{"id":"full_commission-H204037-2023-05-24","awcc_number":"H204037","decision_date":"2023-05-24","opinion_type":"full_commission","claimant_name":"Julie Ingle","employer_name":"Hazen School District","title":"INGLE VS. HAZEN SCHOOL DISTRICT AWCC# H204037 MAY 24, 2023","outcome":"unknown","outcome_keywords":[],"injury_keywords":["ankle","back","sprain","fracture"],"pdf_url":"https://labor.arkansas.gov/wp-content/uploads/Ingle_Julie_H204037_20230524.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/full-commission-opinions/","filename":"Ingle_Julie_H204037_20230524.pdf","text_length":28568,"full_text":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION \n \nCLAIM NO. H204037 \n \n \nJULIE R. INGLE,  \nEMPLOYEE  CLAIMANT \n \nHAZEN SCHOOL DISTRICT,   \nEMPLOYER                 RESPONDENT \n \nARKANSAS SCHOOL BOARDS ASSOC.,  \nCARRIER/TPA RESPONDENT \n \n \nOPINION FILED MAY 24, 2023 \n \nUpon  review  before  the  FULL  COMMISSION,  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: Reversed. \n \n \nOPINION AND ORDER \n \n            The claimant appeals a decision of the Administrative Law \nJudge filed on December 13, 2022. The Administrative Law Judge found \nthat the claimant has failed to satisfy the burden of proof that the additional \nmedical, specifically the surgery recommended by Dr. Jesse Burks, is \nreasonable and necessary for the treatment of the compensable injury. \nAfter our de novo review of the entire record, the Full Commission finds that \nthe claimant has proven by a preponderance of the evidence that she is \n\nINGLE – H 204037                                                               2 \nentitled to additional medical treatment to her left foot in the form of a \nlimited tarsometatarsal arthrodesis as recommended by Dr. Jesse Burks.\n               I.  HISTORY \n  The claimant, now 51 years old, worked for the respondent-\nemployer as a cafeteria worker.  The claimant sustained a compensable \ninjury to her left foot and ankle in a workplace accident on January 8, 2021.  \nThe claimant testified that the accident happened in the following manner: \nQ Tell us a little bit about what happened \n and how you got hurt. \n \nA We were shorthanded that day and I – \n me and my friend, a co-worker, was going \n outside to get some more breakfast stuff, \n and she had just went down the ramp, \n and I started down – it’s a wood ramp – \n and I had started down it and about \n halfway down, my right leg went straight \n out and my left foot bent back behind me, \n and I slid the rest of the way down the \n ramp. \n  \nQ Did you actually fall to the ground? \n \nA Yes.  I kind of grabbed the rail and I tried \n to catch myself and I laid down on the \n side. \n \n  The claimant was first seen for complaints about her left foot \ninjury at Baptist Health Stuttgart Medical Clinic on January 20, 2021.  An x-\nray taken of the claimant’s left foot was negative.  The claimant was \n\nINGLE – H204037                                                               3 \ndiagnosed with a left foot sprain and instructed to ice her foot, take NSAIDs \nfor pain, and prescribed a walking boot.   \n  The claimant came under the care of Dr. Kevin Goodson for \nher left foot injury starting on January 25, 2021.  Dr. Goodson ordered x-\nrays of the claimant’s left foot.  The x-rays revealed the following: \nNo acute findings: No acute fracture, Incidental \nfindings osteophyte at plantar aspect calc \ntuberosity.  At Congruent ankle mortise. No \nsignificant degenerative joint changes. \n \n  Dr. Goodson diagnosed the claimant with a left foot contusion, \nnoting that the clinical findings were consistent with a “midfoot bony \ncontusion”.  Dr. Goodson braced the claimant with an orthosis and \ninstructed her to wear it twenty-four (24) hours per day until her next follow-\nup visit. \n  The claimant returned to see Dr. Goodson on March 3, 2021.  \nThe medical records from that visit contain the following history: \n... Patient returns today for routine follow-up.  \nStates that she wore the short boot for almost 30 \nminutes before having to take it off due to \nsignificant tightness around the calf.  She has \nbeen wearing the tall boot previously provided \nby her PCP since last being seen.  