to her capacity and \noffered her by the respondent-employer” in accordance with Ark. Code Ann. \n§11-9-526.  Robertson is inapposite, however, because the respondents do \nnot argue, in accordance with Ark. Code Ann. §11-9-526, that the claimant \nin the present case unjustifiably refused employment suitable to his \ncapacity.  To the contrary, the claimant in the present case was terminated \nwhile he remained within his healing period and was physically unable to \nperform remunerative labor with reasonable consistency.  Farmers \nCooperative, supra.   \n\nAUSBROOKS - H203317   24\n  \n \n \nAfter reviewing the entire record de novo, the Full Commission finds \nthat the medical treatment of record following the compensable injury was \nreasonably necessary in accordance with Ark. Code Ann. §11-9-\n508(a)(Repl. 2012).  Said reasonably necessary medical treatment includes \nsurgery performed by Dr. Head on December 6, 2022.  We find that the \nclaimant proved he was entitled to temporary total disability benefits \nbeginning April 8, 2022 until a date yet to be determined.  In accordance \nwith Ark. Code Ann. §11-9-521(a)(Repl. 2012), the claimant has not \nsuccessfully returned to work and remains within a healing period.  The \nclaimant’s attorney is entitled to fees for legal services in accordance with \nArk. Code Ann. §11-9-715(a)(Repl. 2012).  For prevailing on appeal to the \nFull Commission, the claimant’s attorney is entitled to an additional fee of \nfive hundred dollars ($500), pursuant to Ark. Code Ann. §11-9-715(b)(Repl. \n2012). \nIT IS SO ORDERED. \n \n    ___________________________________ \n    SCOTTY DALE DOUTHIT, Chairman \n \n    ___________________________________ \n    M. SCOTT WILLHITE, Commissioner \n \n \n \n \nCommissioner Mayton dissents. \n \n \n\nAUSBROOKS - H203317   25\n  \n \n \nDISSENTING OPINION \n \n I respectfully dissent from the Majority’s opinion.  In my de novo \nreview, I find that the claimant’s December 6, 2022 surgery was not \nreasonable and necessary or causally related to the claimant’s \ncompensable injury on March 24, 2022.  Thus, the claimant is not entitled to \nadditional temporary disability benefits.  \nOur rules dictate that the respondent must provide any medical \ntreatment \"as may be reasonably necessary in connection with the injury \nreceived by the employee.\" Ark. Code Ann. § 11-9-508(a).  “A claimant may \nbe entitled to additional medical treatment after the healing period has \nended if said treatment is geared toward management of the injury.”  S. Tire \nMart v. Perez, 2022 Ark. App. 179, 644 S.W.3d 439 (2022).  Such services \ncan include diagnosing the nature and extent of the compensable injury; \nreducing or alleviating symptoms resulting from the compensable injury; \nmaintaining the level of healing achieved; or preventing further deterioration \nof the damage produced by the compensable injury.  Univ. of Cent. Ark. v. \nSrite, 2019 Ark. App. 511, 588 S.W.3d 849 (2019).  It is a claimant's \nburden, however, to establish by a preponderance of the evidence that the \ntreatment is reasonable and necessary and bears a causal connection to \nthe work injury.  Cossey v. Pepsi Beverage Co., 2015 Ark. App. 265, 460 \nS.W.3d 814 (2015).  What constitutes reasonably necessary treatment is a \n\nAUSBROOKS - H203317   26\n  \n \n \nquestion of fact for the Commission.  LVL, Inc. v. Ragsdale, 2011 Ark. App. \n144, 381 S.W.3d 869 (2011).  The Commission has authority to accept or \nreject medical opinion and to determine its medical soundness and \nprobative force.  Cent. Moloney, Inc. v. Holmes, 2020 Ark. App. 359, 605 \nS.W.3d 266 (2020).  Furthermore, it is the Commission's duty to use its \nexperience and expertise in translating the testimony of medical experts \ninto findings of fact and to draw inferences when testimony is open to more \nthan a single interpretation.  Id.  \nIn the case at hand, the Achilles tendon surgery performed by Dr. \nJames Head was not related to the claimant’s March 24, 2022 \ncompensable injury.  The claimant visited Monica Williams, FNP-C on \nMarch 28, 2022. (Resp. Ex. 1, P. 13).  FNP-C Williams’ examination \nrevealed that the claimant’s “pain is in the calf and posterior heel . . . Exam \nreveals minimal swelling and no bruising.  Diagnosis: muscle strain.”  Id.   \nBy March 29, 2022, the claimant reported that his pain had improved, and \nFNP-C Williams noted, “swelling decreased, no bruising noted, no pain to \npalpation, and no pain with heel and toe pressure.”  Id.  The claimant was \ninitially released from the clinic by Ms. Williams on April 1, 2022 once he \nreported that his pain was a 1/10.  Ms. Williams went on to state that there \nwas “less swelling and he is very surprised that the pain is gone, and he is \nable to put on shoes and walk normal.”  