Wendy Peacock vs. Conway Regional Medical Center

BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. H109939 WENDY PEACOCK, EMPLOYEE CLAIMANT CONWAY REGIONAL MEDICAL CENTER, EMPLOYER RESPONDENT RISK MANAGEMENT RESOURCES, INSURANCE CARRIER/TPA RESPONDENT OPINION FILED SEPTEMBER 24, 2025 Upon review before the FULL COMMISSION in Little Rock, Pulaski County, Arkansas. Claimant represented by the HONORABLE DANIEL E. WREN, Attorney at Law, Little Rock, 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 May 27, 2025. The administrative law judge found that the claimant proved she was entitled to additional medical treatment. The Full Commission finds that the claimant proved she was entitled to additional medical treatment as recommended by Dr. Baskin. I. HISTORY Wendy Peacock, now age 52, testified that she had previously been employed with the respondents, Conway Regional Health System, for approximately 13 years. The claimant testified that her employment

PEACOCK - H109939 2 position was “Direct Patient Care.” The parties stipulated that the employment relationship existed on March 1, 2021. The claimant testified on direct examination: Q. On March 1 st , 2021, was there an incident with a bed? A. Yes. Q. Tell me what happened. A. I was taking the bed to – from the room to the OR, and when I pushed it out in the hall, I had to get to the other end to turn it, and when I did, the wheel ran over my foot, like, right across where my – I call them my toe knuckles, but it – and it rolled over the top of it and crushed it. The parties stipulated that the claimant “sustained compensable injuries to her left foot” on March 1, 2021. According to the record, the claimant treated with Dr. Gil E. Johnson on March 3, 2021: Wendy works in labor and delivery at the hospital – CRMC. She was moving a bed and rolled over the top of her left foot. Since that time it occurred on 3/1/21 she’s complained of soft tissue swelling and pain in the left foot. It affects her gait. She reports no prior injury to this foot.... Evaluation of the left foot reveals noted soft tissue swelling and pain to palpate the distal and dorsal aspect of the foot. This is mostly over the distal metatarsal heads one – four....Mild ecchymosis is present....Impression crush injury of soft tissue swelling of left foot, approximately 48 hours out from injury. Dr. Johnson planned diagnostic testing and conservative treatment. The parties stipulated that the respondents “accepted the claim and paid benefits.” An MRI of the claimant’s left foot was taken on March 23, 2021, with the following impression:

PEACOCK - H109939 3 1. Strain of the lateral head of the flexor hallucis brevis and adductor hallucis muscles with partial tear of the flexor hallucis brevis tendon at the attachment to the lateral sesamoid. Dr. James Head performed surgery on December 14, 2021: 1. Excision of fibular sesamoid to treat nonunited fibular sesamoid fracture. 2. Resection of a segment of a superficial peroneal nerve. 3. Resection of a segment of the deep peroneal nerve with transplantation of the nerve into the first metatarsal bone. 4. Closed treatment of calcaneal stress fracture. The pre- and post-operative diagnosis was “1. Left painful nonunited fibular sesamoid fracture. 2. Painful neuroma to the deep peroneal and possibly superficial peroneal nerve to the dorsum of the forefoot. 3. Calcaneal stress fracture.” The claimant testified that the condition of her foot worsened following surgery by Dr. Head. Dr. Carlos Roman subsequently ordered a Nuclear Medicine Three Phase Bone Scan, which was performed on April 28, 2022 with the following impression: There is no scintigraphic evidence of complex regional pain syndrome. Degenerative type activity along the bilateral first metatarsophalangeal joints greater on the left than the right. Dr. Roman noted on July 12, 2022: The patient is a 49-year-old female. She is a Workers’ Compensation patient. She is a healthcare technician. She worked for Labor and Delivery at Conway Regional when her foot was run over by a hospital cart on March 1, 2021. She had a sesamoid fracture and ultimately underwent surgery on her left foot by Dr. Head for fibular sesamoid resection and

