Amanda Engleman vs. Washington Regional Medical Center

BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. H404754 AMANDA ENGLEMAN, EMPLOYEE CLAIMANT WASHINGTON REGIONAL MEDICAL CENTER, EMPLOYER RESPONDENT RISK MANAGEMENT RESOURCES, INSURANCE CARRIER/TPA RESPONDENT OPINION FILED SEPTEMBER 25, 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 MELISSA WOOD, Attorney at Law, Little Rock, Arkansas. Decision of Administrative Law Judge: Reversed. OPINION AND ORDER The respondents appeal an administrative law judge’s opinion filed April 18, 2025. The administrative law judge found that the claimant proved she sustained a compensable injury. After reviewing the entire record de novo, the Full Commission reverses the administrative law judge’s opinion. The Full Commission finds that the claimant did not prove by a preponderance of the evidence that she sustained a compensable injury. I. HISTORY Amanda Engleman, now age 44, testified on direct examinaton:

ENGLEMAN - H404754 2 Q. It is my understanding that you had had an injury to your left shoulder before this June 2, 2023 incident ever happened. Is that correct? A. Yes, I did. Q. Tell us what happened. A. We were remodeling our home and painting the bedroom. My husband took the stepladder out of the room and I saw a spot a little higher up on the wall that I wanted to get. And since he had already taken the stepladder out, I thought it was going to be a smart idea to just jump on a chair and go from the chair to the barstool and I fell. Q. And did you sustain any kind of injury as a result of that fall? A. It hurt for about three weeks, I want to say three weeks, and then it resolved on its own. Q. When you say it, what is it? What part of your body? A. The left shoulder, elbow. I landed on my elbow. Q. You landed on your left elbow? A. Yes. Q. And injured your left shoulder? A. Yes. The claimant sought treatment at Mercy Convenient Care on February 17, 2022. The claimant complained of left shoulder pain and it was noted, “Fall occurred: Tripped and walking. Impact surface: Hard floor.” An x-ray of the claimant’s left shoulder was taken on February 17, 2022 with the impression, “Negative left shoulder x-ray.” The claimant testified that she became employed with the respondents, Washington Regional Medical Center, in November 2022. The claimant testified that her employment position with the respondents was “Operating Room Circulator.”

ENGLEMAN - H404754 3 The parties stipulated that the employment relationship existed on June 2, 2023. The claimant testified on direct examination: Q. Ms. Engleman, where were you employed on June 2 of 2023? A. Washington Regional Medical Center. Q. Did anything unusual happen to you on that day? A. Yes. Q. What? A. We were in a case with Dr. Kendrick and the patient was in a prone position at the time. The CRNA alerted me that the patient was sliding off of the operating room table because Dr. Kendrick had to put her in – well, she was prone and he had to put her in Trendelenburg to get to the area that he was operating on and he said that he needed help. So I got under the table, under the drapes, and was trying to reposition the patient back into a position where she wouldn’t fall off the table and at that time I started feeling pain in my shoulders, so I changed my position and got underneath the patient a little bit better. And then the CRNA said he was going to tilt the bed the opposite direction so that I could push against her and we would have gravity to help us reposition. Instead, he hit the button and it tilted towards me so I had the patient over my head and both shoulders went back. My left shoulder popped. I had to stay there because at that point I couldn’t push the patient any more to the operating room table. And we finished the surgery in about five minutes, so I was there under her the whole five minutes holding her above my head. And when we completed everything and got her switched over to the gurney to transport her to PACU, I went and told the boss my left shoulder had popped and my right one was hurting, they were both hurting, so they sent me to the employee health nurse. The claimant signed a Form AR-N, EMPLOYEE’S NOTICE OF INJURY, on June 2, 2023. The ACCIDENT INFORMATION section of the Form AR-N indicated that the Date of Accident was June 2, 2023, and that

ENGLEMAN - H404754 4 the claimant injured “Both shoulders.” The claimant wrote regarding the cause of injury, “holding heavy weight of patient to prevent injury.” According to the record, the claimant treated at Conservative Care Occupational Health on June 2, 2023: Amanda Engleman is a 42 year-old Female, and employee of Washington Regional/WRMC.... Employer Description of Accident: Employer states patient was trying to reposition a patient on the surgery table and injured both shoulders. Her date of injury is June 2, 2023.... Patient states she was repositioning a large client on the surgical table when she felt a pop and sharp pain in her left shoulder. She had to hold the client with both arms for an extended period of time, and now her right shoulder is hurting as well.... Amanda’s primary problem is Pain located in the Left shoulder. She describes it as burning, sharp....The problem began on 6/2/2023....Amanda’s secondary problem is Pain located in the Right shoulder....The problem began on 6/2/2023.... IMAGING STUDIES X-RAY – Left Shoulder: Degenerative changes. Spurring over the acromion. No Fracture Seen. Acute Findings – Absent. Number of views: 3 views were taken of the left shoulder. XRAY – Right Shoulder: Degenerative changes. No Fracture Seen. Acute Findings – Absent. Number of views: 3 views were taken of the right shoulder.... Patient reports having general aches and pains to her shoulders in the past, last episode approximately 1 year ago, but has never had to have formal treatment for either shoulder before this reported injury. Today’s x-rays are negative for acute abnormalities.... The cause of this problem appears to be related to work activities.

