The issues to be tried by this hearing are:
Issued by DIVISION OF WORKERS' COMPENSATION
Employee: Edward Palmer
1) Whether Employee sustained any disability and, if so, the nature and extent of that disability;
2) Whether the Employer is liable to the Employee for future medical care in order to cure and relieve the effects of the August 19, 2011 accident; and
3) The liability of the Second Injury Fund.
Employee approximately 59 years old at the time of hearing spent his entire vocational career working as either an EMT or firefighter. He has worked the last 19 years for the South Metro Fire District in either the capacity of a firefighter, battalion chief and captain of the department. These particular job duties of the past 19 years are considered to be heavy physical labor in the open labor market.
The parties stipulated that while performing his job duties on August 19, 2011, Employee was walking out of a fire scene and his left foot caught in debris causing him to fall directly onto concrete striking the left knee. This accident was reported to his employer, and as such Employee in August of 2011 went through authorized medical care. He saw Dr. Peter Boylan of Concentra Medical Center where X-rays were taken that did not reveal any acute abnormalities. Dr. Boylan at Concentra diagnosed Employee with a left knee contusion and recommended continuation of regular duty status. Employee attempted to work full-duty status. However, in September of 2011, medical records revealed that patient had attempted to return to regular duty status but could not tolerate his work activities as a result of the left knee.
Due to Employee complaining of pain of the left knee with squatting, stepping and pivotal activity, an MRI was ordered. The MRI revealed meniscal tears with multi compartmental degenerative changes in subcortical sclerosis. At that time he was then sent to Dr. Lowry Jones. Dr. Jones felt Employee had sustained a direct impact injury of the left knee that caused patellofemoral cartilage injury, and a complex medial meniscus tear. On November 8, 2011, Dr. Jones performed a left knee arthroscopy with partial medial and lateral meniscectomy, a chondroplasty of the medial femoral condyle in the patellofemoral joint with excision of the inferior patellar spur. Dr. Jones diagnosed Employee with the following that he finds is the result of the direct impact injury of the left knee: Left knee medial meniscus tear, left knee anterior lateral meniscus tear, advanced grade 4 degenerative arthritis of the medial joint line, grade 4 trochlear lesion with grade 2 patellar articular lesion, and a large inferior patellar spur. Thereafter Employee had some improvement but continued with ongoing symptoms of swelling and stiffness, and had difficulty kneeling, squatting and climbing. Employee underwent physical therapy without much improvement. Dr. Jones then performed Orthovisc injections of his left knee. On February 4, 2012, Dr. Jones stated the Employee was not capable of performing all of his essential job requirements, and because of continued ongoing symptoms of left knee pain, he was referred to Dr. Robert Gardiner, an orthopaedic surgeon.
On April 9, 2012, Dr. Gardiner stated that the Employee was having progressive, severe and intolerable left knee pain and had less than a two block walking tolerance, and difficulty getting in and out of cars and climbing stairs. At that time, patient underwent a total left knee replacement. Eventually on April 10, 2013 Employee was released at maximum medical improvement as a result of the August 2011 injury. Dr. Gardiner, the authorized treating physician, placed the following permanent work restrictions: lifting and carrying less than 25
pounds maximum, alternate sitting and standing, no squatting, crawling, kneeling or climbing and no jumping tasks. As a result of the authorized treating physician's restrictions Employee could not return to his prior employment with the fire department.
As a result of the August 19, 2011 accident, Employee continues with left knee pain that increases with prolonged standing and walking. He has postural restrictions based on the left knee, such as standing tolerance less than 30 minutes and a walking tolerance of less than four blocks. His sitting tolerance is less than an hour and he needs to change positions by sitting and standing. Employee as a result of the August 19, 2011 accident is unable to squat, crawl, kneel or climb using the left knee. Employee since August 19, 2011, now has an altered gait that causes abnormal weight-bearing.
Employee testified, which I find credibly, that he protected the left lower extremity more than the right and now has an altered gait due to abnormal weight-bearing on the right lower extremity. He has also noticed increased grinding and pain of the right knee since the August 19, 2011 injury. Employee testified that he has intermittent mechanical low back pain from the altered gait. Employee testified that he no longer works around the house due to the left knee, the right knee and low back since August 19, 2011. He no longer mows, fishes or goes for walks like he did prior to the August 19, 2011 accident. Employee testified that he could not work on a sustained basis due to the effects of the August 2011 accident and restrictions of Dr. Gardiner. Employee testified his left knee, back and right knee have worsened since August 19, 2011. Employee also testified that prior to 2011 he was able to perform his job duties without hindrances and obstacles to his restrictions despite a 2007 right knee accident.
Indeed, Employee sustained a work-related injury on August 20, 2007, in which he received a 15 percent permanent partial disability settlement with his employer. The 2007 accident resulted in Employee undergoing an arthroscopy, anterior cruciate ligament reconstruction, partial medial and lateral meniscectomies and chondroplasties of the right knee. He was released without restrictions and continued performing his normal job duties up until August of 2011.
Employee testified and the medical records corroborate that Employee did not undergo medical care of his right knee between being released from care in 2008 and August 19, 2011. The evidence also reveals that Employee did not have prior problems of his left knee and low back that were a hindrance or obstacle to his condition. Although Employee on a few occasions prior to 2011 complained of left knee pain and an X-ray revealed s