PEACOCK - H109939 4 superficial peroneal nerve and tendon resection with reimplantation of the nerve. She continued to have pain in the left foot and was diagnosed with calcaneal stress fracture. She obtained a second opinion from Dr. Burks in April and was diagnosed with possible CRPS of the left lower extremity. He suggested no further surgeries until further workup in that regard. Bone scan showed no evidence of CRPS. Her clinical exam does not meet criteria for CRPS. I referred her back to Dr. Burks and she is now scheduled for surgical intervention. I will follow her about three to four weeks after surgery.... Dr. Roman diagnosed “1. Left foot pain. 2. Arthrosis of the left cuneiform bones of the foot. 3. Previous fracture of the metatarsal bone.” Dr. Jesse Burks performed surgery on August 12, 2022: “1. Arthrodesis tarsometatarsal joint, left. 2. Intermediate lateral cuneiform arthrodesis, left. 3. Peroneus brevis tendon tear, left.” The pre- and post- operative diagnosis was “1. Arthrosis, second tarsometatarsal joint. 2. Arthrosis, lateral intermediate cuneiform joint. 3. Peroneus brevis tendon tear, left.” The claimant testified that she did not “respond well” to surgery performed by Dr. Burks. An x-ray of the claimant’s lumbar spine was taken on November 21, 2022 with the following findings and impression: Vertebral body heights are preserved. Alignment is within normal limits. There is mild intervertebral disc height loss noted at L4-L5 and L5-S1. Mild facet arthropathy most pronounced in the lower lumbar spine. Overall, mild degenerative changes, most pronounced in the lower lumbar spine.

PEACOCK - H109939 5 Dr. Billy McBay reported in part on December 1, 2022: She comes in today to discuss her back pain and left foot. She has a history of left foot injury that is being evaluated by Worker’s Compensation. She states her left foot started hurting on 03/01/2021. Her left foot injury affected her walking and ambulation and aggravated her back pain. She also comes in to discuss the result of her lumbar spine x- ray, which showed mild intervertebral disc loss on the L4, L5, and S1 and some facet arthropathy. The patient had low back pain with right-sided radiculopathy, which is aggravated by a recent foot injury and prolonged walking in a walker boot or scooter. Dr. McBay assessed “1. Acute right-sided low back pain with right- sided sciatica[.]...Continue present care measures.” Dr. Robert Daniel Martin noted on January 6, 2023: The patient is seen today for evaluation of her left foot. Back in March of 2021 she had a crush type injury of the left foot. She has had a very long and drawn out course thereafter with multiple surgeries performed by another orthopedic surgeon, and also podiatrist....She has also been seen by pain management for evaluation regarding the possibility of complex regional pain syndrome, this also been (sic) seen by pain management for evaluation regarding the possibility of complex regional pain syndrome, this was felt to be less likely. Currently the patient is unable to work full duty because of left foot pain, she has pain and swelling on a regular basis, she is unable to walk or stand for any prolonged period of time because of pain and swelling mostly on the dorsal foot. She also continues to complain of significant pain over the previous incision over the distal peroneal tendons....She walks with an antalgic gait.... This is a complicated problem, she has had multiple surgeries including attempted midfoot fusion but this has failed, her implants are not really even in the bone. She has persistent pain over where her peroneal tendons were either explored [or] repaired. She has 1 st webspace numbness from previous

PEACOCK - H109939 6 nerve excision. The site of injury is really not even in the area where all of her surgeries have been performed [and] the patient is understandably perplexed by this, as am I. Dr. Martin planned, “At this point I think the patient will require revision midfoot arthrodesis with removal of the failed orthopedic implants, this should provide some improvement in pain. Also would recommend exploration of the distal peroneal tendons in the site of previous surgery as she has significant symptoms here. Unfortunately I think the nerve type symptoms from deep peroneal nerve irritation and numbness, hyperesthesias in the dorsal foot may be permanent based on the chronicity of her problem.” Dr. Martin performed surgery on February 13, 2023: “1. 28730, midfoot arthrodesis of 1 st and 2 nd tarsometatarsal joints, left foot. 2. 20900, harvesting of calcaneal autograft, left foot, separate incision. 3. 27675, open repair of peroneus brevis tendon, left ankle.” The pre- and post- operative diagnosis was “1. Posttraumatic arthropathy of left foot. 2. Nonunion and midfoot arthrodesis, left foot. 3. Peroneus brevis tear, left ankle. 4. Retained failed orthopedic implants, left foot.” Dr. Martin provided follow-up treatment after surgery. The claimant testified on direct examination: Q. During this period of time, were you able to be weight- bearing on that foot?

PEACOCK - H109939 7 A. It was off and on. Sometimes I was, sometimes I wasn’t. I was in a walking boot and on a knee scooter almost the entire time. Q. Did that – A. Until after Dr. Martin done my last surgery. I, eventually, came off of my scooter. Q. Did that change the way you walk at all? A. Oh, most definitely. Q. And at some point, did you develop pain in your back? A. As a matter of fact, yes.... Q. At some point, did your foot swell, change colors, get hot? A. Yes, it was doing that before I saw Dr. Burks, and that’s one of the reasons I went to see Dr. Burks, because it was not healing up and it was just – the color had changed and it was itching and burning, and I had all kinds of issues going on. Dr. Lily F. Guastella examined the claimant on March 14, 2023 and noted in part, “I do suspect that her back pain is related to walking in a cast/boot with scooter for nearly 2 years.” An MRI of the claimant’s lumbar spine was taken on March 24, 2023, with the following conclusion: 1. Moderate facet arthropathy at L4-L5 with a right-sided facet effusion and mild surrounding soft tissue edema and enhancement, indicating acute reactive or inflammatory changes. There are small ganglion cyst formation extending posteriorly from the facet. 2. Mild bilateral neural foramen stenosis at L4-L5. No significant spinal canal stenosis at any level. Dr. Guastella’s assessment on April 3, 2023 was “(1) Abnormal MRI, lumbar spine: Status: Acute....Patient does appear to have acute enhancement and inflammatory changes noted on MRI of the lumbar spine.

