Ramadan Hajdini v. Hyatt Regency St. Louis at the Arch

Issued by THE LABOR AND INDUSTRIAL RELATIONS COMMISSION

(Affirming Award and Decision of Administrative Law Judge with Supplemental Opinion)

**Injury No.:** 15-052459

**Employee:** Ramadan Hajdini

**Employer:** Hyatt Regency St. Louis at the Arch

**Insurer:** New Hampshire Insurance Company

This workers' compensation case is submitted to the Labor and Industrial Relations Commission (Commission) for review as provided by § 287.480 RSMo. Having reviewed the evidence, read the parties' briefs, and considered the whole record, we find that the award of the administrative law judge allowing compensation is supported by competent and substantial evidence and was made in accordance with the Missouri Workers' Compensation Law. Pursuant to § 286.090 RSMo, we affirm the award and decision of the administrative law judge with this supplemental opinion.

The idiopathic conditions of thrombophilia and synovial chondromatosis are not causally connected to the work injury.

Section 287.020.3(1) RSMo provides a definition of a compensable injury:

> "Injury" is hereby defined to be an injury which has arisen out of an in the course of employment. An injury by accident is compensable only if the accident was the prevailing factor in causing both the resulting medical condition and the disability. "The prevailing factor" is defined to be the primary factor, in relation to any other factor, causing both the resulting medical condition and disability.

(Emphasis in original).

The resulting medical condition and disability from the July 19, 2015, work accident was a right knee contusion, as diagnosed by Dr. John Krause. We find Dr. Krause to be persuasive in his diagnosis and in his opinion that thrombophilia and synovial chondromatosis were not caused by the work injury. The work accident was the prevailing factor in causing only a right knee contusion.

Section 287.140 RSMo provides in relevant part:

> ...employer shall provide such medical, surgical, chiropractic, and hospital treatment ... as may reasonably be required after the injury or disability, to cure and relieve from the effects of the injury.

Employee suffered an isolated deep vein thrombosis (DVT) and pulmonary embolism (PE) in late 2015, which may have reasonably flowed from the surgery performed to address his knee symptoms after the work injury. It was therefore, appropriate to treat those incidents flowing from the surgery which was reasonably undertaken to address the suspected meniscus tear. However, there is no persuasive evidence that the work injury caused the idiopathic condition of thrombophilia, which resulted in the singular incident of DVT and PE. As of January 7, 2016, these conditions were not present as determined by objective evidence, a CT scan. Employee testified that he is no longer on anticoagulant medication, aside from a baby aspirin. Transcript,

Injury No.: 15-052459

Employee: Ramadan Hajdini

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page 15. We are not persuaded of the need for continuing or future medical treatment of these conditions resulting from the work injury.

We note the opinion of Dr. Anthony Shen, a pulmonologist, in his two paragraph letter of May 12, 2016, that the prevailing factor¹ of employee's lifetime need for anticoagulation for clot precaution was his work related knee injury. We are not persuaded by Dr. Shen's opinion.

As to the second condition, synovial chondromatosis (rice bodies), we adopt the opinion of Dr. Krause, as confirmed by Dr. Richard Lehman, that the synovial chondromatosis is an idiopathic condition. As such, any injury resulting directly or indirectly from idiopathic causes, is not compensable. § 287.020.3(3) RSMo. We are persuaded by Dr. Krause's opinion that rice bodies is not a condition caused by trauma and it is not causally connected to the work injury. Employer has borne the costs (and employee received the benefit) of the debridement, which was achieved during the surgery intended to repair the suspected meniscus tear. However, no further treatment for this idiopathic condition is reasonably required to cure and relieve the effects of the work injury.

**Conclusion**

We affirm and adopt the award of the administrative law judge as supplemented herein.

The award and decision of Administrative Law Judge Joseph P. Keaveny is attached and incorporated herein to the extent not inconsistent with this supplemental decision.

We approve and affirm the administrative law judge's allowance of attorney's fee herein as being fair and reasonable.

Any past due compensation shall bear interest as provided by law.

Given at Jefferson City, State of Missouri, this 10th day of January 2020.

LABOR AND INDUSTRIAL RELATIONS COMMISSION

Robert Cornejo, Chairman

Reid K. Forrester, Member

SEPARATE OPINION FILED

Curtis E. Chick, Jr., Member

Attest:

Secretary

¹ While Dr. Shen and other doctors in this record use the term, "prevailing factor," it is not necessary to find the accident to be the prevailing factor in the need for treatment, once a compensable injury is found.

Injury No.: 15-052459

Employee: Ramadan Hajdini

The majority has voted to affirm the administrative law judge's award of 6 % permanent partial disability to the right knee and no future medical treatment. I agree that employee has suffered a permanent partial disability to his knee, but I disagree as to the nature and extent of the disability and the ruling regarding future medical treatment.

