At the time of her accident, the employee, Lawana Fay Rowland, was employed as a childcare worker by Farmington Children's Home. The employee's accident occurred when she was kicked by a female resident in the lock down unit. The medical records indicate the employee was kicked in the back of her leg slightly above her left knee.
Both the employee's testimony and the medical records confirm the employee had a significant history for bilateral knee complaints and treatment. Dr. John Wagner performed a lateral release on both of the employee's knees sometime in the mid 1980's. On December 18, 2001 the employee saw Dr. Wagner with complaints of pain and swelling in her left knee. The employee advised Dr. Wagner that she had tripped over a piece of carpet at work. She told Dr. Wagner that after a few weeks, she discussed her injury with her employer, and they indicated since there was no sign of trauma, they would not accept it as a workers' compensation case. The employee did not file any claim for the 2001 incident (Employer's Exhibit 1.
Dr. Wagner's records from December 18, 2001, indicate the employee was experiencing swelling in her left knee every evening, and this had been going on for a long time. The employee also told Dr. Wagner that she had previously been advised that she had evidence of osteoarthritis. An MRI taken on November 7, 2001 showed scelerosis of the medial tibial plateau. Dr. Wagner concluded that the employee had chondromalaciathat "may have been triggered a bit by her incident at work, and then will resolve". Dr. Wagner prescribed Naprosyn, and scheduled the employee for a two-month follow up (Employer's Exhibit 1).
Prior to her return visit with Dr. Wagner, the employee had her accident on February 5, 2002, that is the subject of this claim. Following the kicking incident, the employee emphasized that this time, she reported her accident.
The employer initially authorized treatment with Nurse Practitioner Susan Nesbit and Dr. Edward Dumontier at the Parkland Health Clinic in Farmington. The medical records from Parkland Health Clinic dated February 8, 2002 indicated that the employee gave a history of being kicked in the knee, and complained of "continued edema and pain of knee" (Employer's Exhibit 4).
The employee told Nurse Nesbit about her October accident in which she had tripped on the carpet, but stated that "overall she was starting to do better until the recent episode" (Employer's Exhibit 4). The employee also reported that she had tried someone else's Vioxx, and it worked better than Naprosyn. The employee was diagnosed as having a left knee contusion and treated with a knee immobilizer and a prescription for Vioxx. The employee was allowed to return to work, but was advised not to work in the lock down unit. (Employer's Exhibit 4).
In a follow up visit on February 15, 2002, the employee stated she was feeling better. Nurse Nesbit encouraged the employee to attend her physical therapy sessions, and recommended that she continue to use the immobilizer and Vioxx (Employer's Exhibit 4).
Records from Farmington Sports and Rehabilitation Center indicate the employee had physical therapy for her left knee on February 18, 2002, February 28, 2002 and March 7, 2002. The employee was then referred to Dr. William Harris, who is an orthopedic surgeon in Farmington Missouri. Dr. Harris treated the employee conservatively for several months prior to recommending surgery. During this time the employee continued to complain of pain and swelling in her left knee. Dr. Harris diagnosed the employee has having chondromalicia and synovitis of the left knee (Employer's Exhibit 6and 7).
The operative report dated August 26, 2002 indicates a post-operative diagnosis of grade IV chondromalicia changes of the femoral groove and medial tibial plateau with grade III chondromalicia changes of the under surface of the a patella with anterior patellofemoral synovitis with interarticular loose body (Employer's Exhibit 7). Dr. Harris' medical record of August 27, 2002 notes the employee had grade IV osteoarthritic changes and erosion down to the bone of the tibial plateau. Although the employee had synovitis, she did not have a meniscus tear (Employer's Exhibit 6).
After her surgery, the employee continued to see Dr. Harris on a periodic basis until April 8, 2003. During this time period, the employee continued to complain of pain and swelling in her left knee. Dr. Harris recommended a series of synvisc injections, but the employee showed only limited improvement (Employer's Exhibit 6).