PEACOCK - H109939 8 Likely secondary to compensation from foot injury, does not appear chronic." An x-ray of the claimant’s lumbar spine was taken on April 3, 2023 and was compared with the x-ray taken November 21, 2022. The following findings and conclusions resulted: Lumbar spinal alignment is within normal limits. No displaced fracture or other acute osseous abnormality identified. Multilevel bilateral facet joint arthropathy is noted, worse in the lower lumbar spine. Mild discogenic DJD at L5-S1. SI joints intact. Savannah Bradbury, PA-C reported on April 4, 2023: Very pleasant 49-year-old female using a knee scooter for her left knee to be nonweightbearing in clinic. She describes worsening right-sided low back pain after having to walk with the boot and using a knee scooter. She has degenerative arthritis at L4-5. There is some fluid signal in the right facet joint but there is no spondylolisthesis. I am recommending physical therapy for core low back stretching and strengthening exercises as well as any possible gait training that can help while she is continuing to wear a boot and use a knee scooter. She may also benefit from traction. She is also interested in seeing pain management to discuss facet blocks. At this time surgical intervention is not warranted. I do not have a great explanation for numbness and tingling as well as pain down into her right leg. I suspect is likely more related to spasms and pain in her low back. If her low back pain improved but she continues to have right leg pain with numbness the [next] step would be getting a nerve conduction study. She will call us with any concerns or questions otherwise follow-up as needed. The claimant followed up with Dr. Roman on June 12, 2023. Dr. Roman noted in part, “We will now proceed on with treatment of CRPS and

PEACOCK - H109939 9 lumbar sympathectomies to be done by two block technique and ketamine protocol will be utilized.” Dr. Roman diagnosed “1. Complex regional pain down the left lower extremity, type 1. 2. Left foot pain. 3. She had a left foot fracture. 4. Left ankle fracture. 5. Other long term use of medication.” Dr. Roman performed a procedure on July 6, 2023: “Lumbar sympathetic block, #3 of 3, on the left side, ketamine protocol utilized.” The pre- and post-operative diagnosis was “Complex regional pain syndrome, left lower extremity, type 1.” Dr. Martin reported on July 20, 2023: Patient is seen today in follow-up, overall she reports continued improvement but she [is] still having occasional nerve pain and swelling and does limit her ability to stand for prolonged periods of time.... X-rays demonstrate healed midfoot fusion of 1 st and 2 nd tarsometatarsal joints, no other acute findings are noted. Stable implant position.... The patient is placed at maximum medical improvement, permanent work restrictions are limited ladders and stairs, no standing more than 30 minutes an hour, allowed breaks as needed. Based on 4 th edition AMA guidelines, her permanent partial impairment rating chapter 3, page 81, midfoot ankylosis neutral position, 4% whole person, 10% lower extremity, 14% foot. Dr. Roman assessed maximum medical improvement on August 29, 2023. Dr. Roman noted on October 2, 2023: The patient is a 50-year-old female, is a Workers Compensation patient. She had a left foot injury in March of 2021....A cart ran over her foot. She had a sesamoid

PEACOCK - H109939 10 fracture, ended up with traumatic osteoarthritis of the metatarsal joints. Ultimately she had a nonunion and mid- foot arthrodesis of the first and second metatarsal joints of the left foot. She developed complex regional pain syndrome, we have resolved. The question is the impairment rating as it pertains to foot fractures. By the AMA Guidelines, the only ratable impairment on page 78, table 45 for toe impairments, that the first metatarsophalangeal joint and second metatarsophalangeal joint were fused, it would lead to a mild impairment at a 1% whole person impairment for the lower extremity. Her total impairment, again, is 1% for the first and second metatarsal joint. She has some mild impairment there. No other impairments would be applicable. On October 16, 2023, Casey Garretson and Rick Byrd with Functional Testing Centers, Inc. assessed the claimant as having a 5% whole-person impairment. An orthotic specialist noted on November 10, 2023, “Patient was seen in the office to be measured for a left foot insert due to pain. Patient had an injury to the left foot and has had multiple surgeries and hardware installed. She had a hospital bed run over her forefoot. She has tried other inserts, walking boots and carbon footplates that did not work. Patient has bruising and edema in the foot. She has obvious gait abnormalities due to limping.” Dr. Roman noted on January 3, 2024: The patient is a 50-year-old female, is a Workers Compensation patient. She had a foot injury when she worked at Conway Regional and a cart rolled over her foot. She had a foot surgery, had a sesamoid fracture, calcaneal stress fracture. Dr. Head did surgery and another surgery by

