CLAIM NO. E316449
Before the Arkansas Workers’ Compensation Commission
OPINION FILED DECEMBER 29, 1997
Upon review before the FULL COMMISSION in Little Rock, Pulaski County, Arkansas.
Claimant represented by the HONORABLE SHEILA F. CAMPBELL, Attorney at Law, Little Rock, Arkansas.
Respondents represented by the HONORABLE BETTY J. DEMORY, Attorney at Law, Little Rock, Arkansas.
Decision of Administrative Law Judge: Reversed.
[1] OPINION AND ORDER
[2] The respondents appeal an opinion and order filed by the administrative law judge on January 30, 1997. In that opinion and order, the administrative law judge found that the claimant sustained an injury arising out of and in the course of his employment on June 16, 1993. In addition, the administrative law judge found that arthroscopic surgery recommended by Dr. James Mulhollan is reasonably necessary and related to the treatment of the claimant’s June 16, 1993, compensable injury. After conducting a de novo review of the entire record, we find that the claimant sustained at most a temporary aggravation to a preexisting knee condition and we find that the claimant’s work-related aggravation resolved prior to January of 1996. Therefore, we find that the claimant failed to prove by a preponderance of the evidence that the arthroscopy proposed by Dr. Mulhollan on or after January 26, 1996, was reasonably necessary for the claimant’s work-related injury. Therefore, we find that the decision of the administrative law judge must be reversed.
[5] The medical record indicates that the claimant presented to the UAMS Emergency Room on May 20, 1993, with complaints of left shoulder pain, low back pain, and “tendonitis” in the left knee. The claimant subsequently received an orthopedic referral to Dr. Rex M. Easter on June 18, 1993. Notably, Dr. Easter recorded an injury date of June 16, 1993, although the claimant’s testimony is centered around an injury date of May 17, 1993. [6] Dr. Easter’s physical examination and diagnostic testing was not indicative of any abrasions or lacerations to the claimant’s knee or of any abnormality by diagnostic testing although Dr. Easter did observe tenderness and swelling overlying the patella tendon area. The claimant next sought treatment from Dr. Harold Betton on October 20, 1993, who subsequently referred the claimant to Dr. James Mulhollan, a Little Rock orthopedic surgeon, for a second opinion. Dr. Mulhollan first examined the claimant in November of 1993, and was unable to determine any abnormalities through radiographic studies. By June 16, 1994, Dr. Mulhollan was “at a loss” to explain the claimant’s ongoing difficulties. [7] On June 26, 1996, the claimant demonstrated a “palpable grate in his knee for which Dr. Mulhollan has proposed an arthroscopic procedure. The claimant contends that the palpable grate in his knee identified in January of 1996 is causally related to the his alleged work-related injury sustained in either May or June of 1993. [8] After conducting a de novo review of the entire record, we find that the claimant failed to prove by a preponderance of the evidence that the claimant’s palpable grate and proposed arthroscopic surgery for 1996 is causally related to any knee injury that he may have sustained in 1993. Moreover, we find that any knee injury the claimant sustained in 1993 was a temporary aggravation of a preexisting condition and resolved prior to January of 1996. In reaching that conclusion, we note that the claimant first experienced knee difficulties in 1988 as a result of an automobile accident, and arthroscopic surgery performed shortly thereafter did not detect any miniscal or ligamentous abnormalities but identified a plica formation, a moderation amount of adhesions, and a mild degree of synovitis. [9] The claimant sustained an additional knee injury in the Army in 1990 and received a 10% impairment as a result of this second injury sustained in the military. [10] With regard to the claimant’s 1993 incident while employed by the respondents, the claimant’s testimony and the medical record would indicate that the claimant received a blow to the knee but did not necessarily experience any type of hyperextension of the knee joint. In addition, x-rays performed after the 1993 incident were not indicative of any abnormality and the only objective finding related to the 1993 work-related injury was swelling. The claimant’s treating physician, Dr. Easter, indicated that he did not expect the work-related injury to produce any permanent residuals. [11] Likewise, a MRI of the claimant’s knee performed in July of 1993 also did not reveal any significant abnormalities. In November of 1993, Dr. James Mulhollan, the claimant’s treating knee specialist, advised the claimant that his knee condition by that date was not severe enough to interfere with his ability to work and that he should not mention the problem with his knee in seeking new employment. Dr. Mulhollan released the claimant with a note indicating that the claimant could work at that time in anycapacity. Dr. Mulhollan also advised the claimant at that time that he did not think that there is any other indicated care. [12] Notably, the claimant did not return to Dr. Mulhollan until June of 1994 at which time the claimant complained of a throbbing around the front of his knee and in his calf when he tried to