Joyce Johnson vs. Booker T. Washington Elementary School

BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. H303428 JOYCE JOHNSON, EMPLOYEE CLAIMANT BOOKER T. WASHINGTON ELEMENTARY SCHOOL, EMPLOYER RESPONDENT ARKANSAS SCHOOL BOARDS ASSN., INSURANCE CARRIER/TPA RESPONDENT OPINION FILED JULY 17, 2025 Upon review before the FULL COMMISSION in Little Rock, Pulaski County, Arkansas. Claimant represented by the HONORABLE GREGORY R. GILES, Attorney at Law, Texarkana, 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 claimant appeals an administrative law judge’s opinion filed February 26, 2025. The administrative law judge found that the claimant did not prove she sustained a compensable injury. After reviewing the entire record de novo, the Full Commission finds that the claimant did not prove she sustained a compensable injury in accordance with Ark. Code Ann. §11-9-102(4)(A)(i)(Repl. 2012). In addition, the claimant did not establish a compensable injury by medical evidence supported by objective findings, pursuant to Ark. Code Ann. §11-9-102(4)(D)(Repl. 2012). I. HISTORY

JOHNSON - H303428 2 Joyce Johnson, now age 59, testified that she became employed as a classroom teacher for the respondents, Booker T. Washington Elementary, in 1990. Dr. Adam Smith reported in February 2023 that the claimant had been suffering from a large number of chronic health conditions, including low back pain, “Onset: 06/25/2012 – Lumbago....X- rays of her lumbar spine shows slight loss of her lordosis and significant foraminal stenosis at L5-S1 with retrolisthesis.” Dr. Smith assessed “Lumbar degenerative disc disease with foraminal stenosis.” An MRI of the claimant’s lumbar spine was taken on April 12, 2023 and was compared to an MRI taken November 9, 2011, with the following impression: 1. Multilevel degenerative disc disease. 2. A broad-based central protrusion of the L4-5 disc is superimposed on generalized bulging of the disc. Central spinal canal stenosis at the L4-5 level due to the abnormal disc, facet arthropathy, and thickening of the ligamentum flavum. Right facet arthropathy mildly effaces the right side of the thecal sac. 3. There is narrowing of the right lateral recess at the L4-5 level, with impingement on the descending right L5 nerve root. The claimant underwent a lumbar transforaminal epidural injection in April 2023. The parties stipulated that the employment relationship existed on May 2, 2023. The claimant testified on direct examination:

JOHNSON - H303428 3 Q. So take us to the date in question here, May the 2 nd of ’23, what was the age group of children that you were dealing with that day? A. I had third graders, which were probably eight – around eight years old or nine.... Q. Were you having any issues with any disciplinary problems during the day in the classroom? A. It started from the very beginning, when the teacher left. I was trying to shut the door and this particular student decided to just go stand in the door.... Q. And so as you came to the end of your class time, did you implement procedure that day in terms of how you were going to dismiss the children from the classroom? A. Yes. I decided to dismiss based on their behavior, which is something that I used to do regularly anyway....And this student started walking towards the door....and so we got there about the same time and we both was – he was trying to get out the door....I just shut the door and he rammed into me really hard ... And when he rammed me, he rammed me into the door really hard. Q. Let me ask you this, what part of your body did he strike, physically, when he hit you? Where are you saying that he struck you? A. Okay. My hands were both on the door knob, and so when he came in and he came into my right side and it felt like it was his elbows that hit – like, his elbows and shoulder, maybe, that hit, because it was like all through the upper part and, like, down to my waist.... Q. Did you strike the door? A. Yes, I struck the door, the door knob, ‘cause I was up on the door shutting it, so my body went into the door....I bumped him off with my hip and I yelled at him, “Don’t you ram me into that door.”... Q. Were you experiencing any symptoms or problems at that point in time? A. I was mainly, like, the parts of my body that hit the door, but my left – left leg was – was hurting pretty badly and – Q. Where, specifically, was your left leg hurting? A. It was like my hip down.

