Alan Rogers v. Marion C. Early R V School District

(Affirming Award and Decision of Administrative Law Judge)

**Injury No.:** 15-093845

**Employee:** Alan Rogers

**Employer:** Marion C. Early R V School District

**Insurer:** Missouri United School Insurance Co.

The above-entitled 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 and considered the whole record, the Commission finds that the award of the administrative law judge is supported by competent and substantial evidence and was made in accordance with the Missouri Workers' Compensation Law. Pursuant to § 286.090 RSMo, the Commission affirms the award and decision of the administrative law judge dated May 3, 2021. The award and decision of Administrative Law Judge Kevin A. Elmer, issued May 3, 2021, is attached and incorporated by this reference.

The Commission further approves and affirms the administrative law judge's allowance of attorney's fees 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 _22nd_ day of October 2021.

LABOR AND INDUSTRIAL RELATIONS COMMISSION

Robert W. Cornejo, Chairman

DISSENTING OPINION FILED

Reid K. Forrester, Member

Shalonn K. Curls, Member

Attest:

Secretary

I have reviewed and considered all of the competent and substantial evidence on the whole record. Based on my review of the evidence as well as my consideration of the relevant provisions of the Missouri Worker's Compensation Law, I believe the decision of the administrative law judge should be modified.

For an employer to be responsible for future medical benefits, such care must flow from the accident, via evidence of a medical causal relationship between the condition and the compensable injury. . While an employer may not be ordered to provide future medical treatment for non-work related injuries, an employer may be ordered to provide for future medical care that will provide treatment for non-work related injuries if evidence establishes to a reasonable degree of medical certainty that the need for treatment is caused by the work injury.

Stevens v. Citizens Mem'l Healthcare Found. 244 S.W.3d 234, 238 (Mo. App. 2008) (inner citations omitted).

I am not persuaded that employee met his burden that the need for his total knee replacement actually flowed from the work injury. Employer/insurer approved and paid for two meniscectomies to repair two tears in the meniscus of employee's left knee caused by the work injury. According to Dr. William Goodman, the two meniscectomies were successful in treating employee's work injury. Dr. Goodman noted that the torn sections of cartilage were removed without complications. Dr. Robert Mahnken also noted in his March 21, 2017 visit that employee healed "satisfactorily" from the two meniscectomies. Accordingly, I disagree with the administrative law judge's finding that the meniscectomies were unsuccessful.

It was Dr. Mahnken's subsequent opinion that the need for the total knee replacement was due to employee's "[p]rimary osteoarthritis [in the] left knee." Tr., p. 623. ${ }^{1}$ As the two meniscectomies satisfactorily cured the work injury, then the need for the total knee replacement did not flow from the work injury. Rather, the need for the total knee replacement was only due to the primary osteoarthritis in employee's left knee. Accordingly, employer/insurer should not be liable for the past medical amount of $\ 31,996.07 or temporary total disability for the eight weeks after the knee replacement surgery. Furthermore, there was no need for any future medical benefits after the successful meniscectomies.

I find persuasive Dr. Goodman's assessment of employee's knee rating the work injury at 10 % permanent partial disability at the 160 -week level. Similarly, Dr. Nathan Mall

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[^0]: ${ }^{1}$ We note that there are two page numbers in the transcript. The references in this decision refer to the page numbers in the bottom right of each page.

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rated the work injury at 15% permanent partial disability. As employer/insurer appear to accept the 15% rating, I concur with this assessment.

**Conclusion**

I vote to modify the administrative law judge's award allowing permanent partial disability benefits at a level of a 15% permanent partial disability, at the 160-week level regarding the left knee. I also vote to deny awarding past medical in the amount of $31,996.07; eight weeks of temporary total disability, and future medical benefits. Because the Commission majority has decided otherwise, I respectfully dissent.