ENGLEMAN - H404754 5 Amanda Bell, APRN diagnosed “1. Left shoulder pain” and “2. Right shoulder pain.” Ms. Bell planned conservative treatment, and she assigned a Work Status of “Restricted Duty.” Dr. Konstantin V. Berestnev’s diagnosis on June 9, 2023 was “1. Pain in left shoulder” and “2. Pain in right shoulder....The cause of this problem appears to be related to work activities.” Dr. Berestnev continued the work status “Restricted Duty,” “No work above the shoulders.” The claimant was provided a program of physical therapy. A physical therapist noted on June 14, 2023, “Pt is RHD 42 YOF with C/O constant anterior/superior shoulder pain L>R. Reports initial onset of pain on 6/2/23 after catching a patient from sliding off of a table. Reports table was elevated at OR patient’s midsection and she slid down causing her to be on her knees pushing upward to stop momentum....She is currently on work restrictions. Denies any other shoulder treatments.” The claimant testified that she did not benefit from physical therapy, and that physical therapy “actually aggravated the situation.” Dr. Berestnev stated on June 30, 2023, “Amanda’s recommended work status is Regular Duty.” The claimant was discharged from physical therapy on July 18, 2023. The claimant continued to occasionally follow up at Conservative Care Occupational Health. Dr. Berestnev reported on August 8, 2023, “Patient states her bilateral shoulder pain is better.”

ENGLEMAN - H404754 6 Dr. J. Clayton noted on March 26, 2024 that the claimant’s chief complaint was left shoulder pain. Dr. Clayton noted: History: This patient has had pain in her left shoulder ever since she hurt it about 2 years ago when she was moving a dog into another seat of the car. She is (sic) already done physical therapy which was done this past June through August she has been on ibuprofen she has not had any injections or used prescription NSAIDS. Exam: Patient does not have weakness in the shoulder but does have positive impingement signs. Neurovascularly intact. Imaging: Plain films of the left shoulder failed to demonstrate fracture or dislocation. Medical decision making: Rotator cuff impingement on the left. We are going to try some meloxicam as well as an injection today. If those things are not successful advanced imaging would be reasonable given that she has already done therapy. Dr. Clayton noted on April 16, 2024: This patient had an injury to her left shoulder which was actually from a fall loading her shoulder directly though there was also an incident involving repositioning a dog but that was not actually the inciting event. Short of it is this was a trauma to her shoulder. She has already done injections formal physical therapy and chiropractics and continues to have pain in her shoulder that is severe enough that it wakes her up at night.... Imaging: Plain films of the left shoulder are unremarkable without fracture or dislocation.... Dr. Clayton arranged for an MRI of the claimant’s left shoulder, which was taken on May 7, 2024 with the following impression: 1. There is a small amount of fluid in the subacromial bursa which may be secondary to bursitis or tendinitis. 2. There is mild degenerative change at the acromioclavicular joint.

ENGLEMAN - H404754 7 Dr. Clayton noted on May 14, 2024, “MRI was reviewed with the patient and was largely unremarkable though she does have some degenerative changes at the AC joint. Medical decision making: Given the persistent pain despite nonsurgical treatments it might be reasonable to consider something like a subacromial decompression and distal clavicle excision. I am going to have her see one of my partners to be evaluated but we may also consider ultrasound-guided biceps and were AC joint infection.” Dr. T. Zimmerman reported on May 17, 2024: Ms. Engleman has chronic and symptomatically uncontrolled left shoulder pain likely from multiple etiologies. She does have tendinopathy of the cuff but no overt tearing. She is very tender over the bicipital groove but also over the deltoid, infraspinatus, along the medial border of the scapula with associated trigger point/myofascial pain. She reported her muscles calming down after a landmark guided subacromial corticosteroid injection with Dr. Clayton.... We discussed the various options and ultimately decided to start with corticosteroid injections to the long head of the biceps tendon sheath and AC joint. After obtaining consent, including the risk of tendon rupture after biceps tendon sheath injection, injections were performed as below without issue. If she experiences no relief or only partial relief from today’s injections then I think before considering surgery it [would] be worthwhile to do some trigger point injections/therapeutic needling or consider sending her dry needling.... History of Present Illness: 43 y.o. female who presents for evaluation of left shoulder pain. She reports anterior left shoulder pain which will radiate to her upper arm and some posterior shoulder pain as well. This has been present for over 2 years and she associates it with starting after falling off of a barstool onto her left elbow. She reports associated