JOHNSON - H303428 4 According to the record, the claimant signed a Form AR-N, EMPLOYEE’S NOTICE OF INJURY, on May 3, 2023. The ACCIDENT INFORMATION section of the Form AR-N indicated that the Date of Accident was May 2, 2023, and the claimant described the alleged injury: Right hip, hamstrings, slight right side shoulder blade pain; slight left knee (right side) pain. I was already having some pains for which I had had. My calf pains have also increased. I just stopped using a cane. A male student rammed me into a door as I was turned sideways, pinning me between the door and his body. I had my hands holding the door, so I used my right hip to push him off of me to free myself. Dr. Scott Carle saw the claimant on May 3, 2023 and reported, “Attacked yesterday at school. Hit from the right side. Pain pelvic rim, right thigh and left knee. Has recent LESI for her back and feels like this has made it worse again. She has not cuts or bruises at this point. Admits to being with some anxiety about this event. Neck and posterior shoulders sore.” Dr. Carle’s physical examination showed “Lumbosacral Spine: normal SLR, normal heel/toe gait, no spasms.” Dr. Carle’s assessment on May 3, 2023 was “1. Assault,” “2. Stress reaction,” “3. Pelvic contusion, initial encounter,” and “4. Sprain of other ligament of left knee, initial encounter.” Dr. Carle e-mailed the respondents on May 5, 2023: Joyce Johnson Assaulted by a student. Recent and pre existing back and hip trouble s/p injection.

JOHNSON - H303428 5 Student rammed her from the side. No visible bruises. Doubt serious physical injury but she is emotionally rattled. Recommended some PT and get records and use EAP services for now. Also, gave her a couple of meds. She may not be very easy to get back into a classroom quickly..........:/ The record indicates that the claimant returned to light duty work for the respondents on or about May 15, 2023. An MRI of the claimant’s lumbar spine was taken on May 19, 2023 with the following impression: 1. L4-L5: Mild disc bulge and right paracentral to right foraminal disc herniation with moderate spinal canal stenosis, severe mass effect on the right lateral recess, severe right and moderate left neural foraminal narrowing. 2. L5-S1: Mild disc bulge with moderate bilateral neural foraminal narrowing. 3. No other spinal canal stenosis for moderate to high-grade neural foraminal narrowing. 4. The disc bulges and disc herniations are age indeterminate. These could be chronic and degenerative in etiology, however also could be related to recent reported injury. Clinical correlation is recommended. The record indicates that the claimant stopped returning to work on or about May 22, 2023. A Claims Adjuster for the respondents wrote to Dr. Carle on June 7, 2023: It is my understanding that you are currently treating Ms. Johnson for a workers’ compensation claim with her employer, Little Rock School District. As you know, for workers’ compensation claims to be compensable in the state of Arkansas, there must be objective and measurable findings. The Commission has defined “objective findings” as

JOHNSON - H303428 6 findings that cannot come under the voluntary control of the patient. Therefore, we ask that you please advise what, if any, objective findings Ms. Johnson has to support her injury. I have prepared a space at the bottom of this page for your convenience in responding.... Ms. Joyce Johnson’s objective findings are the following: Dr. Carle replied on June 12, 2023, “None” and wrote, “Negative studies for fracture or internal injuries. No measurable aggravation to pre- existing spine disorder.” The claimant began treating with Dr. Bernard Crowell on July 27, 2023: Ms. Johnson is a very pleasant 57-year-old female who [is] seen today with complaints of back pain along with left lower extremity radiculopathy. She noticed the symptoms several months ago. She underwent an MRI which showed she had a bulging disc at L4-L5. She underwent an epidural steroid injection. However, shortly afterward she was involved in a school altercation. She continued to have increasing back pain with right lower extremity radiculopathy. The radiculopathy is quite severe in nature. She walks with a limp favoring the right lower extremity....She is now using a cane for assistance.... MRI scan lumbar spine reveals large right paracentral disc herniation at L4-L5. It occupies approximately 1/3 of the canal. Disc desiccation also noted.... We discussed surgical intervention. This would be a hemilaminectomy with discectomy.... A Claims Adjuster informed a representative of the Workers’ Compensation Commission on August 8, 2023, “We are in receipt of your letter dated 08/07/23, regarding the above captioned claim. Please be

