Jonathan Mohler vs. Cross Creek Ranch, LLC

BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. H304058 JONATHAN MOHLER, EMPLOYEE CLAIMANT ROBERT A. YOUNG III, (CROSS CREEK RANCH, LLC), EMPLOYER RESPONDENT MIDWEST INSURANCE COMPANY, INSURANCE CARRIER/TPA RESPONDENT OPINION FILED APRIL 2, 2025 Upon review before the FULL COMMISSION in Little Rock, Pulaski County, Arkansas. Claimant represented by the HONORABLE EDDIE H. WALKER, JR., Attorney at Law, Fort Smith, Arkansas. Respondents represented by the HONORABLE MICHAEL C. STILES, Attorney at Law, Little Rock, Arkansas. Decision of Administrative Law Judge: Reversed. OPINION AND ORDER The respondents appeal and the claimant cross-appeals an administrative law judge’s opinion filed September 25, 2024. The administrative law judge found that the claimant proved he sustained a compensable injury. After reviewing the entire record de novo, the Full Commission finds that the claimant did not prove by a preponderance of the evidence that he sustained a compensable injury. I. HISTORY Robert Young testified in a deposition of record that he was the owner of the respondent-employer, Cross Creek Ranch, LLC. Robert

MOHLER - H304058 2 Young described Cross Creek Ranch as “a cattle business. We buy steers that weigh 550, 600 pounds and graze them through the growing season, put additional weight on them and then we send them to a feedlot where they’re finished.” Mr. Young testified that the acreage of Cross Creek Ranch was “a little over 1,000.” The record indicates that Jonathan Mohler, now age 50, became employed with the respondents on or about August 3, 2020. The claimant’s attorney examined Robert Young: Q. And what did you hire Mr. Mohler to do? A. Well, he’s a ranch hand. He tends to the cattle. They require vaccinations. They require being de-bugged and de- flied, spraying them with insecticides and that sort of thing to keep the critters off of them. They would repair fence, build fence. Just everything that needs to be done on the ranch.... Q. How many head of cattle do you typically have? A. Fourteen hundred.... Q. What were his job duties? A. His job duties. Well, they varied every day. They would bale hay. They might be brush-hogging. They might be putting out fertilizer. They might be repairing fence. It is a job that requirements change daily. Q. So did his job cause him to be in wooded areas on a regular basis or not? A. Not so much wooded, although occasionally it would. More in just tall grass.... Q. And what about lodging, did you provide lodging for him? A. Yeah. He had a house on the ranch. Q. And that was part of his employment package, if you will. Is that correct? A. Well, yes. I wanted him on the ranch. Cattle live there 24 hours a day and he is responsible for the cattle, so if a fence broke and they were out on a country highway, he would be there to get them up and get them in.

MOHLER - H304058 3 Q. So would it be correct to say that he was basically a 24- hour-a-day employee? A. He was available 24 hours. Q. He is on call, basically? A. Right.... Q. So his job regularly required him to be in areas with tall grass. Is that correct? A. That is correct.... Q. Do you spend much time on the ranch itself? A. I am usually out there at least once or two days a week. Q. Have you ever observed any ticks while you were out there? A. Yes.... Q. You knew from personal experience if your kids went out there on that ranch, there was a high probability that they would get a tick bite. Is that right or wrong? A. That is correct. The parties stipulated that the employee-employer-carrier relationship existed at all pertinent times. The claimant testified on direct examination: Q. Mr. Mohler, it has been agreed that you were in the employment of Cross Creek Ranch owned by Robert Young back in 2022 and 2023. Will you briefly explain what your job duties were at Cross Creek Ranch? A. So on a day-to-day – the whole schedule is wrapped around the cattle and the livestock control what else I do. So the first thing I would do is tend the cattle in the morning and then most of the time it was deal with the next issue. If there is a tractor broke down or a fence broke, thing that we deal with on a daily basis is the priority.... Q. Now, your wife was talking about you having to repair a fence sometimes and that she thought that the fence repair work was more involved than a lot of your other work. Tell us a little bit about what repairing the fence is involved. A. Well, there is – in most of the pastures – I am trying to think – I think they all have woods in them....The fence goes into the woods maybe 30 yards in some places and other places it will – you have to – the trees fall down, so that’s a big

