IN THE MATTER OF THE CLAIM OF: DARREL THOMAS, Claimant,
v.
HANGERMAN EARTH CYCLE, INC. AND GLACIER ROCK COMPANY, Employer,
and
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...
