ARCTEC Alaska v. Traugott, 060618 AKWC, 249

Docket Nº:Decision 249
Case Date:June 06, 2018
ARCTEC Alaska, Appellant,
Joseph Traugott, Appellee.
Decision No. 249
AWCAC Appeal No. 17-015
AWCB Decision No. 17-0103
AWCB No. 201309316
Alaska Workers’ Compensation Appeals Commission
June 6, 2018
         Final decision on appeal from Alaska Workers’ Compensation Board Final Decision and Order No. 17-0103, issued at Fairbanks, Alaska, on August 29, 2017, by northern panel members Ronald P. Ringel, Chair, and Jacob Howdeshell, Member for Labor.          Commission proceedings: Appeal filed September 12, 2017, with motion for stay; motion for stay granted November 2, 2017; briefing completed February 7, 2018; oral argument held on February 23, 2018.           Robert J. Bredesen, Hillside Law Office, LLC, for appellant, ARCTEC Alaska.           Eric Croft, The Croft Law Office, for appellee, Joseph Traugott.           Commissioners: James N. Rhodes, S. T. Hagedorn, Deirdre D. Ford, Chair.           FINAL DECISION           Deirdre D. Ford, Chair.          1. Introduction.          Appellee, Joseph Traugott, was diagnosed with diabetes in 2002 and, subsequently, developed several medical issues. Appellant, ARCTEC Alaska (ARCTEC), hired Mr. Traugott in March 2013. In May 2013, he developed a small blister in the middle arch of his right foot, which he believes was caused by standing on ladders at work. The blister healed, but he then developed a crack on the same foot for which in July 2013 he was hospitalized for cellulitis of the foot. Following a series of interlocutory decisions and orders, the Alaska Workers’ Compensation Board (Board) issued a final decision and order on August 29, 2017, finding Mr. Traugott’s need for ongoing medical treatment was substantially caused by his work with ARCTEC.[1] ARCTEC timely appealed contending the Board applied an incorrect legal standard. The Alaska Workers’ Compensation Appeals Commission (Commission) heard oral argument on February 23, 2018. The Commission now reverses the Board’s decisions, finding the Board erroneously applied an incorrect interpretation in looking at whether Mr. Traugott’s work for ARCTEC was “in relation to other causes . . . the substantial cause of the . . . need for medical treatment” as stated in AS 23.30.010(a).          2. Factual background and proceedings.2          Mr. Traugott was diagnosed with diabetes in 2002.[3] On August 9, 2004, Mr. Traugott reported a sore on his toe that was healing. A photograph of what appeared to be an open sore on Mr. Traugott’s right big toe has a notation stating “old blister from shoes.”4 On February 7, 2005, the medical record noted Mr. Traugott’s toe had “completely healed over from 8/04.”[5] Mr. Traugott, on April 25, 2005, reported an infection on his left big toe.6          By September 22, 2005, Mr. Traugott complained of a right big toe infection, which began five days earlier, and he was placed on oral antibiotics.7 Mr. Traugott saw Patrick Crawford, D.P.M., on October 3, 2005, who reported that while working in Alaska, Mr. Traugott had a callus that broke down, developing a neurotrophic ulcer on his right big toe, but with no evidence of bony involvement.8 The October 26, 2005, chart note indicated Mr. Traugott’s right big toe was better, but needed debridement.9          On January 5, 2006, Mr. Traugott’s right big toe ulcer was found to be infected with streptococcus.10 Mr. Traugott was seen in follow up for his right big toe after someone had stepped on it, on January 9, 2006. The toe appeared infected, and Mr. Traugott was placed on oral antibiotics.11 The right big toe was healed by March 8, 2006.12          On September 6, 2006, Dr. Crawford diagnosed possible Charcot foot (Charcot neuroarthopathy) in Mr. Traugott’s right foot.13          Mr. Traugott was diagnosed with neuropathy on August 11, 2007.14 Neuropathy, or peripheral neuropathy, is a disruption in the function of peripheral nerves, commonly due to diabetes. It most often involves nerves related to sensation or proprioception.[15] When a person develops neuropathy, their skin stops producing the oils that lubricate the skin and they do not sweat. Because they do not feel damage to the skin, they are at risk of skin ulcers.16 Mr. Traugott, on October 15, 2008, reported continued pain in both feet, some of which was determined to be nerve-related.17          On February 4, 2010, an x-ray revealed evidence of joint destruction in Mr. Traugott’s right foot. Dr. Crawford diagnosed Charcot neuroarthopathy in Mr. Traugott’s right mid-foot. He noted that the second toe on Mr. Traugott’s right foot was a hammer toe.