Kelli Hellums vs. Area Agency On Aging Western Arkansas

BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. H104834 KELLI S. HELLUMS, EMPLOYEE CLAIMANT AREA AGENCY ON AGING WESTERN ARKANSAS, EMPLOYER RESPONDENT RISK MANAGEMENT RESOURCES, INSURANCE CARRIER/TPA RESPONDENT OPINION FILED APRIL 22, 2025 Upon review before the FULL COMMISSION in Little Rock, Pulaski County, Arkansas. Claimant represented by the HONORABLE MATTHEW J. KETCHAM, Attorney at Law, Fort Smith, Arkansas. Respondents represented by the HONORABLE MELISSA WOOD, Attorney at Law, Little Rock, Arkansas. Decision of Administrative Law Judge: Affirmed as Modified. OPINION AND ORDER The respondents appeal an administrative law judge’s opinion filed November 21, 2024. The administrative law judge found that the claimant proved she was entitled to additional medical treatment. After reviewing the entire record de novo, the Full Commission finds that the claimant proved additional medical treatment provided by Dr. Roman was reasonably necessary in accordance with Ark. Code Ann. §11-9-508(a)(Supp. 2024). I. HISTORY Kelli Hellums, now age 63, testified that she was employed with the respondents, Area Agency on Aging, on August 6, 2020. The parties

HELLUMS - H104834 2 stipulated that the employment relationship existed on August 6, 2020, on which date the claimant “sustained a compensable injury to her lower back.” The claimant testified on direct examination: Q. And what was your job with Area Agency? A. I was an in-home aide.... Q. Were you assigned to one particular patient? A. Yes, sir.... Q. What happened [on August 6, 2020]? A. We got her a shower and she sits in her chair. And I usually like kneel down, you know, to put her shoes and socks and stuff on. And when I kneeled to put her shoe on, it just felt like something on my left side just completely separated and I went straight down and was just stuck in a fetal position.... The claimant received emergency treatment on August 6, 2020: Patient presents with complaint of low back pain and transient numbness to her right leg. She reports that she was bending over putting on her patient shoes when she felt something pop in her back and she felt like something was separating....She initially had some numbness in her right leg but it has since resolved. A CT of the claimant’s lumbar spine was taken on August 6, 2020 with the impression, “1. No acute fracture or traumatic malalignment. Moderate degenerative change as described above.” The claimant was prescribed medication and it was noted, “She will follow up with Neurosurgery next week.” The record indicates that the claimant began treating at Mercy Clinic Occupational Medicine-Fort Smith on August 10, 2020. Dr. Ian T. Cheyne reported at that time:

HELLUMS - H104834 3 Kelli’s primary problem is pain located in the lower thoracic region. She describes it as pressure, burning. The problem began on 8/6/2020. Kelli says that it seems to be constant. She has noticed that it is made worse by moving it. Her pain level is 7. Pain is in the left low back....She went to the ED on 8/6. CT showed degenerative changes. She is currently on steroid pack and muscle relaxer.... Due to the significant pain and need for walker to help with ambulation, will set up for an MRI of the lumbar spine. Complete steroid pack and switch to ibuprofen/tylenol afterwards. Hot showers twice daily. Dr. Cheyne diagnosed “1. Strain of muscle, fascia and tendon of lower back[.]” An MRI of the claimant’s lumbar spine was taken on August 19, 2020 with the following impression: Facet hypertrophy L5-S1 with far right-sided disc protrusion but no significant stenosis. Posterior element hypertrophy L4-5 with spondylosis and posterior lateral small protrusions with mild canal and lateral recess stenosis. Posterior element hypertrophy L3-4 with disc bulge versus protrusion and mild canal and lateral recess narrowing. And central disc protrusion at L2-3 with mild left lateral recess narrowing. Other findings as noted. The claimant followed up with Dr. Cheyne on August 24, 2020: “Kelli was assisting a client with putting on their shoes when she felt a pain in her lower back....Kelli’s primary problem is pain located in the lower thoracic region.” Dr. Cheyne diagnosed “1. Strain of muscle, fascia and tendon of lower back[.]...Will refer to PT.”