JOHNSON - H303428 7 advised that we have denied this claim for any additional medical treatment.” Dr. Crowell performed surgery on August 11, 2023: “Hemilaminectomy and diskectomy, L4-L5.” Dr. Crowell provided follow-up treatment after surgery. The record indicates that the claimant retired from employment with the respondents effective November 1, 2023. Dr. Crowell noted on February 1, 2024, “She is complaining of increased low back pain along with right lower extremity radiculopathy. She has undergone physical therapy. However, her therapist terminated further treatment secondary to increased back and right leg pain....She is now using a cane, walking with a significant limp.” Dr. Crowell corresponded with the claimant’s attorney on April 23, 2024: This letter is written in response to your query regarding Mrs. Johnson reaching maximum medical improvement and providing an impairment rating using the AMA Guides to Evaluation of Permanent Impairment Fourth Edition. Mrs. Johnson is a 58-year-old patient who was initially evaluated on 07/23/2023 for an L4-L5 right paracentral disc herniation. She had noticed the symptoms several months prior to presentation. She underwent an MRI which revealed a bulging disc at L4-L5. She underwent non-operative treatment consisting of an epidural steroid injection. This did provide her with relief. However, shortly afterwards she was involved in a school altercation. She noticed an increase in back pain and right lower extremity radiculopathy. The radiculopathy had become quite severe in nature, resulting in

JOHNSON - H303428 8 her ambulating with a limp. She underwent another MRI scan of her lumbar spine which revealed a large right paracentral disc herniation at L4-L5 occupying approximately 1/3 of the canal. She underwent a hemilaminectomy with discectomy at L4-L5 on 8/11/2023. She initially showed improvement following surgery, however, she was unable to undergo physical therapy due to financial circumstances. MRI scan with contrast was performed on 02/09/2024 revealing right laminectomy, discectomy with enhancing granulation tissue at the discectomy and lateral recess.... Based on the AMA Guides to the Evaluation of Permanent Impairment chapter 3, page 113, table 75, section II E she should receive a percent impairment of the whole body of 10. Dr. Wayne L. Bruffett reported on June 22, 2024: I interviewed the patient, examined the patient and reviewed all the pertinent imaging. I performed the medical decision making component in its entirety. The patient readily reported that she had pain in her back and leg prior to the work injury that occurred on May 2, 2023. In fact she had an injection for this pain on April 28, 2023. As a consequence of this work related (sic) of that a child charged her and pushed her into a door I believe. She ultimately had surgery in the form [of] a microscopic partial diskectomy L4-5 on the right by Dr. Bernard Crowell. She sought him out and had this surgery with her regular medical insurance. After surgery she continued physical therapy and had some worsening pain. In January of this year she had further therapy. In February of this year she had an MRI scan.... I had an opportunity to review an MRI scan that was dated 11/09/2011 that scan shows some mild degenerative changes also reviewed the report. There was no significant disc herniation at that time noted at the L4-5 level. Another MRI scan was reviewed from 04/12/2023 and another one from 05/19/2023 and a final study from 02/09/2024. The study from April was done prior to the work related incident and the [May] study was done afterwards. These 2 studies are basically identical. I see no objective change in the MRI findings after this work related event. The final MRI scan does reveal postsurgical changes. X-rays today show postsurgical and degenerative changes as well.

JOHNSON - H303428 9 Although the work related incident that occurred on May 2, 2023 caused some worsening pain for Mrs. Johnson, I would say with a reasonable degree of medical certainty based on the objective imaging and her history of pre-existing complaints and treatments for this problem, specifically an injection 4 days prior to the event, the surgery that was performed and the subsequent treatment was more than 51% related to her pre-existing disc herniation stenosis and radiculopathy that emanated from the L4-5 motion segment. Put another way, I see no objective evidence of injury as a consequence of the incident that occurred on May 2, 2023 at work. With regards to her work injury she is at maximum medical improvement and there is no applicable impairment rating that can be linked to said incident. I have no restrictions to place upon her as a consequence of this work injury. A pre-hearing order was filed on July 2, 2024. The claimant contended, “a. Claimant contends she sustained compensable injuries. The primary injury [being an] aggravation of a pre-existing condition of her low back which has subsequently required surgery; b. Claimant contends entitlement to temporary total disability benefits from the date she began missing work; c. Claimant contends Respondents should be ordered to pay the medical treatment received to date and additional medical treatment; d. Claimant contends Respondents should be ordered to pay attorney’s fees as provided by law.” The parties stipulated that the respondents “have controverted this claim in its entirety.” The respondents contended, “Respondents contend that Claimant did not suffer a compensable injury on or about 5/2/23. In

