Appeal No. 2050974 (Claim No. 2008018382)
Rigoberto Rodriguez, by Gregory S. Prudich, his attorney,
appeals the decision of the West Virginia Workers'
Compensation Board of Review. John Bell Company, Inc., by
Bradley A. Crouser, its attorney, filed a timely response.
issue on appeal is whether unspecified internal derangement
of the right knee, complex regional pain syndrome, and
non-allopathic lesions of the lower extremity are compensable
conditions of the claim. The claims administrator denied all
the above mentioned conditions on February 12, 2015. The
Office of Judges modified the claims administrator's
decision on December 1, 2015, and added internal derangement
of the right knee to the claim. The Board of Review affirmed
the Order of the Office of Judges on June 27, 2016. The Court
has carefully reviewed the records, written arguments, and
appendices contained in the briefs, and the case is mature
Court has considered the parties' briefs and the record
on appeal. The facts and legal arguments are adequately
presented, and the decisional process would not be
significantly aided by oral argument. Upon consideration of
the standard of review, the briefs, and the record presented,
the Court finds no substantial question of law and no
prejudicial error. For these reasons, a memorandum decision
is appropriate under Rule 21 of the Rules of Appellate
Rodriguez, a stone mason for John Bell Company, Inc., injured
his knee at work on October 29, 2007. Prior to his injury, in
2001, an x-ray of his knee showed early degenerative changes
of the medial compartment. He was also treated for knee pain
in 2005. On October 31, 2007, Mr. Rodriguez was seen by Z.
Comeaux, D.O., for right knee pain. Dr. Comeaux diagnosed a
knee strain and possible medial collateral ligament strain or
tear. Dr. Comeaux recommended crutches and that Mr. Rodriguez
remain off work until revaluation. A report of injury was
claims administrator held the claim compensable for a right
knee sprain on November 6, 2007. A November 29, 2007, MRI of
the right knee revealed a probable right anterior cruciate
ligament tear and a small medial meniscus tear. On February
26, 2009, Mr. Rodriguez underwent a diagnostic and operative
arthroscopy of the right knee with partial and lateral
meniscectomy, resection, medial pathologic plica, and
chondroplasty of the distal femur intercondylar notch,
performed by Steven Vess, D.O. Rebecca Thaxton, M.D.,
completed a physician review on November 4, 2009, which
addressed Mr. Rodriguez's request for the authorization
of an anterior cruciate ligament reconstruction with
hamstring autograft. Dr. Thaxton recommended the claim
administrator approve the surgery. Dr. Thaxton noted that Mr.
Rodriguez had persistent symptoms following his February 26,
2009, right knee surgery. Mr. Rodriguez then received a
second opinion by Dr. Diduch at the University of Virginia
who read Mr. Rodriguez's November 29, 2007, MRI as
showing a right knee anterior cruciate ligament tear.
November 10, 2009, Mr. Rodriguez underwent a right knee
arthroscopically assisted anterior cruciate ligament
reconstruction using hamstring autograft performed by Dr.
Diduch. The preoperative diagnosis was a right knee anterior
cruciate ligament tear. The postoperative diagnosis was a
right knee anterior cruciate ligament tear with mild grade II
chondromalacia of the trochlea and the medial femoral
condyle. After the surgery, in May of 2010, Mr. Rodriguez
underwent a functional capacity evaluation. His physical
capabilities did not match his job requirements of performing
heavy work as a stonemason. The evaluator indicated that Mr.
Rodriguez may continue to recover and that he should undergo
Rodriguez underwent a second functional capacity evaluation
on July 26, 2010, which resulted in a recommendation that he
either find alternative work or retraining. The evaluator
stated Mr. Rodriguez showed an ability to work at the light
to medium functional capacity level. On November 4, 2010,
Joseph Grady, M.D., performed an independent medical
evaluation. Dr. Grady stated the compensable conditions were
a tear of the lateral cartilage or meniscus of the right
knee, tear of the medial cartilage or meniscus of the right
knee, and a sprain/strain of the right knee/leg. Dr. Grady
diagnosed status post right knee arthroscopic partial medial
and lateral meniscectomies with chondroplasty and anterior
cruciate ligament reconstruction. Dr. Grady believed Mr.
Rodriguez was at maximum medical improvement and stated he
observed no ligamentous instability of the right knee upon
Rodriguez testified in a deposition on May 4, 2011, that he
injured his right knee while performing his job duties of a
supervisor stonemason. At the time of his deposition, Mr.
