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
P. Ringel, Designated Chair
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.
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).
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.
Was Employee’s employment with Employer the substantial
cause of his disability or need for medical
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.
Was the implantation of an intramedullary rod reasonable and
necessary medical treatment?
findings in Traugott I are incorporated herein. The
following facts are reiterated from Traugott I or
are established by a preponderance of the evidence:
Employee was diagnosed with diabetes in 2002. (Employee
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).
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).
April 25, 2005, Employee reported an infection on his left
big toe. (AK Kidney & Diabetes, Chart Note, April 25,
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).
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).
October 26, 2005 chart note indicates Employee’s right
big toe was better, but needed debridement. (AK Kidney &
Diabetes, Chart Note, October 26, 2005).
January 5, 2006, Employee’s right big toe ulcer was
found to be infected with streptococcus. (Dr. Crawford, Chart
Note, January 5, 2006).
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).
March 8, 2006, Employee’s right big toe had healed.
(Dr. Crawford, Chart Note, March 8, 2006).
September 6, 2006, Dr. Crawford diagnosed possible Charcot
foot (Charcot neuroarthopathy) in Employee’s right
foot. (Dr. Crawford, Chart Note, September 6, 2006).
August 11, 2007, Employee was diagnosed with neuropathy.
(Texas Tech University, Patient Information Sheet, August 11,
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).
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
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).
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).
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).
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).
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).
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).
May 5, 2011, the infection in Employee’s toe was
determined to be a staphylococcus infection. (Dr. Crawford,
Chart Note, May 5, 2011).
May 16, 2011, Dr. Crawford stated he would schedule surgery
to correct Employee’s hammer toes. (Dr. Crawford, Chart
Note, May 2, 2011).
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).
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).
June 21, 2012, the infection in Employee’s second toe
was found to be staphylococcus. (Dr. Crawford, Chart Note,
June 21, 2012).
July 23, 2012, Employee was released to work after the hammer
toe surgery. (Dr. Crawford, Work Release, July 31, 2012).
August 3, 2012, Employee was found to have a staphylococcus
infection in his right third toe. (PPL Laboratory,
Microbiology Report, August 4, 2012).
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...