PEACOCK - H109939 11 Dr. Burks. She was diagnosed with complex regional pain syndrome and had another surgery by Dr. Martin. I did a series of sympathetic blocks on the left lower extremity. The sympathetic tone has normalized. She comes in today with increasing pain in the foot, complaining of swelling, and she was afraid she had a return of complex regional pain syndrome symptoms. She does have pain there, but the temperature, tone and color are all symmetric, and there is no excess swelling. She has hypersensitivity over the foot and burning pain in the foot. I tried to explain to the patient that that does not constitute a complex regional pain syndrome diagnosis. It is a sympathetic dysfunction of the nervous system, which currently is resolved. I do not recommend further interventional procedures again, sympathetic blocks, spinal cord stimulators, etc. I think it would be an unnecessary risk to the patient. She had a Medrol Dosepak that did resolve a lot of the symptoms. I would continue to give her access to gabapentin and diclofenac as needed, but I do not recommend further interventions. I think she is at maximum medical improvement as far as interventional procedures, surgeries, etc.... The left foot tone, color and temperature are symmetric. The vasculature is normal. There are two incision lines on the top of the foot. There is a little bit of skin disruption there, but the skin is mobile. Skin breakdown issues. Peripheral pulses are palpable. By Budapest Criteria, she has complained of pain and hypersensitivity, but that would be the only symptom. She does not have sympathetic dysfunction. She does not have complex regional pain syndrome of the left lower extremity. FINAL DIAGNOSES: 1. History of complex regional pain syndrome, left lower extremity, resolved. 2. Left foot pain. 3. Sequela of a left foot fracture. 4. Sesamoid bone fracture. 5. Calcaneal fracture. 6. Ankle pain. 7. Long-term use of medications. 8. Post-incisional neuropathy. Dr. Roman planned, “Follow up as indicated.”

PEACOCK - H109939 12 The claimant’s attorney corresponded with Dr. Barry D. Baskin on July 17, 2024. The claimant’s attorney queried Dr. Baskin with regard to issues such as complex regional pain syndrome, altered gait, and maximum medical improvement. Dr. Baskin provided a lengthy Second Opinion on July 22, 2024 and reported in part: Ms. Peacock is referred for a second opinion. This is more akin to an IME based on the records and time allotted for this evaluation, approaching an hour and a half face-to-face. My impression is that Ms. Peacock had a crush injury to her left foot. She has had 3 surgeries as outlined. The first surgery resulted in some resection of some of her superficial peroneal branches in the left foot and some resection of the deep peroneal nerve in the left foot with burying of the nerve into the bone. She has had some symptoms that have been felt by her providers, including Dr. Roman, to represent complex regional pain syndrome. She does have, by her record and her examination, clearly some nerve problems in the left foot. My inclination is that she has neuropathic pain as a result of the superficial and deep peroneal nerve resection. Her examination is a little perplexing because the peripheral nerve issues that she has could easily be confused with reflex sympathetic dystrophy or CRPS. I explained to her in great detail that CRPS can result from very minimal trauma such as a hangnail or an ingrown toenail or some minimal problem with the foot or ankle or it can be due to a more serious issue such as surgeries like she has had. Frequently peripheral nerve lesions manifest like CRPS. She does have allodynia, some mild color changes in the skin over the course of our evaluation, and temperature changes. This could very well be coming from the effects of the nerve resections that were done in the first surgical procedure. I think she does have some low back pain and the low back pain might well have resulted from her walking with altered gait mechanics because of the left foot problems, the walker boot, and the knee scooter. She has minimal degenerative changes in her