MOHLER - H304058 4 part of fixing fence. You get a windstorm, branches end up on the fence and you have to repair that, and if the cattle find a weakness, so we try to fix it as quick as we can once we see it. Q. Do you agree with your wife’s description that repairing fence involved you basically wading through bushes and tall grass and working in that environment? A. Yes.... Q. Now, you have filed a claim indicating that you got bitten by a tick on October 29 th of 2022. How do you know that you got bit by a tick on that day? A. I didn’t – I couldn’t think of an example, but somebody told me to look through my pictures in my phone. I looked through my pictures in my phone and realized I had gotten bit by a tick on a day when I had repaired fence. I took a picture of a tree, which was rubbed on is what was noteworthy about it, and that is what helped me recall. Q. Repeat what you said about the tree. It was rubbed on. Is that correct? A. Yes. It was just unique. You know, you see all over the pastures, you see deer rubs on the side of those trees and this one happened to be on the edge of where I stopped and took that picture and I wouldn’t have ever remembered. It was significant that I took a picture. Just neat that we had a little bigger tree that a deer had rubbed on, so it was just cool. Q. So that is the only thing that caused you to specifically be able to identify one time when you got bit by a tick. Is that right? A. Correct. Q. Were there other times that you got bit and you just don’t know when they were? A. Yes. The only way I knew it was then was just because of that picture.... Q. Was there ever a time when you worked at Cross Creek Ranch that you found a tick on your body when you were not actually on the premises? A. No.... Courtney Mohler, the claimant’s wife, testified on direct examination: Q. Mr. Mohler testified in a deposition that he believes he got bitten by a tick on October 29 th of 2022 and that his memory

MOHLER - H304058 5 was jogged by a photograph. Have you seen that photograph? A. Yes, I have. Q. Are you familiar with the location that that photograph shows? A. I couldn’t tell you the exact tree, but if I remember correctly, the pasture is Graham 7 and I know where Graham 7 is. According to the record, the claimant treated at Washington Regional Medical Center on January 14, 2023: The patient is a 48-year-old male who presents to the ED due to dizziness. He reports this been (sic) ongoing for the last several days. He saw his primary care physician and was notably hypointensive per his report. He reports he stopped taking blood pressure medication about 1 month ago. He has had some nausea vomiting for the last 6 weeks.... Medical Decision Making The patient presents to ED due to reported dizziness and low blood pressure. He has also had some nausea vomiting and abdominal pain. He is evaluated with a history and physical exam and labs and EKG and imaging. His EKG does not reveal an obvious cause his symptoms (sic). He is given IV fluids in the ED. His lab work was reassuring. The CT scan of his abdomen pelvis showed no acute intra-abdominal pathology. The chest x-ray showed no acute abnormality as well. He is given prescription for nausea medication....He was stable time of being discharged to follow up with primary care physician. The assessment on January 14, 2023 was “1. Dizziness. 2. Nausea and vomiting. 3. Abdominal pain.” The claimant was instructed to “Follow-up with primary care physician. Return for any worrisome symptoms. Take medication as prescribed.”

MOHLER - H304058 6 The claimant began treating with Dr. Jantzen Slater on January 26, 2023: JONATHAN MOHLER presents with complaints of sudden onset of frequent episodes of vomiting. Episodes started 11 months ago. He is currently experiencing vomiting. Symptoms are worsening. He states his symptoms worsened about 5 months ago. Pt was recently taken off his Amitriptyline by his doctor that he had been taking for the past 10 years and his symptoms have started since stopping this medication. There are numerous other meds that have been changed during this time. Associated symptoms include nausea, headache, lightheadedness, fatigue and weakness.... Labs today to check food allergy panel, celiac panel & alpha gal panel. The claimant underwent an “ALPHA GAL PANEL-91380” at WR Family Clinic Farmington on January 26, 2023. It was noted at that time, “Previous reports (JACI 2009; 123: 426-433) have demonstrated that patients with IgE antibodies to galactose-a-1,3 -galactose are at risk for delayed anaphylaxis, angioedema, or urticaria following consumption of beef, pork, or lamb." The interpretation of the Alpha Gal Panel was “Very High Positive.” It was reported at WR Family Clinic Fayetteville on March 1, 2023, “JONATHAN MOHLER presents with complaints of sudden onset of frequent episodes of vomiting. Episodes started 11 months ago. He is currently experiencing vomiting. Symptoms are improving. He states he hasn’t vomiting (sic) in the past 2 weeks, but he has had severe fatigue and discomfort in his upper esophogus (sic). Associated symptoms include

MOHLER - H304058 7 nausea, headache, lightheadedness, fatigue and weakness.” The assessment at that time was “1. Chronic vomiting,” “2. Depression with anxiety,” “3. Allergy to alpha-gal,” “4. Chronic pain,” and “5. Headache.” Upon a referral by Dr. Slater, Dr. Tina Merritt examined the claimant at The Allergy Asthma Clinic of Northwest Arkansas on March 29, 2023: He feels bad, can’t work, since the first of the year, and he is a cattle farmer[.] Reacting to cleaning chemical.... c/o fatigue Severe, not able to get out of bed. Very pale, diagnosed in Ft. Smith in Dec with anemia, iron and vitamin C given, was getting worse. Colonoscopy and endoscopy Jan, looking for a bleed, they said his stomach was inflamed, esophagus looked good, then 2 weeks later bothering him, now the esophagus is better. Worse if he tries to eat, better with throwing up.... History of systemic reaction[.] Difficulty swallowing. Decreased blood pressure. Dizziness. Nausea or vomiting. Diarrhea. Referred for alpha-gal allergy. Other allergies include Vancomycin HC1 SOLR, shrimp, and wheat (unable to add uncoded allergies).... 5 days in the hospital on multiple antibiotics, septic, acute kidney failure and high calcium. The referral was before this, for Alpha-gal allergy....Not sure when tick bite, but he is a cattle farmer. Weak and throwing up, started late October....In bed all day now. The Social History also indicated, “Tick exposure: May have pulled a tick off last summer 2022, does not recall ever having been bitten.” Dr. Merritt’s assessments on March 29, 2023 were “1. Dermatitis due to ingested food,” “2. Allergy to mammalian meats,” “3. Illness, unspecified,” “4. Encounter for screening for other metabolic disorders,” “5.

