{"id":"full_commission-H204217-2025-06-05","awcc_number":"H204217","decision_date":"2025-06-05","opinion_type":"full_commission","claimant_name":"Terri Sparks","employer_name":"North Arkansas College","title":"SPARKS VS. NORTH ARKANSAS COLLEGE AWCC# H204217 June 05, 2025","outcome":"affirmed","outcome_keywords":["affirmed:1","granted:1","denied:1"],"injury_keywords":["ankle","fracture","sprain","back","knee"],"pdf_url":"https://www.labor.arkansas.gov/wp-content/uploads/Sparks_Terri_H204217_20250605.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/full-commission-opinions/","filename":"Sparks_Terri_H204217_20250605.pdf","text_length":45414,"full_text":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION \n \n \nCLAIM NO.  H204217 \n \nTERRI SPARKS, \nEMPLOYEE \n \nCLAIMANT \nNORTH ARKANSAS COLLEGE,  \nEMPLOYER \n \nRESPONDENT \nPUBLIC EMPLOYEE CLAIMS DIVISION, \nINSURANCE CARRIER/TPA \nRESPONDENT \n  \n      \nOPINION FILED JUNE 5, 2025  \n \nUpon review before the FULL COMMISSION in Little Rock, Pulaski County, \nArkansas. \n \nClaimant represented by the HONORABLE FREDERICK S. “RICK” \nSPENCER, Attorney at Law, Mountain Home, Arkansas. \n \nRespondents represented by the HONORABLE CHARLES H. McLEMORE, \nJR., Attorney at Law, Little Rock, Arkansas. \n \nDecision of Administrative Law Judge:  Reversed. \n \n \n OPINION AND ORDER \nThe claimant appeals an administrative law judge’s opinion filed \nNovember 19, 2024.  The administrative law judge found that the claimant \nfailed to prove she was entitled to additional medical treatment.  After \nreviewing the entire record de novo, the Full Commission finds that the \nclaimant proved she was entitled to medical treatment provided by Dr. \nSteffen, which reasonably necessary treatment included surgery.     \nI.  HISTORY \n Terri Hastings Sparks, now age 59, testified at a deposition of record \nthat she sustained a nonwork-related accident in 2020: \n\nSPARKS - H204217  2\n  \n \n \n  Q.  Tell me what happened. \nA.  I stepped on a cereal bowl of my son’s and slid across the        \nfloor. \nQ.  When did that happen? \n  A.  2020. \n  Q.  What kind of treatment did you have? \n  A.  I had – I believe it was called a debridement.   \n  Q.  Do you remember who your doctor was? \n  A.  Dr. Pleimann.   \n  Q.  Did that take care of the problem you were having? \n  A.  Yes, sir.   \n  Q.  Okay.  Did you do physical therapy after that? \n  A.  Yes, sir.... \n Q.  Did you see Dr. Pleimann after you completed the physical          \n            therapy?        \n  A.  Yes, sir. \n  Q.  Do you remember when that was? \nA.  That would be – the last time I saw him for that injury was \nDecember of 2020.... \nQ.  After you last saw Dr. Pleimann sometime in December of \n2020, do you see any other doctors for your right ankle? \nA.  No, sir, not that I remember.   \n \n The parties stipulated that the employment relationship existed on \nJanuary 12, 2022.  The respondents’ attorney examined the claimant at \ndeposition: \n  Q.  Tell me what kind of work you were doing that day. \nA.  When I fell, I was unlocking the doors to come into the \noffice to start my day....There’s two doors.  I was in between \nthe exterior, and then the next one that you walk into to get \ninto the Learning Center.... \nQ.  How did you hurt yourself? \nA.  Coming in between the first door that I opened and the \nsecond door, somehow I tripped on – you know that black \nmats that are in front of business? \nQ.  Yes.   \nA.  I tripped over the black mat.... \nQ.  What part of your body was hurt? \nA.  My right ankle.   \n\nSPARKS - H204217  3\n  \n \n \n \n The parties stipulated that the claimant “sustained a compensable \ninjury to her right foot and ankle” on or about January 12, 2022.  The \nclaimant signed a Form AR-N, EMPLOYEE’S NOTICE OF INJURY, on \nJanuary 12, 2022.  The ACCIDENT INFORMATION section of the Form \nAR-N indicated, “Employee states she was walking in the library.  She \ntripped over a mat and hit the second entrance door.  She did not fall to the \nfloor.”     \n According to the record, the claimant treated at Washington Regional \nUrgent Care on or about January 13, 2022.  It was noted that the claimant \n“tripped on black door mat at College.”  A Nurse Practitioner noted \n“Moderate swelling in right ankle.”  The diagnosis was \"Ankle pain,” and x-\nray results showed “Foot XR normal.”       \n An x-ray of the claimant’s right ankle was taken on January 13, 2022 \nwith the following findings: \n  The soft tissues are unremarkable.   \n  There is no evidence of acute fracture. \nThe alignment is normal.  Apparent osteochondral defect is \nnoted about the medial talar dome.   \nIMPRESSION:  Medial talar dome OCD. \n \n An x-ray of the claimant’s right foot was also taken on January 13, \n2022: \n  COMPARISON:  Ankle series dated 6/12/2020. \nFINDINGS:  The bony structures appear osteopenic with \nmoderate calcaneal spurring again noted.  Mild spurring is \n\nSPARKS - H204217  4\n  \n \n \nalso present about the ankle joint with mild asymmetric \ndegenerative narrowing across the fifth tarsometatarsal joint.  \nThere is also mild narrowing across the first MTP joint and no \ndefinite fracture is noted.  No other significant findings.   \nIMPRESSION:  Chronic changes as described above.     \n \n The claimant was treated conservatively and was returned to light \nduty.   \nHannah Patterson, an APRN working in conjunction with Dr. Jason \nPleimann, reported on January 26, 2022: \nRadiographs:  Plain films of the right ankle and right foot done \non 1222 are imported and reviewed.  These demonstrate her \nold medial OLT.  I do not see any acute fractures.  Normal \nankle and hindfoot alignment.   \nImpression:  Right ankle sprain, date of injury 1/12/2022.  She \nhas a pre-existing medial osteochondral lesion of the talus \nthat underwent arthroscopic debridement and microfracture \non 12/8/2020.   \nPlan:  She injured this at work when she tripped.  She is not \nsure how her ankle twisted but she had significant pain \nafterwards.  She has been in a boot after being seen and x-\nrayed but is doing her normal work duty.  She still having pain \nin the ankle as well as some swelling.  She says it did bruise \nmedially initially but that is resolved.  Her exam is fairly benign \nother than tenderness in the swelling.  I reassured her that I \nthink things will get better with time.  She will stick with her \nboot she can do her normal work duties.  She will remove it \nfor some gentle range of motion exercises.  Follow-up in 2 \nweeks for repeat exam.  We will probably have her wean out \nof the boot and start physical therapy at that time. \n \n Hannah Patterson assessed “1.  Body mass index 40+ - severely \nobese” and “2.  Sprain of right ankle.”     \n Hannah Patterson’s impression on February 9, 2022 was “Right \nankle sprain, date of injury 1/12/2022.  She has a pre-existing medial \n\nSPARKS - H204217  5\n  \n \n \nosteochondral lesion of the talus that underwent arthroscopic debridement \nand microfracture on 12/8/2020.”  Ms. Patterson returned the claimant to \n“normal work duty with use of the boot” on February 9, 2022. \n The claimant continued to follow up with Hannah Patterson, who \nnoted on March 2, 2022, “She has been in the walking boot, at this point \nshe can begin to transition out of the boot and wear her lace up ankle \nboots....We will continue physical therapy to work on range of motion and \nstrengthening.  She can remain at her normal work and taking breaks when \nneeded.”  The claimant testified that she did not benefit from physical \ntherapy.       \n An MRI of the claimant’s right ankle was taken on May 9, 2022 and \nwas compared with an MRI taken November 4, 2020.  The following \nimpression resulted: \n1. Progressive cystic changes are seen in the talar dome with \njoint space narrowing of the tibiotalar joint.  The tibiotalar \njoint demonstrates a moderate joint effusion and changes \nconsistent with synovitis.   \n2. Reactive edema is seen involving the posterior subtalar \njoint, talonavicular joint, and calcaneocuboid joint. \n3. Edema in the sinus Tarsi which could represent sinus \nTarsi syndrome in the right clinical setting. \n4. Split tear of the peroneal brevis tendon. \n \nDr. Pleimann reported on May 9, 2022: \nRadiographs:  MRI of the right ankle done here today \nreviewed.  These demonstrate significant cystic change in the \ntalar dome more diffusely than the area of her previous OLT.  \n\nSPARKS - H204217  6\n  \n \n \nThere is significant bony edema throughout the talus and \ncalcaneus.   \nImpression:  Right ankle sprain with history of prior \narthroscopic debridement OLT, date of injury 1/12/2022.  Her \nMRI today shows diffuse edema throughout the talus and into \nthe calcaneus.  I am not sure if this represents stress reaction \nor exacerbation of developing arthritis.  It could also \npotentially be consistent with early onset avascular necrosis of \nthe talus.   \nPlan:  She has not been improving with measures tried \npreviously.  I am going to have her go back into her boot and \ngo nonweightbearing on a knee scooter.  She needs to be a \nsitting work only nonweightbearing.  Return in 4 weeks with a \nstanding three-view right ankle.   \n \n The claimant followed up with Dr. Pleimann on June 6, 2022: \nRadiographs:  3 views of the right ankle done here today \ndemonstrate joint narrowing of the tibiotalar joint and what \nlooks to be some subtle collapse through the talus likely \nconsistent with avascular necrosis. \nImpression:  Right ankle sprain with history of prior \narthroscopic debridement OLT, date of injury 1/12/2022.  Her \nMRI today shows diffuse edema throughout the talus and into \nthe calcaneus.  I am not sure if this represents stress reaction \nor exacerbation of developing arthritis.  It could also \npotentially be consistent with early onset avascular necrosis of \nthe talus.   \nPlan:  She tells me that she just got the knee scooter less \nthan 2 weeks ago and that work has still been making her do \nsome standing and walking.  She needs to be completely \nnonweightbearing.  We discussed that this is a very long \nprocess if it does indeed turn out to be avascular necrosis.  \nWe will need to get some serial x-rays over time and may \neven repeat an MRI in 3 months or so.  She will follow-up with \nme in 6 weeks with a standing 3 view right ankle.   \n \n Dr. Pleimann took the claimant off work beginning June 8, 2022 until \nhe could re-evaluate the claimant at a July 18, 2022 follow-up appointment.  \nThe respondents terminated the claimant’s employment effective June 8, \n\nSPARKS - H204217  7\n  \n \n \n2022.  The record indicates that the respondents continued to pay \ntemporary total disability benefits following the claimant’s termination.      \n Dr. Pleimann gave the following impression on July 18, 2022: \nRight ankle sprain with history of prior arthroscopic \ndebridement OLT, date of injury 1/12/2022.  Her MRI today \nshows diffuse edema throughout the talus and into the \ncalcaneus.  I am not sure if this represents stress reaction or \nexacerbation of developing arthritis.  It could also potentially \nbe consistent with early onset avascular necrosis of the talus. \nPlan:  She has had less pain since using the knee scooter and \nkeeping weight off of her foot.  Her x-rays look stable.  At the \nvery least she is (sic) got severe arthritis, and certainly it is \npossible she could have avascular necrosis here.  I am going \nto keep her nonweightbearing for another 6 weeks and repeat \nx-rays then.  As long as there is no change then we will repeat \nher MRI after that visit.  She needs to remain in sitting work \nonly nonweightbearing on this extremity.  