PEACOCK - H109939 13 lumbar spine and some facet arthropathy at L4-5. That problem is a little more clear-cut than the left foot. My recommendation would be to get a 3-phase bone scan and I would recommend EMG and nerve conduction studies of the left lower extremity. From Dr. Head’s operative note the nerve resections were branches of the superficial peroneal and deep peroneal very distally down into the forefoot area. These may not show up on EMG or nerve conduction studies, but I still think the studies would be helpful in looking for objective findings. As well, I think she would benefit diagnostically from a 3-phase bone scan. Mr. Wren has asked some questions regarding my evaluation. 1. Do I believe that Ms. Peacock has CRPS from this injury and surgeries to her left foot? Answer: That has been addressed previously. She certainly may have now and may have had previously CRPS that has gone into remission and come back again. I am inclined to believe that this is more related to chronic nerve pain as a result of the nerve resections more than CRPS. A 3-phase bone scan might give us some good information in answering that question and nerve conduction studies could also be helpful. 2. Do I believe that if Ms. Peacock has CRPS has it permanently been resolved and Ms. Peacock is at maximum medical improvement in regard to CRPS? Answer: I do not think her pain is resolved. I think she is still symptomatic, but again, I do not think that I can clearly say with reasonable medical certainty that her pain syndrome is CRPS versus peripheral nerve injuries from surgery. 3. Do you believe that Ms. Peacock is currently having symptoms of CRPS? Answer: Again, answer previously discussed above. 4. Do I believe that Ms. Peacock has lumbar pain that was caused by long-term altered gait? Answer: Yes. 5. Do I believe that Ms. Peacock is at maximum medical improvement in regards to her lumbar pain? Answer: No. 6. If Ms. Peacock is not at maximum medical improvement in regards to her lumbar pain, what further testing or treatment would you recommend for Ms. Peacock?

PEACOCK - H109939 14 Answer: She does have some referred pain down into her right leg and thigh, mostly in the thigh. She does have clear-cut facet arthropathy that is most likely degenerative in nature, but appears to have been an aggravation from her gait mechanic alterations and the scooter. EMG and nerve conduction studies would be useful on the right lower extremity as well. If she is allowed to have EMG and nerve conduction studies through Worker’s Compensation I would suggest that we get them done with Dr. Mike Chesser and that both lower extremities be evaluated for different etiologies. Also she might benefit from a facet block in the right L4-5 facet. She did appear to be neurologically intact in the right lower extremity completely, but she does still have subjective symptoms that could be coming from sciatica. Her pain problem is more consistent with facet arthropathy, however. This concludes my Independent Medical Evaluation of Ms. Peacock. Greater than 3 hours was spent in performing this exam, reviewing the record, and dictating this note. If there are any questions regarding this evaluation I would be happy to address them if they are forwarded to me. I appreciate the opportunity to assist in this nice lady’s care. A pre-hearing order was filed on December 10, 2024. The claimant contended, “Claimant sustained an injury to her left foot on March 1, 2021, while moving a bed in labor and delivery it rolled over the top of her left foot. She treated with Dr. Robert Martin @ UAMS Ortho Clinic on Shackleford. She has undergone 3 different surgeries on her left foot. The 1 st surgery was on 12/14/2021 with Dr. Adam Head. The second surgery was on 8/12/2022 with Dr. Burks. He kept her on non-weight bearing for a period of time. She used a knee scooter due to swelling in her foot. Dr. Burks noted on 10/26/2022 that she possible (sic) have complex regional pain syndrome and recommended her to see Dr. Roman. Dr. Roman did an Independent

PEACOCK - H109939 15 Medical Evaluation on her on (sic)[.] He did not feel she had the criteria for CRPS. Dr. Roman referred he (sic) back to Dr. Burks for additional treatment. Dr. Burks did a 3 rd surgery on 02/13/2023. She continued to have pain and was seen again by Dr. Roman who felt like she met all the criteria for RSD at that time. She underwent sympathetic blocks. She was released from Dr. Martin and Dr. Roman and received impairment ratings. She had an FCE test on 10-16-23 which stated she had a combined IR of 5% whole person.” The claimant contended, “After continued pain, she was seen by Dr. Barry Baskin for a second opinion/IME. Dr. Baskin opined that she clearly has some nerve problems in the left foot. He stated that because of the the (sic) peripheral nerve issues that she has could easily be confused with CRPS (sic). Dr. Baskin opined that he thinks she does have some low back pain and the low back pain might well have resulted from her walking with altered gait mechanics because of left foot problems, the walker boot and knee scooter. Dr. Baskin has recommended a 3-phase bone scan and EMG and nerve conduction studies of the left lower extremity which have not been approved by Workers Compensation.” The respondents contended, “Respondents contend that all appropriate benefits are being paid with regard to Claimant’s left lower extremity injury sustained on 3/1/21. Treatment recommended by Dr. Barry

