Clifford Conrad v. Jack Cooper Transport

1. Employee incurred a work-related injury to his left knee on April 30, 2004. An MRI indicated a medial meniscal tear as well as chondromalacia of the patella. Employee underwent surgery on his left knee on June 28, 2004, performed by Dr. Jones. Employee was released to full duty without restrictions on August 17, 2004. At that point, Dr. Jones opined employee was not in need of any further medical or surgical treatment. In the March 7, 2005 office visit, Dr. Jones noted that employee experienced pain and swelling in his left knee which was consistent with articular cartilage wear and the fact that he had a medial resection done. Employee was treated conservatively with medication.

In a letter dated August 16, 2005, Dr. Jones stated the following:

[Employee] presented to my office with continued medial joint line pain and patellofemoral pain. This represented articular wear, which was noted at the time of arthroscopy. . . Although I originally felt this was pre-existing disease, with persistent pain that was not resolved with arthroscopic debridement, I added this to his rating. I therefore believe his overall rating, as reflected by my letter on July 25, 2006, adds 10 percent to his previous rating. I therefore believe his overall permanent-partial impairment is the previous 12 percent, and an additional 10 percent. This reflects his ongoing persistent knee pain, the fact that he had considerable chondral wear although it predated his injury, appears to have been significantly aggravated by his injury.

I do think he had considerable chondral wear. He would be a candidate to consider a hyaluronic acid product, and at some day in the future, likely will need a total knee replacement.

It appears from the history that his injury did aggravate his underlying disease process enough to consider this part of his claim. (Tr. 44).

In a subsequent letter dated January 30, 2007, Dr. Jones made the following conclusions:

I do believe in a 51-year-old male the amount of articular disease that [employee] presented at the time of surgery that at some point in the future he will obviously require a total knee replacement. However, I do not believe his original injury was the source of his articular wear.

A total knee in the future would definitely be primarily caused by the chronic wear, not the acute injury. The injury although it may have aggravated to some degree [employee's] articular patellofemoral pain, again was not the primary source for the eventual need for a total knee replacement.

The primary reason for a total knee replacement will definitely in my opinion the pre-existing wear that was present at the time of arthroscopy. (Tr. 45).

In a letter dated March 15, 2007, Dr. Jones reiterated his opinion stating:

[T]he April 30, 2004, accident that Mr. Conrad had resulted in a primary meniscal tear. It was not the substantial contributing factor that would require him to undergo a total knee replacement in the future. (Tr. 46).

In cases involving the award of future medical benefits, the medical care must flow from the accident before the employer is to be held responsible. Landers v. Chrysler Corp., 963 S.W.2d 275, 283 (Mo.App. E.D. 1997). Employee has the burden of proving that future medical care and treatment is reasonably required to cure and relieve him from the effects of the work injury. Section 287.140.1 RSMo (2000); Bowers v. Highland Dairy Company, 132 S.W.3d 260, 266 (Mo.App. S.D. 2004). The need for future medical care need not be established as a certainty, but it must be established as being reasonably probable through competent medical testimony. Bowers, 132 S.W.3d at 270.

Dr. Jones was the treating surgeon and only medical expert to provide an opinion with regard to employee's need for additional medical care and treatment. The medical record when read in totality clearly indicates that future medical treatment is not warranted as a result of employee's work injury. The opinion of Dr. Jones establishes that employee will not require additional medical care to cure and relieve him from the effects of his April 30, 2004 work injury. Dr. Jones states definitively that employee's need for ongoing care and treatment was due to the preexisting underlying degenerative condition of employee's left knee and not his work-related injury. Dr. Jones opined that given the amount of articular disease present at the time of employee's arthroscopy in 2004, employee would at some point in the future need a total knee replacement. Therefore, it is likely that employee would have needed the total knee replacement regardless of whether he incurred the injury at work.

Dr. Jones opined that employee's underlying condition was aggravated by the work injury and that he suffered a 10\% permanent partial impairment at the level of the knee due to his articular disease and persistent pain; however, that does not mean future medical treatment based on the deterioration of that underlying condition is employer's responsibility. Employee must show that the treatment is reasonably necessary to cure and relieve him from effects of his work injury; and it is clear that any additional treatment, including a total knee replacement, is necessary to cure and relieve employee from the effects of his underlying degenerative condition, not his work injury. Therefore, employee has not met the reasonably probable standard required for an award of future medical treatment in this case.

The Commission concludes that the competent and substantial evidence supports a finding that employee has failed to show that future medical care and treatment is necessary to cure and relieve him from the effects of his injury, and this benefit is not awarded. As stated above, all remaining findings of fact and conclusions of law are affirmed.

The Commission further approves and affirms the administrative law judge's allowance of attorney's fee herein as being fair and reasonable.

Given at Jefferson City, State of Missouri, this $\qquad 8^{\text {th }}$ day of February 2008.

LABOR AND INDUSTRIAL RELATIONS COMMISSION

William F. Ringer, Chairman

Alice A. Bartlett, Member

DISSENTING OPINION FILED

John J. Hickey, Member

Attest:

Secretary

After a review of the entire record as a whole, and consideration of the relevant provisions of the Missouri Workers' Compensation Law, I believe the award and decision of the administrative law judge should be affirmed. The award of the administrative law judge is well written, well reasoned, and well supported.

I agree with the majority of the Commission that employee is entitled to compensation in this claim. However, I disagree with the conclusion that employee is not entitled to an award of future medical care and treatment. The administrative law judge found that the medical evidence was sufficient to show a reasonable probability that