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Karon Simpson v. Columbia College

Decision date: July 28, 2017Injury #13-06904523 pages

Summary

The Labor and Industrial Relations Commission modified the administrative law judge's award regarding permanent partial disability benefits for an employee who sustained a left knee injury on September 19, 2013, requiring surgical intervention and ongoing medical treatment. The Commission found the initial determination of 22.5% permanent partial disability was too low given the employee's need for continued treatment including Orthovisc injections and eventual total knee replacement.

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Caption

FINAL AWARD ALLOWING COMPENSATION (Modifying Award and Decision of Administrative Law Judge)
Employee:Karon Simpson
Employer:Columbia College
Insurer:Self-Insured-Colleges & University Trust
This workers’ compensation case is submitted to the Labor and Industrial Relations Commission (Commission) for review as provided by § 287.480 RSMo. We have reviewed the evidence, read the parties’ briefs, and considered the whole record. Pursuant to § 286.090 RSMo, we modify the award and decision of the administrative law judge. We adopt the findings, conclusions, decision, and award of the administrative law judge to the extent that they are not inconsistent with the findings, conclusions, decision, and modifications set forth below.
Preliminaries
The parties asked the administrative law judge to determine the following issues: (1) employer’s liability, if any, for permanent partial disability benefits; (2) employer’s liability, if any, for future medical benefits pursuant to § 287.140 RSMo.; and (3) whether the employee is entitled to attorneys fees and costs pursuant to § 287.560 RSMo.The administrative law judge rendered the following determinations: (1) employee sustained a permanent partial disability of 22.5% at the level of the left knee as a result of her injuries of September 19, 2013; (2) employee will need additional medical treatment in the future, including but not limited to treatment recommended by Dr. Leslie and Dr. Volarich, to cure and relieve employee of the effects of her injuries sustained September 19, 2013; and (3) employee failed to sustain her burden to prove that employer defended this claim on unreasonable grounds; therefore employee is not entitled to an award of costs and attorney fees pursuant to § 287.560, including the costs of Dr. Leslie’s fees for appearing live at the hearing. The administrative law judge further found that employer did not abandon its right to select the treating physician by refusing to provide injections recommended by Dr. Leslie, employer’s authorized treating physician, prior to hearing.Employee filed a timely application for review with the Commission alleging the administrative law judge erred: (1) in that his determination of the extent of permanent partial disability was too low given that the employee currently needs Orthovisc injections in her left knee and ultimately will require a total knee replacement as a result of her work-related injury; (2) in determining that the employer had the right to continue to direct employee’s medical treatment in that employer refused to authorize Orthovisc injections authorized by employer’s treating physician in Spring of 2014 without securing a medical opinion to support its denial for a year and then subsequently claimed that employee’s injury did not cause her current medical problems; and (3) in failing to find that employee was not entitled to attorney fees and expenses pursuant to § 287.560.1, in that employee was denied medical treatment for a year and a half prior to hearing.

Employee: Karon Simpson

For the reasons stated below, we modify the award of the administrative law judge referable only to the issue of employer's liability for permanent partial disability benefits.

Nature and extent of permanent partial disability

Orthopedic surgeon Dr. Christopher Leslie, employer's authorized treating physician, performed a left patella open reduction internal fixation on employee's left knee on September 23, 2013, to address her work injury of September 19, 2013.

On February 3, 2014, Dr. Leslie performed a second operation to remove hardware used in the original surgery which had broken and was causing pain. As the employee underwent physical therapy subsequent to her second surgery, she continued to experience pain and grinding in her knee. As of May 6, 2014, employee still had swelling and effusion of her knee. Dr. Leslie described employee's conditions as significant patellofemoral crepitus and severe chondromalacia of the left patella. Dr. Leslie considered these conditions not unusual following employee's work injury and two surgeries. He described employee's continued problems with her knee as "a very typical cascade of events" following the type of trauma involved in her work related injury. Transcript, page 29.

To address employee's ongoing medical issues, Dr. Leslie recommended a third surgery consisting of a knee arthroscopy. Employer/insurer approved Dr. Leslie's recommendation and on May 19, 2014, employee underwent an arthroscopic chondroplasty of her patellofemoral joint and resection of her patella. During this surgery Dr. Leslie confirmed his earlier finding of grade three chondromalacia of the patellofemoral joint. He further found that employee had developed tri-compartmental reactive synovitis, inflammation inside of the knee resultant from the injury. Dr. Leslie found no meniscus tear inside employee's left knee at the time of the third, May 19, 2014, surgery.

Dr. Leslie next saw the employee on June 3, 2014. On that date, he removed sutures from employee's May 19, 2014, surgery and released the employee, recommending that she continue her home exercise program, return to activities as she could tolerate them, and contact him with any further problems. Dr. Leslie did not recommend physical therapy at that time because of a concern that the additional physical stress could make the employee's condition worse.

Employee next contacted Dr. Leslie on September 16, 2014, complaining of pain in her knee. Pursuant to his examination of claimant's knee on September 23, 2014, Dr. Leslie was concerned that the employee had a torn medial meniscus in her left knee and recommended an MRI. Dr. Leslie advised employer's insurer that he considered the employee's current symptoms and condition consistent and reflective of her work related injury. Employer/insurer authorized the MRI test.

