On behalf of the claimant, the following exhibits were entered into evidence without objection:
Exhibit 1 Medical records from Patients First/Dr. Modad.
Exhibit 2 Independent Medical Examination report from Dr. Shawn Berkin.
Exhibit 3 Deposition of Dr. Christopher Rothrock.
On behalf of the employer/insurer, the following exhibits were admitted into evidence without objection:
Exhibit A Medical records from Barnes-Jewish Hospital.
Exhibit B Medical record from Missouri Baptist Hospital.
Exhibit C Medical records from Dr. William Ricci.
Exhibit D Medical records from Phelps Country Regional Medical Center, Physical Therapy.
Exhibit E Medical records from Dr. James Doll.
Exhibit F Report from Dr. David King.
Exhibit G Medical records from Dr. Rothrock and Dr. James (regarding subsequent treatment).
Exhibit H Deposition for Dr. James Doll, along with CV and June 2010 report.
Note: All marks, handwritten notations, highlighting, and tabs on the exhibits were present at the time the documents were admitted into evidence.
Based on the above exhibits and the testimony presented at the hearing, I make the following findings of fact:
- Claimant was born on July 11, 1972; on the date of the hearing she was 38 years old. She lives in Steeleville, Missouri.
- On September 24, 2008, claimant was working for Chandler Exterior, a business owned by her father, Lonnie Chandler. Claimant's position with Chandler Exterior was parttime. She was also employed with Wal-Mart.
- On September 24, 2008, claimant was replacing gutters for Chandler Exterior (the employer). Claimant was working on a ladder when it "kicked out," causing her to fall with her right leg caught in the rungs of the ladder. Claimant fell five or six feet to the deck.
- Claimant was transported by ambulance to the emergency room of Missouri Baptist Hospital in Sullivan, where she complained of leg pain and x-rays revealed a right femoral fracture. ${ }^{2}$
- Claimant was transported to Barnes-Jewish Hospital for further evaluation and treatment, including additional x-rays. Claimant's chief complaints were right knee and hip pain, as well as neck pain. The records do not mention back pain at this time. ${ }^{3}$ X-rays of the right tibia and fibula revealed an intraarticular comminuted fracture of the distal femoral diaphysis with posterior angulation and displacement of the distal fracture fragment. The x-rays of the right knee revealed the comminuted femoral fracture with a large knee effusion and soft tissue swelling. X-rays of the right femur revealed the intraarticular fracture with posterior displacement of the distal fragment. X-rays of the cervical spine revealed a mild kyphosis without a discernible fracture. Lumbar spine and pelvis x-rays were normal. A CT scan of the right knee revealed a comminuted intraarticular distal femoral fracture with lipohemarthrosis.
- Claimant was admitted to the hospital, and on September 26, 2008, she underwent surgery by Dr. William Ricci for open reduction with internal fixation of the right intercondylar femoral fracture with intramedullary mailing. Postoperative x-rays of the femur, taken on September 26, 2008, revealed internal fixation of the distal femoral fractures with an intramedullary rod with proximal and distal interlocking screws.
- On November 21, 2008, physical therapy began at Phelps Country Regional Medical Center. ${ }^{4}$ Contrary to claimant's testimony at trial, the therapy notes indicate that claimant's pain complaints improved after each session. Her strength and range of motion also improved. On December 16, 2008, Dr. Ricci noted that claimant's range of motion was "quite good." ${ }^{5}$ Dr. Ricci recommended that claimant advance her weight
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[^0]: ${ }^{2}$ Employer/insurer's Exh. B.
${ }^{3}$ Employer/insurer's Exh. A.
${ }^{4}$ Employer/insurer's Exh. D.
${ }^{5}$ Employer/insurer's Exh. C.
bearing as tolerated, continue physical therapy, and he released her to return to work with crutches or a cane.
- Claimant continued with physical therapy, and on January 14, 2009, she reported that she felt like she was getting stronger. ${ }^{6}$ On January 21, 2009, claimant reported that she had no pain in her right knee prior to treatment that day and that she had no pain after treatment.
- Dr. Ricci's February 24, 2009 notes indicate that claimant complained of shooting pain from the posterior buttock extending into her thigh and calf. The pain was affecting her ability to return to work. Physical examination of claimant's knee was normal, and she had no significant tenderness over the fracture site. The doctor noted that claimant's wounds were well-healed, and there was no significant pain on range of motion of the hip and knee. Dr. Ricci indicated that he thought that claimant had developed sciatic nerve irritation and recommended that she be evaluated for her neurologic symptoms. With respect to her fracture, Dr. Ricci released claimant to full duty. ${ }^{7}$ Dr. Ricci did not recommend any additional treatment with respect to claimant's right leg or knee