ENGLEMAN - H404754 8 clicking and difficulty with motion. She has pain with reaching overhead or posteriorly. It loosened up her muscles for about a week and she could feel the muscles release when she received the injection.... Radiographs of the left shoulder are unremarkable. MRI of the right shoulder demonstrates tendinosis of the supraspinatus tendon, degenerative changes of the AC joint, and a little bit of fluid in the long head of the biceps tendon sheath. Dr. Greg Jones reported on May 29, 2024: Ms. Engleman is a 43-year-old nurse. She has worked in the ICU as well as a flight nurse in the past. She is now doing circulating room work at the Washington Regional Hospital and in particular with respect to work when she is “pushing carts or lifting patients” it exacerbates her left shoulder pain. It is fairly constant at 4/10 but it can get up to 10/10 after she has a busy work day. Symptoms began 2-1/2 years ago. She fell off a step ladder doing some painting, landed directly on her elbow, grabbed it up into the shoulder longitudinally and has had symptoms ever since then. She had two episodes when a dog jerked her shoulder. I have looked at her carefully for instability but certainly the stress that the description implies wrenched her shoulder and had worsening of symptoms and she states that she is having increasing trouble “pushing events” when she is moving patients out of the operating room as a part of her normal circulating room duties. She cannot sleep on it, it wakes her up at night on occasion. She has been seen and treated conservatively by Dr. Zimmerman of Sports Medicine and Dr. Clayton, one of my partners. Injections are made both into the subacromial space that lasted about a week, a second injection was made with an ultrasound-guided groove injection. It really did not do much for her and because of those failures of anti- inflammatories time, injections and physical therapy, she presents for consideration of surgery.... I have reviewed the 4-view shoulder x-ray series from 03/26. She has a flat acromion, non-pointed coracoid and normal anatomy of the glenohumeral joint. No evidence of arthritis. She has had impingement changes of the greater tuberosity

ENGLEMAN - H404754 9 and chronic AC arthropathy changes without overt spur formation but definitely sclerosis and cystic changes on the clavicular and the AC joint site. The MRI is likewise reviewed. There is no evidence of full- thickness tear and the biceps tendon has minimal fluid along the sheath. She has some evidence of subacromial bursitis to my evaluation of the exam. There is no full-thickness rotator cuff tear. She has 2-1/2 years of pain. She has positive examination of the AC joint and with impingement maneuvers that had been alleviated albeit temporarily with injection. I think the biceps is not particularly involved nor is there instability. Given the chronicity of symptoms and failure of extended conservative measures, an arthroscopic AC joint resection and subacromial bursectomy given the traumatic nature of the bursitis onset I think are appropriate next steps in management. She is sick of it, it is bothering her badly and she wants to proceed in that direction.... Dr. Jones’ pre-operative diagnosis on June 13, 2024 was “AC arthropathy – posttraumatic, biceps tendinitis, chronic subacromial bursitis – traumatic.” Dr. Jones performed a procedure on August 26, 2024: “1. Glenohumeral arthroscopy with biceps tenotomy. 2. AC resection/Mumford procedure via anterior arthroscopic approach. 3. Extended subacromial bursectomy. No acromioplasty. CA ligament sleeve release.” The post- operative diagnosis was “1. Subluxation of the biceps tendon with longitudinal split and hypervascular tenosynovitis. 2. AC meniscus arthropathy with torn AC meniscal elements. 3. Moderately severe subacromial bursitis, rotator cuff fully intact.” Dr. Jones reported on June 13, 2024:

ENGLEMAN - H404754 10 Ms. Engleman is a healthcare provider with recurrent and increasing job limiting, life-limiting symptoms from her left shoulder since an injury in an incident where she had a fall from a vehicle and landed on her extended left arm, drove over shoulder via the elbow up and sprained her AC joint. It has been symptomatic ever since as she does certain maneuvers in terms of lifting patients and moving things in her job performance. It acutely exacerbates the pain and she has a combination of 3 different findings that are very focused in terms of our exam. The rotator cuff appears to be intact, but the biceps tendon has gotten a great deal more symptomatic and on careful observation has both symptomatic Speed’s and Yergason’s test prior to surgery on exam and a marked tenderness to palpation along the bicipital groove. She also has positive impingement and bursitis, signs of crepitus and the AC joint remains exquisitely uncomfortable to provocative cross-arm and rotatory maneuvers. Based on these findings, 2 and a half years since the incident without improvement, it is felt that an arthroscopic evaluation is appropriate. At this time by MRI and exam, it is felt the rotator cuff is intact, but I certainly think the biceps has risen to a level of pain generator participation that it needs to be addressed at the same setting.... Dr. Jones noted on July 17, 2024: Ms. Engleman is a 43-year-old nurse, who works up at Washington Regional. She is in the OR, heavy lifting. She had a fall at one point from a ladder. In my operative note, I have said it was from a vehicular accident, but was from a fall from a ladder, but there were multiple other episodes were actually documented, one with a pop in her shoulder and she had been sent to physical therapy and it had continued symptoms with the biceps tendon even back in that timeframe. She is an operating room nurse as with all of our patient’s, they are all more frequent to 300 pounds or plus and moving them, putting them on and off a bed, pushing the gurneys, etc., has become an increasingly challenging situation for almost as the particular one, who has had shoulder injury and surgery.

