In re Claim of Thomas, 111320 COWC, 5-064-928

Docket Nº:W.C. 5-064-928, 5-101-704
Case Date:November 13, 2020
PINNACOL ASSURANCE, Insurer, Respondents.
W.C. Nos. 5-064-928, 5-101-704
Colorado Workers Compensation
Industrial Claim Appeals Office
November 13, 2020
          THE FRICKEY LAW FIRM, Attn: ERIN B MONTGOMERY ESQ, (For Claimant)           RUEGSEGGER SIMONS & STERN LLC, Attn: TAYLOR LEONARD ESQ, (For Respondents)          FINAL ORDER          The claimant seeks review of an order of Administrative Law Judge Cannici (ALJ) dated March 12, 2020, that denied and dismissed claimant’s request for a total left knee arthroplasty. We affirm.          The ALJ conducted an evidentiary hearing on February 6, 2020, on whether a recommended total knee replacement is reasonable, necessary, and causally related to either his July 28, 2016 or October 26, 2017 admitted injuries. The ALJ established findings of fact which are summarized below.          July 28, 2016 accident          Claimant worked as a mechanic for the employer. On July 28, 2016, claimant was kneeling down replacing brakes on a semi-truck. A tire weighing over 300 pounds and 52 inches tall fell off the truck and landed on claimant’s left leg Claimant was freed from underneath the tire by two coworkers.          On July 29, 2016, claimant was evaluated at Concentra Medical Centers. Claimant reported pain in his left foot and toes. His chief complaint was a “crush injury to the left foot.” He did not report any pain in his left knee The doctor diagnosed a crush injury of the left foot and a left foot sprain. The doctor prescribed physical therapy (PT) and released claimant to return to work.          Claimant returned to Concentra for a follow-up appointment on August 1, 2016, and was evaluated by FNP Meier and Dr. Nystrom. It was noted the left foot was improving. Claimant did not report injuring his left knee or experiencing any pain in this left knee. PT was again prescribed for his left foot.          PT commenced on August 1 at the Concentra facility. Claimant reported that a semi-truck tire fell on his heel and smashed his foot and toes. The therapist noted that claimant’s symptoms were located specifically in the first and second toes of the left foot. Claimant did not report injuring his left knee or having pain in his left knee to the therapist. Claimant went back to Concentra on August 15 for left “foot/toe pain.” Claimant did not report left knee pain and his gait was normal.          Claimant was next evaluated on March 21, 2017, by Dr. Nystrom for a “recheck of left foot/ankle.” Claimant told the doctor that his “ankle, calf, and knee [were] starting to feel the pain now and his knee was beginning to swell.” Claimant was referred for a consultation with Dr. Jackson which took place on April 4, 2017. Dr. Jackson recounted claimant’s report of having a “truck tire fall on his left heel” nine months earlier. The event caused some “intermittent various aches and pains of his left foot and ankle.” Claimant did not report injuring or experiencing pain in his left knee.          On April 26, 2017, claimant was again seen by Dr. Nystrom. Claimant commented that he had experienced “some left knee pain with the injury to his foot but [had not] focused on that because his foot hurt so much.” The doctor remarked that if the “left knee [was] accepted as part of [claimant’s] foot case, [he] would order an MRI of his knee … if not, the left knee injury would have to be filed as a new injury.”          Claimant followed up with Dr. Nystrom on June 5, 2017. He reported that the pain in his left foot moved to his knee and complained of left knee swelling and stiffness. Dr. Nystrom wrote, “[w]hat actually happened with his injury was [a] large tractor tire fell on his left leg (hit primarily his proximal calf). He initially had a lot of pain and swelling in his foot but now most of his problem [was] with his knee.” Claimant advised that his “knee pain [had] been present for a while.” Dr. Nystrom referred claimant to Dr. McFerran for a consultation.          An MRI was performed on the left knee on June 5, 2017. The MRI revealed a complex tear of the body horn of the medial meniscus, an intermediated grade MCL sprain, a large joint effusion distending the joint recesses and extending into a popliteal cyst, a defect of the anterolateral joint capsule, and extensive prepatellar and infrapatellar subcutaneous edema.          Dr. McFerran evaluated the claimant on June 7, 2017. The claimant recounted the work injury and the doctor noted that he injured his knee “when a semi tire hit his leg. He was on the ground and it hit the inside of his foot. He had some toe injuries. He has always had some knee discomfort, but it was overshadowed by his foot. He has had increasing knee pain over the past 2 months.” Dr. McFerran diagnosed a meniscal tear of an unknown age.          On August 1, 2017, Dr. Raschbacher conducted an advisory review of claimant’s case. The doctor opined that claimant did not injure his left knee on July 28, 2016. The doctor explained that “[I]t is certainly not likely that [claimant’s] foot and toe injury would be causative of a medial meniscus tear which would remain undiagnosed and asymptomatic for a significant period of time.”          Dr. Nystrom followed-up on August 8, 2017. The doctor noted that he did not believe the initial description of claimant’s injury had been sufficiently detailed. He specifically remarked that a 300 pound semi tire fell on claimant’s left leg “hitting his foot primarily but also the back of his knee. In fact, his leg was pinned under the tire and he had to squirm out [from] underneath it.” Dr. Nystrom commented that the left knee condition worsened over the last several months. He concluded that there was a greater than 50% probability that the left knee symptoms were a direct result of the July 28, 2016 accident.          Dr. Nystrom referred the claimant to Dr. Isaacs for a second surgical opinion. Dr. Isaacs saw the claimant on August 24, 2017. Claimant recounted that he was “working on the brakes on a semi when the semi tire and wheel weighing 300 pounds fell on the back of his left leg and slid down his leg and crushed his foot.” Claimant further advised that he complained of left knee pain immediately after the accident and was assured PT would improve his symptoms. Dr. Isaacs also diagnosed a torn left medial meniscus...

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