She tells me that \nshe was fired from the job after she was placed on limitations.  \nUltimately, we may try a tall Arizona type brace after the next \nvisit an MRI to see if it would let her weight-bear with less \npain.   \n \n An MRI of the claimant’s right ankle was taken on September 12, \n2022 with the following impression: \n1. Degenerative changes of the tibiotalar joint, posterior \nsubtalar joint, talonavicular joint, and calcaneocuboid joint.  \nOverall this is stable slightly progressed since the previous \nexam. \n2. Moderate tibiotalar joint effusion with changes consistent \nwith synovitis. \n3. Split tear of the peroneal brevis tendon in the \nretromalleolar region.   \n \nDr. Pleimann reported on September 12, 2022: \nAn MRI of this ankle done here today is reviewed.  It \ndemonstrates moderately worsened tibiotalar subtalar and \n\nSPARKS - H204217  8\n  \n \n \ntalonavicular arthritis with subchondral cystic change.  The \nankle joint looks the worst. \nImpression:  Right ankle sprain with history of prior \narthroscopic debridement OLT, date of injury 1/12/2022.  Her \nMRI shows diffuse edema throughout the talus and into the \ncalcaneus consistent with developing arthritis.  It could also \npotentially be consistent with early onset avascular necrosis of \nthe talus. \nPlan:  Her pain has not improved.  She still unable to bear \nweight.  Her MRI shows progressive arthritic change primarily \nin the ankle and subtalar joint but to a lesser extent the \ntalonavicular joint.  We discussed various treatment options, \nincluding various fusion options, total talus replacement, ankle \nreplacement.  I think given concerns over possible vascularity \nof the talus I think she would do best with a tibiotalar \ncalcaneal arthrodesis.  This would still leave her talonavicular \njoint arthritic, but hopefully this could be managed with \ncortisone injections etc.  She understands she had a very stiff \nankle and hindfoot.  She understands [there] is a risk of \nnonunion, wound healing problems, infection among others.  \nShe wishes to proceed.  She is going to call and let me know \nwhen in the near future would be best for her.  In the interim \nshe could return to sitting work only.  She should not drive. \n \n Ann Wilson, RN, CCM corresponded with Dr. Pleimann on \nSeptember 14, 2022: \nI am a nurse case manager who has been asked by Public \nEmployee Claims Division to provide pre-authorization for the \nproposed right ankle tibiotalar calcaneal arthrodesis and to \nclarify injury relatedness of the proposed surgery in regard to \nMs. Sparks’ injury of 01/12/22.   \nAs you are aware, Ms. Sparks is a 56-year-old female who \ninjured her right ankle when she was walking in the library.  \nShe tripped over a mat and hit the second entrance door \nwithout falling.... \nThe 05/09/22 MRI identified progressive cystic changes in the \ntalar dome with joint space narrowing of the tibiotalar joint, \nmoderate effusion and synovitis in the tibiotalar joint, reactive \nedema of the posterior subtalar joint, talonavicular joint and \ncalcaneocuboid joint, edema in the sinus Tarsi which \n\nSPARKS - H204217  9\n  \n \n \nrepresented a sinus Tarsi syndrome, and a split tear of the \nperoneal brevis tendon.... \nThe 09/12/22 MRI identified degenerative changes of the \ntibiotalar joint, posterior subtalar joint, talonavicular joint and \ncalcaneocuboid joint, stable but slightly progressed, moderate \ntibiotalar joint effusion consistent with synovitis, split tear of \nthe peroneal brevis tendon in the retro malleolar region.  Due \nto worsening arthritis, a fusion was recommended. \nIn view of the above, clarification is needed regarding injury \nrelatedness of the proposed right ankle tibiotalar calcaneal \narthrodesis.  Please consider addressing the following \nquestions at this time.   \n1. What pathology identified on the enclosed MRIs are \nconsidered acute 01/22 injury related?   \n    (Dr. Pleiman replied on September 25, 2022 and wrote     \n“None.”) \n2. Would the reported mechanics of tripping, but not falling, \nhave resulted in her current symptoms and pathology?  \nPlease explain and provide supporting rationale.   \n(Dr. Pleimann wrote “No.”)  \n3. Which of Ms. Sparks’ current symptoms are the direct \nresult of the 01/12/22 injury, versus progressive \ndegenerative joint disease or from the pre-existing \nosteochondritis dissecans lesion and surgery?  Please \nexplain and provide supporting rationale. \n(Dr. Pleimann appeared to write, “The majority, if not all, of \nher symptoms are related to progression of AVN.”)   \n \n Dr. Pleimann also wrote on the correspondence that the proposed \nright ankle arthrodesis was indicated and medically appropriate.  However, \nDr. Pleimann wrote “No” to the question, “5.  Can you state, within a \nreasonable degree of medical certainty, the major cause (greater than 50%) \nfor the proposed right ankle arthrodesis is the direct result of the 01/12/22 \ninjury versus her pre-existing pathology?”     \n Ann Wilson corresponded with Dr. Pleimann on September 27, 2022: \n\nSPARKS - H204217  10\n  \n \n \nBased on your response to my letter, it is my understanding \nthe majority, if not all, of Ms. Terri Sparks’ symptoms and \nneed for proposed right ankle tibiotalar calcaneal arthrodesis \nare indicated and related to her progressive degenerative joint \ndisease of the ankle rather than the 01/12/22 work injury.  \nBased on this information, her surgery and any additional \ntreatment will need to be filed under her private health \ninsurance.   \nIn view of the above, I am writing at the request of Public \nEmployee Claims Division for documentation of achievement \nof maximum medical improvement (MMI) and assignment of \npermanent partial physical impairment rating specifically in \nregards to Ms. Sparks’ injury of 01/12/22.  Please address the \nfollowing questions at this time.   \n1. Since the proposed surgery is not considered 01/12/22 \ninjury related, has Ms. Sparks achieved MMI as the result \nof the 01/12/22 work injury?  If so, what date was MMI \nachieved. \nDr. Pleimann replied, “Yes.  9/12/22.” \n2. If MMI has been achieved, is there any assignment of a \npermanent partial physical impairment rating as the result \nof the 01/12/22 work injury?  If so, please document the \npercentage of impairment and the objective finding this is \nbased in accordance with the enclosed Arkansas Workers’ \nCompensation Rule 34.  Please include edition, page, \ntable, and chart number.   \nDr. Pleimann wrote “0% impairment rating.”   \n \n The respondents’ attorney examined the claimant at deposition: \n  Q.  Do you remember the last time you saw Dr. Pleimann? \n  A.  I think it was September the 19\nth\n. \n  Q.  Did you change to see Dr. Steffen after that? \nA.  No.  Dr. Pleimann, he said that – he called me – his office \ncalled me the day before surgery, which was the 28\nth\n of \nSeptember, I believe, and said that workers’ comp had denied \nmy claim and asked if I would pay out-of-pocket, and I said, \n“You-all know I’m unemployed and I got terminated from the \ncollege,” and I didn’t have $4,500.  And then he dropped me, \nsaying there was nothing wrong with me.   \n \n\nSPARKS - H204217  11\n  \n \n \n The record indicates that the respondents paid the claimant \ntemporary total disability benefits for a period ending October 5, 2022.   \nThe record contains a Change of Physician Order dated January 18, \n2023:  “A change of physician is hereby approved by the Arkansas \nWorkers’ Compensation Commission for Terri Sparks to change from Jason \nPleimann, M.D. to Kevin Steffen, DPM[.]”   \n The claimant began treating with Dr. Kevin J. Steffen, Jr. on \nFebruary 7, 2023: \nPatient presents to clinic complaining of pain in her right \nankle.  Patient fell in 2020 and had arthroscopic surgery to \ndebride the joint and microfracture [and] OCD.  Patient states \nthat she recovered from this and was doing great, and then \nfell in Jan. 2022 and re injured the ankle.  Patient was in a \nwalking boot for about 4 months, had an MRI that confirmed \nsignificant bone marrow edema in the rearfoot and ankle as \nwell as cystic changes to the talus.  Patient was then \nimmobilized and was non weight bearing for another couple \nmonths.  Repeat MRI was then performed which showed \nprogression of the degenerative changes and no improvement \nto the cystic changes or edema.  Patient was then scheduled \nfor ankle and STJ arthrodesis, which was denied by \nworkman’s comp in Sept. 2022.  Patient did not have surgery.  \nPatient is still in the boot and still has significant pain.  Patient \nis here for another opinion.... \nModerate edema with varicosities noted bilaterally with \nincreased edema to the right foot and ankle.  There is \nsignificant pain with palpation to the right foot and ankle and \nwith ROM of the ankle and STJ.... \nRadiographs, 3 views right foot, AP, MO and lateral and 2 \nviews right ankle, AP and mortise, do not reveal acute \nchanges, there are significant degenerative changes noted to \nthe ankle and subtalar joint with cystic changes to the talus \nwith sclerosis of the talus and STJ, there are also \ndegenerative changes to the TN joint. \n\nSPARKS - H204217  12\n  \n \n \nMRIs and CTs from 2020 and 2022 were evaluated, CT in \n2020 suggested osteochondral lesion to the talar dome, 2022 \nMRIs suggested significant bone marrow edema to rearfoot \nand ankle with degenerative changes to the ankle, STJ and \nTN and cystic changes to the talus.   \n \n Dr. Steffen assessed “Post traumatic arthritis right foot and ankle.  \nAVN talus right.  Pain.”  Dr. Steffen treated the claimant conservatively but \nalso discussed the possibility of surgery.   \n Dr. Steffen reported on June 27, 2023, “Patient presents to clinic for \nfollow up of pain in her right ankle.  Patient is still in the boot.  Still has \nsignificant pain and is still non weight bearing on a knee scooter.  Patient is \nasking about surgery....Again discussed risks, complications and post \noperative care of surgery, which would be tibiotalar and subtalar joint fusion \nas well as core decompression....Recommended CT scan to help plan for \nsurgery.” \n The claimant followed up with Dr. Steffen on July 19, 2023:  “Patient \nis here to discuss the CT results.  She is still having quite a bit of pain....CT \nreveals no evidence of avascular necrosis.  Large lucency in the medial \ntalar dome.  Severe DJD in the AJ and STJ.”  Dr. Steffen assessed “Post \ntraumatic arthritis right foot and ankle with cystic changes to the talus.  \nPain....Discussed surgery on the right ankle and patient would like to \nproceed with scope and subchondroplasty.” \n\nSPARKS - H204217  13\n  \n \n \n Dr. Steffen performed surgery on September 1, 2023:  “Ankle \narthroscopy with significant debridement as well as repair of the \nosteochondritis in the right talus.”  The pre- and post-operative diagnosis \nwas “1.  Osteochondritis dissecans of the right ankle.  2.  Arthritis, right \nankle.”  The claimant followed up with Dr. Steffen on September 29, 2023:  \n“Patient’s pain has improved, but still cannot stand or walk for very long \nwithout pain and instability....edema is significantly improved as well as \npain, slight weakness in the ankle.”  Dr. Steffen assessed “Post traumatic \narthritis right foot and ankle with cystic changes to the talus, post op.  OCD \nright talus, post op.  Pain.”   \n Dr. Steffen reported on December 6, 2023: \nPatient presents to clinic for follow up of pain in the right foot.  \nPatient is walking without a boot, but is wearing a brace.  Still \nhas significant pain and swelling.... \nDiscussed continued use of the brace.  Discussed icing, \ncompression, supportive shoes, inserts, anti-inflammatory \nmedications, injections and fusion.  \nPatient would like to continue at home care. \nFollow up PRN.   \n \n Dr. Steffen assessed “1.  Arthritis of right foot” and “2.  Pain, joint, \nankle and foot.”      \n A pre-hearing order was filed on February 6, 2024.  According to the \npre-hearing order, the claimant contended, “The Claimant contends that \nshe sustained a compensable injury to her right foot and ankle in the course \nand scope of her employment on January 12, 2022.  The Claimant did a \n\nSPARKS - H204217  14\n  \n \n \nChange of Physician to Dr. Kevin Steffen.  She contends that she is entitled \nto reasonable and necessary medical treatment under his direction.  The \nClaimant contends that she is entitled to TTD benefits (dates to be \ndetermined).  The Claimant contends that she is entitled to an impairment \nrating by Dr. Steffen and related permanent partial disability benefits.”   \n The respondents contended, “The Respondent contends that the \nclaimant reported having an accident occurring January 12, 2022 when she \nstumbled on a mat and injured her right ankle.  The claimant was diagnosed \nwith a sprain following this date.  Respondent accepted as compensable \nthis sprain injury the claimant sustained.  The claimant was provided \nreasonable and necessary medical treatment for her injury, including MRI \nstudy and treatment with Dr. Jason Pleimann.  The claimant had a \npreexisting condition in her right ankle, and had undergone arthroscopic \nsurgery on her right ankle by Dr. Pleimann on December 8, 2020.  The \nclaimant had arthritis following her surgery.  Dr. Pleimann wrote that the \nclaimant’s need for a surgery at this time is due to her preexisting condition, \nnot a work injury, and released the claimant at maximum Medical \nImprovement on September 12, 2022 with [a 0%] impairment rating.  The \nclaimant was paid TTD benefits for which Respondent is entitled to a credit.  \nThe claimant used her one-time Change of Physician to see Dr. Steffen, \n\nSPARKS - H204217  15\n  \n \n \nand has been provided a visit with her choice of physician by the \nRespondent.”   \n The respondents contended, “Respondent contends that the \nclaimant has been provided reasonable and necessary medical treatment \nand appropriate indemnity benefits for her compensable sprain injury, and \nthat the claimant cannot meet her burden of proving that she is entitled to \nadditional medical treatment reasonable and necessary for or causally \nrelated to her work injury, nor is the claimant entitled to additional indemnity \nbenefits for her work injury.  Respondent further contends that the claimant \ncannot establish that a compensable injury is the major cause of any \npermanent impairment she contends to be entitled to.  The Respondents \nreserve the right to raise additional contentions, or to modify those stated \nherein, pending the completion of discovery.”   \n The parties agreed to litigate the following issue:  “1.  Whether \nClaimant is entitled to additional medical treatment for her compensable \nright foot and ankle injury in the form of surgery as recommended by Dr. \nKevin Steffen.”   \n A hearing was held on August 21, 2024.  The claimant testified that \nshe continued to suffer from swelling in her right ankle.  An administrative \nlaw judge examined the claimant at hearing: \nQ.  Now, after this surgery occurs by Dr. Steffen, tell me how \nyour symptoms are improved or worsened after the surgery.  \n\nSPARKS - H204217  16\n  \n \n \nHow are you doing after this latest surgery?  I know you are \nnot perfect.  You have explained that to us. \nA.  Right. \nQ.  But what are the differences between pre-surgery and \npost-surgery? \nA.  I am not on a scooter. \nQ.  Okay. \nA.  As far as walking and going places, I don’t do things.  I \ndon’t go out very much because of the fact it is hard to.  It is \nvery hard with the pain. \nQ.  Was the pain worse before the surgery than after the \nsurgery? \nA.  Before the surgery it was worse.  But, yes, after, it’s still \nbad.   \n \n An administrative law judge filed an opinion on November 19, 2024.  \nThe administrative law judge found that the claimant failed to prove she was \nentitled to additional medical treatment recommended by Dr. Steffen.  The \nadministrative law judge therefore denied the claim.  The claimant appeals \nto the Full Commission. \nII.  ADJUDICATION \n The employer shall promptly provide for an injured employee such \nmedical treatment as may be reasonably necessary in connection with the \ninjury received by the employee.  Ark. Code Ann. §11-9-508(a)(Supp. \n2024).  The employee has the burden of proving by a preponderance of the \nevidence that medical treatment is reasonably necessary.  Stone v. Dollar \nGeneral Stores, 91 Ark. App. 260, 209 S.W.3d 445 (2005).  Preponderance \nof the evidence means the evidence having greater weight or convincing \nforce.  Metropolitan Nat’l Bank v. La Sher Oil Co., 81 Ark. App. 269, 101 \n\nSPARKS - H204217  17\n  \n \n \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 70 (1984). \n An administrative law judge found in the present matter, “2.  The \nclaimant has failed to prove by a preponderance of the evidence that she is \nentitled to additional medical treatment for her compensable right ankle/foot \ninjury in the form of surgery as recommended by Dr. Steffen.”  The Full \nCommission does not affirm this finding.  We find that the treatment \nprovided by Dr. Steffen was reasonably necessary in accordance with Ark. \nCode Ann. §11-9-508(a)(Supp. 2024).   \n The record indicates that the claimant sustained a previous injury to \nher right ankle when she slipped and fell at home in 2020.  The claimant \ntestified that she received surgical treatment from Dr. Pleimann and was \nreleased without further complications.  The parties stipulated that the \nemployment relationship existed on January 12, 2022.  