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
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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