Rodriguez stated that he had chronic right knee pain every
day which was more severe in the morning. Mr. Rodriguez
testified that lifting heavy objects causes his knees to
buckle. Mr. Rodriguez described a previous left knee injury
which occurred in 2001. He stated that he twisted his left
knee when he stepped in a hole. A workers' compensation
claim was made and accepted for the left knee. Mr. Rodriguez
testified that the injury to his left knee and the injury at
issue to his right knee were his only injuries.
October 19, 2011, Saghir Mir, M.D., performed an independent
medical evaluation. Dr. Mir stated that he did not see any
signs of complex regional pain syndrome in his opposite left
leg. Dr. Mir said Mr. Rodriguez walked with a limp on the
right, but that he did not observe any effusion of the right
knee, though there was slight fullness in the right knee. Dr.
Mir stated Mr. Rodriguez had very slight laxity of the
anterior cruciate ligament and signs of naturally occurring
malalignment of the kneecaps. Dr. Mir stated Mr. Rodriguez
sustained an injury to his right knee superimposed on very
mild early degenerative changes in the medial compartment. He
diagnosed status post partial medial and lateral meniscectomy
of the right knee and status post anterior cruciate ligament
reconstruction. Dr. Mir believed Mr. Rodriguez was at maximum
Garlitz, Mr. Rodriguez's family medicine practitioner,
was deposed on March 8, 2012. Dr. Garlitz testified about the
injury, his surgeries, and subsequent medical treatment. Dr.
Garlitz stated Mr. Rodriguez never had a resolution of his
right knee symptoms. He was concerned Mr. Rodriguez may be
developing complex regional pain syndrome, which he related
to the compensable injury. Dr. Garlitz stated Mr.
Rodriguez's knee muscles are now small and weak, which
further aggravates his symptoms. On March 14, 2012,
Prasadarao Mukkamala, M.D., completed a record review. He
agreed that Mr. Rodriguez was at maximum medical improvement
and required no further treatment. Dr. Mukkamala stated that
any treatment Mr. Rodriguez needed was due to an intervening
16, 2012, Dr. Mukkamala was deposed. He stated that he
believed the only compensable diagnosis was a right knee
sprain. However, the claims administrator accepted the
partial meniscectomy and anterior cruciate ligament repair
surgeries. Dr. Mukkamala did not believe Mr. Rodriguez's
surgeries were related to the compensable injury. However, he
did say that some patients who undergo similar procedures
have continued knee symptoms. Upon cross-examination, Dr.
Mukkamala admitted Mr. Rodriguez did not reinjure his knee
while roofing, but that he developed pain in the right knee.
Mr. Rodriguez was seen by Wassim Saikali, M.D., a
rheumatologist on August 30, 2012. According to Dr. Saikali,
Mr. Rodriguez rated his pain at an eight on the pain scale,
and Mr. Rodriguez was significantly impaired. Dr. Saikali
noted Mr. Rodriguez's hands, wrists, shoulders, knees,
and ankles were swollen and tender. Dr. Saikali diagnosed
active aggressive rheumatoid arthritis and recommended Mr.
Rodriguez undergo blood testing.
Rodriguez saw Dr. Garlitz for knee pain in April of 2013. Dr.
Garlitz stated Mr. Rodriguez had decreased range of motion in
both knees with crepitus. Mr. Rodriguez's right knee was
tender. Dr. Garlitz diagnosed chronic internal derangement of
the knee and complex regional pain syndrome of the lower
limb. On April 19, 2013, an MRI of Mr. Rodriguez's right
knee showed the cruciate ligaments intact; however, there was
thinning of the mid-to-posterior horn of the medial meniscus.
This should correlate with the surgery. The MRI also revealed
a mild thinning of the articular cartilage of the patella
consistent with some degenerative-type thinning. Mr.
Rodriguez was diagnosed with postsurgical change versus
meniscal tear involving the medial meniscus and a Baker's
cyst. An x-ray of Mr. Rodriguez's right knee showed mild
April 10, 2014, Mr. Rodriguez saw Dr. Garlitz for increased
right knee pain. Dr. Garlitz diagnosed chronic internal
derangement of the knee, somatic dysfunction of the lower
extremities, and contact dermatitis. Dr. Garlitz was
concerned Mr. Rodriguez had osteopenia of the fibular head
and recommended an MRI to rule out a fracture. On November
13, 2014, Dr. Garlitz completed a diagnosis update form
requesting that internal derangement of the knee, ...