MOHLER - H304058 8 Allergic urticaria,” and “6. Other spotted fevers.” Dr. Merritt also noted on March 29, 2023, “Alpha-gal allergies develop after a person has been bitten by the Lone Star Tick in the United States. 2019 research found Alpha-gal in the saliva of both Lone Star ticks and Black-legged ticks. Alpha-gal is not naturally present in apes and humans, but is in all other mammals.” The record contains the following notation: LYME AB SCREEN Tina Merritt Tue Apr 04 06:30:14 PM CDT 2023>Negative Lyme screen and negative for other tick diseases tested. Has appointment on the seventh but okay to give results and please change the results from pending to normal on this lab Sams, Heather 04/06/2023 4:17 PM > Informed patient[.]...Discussed with patient, needs to avoid dairy. The claimant continued to follow up with Dr. Merritt. A “WORKERS COMPENSATION – FIRST REPORT OF INJURY OR ILLNESS” was prepared on June 13, 2023. The FIRST REPORT indicated that the DATE OF INJURY/ILLNESS was 8:00 a.m. on April 1, 2023. The DATE EMPLOYER NOTIFIED was April 1, 2023 and the DATE DISABILITY BEGAN was April 1, 2023. The TYPE OF INJURY/ILLNESS was “All Other Occupational Disease Injury.” The PART OF BODY AFFECTED was “Insufficient info to properly identify.” A box was checked “Yes” under the question, “DID INJURY/ILLNESS/EXPOSURE OCCUR ON EMPLOYER’S PREMISES?” It was reported, “While IW was working with tick, IW was bitten and has caused incurable disease.”

MOHLER - H304058 9 Another “FIRST REPORT OF INJURY OR ILLNESS” was prepared on June 20, 2023. It was reported, “CLAIMANT RECEIVED AN INFECTION FROM A TICK BITE.” The DATE OF INJURY/ILLNESS WAS January 14, 2023 and the DATE EMPLOYER NOTIFIED was January 16, 2023. Dr. Slater corresponded on August 17, 2023: I am writing on behalf of Jonathan Mohler who, while employed with his current workplace, suffered an unfortunate incident while on the job. I am requesting your assistance in initiating a Worker’s Compensation claim for Mr. Mohler due to a tick bite acquired during work hours, resulting in the development of an alpha-gal allergy. Unfortunately, during his work, he was bitten by a tick. Subsequent medical evaluation and tests have confirmed that Mr. Mohler has developed an alpha-gal allergy as a direct result of the tick bite. This is thought to be at the root of his current symptoms which have rendered him essentially incapacitated to his previous and presumably any occupation. Alpha-gal allergy, also known as mammalian meat allergy, is a serious condition that can lead to severe allergic reactions upon consumption of red meat and other mammalian products. This condition poses a significant challenge to Mr. Mohler’s quality of life and his ability to perform his job effectively. He now requires constant vigilance and adjustments to his lifestyle to avoid potential triggers. At this juncture, the potential of full recovery is unknown, but Mr. Mohler has seen some interval improvement in his functional status and is hopeful to return to productive employment in the coming weeks and months. Enclosed with this letter, please find all relevant medical documentation, medical assessments, and diagnostic test results. These documents substantiate the causal link between the tick bite, the subsequent development of the alpha-gal allergy, and the resulting medical treatment....

MOHLER - H304058 10 The parties deposed Robert Young on June 7, 2024. The respondents’ attorney examined Mr. Young: Q. Have you ever known any employee to formally report a tick bite? A. No. Q. At any point in time did Mr. Mohler contact you or your designated representative about saying, hey, I removed a tick last night or last week? A. No. Q. Okay. Do you recall ever receiving any kind of report, verbal, written or made aware of a tick bite or tick removal from Mr. Mohler in late 2022? A. No. Q. When was it that you were made aware that this illness of Mr. Mohler’s may have originated from a tick or tick bite? A. Well, he was ill for quite a while before he saw a doctor who diagnosed the disease being a result of a tick bite. I don’t remember what the dates were. Q. But you said originally you thought it was just the flu? A. That’s right. Q. And when you first learned of the tick bite, what was Mr. Mohler’s version of events about getting bit by a tick to cause this? A. I don’t understand the question. Q. Well, did he say that there was any specific date involved or was he doing any specific activity? A. No.... Q. Has any specific day or event been associated with this tick bite from Mr. Mohler’s perspective? A. No. Dr. Slater stated on June 17, 2024, “I am writing on behalf of Jonathan Mohler who as you know is undergoing medical treatment for a work-related injury. Although his treatment has improved his symptoms, he remains unable to work due to his condition.”