JOHNSON - H303428 10 light of this, it is Respondents’ position that Claimant is not entitled to benefits associated with her alleged injury.” Dr. Crowell corresponded with the claimant’s attorney on October 14, 2024: This letter is in response to your query regarding Mrs. Johnson’s evaluation by Dr. Bruffett. I have read his evaluation and have also reviewed the MRI scans of Mrs. Johnson’s lumbar spine. The first was obtained on April 12, 2023 prior to the altercation, and the second was obtained on May 19, 2023 after the altercation. The scans were reviewed in side-by-side comparison. I must preface my statement by noting that the MRI scans were performed by two different MRI scanners. I still believe that the herniation seen in the May scan is slightly larger albeit it is only seen on a few images and may appear to be open to opinion. I still believe that by her description and my evaluation of her, the work- related accident exacerbated her pre-existing condition. This is based on the fact she had undergone a lumbar epidural steroid injection and was feeling well enough to return to work. If she had not obtained a positive response from the injection, it is doubtful she would have returned to work. It is my opinion that when I evaluated her, surgery was necessary due to my findings on physical examination and the location and size of the disc herniation.... Dr. Ryan T. Fitzgerald corresponded with the respondents’ attorney on January 6, 2025 and reported in part: Ms. Johnson was involved in work-place incident on 5/2/23, hereafter for the purposes of this report referred to as the subject event.... MR imaging of the lumbar spine 05/19/2023 was negative for any evidence of an acute traumatic injury. No bone marrow edema, paraspinous soft tissue inflammation, or paraspinous muscle edema was evident at any level. As demonstrated on the prior MRI exam from April 2023, chronic degenerative disease was apparent at multiple levels, most advanced at L4-

JOHNSON - H303428 11 5. Ongoing impingement of the right L5 nerve root within the severely stenotic right subarticular recess at L4-5 was unchanged. No new disc abnormality had developed at L4-5 or elsewhere in the lumbar spine.... In summary, Ms. Johnson’s medical record includes a well- documented history of chronic low back pain and active symptomatology requiring treatment within 1 week of the subject event. On my person (sic) review, MR imaging obtained in May 2023 was negative for any objective evidence of an acute traumatic injury. Severe subarticular recess stenosis on the right at L4-5 and impingement of the right L5 nerve root secondary to a diffuse disc bulge and degenerative facet/ligamentum flavum hypertrophy were unchanged on the 5/19/23 exam relative to the 4/12/23 exam. As such, in my opinion lumbar treatments provided subsequent to the subject event were more likely than not attributable to Ms. Johnson’s long-standing lumbar degenerative disease and independent of the subject event. A hearing was held on January 14, 2025. At that time, the parties agreed to litigate the following issues: 1. Whether the claimant sustained a compensable injury to her back by specific incident. 2. Whether the claimant is entitled to reasonably necessary medical treatment from May 3, 2023 to July 5, 2024. 3. Whether the claimant is entitled to temporary total disability benefits from September 1, 2023 to April 23, 2024. 4. Whether the claimant is entitled to temporary partial disability benefits from June 1, 2023 to August 30, 2023. 5. Whether the claimant is entitled to permanent partial disability benefits, specifically, a 10% impairment rating to the body as a whole. 6. Fees for legal services. An administrative law judge filed an opinion on February 26, 2025. The administrative law judge found that the claimant did not prove she

JOHNSON - H303428 12 sustained a compensable injury. The claimant appeals to the Full Commission. II. ADJUDICATION Act 796 of 1993, as codified at Ark. Code Ann. §11-9-102(4)(Repl. 2012), provides, in pertinent part: (A) “Compensable injury” means: (i) An accidental injury causing internal or external physical harm to the body ... arising out of and in the course of employment and which requires medical services or results in disability or death. An injury is “accidental” only if it is caused by a specific incident and is identifiable by time and place of occurrence[.] A compensable injury must also be established by medical evidence supported by objective findings. Ark. Code Ann. §11-9-102(4)(D)(Repl. 2012). “Objective findings” are those findings which cannot come under the voluntary control of the patient. Ark. Code Ann. §11-9-102(16)(A)(i)(Repl. 2012). An aggravation is a new injury resulting from an independent incident, and being a new injury with an independent cause, it must meet the definition of a compensable injury in order to establish compensability of the aggravation. Hickman v. Kellogg, Brown & Root, 372 Ark. 501, 277 S.W.3d 591 (2008), citing Jim Walter Homes v. Beard, 82 Ark. App. 607, 120 S.W.3d 160 (2007).