HELLUMS - H104834 4 The claimant testified that she underwent physical therapy for six weeks. The claimant testified that physical therapy “didn’t help anything. It made it worse.” Dr. Eugene Becker performed a Lumbar Epidural Steroid Injection on October 20, 2020. The claimant testified that she benefitted from the injection provided by Dr. Becker. The claimant followed up with Dr. Cheyne on November 5, 2020: “Kelli’s primary problem is pain located in the lower thoracic region....Kelli says that it seems to be variable – depending on the activity level. She feels it is almost entirely resolved. Her pain level is 3. Additional History: patient is s/p LESI x 1 and has had significant improvement in pain. She still notices some pain with certain movements but overall much improved....Will place on regular duty but recommend she follow up with pain management for another injection.” Dr. Becker performed Lumbar Epidural Steroid Injections on November 17, 2020 and December 15, 2020. The claimant testified that she benefitted from Dr. Becker’s treatment. The record indicates that the claimant was seen at OrthoArkansas on February 8, 2021. Payton Ransom, PA reported at that time: Ms. Hellums is a 59-year-old female presenting to clinic for Worker’s Comp. evaluation. Her date of injury was August 6, 2020. She was bending down to put a shoe on an elderly patient that she takes care of when she noticed a sharp

HELLUMS - H104834 5 stabbing/pulling sensation in her left lumbar spine. This pain initially was severe. It localizes to the left lower lumbar spine....States that her daily pain scale is a 3-4 out of 10. She has undergone 3 epidural steroid injections by Dr. Becker. She reports minimal relief with these. Additionally she has undergone physical therapy which exacerbated her symptoms. She also tried trials of muscle relaxers, anti- inflammatories, and steroid Dosepaks with minimal relief. She is currently on light duty at work, working at a desk.... AP and lateral x-ray of the lumbar spine ordered, obtained, and interpreted today reveals Mild grade 1 anterolisthesis of L3-4. Mild to moderate degenerative disc disease L3-4, L4-5, L5-S1. Slight scoliotic curvature to the right of the lumbar spine. CT lumbar spine reviewed from August 6, 2020 reveals facet hypertrophy at L5-S1, L4-5, and L3-4. Mild grade 1 anterolisthesis of L3-4. MRI lumbar spine reviewed from 8/19/2020 on disc today reveals Diffuse central posterior disc bulge at L2-3 with mild central stenosis. Diffuse posterior disc bulge at L3-4 with mild to moderate central canal stenosis With facet hypertrophy. Disc bulge and facet hypertrophy at L3-4 creating moderate bilateral subarticular recess stenosis, worse on the right. Mild left foraminal stenosis L5-S1 with bilateral facet hypertrophy.... I reviewed x-ray, MRI and CT with patient and Case manager in clinic today. We discussed the multiple levels of degeneration in the lumbar spine, particularly at L3-4. Patient does have chronic, degenerative processes in the lumbar spine. Additionally, patient’s pain is primarily axial, worse on the left. She does have multiple levels of facet hypertrophy. She has failed other conservative treatment such as physical therapy and epidural steroid injections as well as muscle relaxers. I recommend a trial of facet injections/rhizotomies in hopes of alleviating symptoms. At this point I do not recommend surgical intervention. The patient’s MRI does not show fracture. There are signs of spondylolisthesis At L3-4 which is pre-existing. There are no objective findings of acute injury. However, the patient’s symptoms began on and after the work injury. The patient has no history of pain in the low back or down the leg prior to the work injury. Therefore it is within a certain degree of