The September 23, 2014, MRI of employee's left knee showed severe chondromalacia of the patella consistent with traumatic arthritis from palletar fracture, a torn medial meniscus and joint effusion. Dr. Leslie recommended an arthroscopic surgery to address the meniscal tear. Employer's insurer authorized the procedure and Dr. Leslie performed an arthroscopy of employee's left knee on December 1, 2014.

Dr. Leslie testified that employee's meniscus tear diagnosed in September of 2014 was causally related to her September 19, 2013, work injury. Dr. Leslie based his opinion not just based on employee's denial of any subsequent injury but also based on his physical findings after having scoped employee's knee two times. He concluded that the meniscus tear in employee's left knee was due to trauma based on the location of the tear inside of the employee's cartilage rather than in the periphery of the meniscus.

Dr. Leslie testified that within a year of her initial injury on September 19, 2013, employee had progressed to end-stage osteoarthritis. Dr. Leslie opined that employee's pain in her knee, altered gait subsequent to her injury and multiple related surgeries caused her to develop arthritis and chondromalacia in the area of her left knee. By December of 2014, employee developed grade four chondromalacia in two of three compartments of her knee.

Dr. Leslie recommended Orthovise injections after claimant's fourth surgery in December, 2014, but noted that because employee currently has no articular cartilage, her condition will ultimately require a total replacement of her left knee. Dr. Leslie testified that claimant's current conditions as well as her eventual need for a total knee replacement are all directly related to her original September 19, 2013, work related injury.

Employee credibly testified (and we so find) that her left knee is stiff, aches every day, is sore and tender to touch and has a burning sensation inside. Her knee swells and feels full and tight all the time. Employee's left thigh muscle feels weak and her left thigh is now smaller than the right thigh. She experiences sudden and unexpected popping in her left knee, which is very painful. After standing for more than fifteen or twenty minutes, employee's pain increases so much she is compelled to sit down. She can only walk for twenty to thirty minutes. She avoids stairs because she finds it uncomfortable to go "heel over heel, step over step." She climbs stairs one step at a time and comes down by using side steps, while holding on to a guard rail or her husband. She can kneel but is unable to walk on her knees. She cannot squat. She continues to perform her job, which consists of desk work, because employer allows her to get up and move around as needed. She avoids lifting items heavier than twenty pounds at work. Employee has largely given up her hobby of gardening because she is no longer physically able to maintain her extensive flower beds. She is unable to perform housework involving lifting such as laundry and vacuuming and relies on her husband to assist with these tasks. Prior to her injury, employee exercised by walking two miles outside her home four or five times per week. In spring of 2016 she tried to resume this activity but found it too painful to continue. She is no longer able to enjoy vacations that involve a lot of walking, as she had in the past. She now confines

Injury No.: 13-069045

Employee: Karon Simpson

- 4 -

necessary shopping to short trips in order to avoid walking on concrete floors. Employee suffers chronic pain, which she rates at a level of four to five.

Dr. David T. Volarich's July 14, 2015, report mirrors the present complaints and physical limitations employee testified to at hearing. In addition, Dr. Volarich noted employee experiences difficulty sleeping, and sleeps with a pillow between her knees. She usually wakes up three to four times a night to change positions. His report states that weather changes aggravate employee's symptoms. With regard to the employee's ability to work, Dr. Volarich advised her to limit repetitive stooping, squatting, crawling, keeling, pivoting, climbing, and all impact maneuvers. He cautioned her to be cautious navigating uneven terrain, slopes, steps, and ladders especially if she must handle weight. He instructed employee that, if work activities require her to be on her knees, she should appropriately pad the surface on which she is kneeling.

Based on his independent medical exam, Dr. Volarich found that employee sustained a 50% permanent partial disability of her left lower extremity rated at the knee, for the following pathology:

[T]he patellar fracture that required open reduction internal fixation and subsequent hardware removal, as well as the development of accelerated post-traumatic arthropathy that required arthroscopic chondroplasty and because of a medial meniscal tear, another arthroscopic chondroplasty of the patella with partial medial meniscectomy. *Transcript*, page 948.

His report further explains that this rating "accounts for ongoing discomfort, lost motion, weakness, crepitus and atrophy in the left lower extremity (emphasis added). *Id.*"

After considering employee's testimony concerning her present condition and limitations, Dr. Volarich's evaluation of employee's permanent disability as 50% of the left knee, a form completed by Dr. Leslie rating employee's permanent impairment as 8% of the left knee, and Dr. Mall's rating of permanent partial disability of 10% of the left knee attributable to employee's work injury, the administrative law judge concluded that employee suffered a 22.5% permanent partial disability at the level of the left knee as a result of her injuries on September 19, 2013. We disagree with the administrative law judge's conclusion regarding the nature and extent of employee's permanent partial disability.

Employee's testimony regarding her physical condition and activities prior to the September 19, 2013, work injury is uncontroverted. We further find

Full decision text continues in the plain-text archive copy.

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