MOHLER - H304058 11 A pre-hearing order was filed on June 19, 2024. According to the text of the pre-hearing order, the claimant contended, “The claimant contends he sustained a compensable injury on October 29, 2022 as the result of a tick bite. Although the Commission’s file shows a January 14, 2023 date of injury, said date was actually the date on which the claimant became disabled and his actual injury date should be October 29, 2022. In the alternative, claimant contends that if his condition is not due to the specific tick bite of October 29, 2022, it is due to the cumulative effect of tick bites that he received during the course of his employment from January 1, 2022 until his condition became disabling in January of 2023. Further, claimant contends that his job duties exposed him to ticks at a much greater frequency than members of the general public are exposed to ticks; therefore, even if his condition is determined to be an occupational disease it is still compensable in the same way that histoplasmosis is still compensable for people who develop it as a result of working in the poultry industry. Claimant contends he is entitled to temporary total disability benefits from January 15, 2023 until a date yet to be determined and reasonably necessary medical treatment. In addition, claimant contends that the respondent carrier is not entitled to any credit for payments that the respondent employer has made; rather, the claimant should be ordered to reimburse the respondent employer to the extent that the claimant is

MOHLER - H304058 12 awarded temporary total disability benefits, minus attorney’s fees, during any period of time for which the respondent employer paid full wages while the claimant was temporarily totally disabled. Claimant contends his attorney is entitled to an appropriate attorney’s fee.” The parties contended that the respondents “have controverted this claim in its entirety.” The respondents contended, “The respondents contend the claimant did not sustain a compensable injury in the form of an occupational disease while employed by the respondent employer. The respondents have denied and controverted this claim in its entirety. Accordingly, the respondents have not and are not paying any benefits to or on behalf of the claimant for his supposed occupational disease injury. The claimant’s physical problems and need for medical treatment, if any, are not related to his employment with the respondent employer. Rather, the claimant’s physical problems and need for medical treatment, if any, stem from an unrelated and/or pre-existing condition. Also, the respondents assert A.C.A. §11-9-601, as there is no causal connection between the claimant’s occupation for the respondent employer and the alleged occupational disease. Additionally, no compensation is owed ‘for any ordinary disease of life to which the general public is exposed.’ See A.C.A. §11-9-601(e)(3). The respondents had no notice of the claimant’s alleged injury until January 16, 2023. Accordingly, the respondents are not liable

MOHLER - H304058 13 for any benefits whatsoever prior to January 16, 2023. Also, if it is determined the claimant is entitled to any indemnity benefits with regard to this claim, then the respondents are entitled to a credit for the respondent carrier’s wage continuation payments to the claimant subsequent to January 2023.” The parties agreed to litigate the following issues: 1. Compensability of injury to claimant in the form of a tick bite on October 29, 2022. Alternatively, compensability of injury due to the cumulative effect of tick bites that he received during the course of his employment from January 1, 2022 until his condition became disabling in January of 2023. 2. Related medical treatment. 3. Temporary total disability benefits from January 15, 2023 through a date yet to be determined. 4. Attorney’s fee. 5. Compensation rate. 6. Notice. Dr. Joshua L. Kennedy corresponded with the respondents’ attorney on July 29, 2024: My name is Dr. Joshua L. Kennedy, MD, and I will provide expert insight into alpha-gal syndrome (AGS). I am currently affiliated with the Arkansas Children’s Research Institute and the University of Arkansas for Medical Sciences (UAMS), specializing in allergy and immunology. I started at UAMS in 2013 as an Assistant Professor and was promoted with tenure to Associate Professor in 2019.... The plaintiff is a 50-year-old white male with h/o possible fibromyalgia who presented, based on the entirety of the history, with vomiting, heartburn, chronic fatigue, headache, palpitations, anemia, dizziness, tongue numbness, diarrhea, and possible alpha-gal (0.51→0.11) syndrome vs. mast cell activation disorder vs. other primary GI disorder....

