{"id":"full_commission-H304280-2025-03-12","awcc_number":"H304280","decision_date":"2025-03-12","opinion_type":"full_commission","claimant_name":"Larry Zintel","employer_name":"Pulaski County Road & Bridge,","title":"ZINTEL VS. PULASKI COUNTY ROAD & BRIDGE, AWCC# H304280 March 12, 2025","outcome":"denied","outcome_keywords":["denied:1"],"injury_keywords":["back","neck","shoulder","strain","lumbar","fracture","hip"],"pdf_url":"https://www.labor.arkansas.gov/wp-content/uploads/Zintel_Larry_H304280_20250312.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/full-commission-opinions/","filename":"Zintel_Larry_H304280_20250312.pdf","text_length":31643,"full_text":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION \n \n \nCLAIM NO.  H304280 \n \nLARRY M. ZINTEL, \nEMPLOYEE \n \nCLAIMANT \nPULASKI COUNTY ROAD & BRIDGE,  \nEMPLOYER \n \nRESPONDENT \nAAC RISK MANAGEMENT SERVICES, \nINSURANCE CARRIER/TPA \nRESPONDENT \n  \n      \nOPINION FILED MARCH 12, 2025  \n \nUpon review before the FULL COMMISSION in Little Rock, Pulaski County, \nArkansas. \n \nClaimant represented by the HONORABLE MARK ALAN PEOPLES, \nAttorney at Law, Little Rock, Arkansas. \n \nRespondents represented by the HONORABLE MELISSA WOOD, Attorney \nat Law, Little Rock, Arkansas. \n \nDecision of Administrative Law Judge:  Reversed. \n \n \n OPINION AND ORDER \nThe respondents appeal an administrative law judge’s opinion filed \nMarch 5, 2024.  The administrative law judge found that the claimant \nproved he sustained a compensable injury.  After reviewing the entire \nrecord de novo, the Full Commission reverses the administrative law \njudge’s opinion.  We find that the claimant did not prove by a \npreponderance of the evidence that he sustained a compensable injury.     \nI. HISTORY \n The testimony of Larry M. Zintel, now age 46, indicated that he \nbecame employed with the respondents, Pulaski County Road & Bridge, in \n\nZINTEL - H304280  2\n  \n \n \nabout 2013.  The parties stipulated that the employment relationship existed \nat all pertinent times, including January 18, 2022.  The claimant testified on \ndirect examination: \n Q.  On January the 18\nth\n of 2022, what happened? \nA.  I was driving in to work, my phone rang.  I saw it was \nForeman Gary and I went to reach for it and couldn’t reach it, \nso I had to pull over, get my phone.  I answered it and Gary \nwas instructing me I need to go pick up David Jones because \nhis ride was not able to come in to work.   \nQ.  Okay.  Was he asking you for a personal favor? \nA.  I – I didn’t take it as a personal favor. \nQ.  What did you take it as? \nA.  I took it as he needed me to go pick up a fellow employee \non my way in to work and bring him to work, which, in turn, I’d \nhave to drive past the job, go pick him up and come back.   \nQ.  All right.  Did you feel like you had a choice as to whether \nor not you could go pick up Mr. Jones? \nA.  No, sir. \nQ.  Okay.  Did you think it was a directive from your superior? \nA.  Yes, sir.   \nQ.  All right.  So did you do so, go pick up Mr. Jones? \nA.  I was on my way. \nQ.  You didn’t pick up Mr. Jones.   \nA.  I got hit head-on before I could do it.   \nQ.  Okay.  You got hit head-on.  You were in a motor vehicle \naccident.  A serious motor vehicle accident, and we have the \npolice report in record on that, correct? \nA.  Yes, sir.   \nQ.  Okay.  What happened in the head-on the best you can \nremember? \nA.  I – I was coming up the hill at Roosevelt and Wolfe and the \nguy was coming at me.  The car passed him and he kinda \nswerved over and hit his brakes, and when he did, his front \nbrakes locked up and he slid right over in my lane and I tried \nto veer to keep him from hitting me too bad, and we collided.  I \ngot out the passenger side of my truck and I thought I wasn’t \nhurt because of the adrenaline and everything, and after \neverything was said and done I went home and started hurting \nreal bad.  I couldn’t hardly walk.   \n\nZINTEL - H304280  3\n  \n \n \n \n An ARKANSAS MOTOR VEHICLE CRASH REPORT dated January \n18, 2022 indicated that the Time of Crash was 6:44 a.m.  