JOHNSON - H303428 13 The employee has the burden of proving by a preponderance of the evidence that she sustained a compensable injury. Ark. Code Ann. §11-9- 102(4)(E)(i)(Repl. 2012). 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). It is the duty of the Full Commission to enter findings in accordance with the preponderance of the evidence and not on whether there is substantial evidence to support an administrative law judge’s findings. Roberts v. Leo Levi Hospital, 8 Ark. App. 184, 649 S.W.2d 402 (1983). The Full Commission reviews an administrative law judge’s opinion de novo, and it is the duty of the Full Commission to conduct its own fact-finding independent of that done by an administrative law judge. Crawford v. Pace Indus., 55 Ark. App. 60, 929 S.W.2d 727 (1996). The Full Commission enters its own findings in accordance with the preponderance of the evidence. Tyson Foods, Inc. v. Watkins, 31 Ark. App. 230, 792 S.W.2d 348 (1990). An administrative law judge found in the present matter, “3. The Claimant has not proven that she has sustained an aggravated compensable spinal injury with objective findings.” The Full Commission finds that the claimant did not prove by a preponderance of the evidence that she sustained a compensable injury.

JOHNSON - H303428 14 The claimant became employed as a classroom music teacher for the respondents in 1990. Dr. Smith reported in February 2023 that the claimant had been suffering from chronic low back pain since at least 2012. Dr. Smith assessed “Lumbar degenerative disc disease with foraminal stenosis.” An MRI of the claimant’s lumbar spine in April 2023 showed, among other things, a “broad-based central protrusion of the L4-5 disc.” The claimant underwent a lumbar transforaminal steroid injection in April 2023. The parties stipulated the employment relationship existed on May 2, 2023. The claimant contends that she injured her back that day as the result of an alleged assault by a student. The claimant testified that she was “rammed” into a doorknob by a student who was trying to forcibly exit the classroom. The claimant signed a Form AR-N, EMPLOYEE’S NOTICE OF INJURY, on May 3, 2023 but she did not report a back injury. The claimant wrote that she injured her “Right hip, hamstrings, slight ride side shoulder blade pain; slight left knee (right side) pain.” Dr. Carle examined the claimant on May 3, 2023 and reported “Pain pelvic rim, right thigh and left knee.” Dr. Carle’s assessment included “4. Sprain of other ligament of left knee, initial encounter,” but he did not report a back injury allegedly occurring on May 2, 2023. Dr. Carle informed the respondents on May 5, 2023, “Student rammed her from the side. No visible bruises. Doubt

JOHNSON - H303428 15 serious physical injury but she is emotionally rattled.” The claimant returned to light duty work for the respondents on or about May 15, 2023. An MRI of the claimant’s lumbar spine was taken on May 19, 2023 and showed, among other things, a “Mild disc bulge” which had already been reported in April 2023, before the May 2, 2023 incident. The claimant stopped returning to work for the respondents on or about May 22, 2023. Dr. Carle informed the respondents on June 12, 2023 that there were no objective findings of an injury. Dr. Carle opined that there were “Negative studies for fracture or internal injuries. No measurable aggravation to pre- existing spine disorder [emphasis supplied].” The Full Commission finds that the claimant did not prove by a preponderance of the evidence that she sustained a compensable injury in accordance with Ark. Code Ann. §11-9-102(4)(A)(i)(Repl. 2012). The claimant did not prove that she sustained an accidental injury causing internal or external physical harm to her low back on May 2, 2023. The claimant did not prove that she sustained an injury to her low back which arose out of and in the course of employment, required medical services, or resulted in disability. The Full Commission also finds that the claimant did not establish a compensable injury by medical evidence supported by objective findings. Dr. Carle opined on June 22, 2024 that there were no objective findings of a