Reid K. Forrester, Member

Employee: Alan C. Rogers

Injury No. 15-093845

Dependents: N/A

Employer: Marion C. Early R V School District

Insurer: Missouri United School Insurance Co.

c/o Gallagher Bassett Services Inc.

Additional Party: N/A

Hearing Date: January 25, 2021

Checked by: KAE

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: November 19, 2015.
5. State location where accident occurred or occupational disease was contracted: Greene County, Missouri.
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: Employee was running across a grass covered area to answer a fire alarm when he stepped in a hole, twisting and injuring his left knee with immediate onset of pain.
12. Did accident or occupational disease cause death? No. Date of death? N/A
13. Part(s) of body injured by accident or occupational disease: Left Knee.
14. Nature and extent of any permanent disability: 60 % of the Left Knee.
15. Compensation paid to-date for temporary disability: $\ 8,954.28.
16. Value necessary medical aid paid to date by employer/insurer? $\ 42,574.94
17. Value necessary medical aid not furnished by employer/insurer? $\ 31,966.07

Issued by DIVISION OF WORKERS' COMPENSATION

Employee: Alan C. Rogers

Injury No. 15-093845

1. Employee's average weekly wages: 1,175.19

1. Weekly compensation rate: 783.50 TTD, $464.58 PPD

1. Method wages computation: Stipulation of the parties.

**COMPENSATION PAYABLE**

1. Amount of compensation payable:

96 weeks of permanent partial disability from Employer / Insurer: 44,599.68

8 weeks of temporary total disability: 6,268.00

Unpaid medical expenses: $31,966.07

1. Future requirements awarded: The Employer and Insurer are ordered to provide medical treatment in the future according to Section 287.140 RSMo 2016.

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: Thomas P. Carlton, Esq.

Page 2

Employee: Alan C. Rogers

Injury No. 15-093845

Dependents: N/A

Employer: Marion C. Early R V School District

Insurer: Missouri United School Insurance Co. c/o Gallagher Bassett Services Inc.

Additional Party: N/A

Hearing Date: January 25, 2021

Checked by: KAE

This claim was the subject of a hearing held on Monday, January 25, 2021, for the purpose of entering a Final Award under Section 287.460 RSMo 2016. The Employee Alan C. Rogers appeared and with his counsel Thomas P. Carlton. The Employer and Insurer appeared by their counsel William Lemp. The parties requested the opportunity to submit briefs on or before March 9,2021 , resulting in the final submission of arguments being presented to the undersigned on said date.

The parties entered into a stipulation of facts. The stipulation is as follows:

(1) On or about November 19, 2015, Marion C. Early R-V School District was an employer operating under and subject to The Missouri Workers' Compensation Law, and during this time was fully insured by Missouri United School Insurance Co.

(2) On the alleged injury date of November 19, 2015, Alan Rogers was an employee of the employer, and was working under and subject to The Missouri Workers' Compensation Law.

(3) On or about November 19, 2015, Alan Rogers, the employee, sustained an accident, which arose out of and in the course of his employment with the employer.

(4) The above-referenced employment and accident occurred in Greene County, Missouri. The parties agree to venue lying in Greene County, Missouri. Venue is proper.

(5) The employee notified the employer of his injury as required by Section, 287.420, RSMo.

Issued by DIVISION OF WORKERS' COMPENSATION

Employee: Alan C. Rogers

Injury No. 15-093845

(6) The Claim for Compensation was filed within the time prescribed by Section 287.430, RSMo.

(7) At the time of the alleged accident of November 19, 2015, the employee's average weekly wage was $\ 1,175.19, which is sufficient to allow a compensation rate of $\ 783.50 for temporary total disability compensation / permanent total disability compensation, and a compensation rate of $\ 464.58 for permanent partial disability compensation.

(8) Temporary total disability compensation has been provided to the employee in the amount of $\ 8,954.28, representing $113 / 7$ weeks in disability benefits.