The ARKANSAS \nMOTOR VEHICLE CRASH REPORT NARRATIVE indicated that an \nindividual drove his vehicle into the truck being driven by the claimant.  The \nNARRATIVE indicated, “MR. ZINTEL ADVISED NO INJURIES[.]”     \nAccording to the record, the claimant received emergency medical \ntreatment on January 18, 2022: \nPt is a healthy 43 lyo WM, presents to ED via EMS after MVA, \nhe was a restrained driver hit by oncoming car.  Airbags \ndeployed.  Co HA, doesn’t think he hit his head, no LOC; neck \npain, B shoulder pain.... \nGood painless ROM B shoulders and hips. \nPost c spine tenderness in midline, collar replaced.   \n A physician’s diagnosis on January 18, 2022 was “Motor vehicle \naccident, initial encounter.  Strain of neck muscle, initial encounter.”    \nAn MRI of the claimant’s lumbar spine was taken on April 7, 2022 \nwith the following impression: \nNo evidence of acute lumbar spine injury.  Lower lumbar \ndegenerative findings are present, superimposed on mild \ndiffuse narrowing of the bony spinal canal secondary to short \npedicles, as detailed above.   \n \n The claimant followed up with Dr. Robert R. Ritchie on April 12, \n2022: \nMr. ZINTEL presents with low back pain, unspecified.  He \ncharacterizes it as intermittent, moderate in intensity, and \naching.  The event which precipitated this pain was a motor-\n\nZINTEL - H304280  4\n  \n \n \nvehicle accident (he was the driver).  He notes some pain \nrelief with physical therapy.... \n \n Dr. Ritchie’s assessment included “Low back pain, unspecified....He \nis now released for work.  He will probably return to work on 4/18/2022.”  \nDr. Ritchie completed a Concentra form on April 19, 2022 and indicated that \nthe claimant had reached Maximum Medical Improvement on April 12, \n2022.  Dr. Ritchie subsequently referred the claimant to Arkansas Spine \nand Pain, where the claimant was examined on June 2, 2022.  Dr. \nKrishnappa Prasad’s assessment included “Lumbar spondylosis” and \n“Lumbar radiculitis.”  Dr. Prasad treated the claimant conservatively and \nassigned work restrictions.   \n The claimant’s testimony indicated that the respondents terminated \nhis employment effective June 24, 2022.   \n The claimant began treating with Alexandria Peterson, PA-C on \nAugust 9, 2023: \n45-year-old male here for evaluation of his low back pain that \nhas been ongoing since an MVC in 2022.  He endorses \nmainly achy low back pain and posterior buttock/upper thigh \ntightness as well as bilateral S1 paresthesias worse on the \nright.  In the right leg it goes all the way to the bottom of his \nfoot.  He has undergone several months of nonoperative \ntreatment including 36 therapy sessions with some \nimprovement in symptoms, 1 injection with Arkansas spine \nand pain which worsened his symptoms, and medication \nmanagement.  All these interventions have minimally helped \nand he is still in significant pain.  He has not worked since this \nincident.  No issues prior to MVC. \n\nZINTEL - H304280  5\n  \n \n \nHe does appear to have isthmic anterolisthesis at L5 on S1, \ntransitional anatomy.  He has not had a recent MRI.  I will \nhave him get a new MRI to further evaluate the nature and \nseverity of his symptoms today.  He is currently on gabapentin \n300 mg and diclofenac with some improvement in his \nsymptoms.  He does have hydrocodone but reports that his \ninsurance does not cover this and he is not taking them.  I will \nsend him in a prescription for tizanidine 2 mg that he can use \nat night for his paresthesias in the meantime.  I will have him \nfollow-up with Dr. O. after advanced imaging to discuss \nresults and further treatment options at this time.   \nOccupation:  Road worker, lays concrete, has not been \nworking since incident.   \n \n Ms. Peterson planned “1.  Lumbar MRI to further evaluate the nature \nof severity of his symptoms today.  2.  Prescription sent today for tizanidine \n2 mg at night for his muscle spasms.”       \n An MRI of the claimant’s lumbar spine was taken on August 18, 2023 \nwith the impression, “Bilateral pars defects L5-S1 with grade 1 \nanterolisthesis.  Neural foraminal stenosis worse on the right at L5-S1.”    \n Dr. Ikemefuna Uzo Onyekwelu reported on August 23, 2023: \n45-year-old male who was involved in a motor vehicle \naccident and sustained severe back pain.  Prior to that he has \ndescribed no history of back pain and has never sought \nmedical attention for his lower back.  He works in construction \nand has had difficulty return to work because of this.  At this \ntime he is here today for surgical considerations given failure \nto improve thus far with clinician directed conservative \ntreatment.... \nNeuro Exam:  Grossly intact strength with intact sensation \nextremities.  Except for EHL weakness, right side.  All other \nmyotomies are 5/5 from L2-S1.  With intact station to touch \nL2-S1 except for right L5 paresthesia.   \nRADIOGRAPHIC INTERPRETATION:   \n\nZINTEL - H304280  6\n  \n \n \n8/18/2023 shows an isthmic spondylolisthesis with bilateral L5 \npars defect causing spondylolisthesis at L5-S1 and severe \nright-sided L5-S1 foraminal stenosis with impingement of the \nexiting L5 nerve root.   \nRADIOGRAPHIC INTERPRETATION: \n4 view radiographs lumbar spine obtained and reviewed today \non 8/9/2023 shows no obvious evidence of acute osseous \ninjury such as a fracture or dislocation.  Mild anterior listhesis \nof L5-S1.  Satisfactory alignment in sagittal and coronal \nplanes.  Transitional lumbar anatomy.  Mild hip OA.  Lumbar \nspondylosis.   \n \n Dr. Onyekwelu diagnosed “Lumbar radiculopathy, bilateral S1, R > L.  \nIsthmic lumbar spondylolisthesis, L5-S1.  Low back pain.  Lumbar \nspondylosis.  Transitional lumbar anatomy.  BMI 30+.”  Dr. Onyekwelu \nplanned, “45-year-old male with isthmic spondylolisthesis, unstable \nspondylolisthesis with flexion-extension radiographs.  He does have a \nbilateral L5 pars defect with severe foraminal stenosis at L5-S1 right-sided \nL5 radicular pain is quite severe.  He has tried and failed to improve with \nclincher directed conservative treatment and wants to proceed with surgical \nintervention.  This would include L5-S1 Gill laminectomy and right-sided L5-\nS1 TLIF.”   \n Dr. Onyekwelu reported on September 26, 2023: \nLarry M. Zintel is a 45 y.o. male with severe low back and \nbilateral lower extremity pain right side worse than left.  \nPatient was involved in a motor vehicle accident \napproximately 2 years ago and prior to this denies any history \nof back pain or seeking medical attention for low back pain.  \nHe has worked in construction for most of his life however \nafter the motor vehicle accident according to the patient he \nhas not been unable to do his job in that same capacity.  He \n\nZINTEL - H304280  7\n  \n \n \nhas had difficulty with low back pain including pain radiating to \nhis lower extremities.  Imaging studies revealed evidence of a \npars defect at L5 with severe L5-S1-foraminal stenosis.  This \nis very likely an exacerbation of her pre-existing condition.  \nGiven the patient’s symptomatology with the absence of any \nsymptoms before his accident and the presence of new \nsymptoms after the accident it is probable, 51% likelihood that \nhis symptoms may be related to the incident preceding his \nnew onset low back pain and lower extremity symptoms.  \nAfter 2 years she had tried and failed to improve with clinician \ndirected conservative treatment and has now elected to \nproceed with surgical intervention.... \n \n Dr. Onyekwelu performed a surgical procedure on September 26, \n2023 which included “L5-S1 Gill laminectomy and R TLIF.”  The pre- and \npost-operative diagnosis was “Spondylolisthesis, unspecified spinal region.  \nLumbar stenosis L5-S1.  Isthmic spondylolisthesis L5-S1 with severe \nbilateral L5-S1 foraminal stenosis.  Right-sided L5 radiculopathy secondary \nto right-sided L5-S1 foraminal stenosis.”   \n A pre-hearing order was filed on October 31, 2023.  The claimant \ncontended, “(a)  That he sustained a compensable injury to his back on \n01/18/22; (b)  He is entitled to medical treatment relative to his work \ninjuries.  (c)  That he is entitled to TTD from DOI until a yet-to-be-\ndetermined date in the future; (d)  That this claim is controverted and that \nthe undersigned is entitled to maximum statutory attorney fees.  