PEACOCK - H109939 16 Baskin is not reasonable and necessary associated with the same. All appropriate temporary total disability benefits have been paid.” The parties agreed to litigate the following issues: 1. Whether claimant is entitled to reasonable and necessary medical treatment and related expenses, including a 3- phase bone scan, EMG and nerve conduction study of the left lower extremity. 2. Whether Claimant is entitled to additional reasonable and necessary medical treatment to her lower back as a compensable consequence of the compensable left foot injury. 3. Whether Claimant is entitled to Temporary Total Disability (TTD) benefits from August 29, 2023 to a date yet to be determined. 4. Whether Claimant’s attorney is entitled to a controverted attorney’s fee. 5. All other issues are reserved. A hearing was held on April 1, 2025. The claimant testified that she continued to suffer from pain, and that she wanted to undergo the diagnostic testing recommended by Dr. Baskin. An administrative law judge filed an opinion on May 27, 2025. The administrative law judge found that the claimant did not prove she was entitled to additional temporary total disability or temporary partial disability benefits. The claimant does not appeal those findings. The administrative law judge found that the claimant proved she sustained a compensable back injury as a compensable consequence of the claimant’s compensable left foot injury. The administrative law judge found that the claimant proved

PEACOCK - H109939 17 she was entitled to additional medical treatment. 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 sustained by the employee. Ark. Code Ann. §11-9-508(a)(Repl. 2012). 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 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 750 (1984). An administrative law judge found in the present matter, “3. The Claimant has proven by the preponderance of the evidence that she is entitled to additional reasonable and necessary medical treatment, including a three-phase bone scan, an EMG, and a nerve conduction study of the left lower extremity.” The Full Commission finds that the claimant proved she was entitled to additional medical treatment as currently recommended by Dr. Baskin.

PEACOCK - H109939 18 The parties stipulated that the claimant, who the Full Commission finds was a credible witness, sustained a compensable injury to her left foot on March 1, 2021. The respondents initially accepted the claim and paid benefits. Dr. Johnson’s impression on March 3, 2021 was “crush injury” of the left foot. Dr. Head performed surgery in December 2021. The claimant thereafter began treating with Dr. Roman. Dr. Burks performed surgery in August 2022. Dr. McBay reported in December 2022, “Her left foot injury affected her walking and ambulation and aggravated her back pain.” Dr. Martin noted in January 2023 that the claimant “walks with an antalgic gait.” Dr. Martin performed surgery in February 2023. Dr. Guastella noted in March 2023, “I do suspect that her back pain is related to walking in a cast/boot with scooter for nearly 2 years.” The recommendation of Savannah Bradbury, PA-C in April 2023 included a nerve conduction study. An orthotic specialist in November 2023 reported that the claimant “has obvious gait abnormalities due to limping.” The claimant was assigned varying anatomical impairment ratings on July 20, 2023, October 2, 2023, and October 16, 2023. The record does not clearly show which rating the respondent-carrier accepted and paid. Permanent impairment, which is a medical condition, is any permanent or anatomical loss remaining after an employee’s healing period has ended. Johnson v. General Dynamics, 46 Ark. App. 188, 878 S.W.2d 411 (1994).

PEACOCK - H109939 19 The evidence in the present matter demonstrates that the claimant reached the end of a healing period no later than October 16, 2023, the latest date the claimant was assessed as having a permanent anatomical impairment resulting from the compensable injury. Nevertheless, 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), citing Hydrophonics, Inc. v. Pippin, 8 Ark. App. 200, 649 S.W.2d 845 (1983). In the present matter, the Full Commission finds that the claimant proved she was entitled to additional medical treatment as currently recommended by Dr. Baskin. Dr. Baskin opined that additional medical treatment was necessary in part to treat the claimant’s chronic pain resulting from her compensable injury. Reasonably necessary medical treatment can include an effort to reduce symptoms of pain which result from a compensable injury. University of Central Arkansas v. Srite, 2019 Ark. App. 511, 588 S.W.3d 849. Dr. Baskin’s recommendations, as stated in his July 22, 2024 Second Opinion, include a three-phase bone scan, an EMG, nerve conduction studies, and a facet block. The Full Commission finds that these treatment recommendations are reasonably necessary in accordance with Ark. Code Ann. §11-9-508(a)(Repl. 2012). It is within the