The claimant \ntestified that she tripped and fell while entering her place of employment \nthat day.  The parties stipulated that the claimant “sustained a compensable \ninjury to her right foot and ankle” on January 12, 2022.   \n The respondents provided medical treatment beginning January 13, \n2022, and the claimant eventually began treating with Dr. Pleimann through \nan APRN, Heather Patterson.  Ms. Patterson assessed “2.  Sprain of right \n\nSPARKS - H204217  18\n  \n \n \nankle” on January 26, 2022.  An MRI taken May 9, 2022 showed, among \nother things, a “4.  Split tear of the peroneal brevis tendon.”  Such an \nobjective abnormality had not been shown prior to the stipulated \ncompensable injury of January 12, 2022.  An MRI confirmed September 12, \n2022 confirmed a “3.  Split tear of the peroneal brevis tendon in the \nretromalleolar region.”  It is within the Commission’s province to weigh all of \nthe medical evidence and to determine what is most credible.  Minnesota \nMining & Mfg. v. Baker, 337 Ark. 94, 989 S.W.2d 151 (1999).  Because a \n“split tear of the peroneal brevis tendon” was not demonstrated to be \npresent before the January 12, 2022 compensable injury, the Full \nCommission assigns minimal weight to Dr. Pleimann’s opinion expressed to \nthe Case Manager that this post-injury abnormal diagnostic testing was not \ncausally related to the compensable injury.       \n Dr. Pleimann also opined that the compensable injury sustained by \nthe claimant on January 12, 2022 was not the “major cause” of a need for \nsurgical treatment.  However, the claimant was not required to prove that \nher compensable injury was the “major cause” of her need for medical \ntreatment to include surgery.  See Williams v. L&W Janitorial, Inc., 85 Ark. \nApp. 1, 145 S.W.3d 383 (2004).  Instead, the claimant was required to \nprove that her compensable injury was at least “a factor” in her need for \nadditional medical treatment.  Id.  The Full Commission finds that the \n\nSPARKS - H204217  19\n  \n \n \ncompensable injury was indeed “a factor” in the claimant’s need for medical \ntreatment, including surgery recommended and performed by Dr. Steffen.  \nThe Full Commission has discussed the post-compensable injury diagnostic \ntesting which confirmed a “split tear of the peroneal brevis tendon.”  The \nevidence demonstrates that this objective medical finding was causally \nrelated to the January 12, 2022 compensable injury.  We also find that Dr. \nSteffen’s report of “significant bone marrow edema to rearfoot and ankle” \nwere causally related to the compensable injury, as was Dr. Steffen’s \nassessment of “Post traumatic arthritis.”   \n Dr. Steffen performed surgery on September 1, 2023:  “Ankle \narthroscopy with significant debridement as well as repair of the \nosteochondritis in the right talus.”  Dr. Steffen noted after surgery that the \nclaimant’s pain had lessened and her edema had significantly improved.  \nDr. Steffen also reported on December 6, 2023 that the claimant was able \nto walk without a boot.  The claimant testified before the administrative law \njudge that she was no longer required to use a “knee scooter” after surgery \nperformed by Dr. Steffen.  The claimant also testified that her pain had \nsomewhat decreased after surgery.  Such probative evidence of post-\nsurgical improvement is a relevant consideration in determining whether \nsaid treatment was reasonably necessary.  Hill v. Baptist Med. Ctr., 74 Ark. \n\nSPARKS - H204217  20\n  \n \n \nApp. 250, 48 S.W.3d 544 (2001), citing Winslow v. D&B Mech. Contractors, \n69 Ark. App. 285, 13 S.W.3d 180 (2000).   \n After reviewing the entire record de novo, the Full Commission finds \nthat the claimant proved she was entitled to additional medical treatment as \nrecommended by Dr. Steffen.  We find that the January 12, 2022 \ncompensable injury was at least “a factor” in the claimant’s need for \nadditional medical treatment.  See Williams, supra.  The Full Commission \nfinds that treatment recommended and performed by Dr. Steffen, including \nsurgery, was reasonably necessary in accordance with Ark. Code Ann. §11-\n9-508(a)(Supp. 2024).  For prevailing on appeal to the Full Commission, the \nclaimant’s attorney is entitled to a fee of five hundred dollars ($500), \npursuant to Ark. Code Ann. §11-9-715(b)(Supp. 2024).  The claimant did \nnot prove that any provision of Act 796 of 1993 or the procedures of the \nArkansas Workers’ Compensation Commission are unconstitutional.  See \nWoods v. Tyson Poultry, Inc., 2018 Ark. App. 186, 547 S.W.3d 456. \n IT IS SO ORDERED.      \n \n    ___________________________________ \n    SCOTTY DALE DOUTHIT, Chairman \n \n    ___________________________________ \n    M. SCOTT WILLHITE, Commissioner \n \n \n \nCommissioner Mayton dissents. \n\nSPARKS - H204217  21\n  \n \n \n \nDISSENTING OPINION \n I must respectfully dissent from the Majority’s finding the claimant \nproved she is entitled to additional medical treatment provided by Dr. Kevin \nSteffen. \nArk. Code Ann. § 11-9-508(a) requires an employer to provide an \ninjured employee with medical and surgical treatment \"as may be \nreasonably necessary in connection with the injury received by the \nemployee.\"  The claimant has the burden of proving by a preponderance of \nthe evidence the additional treatment is reasonable and necessary.  Nichols \nv. Omaha Sch. Dist., 2010 Ark. App. 194, 374 S.W.3d 148 (2010). \nWhat constitutes reasonably necessary treatment is a question of \nfact for the Commission.  Gant v. First Step, Inc., 2023 Ark. App. 393, 675 \nS.W.3d 445 (2023).  In assessing whether a given medical procedure is \nreasonably necessary for treatment of the compensable injury, the \nCommission analyzes both the proposed procedure and the condition it \nsought to remedy.  