ENGLEMAN - H404754 11 I am a little bit confused and that this appears to have had clearly a work component. A diagnosis is made at work that prompted the use of physical therapy for that purpose, I think confirming this was; 1. Reported. 2. Recognized. 3. In my opinion, greater than 50% contribution to the problems that exist, I think she needs to pursue this in appropriate fashion and I have recommended same. Today’s x-rays, copy as report demonstrate satisfactory AC joint resection or flat acromion on the outlet view, no dystrophic calcification or calcific tendinitis. There are no fractures. Copy that as a 2-view left shoulder x-ray report.... Takes at least 3 months to get over her surgery such as this. If she has to return to “full unrestricted lifting activity,” she is not ready to do that and I am going to ask that she see me back in 2 months and we will consider return at that juncture depending on her surgery was 06/13/2024 on left shoulder; AC resection, biceps tenotomy, and subacromial bursectomy. A pre-hearing order was filed on September 27, 2024. The claimant contended, “She is entitled to temporary total disability benefits from June 13, 2024 to a date yet to be determined and reasonably necessary medical treatment. The claimant contends that her attorney is entitled to an appropriate attorney’s fee.” The parties stipulated that the respondents “have controverted the claim in its entirety.” The respondents contended, “Claimant’s bilateral shoulder injuries were initially accepted as a medical-only claim, but the claim has now been denied in its entirety due to a lack of objective findings. Additionally, respondents contend that claimant has pre-existing issues with her shoulders and possibly underwent new injuries after June 2, 2023.”

ENGLEMAN - H404754 12 The parties agreed to litigate the following issues: 1. Whether the claimant sustained a compensable injury on June 2, 2023, specifically bilateral shoulder injuries. 2. If compensable, whether the claimant is entitled to temporary total disability benefits, and reasonably necessary medical treatment. 3. Fees for legal services. The parties reserve all other issues. Dr. Jones corresponded with the claimant’s attorney on or about October 21, 2024: I write in response to your letter dated 10/14/2024 regarding your client and my patient, Amanda Engleman. As you are aware from the medical records, I had first opportunity to see her 05/29/2024 and will detail those findings. I have also had opportunity to go through medical records from Mercy Convenient Care from conservative care, Occupational Health from her work-related injury, on June 2, 2023 and more recent visits in our office with Dr. Zimmerman and Dr. Clayton with respect to her bilateral shoulder difficulties. As is outlined in my office note from 05/29/2024, the principal reason in which she had presented to me with an increased and life-limiting level of pain that had failed to respond to conservative care, left worse than right shoulder was the injury sustained and subsequent pushing “patients” after June 2, 2023, work injury. I am well aware that she had 2 other incidents, one of fall with a contusion that subsequently healed without problem. Second, a dog moving incident on a couple of occasions, but nothing that rose to the level of the nature of symptomatology with which she presented to me. Her history and physical examination at that time were consistent with injuries from a mechanical nature and were consistent with the pattern of injury that she had described. It was because she had received optimum opportunity for conservative care including extended physical therapy with a conservative care, occupation health department or positions

ENGLEMAN - H404754 13 and as detailed notes revealed that was considered a work- related injury and persistent in its character and although did not rise to the level of “needing surgery” had remained of the principal diagnosis when she completed care under their auspices. When she saw me her symptoms had continued to worsen and despite injections and extended physical therapy and observation, they have become life-limiting. It is my opinion that the nature of the injury sustained in the work incident described and detailed historically both by her and in the medical record previously making clear to me that within a reasonable medical degree of certainty that June 2, 2023 incident is more than 50% the cause of the injury, subsequent symptomatology and findings that led me to recommend the surgical procedure undertaken 06/13/2024. There had been some question I gather as to whether or not a vehicular accident, had been involved at any time with this injury and I do not recall nor do I see documentation of that being the case. Having reviewed all these records, I remain convinced that with medical certainty, greater than 50% of the cause of her need for surgery on the left shoulder was due to the work- related incident. Dr. Jones noted on December 4, 2024: Ms. Engleman is seen in followup regarding her left shoulder. She has been plagued since the incident when she caught the 300 pounds plus person in her role as a circulating nurse, had bilateral AC sprain, she had continued difficulties. We had taken her to surgery on the left shoulder, did biceps release, AC resection arthroscopically and while the biceps relieved her symptoms remarkably better. She is still having some tenderness over the top side of her AC joint and provocative testing increased anteroposterior plane, not superior, but anteroposterior. I think this is a setting in which we got traumatic AC joint injury that all looked better. Since the AC resection has enough residual instability, but it is limiting her ability to return to her previous work and in this instance, I would recommend an open deltotrapezial fascial repair. 90% of people who are successful in alleviating the symptoms that she is

ENGLEMAN - H404754 14 experiencing and displaying on both my examination and historical evidence provided. She has ongoing problems with severely injured right shoulder in terms of the AC joint flexibility and pain with provocative cross-arm rotatory range of motion and if and when we get to the point of taking care of the right shoulder, I would just do it as open AC resection given the display that she has made with returns to the bilateral stretching injury and catching the patient is likely to have the same sort of AC sprain on the right as we have seen on the left. In a nutshell, she has residual AC joint resection site pain, it is related to anteroposterior instability and deltotrapezial fascial repair would be the next best step in management. Rationale for same, necessary perioperative activity modification, rehab participation are detailed. She voiced understanding and we will proceed in that direction. We will hold off the MMI declaration with respect to her work injury made previously until that surgery is completed and I might again note that the right shoulder was also injured in the same work injury at the hospital as described previously. Bilateral shoulder x-rays are made today and they demonstrate subtle superior displacement of the right distal clavicle compared to the acromion. The left shoulder has a wide AC resection, flat acromion. No glenohumeral arthritis or evidence of fracture or destructive lesion with respect to the left, 4-view series. The right 4 view series demonstrates mild- to-moderate AC arthropathy with slight dorsal displacement. No glenohumeral fracture displacement and no calcifications in the rotator cuff insertion on either shoulder. Copy that as a bilateral shoulder 4 view series. We will see her when she comes in for the left shoulder open deltotrapezial fascial repair at the AC joint residual instability. After a hearing, an administrative law judge found that the claimant proved she sustained a compensable injury. The administrative law judge awarded medical treatment and temporary total disability benefits. The respondents appeal to the Full Commission. II. ADJUDICATION