At that point, she discharged him \n\nAUSBROOKS - H203317   27\n  \n \n \nfrom the clinic for the strain and noted the claimant had significantly \nimproved with no pain.  (Resp. Ex. 1, P. 14).  \nThe claimant returned nearly three weeks later, on April 18, 2022, \ncomplaining of “burning, throbbing and tingling pain of 7/10 for 3 weeks.”  \nId.  Meagan Celsor, NP offered a presumptive diagnosis of a ruptured \nAchilles tendon and recommended an MRI.  Id.  The MRI, conducted on \nApril 21, 2022, revealed:  \nThe Achilles tendon is markedly enlarged with \ndiffuse increased signal intensity and \nheterogeneity of the tendon fibers (severe \ntendinosis of the Achilles tendon.)  There is an \nirregular, intrasubstance intermediate grade \ntear that begins near the level of the distal \nmyotendinous junction and extends caudally to \n4 mm cranial to the insertion.  No full-thickness \ncomponent is appreciated. Surrounding soft \ntissue edema is present.  Low-grade sprains of \nthe anterior talofibular and calcaneofibular \nligaments. Mild degenerative changes of the \nsubtalar joints and joints of the midfoot. Id.  \n  \nAt a June 17, 2022 visit with Dr. Robert Martin, the claimant reported \n“stepping out of the shower and feeling a painful pop and increased \nswelling . . . Pain appears out of proportion on examination.”  (Resp. Ex. 1, \nP. 15).  \nThe claimant requested and was granted a one-time change of \nphysician through the Commission and began treating with Dr. James Head \non July 8, 2022.  (Resp. Ex. 1, P. 15).  The claimant had another MRI on his \n\nAUSBROOKS - H203317   28\n  \n \n \nright ankle on August 1, 2022.  Dr. Justin Long conducted an independent \nreview of the claimant’s April 21, 2022 and August 1, 2022 MRIs and \ndetermined that:  \nThe patient’s partial thickness Achilles tendon \ntear could certainly be acute given the history \nof tripping at work.  However, this undoubtably \noccurs on a background of chronic Achilles \ntendinopathy present previous to the acute \ntraumatic event.  On the follow-up MRI in \nAugust, the partial thickness Achilles tear has \nlargely healed although the features of Achilles \ntendinopathy remain.  With regards to the need \nfor surgery, the imaging findings discussed \nabove could support surgical treatment as an \noption due to persistent, chronic tendinopathy \nand previous tearing . . . However, by imaging, \nthe acute Achilles tendon partial-thickness \nintrasubstance and myotendinous tear has \nundergone significant healing in the interval \nbetween the MRI exams suggesting that the \nsurgery would be treating the continued \ntendinopathy and reducing risk for recurrent \ntear.  Ultimately, the need for surgery should \nbe largely clinical and related to the persistent \nsymptomatology in the setting of chronic \nAchilles tendinopathy and the resultant lifestyle \nlimitations. (Resp. Ex. 1, P. 10)(emphasis \nadded.).  \n  \nUpon review of Dr. Long’s opinion, Dr. Head was asked whether his \nrecommended surgery was greater than 51% related to claimant’s on-the-\njob injury, and Dr. Head responded, “Exacerbation of pre-exiting condition, I \ncan’t put a % on that.”  (Resp. Ex. 1, P. 11).  Dr. Robert Martin, when asked \nthe same question, responded that in his opinion, “this is related to chronic \n\nAUSBROOKS - H203317   29\n  \n \n \npre-existing Achilles tendinopathy, his partial Achille’s tear has healed on \nhis most recent MRI.  The recommended surgery is NOT > 51% related \ndirectly to acute 3/24/2022 injury.”  (Resp. Ex. 1, P. 12).  \nAfter Dr. Head performed a debridement of claimant’s Achille’s \ntendon, the respondents obtained an additional third-party opinion \nregarding the two MRIs from Dr. Jason Stewart, a board-certified orthopedic \nsurgeon specializing in foot and ankle care.  Dr. Stewart determined that \n“the surgery was not appropriate or necessary to treat the injury on 3/24/22. \nThe surgical procedures Dr. Head performed were appropriate for the \ntreatment of a chronic condition (Achilles tendinosis).”  (Resp. Ex. 1, P. \n19)(emphasis in original).  Dr. Stewart further stated:  \nThe ability to compare MRI studies from 1 \nmonth and 5 months after the injury is \ninvaluable in this case.  The initial MRI findings \nshowing some increased signal intensity of the \nAchilles tendon which suggested partial tearing \napproximately one month later would be \nconsistent within this time frame of still having \nevidence of an injury but also acknowledging \nthere are significant surrounding changes \nclearly much older than 1 month.  The follow-\nup MRI represents an improvement, the \nchanges initially presumed to be acute are no \nlonger present, and while the chronic findings \nappear to be still present and unchanged in \nnature.  