Patient was \nhaving mild improvement however while at work \non 2/23, she felt a pop with sharp pain along the \ndorsal midfoot.  That sharp pain pain [sic] is now \na constant dull ache.  Denies any numbness or \ntingling. \n \n\nINGLE – H204037                                                               4 \n  X-rays taken during this visit revealed “No acute fracture. No \npenosteal reaction to suggest acute occult fracture of the midfoot.”  Dr. \nGoodson ordered a left foot MRI for further evaluation. \n  The claimant underwent an MRI of her left foot on March 8, \n2021, which showed the following: \nFindings:  Diagnostic quality is mildly degraded \nby patient motion. \n \nBones:  No fracture or marrow signal \nabnormality. \n \nHallux sesamoids:  Normal signal and \npositioning. \n \nJoints:  Midfoot alignment is normal.  Minimal \ndorsal 1\nst\n tarsometatarsal joint marginal \nspurring.  There is a small 1\nst\n MTP joint effusion. \n \nLisfranc ligament complex:  Intact. \n \nMuscles:  Normal bulk and signal. \n \nTendons:  The imaged flexor and extensor \ntendons are normal in course, caliber, and \nsignal. \n \nSoft tissues:  Mild subcutaneous edema in the \ndorsal midfoot/forefoot. \n \nIMPRESSION: \n1. No stress fracture. \n \n2. Minimal dorsal 1\nst\n tarsometatarsal joint \nmarginal spurring. \n \n3. Small 1\nst\n MTP joint effusion. \n \n\nINGLE – H204037                                                               5 \n4. Mild subcutaneous edema in the dorsal \nmidfoot/forefoot. \n \n  The claimant returned to see Dr. Goodson for a follow-up visit \non April 14, 2021.  Dr. Goodson referred the claimant to physical therapy \nwith a recommended frequency of “1-2 times per week for 6 weeks”. \n  After eighteen (18) physical therapy sessions, the claimant \nreturned to see Dr. Goodson on June 16, 2021.  In the records regarding \nthis visit, Dr. Goodson noted the following plan: \nPlan: I had a lengthy discussion with the patient \nin regards to no frank evidence of fracture or soft \ntissue injury.  Due to persistent symptoms, will \ninitiate physical therapy with focus on modalities \nincluding iontophoresis, hot/cold, ultrasound, \netc.  Patient will continue to work at full duty as \noutlined at her last clinic visit.  Patient \nunderstand[s] and is in agreement with plan.  All \nquestions were answered.  She will call for \nfuture follow-up at her request. \n \n  In response to a letter dated August 9, 2021 from a claims \nadjuster with the Arkansas School Boards Association, Dr. Goodson, \nprovided the following opinion: \nAs to the inquiry if patient Julie Ingle’s work-\nrelated injury is the major cause (i.e. greater \nthan 50%) of her left foot pain, I believe that it is \nbased on previous clinical and radiographic \nevaluation over the last 6+ months of care since \ninitial presentation on January 25\nth\n, 2021.  This \nis also based upon review of patient’s outside \nclinical records prior to presentation to my clinic. \n... \n \n\nINGLE – H204037                                                               6 \n  The claimant continued to experience pain and sought \ntreatment from Dr. Jesse Burks on December 2, 2021.  Dr. Burks ordered x-\nrays which showed, “No distinct evidence of fracture.  However there is an \nabnormal separation between the medial and intermediate cuneiforms.” \n  Regarding the x-rays, Dr. Burks noted: \nI have reviewed with the patient that this could \nbe an indication of rupture of Lisfranc’s ligament.  \nEspecially given her symptoms and the type of \ninjury she sustained. On the oblique view there \nare also changes consistent with posttraumatic \narthrosis.  This could have been from \nsubluxation at the second metatarsal \nintermediate cuneiform joint. \n \n  Dr. Burks ordered an MRI of the claimant’s left foot.  The \nresults of the MRI taken on December 14, 2021, showed the following: \nFINDINGS: \n \nBones/Marrow: No evidence for occult fracture. \n \nJoints/DJD: Moderate DJD noted at the second \nthrough the fifth TMT joints.  