Opinion
CLAIM NO. F014289
OPINION FILED MARCH 11, 2002
Upon review before the FULL COMMISSION in Little Rock, Pulaski County, Arkansas.
Claimant represented by the HONORABLE PAUL E. KEITH, Attorney at Law, Monticello, Arkansas.
Respondents represented by the HONORABLE ROBERT H. MONTGOMERY, Attorney at Law, Little Rock, Arkansas.
Decision of the Administrative Law Judge: Affirmed.
OPINION AND ORDER
The respondents appeal a decision by the Administrative Law Judge finding that the claimant proved by a preponderance of the evidence that his total knee replacement was reasonable and necessary medical treatment for the claimant's work-related knee injury sustained on November 1, 2000. Based upon our de novo review of the record, we affirm the decision of the Administrative Law Judge.
The claimant was employed by the respondent employer as the Executive Director. On November 1, 2000, the claimant and another person came to Little Rock to pick up some food at a food bank and supplies at a federal supply facility. At the first stop, the supplies, which included a storage cabinet, were secured. These supples were loaded onto the back of a pickup truck. The claimant then traveled to the food bank to get some supplies. While in the process of rearranging the supplies already in the back of the truck, the claimant fell off the tailgate of the truck and landed on his right knee. The claimant twisted his knee, fell to the ground, and also injured his left elbow. An ambulance was called and took the claimant to the VA Hospital, where he received emergency medical treatment. The claimant was later discharged with instructions to use crutches, have his prescriptions filled, and follow-up with his local physician.
On November 3, 2000, the claimant sought medical treatment from Dr. Sandra Huey, a Monticello general practitioner. The claimant again saw Dr. Huey on November 9, 2000, who referred the claimant to Dr. Charles Clark, an orthopaedic surgeon at South Arkansas Orthopaedic Center, on November 16, 2000. Dr. Clark diagnosed the claimant with severe bilateral degenerative arthritis in both knees, with the right knee exacerbated by the twisting injury from November 1, 2000. Dr. Clark tentatively scheduled the claimant for a right knee replacement in December 2000.
The claimant continued receiving his regular salary through December 29, 2000, at which time he was taken off work due to medical reasons. The claimant testified that he was unable to perform his regular job duties, as a result of taking Oxycontin medication.
From January 2001 through May 2001, the claimant remained off work. On March 19, 2001, the claimant underwent surgery in the form of a total right knee replacement. On June 1, 2001, the claimant returned to the respondent employer as Executive Director.
The claimant now contends that he is entitled to have the right knee replacement surgery paid for by the respondent employer. Specifically, the claimant contends it is reasonable and necessary medical treatment. The claimant is also seeking temporary total disability benefits for the period January 1, 2001 through May 31, 2001. The respondents contend that the claimant's long-standing knee problems and previous injuries were more likely than not responsible for the claimant's need for total knee replacement rather than the job-related injury of November 1, 2000.
Claimant has the burden of proving by a preponderance of the credible evidence that medical treatment is reasonable and necessary. Norma Beatty v. Ben Pearson, Inc., Full Workers' Compensation Commission, Opinion filed February 17, 1989 (W.C.C. No. D612291); B.R. Hollingshead v. Colson Caster, Full Workers' Compensation Commission, Opinion filed August 27, 1993 (W.C.C. No. D7033346). Employers are only liable for medical treatment and services which are deemed reasonably necessary for the treatment of employees' injuries. DeBoard v. Colson Co., 20 Ark. App. 166, 725 S.W.2d 857 (1987). In workers' compensation cases, the burden rests upon the claimant to establish his claim for compensation by a preponderance of the evidence. Kuhn v. Majestic Hotel, 50 Ark. App. 23, 899 S.W.2d 845 (1995); Bartlett v. Mead Container Board, 47 Ark. App. 181, 888 S.W.2d 314 (1994). When assessing whether medical treatment is reasonably necessary for the treatment of a compensable injury, we must analyze both the proposed procedure and the condition it is sought to remedy. Deborah Jones v. Seba, Inc., Full Workers' Compensation Commission, Opinion filed December 13, 1989 (W.C.C. No. D512553).