HELLUMS - H104834 6 medical certainty that at least 51% of the patient’s current symptoms are directly related to their work injury. Injury was [an] acute exacerbation of a chronic, degenerative process. I am placing the patient on work restrictions of no bending, twisting or lifting over 20 pounds. Payton Ransom assessed “Degenerative disc disease, lumbar spine, with facet hypertrophy, with axial back pain, worse on the left. Mild grade 1 degenerative spondylolisthesis, L3-4. Muscle strain, lumbar spine.” Dr. Carlos Roman performed a procedure on February 12, 2021: “Lumbar facet injections done, L3-L4, L4-L5, L5-S1 with medial branch block.” The pre-and post-operative diagnosis was “1. Lumbar spondylosis. 2. Severe low back pain. 3. Lumbar degenerative disc disease. 4. Lumbar listhesis, L3-L4.” Dr. Roman advised the claimant, “Followup in two to three weeks for medial branch blocks for possible rhizotomy if the pain in her back persists.” Dr. Roman performed a procedure on February 26, 2021: “Left- sided medial branch blocks at lumbar facets at L3-L4, L4-L5, and L5- S1....Follow up in two weeks for rhizotomy.” Dr. Roman performed a procedure on March 19, 2021: “Rhizotomy of lumbar facet joints left side at L3-L4, L4-L5, and L5-S1.” The claimant testified that she did not benefit from treatment provided by Dr. Roman. Payton Ransom noted on April 21, 2021:

HELLUMS - H104834 7 Ms. Hellums is a 59-year-old female presenting to clinic for Worker’s Comp. evaluation....Her date of injury was August 6, 2020. She was bending down to put a shoe on an elderly patient that she takes care of when she noticed a sharp stabbing/pulling sensation in her left lumbar spine.... She has undergone 3 epidural steroid injections by Dr. Becker. She reports minimal relief with these. Additionally she has undergone physical therapy which exacerbated her symptoms. She also tried trials of muscle relaxers, anti- inflammatories, and steroid Dosepaks with minimal relief. She is currently on light duty, working at a desk. She is here today for follow-up after L3 S1 rhizotomies by Dr. Roman. She states that her pain was good with both the facet blocks but she has had some increased pain after the actual rhizotomy. Still complaining of the same pain.... The patient states they are unable to return back to work due to their pain. My recommendation is for a functional capacity exam. If the patient has a valid functional capacity exam, then they may return back to work per the defined restrictions of that the valid functional capacity exam. If the functional capacity exam is invalid, the patient may return back to work full duty without restrictions.... There is no need for the patient to follow up after this functional capacity exam.... The patient is at maximum medical improvement. The patient’s work restrictions are to return back to work full duty without restrictions. The patient’s impairment rating will be a 0% as taken out of page 113 of the “Guides to the Evaluation of Permanent Impairment, Fourth Edition.” This is for a grade 1 degenerative spondylolisthesis, not operated on. I am releasing the patient from my medical care. I will see the patient back only as needed. Payton Ransom’s assessment on April 21, 2021 was “Mild grade 1 degenerative spondylolisthesis, L3-4, with mild central stenosis and facet hypertrophy, with axial back pain, worse on the left. Muscle strain, lumbar spine. Degenerative disc disease, lumbar spine.”

HELLUMS - H104834 8 The claimant participated in a Functional Capacity Evaluation on May 10, 2021: “The results of this evaluation indicate that a reliable effort was put forth, with 50 of 50 consistency measures within expected limits....Ms. Hellums completed functional testing on this date with reliable results. Overall, Ms. Hellums demonstrated the ability to perform work in the LIGHT classification of work[.]” The claimant testified that the respondents terminated her employment following the Functional Capacity Evaluation. A pre-hearing order was filed on August 22, 2024. According to the text of the pre-hearing order, the claimant contended, “She received a compensable injury to her low back on August 6, 2020 when she was helping a patient get dressed and felt a sharp shooting pain in her low back. The claimant followed up with Dr. Ian Cheyne at Mercy Clinic Occupational Medicine for continued low back pain. The claimant was referred for pain management and lumbar injections. On August 19, 2020 the claimant received an MRI of her lumbar spine and referred for additional pain management. The claimant was treated and evaluated at Ortho Arkansas for her continued low back pain.” The respondents contended, “All appropriate benefits were paid with regard to claimant’s injury sustained on August 6, 2020. She was found to be at maximum medical improvement with a 0% rating assigned on April

