{"id":"full_commission-H204642-2024-11-14","awcc_number":"H204642","decision_date":"2024-11-14","opinion_type":"full_commission","claimant_name":"Margaret Freeman","employer_name":"Miller County Judge","title":"FREEMAN VS. MILLER COUNTY JUDGE AWCC# H204642 November 14, 2024","outcome":"granted","outcome_keywords":["granted:2"],"injury_keywords":["ankle","knee","fracture","back"],"pdf_url":"https://www.labor.arkansas.gov/wp-content/uploads/Freeman_Margaret_H204642_20241114.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/full-commission-opinions/","filename":"Freeman_Margaret_H204642_20241114.pdf","text_length":19040,"full_text":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION \n \n \nCLAIM NO.  H204642 \n \nMARGARET A. FREEMAN, \nEMPLOYEE \n \nCLAIMANT \nMILLER COUNTY JUDGE,  \nEMPLOYER \n \nRESPONDENT \nASS’N OF ARKANSAS COUNTIES/ \nAAC RISK MG’T SERVICES, INC., \nINSURANCE CARRIER/TPA \nRESPONDENT \n  \n      \nOPINION FILED NOVEMBER 14, 2024 \n \nUpon review before the FULL COMMISSION in Little Rock, Pulaski County, \nArkansas. \n \nClaimant represented by the HONORABLE NEAL L. HART, Attorney at \nLaw, Little Rock, Arkansas. \n \nRespondents represented by the HONORABLE CAROL LOCKARD \nWORLEY, Attorney at Law, Little Rock, Arkansas. \n \nDecision of Administrative Law Judge:  Affirmed. \n \n \n OPINION AND ORDER \nThe claimant appeals an administrative law judge’s opinion filed July \n15, 2024.  The administrative law judge granted the respondents’ motion for \nan Independent Medical Evaluation.  After reviewing the entire record de \nnovo, the Full Commission finds that an Independent Medical Evaluation is \nreasonable in accordance with Ark. Code Ann. §11-9-511(a)(Repl. 2012).     \nI.  HISTORY \n The parties stipulated that Margaret A. Freeman, now age 61, \n“sustained an admittedly compensable injury to her left ankle, left foot, left \nleg, and right knee” on June 15, 2022.  According to the record, Ms. \n\nFREEMAN - H204642  2\n  \n \n \nFreeman treated at CHRISTUS Health Ark-La-Tex on June 15, 2022:  “59-\nyear-old female patient presents emergency department for complaints of \nleft ankle pain after falling today.  The patient fell down some stairs today \nresulting in her left ankle injury.”  Physical examination showed “Moderate \nabrasion to the right lateral shin, Other – Limited range of motion to the left \nankle with joint effusion and moderate ecchymosis; deformity to the left \nmedial ankle with significant tenderness and tenting of the skin[.]”   \n An x-ray of the claimant’s left ankle was taken on June 15, 2022 with \nthe impression, “Post reduction left ankle x-ray independently reviewed and \ninterpreted by me demonstrates trimalleolar fracture in good alignment with \nsignificant improvement from prereduction x-ray.”   \n Kellie L. Flaherty, PA provided a Differential Diagnosis on June 15, \n2022: \n59-year-old female presents to the ED by EMS after fall down \na couple of steps at the bottom of the stairs as detailed per \nHPI.  She denies other injury besides abrasion to the lateral \nright ankle and shin, and more significantly the deformed and \ntenting painful and swollen left ankle.  Upon initial evaluation \nthere are 2 abrasions/small lacerations overlying the \ndeformed joint however there is not definite communication \nwith the underlying fracture.  Patient’s x-ray reveals a \ndisplaced trimalleolar fracture dislocation of the left ankle.  \nOrthopedics was consulted and recommended reduction and \nsplint placement in the ED followed by CT for further \nevaluation of the extent of fracture.  Procedures documented \nas above.  I assisted my ED attending Dr. Phillips in \nperforming these procedures.  At the time of reduction this \nwas confirmed to be an open fracture, grade 1.... \n \n\nFREEMAN - H204642  3\n  \n \n \n Dr. Howard R. Brown performed surgery on June 16, 2022:  “Left \nankle irrigation and debridement with open reduction internal fixation of \ntrimalleolar fracture including a posterior fragment.”  