Based on the substantial and competent evidence of record, including the relevant medical records, documents, Claimant's testimony, and the testimony of other witnesses, I make the following findings of fact:
Claimant is a married 57-year-old man who last worked in January 2006, and retired effective March 2006, after 27.6 years of employment with Employer or its predecessors. Claimant worked 5 or 6 days per week, up to 10 or 12 hours per day. As a sheet metal and bonding mechanic, Claimant had a physical job which involved standing on concrete and climbing on platforms. He performed drilling, riveting and assembling or aircraft parts, usually standing at a table within a 200 square foot area. A few times a week he climbed 15 to 20 steps to the office or cafeteria. Once or twice a week Claimant had to walk to the other side of the building to get a tool or part, although in the past that occurred much more often. He sat during breaks, and his safety shoes had a "cush insole" that made him feel as if he was "walking on air."
In 1979, Claimant fell of a hay truck, injured his left knee, and underwent surgery to repair damaged ligaments. He had a good recovery, and testified credibly he did not have further problems until 2002. Claimant was diagnosed with diabetes the early 2000's, and claimed it was under control until he had surgery in 2005. Now, he occasionally takes diabetes medicine.
In 2002, Claimant began to have problems in his knee and back, which he attributed the to years of climbing in and out of airplanes, up ladders, and being on his feet while engaging in work for Employer. On June 11, 2002, Claimant told Dr. Moore, his primary care doctor, he hurt his left knee while deep sea fishing, and the exam showed fullness. On July 18, 2002, Claimant presented to Dr. William K. Harris with a history of left knee pain and low back pain. The MRI ordered by Dr. Harris showed "some significant chondromalacia changes and osteochondral defect of lateral tibial plateau, degenerative changes of the lateral medial meniscus." The lumbar spine had degenerative changes at L4-5, and L5-S1 with spinal/nerve root canal stenosis and disc protrusion at L5-S1. Claimant had left knee complaints throughout 2003, but did not make back complaints after the initial visit.
Although he recommended the procedure in 2002, Dr. Harris performed a therapeutic arthroscopy with chondroplasty and synovectomy on January 7, 2004, for significant osteoarthric changes throughout the knee. Claimant returned to full time work as of February 14, 2004. In May 2004, Claimant experienced an increase in symptoms, and sought care several times at the emergency room. As of June 2004, Dr. Harris offered the option of a total knee arthroplasty replacement. At his deposition, Dr. Harris offered the opinion the work activities were not a substantial factor in causing the condition, but agreed the work could aggravate a degenerative condition.
On June 18, 2004, Claimant saw orthopedic surgeon Craig Ruble, who noted Claimant had a valgus deformity, crepitus, tenderness and limited range of motion of the left knee. Dr. Ruble noted it "is entirely possible" standing on concrete at work could have "significantly contributed to his knee degenerative changes," but his prior surgery "would predispose him to degenerative changes as well." Dr. Ruble recommended Vioxx, ice, and physical therapy.
On May 27, 2004, Claimant was working when he got a catch in his back and felt something snap. This event is the basis of the claim in Injury No. 04-062038. He testified he could not move for a few minutes, but when he did move he felt pain. He left work and saw his own doctor, who diagnosed a "pinched nerve." About a week later, Employer sent Claimant to Concentra and Dr. Suthar, which was the extent of the authorized treatment. He did receive treatment on his own from Dr. Albana, including an MRI and several epidural shots. On August 20, 2004, Claimant had a recurrence of back pain. He could not recall exactly what happened, whether he was bending over or doing something of that sort, but he felt pain. This event is the basis of the claim in Injury No. 04-089871. Claimant ultimately underwent a lumbar fusion on February 25, 2005, and a duraplasty soon thereafter to repair a dural leak. For over one year, Claimant followed up with Dr. Albana, who reported Claimant had pain relief from surgery, but was left with problematic paresthesias and was unable to work. Claimant was off work from February to October 2005 following surgery. He tried to work in the Fall and Winter of 2005, but ultimately stopped working in January 2006 due to post-surgical back pain and swelling.
Currently Claimant's left knee gets swollen and is painful. He cannot do a lot of bending, walking or standing due to his back, and must lay down for two or three hours a day to deal with his pain. He takes up to three pain pills a day to control his symptoms.
Dr. Christopher Kostman is an orthopedic surgeon who specializes in joint surgery of the extremities. He evaluated Claimant, took a history consistent with the evidence at hearing, and testified on Employer's behalf. His exam was positive for mild effusion, tenderness, and a genu valgum deformity (knock-knee) of the left knee. Dr. Kostman diagnosed unilateral advanced degenerative arthritis of the lateral compartment of the left knee, or "posttraumatic arthritis." On the issue of causation, Dr. Kostman offered a credible explanation of why work was not a substantial factor in causing Claimant's condition. Given the common finding of medial compartment arthritis in the uninvolved right knee, the existence of arthritis in the lateral compartment of the left knee indicates the trauma necessitating the prior surgical intervention to the lateral compartment is a substantial factor in developing that condition. In his experience, Dr. Kostman has seen many patients develop the insidious onset of pain well after a trauma. Dr. Kostman felt one's daily activity level can affect the symptoms of arthritis, but did n