[18] Charcot neuropathy or Charcot foot is a condition that occurs in a small percentage of individuals with neuropathy. It appears as inflammation in a joint or bone, and the foot gets red, swollen, and looks infected, but there is no organism present. During the inflammation stage, the bones begin to crumble and fall apart. It is unknown why Charcot foot occurs. A flare up of Charcot foot may lead to a deformity causing an abnormal weight-bearing surface. These abnormal weight-bearing surfaces are at additional risk of ulceration because the skin breaks down very easily.[19] Hammer toe can develop as a result of neuropathy. The damage to the nerve causes an imbalance in the muscles of the toe, causing the toe to curl.20          Dr. Crawford, on May 2, 2011, noted Mr. Traugott’s hammer toe had become infected and recommended surgery to correct the condition.21 The chart note indicated on the same day that Mr. Traugott had decreased sensation to touch in both legs.22 Dr. Crawford, on May 5, 2011, stated the infection in Mr. Traugott’s toe was a staphylococcus infection.23 Dr. Crawford stated, on May 16, 2011, he would schedule surgery to correct Mr. Traugott’s hammer toes.24 However, due to unrelated medical complications, the surgery on Mr. Traugott’s toes was not performed until May 29, 2012, when Dr. Crawford fused the joints in the second and third toes on Mr. Traugott’s right foot using internal fixation.25 On May 21, 2012, Mr. Traugott reported the lesions on his toe had increased in size, and he was diagnosed with a diabetic ulcer and bone infection (osteomyelitis).26 On June 21, 2012, the infection in Mr. Traugott’s second toe was found to be staphylococcus.27 However, on July 23, 2012, Mr. Traugott was released to work following the hammer toe surgery.28 By August 3, 2012, Mr. Traugott had a staphylococcus infection in his right third toe.29          ARCTEC hired Mr. Traugott in March 2013, and at the time of hiring he was given a physical examination. He was approved for work without restriction, but was notified he should consult his doctor because his pulmonary function test was abnormal. Mr. Traugott worked about three weeks at the Indian Mountain site before being transferred to Tin City. While at Tin City, Mr. Traugott primarily worked replacing heating and cooling systems. The work was six days per week, at least 10 hours per day. Most of the work was overhead, requiring him to spend significant time standing on ladders. Mr. Traugott testified standing on the ladders caused pressure on the middle of his feet.30          In the middle of May 2013, Mr. Traugott developed a blister, smaller than the size of a dime, located in the middle of the arch of his right foot toward the outside. He believed the blister was caused by the pressure on his foot while standing on ladders. Mr. Traugott did not seek medical attention and did not report the injury. He treated the blister himself by keeping it clean and did not use any antibiotics. The blister healed and went away within a couple of weeks.[31]          On July 5, 2013, the skin on the sole of Mr. Traugott’s right foot cracked open within an inch of where the blister had appeared in May. There was a fetid discharge. Because there are no medical facilities at Tin City, ARCTEC flew Mr. Traugott to Nome the next day.32 He was hospitalized in Nome with an initial diagnosis of cellulitis of the foot, secondary to diabetes. He reported that, while he had no recent injury to the foot, he had been experiencing foot problems for about a week.33 Following its usual practice to report all injuries whether compensable or not, ARCTEC, on July 9, 2013, filed a report of occupational injury or illness.34          Mr. Traugott was discharged from Norton Sound Regional Hospital on July 11, 2013, with a diagnosis of moderately severe cellulitis. X-ray and CT scans showed a soft tissue ulcer with no evidence of osteomyelitis, although the possibility of osteomyelitis remained a concern. Wound and blood cultures were negative, suggesting an anaerobic infection. The wound was debrided, and Mr. Traugott was to...

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