The post-operative \ndiagnosis was “Open fracture ankle, trimalleolar....The patient will be \nnonweightbearing for at least 6 weeks, she will need at least 24-48 hours of \nIV antibiotics, and then p.o. antibiotics when she goes home with Keflex \nand Bactrim DS.  As stated she will be nonweightbearing, and in a fracture \nboot.”   \n The claimant was discharged from CHRISTUS Health Ark-La-Tex on \nJune 20, 2022.  The diagnosis was “(1)  Trimalleolar fracture of left ankle.”  \nThe parties stipulated that the respondents “paid medical and indemnity \nbenefits.” \n Dr. Brown reported on September 7, 2022, “RADIOGRAPHIC:  \nThree views of the ankle reveal hardware in place.  Medial malleolus and \nposterior malleolus are healing.  Lateral malleolus is also healing.  Ankle \nmortise is intact.  There is minor micro subcortical cyst formation consistent \nwith RSD....The patient is improving, but slowly.”   \n Dr. Richard B. Sharp examined the claimant on February 23, 2023 \nand assessed “Causalgia of left lower limb....Continue therapy.  Continue \nmedications.”  The claimant continued to follow up with Dr. Sharp.     \n\nFREEMAN - H204642  4\n  \n \n \n The claimant began treating with Dr. Gregory Ardoin on April 3, \n2023: \nMargaret Freeman is a 60 year old female who presents to \ndiscuss concerns about their Ankle, that began on \n06/15/2022. \nPatient fractured her ankle at work after falling down some \nstairs.  She had a grade 1 open fracture....Patient had a \nclosed reduction in the emergency department and then had \nsurgery on 6/16/2022 for debridement of the open fracture \nand open reduction internal fixation of the trimalleolar ankle \nfracture.... \nShe had a fairly routine postoperative course however she \ndeveloped complex regional pain syndrome (CRPS).  Patient \nhas gone on to her extensive physical therapy....Any \nsensitivity below the knee touch to the leg causes severe \npain.  Burning type pain in her foot.... \nFoot and ankle exam:  Left foot and ankle exam reveals \naltered color purpleish reddish leg from mid leg all the way \ndown to the toes.... \nImpression:  1.  Left ankle trimalleolar fracture dislocation \ngrade 1 open status post debridement, open reduction and \ninternal fixation. \n2.  Resultant CPRS not controlled on Lyrica alone....My \nrecommendation is to transition care over to pain \nmanagement specialists (sic) that specializes in RSD and \nwilling to perform sympathetic blocks for this.  I think she \nneeds trial of 3 to 6 injections.  I will make a referral to Dr. \nWalker or Dr. Frankowski and hopefully they will be able to \nhelp this patient get the CRPS under control.  Physical \ntherapy for CRPS should also be continued.... \n \n The claimant began treating with Dr. Gary Frankowski on April 20, \n2023.  Dr. Frankowski assessed “1.  60-year-old patient with history of left \nfoot and ankle injury along with reconstructive stabilization surgery.  Patient \nwith neuropathic chronic pain with tactile allodynia.  Does not meet criteria \nfor Budapest criteria for CRPS.  But definitely meets criteria for neuropathic \n\nFREEMAN - H204642  5\n  \n \n \npain.”  Dr. Frankowski recommended conservative management, \nmedication, and a TENS unit.   \n An Electrodiagnostic Report was done on July 18, 2023 with the \nfollowing impression: \nThis is an abnormal study.  There is electrophysiologic \nevidence of \n1.  Mild Lt. superficial peroneal nerve entrapment/neuropathy \nat or about ankle affecting the myelin and axons of the \nsensory nerve fibers. \n2.  Pt also have demyelinating Lt. sural nerve \nentrapment/neuropathy at or about ankle. \n3.  There is no additional focal entrapment or radiculopathic \nprocess.  Patient has weakness with all the muscles tested \nbut will benefit with continuation of therapy.   \n \n The claimant participated in a Functional Capacity Evaluation on \nJanuary 10, 2024:  “The results of this evaluation indicate that a reliable \neffort was put forth, with 51 of 51 consistency measures within expected \nlimits....Ms. Freeman completed functional testing on this date with reliable \nresults.  