Opinion
CLAIM NO. E410502
OPINION FILED MAY 2, 1996
Upon review before the FULL COMMISSION in Little Rock, Pulaski County, Arkansas.
Claimant represented by KELLY M. TIDWELL, Attorney at Law, Texarkana, Texas.
Respondents represented by WILLIAM G. BULLOCK, Attorney at Law, Texarkana, Texas.
Decision of Administrative Law Judge: Affirmed.
OPINION AND ORDER
An administrative law judge entered an opinion and order in the above-captioned case on May 10, 1995, finding that on February 10, 1994, claimant Tony Sanders sustained a compensable recurrence of a previous work-related injury. Respondent now appeals from that opinion and order, contending that the February 10 episode was not work-related but occurred as the result of an idiopathic fall. Following our de novo review of the entire record, we find that claimant has proven that he did indeed sustain a compensable recurrence on February 10, 1994. The administrative law judge's findings must therefore be affirmed.
Claimant, a forklift driver for respondent Cooper Tire, sustained a work-related injury on September 15, 1993, when he received a lateral blow to the right knee from a stock-laden moving skid. About one week later, Dr. Craig Ditsch initially determined that claimant had suffered a "contusion" to the knee, and began a course of conservative treatment which included medication. Though he never missed any work as result of the September 15 injury, claimant's medical records reveal that he continually experienced difficulties with his knee. These problems included swelling, a burning sensation, and "buckling of the knee."
Dr. Ditsch's office notes reveal that claimant returned for an evaluation on October 8, at which time he reported migrating pain in his knee accompanied by instability. Following an "equivocal" MRI on October 13, Dr. Ditsch referred claimant to Dr. Mark Young, an orthopedic surgeon, for further evaluation. Claimant remained on pain medication during this time.
Claimant first consulted Dr. Young on October 25, 1993, who confirmed Dr. Ditsch's initial assessment of a contusion to the right knee and also noted an associated bone bruise to the right tibia. Dr. Young maintained conservative treatment and, noting some improvement, elevated claimant to "full activity" on November 29, 1993. However, in that same report, Dr. Young also noted that claimant's pain was still "lingering."
Claimant thereafter made additional visits to Dr. Ditsch on December 10, 1993, and January 10, 1994 — at which time he reported that his knee was "about the same." Throughout the course of his consultations with Drs. Ditsch and Young, claimant continued to try and manage his pain with medication.
On February 10, 1994, with the prior injury still unresolved, claimant fell on his right knee when he attempted to climb onto his forklift:
"Just when I went to step up on the fork, my knee buckled and I went out. I fell back and my leg was pinned underneath me. I couldn't get up." (Emphasis added).
At some point during his fall from the forklift, claimant passed out.
Following this event, claimant again consulted Dr. Ditsch on March 4, 1994, and complained that his knee was now "hurting him like it did before." Dr. Ditsch suggested a return visit to Dr. Young, who recommended NSAID treatment and physical therapy, neither of which were able to resolve claimant's knee pain over time. Dr. Young's records indicate that by March 28, claimant's continued complaints of medial joint line pain suggested a medial meniscal lesion. On April 26 claimant underwent a right knee arthroscopic debridement, after which his right knee problems ceased.
I.
Respondent cites claimant's occasional failure to take insulin and physician reports indicating he may have passed out from "stress" as sufficient cause to categorize the February 10, 1994 fall as an idiopathic one — or one caused by a reason personal to claimant and not related to his prior injury or employment. On the evidence before us, we are unable to agree with this conclusion.
We specifically find claimant's testimony in this case to be credible, and we note his statement that during the February 10, 1994 fall, his knee buckled before he "went out." Claimant also stated that one of his problems following the initial compensable injury and prior to the February 10 fall was a "buckling of the knee." Finally, claimant testified that he had consistent problems and weakness in his knee during each of the months between the September 15, 1993 injury and the February 10, 1994 fall.
It is true that claimant is diabetic, and some testimony was offered that he did not always take his insulin as prescribed. Respondent suggests that claimant's failure to do so may have contributed to his passing out. However, there are no medical records of insulin-related diabetic complications accompanying the February 10, 1994 episode. Furthermore, the physician reports which suggest that stress played a role in causing the blackout appear to be no more than speculation.
We are thus persuaded that the operative fact is that claimant's knee buckled before he passed out, and we find the evidence insufficient to support the contention that the blackout itself, for whatever reason it occurred, played a role in causing his fall or subsequent increased knee difficulties. In turn, we also find that claimant's February 10, 1994 fall was not idiopathic.
II.