Mild grade IV \nchondromalacia noted in the tarsal navicular at \nthe talonavicular joint. \n \nTendons: The flexor and extensor tendons are \nnormal in course caliber and signal. \n \nMuscles/Soft Tissues: Moderate edema noted in \nthe ventral aspect of the subcutaneous tissues \nof the midfoot and imaged forefoot. \n \nLisfranc Ligament: Intact. Increased T2 signal \nnoted in the mid and distal aspect of the \nligament consistent with sprain (coronal PD F5 \nimages 6-9). \n\nINGLE – H204037                                                               7 \nIMPRESSION: \nIntact Lisfranc ligament. Increased T2 signal \nnoted in the mid and distal aspect of the \nligament consistent with sprain (coronal PD F5 \nimages 6-9). \n \nMild DJD noted at the second through fifth \ntarsal-metatarsal joints. Mild grade IV \nchondromalacia noted in the tarsal navicular at \nthe talonavicular joint. \n \nNo occult fracture or dislocation identified in the \nforefoot or imaged mid foot. \n \n  In the December 15, 2021 medical record, Dr. Burks noted, \n“Patient called complaining of significant pain in her foot.  Rx’d prescription \nfor Toradol 10 mg every 8 hours.  Because of the severity of her pain and \nthe fact that it occurred greater than a year ago, will most likely need to \npursue tarsometatarsal arthrodesis.” \n  By letter dated January 31, 2022, Dr. Burks offered the \nfollowing information and opinions regarding the claimant’s foot injury: \n1. Her original diagnosis on 2021-02-08 was a \nfoot sprain. When I evaluated her, my working \ndiagnosis has been tarsal-metatarsal \ndislocation. \n2. The pathology on the MRI and x-ray reveals \nincreased separation between the medial and \nintermediate cuneiforms. This is injury related. I \ndo not find any pre-existing condition. \n3. In regards to the foot, I believe that all of her \nsymptoms are directly related to the 2021-01-08 \ninjury.  \n4. She has failed all forms of conservative \ntreatment. Injections have provided temporary \nrelief. It is too far out from the initial injury to \nperform a repair of the soft tissue.  My \n\nINGLE – H204037                                                               8 \nrecommendation is limited tarsometatarsal \narthrodesis of the affected areas. \n5. Current treatment is indicated. This would \ninclude a limited tarsometatarsal arthrodesis. \nThis is a result of the 2021-01-08 injury. \n6. Additional treatment is indicated. Patient is \nnot at MMI. \n7. Patient is not at MMI. \n \n  On May 19, 2022, Dr. Gregory Ardoin conducted an \nIndependent Medical Examination which resulted in the following opinions: \n1. Injury diagnosis left foot contusion. Not pre-\nexisting. \n \n2. Initial MRI pathology MRI left foot dated \n3/8/2021 reveals intact Lisfranc ligament \ncomplex no stress fracture. There was some \nmarginal osteophytes on the dorsal first \ntarsometatarsal joint and some mild \nsubcutaneous edema noted. There was a small \nfirst MTP joint effusion noted but noting of \nsignificance relating to her area of pain.  X-rays \ndid not reveal any Lisfranc ligament widening at \nany point. There were some pre-existing \nosteophytes and early changes of osteoarthritis. \n \n3. Patient has more evidence of degenerative \nerosive arthritis now however the contusion \nlikely did not predispose her to this. This is made \nwithin a reasonable degree of medical certainty \ngiven her diagnosis of erosive osteoarthritis and \nmorbid obesity. \n \n4. Patient has significant tenderness in joints \nother than the second and third tarsometatarsal \njoints on the left foot which should be addressed \nprior to any considered surgery with selective \njoint injections to see where her pain may be \ncoming from since she has arthritis in the TMT \njoints 1 through 5 as well as the talonavicular \njoint. \n\nINGLE – H204037                                                               9 \n \nPatient’s BMI also needs to be corrected prior to \nany considered foot and ankle surgery down to \n40 or below. \n \n5. I cannot state within a reasonable degree of \nmedical certainty that the proposed limited \nmidfoot arthrodesis is a direct result of the \n1/8/2021 work-related injury. \n \n6. There is no further treatment needed for the \ncontusion that she sustained on 1/8/2021 with \n[sic] reasonable degree of medical certainty. \n \n7. The patient is at MMI in regards to the foot \ncontusion she sustained on 1/8/2021. The \npatient has no permanent impairment according \nto the Guides to the Evaluation of Permanent \nImpairment fourth edition [sic].  \n \nThe patient has no work restrictions. \n \n  By letter dated October 25, 2022, Dr. Burks addressed Dr. \nArdoin’s opinions as follows: \nI have had the opportunity to review Ms. Ingel’s \n[sic] Independent medical evaluation performed \nby Dr. Gregory Ardoin. \n \nI continue to feel, in my professional opinion, \nthat the nature of her injury directly contributed \nto the pain in her midfoot.  They [sic] \ndegenerative changes in the tarsometatarsal \nregion of her foot are consistent with her \ndescription of the pain and also the injury. \n \nThis is a progressive condition, that we [sic] will \nat some point require surgical intervention. ... \n \n \n\nINGLE – H204037                                                               10 \n  Prior to her work accident, the claimant was diagnosed with \nand received treatment for left heel plantar fasciitis, erosive osteoarthritis, \nand degenerative arthritis.  X-rays of the claimant’s bilateral feet taken on \nMarch 3, 2020, revealed, “plain film bilateral feet show osteophytosis[;] both \ngreat toes hammertoe formation[;] there is normal metatarsophalangeal \njoints[;] there is significant posterior calcaneal spurring”. \n  A Pre-hearing Order was filed on December 8, 2021.  \n“Claimant contends that she [is] entitled to additional medical treatment \nbeing recommended by Dr. Jesse Burks, specifically, surgery.” \n  “Respondents contend that the recommended surgery is not \nreasonable and necessary for the claimant’s compensable injury.  Both Drs. \nGoodson and Ardoin have indicated only conservative treatment is \nrecommended.  The surgery did not pass precertification.  It is \nRespondents’ position that Claimant has been released as having reached \nmaximum medical improvement and that additional medical treatment in the \nform of surgery is not reasonable and necessary.” \n  The parties agreed to litigate the following issue:  \n(1) Whether Claimant is entitled to additional \nmedical treatment after reaching MMI as \nrecommended by Dr. Burks. \n \n The parties were unable to stipulate to the claimant’s average \nweekly wages.  Prior to the start of the hearing, the parties made arguments \n\nINGLE – H204037                                                               11 \nregarding the calculation of the claimant’s average weekly wages and the \nAdministrative Law Judge added this as a second issue to be litigated. \n After a hearing, an Administrative Law Judge filed an opinion \non December 13, 2022.  The Administrative Law Judge found: \n1.  The Arkansas Workers’ Compensation \nCommission has jurisdiction over this claim. \n \n2.  An employer-employee relationship existed \non January 8, 2021, when the claimant \nsustained a compensable injury to her left foot \nand ankle.  \n \n3.  The claimant earned an average weekly \nwage of $416.72, sufficient to entitle her to a \ntemporary total disability rate of $278.00 and a \npermanent partial disability rate of $209.00. \n \n4.  The claimant was released at maximum \nmedical improvement as of May 19, 2022, with a \nzero percent (0%) permanent partial impairment \nassigned.  The claimant continued to work for \nthe respondent/employer. \n \n5.  The claimant has failed to satisfy the required \nburden of proof that the additional medical, \nspecifically the surgery recommended by Dr. \nJessie [sic] Burks, is reasonable and necessary \nfor the treatment of the compensable injury. \n \n The claimant appeals these findings to the Full Commission. \n II.  ADJUDICATION \n       A.   Average Weekly Wage \n  A.C.A. §11-9-518 reads, in pertinent part, as follows: \n(a)(1) Compensation shall be computed on the \naverage weekly wage earned by the employee \n\nINGLE – H204037                                                               12 \nunder the contract of hire in force at the time of \nthe accident and in no case shall be computed \non less than a full-time workweek in the \nemployment. \n \n  In Magnet Cove School District v. Barnett, 81 Ark. App. 11, 97 \nS.W.3d 909 (2003), the Court of Appeals calculated the average weekly \nwage of a teacher contracted to work 188 days by dividing her total \ncompensation by the stated length of the contract which was thirty-nine \nweeks. \n  In the present matter, the terms of the claimant’s employment \ncontract with the respondent-employer for the 2020-2021 school year were \nfor $11.70 per hour, 8 hours per day for 180 days.  