PEACOCK - H109939 20 Commission’s province to weigh all of the medical evidence and to determine what is most credible. Minnesota Mining & Mfg. v. Baker, 337 Ark. 94, 989 S.W.2d 151 (1999). The Full Commission finds in the present matter that Dr. Baskin’s treatment recommendations are sound and are entitled to more evidentiary weight than Dr. Roman’s conclusion that additional treatment is not reasonably necessary. The Full Commission also finds that the claimant’s low back complaints are causally related to the compensable injury to the claimant’s left foot. If an injury is compensable, then every natural consequence of that injury is also compensable. Hubley v. Best Western Governor’s Inn, 52 Ark. App. 226, 916 S.W.2d 143 (1996). The basic test is whether there is a causal connection between the two episodes. Jeter v. B.R. McGinty Mechanical, 62 Ark. App. 53, 968 S.W.2d 645 (1998). The burden is on the claimant to establish the necessary causal connection. Nichols v. Omaha Sch. Dist., 2010 Ark. App. 194, 374 S.W.3d 148. Whether there is a causal connection is a question of fact for the Commission. Jeter, supra. In workers’ compensation cases, the Commission functions as the trier of fact. Blevins v. Safeway Stores, 25 Ark. App. 297, 757 S.W.2d 569 (1988). The Commission is not required to believe the testimony of the claimant or any other witness but may accept and translate into findings of fact only those

PEACOCK - H109939 21 portions of the testimony it deems worthy of belief. Farmers Co-op v. Biles, 77 Ark. App. 1, 69 S.W.3d 899 (2002). The claimant sustained a compensable crush injury to her left foot on March 3, 2021. The claimant credibly testified that she developed low back pain as a result of her compensable injury. The medical evidence corroborated the claimant’s testimony. Dr. McBay noted in December 2022, “Her left foot injury affected her walking and ambulation and aggravated her back pain.” Dr. Martin reported in January 2023 that the claimant “walks with an antalgic gait.” Dr. Guastella stated in March 2023, “I do suspect that her back pain is related to walking in a cast/boot with scooter for nearly 2 years.” A physician’s assistant reported in April 2023, “She describes worsening right-sided low back pain after having to walk with the boot and using a knee scooter.” An orthotic specialist noted in November 2023, “She has obvious gait abnormalities due to limping.” Finally, Dr. Baskin expressly opined on July 22, 2024 that the claimant’s lumbar pain was caused by “long-term altered gait.” The claimant in the present matter proved by a preponderance of the evidence that her low back pain was a natural consequence of the stipulated compensable injury. Hubley, supra. After reviewing the entire record de novo, the Full Commission finds that the claimant proved she was entitled to additional medical treatment.

PEACOCK - H109939 22 The claimant proved that Dr. Baskin’s current treatment recommendations were reasonably necessary in accordance with Ark. Code Ann. §11-9- 508(a)(Repl. 2012). For prevailing on appeal, the claimant’s attorney is entitled to a fee of five hundred dollars ($500), pursuant to Ark. Code Ann. §11-9-715(b)(Repl. 2012). IT IS SO ORDERED. ___________________________________ SCOTTY DALE DOUTHIT, Chairman ___________________________________ M. SCOTT WILLHITE, Commissioner Commissioner Mayton dissents. DISSENTING OPINION I must respectfully dissent from the majority opinion. In my de novo review of the record, I find the claimant has not proven by a preponderance of the credible evidence that her purported low-back pain is a result of her compensable left foot injury or met her burden of proving that she is entitled to additional medical treatment for the injury to her left foot. The claimant suffered an admittedly compensable injury to her left foot on March 1, 2021. The claimant contends that she sustained compensable back injury as a result of her foot injury and is entitled to additional medical treatment for the injury to her left foot. After a hearing, an administrative law judge (ALJ)

PEACOCK - H109939 23 determined that the claimant is entitled to additional medical treatment for her foot injury and that she has sustained a compensable low-back injury. Ark. Code Ann. § 11-9-508(a) requires an employer to provide an injured 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 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). It is within the Commission's province to weigh all the medical evidence to determine what is most credible and to determine its medical soundness and probative force. Sheridan Sch. Dist. v. Wise, 2021 Ark. App. 459, 637 S.W.3d 280 (2021). In weighing the evidence, the Commission may not arbitrarily disregard medical evidence or the testimony of any witness. Id. However, the Commission has the authority to accept or reject medical opinions. Williams v.

PEACOCK - H109939 24 Ark. Dept. of Community Corrections, 2016 Ark. App. 427, 502 S.W. 3d 530 (2016). Furthermore, it is the Commission's duty to use its experience and expertise in translating the testimony of medical experts into findings of fact and to draw inferences when testimony is open to more than a single interpretation. Id. In the present case, the claimant has undergone three surgeries throughout the course of her treatment, conducted by Dr. Adam Head, Dr. Jesse Burks, and Dr. Robert Martin. The claimant ultimately obtained an opinion from Dr. Barry Baskin regarding further treatment on July 22, 2024. In his four-page report, Dr. Baskin outlines the claimant’s treatment history, focusing largely on nerve pain observed in Dr. Head’s 2021 operative notes. Dr. Baskin noted: [f]rom Dr. Head’s operative note the nerve resections were branches of the superficial peroneal and deep peroneal very distally down into the forefoot area. These may not show up on EMG or nerve conduction studies, but I still think the studies would be helpful in looking for objective findings. As well, I think she would benefit diagnostically from a 3-phase bone scan. The claimant’s second surgery was by Dr. Burks, which included “peroneus brevis tendon repair to the left” as noted by Dr. Baskin in his report. The third surgery performed by Dr. Martin on February 13, 2023, addressed “left midfoot arthrodesis of the 1 st and 2 nd tarsometatarsal joints of the left foot, harvesting of the calcaneal autograft left foot through a separate incision, and open repair of the peroneus brevis tendon left ankle.”