MOHLER - H304058 14 In summary, the plaintiff has a low-positive IgE to alpha-gal (0.51 kU/L), which became even lower (0.11 kU/L) on a second test. While there is very little dietary history in the notes that were received, one can assume that the plaintiff was eating red meat at the time of the first test. At the visit with Dr. Merritt on 3/23, he was told to avoid animal meat and by-products. If the patient was avoiding these items, he should no longer have symptoms associated with the alpha- gal syndrome (AGS). Because of the low levels of IgE to alpha-gal and the poor response to the removal of alpha-gal from his diet, it is my opinion that other diagnoses should be considered, including diseases with a primary gastrointestinal etiology.... While at the emergency department on 1/14/23, he has documented low blood pressure (75/45). At that visit, there are no other symptoms that are discussed except dizziness (a symptom of hypotension) and vomiting. He is admitted and treated for sepsis with antibiotics. He returned later (1/17/23) with high blood pressure (not a symptom of either MCAD/S or alpha-gal), jitteriness, and generalized flushing. In this note, there was no mention of rash. On 3/23/23, the plaintiff returned to the ED, where he again had documented low blood pressure (92/70), but the only other symptom mentioned was vomiting....It is also important to note that MCAD/S is not associated with tick bites. It is my medical opinion, within a reasonable degree of medical certainty, that the patient should be able to avoid red meat and animal by-products and live a normal quality life. If this does not happen, the diagnoses should be in question, or the patient’s compliance with dietary measures should be evaluated. It is my opinion, within a reasonable degree of medical certainty, that the plaintiff should be capable of returning to work if he is avoiding mammalian meat. While I have heard of patients who must stop working secondary to food allergy because they work in the restaurant industry, there are very few, if any, other instances where one might have to stop working because of food allergy, including alpha- gal, as the symptoms subside when the allergen is avoided. Some might suggest that “alpha-gal is everywhere,” therefore making it difficult to avoid; however, I have hundreds of patients who can live a good quality life with this disease who have much higher IgE to alpha-gal than the plaintiff.

MOHLER - H304058 15 I am available to provide further details on my research and clinical findings regarding alpha-gal syndrome and to answer any questions that may arise. A hearing was held on August 5, 2024. The respondents’ attorney cross-examined the claimant: Q. Now, in your deposition you told me that this accident, this work-related incident occurred on October 29, 2022. Is that still your testimony, your contention today? A. That is when I can decisively recall being bit by that tick. I can’t give you other dates because I don’t have that picture, you know.... Q. And this tick that you found on October 29, 2022, in your deposition you told me you found it on the back of your leg. Correct? A. Yes. It was on the back side of my knee, in that – Q. Which leg? A. My right leg.... Q. And upon finding or seeing this tick, did you immediately remove it? A. Yes.... Q. Can you state with certainty that that tick that you removed on October 29, 2022, contained alpha-gal to introduce it into your bloodstream? A. I would have either burned the tick or – Q. What? A. I would have either burned it, so there is no – Q. You can’t state what was inside of that tick, can you? A. No. Q. Did you report this incident or this tick removal to anyone associated with Cross Creek Ranch? A. No. The claimant’s attorney re-examined the claimant: Q. Now, I understand your testimony as being that the October 29, 2022 tick bite is the only tick bite that you can actually specifically identify date-wise and that is because of the photograph? A. Correct.

MOHLER - H304058 16 Q. But you have had multiple other tick bites during your employment with Cross Creek Ranch? A. Correct. An administrative law judge filed an opinion on September 25, 2024. The administrative law judge found, among other things, that the claimant proved he sustained a compensable injury. The administrative law judge awarded medical treatment and temporary total disability benefits. The administrative law judge found that the respondents were “entitled to a credit for wages claimant was paid beginning January 14, 2023 and continuing through a date yet to be determined.” The respondents appeal to the Full Commission and the claimant cross-appeals. II. ADJUDICATION A. Alleged Accidental Injury 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 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.

MOHLER - H304058 17 2012). Causation does not need to be established by objective findings, so long as objective medical evidence establishes the injury’s existence and a preponderance of other nonmedical evidence establishes a causal relation to a work-related incident. Bean v. Reynolds Consumer Products, 2022 Ark. App. 276, 646 S.W.3d 655, citing Wal-Mart Stores, Inc. v. VanWagner, 337 Ark. 443, 990 S.W.2d 522 (1999). The employee has the burden of proving by a preponderance of the evidence that he 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). An administrative law judge found in the present matter, “3. Claimant has met his burden of proving by a preponderance of the evidence that he suffered a compensable injury in the form of a tick bite resulting in alpha-gal allergy.” The Full Commission does not affirm this finding. The record indicates that the claimant became employed as a ranch hand for Cross Creek Ranch on or about August 3, 2020. The claimant performed a variety of activities on the respondent-employer’s ranch, including cattle work, fence repair, and hay baling. The claimant’s work for the respondents routinely required him to be in grassy and wooded areas.