All other \nissues are reserved.”   \n The parties stipulated that the respondents “have controverted this \nclaim in its entirety.”  The respondents contended, “Respondents contend \n\nZINTEL - H304280  8\n  \n \n \nthat Claimant was not performing employment related services at the time \nof his injury.  In light of this, it is Respondents’ position that they are not \nliable for benefits associated with his injury.  Alternatively, Respondents \nassert that the claimant did not suffer a compensable injury on or about \n1/18/22, there are no objective findings of an injury and the medical \ndocumentation does not support entitlement to benefits in the event \ncompensability is found.  Respondents also contend that the claimant was \nreleased as having reached maximum medical improvement on 4/12/22 \nand that in the event compensability is found, he would not be entitled to \ntemporary disability benefits beyond his MMI date.”   \n The parties agreed to litigate the following issues: \n1. Whether the Claimant sustained a compensable injury to \nhis back injury (sic) on January 18, 2022.   \n2. If the Claimant’s alleged back injury is deemed \ncompensable, the extent to which he is entitled to medical \nbenefits and temporary total disability benefits beginning \non January 19, 2022 and continuing until a date yet to be \ndetermined. \n3. Whether the Claimant’s attorney is entitled to a \ncontroverted fee.   \n \n  Dr. Ryan T. Fitzgerald corresponded with counsel for the \nrespondents on November 28, 2023 and stated in part: \nMr. Zintel was involved in a motor vehicle accident on 1/18/22, \nhereafter referred to as the subject event for the purposes of \nthis report. \nOn my personal review, MR imaging of the lumbar spine on \n4/7/2022 revealed no evidence of an acute traumatic injury.  \nGrade 1 anterolisthesis at L5-S1 was related to chronic \n\nZINTEL - H304280  9\n  \n \n \nbilateral L5 spondylolysis.  Findings consistent with chronic \ndegenerative disease included mild disc space narrowing and \ndisc desiccation at L5-S1, variable endplate osteophytes \n(alternatively known as bone spurs) from L1 through S1, and \nfacet arthrosis at and below L3/4.  A chronic-appearing \nannular fissure at L5-S1 was not accompanied by any active \nmarrow edema or adjacent soft tissue inflammation.  Minimal \ndisc bulges at T10/11, L1/2, L5/S1 did not compromise the \nspinal canal or result in any nerve root impingement.  Facet \narthrosis contributed to mild narrowing of the right neural \nforamen at L4/5 and mild-moderate narrowing of the right \nneural foramen at L5/S1.   \nMR imaging of the lumbar spine obtained on 8/18/2023 was \nsimilarly negative for any findings to indicate an acute \ntraumatic injury.  Chronic degenerative disease was again \nevident in the form of endplate osteophytes, facet arthrosis, \nand disc desiccation.  Grade I anterolisthesis at L5/S1 related \nto chronic bilateral L5 spondylolysis had not progressed.  \nMild-moderate narrowing of the right neural foramen \nsecondary to degenerative disc space narrowing and facet \narthrosis was unchanged.  No lumbosacral nerve root \nimpingement was demonstrated. \nIn summary, MRI exams obtained in April 2022 and August \n2023 showed, on my personal review, no evidence of an \nacute traumatic injury.  Instead, both exams revealed multiple \npotential degenerative pain generators independent of the \nsubject event.   \n \n After a hearing, an administrative law judge filed an opinion on \nMarch 5, 2024.  The administrative law judge found, among other things, \nthat the claimant proved he sustained a compensable injury.  The \nadministrative law judge awarded medical treatment and temporary total \ndisability benefits.  The respondents appeal to the Full Commission. \nII.  ADJUDICATION \n Ark. Code Ann. §11-9-102(4)(Supp. 2024) provides in pertinent part: \n\nZINTEL - H304280  10\n  \n \n \n(A)  “Compensable injury” means: \n(i) An accidental injury causing internal or external \nphysical harm to the body ... arising out of and in \nthe course of employment and which requires \nmedical services or results in disability or death.  