The total contract \namount was “up to $16,848.00” between the dates of July 1, 2020 and June \n30, 2021.           \n  Regarding the dates that she worked that school year, the \nclaimant testified on cross-examination as follows: \nQ We’re showing that the school year, your \n contract that year, that dates you would \n have worked would be between August \n 24\nth\n of ’20 and June 2\nnd\n of ’21.  Do you \n have any reason to dispute that? \n \nA No. \n \nQ Was it your option to receive pay \n throughout the whole year monthly, every \n 12 months? \n \nA That’s their option.  We have no choice. \n \n\nINGLE – H204037                                                               13 \n  The Full Commission finds that the claimant's average weekly \nwage should be calculated by dividing her salary of $16,848 by 36 weeks \n(180 days/5 work days/week). Therefore, the claimant’s average weekly \nwage is $468.00 which translates to a temporary total disability rate of \n$312.00 per week and a permanent partial rate of $234.00 per week. \n  B. Additional Medical Treatment \n       An employer shall promptly provide for an injured employee \nsuch medical treatment as may be reasonably necessary in connection with \nthe injury 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 reasonably necessary medical \ntreatment is a question of fact for the Commission.  Wright Contracting Co. \nv. Randall, 12 Ark. App. 358, 676 S.W.2d 750 (1984). \n  Reasonable and necessary medical services may include \nthose necessary to accurately diagnose the nature and extent of the \ncompensable injury; to reduce or alleviate symptoms resulting from the \ncompensable injury; to maintain the level of healing achieved; or to prevent \nfurther deterioration of the damage produced by the compensable injury.  \nJordan v. Tyson Foods, Inc., 51 Ark. App. 100, 911 S.W.2d 593 (1995).  A \nclaimant does not have to support a continued need for medical treatment \n\nINGLE – H204037                                                               14 \nwith objective findings.  Chamber Door Industries, Inc. v. Graham, 59 Ark. \nApp. 224, 956 S.W.2d 196 (1997). \n  When medical opinions conflict, the Commission may resolve \nthe conflict based on the record as a whole and reach the result consistent \nwith reason, justice and common sense.  Barksdale Lumber v. McAnally, \n262 Ark. 379, 557 S.W.2d 868 (1977).  A physician’s special qualifications \nand whether a physician rendering an opinion ever actually examined the \nclaimant are factors to consider in determining weight and credibility.  Id. \n  Dr. Burks diagnosed the claimant with tarsal-metatarsal \ndislocation based on MRI results which showed increased separation \nbetween the medial and intermediate cuneiforms.  Because the claimant \nhas failed all forms of conservative treatment, Dr. Burks recommended that \nthe claimant undergo a limited tarsometatarsal arthrodesis.  Dr. Burks \nexplained that previous injections have provided only temporary relief for \nthe claimant.  Additionally, Dr. Burks opined that it is too far out from the \ninitial injury to perform a repair of the soft tissue.  Thus, Dr. Burks’ \nrecommendation is that the claimant undergo a limited tarsometatarsal \narthrodesis of the affected areas. The Full Commission finds that the \nclaimant has proven by a preponderance of the evidence that a limited \ntarsometatarsal arthrodesis as recommended by Dr. Burks is reasonably \nnecessary.   \n\nINGLE – H204037                                                               15 \n  We are not unmindful of the opinions offered by Dr. Gregory \nArdoin in this matter.  The claimant was referred to Dr. Ardoin for an \nIndependent Medical Evaluation.  Dr. Ardoin opined that he cannot state \nwithin a reasonable degree of medical certainty that the proposed limited \nmidfoot arthrodesis is a direct result of the January 8, 2021 work-related \ninjury.  