Full Opinion

Cite as 2026 Ark. App. 367 ARKANSAS COURT OF APPEALS DIVISION IV No. CV-25-580 Opinion Delivered August 19, 2026 NORTH ARKANSAS COLLEGE AND ARKANSAS PUBLIC EMPLOYEE CLAIMS APPEAL FROM THE ARKANSAS DIVISION WORKERS’ COMPENSATION APPELLANTS COMMISSION [NO. H204217] V. TERRI SPARKS APPELLEE AFFIRMED MIKE MURPHY, Judge Appellant North Arkansas College appeals the decision of the Arkansas Workers’ Compensation Commission (the Commission) finding that appellee Terri Sparks is entitled to additional medical treatment in the form of ankle surgery. On appeal, North Arkansas argues that substantial evidence does not support the Commission’s finding. We affirm. Fifty-eight-year-old Sparks worked for North Arkansas College as a test proctor. On January 12, 2022, Sparks tripped and fell on a mat as she was walking into the library. She testified that she “face-planted the glass door,” and her right ankle hurt immediately. She went to urgent care and was diagnosed with ankle pain. On February 9, she was seen at Ozark Orthopedic. The notes from that visit provide that Sparks had a right ankle sprain from the January 12 fall as well as “a pre-existing medial osteochondral lesion of the talus that underwent arthroscopic debridement and microfracture on 12/8/2020.” Sparks testified that after the 2020 surgery, she recovered and did not seek further treatment for her ankle before the January 2022 accident, though her ankle did still bother her some. Despite conservative treatment, Sparks continued to experience pain and was unable to put weight on her ankle, prompting an MRI in May 2022. Dr. Jason Pleimann, who had performed her previous ankle surgery, reviewed the MRI and concluded that it showed “significant cystic change” in the talar dome and “bony edema throughout the talus and calcaneus,” which could represent a stress reaction, an exacerbation of developing arthritis, or early avascular necrosis of the talus. Sparks still could not bear weight on her ankle in September and had another MRI. In light of those findings, Dr. Pleimann suggested surgery. That same month, North Arkansas College requested that Dr. Pleimann answer some questions regarding Sparks’s ankle injury that occurred in January 2022, including, “What pathology identified on the enclosed MRIs are considered acute 01/12/22 injury related?” Dr. Pleimann replied, “None.” North Arkansas College then sent a follow-up letter with two additional questions. Those two questions and Dr. Pleimann’s handwritten responses were as follows: [Q.] Since the proposed surgery is not considered 01/12/22 injury related, has Ms. Sparks achieved MMI as the result of the 01/12/22 work injury? If so, what date was MMI achieved? [A.] Yes. 9/12/22. [Q.] If MMI has been achieved, is there any assignment of a permanent partial physical impairment rating as the result of the 01/12/22 work injury? If so, please document the percentage of impairment and the objective finding this is based in accordance with the enclosed Arkansas Workers’ Compensation Rule 34. Please include edition, page, table, and chart number. [A.] 0% impairment rating. 2 Sparks asked for a change of physician on January 6, 2023, and it was granted. Sparks began seeing Dr. Kevin Steffen the following month. After reviewing Sparks’s MRIs and CTs from 2020 and 2022, Dr. Steffen concluded that Sparks had “posttraumatic arthritis” in her right foot and ankle. Sparks ultimately had ankle surgery on September 1, 2023. Following surgery, North Arkansas College requested that the Commission determine whether the surgical intervention performed by Dr. Steffen was reasonable and necessary medical treatment for the injury Sparks suffered at work in January 2022. The matter came for a hearing on August 21, 2024. After reviewing the evidence, the ALJ found that Sparks had suffered a compensable ankle sprain on January 12, 2022, but gave significant weight to Dr. Pleimann’s opinion in light of his prior treatment of Sparks and his performance of her 2020 ankle surgery. Relying largely on Dr. Pleimann’s opinion, the ALJ found that the MRI findings and surgery performed by Dr. Steffen were attributable to Sparks’s preexisting degenerative ankle condition—not the compensable injury. It was further of note to the ALJ that Dr. Steffen’s notes did not clearly tie Sparks’s surgical need to the January 2022 fall. Sparks appealed this finding to the full Commission. The Commission reversed, reasoning that Sparks was not required to prove that her compensable injury was the major cause of her need for additional medical treatment but only that it was “a factor” in that need. The Commission acknowledged Dr. Pleimann’s opinion that the claimant’s need for treatment and surgery were unrelated to the compensable injury but assigned that opinion “minimal weight” because the MRI performed after the work-related injury revealed a split tear of the peroneal brevis tendon that had not appeared on earlier imaging. The Commission instead credited Dr. 3 Steffen’s opinion that Sparks suffered from posttraumatic arthritis and significant bone-marrow edema causally related to the January 2022 injury. The Commission further noted that Sparks experienced improvement in her pain and mobility following surgery, concluding that the surgery performed by Dr. Steffen constituted reasonably necessary medical treatment. North Arkansas College now appeals. On appeal, it argues that substantial evidence does not support the Commission’s finding that Sparks was entitled to additional medical treatment in the form of surgery. North Arkansas College contends on appeal that the Commission arbitrarily disregarded Dr. Pleimann’s opinions regarding causation. It emphasizes that Pleimann treated Sparks both before and after the compensable injury and had also performed her 2020 ankle surgery. After reviewing Sparks’s MRIs, Pleimann expressly opined that none of the MRI findings were related to the January 2022 injury, that Sparks had reached maximum medical improvement for the compensable injury, and that she had sustained no permanent impairment as a result of the work-related accident. North Arkansas further argues that although the Commission assigned “minimal weight” to