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...