Claimant's aforementioned testimony, taken in conjunction with the medical evidence, also demonstrates a causal connection between his February 10, 1994 fall and his original compensable injury of September 15, 1993. Both sources of evidence reveal that claimant's knee problem was continuing and had failed to resolve prior to February 10, 1994. Dr. Young, in a May 13, 1994 letter to Ricky Norton of Cooper Tire, corroborates claimant's testimony regarding his continuing problems:
"Tony had initially injured his knee on September 15, 1993. The patient bent his right knee in a valgus related force. The patient was treated conservatively and had some progression, however, the patient was never totally without knee related problems. . . It was believed that the patient had a meniscus related problem. The patient was sent back to me. I reexamined Mr. Sanders and thought that that was a most definite possibility. The patient underwent arthroscopic debridement. . . In summary Ricky, Tony had originally hurt his knee in a work related accident. He had residual problems. He was sent in an attempt to rehab his right knee. This was unsuccessful. Patient was sent back to me and underwent arthroscopic surgery with noted encountered pathology with subsequent debridement." (Emphasis added).
The continuity of his knee problems, the nature of his complaints, and Dr. Young's comments all convince us to find that claimant's fall of February 10, 1994, was causally connected to his initial compensable right knee injury suffered on September 15, 1993.
Accordingly, based on our de novo review of the entire record, and for the reasons set forth herein, we specifically find that claimant Tony Sanders has proven by a preponderance of the credible evidence that on February 10, 1994, he suffered a compensable recurrence of his work-related right knee injury of September 15, 1993. We therefore order all accrued benefits to be paid in 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 (1987). For prevailing on this appeal before the Commission, claimant's attorney is hereby awarded an additional attorney's fee in the amount of $250.00.
IT IS SO ORDERED.
DISSENTING OPINION
I respectfully dissent from the majority's opinion finding that the claimant has proven that he sustained a compensable recurrence on February 10, 1994. I would reverse the Administrative Law Judge's findings that the claimant's February 10, 1994 knee injury is compensable. In my opinion, the claimant had a new injury on February 10, 1994 which is not causally related in any way to his February 15, 1993 compensable knee injury. Moreover, it is my opinion that the claimant has failed to prove by a preponderance of the evidence that his fall on February 10, 1993 was anything other than idiopathic. Subsequent to the September 15, 1993 compensable injury and prior to the February 10, 1994 incident, the claimant was examined by both Dr. Craig Ditsch and Dr. Mark Young. The examinations by these physicians, which did include an MRI, failed to reveal any instability in the claimant's knee. Although the claimant experienced swelling and tenderness, there was no inter-articular pathology prior to the February 10, 1994 incident.
Form AR-N signed by the claimant on the day of his injury simply describes the cause of the claimant's injury as "past out". In the AR-N completed by the claimant for his September 15, 1993 injury the claimant went into great detail when asked to briefly describe the cause of his injury. Such detail is lacking from the February 10, 1994 AR-N Form. The claimant merely described the cause of his right knee injury as passing out. Moreover, the February 29, 1994 medical record of Dr. David Fisher provides a history of the February 10th incident as follows: "Additionally, the patient relates that on 2-10-94 he passed out and fell to the ground striking his right his knee." In addition, the March 4, 1994 medical record of Dr. Ditsch states, "[H]e claims that on the 10th of February, about three weeks ago, he `passed out' at work and fell on his right knee. This is the same knee that was bothering him before. Apparently, it was not his [blood sugar] causing him to pass out. Mr. Sanders says it was stress." The claimant made absolutely no mention of his knee buckling when relating the history of the February 10, 1995 injury on either the AR-N or during his visits with Dr. Fisher and Dr. Ditsch. Moreover, the testimony of Lionel Joe Thomas, the claimant's supervisor, revealed that the claimant advised Mr. Thomas that he passed out due to his failure to take his medicine. (T. 23-24) Thus, the credible evidence of record clearly reveals that the claimant's fall was idiopathic in nature and not related to his previous injury. In Nu-Way Laundry Cleaners v. Palmer, 12 Ark. App. 31, 670 S.W.2d 464 (1984), the Arkansas Court of Appeals held that an idiopathic fall is not compensable unless the employment circumstances significantly added to the risk of the fall from the idiopathic condition. Clearly, the claimant's employment circumstances did not significantly add to the risk of the claimant passing out while at work. It was not until the claimant began seeking compensation for his knee condition subsequent to the February 10, 1994 that he began asserting that his right knee buckled. There is simply insufficient evidence in the record to support the claimant's contention. Moreover, the claimant's condition subsequent to the February 10, 1994 incident are significantly different than the claimant's condition prior to that fall. It was not until after the February fall that the claimant required arthroscopic surgery. Both Dr. Fisher and Dr. Young noted medial meniscal pathology as a result of the February injury. (See Dr. Fisher's notes dated March 29, 1994 and Dr. Young's notes dates April 18, 1994). These new findings after February 10, 1994 cannot and have not been related in anyway to the claimant's compensable September 15, 1993 injury. For all these reasons, I find that the claimant has failed to prove by a preponderance of the evidence that the February 10, 1995 incident is compensable. Therefore, I respectfully dissent from the majority opinion.
ALICE L. HOLCOMB, Commissioner