Traugott v. ARCTEC Alaska, 082917 AKWC, 17-0103

Docket Nº:AWCB Decision 17-0103
Case Date:August 29, 2017
JOSEPH TRAUGOTT, Employee, Claimant,
ARCTEC ALASKA, Self-Insured Employer, Defendant.
AWCB Decision No. 17-0103
AWCB No. 201309316
Alaska Workers’ Compensation Board
August 29, 2017
          FINAL DECISION AND ORDER           Ronald P. Ringel, Designated Chair          Joseph Traugott’s July 16, 2015 and November 10, 2015 claims were heard on July 6, 2017 in Fairbanks, Alaska. This hearing date was selected on March 8, 2017. Attorney Eric Croft appeared and represented Joseph Traugott (Employee). Attorney Robert Bredesen appeared and represented ARCTEC Alaska (Employer). Witnesses included Employee and Marilyn Yodlowski, M.D., who appeared in person, and Jerry Grimes, M.D., and Carol Frey, M.D., who testified telephonically. The record closed after deliberations concluded on July 27, 2017.          After a February 18, 2016 hearing on Employee’s claims, the panel concluded it lacked sufficient understanding of the medical records to properly weigh the medical testimony. As a result, Traugott v. ARCTEC Alaska, AWCB Decision No. 16-0018 (March 10, 2016) (Traugott I) ordered a second independent medical evaluation (SIME).          ISSUES          Employee contends his work for Employer was the substantial cause of his osteomyelitis, and consequently his resulting disability and need for medical treatment are compensable under the Act. Employer contends Employee’s disability and need for medical treatment are due to Charcot arthropathy, a consequence of his preexisting diabetes, and, as a result, he is not entitled to benefits under the Act.          1. Was Employee’s employment with Employer the substantial cause of his disability or need for medical treatment?          If Employee’s work for Employer is the substantial cause of his disability and need for medical treatment, Employer contends the use of an intramedullary rod to fuse Employee’s ankle was not reasonable medical treatment. Employee contends the choice of an intramedullary rod was reasonable and necessary treatment.          2. Was the implantation of an intramedullary rod reasonable and necessary medical treatment?          FINDINGS OF FACT          All findings in Traugott I are incorporated herein. The following facts are reiterated from Traugott I or are established by a preponderance of the evidence:          1. Employee was diagnosed with diabetes in 2002. (Employee Deposition).          2. On August 9, 2004, Employee reported a sore on his toe that was healing. A photograph of what appears to be an open sore on Employee’s right big toe has a notation stating “old blister from shoes.” (AK Kidney & Diabetes, Chart Note, August 8, 2004).          3. On February 7, 2005, it was noted that Employee’s toe had “completely healed over from 8/04.” (AK Kidney & Diabetes, Chart Note, February 7, 2005).          4. On April 25, 2005, Employee reported an infection on his left big toe. (AK Kidney & Diabetes, Chart Note, April 25, 2005).          5. On September 22, 2005, Employee complained of a right big toe infection, which began five days earlier, and was placed on oral antibiotics. (AK Kidney & Diabetes, Chart Note, September 22, 2005).          6. On October 3, 2005, Employee was seen by Patrick Crawford, D.P.M. Dr. Crawford reported that while working in Alaska, Employee had a callus that broke down developing a neurotrophic ulcer on his right big toe. There was no evidence of bony involvement. (Dr. Crawford, Chart Notes, October 3 and 17, 2005).          7. An October 26, 2005 chart note indicates Employee’s right big toe was better, but needed debridement. (AK Kidney & Diabetes, Chart Note, October 26, 2005).          8. On January 5, 2006, Employee’s right big toe ulcer was found to be infected with streptococcus. (Dr. Crawford, Chart Note, January 5, 2006).          9. On January 9, 2006, Employee was seen for follow up of his right big toe after someone had stepped on it. The toe appeared infected, and Employee was placed on oral antibiotics. (AK Kidney & Diabetes, Chart Note, January 9, 2006).          10. By March 8, 2006, Employee’s right big toe had healed. (Dr. Crawford, Chart Note, March 8, 2006).          11. On September 6, 2006, Dr. Crawford diagnosed possible Charcot foot (Charcot neuroarthopathy) in Employee’s right foot. (Dr. Crawford, Chart Note, September 6, 2006).          12. On August 11, 2007, Employee was diagnosed with neuropathy. (Texas Tech University, Patient Information Sheet, August 11, 2007).          13. 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. (Dr. Yodlowski, EME Report, January 5, 2016).          14. 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. (Dr. Grimes, Deposition Testimony, February 6, 2016).          15. On October 15, 2008, Employee reported continued pain in both feet, some of which was determined to be nerve-related. (AK Kidney & Diabetes, Chart Note, October 15, 2008).          16. On February 4, 2010, an x-ray revealed evidence of joint destruction in Employee’s right foot. Dr. Crawford diagnosed Charcot neuroarthopathy in Employee’s right midfoot. It was noted that the second toe on Employee’s right foot was a hammer toe. (Dr. Crawford, Chart Note, February 10, 2010).          17. 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 of Charcot 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. (Dr. Grimes, Deposition Testimony, February 6, 2016).          18. 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. (Yodlowski).          19. On May 2, 2011, it was noted that Employee had decreased sensation to touch in both legs. (Amarillo Family Physicians Clinic, Chart Note, May 2, 2011).          20. On May 2, 2011, Dr. Crawford noted Employee’s hammer toe had become infected and recommended surgery to correct the condition. (Dr. Crawford, Chart Note, May 2, 2011).          21. On May 5, 2011, the infection in Employee’s toe was determined to be a staphylococcus infection. (Dr. Crawford, Chart Note, May 5, 2011).          22. On May 16, 2011, Dr. Crawford stated he would schedule surgery to correct Employee’s hammer toes. (Dr. Crawford, Chart Note, May 2, 2011).          23. Because of unrelated medical complications, the surgery on Employee’s toes was not performed until May 29, 2012, when Dr. Crawford fused the joints in the second and third toes on Employee’s right foot using internal fixation. (Dr. Crawford, Chart Notes, August 17, 2011 to May 29, 2011).          24. On May 21, 2012, Employee reported the lesions on his toe had increased in size. He was diagnosed with a diabetic ulcer and bone infection (osteomyelitis). (Amarillo Family Physicians Clinic, Chart Note, May 21, 2012).          25. On June 21, 2012, the infection in Employee’s second toe was found to be staphylococcus. (Dr. Crawford, Chart Note, June 21, 2012).          26. On July 23, 2012, Employee was released to work after the hammer toe surgery. (Dr. Crawford, Work Release, July 31, 2012).          27. On August 3, 2012, Employee was found to have a staphylococcus infection in his right third toe. (PPL Laboratory, Microbiology Report, August 4, 2012).          28. Employee was hired by Employer in March 2013. 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 a pulmonary function test had been abnormal. Employee worked about three weeks at the Indian Mountain site, and was transferred to Tin City. While at Tin City, Employee 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 Employee to...

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