Pleimann’s opinions because later imaging revealed a split tear of the peroneal brevis tendon, Dr. Steffen never expressly opined that the surgery itself was necessitated by the January 2022 injury. Instead, according to North Arkansas, both Pleimann’s and Steffen’s records repeatedly referenced significant degenerative changes and possible avascular necrosis. The standard of review in workers’-compensation cases is well settled. On appeal, this court views the evidence in the light most favorable to the Commission’s decision and affirms the decision if it is supported by substantial evidence. Univ. of Ark. at Pine Bluff v. Hopkins, 2018 Ark. App. 578, at 4, 561 S.W.3d 781, 784. Substantial evidence exists if reasonable minds could 4 reach the Commission’s conclusion. Id. The issue is not whether the appellate court might have reached a different result from the Commission but whether reasonable minds could reach the result found by the Commission; if so, the appellate court must affirm. Id. Pursuant to Arkansas Code Annotated section 11-9-508(a) (Repl. 2025), employers are required to provide medical services that are reasonably necessary in connection with the injury received by an employee. Claimants have the burden of proving that treatment is reasonably necessary by a preponderance of the evidence, and what constitutes reasonably necessary treatment is a question of fact for the Commission. St. Edward Mercy Med. Ctr. v. Chrisman, 2012 Ark. App. 475, at 9, 422 S.W.3d 171, 176. Where treatment is for other conditions not causally related to the compensable injury, such treatment is not the responsibility of the employer. Id. The Commission may not arbitrarily disregard evidence, but it is the ultimate arbiter of weight and credibility. Unimin Corp. v. Duncan, 2010 Ark. App. 119. Likewise, the Commission has the authority to accept or reject medical opinions, and its resolution of conflicting medical evidence has the force and effect of a jury verdict. Chrisman, supra. Here, the Commission did not arbitrarily disregard Dr. Pleimann’s opinion. Instead it acknowledged Dr. Pleimann’s opinion and weighed it against the other evidence in the file. That other evidence included imaging taken after the fall that showed a split tear of the peroneal brevis tendon that was not present in earlier imaging. It further included Dr. Steffen’s characterization of Sparks’s condition as “posttraumatic arthritis” accompanied by significant bone-marrow edema following the January 2022 injury. And it also included Sparks’s testimony that although she had undergone ankle surgery in 2020, she had recovered sufficiently to return 5 to work and was able to function before the January 2022 fall, after which her symptoms significantly worsened. Nor are we persuaded by North Arkansas’s argument that because the surgery notes do not show that Dr. Steffen repaired or otherwise treated the split tear of the peroneal brevis tendon, the surgery was therefore not causally related to the compensable injury. As the Commission explained, the compensable injury was at least “a factor” in Sparks’s need for surgery. In workers’-compensation cases involving claims for additional medical treatment, a claimant is not required to prove that the compensable injury was the major cause of the need for treatment. Rather, the claimant need only establish that the compensable injury was a factor in the need for additional treatment. See Williams v. L&W Janitorial, Inc., 85 Ark. App. 1, 145 S.W.3d 383 (2004). In Williams, the doctor testifying was under the mistaken belief that the work injury had to be the major cause of the need for surgery for it to be compensable. The doctor explained that the complicating factor in the discussion was appellant’s arthritis and that her ability to work was materially affected by the November 2000 injury on the assumption that she was able to work and now she is not. He said that “the fall was a contributing factor to her occupational disability.” This court went on to explain, however, that, in workers’-compensation law, an employer takes the employee as he finds him, and employment circumstances that aggravate preexisting conditions are compensable. Id. An aggravation of a preexisting noncompensable condition by a compensable injury is, itself, compensable. Id. An aggravation is a new injury resulting from an independent incident. Id. An aggravation, being a new injury 6 with an independent cause, must meet the definition of a compensable injury in order to establish compensability for the aggravation. Id. Consider also University of Central Arkansas v. Srite, for example. 2019 Ark. App. 511, 588 S.W.3d 849. In that case, despite evidence that the claimant had longstanding degenerative back problems and years of prior pain-management treatment, this court nevertheless affirmed an award of additional medical treatment because the Commission credited testimony and medical evidence showing that the claimant’s symptoms worsened after the compensable injury. We emphasized that the Commission relied on medical opinion, Srite’s testimony describing a different severity of pain following the injury, and records documenting worsening symptoms. Id. at 10–11, 588 S.W.3d at 856. Similarly here, the Commission relied on Dr. Steffen’s characterization of Sparks’s condition as “posttraumatic arthritis,” Sparks’s testimony that her ankle condition worsened after the January 2022 fall, and postinjury imaging showing changes not previously identified. The Commission has the authority to accept or reject medical opinions, and its resolution of conflicting medical evidence has the force and effect of a jury verdict. St. Edward Mercy Med. Ctr., 2012 Ark. App. 475, at 2–3, 422 S.W.3d at 173. On this record, even if the surgery principally addressed degenerative conditions rather than the tendon tear itself, the Commission could still conclude that the compensable injury aggravated Sparks’s preexisting ankle condition and contributed to her need for treatment. We affirm. Affirmed. KLAPPENBACH, C.J., and HARRISON, J., agree. Charles H. McLemore Jr., Public Employee Claims Division, for appellant. 7 Spencer Law Firm, by: Frederick S. “Rick” Spencer, for appellee. 8