In re Claim of Jones, 021221 COWC, 5-040-522-002

Docket Nº:W.C. 5-040-522-002
Case Date:February 12, 2021
Court:Colorado
IN THE MATTER OF THE CLAIM OF: JOE M JONES, Claimant,
v.
HHS INC, Employer,
and
HARTFORD INSURANCE COMPANY, Insurer, Respondents.
W.C. No. 5-040-522-002
Colorado Workers Compensation
Industrial Claim Appeals Office
February 12, 2021
          WITHERS SEIDMAN RICE MUELLER GOODBODY PC, Attn: DAVID B MUELLER ESQ, (For Claimant)           POLLART MILLER LLC, Attn: JESSICA L GRIMES ESQ, (For Respondents)          FINAL ORDER          The claimant seeks review of an order of Administrative Law Judge Sidanycz (ALJ) dated October 15, 2020, that denied and dismissed his claim for medical benefits for his right knee. We affirm.          This matter went to hearing on whether the claimant demonstrated, by a preponderance of the evidence, that treatment of his right knee, more specifically a computerized tomography (CT) scan of the right knee, is reasonable medical treatment necessary to cure or relieve the claimant from the effects of an admitted February 28, 2017, work injury. After the hearing, the ALJ made findings and conclusions that are summarized below.          The claimant was injured at work on February 28, 2017. The injury occurred while the claimant was working as a security guard at a hospital. The claimant approached two individuals at a vehicle. When the individuals backed the vehicle, the claimant was struck and knocked to the ground.          Following the February 28, 2017, work injury the claimant initially was seen in the emergency department at Community Hospital. On that date, Dr. Kueber diagnosed the claimant with an acute L4 compression fracture, and a left talus fracture. Dr. Kueber specifically noted that the claimant’s [right] lower extremity was atraumatic.[1]          Throughout the claimant’s post-injury medical records, he was diagnosed with a left foot crush injury and low back pain with radiculopathy. The claimant has undergone significant medical treatment including left ankle surgery and diagnosis of left lower extremity complex regional pain syndrome (CRPS). The claimant has been seen by a number of medical providers during this claim, including Dr. Utt, Dr. Price, Dr. Clifford, and Dr. Copeland.          At the request of the respondents, Dr. Castro performed a review of the claimant’s medical records. In his September 19, 2018, report, Dr. Castro noted that the claimant suffered injuries to his left ankle and low back on February 28, 2017, followed by the development of CRPS. Dr. Castro also noted that the claimant had a history of low back symptoms. Dr. Castro opined that the February 28, 2017, injury exacerbated the claimant’s pre-existing back symptoms. Dr. Castro also noted that due to the advancing CRPS, the claimant might not be a good surgical candidate as it related to a recommended lumbar surgery.          On March 7, 2019, the claimant was seen by Dr. Price. Dr. Price determined that the claimant had reached maximum medical improvement (MMl) on that date. She assessed permanent impairment for the claimant’s lumbar spine of 22% whole person. Dr. Price also assessed a 30% left lower extremity impairment (which converts to 12% whole person). Dr. Price calculated a total whole person impairment of 31%.          The respondents timely requested a Division-sponsored Independent Medical Examination (DIME). The following regions/body parts were requested to be reviewed by the DIME physician: lumbar spine, left foot, left ankle, and left lower extremity CRPS. At no time after this request did the claimant request additional body parts to be considered by the DIME.          Dr. Wakeshima performed the DIME on June 28, 2019. In his DIME report, Dr. Wakeshima documented that the claimant’s chief complaint on the date of the exam was low back pain and left lower extremity pain to the ankle and the foot. Significantly, Dr. Wakeshima performed a physical examination of the right knee and found “right leg, ankle and foot exam demonstrates no pain and tenderness.” Additionally, he stated that the right knee exam “demonstrates full active range of motion with no pain and tenderness bilaterally.” Dr. Wakeshima opined that the claimant had the following work-related diagnoses: left ankle and foot pain, low back pain, and CRPS. Dr. Wakeshima assessed a permanent impairment rating of 48% whole person (30% for CRPS and 24% for lumbar spine impairment). Dr. Wakeshima did not find a right knee condition to be work-related, nor did he assess an impairment for any right knee condition.          On August 8, 2019, the claimant was seen by Dr. Price and reported right knee pain. In her August 8, 2019, report, Dr. Price referenced a hematoma on the claimant’s right knee at the time of the February 28, 2017, work injury. Dr. Price opined that the claimant needed evaluation of his right knee because he was “gaiting heavily on the right side.” At that time, she ordered x-rays of the claimant’s right knee. Subsequently, the claimant reported to physical therapist, Matthew MacAskill, pain in his right knee when going up and down stairs.          Based upon Dr. Wakeshima’s DIME report, on September 5, 2019, the respondents filed a Final Admission of Liability (FAL) admitting for the MMI date of March 7, 2019, and a whole person impairment rating of 47%. The claimant timely objected to the FAL, and filed an Application for Hearing endorsing the issues of permanent total disability (PTD) benefits and disfigurement. A hearing was scheduled for these issues.          Thereafter, on December 12, 2019, the parties entered into a partial settlement agreement, leaving maintenance care open. The partial settlement agreement specifically provides that on February 28, 2017, the claimant suffered injuries “including, but not limited to his low back, left ankle, right foot, and CRPS condition.” The partial settlement agreement also provides that “[o]ther disabilities, impairments and...

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