Tyler Moore v. Rock Busters, Inc.

Employee appealed to the Commission alleging the ALJ erred in finding that the accident of September 21, 2005, was not the prevailing factor in causing his injury to his ACL and resulting disability and reconstructive surgery. Employee also alleged in his appeal that any injury and need for medical treatment that resulted from the January 2007 incident was a direct and natural result of the original injury. Employee argues that employer/insurer is liable for all of his unpaid medical bills from both the September 21, 2005 and January 2007 incidents, totaling $\ 46,735.24. Employee also seeks a temporary or partial award for additional temporary total disability benefits and additional medical care. Employee does not believe he has reached maximum medical improvement and, therefore, does not believe that the nature and extent of his permanent partial disability should be decided at this time.

Therefore, the issues currently before the Commission include the following: 1) causation of employee's ACL tear and resulting ACL reconstruction; 2) whether the January 2007 incident was part of a continuous chain of causation flowing from the September 21, 2005, accident; and 3) whether employee has achieved maximum medical improvement such that a final award is appropriate.

The findings of fact and stipulations of the parties were accurately recounted in the award of the administrative law judge and are incorporated and adopted by the Commission herein, to the extent they are not inconsistent with the facts listed below.

On September 21, 2005, while employee was in the course of his employment he slipped and fell approximately five feet off a backhoe, landing directly on his right leg. His right knee began to swell immediately after the injury. Employee saw Dr. Hufft, who prescribed "time healing" and physical therapy for his right knee. Dr. Hufft released employee to go back to work in December 2005.

Employee continued to have problems with his right knee and two weeks after he returned to work employee quit his job with Rock Busters, Inc. Employee began working at Lowe's in January 2006. However, his problems with his right knee had continued to get progressively worse.

On September 27, 2006, while working for Lowe's, employee got on all fours to move a product forward and when he attempted to stand up he put weight on his right leg and it collapsed, causing him to fall. Employee was not able to do his job at Lowe's and was bound to crutches until seeing Dr. Goodman in December 2006.

Dr. Goodman performed arthroscopic ACL debridement surgery on employee's right knee on January 2, 2007. Employee was prescribed crutches after his surgery.

Following a major ice storm, employee fell at his home in January 2007. On the morning following the ice storm, employee walked out of his home to determine what damage had occurred to his personal and real property. Employee testified that he wanted to check his fence because said fence contains a couple of horses employee

owns on five acres of land. Employee stated that he has trees along the fence line and he wanted to make sure that the trees had not taken the fence down.

Employee traversed around his house on crutches on a sidewalk made of flat sandstones when the crutch on his left side went out and he was forced to place weight on the right knee.

Employee went back to Dr. Goodman, told him about the January 2007 incident, and on March 5, 2007, Dr. Goodman performed an ACL reconstruction surgery on employee's right knee. Employee continued to treat with Dr. Goodman through October 2007 and saw him again on at least one occasion in 2009. However, employee still had complaints with his knee in that it started to pop and swell again.

Employee testified that he currently continues to have popping and swelling in his knee and has problems doing his prior activities such as playing basketball, softball, volleyball, water skiing and he cannot go up and down ladders. Employee also complained that he has problems driving and that after driving for long periods of time he gets "blotchy places" and bruises on his knee.

Dr. Woodward evaluated employee on August 18, 2009, and was of the opinion that employee's initial right knee injury on September 21, 2005, caused a medial meniscus tear and only a partial ACL tear. Dr. Woodward further opined that employee's slip and fall on ice while using crutches caused an additional injury and trauma to the right knee and necessitated the ACL reconstruction surgery, which was performed by Dr. Goodman on March 5, 2007.

Dr. Hufft treated employee for injuries resulting from the initial September 21, 2005, accident and saw employee for an independent medical evaluation on April 27, 2007. In his independent medical evaluation report, Dr. Hufft indicated that had he chosen to perform arthroscopic surgery on employee's right knee, following the September 21, 2005, accident, it is probable that a medial meniscus tear would have been found based upon the treatment history. As a result, Dr. Hufft stated it is his opinion that employee sustained a torn medial meniscus and partial ACL tear during the initial injury of September 21, 2005. Dr. Hufft believed the event at Lowe's was merely an episode of acute displacement of a bucket handle tear and was not a new event. Dr. Hufft stated that the partial ACL tear was healing at the time of the arthroscopic surgery on January 2, 2007, based upon Dr. Goodman's description in the medical records. Dr. Hufft further opined that the subsequent complete tear of the ACL was the result of the slip and fall on ice in January 2007 and not as a result of the initial injury.

Dr. Rogers evaluated employee on November 6, 2006, and November 17, 2009. Dr. Rogers is of the opinion that the ACL tear, which he believed was initially caused by employee's 2005 injury, still has instability after the surgery performed by Dr. Goodman on March 5, 2007. Dr. Rogers believes employee needs additional surgeries in relation to his right knee because he is unable to straighten it by 26 degrees of extension, is still walking with a limp, and has additional pain. Dr. Rogers is of the opinion that without additional surgery there will be a definite impact on employee's ability to be employed.

Dr. Rogers believes that if employee has additional treatment to his knee that it was still possible that he will need a knee replacement. Lastly, Dr. Rogers believes employee is at a greater risk to suffer arthritis than someone who never had his injuries.

With regard to the issue of causation of employee's complete ACL tear and subsequent ACL reconstruction, we agree with the ALJ in finding that the ACL reconstruction was necessitated by the aggravation of the initial injury that occurred when employee fell on the ice at his home in January 2007. This finding is supported by the expert opinions of both Drs. Woodward and Hufft and is further supported by the medical records of Dr. Goodman. As the ALJ pointed out, it is not logical that Dr. Goodman, after seeing the damage to employee's knee during the January 2, 2007, surgery, would have merely performed an ACL debridement rather than an ACL reconstruction if the ACL was completely torn at that time. Having made this causation finding, the primary issue then turns on whether the January 2007 incident was part of a continuous chain of causation flowing from the September 21, 2005, accident.

Under Missouri Workers' Compensation Law, once it is determined that an accident, arising out of and in the course of employment, is the prevailing factor in producing an injury, every natural consequence that flows from said injury is compensable as a direct and natural result of the primary original injury. Manley v. American Packing Co., 285 S.W.2d 165, 169 (Mo. 1952). Employee contends that his January 2007 fall on ice and resulting injury was a natural consequence that flowed from the September 21, 2005, injury.

The facts in Manley are very analogous to the facts in this case. In Manley, the claimant suffered a work-related knee injury. After the injury, the claimant knew his right knee would not hold him, he could not drive a car, and he had to use a cane to keep from falling. Some short time after the claimant's injury from which he suffered problems with his knee, he and his son were walking in an orchard when claimant's leg gave way, causing him to fall. The orchard where the claimant fell was level, unplowed ground, in bluegrass clover not over six or eight inches high. The fall caused claimant to have to undergo a surgical operation to repair the knee. During the surgery, the claimant suffered a pulmonary embolism which resulted in his death. Id. at 167-69.

In Manley, the Supreme Court of Missouri affirmed the Commission's award of death benefits, stating:

[The claimant's] fall in the orchard while walking on level unplowed grassland, was due to the weakened and injured knee rather than to some external force; and that the fatal embolism which followed was, in fact, the culmination of a ser