PEACOCK - H109939 25 In short, the nerve issues Dr. Baskin wants to address have been treated over the course of this claim, and Dr. Baskin’s report does nothing to explain the reason to readdress these issues which have been fully explored. Further, Dr. Baskin states in his report that any findings “may not show up on EMG or nerve conduction studies.” Dr. Baskin also recommends a three-phase bone scan; however, the claimant has previously undergone this exact test on April 28, 2022. This revealed “no scintigraphic evidence of complex regional pain syndrome. Degenerative type activity along the bilateral first metasophalangeal joints greater in the left than the right.” None of the claimant’s treating physicians have recommended an additional bone scan, including her pain management specialist Dr. Carlos Roman. In fact, Dr. Roman has opined that the claimant’s complex regional pain syndrome had resolved by January 3, 2024. Even Dr. Baskin himself believes that the claimant’s pain is “more related to chronic nerve pain as a result of the nerve resections more than CRPS.” The studies recommended by Dr. Baskin are clearly not reasonable and necessary. The issues they seek to identify have either resolved or have been addressed by the claimant’s treating physicians. Dr. Baskin is not confident that these studies will result in any findings that will aid in the claimant’s treatment

PEACOCK - H109939 26 and will do nothing to further the claimant’s care. For these reasons, the claimant has failed to meet her burden of proof. Generally, a specific incident injury is an accidental injury arising out of the course and scope of employment caused by a specific incident identifiable by time and place of an occurrence. Ark. Code Ann. § 11-9-102(4)(A)(i). This, therefore, requires that a claimant establish by a preponderance of the evidence: (1) an injury arising out of and in the course of employment; (2) that the injury caused internal or external physical harm to the body which required medical services or resulted in disability or death; (3) medical evidence supported by objective findings establishing an injury as defined in Ark. Code Ann. §11-9- 102(16) and; (4) that the injury was caused by a specific incident identifiable by time and place of occurrence. Ark. Code Ann. § 11-9-102(4)(A)(i). However, a compensable injury may also arise as a compensable, or natural, consequence of a prior specific incident injury. If an injury is compensable, then every natural consequence of that injury is also compensable. Martin Charcoal, Inc. v. Britt, 102 Ark. App. 252, 284 S.W.3d 91 (2008). The basic test is whether there is a causal connection between the two episodes. Walker v. Fresenius Med. Care Holding, Inc., 2014 Ark. App. 322, 436 S.W.3d 164 (2014). The claimant suffers from common degenerative changes to her spine. A July 2020 X-ray of the claimant’s lumbar spine revealed narrowing at L4-5. An

PEACOCK - H109939 27 X-ray conducted on November 21, 2022, showed mild disc height loss at L4-5 and L5-S1. A March 24, 2023 MRI showed mild facet arthropathy and no significant stenosis at L5-S1. Upon examining the claimant, Dr. Regan Gallaher, a neurosurgeon, noted mild degenerative changes, no significant central canal or foraminal narrowing, and degenerative arthritis at L4-5. Dr. Baskin’s findings agree with previous assessments, finding “minimal degenerative changes in her lumbar spine.” Dr. Baskin conducted a physical examination of the claimant’s lumbar spine and found no muscle spasms and normal lumbar lordosis. The claimant’s statements concerning the origin of her back pain have been inconsistent. On March 14, 2023, the claimant stated in her history to Conway Regional Health System that her back pain began in June of 2022, well after her compensable injury. However, at the hearing, she testified that her back pain began in March of 2021. There is no evidence in the record to support a finding that the claimant’s back pain has any causal connection to her compensable left foot injury. The claimant’s pain is a clear result of degenerative problems as outlined by her treating physicians. Not one of the physicians who treated the claimant has stated with a reasonable degree of medical certainty that her back problems are related to her compensable foot injury.

PEACOCK - H109939 28 Accordingly, for the reasons set forth above, I must dissent. ___________________________________ MICHAEL R. MAYTON, Commissioner