HELLUMS - H104834 9 21, 2021. The medical records do not support entitlement to indemnity benefits, and additional medical treatment is not reasonable and necessary.” The parties agreed to litigate the following issue: “1. Whether claimant is entitled to additional medical benefits. All other issues are reserved by the parties.” A hearing was held on October 14, 2024. The claimant testified that she had received injections from Dr. Roman the previous Friday. The claimant testified that she felt “better than I have in two years.” An administrative law judge filed an opinion on November 21, 2024. The administrative law judge found, “2. Claimant has met her burden of proving that she is entitled to additional medical treatment for her compensable back injury of August 20, 2020.” The respondents appeal to the Full Commission. II. ADJUDICATION The employer shall promptly provide for an injured employee such medical treatment as may be reasonably necessary in connection with the injury received by the employee. Ark. Code Ann. §11-9-508(a)(Supp. 2024). The employee has the burden of proving by a preponderance of the evidence that medical treatment is reasonably necessary. Stone v. Dollar General Stores, 91 Ark. App. 260, 209 S.W.3d 445 (2005). Preponderance

HELLUMS - H104834 10 of the evidence means the evidence having greater weight or convincing force. Metropolitan Nat’l Bank v. La Sher Oil Co., 81 Ark. App. 269, 101 S.W.3d 252 (2003). What constitutes reasonably necessary medical treatment is a question of fact for the Commission. Wright Contracting Co. v. Randall, 12 Ark. App. 358, 676 S.W.2d 70 (1984). An administrative law judge found in the present matter, “2. Claimant has met her burden of proving that she is entitled to additional medical treatment for her compensable back injury of August 20, 2020.” The Full Commission finds that the claimant proved additional treatment with Dr. Roman was reasonably necessary in connection with her compensable injury. The parties stipulated that the claimant sustained a compensable injury on August 6, 2020. The claimant testified that she felt a “separation” in her back while bending over to assist a home health patient. Dr. Cheyne subsequently diagnosed a “strain of muscle” in the claimant’s lower back. A CT and MRI showed degenerative abnormalities in the claimant’s lumbar spine, but no physician of record has recommended surgical treatment. The claimant did not benefit from physical therapy after lumbar epidural steroid injections performed by Dr. Becker. Payton Ransom, PA examined the claimant at OrthoArkansas on February 8, 2021 and assessed the following: “Degenerative disc disease,

HELLUMS - H104834 11 lumbar spine, with facet hypertrophy, with axial back pain, worse on the left. Mild grade 1 degenerative spondylolisthesis, L3-4. Muscle strain, lumbar spine.” Dr. Roman initiated a series of branch blocks and eventually a rhizotomy, but the claimant testified that she initially received no improvement following Dr. Roman’s treatment. Payton Ransom opined on April 21, 2021 that the claimant had reached Maximum Medical Improvement. Payton Ransom noted, “I am releasing the patient from my medical care. I will see the patient back only as needed.” The claimant put forth a valid effort during a Functional Capacity Evaluation performed on May 21, 2021. The probative evidence before the Full Commission demonstrates that the claimant reached Maximum Medical Improvement no later than April 21, 2021, the date Maximum Medical Improvement was assessed by Payton Ransom. We find that Payton Ransom’s assessment of Maximum Medical Improvement was corroborated by the record and was entitled to significant evidentiary weight. See Minnesota Mining & Mfg. v. Baker, 337 Ark. 94, 989 S.W.2d 151 (1999). However, it is well-settled that a claimant may be entitled to ongoing medical treatment after the healing period has ended, if the medical treatment is geared toward management of the claimant’s injury. Patchell v. Wal-Mart Stores, Inc., 86 Ark. App. 230, 184 S.W.3d 31 (2004). As we have discussed, the claimant testified that she

HELLUMS - H104834 12 received an injection from Dr. Roman on or about October 11, 2024. The claimant testified that afterward she felt “better than I have in two years.” The Full Commission finds that the claimant proved that additional conservative treatment provided by Dr. Roman was reasonably necessary in connection with the compensable injury sustained by the claimant on August 6, 2020. After a de novo review of the entire record currently before us, the Full Commission finds that the claimant proved she was entitled to additional medical treatment as recommended by Dr. Roman. The claimant proved that said treatment was reasonably necessary in accordance with Ark. Code Ann. §11-9-508(a)(Supp. 2024). For prevailing on appeal to the Full Commission, the claimant’s attorney is entitled to a fee of five hundred dollars ($500), pursuant to Ark. Code Ann. §11-9-715(b)(Supp. 2024). IT IS SO ORDERED. ___________________________________ SCOTTY DALE DOUTHIT, Chairman ___________________________________ M. SCOTT WILLHITE, Commissioner Commissioner Mayton dissents.

