WRIGHT STEEL & MACHINE, INC., AND SECURITY NATIONAL INSURANCE COMPANY APPELLANTS
JAMES D. HEIMER APPELLEE
FROM THE ARKANSAS WORKERS' COMPENSATION COMMISSION [NO.
Law Firm, P.A., by: William C. Frye, for appellants.
& Brooks, P.A., by: Evelyn E. Brooks, for appellee.
MARK KLAPPENBACH, JUDGE.
Wright Steel & Machine, Inc., and Security National
Insurance Company appeal from the decision of the Arkansas
Workers' Compensation Commission (Commission) finding
that appellee James Heimer had proved entitlement to
additional medical treatment in the form of back surgery.
Appellants argue that the Commission's decision is not
supported by substantial evidence. We affirm.
began working for Wright Steel & Machine, Inc., in 2005
as a welder/fabricator. He said that his job required heavy
lifting on a daily basis of an average of 50 to 100 pounds.
Although the injury at issue here occurred in 2015,
Heimer's medical records reflected a history of back pain
dating back to at least 2009. In December 2009, Heimer saw
his family physician for low back pain and numbness going
down his left leg. He was referred to another doctor and
received injections. Heimer eventually had surgery on both
his neck and low back in 2012. He was off work for a few
months to recover after his surgeries. Medical records from
October 2012 showed that Heimer was doing "quite
well" after his back surgery, that he had no significant
leg pain remaining, that he had met all of his
physical-therapy goals, and that he was released to full
activity. Heimer said that he returned to his regular duties
but started getting sore again about a year after surgery. He
had what he called "normal aches and pains" in his
back due to the heavy lifting and pain in his hip and thigh.
He had prescriptions for pain medications for his low back
and neck but said that he took them only when needed, which
was not every day. He acknowledged having to miss work on
occasion due to his pain. Medical records showed that he was
seen by three doctors in 2014 for neck pain, back pain, and
joint pain. Before his May 2015 injury, the last complaint of
back pain in his medical records was from December 2014.
Wright, one of the owners of Wright Steel & Machine,
Inc., testified that Heimer seemed to do well immediately
following his 2012 back surgery but later suffered a decline
in his well-being and productivity. Wright said that it was
obvious Heimer was in pain, that his pain medication affected
his work, and that Heimer sometimes decided to go home due to
the pain. Wright said that Heimer worked up until the May
2015 injury but he had missed a considerable amount of work.
testified that on May 6, 2015, after lifting heavy steel, he
"went down" and experienced pain like never before.
The pain was in his lower back, radiating down his left leg
to his foot. He said that before this injury, he had pain in
his thigh and around his hip, but he had not had this kind of
leg pain and numbness into his foot since his 2012 surgery.
Heimer reported his injury and saw a doctor the next day. He
eventually had injections and two rounds of physical therapy
but obtained no lasting relief. Heimer testified that he
could no longer perform his job or activities like using a
2015, Heimer was referred to Dr. Cathey for an independent
medical evaluation. After examining Heimer and reviewing an
MRI from June 2015, Dr. Cathey opined that Heimer was not a
candidate for additional spinal surgery or other
neurosurgical intervention. Dr. Cathey believed that Heimer
had chronic degenerative lumbar disc disease and would likely
suffer acute exacerbations in the future, but he was at
maximum medical improvement with regard to the May injury.
Heimer's condition did not improve, and he received a
change of physician to Dr. Blankenship. Dr. Blankenship
examined Heimer in November 2015 and noted his complaints of
low back pain that radiated to his left hip, buttock, and
groin and pain and numbness down his left leg to his foot.
Dr. Blankenship informed Heimer that he disagreed with Dr.
Cathey and believed that surgery, specifically an anterior
lumbar interbody arthrodesis at the lumbosacrum, had a good
chance of affording him relief. If Heimer elected to do the
surgery at the L5-S1 level, Dr. Blankenship also recommended
doing surgery at the L4-L5 level.
deposition, Dr. Cathey testified that there were different
schools of thought regarding whether the surgery offered by
Dr. Blankenship would alleviate any pain for a patient like
Heimer, but Dr. Cathey did not believe it would. Furthermore,
he testified that the proposed surgery would address
preexisting degenerative operative changes in Heimer's
lower back, not his occupational injury. Dr. Cathey saw no
objective findings of an acute injury that had taken place in
May 2015 and noted that Heimer's preinjury medications
indicated that he had not been doing well before May 2015.
Blankenship testified in his deposition that he examined
Heimer, took x-rays, and read the report of the June 2015
MRI. Dr. Blankenship said that Heimer had indicated to him
that his 2012 back surgery had addressed pain in his right
leg, not his left leg; Dr. Blankenship did not have the
operative note when he saw Heimer. Dr. Blankenship was unaware
that Heimer had seen doctors as far back as 2009 with
left-leg pain complaints similar to what he presented to Dr.
Blankenship. He did not know how long Heimer had been on pain
medication, but he did not consider the pain medicine Heimer
was taking to be an extensive amount. He said that patients
who are stable and manage their pain on medication can be
considered to be doing well. Dr. Blankenship said that he
still would have offered the surgery if he had known these
things when he evaluated Heimer.
questioned by appellants' attorney regarding whether
Heimer's condition was new or preexisting, Dr.
Blankenship said that based on the new information about
Heimer's prior left-leg pain, it would be difficult to
state "when did it actually occur" without having
the benefit of talking with the patient. Dr. Blankenship
noted that there was an indication in Heimer's 2015 MRI
that there had been some worsening and that he had annular
fissuring, which was a tear in the lining around the disc
space, but he did not have the older MRI to compare it to.
Dr. Blankenship said that with the newer information, it was
difficult to state whether the annular fissuring was related
to the incident. He said that the fact that Heimer was not
pain free before the injury did not preclude the fact that
his injury may be the reason he needed treatment, but it
clouded the issue significantly to the point he could not say
one way or the other.
examination by Heimer's attorney, Dr. Blankenship agreed
that the June 2015 MRI showed an annular tear, which could
have been caused by trauma, and that the radiologist who read
the MRI opined that Heimer's moderate bilateral neural
foraminal narrowing had worsened. Heimer's attorney then
asked Dr. Blankenship for a conclusion about the May 2015
injury based on the history of Heimer's returning to work
after recovering from his 2012 surgery and doing heavy
lifting from 50 to 120 pounds on occasion. Dr. Blankenship
there's not much doubt in my mind that the
gentleman's need for further treatment occurred as a
result of that injury because, as Dr. Ceola had ...