MOHLER - H304058 18 Robert Young, the owner of Cross Creek Ranch, testified that ticks were prevalent on the property. The claimant testified that he was bitten by a tick while performing employment services on October 29, 2022. The claimant testified that he did not know he had been bitten until looking through pictures on his phone. The claimant testified, “I looked through my pictures on my phone and realized I had gotten bit by a tick on a day when I had repaired fence. I took a picture of a tree, which was rubbed on is what was noteworthy about it, and that is what helped me recall.” The claimant’s wife, Courtney Mohler, confirmed that she had seen pictures of a tree but did not directly corroborate the claimant’s testimony that he removed a tick from his right leg. There is no probative evidence before the Commission demonstrating that the claimant actually received a tick bite on or about October 29, 2022 or any other pertinent date. The Full Commission recognizes that the statute does not require, as a prerequisite to compensability, that the claimant identify a precise time or numerical date upon which an alleged accidental injury occurred. See Edens v. Superior Marble & Glass, 346 Ark. 487, 58 S.w.3d 369 (2001). Instead, the statute only requires that the claimant prove that the occurrence of the injury is capable of being identified. Id.

MOHLER - H304058 19 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 portions of the testimony that are deemed worthy of belief. Morelock v. Kearney Co., 48 Ark. App. 227, 894 S.W.2d 603 (1995). In the present matter, with regard to whether the claimant was bitten by a tick on or about October 29, 2022, the Full Commission is constrained to find that the claimant was not a credible witness. There was no probative evidence of record corroborating the claimant’s testimony that he was bitten by a tick on or about October 29, 2022 or any other date. Robert Young, the owner of respondent-employer Cross Creek Ranch, testified that the claimant never reported a tick bite to him in 2022. The evidence in the present matter does not corroborate the existence of a tick bite. See Bean, supra. Moreover, the claimant initially did not inform the medical providers that he had allegedly received a tick bite. The claimant began treating at Washington Regional Medical Center on January 14, 2023. The claimant reported that he had been suffering from dizziness, nausea, and vomiting since he had stopped taking blood pressure medication one month earlier. A physician assessed “1. Dizziness,” “2. Nausea and vomiting,” and “3. Abdominal pain.” There was no report of a tick bite. The claimant began treating with Dr. Slater on January 26, 2023. Dr. Slater reported that the claimant’s symptoms of nausea and vomiting had begun “11 months ago”

MOHLER - H304058 20 with no reference to an alleged tick bite. The claimant underwent an “ALPHA GAL PANEL – 91380” at WR Family Clinic on January 26, 2023. It was noted that Alpha-Gal was related to “consumption of beef, pork, or lamb.” There was no reference to a tick bite, and there was no report that the claimant had sustained a tick bite. The first medical report of record that the claimant had allegedly been bitten by a tick occurred on March 29, 2023, over five months after the date contended by the claimant, October 29, 2022. Dr. Merritt noted at that time, “Not sure when tick bite, but he is a cattle farmer.” The Social History on March 29, 2023 also indicated, “May have pulled a tick off last summer 2022, does not recall ever having been bitten [emphasis supplied].” It was also reported on or about April 6, 2023, “Negative Lyme screen and negative for other tick diseases tested [emphasis supplied]. The evidence of record does not demonstrate that the claimant contracted Alpha-Gal Syndrome as the result of being bitten by a tick at Cross Creek Ranch on October 29, 2022 or any other pertinent date. The Commission’s authority to resolve conflicting evidence also extends to medical testimony. Maverick Transp. v. Buzzard, 69 Ark. App. 128, 10 S.W.3d 467 (2000). The Commission is entitled to review the basis for a doctor’s opinion in deciding the weight and credibility of the opinion and medical evidence. Id. In the present matter, the Full Commission attaches minimal evidentiary weight to

MOHLER - H304058 21 Dr. Slater’s opinion written August 17, 2023 that the claimant developed an alpha-gal allergy following an alleged tick bite at work. The probative evidence of record does not corroborate Dr. Slater’s opinion. The Full Commission finds that the claimant did not prove by a preponderance of the evidence that he sustained a “compensable injury” in accordance with Ark. Code Ann. §11-9-102(4)(A)(i)(Repl. 2012). The claimant did not prove he sustained an accidental injury causing internal or external physical harm to the body. The claimant did not prove that he sustained an injury which arose out of and in the course of employment, required medical services, or resulted in disability. The claimant did not prove that he sustained an injury which was caused by a specific incident identifiable by time and place of occurrence on October 29, 2022 or any other pertinent date. Additionally, the claimant did not establish a compensable injury supported by objective medical findings. The claimant did not prove that he sustained a tick bite at work, and the claimant did not prove he sustained Alpha-Gal Syndrome as the result of an alleged tick bite at work. B. Alleged Occupational Disease Ark. Code Ann. §11-9-601(Repl. 2012) provides, in pertinent part: (e)(1)(A) “Occupational disease”, as used in this chapter, unless the context otherwise requires, means any disease that results in disability or death and arises out of and in the course of the occupation or employment of the employee or