Walker v. United Cerebral Palsy of Ark., 2013 Ark. App. \n153, 426 S.W.3d 539 (2013).  \nIt is within the Commission's province to weigh all the medical \nevidence to determine what is most credible and to determine its medical \nsoundness and probative force.  Sheridan Sch. Dist. v. Wise, 2021 Ark. \nApp. 459, 637 S.W.3d 280 (2021).  \n\nSPARKS - H204217  22\n  \n \n \nIn weighing the evidence, the Commission may not arbitrarily \ndisregard medical evidence or the testimony of any witness.  Id.  However, \nthe Commission has the authority to accept or reject medical opinions. \nWilliams v. Ark. Dept. of Community Corrections, 2016 Ark. App. 427, 502 \nS.W. 3d 530 (2016).  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. \nThe claimant has a documented history of issues with her right ankle \nand foot resulting from a fall in 2020.  Due to that injury, Dr. Jason Pleimann \nperformed an arthroscopic debridement on the claimant’s ankle and foot on \nDecember 8, 2020.  The claimant on direct examination testified, “I can say, \nhonestly, my ankle was bothering me before the second fall.  I mean I was \nstill able to drive and do whatever I wanted to do, but after the fall, it swells -\n- basically, I mean I don’t know how to say it, three to four times the size.  I \nwould have to go get groceries, but I have to go to Walmart and do the call-\nin and they bring it out to you because I couldn’t walk through Walmart.” \nThe claimant sustained a compensable injury to her right ankle and \nfoot on January 12, 2022, when she tripped and fell while walking into the \nlibrary where she worked.  That day, the claimant was treated at \nWashington Regional Urgent care for complaints of right ankle pain and \n\nSPARKS - H204217  23\n  \n \n \nswelling.  The claimant underwent an x-ray at that visit and the results were \nnormal.  She was prescribed medication and was referred to “ortho.”  \nOn February 9, 2022, the claimant was seen at Ozark Orthopedics \nby APRN Hannah Patterson, who’s findings stated: \nAssessment/Plan Impression: \n \nRight ankle sprain, date of injury \n1/12/2022. She has a pre-existing \nmedial osteochondral lesion of the \ntalus that underwent arthroscopic \ndebridement and microfracture on \n12/8/2020.  \n \nPlan: She has been in the boot \nweightbearing as tolerated, she \nstill has pretty considerable \nswelling today on exam.  She has \nbeen off work quite a bit due to the \nweather, but is still doing her \nnormal work duty with the use of \nthe boot.  I told her I think she can \nstay in the boot for another 2 \nweeks, then transition back to her \nlace up ankle boots if she feels \nable before her next appointment. \nWe have discussed that with her \nhistory of surgery on this ankle, \nthis could take a while before it \ncomes around fully.  I want her to \ncontinue to ice, take ibuprofen as \nneeded, and give this some \nrelative rest.  We will get her into \nsome physical therapy to work on \nrange of motion and strengthening. \nFollow-up in 3 weeks for \nreevaluation.  I expect MMI in  \n6 to 8 weeks.  \n \n\nSPARKS - H204217  24\n  \n \n \nOn May 2, 2022, APRN Patterson referred the claimant for an \nMRI, which she had on May 9, 2022. The MRI revealed: \n1. Progressive cystic changes are \nseen in the talar dome with joint \nspace narrowing of the tibiotalar \njoint.  The tibiotalar joint \ndemonstrates a moderate joint \neffusion and changes consistent \nwith synovitis.  \n \n2. Reactive edema is seen \ninvolving the posterior subtalar \njoint, talonavicular joint, and \ncalcaneocuboid joint. \n \n3. Edema in the sinus Tarsi which \ncould represent sinus Tarsi \nsyndrome in the right clinical \nsetting.  \n \n4. Split tear of the peroneal brevis \ntendon.  \n \nThat day, the claimant was seen by Dr. Jason Pleimann, an \northopedic surgeon at Ozark Orthopedics who reviewed the claimant’s MRI \nand opined: \nAssessment/Plan \n  \nRadiographs: MRI of the right \nankle done here today reviewed. \nThese demonstrate significant \ncystic change in the talar dome \nmore diffusely than the area of her \nprevious OLT.  There is significant \nbony edema throughout the talus \nand calcaneus.  \n \n\nSPARKS - H204217  25\n  \n \n \nImpression: Right ankle sprain with \nhistory of prior arthroscopic \ndebridement OLT, date of injury \n1/12/2022.  Her MRI today shows \ndiffuse edema throughout the talus \nand into the calcaneus.  I am not \nsure if this represents stress \nreaction or exacerbation of \ndeveloping arthritis.  It could also \npotentially be consistent with early \nonset avascular necrosis of the \ntalus. \n \nThe claimant followed up with Dr. Pleimann on July 18, 2022.  Dr. \nPleimann reviewed standing three-view imaging of the claimant’s ankle and \nreported that “[t]hese again show some cystic change to the talus and some \nmild sclerosis.  No obvious collapse.  Dr. Pleimann’s records reflect his \nopinion that the claimant suffers from worsening arthritis: \nImpression: Right ankle sprain with \nhistory of prior arthroscopic \ndebridement OLT, date of injury \n1/12/2022.  Her MRI today shows \ndiffuse edema throughout the talus \nand into the calcaneus.  I am not \nsure if this represents stress \nreaction or exacerbation of \ndeveloping arthritis.  It could also \npotentially be consistent with early \nonset avascular necrosis of the \ntalus.  \n \nPlan: She has had less pain since \nusing the knee scooter and \nkeeping weight off of her foot.  Her \nx-rays look stable.  At the very \nleast she is (sic) got severe \narthritis, and certainly it is possible \n\nSPARKS - H204217  26\n  \n \n \nshe could have avascular necrosis \nhere.  I am going to keep her \nnonweightbearing for another 6 \nweeks and repeat x-rays then.  As \nlong as there is no change we will \nrepeat her MRI after that visit.  \n \nOn September 12, 2022, the claimant underwent an additional right \nankle MRI.  