CLAIM NO. E707361
Before the Arkansas Workers’ Compensation Commission
OPINION FILED JULY 6, 1998
Upon review before the FULL COMMISSION in Little Rock, Pulaski County, Arkansas.
Claimant represented by the HONORABLE SHANNON MUSE CARROLL, Attorney at Law, Hot Springs, Arkansas.
Respondents represented by the HONORABLE CAROL LOCKARD WORLEY, Attorneys at Law, Little Rock, Arkansas.
Decision of Administrative Law Judge: Affirmed.
[1] OPINION AND ORDER[2] The claimant appeals the opinion of an administrative law judge filed January 22, 1998. The administrative law judge found that the claimant did not prove that she sustained a compensable injury on July 13, 1996; that relative to treatment commencing February 28, 1997 and following, the claimant did not prove that she sustained a compensable injury; and that the claimant failed to report an injury as required by Ark. Code Ann. § 11-9-701. We have reviewed the entire record de novo. We find that the claimant failed to prove by a preponderance of the evidence that she is entitled to any benefits in excess of those benefits paid by the respondents through October 22, 1996. On that basis, we find that the administrative law judge’s decision must be affirmed. [3] The claimant contends that she sustained a compensable injury to her left knee on or about July 13, 1996. While the claimant was unloading a cart for the respondent-employer, she hurt her knee while turning around to pick up a tray: “when I turned it felt like it popped out.” An x-ray of the claimant’s left knee was taken on July 15, 1996 and interpreted by Dr. Robert Fore:
[4] Dr. Fore’s impression was no acute findings of the left knee, suspected chronic change and perhaps evidence of an old injury affecting the anterior tibial spine. An ER physician diagnosed “strained knee” and prescribed a bulky dressing and Advil. The respondents began payment of medical benefits. On July 30, 1996, after continuing complaints of pain, the claimant was given a knee immobilizer and crutches. Dr. Robert Olive, an orthopaedist, also examined the claimant. Dr. Olive diagnosed left knee sprain and began a course of conservative treatment which included physical therapy. By September, 1996, the physical therapist commented that the claimant was pain-free except with maximal effort. On October 22, 1996, Dr. Olive released the claimant from further treatment:Two views show no fractures or dislocations. There is no evidence of joint effusion. There is a 4mm projection of bone off of the anterior tibial spine, seen on both AP and lateral views.
This has smooth margins and does not appear to represent an acute fracture but may be due to old injury or other degenerative change. I do not believe this represents a loose body.
[5] The respondents discontinued paying medical benefits at this time. In the present claim, the claimant seeks benefits for knee problems she experienced approximately three months after Dr. Olive determined that the claimant’s work-related knee strain had resolved. [6] In this regard, on February 28, 1997, the claimant returned to Dr. Olive for knee problems. Dr. Olive reported that the claimant “apparently restrained” her knee, and he diagnosed a “possible meniscal injury.” The claimant did not see Dr. Olive again until April 21, 1997, when Dr. Olive reported:Willa comes in today for f/u. Overall, I think that she is doing well. She has only occasional discomfort with weather changes. On examination, she has full range of motion of the knee. There is no pain to palpation of the joint line or stressing of the medial or lateral collateral ligaments. The cruciate ligaments are intact.
There is no other pain. At this time, I feel that she has reached maximum medical improvement. I see no reason to follow up further. We will see her back on an as needed basis. Diagnosis is left knee strain resolved in nature.
[7] Dr. Olive reexamined the claimant’s left knee on July 24, 1997. Dr. Olive’s impression was probable medial meniscal tear vs. severe chondromalacia, for which he performed arthroscopy and debridement. In October, 1997 correspondence to claimant’s counsel, Dr. Olive stated, “I do feel that Mrs. Sanders’ reinjury to her knee was simply an exacerbation of a previously existing condition.” Dr. John Yocum, an orthopedist, presented the respondents with the following report in November, 1997:She is having problems now with her left foot. In trying to protect her left knee when she walks, she unfortunately has been walking somewhat awkwardly with her left foot. She apparently has been walking on the side just a little bit and as a result has suffered a non displaced fracture of the 5th metatarsal. X-rays do show a non displaced fracture seen on both AP and lateral views. . . . Diagnosis is probable medial meniscal tear of left knee and metatarsal fracture of left 5th metatarsal.
I reviewed the medical records regarding Ms. Sanders’ injuries and subsequent treatment. It appears that Ms. Sanders claimed a knee injury in July, 1996, and subsequently underwent rehabilitation as well as medical treatment. Ms. Sanders apparently returned to work in October, 1996 relatively asymptomatic.
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It is my opinion that the type pathology observed intra operatively is not one that is typically associated with a traumatic event but rather of a degenerative nature. This type of cartilage damage may be brought into disabling reality by a traumatic event or increased activity, however. Ms. Sanders apparently enjoyed a several month interval of symptom-free function of the knee following the initial injury and rehabilitation.
I would think it most likely that a recurrence of symptoms following this symptom-free interval would most likely result from a period of increased activity or perhaps a second injury that aggravated her pre-existing chondromalacia.
On December 15, 1997, Dr. Olive wrote:
I have read Dr. Yocum’s medical report. Although Dr. Yocum is a very capable and knowledgeable surgeon, I think everyone seems to be fixated on the intraarticular findings.
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[8] After reviewing the alternative opinions of Dr. Yocum and Dr. Olive, Dr. Olive’s office records and all other evidence in the record, we find that the greater weight of the evidence in the record establishes that the claimant experienced, at most, a temporary work-related knee strain injury which resolved by October 22, 1996. In reaching that conclusion, we note that, after a period of conservative care and physical therapy, Dr. Olive indicated that the claimant’s knee strain had resolved by October 22, 1996. Dr. Olive later reported that the claimant re-strained her knee. To the extent that Dr. Olive’s December 15, 1997 letter suggests that the claimant “re-injured” her knee at work a second time, we see no basis to reach that finding on this record. To the contrary, the claimant argues that her knee symptoms in February of 1997 were causally related to the incident on July 13, 1996. In light of the evidence that Dr. Olive indicated that the claimant’s work-related knee strain resolved in October of 1996, the fact that the claimant arthroscopy did notAgain, I guess the major question is whether or not Ms. Sanders’ injuries were totally related to her knee pain. I do feel that there was most likely some chondromalacia present prior to the initial injury. However, she was not painful at that time. She developed pain only after her at-work injury. She then experienced a pain-free interval, brought on hopefully by physical therapy and anti-inflammatory medications. She again reinjured her knee at work, and again, suffered significant pain.
indicate a medial meniscus tear injury, and Dr. Yocum’s opinion that the pathology was not one typically associated with a traumatic event, we find that the work-related symptomatology and strain injury resolved by October 22, 1996. [9] We thus affirm the administrative law judge’s decision denying additional workers’ compensation benefits. Our decision renders moot the respondents’ alternative contentions that the claimant failed to prove a compensable injury in July, 1996, and that the claimant failed to report an injury as required by Ark. Code Ann. § 11-9-701 (Repl. 1997). [10] IT IS SO ORDERED.
ELDON F. COFFMAN, Chairman MIKE WILSON, Commissioner
[11] Commissioner Humphrey dissents.