Mr. McDaniel testified that there was no one specific incident at work that caused him to make a complaint as to his knees. Further, there is nothing in the various medical records to support the conclusion that the claimant suffered a specific traumatic event in July of 2004 or on any other particular date at work that could be interpreted as a discrete injury by accident to his knees. Claimant testified to a history of having worked as a carpenter at G.M for over 18 years, bending, stooping, crawling, and lifting on a regular basis up until his last day of work for G.M. on or about 10/04/04.
The expert medical testimony in the matter, in conjunction with claimant's history of evaluation and treatment of knee complaint, persuades that Mr. McDaniel suffers from an osteoarthritic condition that is present in both of his knees. On 8/15/01 x-ray of both knees was interpreted as follows:
"Standing frontal view of both knees demonstrate moderate to marked degenerative change within both knees. It is most pronounced within the medial femoral tibial joint space on the left and slightly worse within the lateral femorotibial joint space on the right. No acute fracture or dislocation is identified" (Medical records of Washington University Medical School, Claimant's Exhibit E). As early as 10/18/00, an x-ray of the right knee was interpreted as showing "Severe three compartment osteoarthritis of the right knee with osteocartilaginous bodies in the posterior aspect of the joint"
(Medical records of Barnes-Jewish Hospital, Claimant's Exhibit B).
The letter of Dr. Shively to Dr. Butler dated 8/15/01 (See Claimant's Exhibit E) notes, in part, as follows: "I saw Mr. McDaniel in the office today. He is a 57 year-old gentleman who complaining of both knees and his left heel. He had difficulty for a number of years. He had an open right medical meniscectomy in the late 70s. He did ok until about 1 year ago, when he had gradual onset of bilateral knee pain, worsening over time..." Dr. Shively went on to note that he found Mr. McDaniel to have severe osteoarthritis, and speculated that ultimately the claimant would need a bilateral total knee replacement.
In May of 2003 Dr. Shively treated knee complaints with intrarticular steroid injections. In May of 2004, Dr. Shively had further occasion to evaluate the claimant's knee complaints. X-ray taken on 5/20/04 was interpreted as follows:
Right knee: there is severe tricompartmental osteoarthritis of the right knee with near bone-on-bone appearance in the medial compartment. There is exuberant osteophytosis in the patellofemoral compartment, also with near bone -on -bone appearance in lateral projection. A 1 cm ossified fragment projecting posterior to the right knee may represent a loose body, but is unchanged from the prior study. There is no fracture. There is no dislocation. There is no effusion.
Left knee: There is severe tricompartmental osteoarthritis of the left knee, worst in the lateral compartment. There is no effusion. There
is no fracture or dislocation.
Impression: Stable bilateral severe tricompartmental osteoarthritis.
The earliest record of x-ray finding in the knee is by reference of Dr. Morrow to an x-ray taken of the right knee as a part of his disability evaluation dated 1/21/97 (See Claimant's Exhibit K). Dr. Morrow noted, in part, that the x-rays revealed "very thin medial joint space getting close to bone on bone..."
Both Drs. Poetz and Randolph agree that the claimant suffers from osteoarthritis that had been present for some time. Dr. Poetz further believes that the wearing thin of medial cartilage in the knees is work related (Claimant's Exhibit A, at page 15). To the contrary, Dr. Randolph opined with respect to the knees as follows:
With regard to Mr. McDaniel's knee complaints, he has severe osteoarthritis of the knees. In my opinion, these conditions are related to constitutional and hereditary factors and that work activities have not substantially aggravated or caused
these conditions. It should be also noted that he has a history of a surgery to the right
knee in the 1960s which was for a cartilage injury. And this has also contributed to the development of osteoarthritis of the right knee. (Employer and Insurer's Exhibit No 1, at page. 8)
Dr. Randolph further noted that the claimant provided him with a history of slip and fall in July of 2004 that Dr. Randolph was unable to verify through his review of the record. Note that at trial Mr. McDaniel offered no testimony with respect to a fall in July of 2004 affecting his knees, and further specifically disavowed a history of trauma to his knees as the result of a specific event.
The claimant has the burden of proving all the essential elements of the claim for compensation. It is noted that the proof as to medical causation need not be by absolute certainty, but rather by a reasonable probability. "Probable" means founded on reason and experience which inclines the mind to believe but leaves room for doubt. Tate v. Southwestern Bell Telephone Co., 715 S.W.2d 326, 329 (Mo.App. 1986).
"Medical causation, not within the common knowledge or experience, must be established by scientific or medical evidence showing the cause and effect relationship between the complained of condition and the asserted cause". Brundige v. Boehringer Ingelheim, 812 S.W. 2d 200, 202 (Mo.App. 1991); McGrath v. Satellite Sprinkler Systems, Inc., 877 S.W.2d 704, 708 (Mo.App. E.D. 1994). The ultimate importance of expert testimony is to be determined from the testimony as a whole and less than direct statements of reasonable medical certainty will be sufficient. Choate v. Lily Tulip, Inc., 809 S.W. 2d 102, 105 (Mo.App.1991).
Medical causation as to a progressive degenerative condition of the lower extremities cannot be considered uncomplicated. The commission may not substitute an administrative law judge's personal opinion on the question of medical causation for the uncontradicted testimony of a qualified medical expert. Wright v. Sports Associated, Inc., 887 S.W.2d 596, 600 (Mo banc 1994), citing Merriman v. Ben Gutman Truck Service, Inc., 392 S.W.2d 292, 297 (Mo. 1965).
"A medical expert's opinion must have in support of it reasons and facts supported by competent evidence which will give the opinion sufficient probative force to be substantial evidence." (citations omitted) Pippin v. St. Joe Minerals Corp... 799 S.W.2d 898, 904 (Mo.App. 1990).
Drs. Poetz and Randolph disagree as to a medical causal relationship between the degenerative condition suffered by the claimant in his knees and his work as a carpenter at General Motors. Claimant has the burden to prove not only a medical causal relationship, but must also prove that work was "a substantial factor in the cause of the resulting medical condition or disability", Subsection 2 of Section 287.020 RSMo.
The testimony of Dr. Randolph is found more persuasive than that of Dr. Poetz as it relates to the medical causal relationship between the claimant's degenerative and progressive knee condition and his work at General Motors. Further, there is no evidence to support the conclusion that the claimant suffered some traumatic event on or about 7/04 that would have resulted in a new injury or exacerbation of the degenerative condition of the knees at the time.
The issues as to medical causation, occupational injury, and injury by accident arising out of and in the course of employment are found in favor of the employer and insurer. The claim for compensation as against the employer and insurer is denied.
A finding in favor of the employer and insurer as to medical causation, occupational disease, and injury by accident arising out of and in the course of employment renders moot the issues as to notice, future medical care, temporary total disability, and permanent disability.