(9) The employer and insurer have provided medical treatment to the employee, having paid $\ 42,574.94 medical expenses.

The parties further agreed that should the undersigned Administrative Law Judge find that on November 19, 2015 the employee sustained an accident, and that the accident caused the injuries and disabilities, including the left total knee replacement, for which benefits are now being sought, they would make the following additional stipulations:

(10) The employee is entitled to past medical expenses in the amount of $\ 31,966.07 to be paid directly to the employee.

(11) The employee is entitled to unpaid temporary total disability compensation in the amount of 8 weeks or $\ 6,268.00.

The issues to be resolved by hearing include:

(1) Whether the alleged accident caused the injuries and disabilities for which benefits are now being claimed, and the need for the past total knee replacement?

(2) Whether the employer and insurer are obligated to pay for certain past medical care and expenses in the amount of $\ 31,966.07 ?

(3) Whether the employee has sustained injuries that will require additional or future medical care in order to cure and relieve the employee from the effects of the injuries?

(4) Whether the employee is entitled to temporary total disability compensation? (The employee seeks payment for 8 weeks of temporary total disability compensation, payable in the amount of $\ 6,268.00.)

(5) Whether the employee sustained any permanent disability as a consequence of the alleged accident of November 19, 2015; and, if so, what is the nature and extent of the disability?

The employee testified at the hearing in support of his claim. In addition, the employee offered for admission the following exhibits:

Exhibit 1

Dr. Stuckmeyer Report and documents relied upon

Exhibit 2

Total of unpaid TTD claimed owed

Exhibit 3

Medical bills and expenses

The exhibits were received and admitted into evidence.

The employer and insurer did not present witnesses at the hearing of this case. However, the employer and insurer offered for admission the following exhibits:

Exhibit A Treatment Records

Exhibit B Dr. Galligos Report and CV

Exhibit C Dr. Mall Report and CV

The exhibits were received and admitted into evidence.

All exhibits appear as the exhibits were received and admitted into evidence at the evidentiary hearing. There has been no alteration (including highlighting or underscoring) of any exhibit by the undersigned judge.

The employee, Alan Rogers, is fifty-eight (58) years of age, having been born on February 21, 1962. Mr. Rogers resides in Morrisville, Missouri.

Mr. Rogers graduated from high school. Since graduating, he has held various jobs but has worked primarily for the employer. He has worked for employer for 27 years and continues to work for them.

Prior to injuring himself on November 19, 2015, Mr. Rogers had never had an injury to his left knee. He had never sought any medical treatment through any doctor, hospital or clinic, or had any injuries or limitations whatsoever with his left knee. He also never suffered from any physical complaints to the left knee prior to November 19, 2015.

On approximately November 19, 2015 employee was running across a grass covered area to answer a fire alarm when he stepped in a hole, twisting and injuring his left knee with immediate onset of pain. Employee felt an immediate onset of pain in his left knee and had never felt any pain in his left knee prior to this accident.

On November 20, 2015 employee was seen by Guy Ruddick FNP at Mercy Clinic on West Kearney, in Springfield, Missouri. Employee was evaluated and placed in a hinged brace. X-rays were obtained of his left knee which revealed mild joint space narrowing with osteophytosis in all three compartments, but no fractures were identified. A follow-up visit occurred with Mr. Ruddick on November 25, 2015 wherein he was put on Tramadol and was provided with crutches for ambulatory support. A follow-up visit occurred once again with Mr. Ruddick on December 2, 2015, and it appears that due to the chronicity of the symptoms, an MRI scan was recommended. An MRI scan was obtained on December 8, 2015 of his left knee, which revealed an oblique tear of the posterior horn of the medial meniscus extending to the tibial undersurface. In follow-up with Mr. Ruddick on December 11, 2015, an orthopedic consultation was warranted.