An \ninjury is “accidental” only if it is caused by a specific \nincident or is identifiable by time and place of \noccurrence[.]   \n \nA compensable injury must also be established by medical evidence \nsupported by objective findings.  Ark. Code Ann. §11-9-102(4)(D)(Supp. \n2024).  “Objective findings” are those findings which cannot come under the \nvoluntary control of the patient.  Ark. Code Ann. §11-9-102(16)(A)(i)(Supp. \n2024).  The requirement that a compensable injury must be established by \nmedical evidence supported by objective findings applies only to the \nexistence and extent of the injury.  Stephens Truck Lines v. Millican, 58 Ark. \nApp. 275, 950 S.W.2d 472 (1997).     \nThe employee has the burden of proving by a preponderance of the \nevidence that he sustained a compensable injury.  Ark. Code Ann. §11-9-\n102(4)(E)(i)(Supp. 2024).  Preponderance of the evidence means the \nevidence having greater weight or convincing force.  Metropolitan Nat’l \nBank v. La Sher Oil Co., 81 Ark. App. 269, 101 S.W.3d 252 (2003). \nAn administrative law judge found in the present matter, “3.  The \nclaimant has met his burden of proof in demonstrating he sustained a \ncompensable lower back injury/lumbar spine specific injury – the bilateral \npars defect and/or the aggravation or acceleration of the preexisting \n\nZINTEL - H304280  11\n  \n \n \ndegenerative condition(s) of his lumbar spine – as a result of the January \n18, 2022, MVA.  Based on the applicable law and the facts of this claim, \nthese conditions constitute ‘objective findings’ sufficient to support a claim \nfor benefits herein.”  The Full Commission does not affirm this finding.   \nThe claimant became employed with the respondents, Pulaski \nCounty Road & Bridge, in 2013.  The claimant testified that he was driving \nto his workplace on the morning of January 18, 2022.  The claimant testified \nthat a supervisor contacted him on the way and instructed him to pick up a \nco-worker, David Jones, to transport Mr. Jones to the place of employment.  \nDavid Jones testified that he had contacted the claimant on January 17, \n2022 and had asked the claimant to take him to work.   \nIn any event, the claimant testified that he was involved in a \nvehicular collision on January 18, 2022 while driving to pick up David \nJones.  An ARKANSAS MOTOR VEHICLE CRASH REPORT dated \nJanuary 18, 2022 indeed indicated that the claimant had been involved in a \nmotor vehicle accident.  We note that the ARKANSAS MOTOR VEHICLE \nCRASH REPORT indicated, “MR. ZINTEL ADVISED NO INJURIES[.]”  \nAccording to the record, the claimant received emergency medical \ntreatment on January 18, 2022.  At that time, a physician diagnosed “Strain \nof neck muscle, initial encounter.”  The medical evidence did not \n\nZINTEL - H304280  12\n  \n \n \ndemonstrate that the claimant had injured his lower back or lumbar spine as \na result of the January 18, 2022 motor vehicle accident.   \nAn MRI of the claimant’s lumbar spine was taken nearly three \nmonths later, on April 7, 2022.  The lumbar MRI showed degenerative \nfindings with “No evidence of acute lumbar spine injury [emphasis \nsupplied].”  Dr. Ritchie released the claimant to return to work on or about \nApril 18, 2022.  Dr. Ritchie also opined that the claimant had reached \nmaximum medical improvement on April 12, 2022.  The respondents \nterminated the claimant’s employment effective June 24, 2022.   \nAs we have noted, the claimant began treating with Alexandria \nPeterson, PA-C on August 9, 2023.  Ms. Peterson noted in part, “I will send \nhim in a prescription for tizanidine 2 mg that he can use at night for his \nparesthesias[.]”  There is no indication that “paresthesias” can be \ninterpreted as an objective medical finding establishing a compensable \ninjury.  The physician’s assistant planned a lumbar MRI and “2.  \nPrescription sent today for tizanidine 2 mg at night for his muscle spasms.”  \nThe Full Commission recognizes that a report of muscle spasms can \nconstitute objective medical findings.  Continental Express, Inc. v. Freeman, \n339 Ark. 142, 4 S.W.3d 124 (1999).  