June 14, 2011
FACTS: Claimant worked as a registered nurse for the Employer. On January 7, 2006, claimant injured her right knee while she was assisting a co-worker moving a patient. Claimant continued to work but eventually the pain became too severe. The Employer authorized treatment initially with Dr. Michael Perll. The doctor ordered an MRI and diagnosed a torn lateral meniscus and degenerative changes involving the medial meniscus related to arthritis. Subsequently, claimant was referred to an orthopedic surgeon, Dr. Gregory Van den Berghe. That doctor concurred with Dr. Perll’s diagnosis. It was his opinion that both the lateral torn meniscus and claimant’s arthritis were contributing to her pain. Dr. Van den Berghe recommended a total knee replacement as opposed to arthroscopic surgery since the total knee would provide her with more lasting relief.
The Employer then referred claimant for a second opinion with Dr. Daniel Stechschulte. The doctor confirmed the diagnosis of torn lateral meniscus and degenerative arthritis of the right knee. It was his opinion that arthroscopic surgery, which would generally be used to repair the meniscus tear, would not be recommended for someone with severe arthritis. Dr. Stechschulte also recommended a total knee but was of the opinion that claimant’s pre-existing arthritis was the “major prevailing factor for the need for surgery”.
Although the Employer accepted claimant’s meniscus tear as related to the work accident, based on the evaluation and opinions of Dr. Stechschulte’s, it refused any further medical care including the total knee replacement.
Claimant, however, did eventually undergo a total knee replacement. After surgery, she remained at the Employer working full duty with no restrictions until her planned retirement in October of 2007. In November 2007, she filed a worker’s compensation claim seeking benefits for her work injury including reimbursement for the cost of the total knee surgery, future medical for her right knee, TTD, and permanent partial disability. At hearing, claimant entered the testimony of her evaluating physician, Dr. Brent Koprivica, who agreed with the previous physicians as to diagnosis and treatment. Dr. Koprivica, however, opined that the January 7, 2006, work accident “destabilized” claimant’s right knee causing an “aggravation and progression” of the pre-existing arthritis. In the doctor’s opinion, this resulted in the injury being the prevailing factor in causing the need for the total knee replacement.
FINDINGS: In its Final Award, the Commission found that claimant did sustain a compensable work accident, specifically an acute lateral meniscus tear. However, the Commission, in a 2 to 1 decision, denied any additional benefits beyond what the Employer had previously paid because it found that the work accident was not the prevailing factor in causing the need for claimant’s knee replacement. The Commission instead found that the cause of her knee replacement, time off of work, and any disability was related to her pre-existing degenerative arthritis. Although the Court of Appeals, Western District, affirmed the Commission’s finding of compensable accident, the Court reversed the Commission’s denial of benefits. The Court further remanded the case back with instructions to award benefits consistent with its opinion including medical, future medical, TTD, and permanent partial disability. The Court found that once claimant was able to show she had sustained a compensable work accident, the proper standard under 287.140.1 was not the prevailing factor test but rather whether the treatment was reasonably required to cure and relieve claimant from her compensable injury. As the Court summarized, the medical evidence was uncontested that claimant’s total knee replacement was reasonably required and she was entitled to an award of benefits necessitated by that surgery.