JOHNSON - H303428 16 compensable injury to the claimant’s back. Dr. Bruffett opined that there was “no objective change” in MRI findings taken before and after the alleged May 2, 2023 classroom assault. Dr. Bruffett expressly stated, “I see no objective evidence of injury as a consequence of the incident that occurred on May 2, 2023 at work.” Dr. Fitzgerald opined on January 6, 2025 that that MR imaging was “negative for any objective evidence” of an injury to the claimant’s low back. Dr. Fitzgerald stated, “As such, in my opinion lumbar treatments provided subsequent to the subject event were more likely than not attributable to Ms. Johnson’s long-standing lumbar degenerative disc disease and independent of the subject event.” We recognize Dr. Crowell’s opinion on April 23, 2024 that the claimant had essentially sustained a herniated disc as result of the alleged low back injury. Dr. Crowell informed the claimant’s attorney in October 2024, “I still believe that the herniation seen in the May scan is slightly larger albeit it is only seen on a few images and may appear to be open to opinion.” The Commission has the duty of weighing medical evidence and, if the evidence is conflicting, its resolution is a question of fact for the Commission. Green Bay Packaging v. Bartlett, 67 Ark. App. 332, 999 S.W.2d 695 (1999). It is within the 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). In the present

JOHNSON - H303428 17 matter, the Full Commission finds that the opinions of Dr. Carle, Dr. Bruffett, and Dr. Fitzgerald are corroborated by the evidence of record and are more credible than the opinion of Dr. Crowell. After reviewing the entire record de novo, the Full Commission finds that the claimant did not prove by a preponderance of the evidence that she sustained a compensable injury in accordance with Ark. Code Ann. §11-9- 102(4)(A)(i)(Repl. 2012). The claimant did not prove she sustained an accidental injury causing internal or external physical harm to her low back. The claimant did not prove that she sustained an injury to her low back which arose out of and in the course of employment, required medical services, or resulted in disability. In addition, the claimant did not establish a compensable injury to her back by medical evidence supported by objective medical findings, in accordance with Ark. Code Ann. §11-9- 102(4)(D)(Repl. 2012). The Full Commission therefore respectfully denies and dismisses the claim. IT IS SO ORDERED. ___________________________________ SCOTTY DALE DOUTHIT, Chairman ___________________________________ MICHAEL R. MAYTON, Commissioner Commissioner Willhite dissents.

JOHNSON - H303428 18 DISSENTING OPINION The Administrative Law Judge (hereinafter referred to as “ALJ”) found that the Claimant had not proved that Claimant sustained an aggravated compensable spinal injury with objective findings. After my de novo review of the record, I would dissent with the ALJ’s findings. To establish a compensable injury by a preponderance of the evidence the Claimant must prove: (1) an injury arising out of and in the course of employment; (2) that the injury caused internal or external harm to the body which required medical services or resulted in disability or death; (3) medical evidence supported by objective findings, as defined in Ark. Code Ann. §11-9-102(16), establishing the injury; and (4) that the injury was caused by a specific and identifiable time and place of occurrence. A compensable injury must be established by medical evidence supported by objective findings and medical opinions addressing compensability must be stated within a degree of medical certainty. Smith-Blair, Inc. v. Jones, 77 Ark. App. 273, 72 S.W.3d 560 (2002). The employer takes the employee as he finds him. Conway Convalescent Center v. Murphree, 266 Ark. 985, 585 S.W.2d 462 (Ark. App. 1979). A pre-existing disease or infirmity does not disqualify a claim if the employment aggravated, accelerated, or combined with the disease or infirmity to produce the disability for which compensation is sought. See,

JOHNSON - H303428 19 Nashville Livestock Commission v. Cox, 302 Ark. 69, 787 S.W.2d 664 (1990); Conway Convalescent Center v. Murphree, 266 Ark. 985, 585 S.W.2d 462 (Ark. App. 1979); St. Vincent Medical Center v. Brown, 53 Ark. App. 30, 917 S.W.2d 550 (1996). An increase in symptoms of a pre- existing degenerative condition is sufficient to establish a compensable injury. Parker v. Atlantic Research Corp., 87 Ark. App. 145, 189 S.W.3d 449 (2004). The Claimant has a prior history of symptomology and diagnoses for her lumbar spine. Claimant underwent a lumbar spine MRI on April 12, 2023, which showed: 1. Multilevel degenerative disc disease. 2. A broad-based central protrusion of the L4-5 disc is superimposed on generalized bulging of the disc. Central spinal canal stenosis at the L4-5 level due to the abnormal disc, facet arthropathy, and thickening of the ligamentum flavum. Right facet arthropathy mildly effaces the right side of the thecal sac. 3. There is narrowing of the right lateral recess of the L4-5 level, with impingement on the descending right L5 nerve root. Based on this MRI, Claimant was given a lumbar epidural steroid injection (hereinafter referred to as “LESI”) on April 28, 2023. On May 2, 2023, Claimant was pushed by a student while working for the Respondent. On May 3, 2023, Claimant was seen by Dr. Scott Carle where she reported that she had a LESI for her back and that her back felt “worse again” after the