MOHLER - H304058 22 naturally follows or unavoidably results from an injury as that term is defined in this chapter. (B) However, a causal connection between the occupation or employment and the occupational disease must be established by a preponderance of the evidence.... (3) No compensation shall be payable for any ordinary disease of life to which the general public is exposed.... (g)(1) An employer shall not be liable for any compensation for an occupational disease unless: (A) The disease is due to the nature of an employment in which the hazards of the disease actually exist and are characteristic thereof and peculiar to the trade, occupation, process, or employment and is actually incurred in his or her employment[.] An occupational disease is characteristic of an occupation, process, or employment where there is a recognizable link between the nature of the job performed and an increased risk in contracting the occupational disease in question. Sanyo Mfg. Corp. v. Leisure, 12 Ark. App. 274, 675 S.W.2d 841 (1984). Occupational diseases are generally gradual rather than sudden in onset. Hancock v. Modern Indus. Laundry, 46 Ark. App. 186, 878 S.W.2d 416 (1994). Ark. Code Ann. §11-9-603(a)(2)(A)(Repl. 2012) provides, “Written notice shall be given to the employer of an occupational disease by the employee, or someone in his or her behalf, within ninety (90) days after first distinct manifestation thereof.” The 90-day statutory period does not begin to run until the employee knows or should reasonably be expected to know that he is suffering from an occupational disease. Quality Service Railcar v. Williams, 36 Ark. App. 29, 820 S.W.2d 878 (1991). Failure to give notice

MOHLER - H304058 23 shall not bar any claim if the employer had knowledge of the injury; of the employee had no knowledge that the condition arose out of and in the course of employment; or if the Commission excuses the failure on the grounds that, for some satisfactory reason, the notice could not be given. Ark. Code Ann. §11-9-701(b)(Repl. 2012). An administrative law judge found in the present matter, “2. Claimant’s claim for a compensation injury is an accidental injury, not an occupational disease.” The claimant states on appeal, “The claimant contended that his tick bite injury is the result of an occupational disease injury, or in the alternative, it is due to a specific incident injury....As indicated above, the claimant also considers this tick bite and the development of AGS to be compensable as an occupational disease.” The Full Commission finds that the claimant did not prove by a preponderance of the evidence that he sustained a compensable “occupational disease” in accordance with Ark. Code Ann. §11-9-601(Repl. 2012). As we have discussed, the claimant became employed with the respondents, Cross Creek Ranch, on or about August 3, 2020. The claimant’s work for the respondents routinely required him to work in wooded and grassy areas. The claimant began receiving medical treatment at Washington Regional Medical Center on January 14, 2023. The claimant complained of dizziness, nausea, and vomiting. There was no reference in

MOHLER - H304058 24 the medical records to gradual or “cumulative tick bites.” There was no probative or physical evidence in the record which demonstrated that the claimant ever became sick as the result of a tick bite or tick bites he allegedly sustained on the respondents’ premises. The ALPHA GAL PANEL done on January 26, 2023 related the claimant’s symptoms to “consumption of beef, pork, or lamb.” The evidence does not demonstrate that the claimant became ill as the result of eating an animal which had been bitten by a tick. The Full Commission also reiterates the April 6, 2023 medical report which indicated, “Negative Lyme screen and negative for other tick diseases tested [emphasis supplied].” The claimant was advised to “avoid dairy.” The Full Commission reiterates that we have attached minimal evidentiary weight to Dr. Slater’s opinion that the claimant suffered from a tick bite “resulting in the development of an alpha-gal allergy.” The probative evidence of record does not corroborate the claimant’s contention that his Alpha-Gal condition was "due to the cumulative effect of tick bites that he received during the course of his employment from January 1, 2022 until his condition became disabling in January of 2023." A finding of a compensable injury cannot be based on speculation and conjecture. Smith- Blair, Inc. v. Jones, 77 Ark. App. 273, 72 S.W.3d 560 (2002). In the present matter, the Full Commission would be forced to resort to speculation and

MOHLER - H304058 25 conjecture to find that the claimant proved he sustained a compensable occupational disease in accordance with Ark. Code Ann. §11-9-601(Repl. 2012). After reviewing the entire record de novo, the Full Commission reverses the administrative law judge’s finding that the claimant proved he sustained a compensable injury. The Full Commission finds that the claimant did not prove by a preponderance of the evidence that he sustained a compensable injury in accordance with Ark. Code Ann. §11-9- 102(4)(Repl. 2012). The claimant did not prove by a preponderance of the evidence that he sustained a compensable occupational disease in accordance with Ark. Code Ann. §11-9-601(Repl. 2012). This claim is respectfully denied and dismissed. IT IS SO ORDERED. ___________________________________ SCOTTY DALE DOUTHIT, Chairman ___________________________________ MICHAEL R. MAYTON, Commissioner Commissioner Willhite dissents. DISSENTING OPINION The ALJ in this case found that the Claimant proved by a preponderance of the evidence that he suffered a compensable injury in the