On December 15, 2015, the patient was seen in consultation by orthopedic surgeon, William Goodman, M.D. Dr. Goodman stated that the patient presented with symptoms of left knee pain, discomfort, and mechanical issues of catching and locking as well as giving way. Dr. Goodman narrated that the patient had no prior issues with the left knee. He assessed the patient as having left knee patellofemoral joint arthritis and acute onset of medial meniscal tear causing mechanical issues and recommended proceeding with operative intervention. On January 13, 2016 Dr. Goodman performed a left knee arthroscopy and debridement of medial meniscal tear, left knee arthroscopy and chondroplasty of patella, and chondroplasty of the medial femoral condyle.

On February 16, 2016 employee was seen in consultation by Dr. Scott Galligos who stated the patient should be referred for a course of physical therapy. On February 29, 2016 employee was seen by Dr. Galligos complaining of sleep interference with persistent pain in the anterior and medial aspect of the left knee. Dr. Galligos recommended another MR arthrogram which was obtained on March 2, 2016. The scan revealed flap tear identified in the body of the medial meniscus with residual superficial oblique hyperintense signal suggesting residual tear, and small cartilage defects in the apex of the patella.

In follow-up with Barry Rineer, PA on March 10, 2016, the employee complained of persistent symptoms of knee pain and swelling and a locking sensation, he felt that a follow-up visit with Dr. Goodman was indicated. On March 23, 2016 Dr. Goodman assessed the employee as having a recurrent medial meniscal tear with mechanical symptoms. He felt that repeat surgical intervention was indicated.

On April 4, 2016, a second operative procedure consisted of left knee arthroscopy and debridement of medial meniscal tear, a left knee arthroscopy and chondroplasty of patella, chondroplasty of distal femoral condyle medially, and a left knee arthroscopy and debridement of plica and adhesions was performed by Dr. Goodman.

Subsequent to the second operative procedure, employee continued under the care of Dr. Galligos wherein on April 27, 2016 employee was prescribed a brace and ongoing physical therapy. In follow-up with Dr. Galligos for ongoing left knee pain on May 19, 2016 and again June 20, 2016 Dr. Galligos continued the employee in the brace and physical therapy. On July 25, 2016 Dr. Galligos recommend a trial of return to full duty status. On August 29, 2016 there was a discussion of proceeding with steroid injection therapy. In follow-up on September 12, 2016,

Issued by DIVISION OF WORKERS' COMPENSATION

Employee: Alan C. Rogers

Injury No. 15-093845

employee had developed symptoms of left calf pain and Dr. Galligos felt that an ultrasound was

warranted. On October 3, 2016 Dr. Galligos stated the employee had failed conservative treatment.

Employee was seen by Dr. Goodman on November 1, 2016 for persistent symptoms of left knee

pain and since the patient had undergone two operative procedures, he felt the only other

consideration would be a total knee replacement. In the interim, however, employee did undergo

a Synvisc injection provided by Dr. Goodman. On December 21, 2016 Dr. Galligos stated

employee continued to be symptomatic and ongoing postoperative conservative management was

provided. On January 4, 2017 Dr. Galligos stated the patient was discharged to full duty status. On

January 11, 2017, Dr. Goodman issued an opinion that the patient warranted a total knee

replacement but stating the meniscal pathology was work related, but the arthritis was not. He

opined the prevailing factor for the need for the total knee replacement was not work related.

Workers' Compensation officially denied the left total knee replacement on or about January 17,

1. Employee followed up with Dr. Goodman again on February 1, 2017 wherein Dr. Goodman

again stated he felt the employee warranted a total knee replacement. Employee testified at trial

that Dr. Goodman initially told him he was "going to try" to get the total knee replacement

"through on work comp."

Employee was seen by Dr. Mahnken on March 21, 2017. Dr. Mahnken felt employee

warranted a left total knee replacement. On April 21, 2017 employee underwent a left total knee

replacement performed by Dr. Mahnken. Employee underwent extensive postoperative therapy.