I would interpret this as a recovery to \nbaseline chronic diagnosis with clear evidence \nof resolution of the acute injury.  Id.  \n  \n\nAUSBROOKS - H203317   30\n  \n \n \nDr. Stewart went on to explain that Dr. Head removed nearly 50% of \nthe Achilles tendon substance, which is treatment for degenerative changes \nand not “evidence of an acute or subacute injury.”  Id.  “The surgical \ntreatment for an acute Achilles tear is to repair the tear with sutures, not \nremove half the tendon.”  (Resp. Ex. 1, P. 20).  Dr. Stewart further noted the \nclaimant’s ongoing non-compliance with medical advice, history of symptom \nmagnification, and the claimant’s admission of re-injury at home.  Id.  \nIt is well settled that the Commission has the authority to accept or \nreject medical opinions, and its resolution of the medical evidence has the \nforce and effect of a jury trial.  See Cossey v. Gary A. Thomas Racing \nStable, 2009 Ark. App. 666, 344 S.W.3d 684; Poulan Weed Eater v. \nMarshall, 79 Ark. App. 129, 84 S.W.3d 878 (2002).  The Commission is to \ndetermine the credibility and weight to be accorded to each witness's \ntestimony.  Arbaugh v. AG Processing, Inc., 360 Ark. 491, 202 S.W.3d 519 \n(2005).  \nIn this case, to find that the debridement performed by Dr. Head was \nreasonable, necessary, or causally related to the claimant’s March 24, 2022 \ninjury is to disregard the independent opinions of Dr. Long, Dr. Martin, and \nDr. Stewart.  Prior to the surgery, Dr. Long and Dr. Martin each confirmed \nthat the claimant’s Achilles tear had healed and that the planned surgery \nwould only address the claimant’s chronic pre-existing tendinopathy.  After \n\nAUSBROOKS - H203317   31\n  \n \n \nthe surgery, Dr. Stewart confirmed the same, and cited Dr. Head’s \noperative report as evidence that no tear was revealed during the surgery. \nAccording to Dr. Stewart, the operative report of Dr. Head made no mention \nof seeing any evidence of an acute or subacute injury, nor the consequence \nof an injury at the time of surgery, and there was no mention of tearing in \nthe operative note.   \nWhile it is true that the treatment provided to the claimant leading up \nto the surgery performed by Dr. Head was reasonable, necessary, and \nrelated to a partial thickness Achilles tendon tear, the weight of the medical \nevidence proves that the surgical debridement was wholly unrelated to the \nclaimant’s work-related injury but rather treated a chronic, pre-existing \ncondition for which the respondents are not responsible.   \nIt is undisputed that the claimant’s injury in this matter falls within the \nprovisions set out in Ark. Code Ann. § 11-9-521.  Section 11-9-521(a) \nprovides that: \nAn employee who sustains a permanent \ncompensable injury scheduled in this section \nshall receive, in addition to compensation \nfor temporary total and temporary partial \nbenefits during the healing period or until the \nemployee returns to work, whichever occurs \nfirst, weekly benefits in the amount of the \npermanent partial disability rate attributable to \nthe injury, for that period of time.  \n  \n\nAUSBROOKS - H203317   32\n  \n \n \nIn the present case, the claimant’s employment was terminated on \nApril 8, 2022.  As discussed above, the reports of the physicians \ninterpreting the results of the MRIs agree that the claimant’s partial-\nthickness Achilles tendon tear had healed by August 1, 2022.  These \nphysicians agree that any ongoing issues were the result of chronic \ntendinosis rather than the acute injury in March 2022.  (See Resp. Ex. 1, \nPp. 10, 19-20).  The claimant’s healing period had therefore ended by \nAugust 1, 2022.  Because the December 2022 surgery performed by Dr. \nHead was not necessary, reasonable, or causally related to the claimant’s \nMarch 24, 2022 injury, and I do not agree with the Majority’s findings that \nthe claimant is entitled to any additional disability benefits arising from that \nsurgery, and any TTD benefits should be limited to the period between \nMarch 24 through August 1, 2022.  \nAccordingly, for the reasons stated above, I respectfully dissent. \n \n \n    ___________________________________ \n    MICHAEL R. MAYTON, Commissioner","preview":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. H203317 MARK A. AUSBROOKS, EMPLOYEE CLAIMANT LEXICON, INC., EMPLOYER RESPONDENT TRISTAR CLAIMS MANAGEMENT SERVICES, INC., INSURANCE CARRIER/TPA RESPONDENT OPINION FILED JANUARY 9, 2024","fetched_at":"2026-05-19T22:29:46.044Z","links":{"html":"/opinions/full_commission-H203317-2024-01-09","pdf":"https://labor.arkansas.gov/wp-content/uploads/Ausbrooks_Mark_H203317_20240109.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/full-commission-opinions/"}}