Claimant is a fifty-eight-year-old man who worked for Employer as a "prim tech" from 2008 to July 14, 2011. His job involved installing Employer's "U-Verse" technology in residences and businesses, which required climbing utility poles and ladders, ascending and descending stairs, climbing into and crawling around attics and crawl spaces, frequent bending, stooping, and kneeling, and walking on uneven surfaces. Other than occasional pain and stiffness in his knees and wrists that he attributed to "getting older", Claimant never had any problems with his right knee before July 9, 2010. Likewise, prior to July 9, 2010, Claimant never injured his right knee, received medical treatment or missed time from work due to his right knee.
On July 9, 2010, while performing an installation, Claimant had to pull coaxial cable through a wet, sloped, wooded area. While doing so, he slipped, twisted his right knee and fell to the ground landing on the knee. Claimant felt immediate pain in the knee.
Employer directed Claimant to Concentra Medical Center that day for treatment. Concentra records reflect a history of Claimant's accident as well as a history of swelling in the right knee off and on for the last six months. Claimant explained that he told the Concentra medical personnel about the aches and pains he had experienced in both of his knees and wrists before the accident, but did not recall telling them that his right knee had previously swelled.
Concentra medical personnel diagnosed Claimant with a right knee strain, provided him with an ACE bandage, referred him to physical therapy, and instructed him to ice and exercise the knee. Work restrictions of no squatting, kneeling or ladder climbing were imposed. Employer did not have work available within those restrictions. The July 16, 2010 record of Employee's follow-up visit states, "[a]ccording to the history provided by the patient and the physical exam it is my professional opinion that work was the prevailing factor in the patient's injury."
Physical therapy did not help Claimant's condition. An MRI revealed signal changes in the medical meniscus suggesting the possibility of a radial tear. Concentra personnel diagnosed a meniscal tear, referred Claimant to an orthopedic surgeon, and imposed work restrictions of no climbing and sitting 50 % of the time. Employer could not accommodate those restrictions.
On August 12, 2010, orthopedic surgeon Dr. Christopher Kostman, evaluated Claimant, recorded a history of Claimant's July 9, 2010 accident, and diagnosed a right knee injury with probable medial meniscal tear. Dr. Kostman injected Claimant's knee and recommended surgery. Employer could not accommodate the continued work restrictions.
After obtaining cardiac clearance ${ }^{1}$, on December 10, 2010, Dr. Kostman performed an arthroscopic partial medial meniscectomy and chondroplasty of the patellofemoral joint.
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[^0]: ${ }^{1}$ Claimant has a history of cardiac issues, including heart attacks in 1995 and 2000. He obtained clearance from his cardiologists by undergoing testing at Belleville Memorial Hospital in the Fall of 2010, prior to his first surgery. He incurred medical expenses of $\ 9,666.98. Clearance from his cardiologist was a prerequisite for surgery.
Following surgery, Dr. Kostman excused Claimant from work, referred him for additional physical therapy, and on December 22, 2010, released him to return to work with restrictions of 50 % deskwork, no lifting, pushing or pulling greater than 35 pounds and no ladder climbing. Employer could not accommodate those restrictions.
The January 24, 2011 functional capacity evaluation ("FCE") revealed an overall good effort and determined that Claimant could return to work in the medium work level, but that he did not meet the essential job demands required by his position with Employer. On January 25, 2011, Dr. Kostman released Claimant to return to work without restrictions and declared Claimant to be at maximum medical improvement ("MMI"). Although Dr. Kostman's report indicated full range of motion, almost no swelling and tenderness to palpation, Claimant testified that as of that date, he still experienced knee pain, swelling, occasional popping, and a feeling that his knee would give out while ascending and descending stairs.
Claimant returned to work for Employer with an assigned a helper, and testified that he was able to do his job with difficulty. He purchased an over-the-counter knee brace, but still had significant difficulty performing his job duties of pole and ladder climbing. Sometime in March 2011, Claimant's right knee gave out when he stepped out of his truck. He grabbed a handle on the truck to keep from falling. He testified that the incident did not change the symptoms he felt when he last saw Dr. Kostman.
Employer denied Claimant's request ${ }^{2}$ to return to Dr. Kostman, so Claimant sought medical treatment with his family physician, Dr. Kelly Wood, on April 1, 2011. Dr. Wood recorded symptoms of post-operative pain, buckling, popping, grinding and swelling. She noted Claimant has difficulty performing his job duties, especially climbing poles. Dr. Wood diagnosed post surgery right knee pain, ordered X-rays, prescribed medication, and referred Claimant for another FCE. Dr. Wood also placed work restrictions of no kneeling or climbing, which Employer could not accommodate.
The April 14, 2011 FCE revealed near full levels of physical effort on Claimant's behalf as well as full reliability of Claimant's reports of pain and disability. The FCE determined that Claimant is not capable of performing his job duties as a "communications technician", but was able to work at the "light-medium" level.
At Dr. Wood's referral, orthopedic surgeon Dr. Forbes McMullin saw Claimant on April 5, 2011. Dr. McMullin recorded a history of the