In the present matter, however, there \nis no probative medical evidence of record demonstrating that the claimant \nsuffers from lumbar muscle spasms as a result of the January 18, 2022 \n\nZINTEL - H304280  13\n  \n \n \nmotor vehicle accident.  We therefore find that Ms. Peterson’s prescription \nof Tizanidine is not objective medical evidence establishing a compensable \ninjury to the claimant’s low back or lumbar spine.  See Howell v. \nArkadelphia Human Dev. Ctr., 2023 Ark. App. 441, 675 S.W.3d 925.   \nAn MRI of the claimant’s lumbar spine was taken on August 18, 2023 \nwith the impression, “Bilateral pars defects L5-S1 with grade 1 \nanterolisthesis.”  The record does not show that “Bilaterals pars defects L5-\nS1” can be interpreted as medical evidence establishing a compensable \ninjury to the claimant’s low back or lumbar spine.  Dr. Onyekwelu reported \nin part on September 26, 2023, “Given the patient’s symptomatology with \nthe absence of any symptoms before his accident and the presence of new \nsymptoms after the accident it is probable, 51% likelihood that his \nsymptoms may be related to the incident preceding his new onset low back \npain and lower extremity symptoms [emphasis supplied].”  Medical opinions \naddressing compensability must be stated within a reasonable degree of \nmedical certainty.  Ark. Code Ann. §11-9-102(16)(B)(Supp. 2024).  Expert \nopinions based on “could,” “may,” or “possibly” lack the definiteness \nrequired to meet the claimant’s burden to prove causation in accordance \nwith Ark. Code Ann. §11-9-102(16)(B).  See Frances v. Gaylord Container \nCorp., 341 Ark. 527, 20 S.W.3d 280 (2000).  In the present matter, the Full \nCommission finds that Dr. Onyekwelu’s use of the term “may” does not \n\nZINTEL - H304280  14\n  \n \n \nmeet the definiteness required to prove causation within a reasonable \ndegree of medical certainty.  Accordingly, the Full Commission attaches \nminimal evidentiary weight to Dr. Onyekwelu’s opinion.  It is within the \nCommission’s province to weigh all of the medical evidence and to \ndetermine what is most credible.  Minnesota Mining & Mfg. v. Baker, 337 \nArk. 94, 989 S.W.2d 151 (1999).   \nFinally, Dr. Onyewkelu performed a lumbar laminectomy and fusion \non September 26, 2023.  The pre- and post-operative diagnoses were \n“Spondylolisthesis, unspecified spinal region.  Lumbar stenosis L5-S1.  \nIsthmic spondylolisthesis L5-S1 with severe bilateral foraminal stenosis.  \nRight-sided L5 radiculopathy secondary to right-sided L5-S1 foraminal \nstenosis.”  The Full Commission finds that these diagnoses cannot be \nconstrued as objective medical evidence establishing a compensable injury \nto the claimant’s lumbar spine.  \nTherefore, after reviewing the entire record de novo, the Full \nCommission finds that the claimant did not prove he sustained a \ncompensable injury in accordance with Ark. Code Ann. §11-9-\n102(4)(A)(i)(Supp. 2024).  The claimant did not prove he sustained an \naccidental injury causing internal or external physical harm to his low back \nor lumbar spine.  The claimant did not prove that he sustained an injury to \nhis low back or lumbar spine which arose out of and in the course of \n\nZINTEL - H304280  15\n  \n \n \nemployment, required medical services, or resulted in disability.  The \nclaimant did not establish a compensable injury by medical evidence \nsupported by objective findings.  Because the Full Commission has found \nthat the claimant did not prove he sustained a compensable injury in \naccordance with Ark. Code Ann. §11-9-102(4)(A)(i)(Supp. 2024), we need \nnot adjudicate whether the claimant proved he was performing employment \nservices in accordance with Ark. Code Ann. §11-9-102(4)(B)(iii)(Supp. \n2024).  The Full Commission reverses the administrative law judge’s finding \nthat the claimant proved he sustained a compensable injury, and this claim \nis respectfully denied and dismissed. \nIT IS SO ORDERED.                  \n \n    ___________________________________ \n    SCOTTY DALE DOUTHIT, Chairman \n \n    ___________________________________ \n    MICHAEL R. MAYTON, Commissioner \n \n \nCommissioner Willhite dissents. \n \nDISSENTING OPINION \n The Administrative Law Judge (hereinafter referred to as “ALJ”) \nfound that the Claimant proved he sustained a compensable lower back \ninjury/lumbar spine specific injury as a result of his January 18, 2022, motor \nvehicle accident and was entitled to reasonable and necessary medical \n\nZINTEL - H304280  16\n  \n \n \ncare for his compensable injury.  After conducting a thorough review of the \nrecord, I concur with the ALJ and dissent with the majority.  \nTo establish a compensable injury by a preponderance of the \nevidence the Claimant must prove: (1) an injury arising out of and in the \ncourse of employment; (2) that the injury caused internal or external harm \nto the body which required medical services or resulted in disability or \ndeath; (3) medical evidence supported by objective findings, as defined in \nArk. Code Ann. §11-9-102(16), establishing the injury; and (4) that the injury \nwas caused by a specific and identifiable time and place of occurrence.  A \ncompensable injury must be established by medical evidence supported by \nobjective findings and medical opinions addressing compensability must be \nstated within a degree of medical certainty.  Smith-Blair, Inc. v. Jones, 77 \nArk. App. 273, 72 S.W.3d 560 (2002).  \nThe employer takes the employee as he finds him.  Conway \nConvalescent Center v. Murphree, 266 Ark. 985, 585 S.W.2d 462 (Ark. \nApp. 1979).  A pre-existing disease or infirmity does not disqualify a claim if \nthe employment aggravated, accelerated, or combined with the disease or \ninfirmity to produce the disability for which compensation is sought. See, \nNashville Livestock Commission v. Cox, 302 Ark. 69, 787 S.W.2d 664 \n(1990); Conway Convalescent Center v. Murphree, 266 Ark. 985, 585 \nS.W.2d 462 (Ark. App. 1979); St. Vincent Medical Center v. Brown, 53 Ark. \n\nZINTEL - H304280  17\n  \n \n \nApp. 30, 917 S.W.2d 550 (1996).  An increase in symptoms of a pre-\nexisting degenerative condition is sufficient to establish a compensable \ninjury.  Parker v. Atlantic Research Corp., 87 Ark. App. 145, 189 S.W.3d \n449 (2004). \nAn employer shall promptly provide for an injured employee such \nmedical treatment as may be reasonably necessary in connection with the \ninjury received by the employee.  Ark. Code Ann. § 11-9-508(a). \nReasonable and necessary medical services may include those necessary \nto accurately diagnose the nature and extent of the compensable injury; to \nreduce or alleviate symptoms resulting from the compensable injury; or to \nmaintain the level of healing achieved; or to prevent further deterioration of \nthe damage produced by the compensable injury.  Jordan v. Tyson Foods, \nInc., 51 Ark. App. 100, 911 S.W.2d 593 (1995).  \nOn January 18, 2022, the Claimant was requested by a Respondent \nmanager or supervisor to pick up a co-worker.  On the way he was in a \nmotor vehicle accident in which the Claimant was hit head-on by another \nvehicle and the airbags deployed.  Claimant rejected medical care on the \nscene of the accident, but ultimately went to the emergency department of \nhis local hospital because of injuries he received in the motor vehicle \naccident.  Claimant was initially diagnosed with a strain of the neck muscle.  \nOn June 2, 2022, Claimant was seen by Dr. Krishnappa Prasad who \n\nZINTEL - H304280  18\n  \n \n \ndiagnosed the Claimant with lumbar spondylosis, and lumbar radiculitis, \nand facet arthritis of the lumbar spine.  Dr. Prasad also gave the Claimant \nthe work restrictions of “no heavy lifting more than 10 pounds / No \nprolonged standing or sitting for more than 15-20 minutes.  No extreme \nbending or twisting.” On August 9, 2023, Claimant was seen by Physician’s \nAssistant Alexandria Peterson who obtained the radiographic images from \nthe hospital and other imaging taken in the course and scope of Claimant’s \ntreatment.  Peterson found that Claimant had mild anteriorlisthesis of L5-S1 \nand diagnosed the Claimant with lumbar radiculopathy, bilateral S1, Isthmic \nlumbar spondylolisthesis of L5-S1, and lumbar spondylosis and referred the \nClaimant for a lumbar MRI based on those diagnoses.  