Upon review, Dr. Pleimann states that “[i]t demonstrates \nmoderately worsened tibiotalar subtalar and talonavicular arthritis with \nsubchondral cystic change.  The ankle joint looks the worst.” Dr. Pleimann \nopined that this could potentially be consistent with early onset avascular \nnecrosis of the talus as he had previously considered.  At that time, Dr \nPleimann proposed surgery to treat the claimant’s chronic conditions. \n On September 14, 2022, the RN.CCM, Ann Wilson, of Systemedic \nwrote Dr. Pleimann asking a series of questions regarding the claimant’s \ninjury.  Most notably, she  asked, “What pathology identified on the \nenclosed MRIs are considered acute 01/12/22 injury related?”  Dr. \nPleimann responded “None.”  Dr. Pleimann further explained that “[t]he \nmajority, if not all, of her symptoms are related to progressive [illegible].” \nMs. Wilson also asked, “If the ankle arthrodesis is indicted for pre-existing \npathology, is there an additional treatment indicated as the result of the \n1/12/22 injury?”  Dr. Pleimann replied, “No.”  Her final question to the doctor \nwas, “If the ankle arthrodesis is indicated, medically appropriate, and the \ndirect result of the 1/12/22 injury, what is the potential outcome based on \n\nSPARKS - H204217  27\n  \n \n \nher pre-existing and co-existing medical conditions?”  Dr. Pleimann replied, \n“N/A.”  \nMs. Wilson sent a follow-up letter to Dr. Pleimann on September 27, \n2022, with two follow-up questions, to which Dr. Pleimann responded:  \n1. Since the proposed surgery is \nnot considered 01/12/22 injury \nrelated, has Ms. Sparks achieved \nMMI as the result of the 01/12/22 \nwork injury?  If so, what date was \nMMI achieved?  \n \nYes.  9/12/22.  \n \n2. If MMI has been achieved, is \nthere any assignment of a \npermanent partial physical \nimpairment rating as the result of \nthe 01/12/22 work injury?  If so, \nplease document the percentage \nof impairment and the objective \nfinding this is based in accordance \nwith the enclosed Arkansas \nWorkers’ Compensation Rule 34. \nPlease include edition, page, table, \nand chart number.  \n \n0% impairment rating.  \n \nThe claimant requested a change of physician from the Commission \non January 6, 2023, and a Change of Physician Order was entered on \nJanuary 18, 2023 changing the claimant’s treating physician from Dr. \nPleimann to Dr. Kevin Steffen.  \nAt a February 7, 2023 visit, Dr. Steffen opined: \n\nSPARKS - H204217  28\n  \n \n \nRadiographs, 3 views right foot, \nAP, MO and lateral and 2 views \nright ankle, AP and mortise do not \nreveal acute changes, there are \nsignificant degenerative changes \nnoted to the ankle and subtalar \njoint with cystic changes to the \ntalus with sclerosis of the talus and \nSTJ, there are also degenerative \nchanges to the TN joint.  MRIs and \nCTs from 2020 and 2022 were \nevaluated, CT in 2020 suggested \nosteochondral lesion to the talar \ndome, 2022 MRIs suggested \nsignificant bone marrow edema to \nrearfoot and ankle with \ndegenerative changes to the ankle, \nSTJ and TN and cystic changes to \nthe talus. \n \nDr. Steffen “[d]iscussed that both sudden injury and chronic \ndegenerative changes from an old injury could cause the AVN of the talus.”  \nDr. Steffen ultimately performed a right ankle arthroscopy and debridement \non September 1, 2023.  Operative notes reflect Dr. Steffen’s opinion that \nthe changes he treated were degenerative, stating that there were \n“significant degenerative changes to the ankle joint as well as cystic and \nosteochondral defects in the talus and the distal tibia.”  His operative notes \nalso state, “Some, if not most, of her pain may be related to her \ndegenerative changes in the ankle joint.” \nThe claimant has presented no clear evidence that Dr. Steffen \nbelieved that the need for a right ankle arthroscopy was causally related to \n\nSPARKS - H204217  29\n  \n \n \nthe claimant’s January 2022 injury. In fact, Dr. Steffen notes degenerative \nchanges to the claimant’s ankle in his operative notes and discussed with \nthe claimant the likelihood that her condition was due to degenerative \nchanges from her 2020 injury. \nThe objective findings from the claimant’s treatment with Dr. \nPleimann is consistent with Dr. Steffen’s opinion that the claimant suffered \na right ankle sprain on January 12, 2022, but the pathology found in her \nimaging are degenerative in nature and related to her fall in 2020 and not \nher injury on January 12, 2022. \nDr. Pleimann has stated that none of the pathology on the MRI’s \nafter the 2022 injury were acute and related to the 2022 injury.  It was also \nhis opinion that the suggested ankle surgery after the 2022 accident was for \nthe pre-existing pathology.  Dr. Pleimann’s opinion carries much more \nweight than that of Dr. Steffen since he was the claimant’s treating \nphysician for the non-related 2020 injury and the compensable injury on \nJanuary 12, 2022.  \nThe claimant has wholly failed to prove by the preponderance of the \nevidence that she is entitled to the additional medical treatment provided by \nDr. Steffen, and for these reasons, the ALJ’s findings should be affirmed. \nAccordingly, for the reasons set forth above, I respectfully dissent. \n \n\nSPARKS - H204217  30\n  \n \n \n     _________________________________  \n     MICHAEL R. MAYTON, Commissioner","preview":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. H204217 TERRI SPARKS, EMPLOYEE CLAIMANT NORTH ARKANSAS COLLEGE, EMPLOYER RESPONDENT PUBLIC EMPLOYEE CLAIMS DIVISION, INSURANCE CARRIER/TPA RESPONDENT OPINION FILED JUNE 5, 2025","fetched_at":"2026-05-19T22:29:44.234Z","links":{"html":"/opinions/full_commission-H204217-2025-06-05","pdf":"https://www.labor.arkansas.gov/wp-content/uploads/Sparks_Terri_H204217_20250605.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/full-commission-opinions/"}}