ENGLEMAN - H404754 15 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 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). The requirement that a compensable injury be established by medical evidence supported by objective findings applies only to the existence and extent of the injury. Ford v. Chemipulp Process, Inc., 63 Ark. App. 260, 977 S.W.2d 5 (1998), citing Stephens Truck Lines v. Millican, 58 Ark. App. 275, 950 S.W.2d 472 (1997). 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).

ENGLEMAN - H404754 16 An administrative law judge found in the present matter, “2. Claimant has met her burden of proving that she suffered a compensable bilateral shoulder injury on June 2, 2023, and is entitled to reasonable and necessary medical treatment for that injury as recommended by Dr. Greg Jones.” The Full Commission does not affirm this finding. We find that the claimant did not prove by a preponderance of the evidence that she sustained a compensable injury to her left shoulder or right shoulder. The claimant’s testimony indicated that she first injured her left shoulder in 2022 after she fell from a chair at home. The claimant sought medical treatment for this nonwork-related injury in February 2022. The claimant testified that she became employed as an Operating Room Circulator for the respondents in November 2022. The parties stipulated that the employment relationship existed on June 2, 2023. The claimant testified that she injured her left and right shoulders that day while positioned underneath a table, holding a hospital patient. The claimant signed a Form AR-N, EMPLOYEE’S NOTICE OF INJURY, on June 2, 2023. The claimant reported that she injured “both shoulders” while “holding heavy weight of patient to prevent injury.” The Full Commission finds that the claimant did not establish a compensable injury by medical evidence supported by objective findings. The claimant treated at Conservative Care Occupational Health on June 2,

ENGLEMAN - H404754 17 2023. No objective findings were shown during this treatment. No fracture was seen and no injury was demonstrated after x-rays of the claimant’s left and right shoulders. An APRN diagnosed “left shoulder pain” and “right shoulder pain” but did not report any objective medical findings. Dr. Berestnev returned the claimant to regular work duty on June 30, 2023. The record does not corroborate the claimant’s testimony that Dr. Berestnev refused to provide additional diagnostic testing. 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 it deems worthy of belief. Whaley v. Hardee’s, 51 Ark. App. 166, 912 S.W.2d 14 (1995). In the present matter, the Full Commission is constrained to find that the claimant was not a credible witness. The claimant sought treatment with Dr. Clayton on March 26, 2024. The claimant informed Dr. Clayton that she had injured her left shoulder two years earlier in a dog-related incident. Dr. Clayton noted on April 16, 2024 that the claimant’s left shoulder condition “was actually from a fall loading her shoulder directly though there was also an incident involving repositioning a dog but that was not actually the inciting event.” Dr. Clayton also noted, “Plain films of the left shoulder are unremarkable without fracture or dislocation.” Dr. Clayton reported on May 14, 2024 that a left shoulder MRI showed “degenerative changes at the AC

ENGLEMAN - H404754 18 joint.” The evidence does not demonstrate that these “degenerative changes” were causally related to the June 2, 2023 incident. Dr. Zimmerman reported on May 17, 2024 that the claimant was suffering from “uncontrolled left shoulder pain likely from multiple etiologies [emphasis supplied].” Dr. Zimmerman reported that the claimant had injured her left shoulder two years earlier “after falling off of a barstool onto her left elbow.” Dr. Zimmerman did not report an incident occurring June 2, 2023. The claimant began treating with Dr. Jones on May 29, 2024. Dr. Jones noted, “She fell off a step ladder doing some painting, landed directly on her elbow, grabbed it up into the shoulder longitudinally and has had symptoms ever since then.” Dr. Jones also reported that “a dog jerked her shoulder.” Dr. Jones did not report an incident occurring June 2, 2023. Dr. Jones stated on June 13, 2024 that the claimant had injured her left shoulder after “a fall from a vehicle.” Dr. Jones noted on July 17, 2024 that there had been “multiple other episodes” involving the claimant’s left shoulder. Dr. Jones finally reported on October 21, 2024 that, in his opinion, “within a reasonable degree of medical certainty that [the] June 2, 2023 incident is more than 50% the cause of the injury, subsequent symptomatology and findings that led me to recommend the surgical procedure undertaken 06/13/2024.”