MOHLER - H304058 26 form of a tick bite resulting in alpha-gal allergy, that Respondent is liable for payment of all reasonable and necessary medical treatment provided in connection with the Claimant’s compensable injury, and that Claimant has met his burden of proving by a preponderance of the evidence that he is entitled to temporary total disability benefits beginning January 14, 2023 and continuing through a date yet to be determined. After my de novo review of the record, I dissent with the majority and would concur with the ALJ’s findings regarding compensability but would find that Claimant sustained an occupational disease in the form of a tick bite resulting in an alpha-gal allergy rather than a specific incident injury. Claimant began working for Respondent at Cross Creek Ranch in July of 2020. Respondent’s owner, Robert Young III testified that he hired the Claimant as a ranch hand to tend cattle. Young testified that Claimant was responsible for anything that needed to be done on the ranch. Claimant was provided with a home for he and his family to live in on the ranch. Testimony from the Claimant, Courtney Mohler (Claimant’s wife), and Young all state that ticks are prevalent on Cross Creek Ranch. Claimant testified that he suffered a tick bite on October 29, 2022. In November 2022, Claimant began vomiting without warning. Ms. Mohler testified that she began noticing Claimant was having new health issues in December of 2022. On January 14, 2023, Ms. Mohler took Claimant to the

MOHLER - H304058 27 emergency room due to uncontrollable vomiting, stomach pain, and irritation in the throat and esophagus. Claimant followed up with his primary care physician, Dr. Jantzen Slater, who tested Claimant for alpha-gal which is described as an allergy triggered by a tick bite. Claimant was diagnosed with alpha-gal syndrome on February 7, 2023. Claimant contended that his diagnosis of alpha-gal syndrome is an occupational disease resulting from a tick bite, I agree. Occupational disease “means any disease that results in disability or death and arises out of and in the course of the occupation or employment of the employee or naturally follows or unavoidably results from an injury” Ark. Code Ann. § 11- 9-601(e)(1)(A). Ark. Code Ann. § 11-9-601 does not define the distinction between “accidental injury” and “disease,” but a widely accepted distinction is that occupational diseases are generally gradual rather than sudden in onset. Johnson v. Democrat Printing and Lithograph, 57 Ark. App. 274, 944 S.W.2d 138 (1997); Hancock v. Modern Indus. Laundry, 46 Ark. App. 186, 878 S.W.2d 416 (1994). Further “a worker must establish that his or her occupational disease came about as a matter of course as a natural consequence or incident of distinctive conditions of his or her particular employment.” Crossett Sch. Dist. V. Gourley, 50 Ark. App. 1, 899 S.W.2d 482 (1995). Alpha-gal syndrome is:

MOHLER - H304058 28 [A]n allergic reaction to a type of sugar community called alpha- gal. It is found in the meat and organ meats of mammals, such as cows, pigs, and sheep. It may also be found in products that come from animals, such as gelatin, medicines, medicine capsules, some milk products, vaccines, and cosmetics. (Claimant’s Exhibit 1, p. 95). Further: This allergy is first triggered by a tick bite from a lone star or blackleg tick. These ticks bite animals, such as cows, pigs, or sheep, and pick up the alpha-gal sugar from their blood. If this same tick bites you, it may cause your body’s defense system (immune system) to produce antibodies to alpha-gal and cause the allergic reaction. Id. Claimant became symptomatic in November 2022 shortly after suffering a tick bite on October 29, 2022. Claimant exhibited additional symptoms and health issues in December of 2022. On January 14, 2023, Claimant began experiencing such uncontrolled symptoms of alpha-gal syndrome that he sought emergency treatment. These unusual symptoms appear to be logically related to the tick bite. Lastly, Claimant was living on the ranch as a condition of his employment and the Respondent’s own witness admitted that ticks were prevalent. As such, a tick bite resulting in the alpha-gal syndrome appears to be a natural consequence or incident of the distinctive conditions of Claimant’s employment. Based upon the credible evidence in the record, I find that the Claimant received a tick bite which caused him to experience the alpha-gal syndrome. I also find that due to the nature of Claimant’s employment he was exposed to a greater risk of this disease than the general public. I further

MOHLER - H304058 29 find that the Claimant’s symptoms and disability arose soon after the tick bite with nothing to suggest any alternate explanation for his condition so that there is a logical connection between them. Additionally, since an employee is not required to prove the source of an infection with absolute certainty, I find that the Claimant met his burden of proof that he suffered a compensable occupational disease from this course of events and is entitled to all reasonable and necessary medical benefits required from the tick bite and associated symptoms. Therefore, I dissent with the majority and would rule that the Claimant suffered a compensable occupational disease as a result of a tick-bite and is entitled to associated medical benefits. For the reasons stated above, I respectfully dissent. ___________________________________ M. SCOTT WILLHITE, Commissioner