playbasketball. In December of 1994 the claimant again returned to Dr. Mulhollan indicating that he had developed a knot on his knee with throbbing discomfort when he went jogging. When the claimant next returned in August of 1995, reporting persistent complaints, Dr. Mulholland indicated that he was not impressed enough by the claimant’s symptoms to consider a repeat intervention (i.e., an additional arthroscopy), and Dr. Mulhollan indicated that he did not believe additional diagnostic testing such as a MRI would be especially helpful. [13] In assessing the weight to be accorded the claimant’s assertion that the palpable grate observed by Dr. Mulhollan in 1996 is somehow causally related to the claimant’s 1993 incident at work, we note that Dr. Mulhollan first observed the palpable grate in the claimant’s knee on January 26, 1996 and proposed the arthroscopy at issue in this claim over two and a half years after the claimant’s work-related injury. In addition, we note that Dr. Mulhollan proposed arthroscopy at that time on the basis that “a palpable grate indicates that there is usually pathology that can be remedied with surgery.” However, we also note that Dr. Mulhollan has never opined any basis to conclude that the palpable grate observed in January of 1996 is in any way causally related to any injury sustained in 1993. Moreover, we note that the only objective medical finding of any injury sustained in 1993 was knee swelling and we note that the claimant’s equivocal testimony in this regard at the hearing would indicate that the claimant was apparently experiencing knee swelling while employed by the respondents both before and after the incident involving a metal bar. Moreover, in light of the lack of objective diagnostic findings of any abnormality in the claimant’s knee following the 1993 incident, the extremely long period of time between the date of the alleged 1993 injury, and the first indication of a palpable grate in the claimant’s knee two and a half years later, the occurrence of at least two prior disabling knee injuries which preceded the alleged work-related knee injury in 1993, the indications in the medical record that the claimant participated in jogging and basketball after the 1993 injury, the indication from the claimant’s testimony that the claimant experienced swelling both before and after the claimant’s 1993 injury, and the lack of any medical opinions suggesting how the palpable grate identified in 1996 might be causally related to the claimant’s injury in 1993, we find that the greater weight of the evidence in the record indicates that the claimant’s 1993 injury was, at most, a temporary aggravation of two prior disabling knee injuries, which resulted in swelling but which resolved long before the palpable grate was first identified in January of 1996. Therefore, for the reasons discussed herein, we find the decision of the administrative law judge must be and hereby is, reversed. [14] IT IS SO ORDERED.Yes. I came in there, and I got the list I had to go on, to pull for the hospital that I had to pull for, and while I was going down the aisles, we had like three levels where we had to get our items from, and I had to raise my forklift to the second level to get the items I needed, but the item that I needed was in the back of the pallet, so I had to climb up there and get the thing, and the pallet came from under me, and then my leg hit the iron pole at General Medical. . . I didn’t fall. My safety latch caught me, and then this other guy, Mark, who worked with me, came and unhooked me and got me down.
ELDON F. COFFMAN, Chairman
[15] Commissioner Wilson concurs. [16] Commissioner Humphrey dissents.[17] DISSENTING OPINION
[18] I must respectfully dissent from the majority opinion finding that claimant’s current knee difficulties are not causally connected to any work-related injury and that the arthroscopic surgery proposed by Dr. Mulhollan is not reasonably necessary for the treatment of any work-related condition.
(1992) (under Act 796, medical opinions must be stated “within a reasonable degree of medical certainty,” as per Ark. Code Ann. § 11-9-102(16)(B) (Repl. 1996), so that the latter portion of the rule stated in Osmose Wood Preserving is no longer available.) [20] Dr. Mulhollan expressly opined, during his deposition, that claimant’s “palpable grate” could have been caused by his injury. Admittedly, Dr. Mulhollan has also acknowledged that it might not have been, and that there is essentially no way to tell for certain. However, the possibility of a causal relationship between the two, combined with claimant’s credible testimony and persistent symptoms since May, 1993, permits us to draw a powerful inference that the knee abnormality is related to the injury in May or June of 1993. [21] I would also find that Dr. Mulhollan’s proposed arthroscopic surgery is reasonably necessary for the treatment of claimant’s ongoing work-related knee problems. In a letter of January 26, 1996, Dr. Mulhollan plainly stated that “when there is a palpable grate, there is usually pathology that can be remedied with surgery.” Such an express statement, in my opinion, is a sufficient justification to find the proposed surgery reasonably necessary. [22] Based on the above, I respectfully dissent from the majority opinion. [23] PAT WEST HUMPHREY, Commissioner