ENGLEMAN - H404754 19 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 matter, the Full Commission finds that Dr. Jones’ October 21, 2024 causation opinion is not supported by the record and is entitled to minimal evidentiary weight. Nor does the record support Dr. Jones’ conclusion on December 4, 2024 that the claimant sustained a “bilateral AC sprain” on June 2, 2023. The Full Commission finds in the present matter that the claimant was not a credible witness. The claimant reported several alleged causes for her bilateral shoulder pain, including a fall at home and an alleged injury related to handling a dog. Dr. Jones reported “multiple other episodes” allegedly causing injury to the claimant’s shoulders. The Full Commission recognizes that an APRN diagnosed “Left shoulder pain” and “Right shoulder pain" following the specific incident on June 2, 2023. Nevertheless, we find that the claimant did not prove that the June 2, 2023 incident caused internal or external physical harm to the left shoulder or right shoulder. Nor did the claimant establish a compensable injury by medical evidence supported by objective findings. The evidence does not demonstrate that the subluxation of the biceps tendon or “torn AC meniscal elements” shown during surgery on June 13, 2024 were causally related to the June 2, 2023 incident. See Ford, supra. Additionally, there is no

ENGLEMAN - H404754 20 probative evidence demonstrating that the purported “subtle superior displacement of the right distal clavicle” described by Dr. Jones on December 4, 2024 was causally related to the June 2, 2023 specific incident. After reviewing the entire record de novo, the Full Commission finds that the claimant did not prove she sustained an accidental injury causing internal or external physical harm to her left shoulder or right shoulder. In addition, we find that the claimant did not prove she established a compensable injury to her left shoulder or right shoulder by medical evidence supported by objective findings. We therefore reverse the administrative law judge’s finding that the claimant proved she “suffered a compensable bilateral shoulder injury on June 2, 2023[.]” The respondents are not liable for medical treatment provided by Dr. Jones, and this claim is respectfully denied and dismissed. IT IS SO ORDERED. ___________________________________ SCOTTY DALE DOUTHIT, Chairman ___________________________________ MICHAEL R. MAYTON, Commissioner Commissioner Willhite dissents.

ENGLEMAN - H404754 21 DISSENTING OPINION The Administrative Law Judge (hereinafter referred to as “ALJ”) found that the Claimant had proved by a preponderance of the evidence that she suffered a compensable bilateral shoulder injury on June 2, 2023, and was entitled to reasonable and necessary medical treatment for that injury as recommended by Dr. Greg Jones. Further, the ALJ found that the Claimant had met her burden of proof that she is entitled to temporary total disability from June 13, 2024, to a date yet to be determined. The Respondent appeals this decision. After conducting a thorough review of the record, I find that the Claimant proved she sustained a compensable bilateral shoulder injury, and is entitled to temporary total disability from June 13, 2024, to a date yet to be determined. 1. The Claimant has proven by a preponderance of the evidence that she suffered compensable bilateral shoulder injuries on June 2, 2023, and is entitled to reasonable and necessary medical treatment for those injuries as recommended by Dr. Greg Jones. 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

ENGLEMAN - H404754 22 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). An employer shall promptly provide for an injured employee such medical treatment as may be reasonably necessary in connection with the injury received by the employee. Ark. Code Ann. § 11-9-508(a). Reasonable and necessary medical services may include those necessary to accurately diagnose the nature and extent of the compensable injury; to reduce or alleviate symptoms resulting from the compensable injury; or to maintain the level of healing achieved; or to prevent further deterioration of the damage produced by the compensable injury. Jordan v. Tyson Foods, Inc., 51 Ark. App. 100, 911 S.W.2d 593 (1995). On June 2, 2023, Claimant was working in her capacity as an Operating Room Circulator for Respondent when a patient started slipping off of an operating table. The Claimant placed herself under the operating table and began pushing it up to keep the patient from sliding off of the table. The Claimant remained in this position pushing up for several minutes and the Claimant felt her left shoulder pop. After the incident, the Claimant also began suffering from right shoulder pain.

ENGLEMAN - H404754 23 Claimant was seen by Amanda Bell, APRN on June 2, 2023. Bell noted in relevant portions of the medical report as follows: Patient states she was repositioning a large client on the surgical table when she felt a pop and sharp pain in her left shoulder. She had to hold the client with both arms for an extended period of time and now her right shoulder is hurting as well. [...] Patient reports having general aches and pains to her shoulders in the past, last episode approximately 1 year ago, but has never had to have formal treatment for either shoulder before this reported injury. Today’s x-rays are negative for acute abnormalities. Further, Bell restricted the Claimant’s work activities and noted that “Medical causation: The cause of this problem appears to be related to work activities.” On June 9, 2023, Claimant was seen by Dr. Konstantin Berestnev. At this visit, Dr. Berestnev noted: Employer Description of Accident: Employer states patient was trying to reposition a patient on the surgery table and injured both shoulders. [...] Musculoskeletal: Positive for joint pain, joint swelling and limited motion. [...] Medical causation: The cause of this problem appears to be related to work activities. Claimant was subsequently given an injection of methylprednisone and referred to physical therapy by Dr. Berestnev as Claimant was symptomatic bilaterally in her shoulders as a result of the June 2, 2023, work accident.