On April 10, 2003, the employee was examined by Dr. Richard Rende, who is an orthopedic surgeon in St. Louis Missouri. Based on his examination and the x-rays taken of the employee's left knee, Dr. Rende concluded that the employee was suffering from "advanced degenerative arthritis with bone against bone in the medial joint space and significant narrowing of the patellofemoral joint space (Employer's Exhibit 8). Dr. Rende felt that the employee's degenerative arthritis was "of long standing duration". Although Dr. Rende agreed that the employee needed a knee replacement, he did not feel her need for a knee replacement was "in any way work related" (Employer's Exhibit 8). He added "it is my opinion that any aggravation of it by this kick clearly has come and gone, and I believe she is at her maximum medical improvement" (Employer's Exhibit 8). Dr. Rende gave the employee several permanent restrictions, but did not believe her restrictions "were the result of an on the job injury" (Employer's Exhibit 8).
During Dr. Rende's deposition testimony, he restated his conclusion that the employee's current complaints were caused by her osteoarthritis (Employer's Exhibit 9, page 6) and confirmed that he did not believe that her February 5, 2002 work incident was a substantial factor in causing the employee's need for a total knee replacement (Employer's Exhibit 9, page 7). Dr. Rende also noted that during the arthroscopic surgery there were no signs that she had suffered any acute damage or abnormality as a result if her February 2002 work incident (Employer's Exhibit 9 page 10). He then repeated that the reason the employee needed a total knee replacement was her grade IV bone on bone chondromalicia (Employer's Exhibit 9, page 11).
To counter the opinion of Dr. Rende, the employee offered a medical report and a deposition of Dr. Shawn Berkin. Dr. Berkin examined the employee on January 15, 2004. Based on his examination of the employee and his review of certain medical records, Dr. Berkin diagnosed the employee as having a left knee strain and chondromalicia (Deposition Exhibit 2, Employee's Exhibit A). Dr. Berkin further concluded that the employee's February 5, 2002 accident was a substantial factor in causing her left knee strain and an aggravation of her preexisting chondromalicia and degenerative arthritis. Dr. Berkin agreed that the employee needed a total knee replacement, and felt that it was the February 5, 2002 accident that "has now required her to consider surgery for a total knee replacement" (Deposition Exhibit 1, Employee's Exhibit A).
In addition to his views on causation, Dr. Berkin also concluded that the employee had a 50\% partial disability to her left knee that was caused by her accident at work. He then assigned an additional 20\% permanent partial disability to her left knee for pre-existing conditions (Deposition Exhibit 2, Employee's Exhibit A).
During cross examination by the employer's attorney, Dr. Berkin agreed that he had only reviewed limited medical records (Employee's Exhibit A, Page 7). He also agreed that, at the time of her surgeries, the employee was found to have grade III and grade IV chondromalicia. Dr. Berkin further admitted that the employee's history was that she had been kicked on the posterior surface of her knee, and the surgery revealed no evidence of damage to the meniscus or ligaments (Employee's Exhibit A, page 9).
At the time of the hearing, the employee noted that prior to February 5, 2002 her left knee felt "terrific", with "no symptoms whatsoever". Immediately after her accident, the employee experienced pain and swelling, and she was still having those symptoms at the time of the hearing. As a result of those symptoms, the employee experiences problems at work, and has to limit her activities at home. The employee also has to restrict her participation in certain recreational activities.
At the conclusion of the hearing the employee requested an award requiring the employer to provide additional medical treatment. The employee believes she needs a total knee replacement, and feels that the employer should be responsible for that surgery.
Neither the employee's attorney nor the employer's attorney requested leave to file briefs on the disputed issues. After a post hearing discussion, the parties expressed an interest in trying to settle the claim, and the administrative law judge agreed to postpone writing the award for 30 days. As of September 30, 2005, however, no further communication has been received regarding a possible settlement.