Overall, Ms. Freeman demonstrated the ability to perform work in \nthe LIGHT classification of work[.]”   \n Dr. Ardoin reported on January 18, 2024: \nMargaret Freeman is a 61 year old female.  Since their last \nvisit, patient reports feeling Worse.   \nPatient presents today with chief complaint of left foot burning \npain coolness numbness weakness.  She had ankle fracture \nrepair back in June 2022 work-related injury.  Patient had a \nnerve block that lasted for 2 weeks.  She now has nerve injury \nneuralgia nerve pain syndrome associated with it.  Is not really \ngetting better.  She takes medications prescribed by Dr. \nFrankowski.   \n\nFREEMAN - H204642  6\n  \n \n \nShe uses a dorsiflexion assist AFO brace.  It wakes her up at \nnight burns and tingles.... \nFoot and ankle exam:  Steppage gait on the left.  Patient has \nweakness to plantarflexion and dorsiflexion.  She is able to \nplantarflex and dorsiflex however but she has about 3-4 out of \n5 strength in dorsiflexion and plantarflexion.  The foot is cool \non the left however she has great palpable pulses.  She has \ncalf atrophy on the left as compared to the right of about 2 cm \ndifference in mid circumference calf.... \nImpression:  Left ankle fracture with nerve injury.  Likely from \nnerve block with resultant neuritis and foot drop weakness \nboth anterior and posterior muscles.   \nPlan:  Patient is at MMI in regards to orthopedic manages his \nnerve pain (sic).  I do not see any surgery that I can do to help \nher with that.  She needs to continue treatment with the pain \nmanagement physician Dr. Frankowski.... \nPrimary impairment will be given according to the Guides to \nthe Evaluation of Permanent Impairment fourth edition, fourth \nedition page 83 table 62.  Ankle joint space narrowing of less \nthan 3 mm cartilage interval 6% whole person 15% left lower \nextremity and 21% left foot.   \n \n The parties stipulated that “the claimant’s treating physician, Dr. \nArdoin, opined she reached maximum medical improvement (MMI) on \nJanuary 18, 2024, and assigned her a permanent anatomical impairment \nrating of 15% to the left lower extremity, which the respondents have \naccepted and are paying.” \n The record indicates that the claimant followed up with Dr. \nFrankowski on January 18, 2024.  Dr. Frankowski refilled the claimant’s \nmedication, and he also ordered a mental health evaluation with regard to \nthe claimant’s chronic pain.  Dr. Frankowski planned, “We also presented to \nour patient and her husband about using a spinal cord stimulator to help \n\nFREEMAN - H204642  7\n  \n \n \nwith [her] chronic neuropathic pain.  We discussed the trial to see how \nmuch it helps and then the consideration of permanent device.  It was \ndescribed as kind of a pacemaker for the spinal cord in regards to \nprocessing this chronic pain.”     \n A pre-hearing order was filed on May 3, 2024.  According to the pre-\nhearing order, the claimant contended the following:  “The claimant \ncontends she was involved in an admittedly compensable work accident on \nJune 15, 2022, in which she sustained injuries to multiple body parts, \nincluding her left foot, left ankle, left leg, and right knee.  Thereafter, Dr. \nArdoin performed surgery on her left ankle, and the claimant contends she \nnow suffers from residual, documented nerve damage, neuralgia, neuritis, \nleft lower leg weakness, left foot drop, possible complex regional pain \nsyndrome, and neuropathic pain.  Dr. Gary Frankowski, a pain \nmanagement specialist the claimant contends the respondents chose, has \nopined she requires additional medical treatment in the form of a spinal \ncord stimulator.  The claimant contends Dr. Frankowski’s recommendation \nconstitutes reasonably necessary medical care related to her compensable \ninjuries and, therefore, the respondents should be required to provide it.  \nThe claimant states she has a scheduled injury.  She contends the \nrespondents’ chosen physician has recommended additional medical care \nintended to improve her condition, and that she is not currently working as \n\nFREEMAN - H204642  8\n  \n \n \nshe is unable to work due to her compensable injuries.  The claimant further \ncontends that since the respondents have to date directed all her medical \ncare, on these facts compelling her to see yet another doctor for an IME is \nnot reasonably necessary and, therefore, the respondents’ request should \nbe denied.  The claimant contends her attorney is entitled to payment of a \nstatutory fee on any and all controverted indemnity benefits; and she \nrespectfully reserves the right to amend and/or otherwise alter the above \ncontentions as discovery progresses.  All other potential issues except the \nthreshold issue concerning the respondents’ entitlement to an IME are \nexpressly reserved for litigation at a later date including, but certainly not \nlimited to, issues involving permanent impairment.  The claimant also \nspecifically reserves the issue of controversion, as well as any and all \nissues not specifically addressed herein, for future determination and/or \nlitigation.  This is a claim for additional compensation, and the claimant \nhereby renews her request for an award of any and all benefits to which she \nmay be entitled pursuant to the Arkansas Workers’ Compensation Act (the \nAct).”   \n The respondents contended, “The respondents contend that Dr. \nFrankowski is continuing to treat the claimant for pain management, and he \nhas ‘suggested’ a spinal cord stimulator ‘may’ be appropriate.  The \nrespondents are simply requesting an IME , which they contend is in \n\nFREEMAN - H204642  9\n  \n \n \nessence a second opinion in order to determine whether this invasive \nsurgical recommendation is appropriate for treatment of the claimant’s \ncompensable injuries.  The respondents further contend the ALJ has the \nstatutory authority to grant their motion for an IME/second opinion, \nespecially based on these facts given the invasive nature and arguably \nineffective clinical efficacy of Dr. Frankowski’s recommendation herein.  The \nrespondents contend they have not controverted any medical or indemnity \nbenefits in this claim to date, and specifically reserve this and any and all \nother issues not specifically litigated herein for further determination and/or \nlitigation.”   \n The parties agreed to litigate the following issues: \n1.  Whether the respondents are entitled to an IME concerning \nwhether the spinal cord stimulator Dr. Frankowski has \nrecommended is related to, and constitutes reasonably \nnecessary treatment for, her compensable injuries.   \n2.  The parties specifically reserve any and all other issues for \nfuture determination and/or litigation.   \n \n The claimant followed up with Dr. Frankowski on May 7, 2024:  \n“Patient with severe neuropathic pain left lower extremity.  Patient is having \nacute flareup over the past few weeks the pain is intensified mainly at night \ncausing her to be nauseated feel like she has to throw up.  She is also \nhaving more right-sided leg pain she has to rely on the right leg when she is \nambulatory and she uses a cane.  We discussed about potentially \n\nFREEMAN - H204642  10\n  \n \n \nperforming a spinal cord stimulator but that was denied by the insurance \nadjuster....She rates her pain as 8 out of 10 on the pain severity scale.”   \nAn administrative law judge filed an opinion on July 15, 2024.  The \nadministrative law judge found, among other things, that the respondents \nwere entitled to an Independent Medical Evaluation to be performed by Dr. \nCarlos Roman.  The claimant appeals to 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)(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).   \n In the present matter, the claimant contends that Dr. Frankowski’s \nrecommendation of a spinal cord stimulator constitutes reasonably \nnecessary medical treatment.  The administrative law judge concluded in \npart: \nI do not find the fact Dr. Frankowski is the physician who has \nrecommended the surgical insertion of a spinal cord stimulator \n\nFREEMAN - H204642  11\n  \n \n \ninto the claimant’s body – apparently as a last-ditch, “hail-\nMary” effort to treat the claimant’s continued complaints of \npain and weakness based on a rather vague diagnosis \napparently devoid of sufficient objective medical evidence – is \ndispositive on these facts.   \n \n The Full Commission notes that no treating physician of record, \nincluding Dr. Frankowski, has described any portion of the claimant’s \nmedical treatment following the compensable injury to be a “hail-Mary \neffort.”  It is also well-settled that an employee who has sustained a \ncompensable injury is not required to offer objective medical evidence to \nprove she is entitled to additional benefits.  Ark. Health Ctr. v. Burnett, 2018 \nArk. App. 427, 558 S.W.3d 408.  See also Chamber Door Indus., Inc. v. \nGraham, 59 Ark. App. 224, 956 S.W.2d 196 (1997); Ark. Dep’t of Cmty. \nCorr. v. Moore, 2018 Ark. App. 60.  Moreover, the Full Commission notes \nfrom the record that there were many prominent objective medical findings \ndemonstrated following the compensable injury.  These conspicuous \nobjective medical findings included joint effusion, ecchymosis, tenting of the \nskin, trimalleolar fracture, subcortical cyst formation consistent with Reflex \nSympathetic Dystrophy, purple and red coloring in the claimant’s lower left \nleg, an abnormal Electrodiagnostic Study, and cooling and atrophy in the \nclaimant’s left leg. \n Ark. Code Ann. §11-9-511(Repl. 2012) provides, in pertinent part: \n(a)  An injured employee claiming to be entitled to \ncompensation shall submit to such physical examination and \n\nFREEMAN - H204642  12\n  \n \n \ntreatment by another qualified physician, designated or \napproved by the Workers’ Compensation Commission, as the \ncommission may require from time to time if reasonable and \nnecessary.   \n \n In the present matter, the respondents request that the claimant \nparticipate in an Independent Medical Evaluation in accordance with Ark. \nCode Ann. §11-9-511(Repl. 2012) and Ark. Code Ann. §11-9-811(Repl. \n2012).  We find that the respondents’ request is reasonable in accordance \nwith Ark. Code Ann. §11-9-511(a)(Repl. 2012).  We direct the claimant to \nparticipate in an Independent Medical Evaluation to be performed by Dr. J. \nCarlos Roman.  The place of examination shall be reasonably convenient \nfor the claimant pursuant to Ark. Code Ann. §11-9-511(b)(Repl. 2012).  The \nFull Commission finds that the Independent Medical Evaluation is not \ncontrary to the Court of Appeals’ holding in Burkett v. Exxon Tiger Mart, \n2009 Ark. App. 93, 304 S.W.3d 2, because the parties have not yet \n“litigated their case.” \n The Full Commission therefore directs the claimant to present for an \nIndependent Medical Evaluation to be performed by Dr. J. Carlos Roman in \naccordance with Ark. Code Ann. §11-9-511(Repl. 2012).     \n  \n \n \n \n\nFREEMAN - H204642  13\n  \n \n \nIT IS SO ORDERED. \n \n    ___________________________________ \n    SCOTTY DALE DOUTHIT, Chairman \n \n    ___________________________________ \n    M. SCOTT WILLHITE, Commissioner \n \n    ___________________________________ \n    MICHAEL R. MAYTON, Commissioner","preview":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. H204642 MARGARET A. FREEMAN, EMPLOYEE CLAIMANT MILLER COUNTY JUDGE, EMPLOYER RESPONDENT ASS’N OF ARKANSAS COUNTIES/ AAC RISK MG’T SERVICES, INC., INSURANCE CARRIER/TPA RESPONDENT","fetched_at":"2026-05-19T22:29:44.809Z","links":{"html":"/opinions/full_commission-H204642-2024-11-14","pdf":"https://www.labor.arkansas.gov/wp-content/uploads/Freeman_Margaret_H204642_20241114.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/full-commission-opinions/"}}