ENGLEMAN - H404754 24 Claimant was also given the work restrictions of “no work above the shoulders.” On June 30, 2023, Claimant followed up with Dr. Berestnev after completing four physical therapy sessions and reported that her bilateral shoulder pain “is getting tolerable.” At that visit, Dr. Berestnev released Claimant to work at regular duty. On July 21, 2023, Claimant followed up with Ceth Dawson, PA, who found that the Claimant had bilateral impingement to her shoulders as a result of the June 2, 2023, work accident. The Claimant was seen again on August 8, 2023, at which time she was given a home exercise plan and instructions to take over the counter medication for her bilateral shoulder injuries. On March 26, 2024, Claimant was seen by Dr. J. Clayton. At this visit, the Claimant’s medical history was taken in regard to her left shoulder pain as follows: History: This patient has had pain in her left shoulder ever since she hurt it about two years ago when she was moving a dog into another seat of the car. She is already done physical therapy which was done this past June through August she has been on ibuprofen she has not had any injections or used prescription NSAIDs. This history was corrected by the Claimant at her next visit with Dr. J. Clayton on April 16, 2024 as follows: History: This patient had an injury to her left shoulder which was actually from a fall loading her shoulder directly though there was also an incident involving repositioning a dog but that was not actually the inciting event. Short of it is this was a trauma to her shoulder. She has

ENGLEMAN - H404754 25 already done injections formal physical therapy and chiropractics and continues to have pain in her shoulder that is severe enough that it wakes her up at night. Dr. Clayton then referred the Claimant to his medical partner, Dr. T. Zimmerman for consideration of a subacromial decompression and distal clavicle excision. On May 17, 2024, Claimant was seen by Dr. T. Zimmerman. Dr. Zimmerman reviewed Claimant’s MRI and noted “right shoulder demonstrates tendinosis of the supraspinatus tendon, degenerative changes of the AC joint, and a little bit of fluid in the long head of the biceps tendon sheath.” Dr. Zimmerman concurred with Dr. Clayton that a subacromial decompression and distal clavicle excision would be appropriate along with trigger point injections and therapeutic needling. Dr. Zimmerman then referred the Claimant to Dr. G. Jones for analysis of Claimant’s bilateral shoulder injury. Claimant was seen by Dr. Jones on May 29, 2024. Dr. Jones provided a complete narrative summary as to the Claimant’s bilateral shoulder symptomology: Symptoms began 2-1/2 years ago. She fell off a step ladder doing some painting, landed directly on her elbow, grabbed it up into the shoulder longitudinally and has had symptoms ever since then. She had two episodes when a dog jerked her shoulder. I have looked at her carefully for instability but certainly the stress that the description implies wrenched her shoulder and had worsening symptoms and she states that she

ENGLEMAN - H404754 26 is having increasing trouble “pushing events” when she is moving patients out of the operating room as a part of her normal circulating room duties. Dr. Jones then reviewed the Claimant’s imaging and found: I have reviewed the 4-view shoulder x-ray series from 03/26. She has a flat acromion non- pointed coracold and normal anatomy of the glenohumeral joint. No evidence of arthritis. She has had impingement changes of the greater tuberosity and chronic AC arthropathy changes without over spur formation but definitely sclerosis and cystic changes on the clavicular and AC joint site. The MRI is likewise reviewed. There is no evidence of full-thickness cuff tear and the biceps tendon has minimal fluid along the sheath. She has some evidence of subacromial bursitis to my evaluation of the exam. There is no full-thickness rotator cuff tear. Dr. Jones then recommended the Claimant for a left shoulder arthroscopic AC resection, and subacromial bursectomy surgery and provided that these surgeries were appropriate due to the “traumatic nature of the bursitis onset.” This surgery was performed on June 13, 2024. The operative report showed evidence of “dense hypertrophic bursitis” that was “clearly mechanically impinging.” As a result, Dr. Jones completed an arthroscopy with tenotomy, AC resection and a bursectomy. The Claimant’s post-operative appointment with Dr. Jones was on July 17, 2024. In his note Dr. Jones stated: Ms. Engleman is a 43-year-old nurse, who works up at Washington Regional. She is in the OR, heavy lifting. She had a fall at one point from a ladder. In my operative note, I have said it was from a vehicular accident but was from a fall from

ENGLEMAN - H404754 27 a ladder, but there were multiple other episodes [that] were actually documented, one with a pop in her shoulder and she had been sent to physical therapy and it had continued symptoms with the biceps tendon even back in that timeframe. She is an operating room nurse as with all of our patients, they are all more frequent to 300 pounds or plus and moving them, putting them on and off a bed, pushing the gurneys, etc., has become an increasingly challenging situation for almost as the particular one, who has had shoulder injury and surgery. I am a little bit confused [in] that this appears to have had clearly a work component. A diagnosis is made at work that prompted the use of physical therapy for that purpose, I think confirming this was; 1. Reported 2. Recognized 3. In my opinion, greater than 50% contribution to the problems that exist, I think she needs to pursue this in appropriate fashion and I have recommended same. Dr. Jones then took the Claimant off of work until her next post-operative appointment in October of 2024. On August 28, 2024, Claimant followed up with Dr. Jones for a wound check after her recent surgery. In this note Dr. Jones stated: I have made clear my thoughts as to it being reported, recognized and a greater than a 50% contribution to the problems that required treatment and now off-work status. Dr. Jones also stated that he was concerned as Claimant was so “anxious to get back to work” she is really “pressuring her shoulder in terms of her range of motion and recovery and even early strengthening and basically her shoulder is very inflamed with bursitis at present.”