A preexisting disease or infirmity does not disqualify a claim if the employment aggravated, accelerated, or combined with the disease or infirmity to produce the disability for which compensation is sought.See, Nashville Livestock Commission v. Cox, 302 Ark. 69, 787 S.W.2d 664 (1990); Minor v. Poinsett Lumber Mfg. Co., 235 Ark. 195, 357 S.W.2d 504 (1962); Conway Convalescent Center v. Murphree, 266 Ark. 985 588 S.W.2d 462 (Ark.App. 1979); St. Vincent Medical Center v. Brown, 53 Ark. App. 30, 917 S.W.2d 550 (1996). As is commonly stated, the employer takes the employee as he finds him. Murphree, supra. In such cases, the test is not whether the injury causes the condition, but rather the test is whether the injury aggravates, accelerates, or combines with the condition. However, although a disabling symptom of a preexisting condition may be compensable if it is brought on by an accident arising out of and in the course of employment, the employee's entitlement to compensation ends when his condition is restored to the condition that existed before the injury unless the injury contributes to the condition by accelerating or combining with the preexisting condition. See,Arkansas Power Light Co. v. Scroggins, 230 Ark. 936, 328 S.W.2d 97 (1959).
In the present case, the dissent asserts that the claimants work-related injury ultimately resolved and his preexisting arthritis caused his need for knee replacement surgery. We agree that there is no dispute that the claimant had long-standing knee problems. In fact, over the preceding 30 years, he has had a total of five operations on both of his knees. Also, for a period of about 15 years prior to the injury, he had been taking medications to combat chronic knee swelling and pain.
However, we also point out that the only medical opinion presented as to the reasonableness and necessity of the claimant's knee replacement surgery was the opinion of Dr. Charles Clark. In a report dated November 16, 2000, Dr. Clark detected palpable catching in the claimant's knee that he attributed to a dislodged fragment of arthritic debris. Dr. Clark went on to state that the claimant's treatment options were limited and that he needed a knee replacement. The doctor concluded that there were no other forms of intervention that would provide relief. In a subsequent report dated March 29, 2001, Dr. Clark stated that while the claimant's job-related accident did not cause degenerative arthritis, the accident aggravated the underlying condition.
The only medical evidence offered in this case clearly establishes that the claimant's job-related injury aggravated a preexisting arthritic condition and the procedure necessary to treat this aggravation was knee replacement surgery. While the dissent notes that the claimant was going to likely need knee replacement surgery at some point in the future, we point out that the claimant was functioning prior to the November 1, 2000 fall, and this fall has accelerated when the claimant needed knee replacement surgery. Accord Wackenhut Corp. v. Jones, 73 Ark. App. 158, 40 S.W.3d 333 (2001); Janet Roberts v. Baxter International, Full Workers' Compensation Commission, Opinion filed April 12, 2001 (W.C.C. No. E714892); Donald P. Busbea v. W. Roper Construction, Full Workers' Compensation Commission, Opinion filed April 20, 1998 (W.C.C. No. D409144).
Therefore, after conducting a de novo review of the entire record and for the reasons discussed herein, we affirm the Administrative Law Judge's finding that knee replacement surgery was reasonably necessary to treat the claimant's November 1, 2000 knee injury. The respondents are directed to comply with the Administrative Law Judge's award of benefits.
All accrued benefits shall be paid in a lump sum without discount and with interest thereon at the lawful rate from the date of the Administrative Law Judge's decision in accordance with Ark. Code Ann.§ 11-9-809 (Supp. 2001).
For prevailing on this appeal before the Full Commission, the claimant's attorney is hereby awarded an additional attorney's fee in the amount of $250.00 in accordance with Ark. Code Ann. § 11-9-715 (Supp. 2001).
IT IS SO ORDERED.
______________________________ ELDON F. COFFMAN, Chairman
______________________________ SHELBY W. TURNER, Commissioner
Commissioner Yates dissents.
DISSENTING OPINION
I respectfully dissent from the majority opinion finding that the claimant proved by a preponderance of the evidence that his total knee replacement was reasonable and necessary medical treatment. Based upon myde novo review of the record, I would reverse the decision of the Administrative Law Judge.
In my opinion, the claimant has failed to meet his burden of proof. The medical evidence shows that the claimant has long-standing knee problems. The claimant suffered a knee injury at least twice while he was in the Air Force from 1962 through 1967. The claimant has undergone a total of five arthroscopic procedures on both knees over the years. The claimant concedes he has used prescription medication since undergoing those arthroscopic procedures. The claimant characterized the pain as intermittent, with symptoms of swelling and pain in the knees. The claimant has also received a diagnosis of degenerative arthritis on both knees by the physicians at the VA Hospital prior to the work-related incident. Specifically, Dr. Goodman, who is the claimant's treating physician at the VA Hospital, stated that the claimant would require a total knee replacement at some point in the future. The claimant has never been pain-free over the last 30 years. The claimant is obese, weighing 290 pounds, and 6'1" tall. The evidence reflects that the claimant has pre-existing severe degenerative arthritis in both knees.
Therefore, for all the reasons set forth herein, I find that the total knee replacement surgery is not reasonable and necessary medical treatment. Accordingly, I must respectfully dissent from the majority opinion.
_______________________________ JOE E. YATES, Commissioner