According to Dr. Ardoin, there is no further treatment needed for the \ncontusion that the claimant sustained on January 8, 2021. Dr. Ardoin further \nopined that the claimant has reached maximum medical improvement \nregarding the foot contusion she sustained on January 8, 2021.   \n  Dr. Ardoin’s opinion seems to limit the claimant’s \ncompensable injury to a contusion; however, Dr. Burks’ working diagnosis \nfor the claimant’s injury is tarsal-metatarsal dislocation.   Dr. Ardoin also \nattributes the claimant’s symptoms to arthritis.  However, Dr. Burks opined \nthat “the pathology on the MRI and x-ray reveals increased separation \nbetween the medial and intermediate cuneiforms. This is injury related. I do \nnot find any pre-existing condition.”  Dr. Burks further opined, “[i]n regards \nto the foot, I believe that all of her symptoms are directly related to the \n2021-01-08 injury.”   We assess greater weight to the opinion of Dr. Burks \nwho is the claimant’s treating physician. \n  For the aforementioned reasons, we find that the claimant is \nentitled to a limited tarsometatarsal arthrodesis as recommended by Dr. \nBurks. \n\nINGLE – H204037                                                               16 \n   III. Conclusion     \n   Based on our de novo review of the entire record, the Full \nCommission finds that the claimant has proven by a preponderance of the \nevidence that she is entitled to reasonable and necessary medical \ntreatment provided in relation to her compensable left foot injury, including a \nlimited tarsometatarsal arthrodesis.  For prevailing on appeal to the Full \nCommission, the claimant’s attorney is entitled to an additional fee of five \nhundred dollars ($500.00), pursuant to Ark. Code Ann. §11-9-715(b) (Repl. \n2012). \n IT IS SO ORDERED. \n \nSCOTTY DALE DOUTHIT, Chairman \n \n \n      ______________________________________ \nM. SCOTT WILLHITE, Commissioner  \n \n \n \nCommissioner Mayton dissents. \n \nDISSENTING OPINION \n  I must respectfully dissent from the Majority’s findings that the \nclaimant’s average weekly wage in January 2021 was $468.00 per week \ntranslating to a temporary total disability rate of $312.00 per week.  I must \nfurther dissent from the Majority’s determination that the claimant has \n\nINGLE – H204037                                                               17 \nproven by a preponderance of the evidence that she is entitled to additional \nmedical treatment to her left foot in the form of a limited tarsometatarsal \narthrodesis as recommended by Dr. Jesse Burks.  \n Arkansas Code Annotated section 11-9-518(a)(1) provides in \npertinent part, “Compensation shall be computed on the average weekly \nwage earned by the employee under the contract of hire in force at the time \nof the accident and in no case shall be computed on less than a full-time \nworkweek in the employment.” It is well settled in this State that a school \nemployee’s average weekly wage should be calculated by dividing her \nsalary by the number of weeks she is under contractual obligation to work \nrather than the number of weeks over which she is paid, even when the \nnumber of weeks worked is fewer than fifty-two. Magnet Cove Sch. Dist. v. \nBarnett, 81 Ark. App. 11, 97 S.W.3d 909 (2003).  Here, the claimant \nactually worked from August 24, 2020 to June 2, 2021 for a total of 40.43 \nweeks for a salary of $16,848.00. Dividing the claimant’s salary by the \nweeks worked under the claimant’s contract for hire, the ALJ correctly \ndetermined the claimant’s average weekly wage to be $416.72. \n  With regard to the claimant’s injury itself, what constitutes \nreasonably necessary treatment is a question of fact for the Commission, \nwhich has the duty to use its expertise to determine the soundness of \nmedical evidence and to translate it into findings of fact. Hamilton v. \nGregory Trucking, 90 Ark. App. 248, 205 S.W.3d 181 (2005).  The \n\nINGLE – H204037                                                               18 \nCommission has authority to accept or reject a medical opinion and to \ndetermine its medical soundness and probative force. Oak Grove Lumber \nCo. v. Highfill, 62 Ark. App. 42, 968 S.W.2d 637 (1998).  