The employer/insurer officially denied the total knee replacement on or about January 17, 2017 so

employee was forced to seek the surgery on his own.

Independent Medical Examinations

On June 27, 2018 Dr. William Hopkins, a board-certified orthopedic surgeon, opined that

without a history of prior knee injuries or disabilities in employee's left knee, employee would not

necessarily have required a left knee replacement during his lifetime. Therefore, employee's left

knee injury on or about November 19, 2015 was the direct and prevailing factor. The November

19, 2015 work injury created a need for two arthroscopic operations on his left knee for a lacerated

medial meniscus followed by a left knee replacement. In addition, Dr. Hopkins stated that it would

be approximately eight weeks subsequent to a knee replacement that employee would be phys-

ically capable of returning back to his employment. Dr. Hopkins further opined, it is reasonably

likely that employee will, in his lifetime, require a revisional knee replacement as the direct and

prevailing factor of his November 19, 2015 accident when his life expectancy according to the

U.S. National Center for Health Statistics will be approximately 80 years of age.

On November 27, 2018, Dr. William Hopkins opined that with the meniscal tear requiring

initially a partial and later more significant removal of the medial meniscus, more and more weight

is transferred onto the previous non-symptomatic arthritic changes in his left knee which were

originally mild in character as described on his x-rays. The reason that the original operation was

performed was because of the impingement type pain from meniscal tears which can be quite

severe even with small tears. The consequence of the series of events is that minimal or

nonsymptomatic arthritic changes in a person's knee can become profoundly and increasingly

symptomatic when meniscal removal is required. This procedure results in a transfer of body

weight from the meniscus to the joint surface. In addition, it is recognized in the medical literature

that with a high incidence nonsymptomatic arthritic knees without meniscal abnormalities function

quite well and may not be symptomatic until the meniscus tear occurs. This is true particularly in

persons above 50 years of age who ultimately require knee replacements; however, the

Page 7

Issued by DIVISION OF WORKERS' COMPENSATION

Employee: Alan C. Rogers

Injury No. 15-093845

replacements are due to the meniscal injuries and has required surgical treatments. Further, Dr.

Hopkins stated that with an abundance of support from outside opinions in the medical literature

an arthritic knee with functioning menisci may never need additional treatment; however, when

the complication of a meniscus tear requiring removal occurs then unfortunately, the only

additional option to provide a functional knee is to perform a knee replacement. Therefore, Dr.

Hopkins further stated the injury that employee sustained on or about November 19, 2015 is the

direct and prevailing factor creating his left knee injuries and the ultimate need for a left total knee

replacement.

On August 31, 2020, Dr. James A. Stuckmeyer, an Orthopedic Surgeon with extensive

background in total joint replacements, opined that predating the accident occurring on November

19, 2015, employee was completely asymptomatic, which is confirmed by various physicians. He

was not actively seeking any treatment for his left knee. Further, Dr. Stuckmeyer stated while

chondroplasties may be indicated and appropriate, it is also possible that these chondroplasty

procedures caused further damage to the articular surface due to further disruption due to the

chondroplasty procedures. This is clearly evident in employee's case in that he did not do well

following either of these operative procedures. Employee then went from an asymptomatic knee,

required two separate surgical procedures including the chondroplasty procedures, and then

underwent a series of injection therapy, all of which was unsuccessful. Dr. Stuckmeyer stated "it

is noteworthy that not only did Dr. Goodman address the medial meniscal pathology, but also

performed chondroplasties of the medial compartment as well as patella femoral joint." Dr.

Stuckmeyer agreed with Dr. Hopkins that as a direct, proximate and prevailing factor of the

accident occurring on November 19, 2015, that employee did indeed require a left total knee

replacement. Dr. Stuckmeyer assessed a sixty percent (60%) permanent partial disability to the left

knee.