JOHNSON - H303428 20 accident. On May 19, 2023, Claimant underwent another lumbar spine MRI which showed: 1. L4-L5: Mild disc bulge and right paracentral to the right foraminal disc herniation with moderate spinal canal stenosis, severe mass effect on the right lateral recess, severe right and moderate left neural foraminal narrowing. 2. L5-S1: Mild disc bulge with moderate bilateral neural foraminal narrowing. 3. No other spinal canal stenosis for moderate to high-grade neural foraminal narrowing. 4. The disc bulges and disc herniations are age indeterminate. These could be chronic and degenerative in etiology, however also could be related to recent reported injury. Clinical correlation is recommended. Based on this MRI, Dr. Scott Carle e-mails a representative of the Respondent on Claimant’s condition where he states that Claimant’s neurogenic claudication or radiculopathy was significantly worsening. Claimant was referred to Dr. Bernard Crowell who stated on July 27, 2023, that Claimant’s May 19, 2023, MRI revealed “a large lumbar disc herniation displacing the exiting nerve root and occupying one third of the central canal.” Dr. Crowell then recommends Claimant for a hemilaminectomy with discectomy which was performed on August 11, 2023. On June 21, 2024, Dr. Wayne Bruffett was asked by the Respondent to perform an independent medical evaluation. In this evaluation Dr. Bruffett found that there was “no objective evidence of injury as a consequence of the incident that occurred on May 2, 2023.” In response to this, Dr. Crowell

JOHNSON - H303428 21 is asked by the Claimant to render his opinion on Claimant’s injury for which he stated: I still believe that the herniation seen in May scan is slightly larger albeit it is only seen on a few images and may appear to be open to opinion. I still believe that by her description and my evaluation of her, the work-related accident exacerbated her pre-existing condition. This is based on the fact she had undergone a lumbar epidural steroid injection and was feeling well enough to return to work. If she had not obtained a positive response from her injection, it is doubtful she would have returned to work. It is my opinion that when I evaluated her, surgery was necessary due to my findings on physical examination and the location and size of the disc herniation. When medical opinions conflict, the Commission may resolve the conflict based on the record as a whole and reach the result consistent with reason, justice, and common sense. Barksdale Lumber v. McAnally, 262 Ark. 379, 557 S.W.2d 868 (1977). It is within the 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). Based on my review of the record, I find that Dr. Crowell’s medical opinion should be given more weight as he is an orthopedic surgeon, had personal contact with the patient and extensively reviewed the Claimant’s current and past medical history in relation to her spine. It is somewhat rare for there to be objective evaluations of an injured employee’s spine shortly before and after a work accident. However, in this case the MRIs of April 12, 2023, and May 19, 2023, provide the physicians with a reasonably clear

JOHNSON - H303428 22 basis to determine the effect of the May 2, 2023, work accident. It appears that the physician who interpreted the MRI results agreed with Dr. Crowell’s assessment that the Claimant’s condition was progressively worse after the work accident. Although the Claimant clearly had a pre-existing condition, there is clear and credible evidence that she suffered from an aggravation of the injury after the work accident on May 2, 2023. The Courts have held in several cases that an increase in symptoms following a work-related accident is sufficient proof to establish compensability. Parker v. Atlantic Research Corp., 87 Ark. App. 145, 189 S.W.3d 449 (2004). There was an objective change in the condition of Claimant’s lumbar spine following her work accident and Dr. Crowell opined that this change was related to the May 2, 2023, work incident. Therefore, I find that the Claimant has sustained compensable injury to her back. For the reasons stated above, I respectfully dissent. ___________________________________ M. SCOTT WILLHITE, Commissioner