Claimant has a history of difficulties with his right knee dating back to 2006. At that time, he was diagnosed with degenerative joint disease of the medial compartment of the right knee. Dr. Henderson performed surgery involving arthroscopic partial medial meniscectomy, and chondroplasty of the medial femoral chondyle. Post operatively, Claimant continued to have significant problems with his right knee and remained off work and in physical therapy. A cortisone injection was administered on February 14, 2006, without significant relief. Claimant continued physical therapy and a total joint replacement were discussed. Rather than the knee replacement, Claimant underwent Synvisc injections on three occasions in October 2006 and was under no further medical care leading up to his work-related injury on August 23, 2007.
Claimant characterized the pain following the primary injury as worse than the pain prior to the work-related injury. Prior to the work incident on August 23, 2007, Claimant still had some pain, clicking and locking in the right knee, but was able to continue working as a floor layer up until the time of his injury on August 23, 2007. Following the August 23, 2007 work-related injury, Claimant complains of increased pain, popping and swelling in his right knee. He is unable to stand or walk for more than 20 to 30 minutes, and he avoids ladders and takes stairs slowly. After sitting in one spot too long, Claimant's right leg becomes stiff. He has to get up and move around. He is only able to drive approximately one hour, and then needs to stretch. He takes pain medication regularly.
Claimant developed right elbow pain in 1986. His elbow was injected with cortisone, and aspirated without relief. He was diagnosed with right olecranon bursitis and underwent excision of the right bursa. Following this surgery, Claimant returned to work full duty as a floor layer, but continued to have right elbow pain with difficulty extending his right arm fully. He had difficulty leaning on his right elbow due to pain and weakness.
Prior to August 23, 2007, Claimant had pain and stiffness in his left elbow after falling. He was diagnosed with a small avulsion fracture of the coronoid and was placed in a sling. Leading up to August 23, 2007, Claimant continued to have left elbow pain and difficulty fully extending his left arm. He tried to avoid heavy lifting, and was hindered at work.
Prior to August 23, 2007, Claimant had difficulty with his low back. He treated with a chiropractor, and was careful how he lifted despite continuing to work full duty.
Prior to August 23, 2007, Claimant was diagnosed with chronic obstructive pulmonary disease and sleep apnea. At the time of the hearing, Claimant utilized an oxygen tank. He was not using oxygen prior to the injury on August 23, 2007. Since the work injury of August 23, 2007, Claimant is limited to standing and walking due to knee pain. He avoids kneeling and squatting all together. After standing for around 15 minutes, he has to lean or sit down. Claimant lays down one to two hours every day.
Dr. Keohane testified that the work injury of August 23, 2007 caused Claimant's medial meniscus tear, and was the prevailing factor in the need for the total knee replacement. Dr. Keohane rated Claimant's disability for the meniscus tear at 20 %, and testified the total knee replacement would be additional disability over and above that 20 %.
Dr. David Volarich reviewed Claimant's treatment records from the primary injury as well as the pre-existing injuries and subsequent medical conditions, examined Claimant, prepared a report, and testified on behalf of Claimant. Claimant told Dr. Volarich that although he had continued pain, clicking and locking in the right knee prior to August 23, 2007, the injury of August 23, 2007 increased the level of pain severely. Dr. Volarich opined, within a reasonable degree of medical certainty, that the August 23, 2007 work-related accident resulted in 37.5\% PPD of the right knee; that Claimant had 37.5 % PPD of the right knee prior to the August 23, 2007 accident and that the total knee joint replacement was not completely due to the August 23, 2007 accident, but was due to the August 23, 2007 accident and the pre-existing condition in the right knee from 2006. Dr. Volarich testified it could not be stated to a reasonable degree of reasonable certainty that Claimant would have required a total knee replacement due to the August 23, 2007 accident in isolation without the preexisting history.
Dr. Volarich opined, within a reasonable degree of medical certainty, Claimant suffered from 20 % permanent partial disability of the right elbow and 15 % permanent partial disability of the left elbow prior to August 23, 2007. Dr. Volarich further testified a small amount of disability existed prior to August 23, 2007 in the low back and there was disability from the chronic obstructive pulmonary disease prior to August 23, 2007. Dr. Volarich testified if vocational assessment was unable to identify a job for which the Claimant is suited; Claimant is permanently and totally disabled as a result of the work-injury of August 23, 2007 in combination with his pre-existing medical conditions.
James England interviewed Claimant on October 12, 2009, prepared a report, and testified on behalf of Claimant. Mr. England opined it was obvious Claimant could not return to the type of work he performed his entire work life, and when considering the restrictions indicated by Dr. David Volarich, Claimant is precluded from any sedentary work activity because
of the combination of his knee and upper extremity problems. Mr. England further testified given Claimant's limitations and size, it would be difficult for him to compete for employment in the open labor market. Mr. England testified because of Claimant's presentation and difficulty he has sitting very long before he needs to get up and move around, it would be very difficult for him to successfully compete in the open labor market. He testified there is no reason for an employer to pick Claimant over other alternative candidates.