ENGLEMAN - H404754 28 At Claimant’s follow-up appointment on October 2, 2024, Dr. Jones continued Claimant’s off-work status as a result of her recent surgery, specifically noting Claimant’s functional limitations in terms of lifting at most 5-10 pounds. These work restrictions remained in place for at least two months following the appointment. Dr. Jones wrote a letter on Claimant’s behalf on October 14, 2024, in which he stated: I am well aware that she had two other incidents, once of fall with a contusion that subsequently healed without problem. Second, a dog moving incident on a couple of occasions, but nothing that rose to the level of the nature of symptomatology with which she presented to me. Her history and physical examination at that time were consistent with injuries from a mechanical nature and were consistent with the pattern of injury that she had described. (...) It is my opinion that the nature of the injury sustained in the work incident described and detailed historically both by her and in the medical record previously making clear to me that within a reasonable degree of certainty that June 2, 2023, incident is more than 50% the cause of the injury, subsequent symptomatology and findings that led me to recommend the surgical procedure undertaken on June 13, 2024. Regardless of Claimant’s prior incidents with either shoulder, it is clear from the record that she was not seeking medical care and was able to work on a full-time basis prior to the work accident on June 2, 2023. Dr. Jones fully evaluated the Claimant’s history in the medical records and provided a

ENGLEMAN - H404754 29 credible analysis of the causation of the Claimant’s shoulder injuries, and need for medical care, including surgery. An employer takes the employee as he finds him, and employment circumstances which aggravate pre-existing conditions are compensable. Heritage Baptist Temple v. Robinson, 82 Ark. App. 460, 464, 120 S.W.3d 150, 152 (2003). An aggravation of a pre-existing, non-compensable condition by a compensable injury is, itself, compensable. Williams v. L&W Janitorial, Inc., 85 Ark. App. 1, 145 S.W.3d 383 (2004). The lack of significant medical care prior to the work accident, and the Claimant’s continued ability to work up to the work accident support Dr. Jones’s statements on these issues. The medical notes prior to the Claimant’s left shoulder surgery reveal the traumatic nature of the injury to the bursa, and the operative report confirms the treatment necessary to alleviate the impingement resulting from this injury. This finding clearly demonstrates an objective injury that Dr. Jones attributes with a reasonable degree of medical certainty to the Claimant’s work accident. The Claimant’s right shoulder became symptomatic shortly after her work accident and the diagnostic testing revealed supraspinatus tendinosis, degenerative changes of the AC joint and fluid in the tendon sheath, as well as a subtle superior displacement of the right distal clavicle. These findings demonstrate an objective injury to the right shoulder. As noted in the medical records, the

ENGLEMAN - H404754 30 Claimant also had at least two other incidents which may have affected her shoulders. However, the evidence shows that neither of those incidents resulted in significant treatment of her shoulders or inhibited her from working. As previously stated, aggravation of a pre-existing condition can result in a compensable injury. Therefore, based upon the credible evidence in the record, I find that the objective problems in the Claimant’s shoulders identified above were either caused by or made symptomatic, or both, by her work accident on June 2, 2023, and that she suffered a compensable injury to both of her shoulders as a result of this work accident. The Claimant is entitled to reasonable and necessary medical treatment for her compensable injuries including the treatment recommended by Dr. Jones. 2. The Claimant has met her burden of proof by a preponderance of the evidence that she is entitled to temporary total disability from June 13, 2024, to a date yet to be determined. Temporary total disability benefits are appropriate where the employee remains in the healing period and is totally incapacitated from earning wages. Ark. State Highway Dep’t v. Breshears, 272 Ark. 244, 613 S.W.2d 392 (1981). On June 13, 2024, Claimant underwent a glenohumeral arthroscopy with biceps tenotomy, AC resection and an extended subacromial bursectomy with Dr. Jones. Claimant had a post-operative appointment with Dr. Jones on July 17, 2024. At this time, Dr. Jones stated:

ENGLEMAN - H404754 31 Takes at least 3 months to get over her surgery such as this. If she has to return to “full unrestricted lifting activity,” she is not ready to do that and I am going to ask that she see me back in 2 months and we will consider return at that juncture depending on her surgery was 06/13/2024 on left shoulder, AC resection, biceps tenotomy, and subacromial bursectomy. Dr. Jones then wrote a letter specifically stating that the Claimant is “unable to work until seen in 2 months.” Claimant followed up with Dr. Jones on October 2, 2024. As to Claimant’s work status Dr. Jones stated: She has functional limitations in terms of lifting at most 5- to 10-pound weight limit. Unfortunately, because of the nursing activities in previous position, there is a lot of lifting requirements and the lesser sedentary one-armed position at 5- pound weight duty status, she is not yet ready for work. Dr. Jones concluded this visit by stating he will see the Claimant in two months to assess activity increase and potential return to work. The last medical record in evidence shows that the Claimant was seen by Dr. Jones on December 4, 2024. At that visit, Dr. Jones specifically noted that he is holding off on a maximum medical improvement designation as the Claimant had residual instability since the June 13, 2024, surgery. Therefore, based upon these limitations by the treating physician, I find that the Claimant has remained within her healing period and suffers a total incapacity to earn wages. Thus, making her entitled to temporary total disability benefits from June 13, 2024, to a date yet to be determined.

ENGLEMAN - H404754 32 ___________________________________ M. SCOTT WILLHITE, Commissioner