When the \nCommission weighs medical evidence and the evidence is conflicting, its \nresolution is a question of fact for the Commission. Medic One, LLC v. \nColbert, 2011 Ark. App. 555, 386 S.W.3d 58 (2011). \n On January 28, 2021, Dr. Kevin Goodson diagnosed the claimant \nwith a “midfoot bony contusion” and prescribed an orthotic boot to be used \nby the claimant 24 hours per day. (Cl. Ex. 1, P. 46). Dr. Goodson educated \nthe claimant that they would “continue to treat symptomatically and this will \ncontinue to improve with time.” Id. Dr. Goodson is an orthopedic foot and \nankle specialist.  \nOn March 7, 2021, Dr. Goodson opined that the claimant should \ncontinue with conservative treatment and ordered an MRI for further \nevaluation. (Cl. Ex. 1, P. 53).  Upon review of the claimant’s MRI, Dr. \nGoodson determined that there was “no evidence of occult fracture,” and \n“reiterated that these bony contusions can often take several months to \nresolve.” (Cl. Ex. 1, P. 61).  The claimant’s care plan included wearing a \nrigid soled shoe at all times and taking an NSAID twice daily. Id. On June \n16, 2021, Dr. Goodson “had a lengthy discussion with the patient in regards \nto no frank evidence of fracture or soft tissue injury.” (Cl. Ex. 1, P. 118). \n\nINGLE – H204037                                                               19 \n Dr. Gregory (“Troy”) Ardoin conducted an independent medical \nevaluation (“IME”) of the claimant’s injury and found that the claimant \nsuffered from “mild degenerative changes of the tibiotalar joint with mild \njoint space narrowing.” (Cl. Ex. 1, P. 150).  Dr. Ardoin’s findings included \n“no evidence of any Lisfranc injury or midfoot sprain,” and her left foot \ncontusion had resolved Id. In short, there was “nothing of significance \nrelating to her area of pain.” Id. In his IME, Dr. Ardoin opined that he could \nnot “state within a reasonable degree of medical certainty that the proposed \nlimited midfoot arthrodesis is a direct result of the 1/8/2021 work-related \ninjury.” (Cl. Ex. 1, P. 151).  Dr. Ardoin opined in his May 23, 2022 report that \nthe claimant had reached MMI for her January 8, 2021 injury, sustained no \npermanent impairment, and was under no ongoing work restrictions. Id.  \nLike Dr. Goodson, Dr. Ardoin is an orthopedic foot and ankle specialist.  \n Unlike Dr. Goodson and Dr. Ardoin, Dr. Jesse Burks is a podiatrist. \nDr. Burks first opined that the claimant would require tarsometatarsal \narthrodesis. (Cl. Ex. 1, P. 134). Of the three doctors reviewing the same \nMRI, Dr. Burks was the only doctor who concluded that the claimant would \nneed surgery. Importantly, Dr. Burks is a podiatrist, while Drs. Goodson and \nArdoin are orthopedic foot and ankle specialists and are much better \nqualified to diagnose the claimant’s orthopedic needs than a podiatrist.  I \nafford much greater weight to the matching opinions of the two orthopedic \n\nINGLE – H204037                                                               20 \nfoot and ankle specialists that treated the claimant, Dr. Goodson and Dr. \nArdoin, than that of Dr. Burks, a podiatrist. \nThe majority places weight on the premise that Dr. Burks is the \nclaimant’s treating physician.  It should be pointed out that Dr. Goodson \nwas also the claimant’s treating physician and as her original treating \nphysician is the best person to determine if surgery is reasonable and \nnecessary. In addition, Dr. Goodson was the claimant’s treating physician \nfrom January 2021 until June 2021 and Dr. Burks only saw and examined \nthe claimant three times on December 2, 2021; December 14, 2021; and \nJanuary 19, 2022. \nFor the reasons stated above, I respectfully dissent. \n      \n \n     \nMICHAEL R. MAYTON, Commissioner","preview":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. H204037 JULIE R. INGLE, EMPLOYEE CLAIMANT HAZEN SCHOOL DISTRICT, EMPLOYER RESPONDENT ARKANSAS SCHOOL BOARDS ASSOC., CARRIER/TPA RESPONDENT OPINION FILED MAY 24, 2023 Upon review before the FULL COMMISSION, Little Rock, Pulaski County, Arkansas. Claimant rep...","fetched_at":"2026-05-19T22:29:46.394Z","links":{"html":"/opinions/full_commission-H204037-2023-05-24","pdf":"https://labor.arkansas.gov/wp-content/uploads/Ingle_Julie_H204037_20230524.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/full-commission-opinions/"}}