On December 16, 2019 Dr. Nathan Mall opined that the knee at the time of the January

2016 surgery already demonstrated signs of significant breakdown occurring and that this is not

uncommon. Further, he stated knee arthritis is a degenerative and progressive condition and

develops from a multitude of factors which include obesity, genetics, and alignment of the lower

extremity. Meniscal tears and cartilage breakdown are part of this degenerative process. These

occur due to mechanical factors as well as the degradative enzymes that are breaking down the

joint and cause a loss of water content in the cartilage making it more friable and easier to break

down. He stated a similar process occurs to the meniscus. Further, Dr. Mall opined the employee

denies any new injury after his initial injury but has what appears to be both new and residual

meniscal tearing as well as further breakdown of the joint. Dr. Mall goes on to state this is an

excellent demonstration of the biologic process that is occurring in employee's knee and very well

was the cause of the initial meniscus tear. This progression or breakdown of the knee is a biologic

process and unrelated to employee's work injury. Further, Dr. Mall stated he does not believe the

need for a total knee arthroplasty in any way flows from the work accident but is related to the

degenerative process that had already started prior to the work injury.

Dr. Mall seems to bolster employee's case that any "biological process" necessitating the

total knee replacement occurred after the work injury and was a result of the initial work injury.

On January 11, 2017, Dr. William Goodman stated he does not feel that the underlying

arthritis was the result of the work-related injury that occurred on November 19, 2015. He stated

specifically that the medial meniscus tear is part of the work injury, but the arthritis portion is not.

Page 8

Issued by DIVISION OF WORKERS' COMPENSATION

Employee: Alan C. Rogers

Injury No. 15-093845

Further, Dr. Goodman opined the employee's arthritis is the prevailing factor in the cause for

needing a left total knee arthroscopy and the arthritis is not part of the work injury.

Dr. Robert Mahnken did not specifically address causation in this case, but his record of

March 21, 2017 clearly outlines the work-related left knee surgeries and noted his pain was an 8

on a scale of 1 to 10. Dr. Mahnken also recommended total knee arthroplasty and ultimately did

perform that surgery noting "it is the most likely intervention to give him lasting relief." It is clear

he was recommending the total knee replacement to alleviate the pain generated from the work-

related injury.

On February 23, 2017 Dr. Scott Galligos opined the employee does have degenerative

change/arthritis to the left knee.

APPLICABLE LAW

Missouri Law provides, in pertinent part, that:

In addition to all other compensation paid to the employee under this section, the

employee shall receive, and the employer shall provide such medical, surgical,

chiropractic, and hospital treatment, including nursing, custodial, ambulance and

medicines, as may reasonably be required after the injury or disability, to cure and

relieve from the effects of the injury.

RSMo. Section 287.140.1

The legal standard for determining an employer's obligation to afford medical care is

clearly and plainly articulated in 287.140.1 as whether the treatment is reasonably required to cure

and relieve the effects of the injury. Tillotson v. St. Joseph Medical Center, 347 S.W.3d 511 (Mo.

App. W.D. 2011). Once it is determined that there has been a compensable accident, a claimant

need only prove that the need for treatment and medication flow from the work injury. Bowers v.

Hilland Dairy Co. 188 S.W.3d 79 (Mo. App. S.D. 2006).

The employee had no prior complaints, issues, surgeries or problems of any kind prior to

the work injury of November 19, 2015. Following that injury, he had two unsuccessful surgeries

to the knee both paid for by the employer/insurer. The need for the total knee replacement flowed

from the injury and those two surgeries.

Present Complaints

At the hearing, employee testified that he has swelling in the left knee, a constant dull

aching pain in the left knee, and periods of time with sharp pain in the knee. He has some type of

pain every day. In addition, employee testified that he had atrophy of the left quadricep and that

he walked with a limp. He has problems kneeling, jumping, or running. He also has difficulties

walking for long distances. He is allowed at work to make accommodations for himself. He avoids

climbing ladders if at all possible and limits kneeling. He testified he loves his employer and loves

working for them and they are great about letting him accommodate. He's not sure he could work

Page 9

The parties stipulated that a compensable accident occurred on November 19, 2015 when employee injured his left lower extremity, knee.