Peterson also \ndiagnosed Claimant as having paresthesia and prescribed him tizanidine for \nmuscle spasms.  Claimant underwent the lumbar MRI on April 18, 2023, \nwhich showed “Bilateral pars defects L5-S1 with grade 1 anterolisthesis.  \nNeural foraminal stenosis worse on the right at L5-S1.” On August 23, \n2023, Claimant was seen by Dr. Onyekwelu to discuss the results of the \nClaimant’s lumbar MRI.  Dr. Onyekwelu recommended surgical intervention \nin the form of L5-S1 Gill laminectomy and a right-sided L5-S1 TLIF because \nthe Claimant had failed to improve with conservative treatment.  On \nSeptember 26, 2023, Claimant underwent surgery performed by Dr. \nOnyekwelu who opined:  \n\nZINTEL - H304280  19\n  \n \n \nPatient was involved in a MVA approximately 2 years ago and prior \nto this denies any history of back pain or seeking medical attention \nfor low back pain.  He has worked in construction for most of his life \nhowever after the MVA according to the patient he has not been \nunable to do his job in that same capacity.  He has had difficulty with \nlow back pain including pain radiating to his lower extremities.  \nImaging studies revealed evidence of a pars defect at L5 with severe \nL5-S1 foraminal stenosis.  This is very likely an exacerbation of his \npre-existing condition.  Given the patient’s symptomatology with the \nabsence of any symptoms before his accident and the presence of \nnew symptoms after the accident it is probable, 51% likelihood that \nhis symptoms may be related to the incident preceding his new onset \nlow back pain and lower extremity symptoms. \n \nA doctor is not required to be absolute in an opinion nor are the \nmagic words “within a reasonable degree of medical certainty” even \nrequired to be used by the doctor for an injury to be related to the work \naccident.  Freeman v. Con-Agra Frozen Foods, 344 Ark. 296 (2001).  \nRather, the medical opinion must simply be more than speculation.  Id. If a \ndoctor renders an opinion about causation of a workers’ compensation \ninjury with language that goes beyond possibilities and establishes that \nwork was the reasonable cause of the injury, this should pass muster.  Id.\n In the present case, Claimant has an objective injury to his lumbar \nspine and Dr. Onyekwelu states that this injury is “very likely” an \nexacerbation of a pre-existing condition in Claimant’s lower back. A pre-\nexisting disease or infirmity does not disqualify a claim if the employment \naggravated, accelerated, or combined with the disease or infirmity to \nproduce the disability for which compensation is sought.  See, Nashville \n\nZINTEL - H304280  20\n  \n \n \nLivestock Commission v. Cox, 302 Ark. 69, 787 S.W.2d 664 (1990); \nConway Convalescent Center v. Murphree, 266 Ark. 985, 585 S.W.2d 462 \n(Ark. App. 1979); St. Vincent Medical Center v. Brown, 53 Ark. App. 30, 917 \nS.W.2d 550 (1996).  An increase in symptoms of a pre-existing \ndegenerative condition is sufficient to establish a compensable injury.  \nParker v. Atlantic Research Corp., 87 Ark. App. 145, 189 S.W.3d 449 \n(2004). \nThere is no credible evidence in the record to suggest that Claimant \nhad experienced significant symptomology in his lower back prior to the \nmotor vehicle accident on January 18, 2022.  \nTherefore, I would find that Claimant suffered a compensable lower \nback injury as a result of his January 18, 2022 work accident and is entitled \nto reasonable and necessary medical treatment of such injury including the \nsurgery performed by Dr. Onyekwelu.  \nFor the reasons stated above, I respectfully dissent. \n \n    ___________________________________ \n    M. SCOTT WILLHITE, Commissioner","preview":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. H304280 LARRY M. ZINTEL, EMPLOYEE CLAIMANT PULASKI COUNTY ROAD & BRIDGE, EMPLOYER RESPONDENT AAC RISK MANAGEMENT SERVICES, INSURANCE CARRIER/TPA RESPONDENT OPINION FILED MARCH 12, 2025","fetched_at":"2026-05-19T22:29:44.525Z","links":{"html":"/opinions/full_commission-H304280-2025-03-12","pdf":"https://www.labor.arkansas.gov/wp-content/uploads/Zintel_Larry_H304280_20250312.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/full-commission-opinions/"}}