In line with employee's independent medical examiner, Dr. D. Wade Hammond, I would find employee suffered a 25 % permanent partial disability. Dr. Hammond noted the continuing problems and severity of disability that employee experiences with his right knee, and he opined that employee may very well require further medical and/or surgical intervention to alleviate his symptoms. I find Dr. Hammond to be more persuasive as to the extent of his disability flowing from the work injury to the right knee.

Likewise, employee provided persuasive evidence through the opinion of Dr. Richard Lehman, that the synovial chondromatosis (rice bodies), is causally connected to the work injury. I would adopt his opinion that the work injury aggravated the underlying synovial disease and resulted in further changes and post-traumatic issues in the knee. *Transcript*, pages 380, 381.

I also disagree with the majority and the administrative law judge on the need for future medical treatment which flows from the work injury.

The statute instructs us that: An injury is compensable only if the accident was the prevailing factor in causing both the resulting medical condition and disability. (§ 287.020.3) It further states that the "prevailing factor" is the primary factor, in relation to any other factor, causing both the resulting medical condition and disability. However, in terms of future medical treatment the "prevailing factor" is not a necessary step in analysis.

*Tillotson* makes it clear that once it is established that there is a compensable injury, the issue of "prevailing factor" is no longer in question. The "prevailing factor" test need not be applied to the medical treatment that flows from the injury. *Tillotson v. St. Joseph Medical Center*, 347 S.W. 3d 511 (Mo. App. W.D. 2011). The deep vein thrombosis (DVT) and the pulmonary embolism experienced by employee are causally related to his work injury in that the reasonable treatment for the work injury brought on these conditions. Dr. Hammond notes the close proximity (15 days) between the surgery and the development of the DVT, which "suggests that this is directly related to the arthroscopic surgery." *Transcript*, page 379.

Employee has provided further support for his position through the opinion of Dr. Anthony Shen, the only pulmonologist reviewing the medical evidence, who unequivocally states employee will require lifetime anticoagulation¹ for clot precaution and that the need for this treatment flows from his work related knee injury with a reasonable degree of medical certainty.

In regard to future treatment for synovial chondromatosis, Dr. Lehman notes employee continues to suffer pain from that condition as a result of the work injury, and therefore it is reasonably probable that future medical treatment be required.

¹ I believe the fact that employee may have had his medication reduced to baby aspirin at a particular period in time is irrelevant. This still is indicative of the need to take precautions to monitor and address a blood clot problem.

Employee: Ramadan Hajdini

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Therefore, I respectfully dissent from the majority and would modify the award, as I have set forth.

Curtis E. Chick, Jr., Member

1. Are any benefits awarded herein? Yes
2. Was the injury or occupational disease compensable under Chapter 287? Yes
3. Was there an accident or incident of occupational disease under the Law? Yes
4. Date of accident or onset of occupational disease: July 19, 2015
5. State location where accident occurred or occupational disease was contracted: St. Louis City
6. Was above employee in employ of above employer at time of alleged accident or occupational disease? Yes
7. Did employer receive proper notice? Yes
8. Did accident or occupational disease arise out of and in the course of the employment? Yes
9. Was claim for compensation filed within time required by Law? Yes
10. Was employer insured by above insurer? Yes
11. Describe work employee was doing and how accident occurred or occupational disease contracted: While pulling a cart of tables, a table slipped off the cart and struck Employee on the knee.
12. Did accident or occupational disease cause death? No
13. Part(s) of body injured by accident or occupational disease: Right knee
14. Nature and extent of any permanent disability: 6% right knee
15. Compensation paid to-date for temporary disability: $5,302.40
16. Value necessary medical aid paid to date by employer/insurer? $46,987.60

Revised Form 31 (3/97)

Page 1

1. Value necessary medical aid not furnished by employer/insurer? N/A
2. Employee's average weekly wages: $\ 1,242.45
3. Weekly compensation rate: $\ 828.30 TTD/ $\ 464.58 PPD
4. Method wages computation: Stipulation

1. Amount of compensation payable:

$\ 4,459.97

1. Second Injury Fund liability: No

TOTAL:

$\ 4,459.97

1. Future requirements awarded:

N/A

Said payments to begin immediately and to be payable and be subject to modification and review as provided by law.

The compensation awarded to the claimant shall be subject to a lien in the amount of 25 % of all payments hereunder in favor of the following attorney for necessary legal services rendered to the claimant: Scott L. Kolker

On May 7, 2019, the parties appeared for a hearing at the Missouri Division of Workers' Compensation, St. Louis Office ("Division"). Ramadan Hajdini ("Employee") appeared in person and with counsel (Scott L. Kolker). Hyatt Corporation ("Employer") and New Hampshire Insurance Company ("Insurer") were represented by Brian McBrearty.

1. The Employer, Hyatt Corporation, was operating subjec