HELLUMS - H104834 13 DISSENTING OPINION I must respectfully dissent from the majority’s opinion finding the claimant met her burden of proving she is entitled to additional medical treatment. The claimant sustained an injury to her lower back while working for the respondent employer on August 6, 2020. After eight months of conservative treatment, the claimant was released at maximum medical improvement with no permanent impairment. Over four years later, after the accident in question, the claimant sought additional treatment in the form of injections recommended by Dr. Carlos Roman. An administrative law judge ruled the claimant met her burden of proving she is entitled to additional medical treatment, and the respondents appeal. Ark. Code Ann. § 11-9-508(a) requires an employer to provide an employee with medical and surgical treatment "as may be reasonably necessary in connection with the injury received by the employee." The claimant has the burden of proving by a preponderance of the evidence the additional treatment is reasonable and necessary. Nichols v. Omaha Sch. Dist., 2010 Ark. App. 194, 374 S.W.3d 148 (2010). What constitutes reasonably necessary treatment is a question of fact for the Commission. Gant v. First Step, Inc., 2023 Ark. App. 393, 675

HELLUMS - H104834 14 S.W.3d 445 (2023). In assessing whether a given medical procedure is reasonably necessary for treatment of the compensable injury, the Commission analyzes both the proposed procedure and the condition it sought to remedy. Walker v. United Cerebral Palsy of Ark., 2013 Ark. App. 153, 426 S.W.3d 539 (2013). In workers’ compensation cases, a decision often rests solely on the credibility of the claimant as a witness. A determination of the weight and credibility of a witness' testimony is exclusively within the province of the Commission. Wade v. Mr. C. Cavenaugh's, 298 Ark. 363, 768 S.W.2d 521 (1989). The Commission has the right to believe or disbelieve the testimony of any witness, and the Commission's decision is entitled to the weight we give a jury verdict. Tyson Foods, Inc. v. Disheroon, 26 Ark. App. 145, 761 S.W.2d 617 (1988). After her injury on August 6, 2020, Dr. Ian Cheyne prescribed physical therapy and muscle relaxers. The claimant was ultimately referred to Dr. Eugene Becker who performed three lumbar epidural steroid injections. The claimant reported on November 5, 2020, that her pain had almost entirely resolved. When the claimant reported ongoing pain on January 20, 2021, Dr. Cheyne referred the claimant for facet injections, which were performed by

HELLUMS - H104834 15 Dr. Carlos Roman on February 12, 2021. Ultimately, Dr. Roman performed a rhizotomy in February of 2021, which the claimant testified did not work at all. The claimant was released at maximum medical improvement (MMI) with no impairment rating on April 21, 2021. At that time, PA Payton Ransom opined: Patient does have chronic, degenerative processes in the lumbar spine. Additionally, patient’s pain is primarily axial, worse on the left. She does have multiple levels of facet hypertrophy. She has failed all other conservative treatment such as physical therapy and epidural steroid injections. She recently failed rhizotomies. The claimant was released at maximum medical improvement with no impairment rating and waited three and a half years until after a motion to dismiss was filed by the respondents to seek additional medical treatment. The additional treatment recommended by Dr. Roman has failed to address the claimant’s ongoing complaints during her initial treatment, and there is no evidence that it would be any different today, nor has the claimant diligently sought this treatment prior to a motion to dismiss being filed.

HELLUMS - H104834 16 The claimant has wholly failed to meet her burden of proving that the treatment she seeks is necessary, reasonable, or causally related to her work-related injury. Accordingly, for the reasons set forth above, I must dissent. ___________________________________ MICHAEL R. MAYTON, Commissioner