The first major issue to address is whether or not the total knee replacement which employee had was necessitated by the work-related injury. The employee testified that he did not have any prior problems whatsoever with his left knee. He had never treated his left knee, had pain or problems in his left knee, or had to accommodate any type of activities in his personal or work life because of any issues with his left knee. There is no dispute following the work-related injury of November 19, 2015 he underwent two surgeries, which were authorized and paid for by employer/insurer in this case. The surgeries consisted of a left knee scope and debridement of medial meniscal tear, chondroplasty of patella, chondroplasty of the distal medial femoral condyle, and debridement of the plica, as well as debridement of adhesions. Again, both of these procedures were authorized and paid for by the employer/insurer in this case. It was only after Dr. Goodman, based on continued complaints by the employee, recommended a left total knee replacement, did the employer/insurer deny further treatment.

I believe that it is clear from the opinions of Dr. Stuckmeyer and Dr. Hopkins, as well as the Tillotson case, the employee's left total knee replacement was in fact necessitated by the work injury on November 19, 2015. There was no medical evidence presented that the employee had any prior injuries or conditions with the left knee which would have led to his need for a total knee arthroplasty in the future but for the work injury of November 19, 2015.

The employee testified to ongoing complaints of swelling and pain on a constant basis, as well as atrophy of the left quadriceps. Employee testified he makes significant accommodations for himself at work. These accommodations are significant enough that employee is not sure he could work anywhere else with these accommodations. I believe that Dr. Stuckmeyer's assessment of permanent partial disability is a fair representation of the employee's disability and I find that the employee suffered a permanent partial disability of sixty percent ( 60 % ) to the left knee.

Having heard and seen the employee and carefully listened to his testimony, I find employee's testimony very credible. I find employee's testimony to be genuine, honest, reliable, and trustworthy. Employee's testimony highlighted above was not significantly challenged or called into question. In addition, the physical job tasks testified to by employee were not disputed by employer/insurer. I find employee's testimony is persuasive and credible to support his disability. Additionally, I find employee's testimony is validated by the objective findings in the medical records and the conclusions of the expert witnesses who testified.

I find the reports of Dr. Stuckmeyer and Dr. Hopkins much more persuasive, more credible and much more consistent with the medical records and consistent with employee's testimony.

I believe that employee proved his case and is entitled to future medical care as a result of an implantation of the total knee arthroplasty and the opinions of Dr. Stuckmeyer and Dr. Hopkins

Employee: Alan C. Rogers

Injury No. 15-093845

that it may need to be replaced or a revision surgery would be required in his lifetime, therefore, I am leaving future medical open.

I also find that the employee afforded the opportunity to the employer/insurer to provide and pay for the total knee replacement as it had done with the two prior left knee surgeries. In January of 2017 the employee was notified of the total knee replacement and was not authorized and employee sought treatment on his own. The employee testified properly pursuant to the *Mid America case* and I find that employee is entitled to the payment of $31,966.07. The parties stipulated prior to trial that if this amount was awarded, employer/insurer agree to pay this directly to the employee.

In addition, I also find that the employee was kept off of work for eight weeks following the total knee replacement by Dr. Mahnken, and this is a reasonable amount of time for temporary total disability. Therefore, I award employee eight weeks of temporary total disability.

The employee's attorney has requested a 25% attorney's fee, which I find to be reasonable, and as a result, I allow employee's attorney, Thomas P. Carlton, an attorney fee of 25% of all amounts awarded herein, plus expenses incurred by way of trial which shall constitute a lien upon this Award. This is a reasonable fee for necessary legal services provided to employee.

By ***_******_******_***_____