ANGELA B. CRITES, Claimant Below, Petitioner
ARMSTRONG HARDWOOD FLOORING COMPANY, Employer Below, Respondent
Appeal No. 2051366 (Claim No. 2014008606)
Angela B. Crites, by Robert L. Stultz, her attorney, appeals
the decision of the West Virginia Workers' Compensation
Board of Review. Armstrong Hardwood Flooring Company, by
Alyssa A. Sloan, its attorney, filed a timely response.
issue on appeal is whether a request from Lucas Pavlovich,
M.D., for a right knee arthroscopy and the prescription
medications Percocet 5/500, Vicodin 5/500, and Ultram 50 mg
for post-operative pain, as well as unicompartment knee
replacement surgery, is medically related and reasonably
required to treat the compensable injury. The claims
administrator determined that neither the surgeries nor the
medications are necessary on November 12, 2015. The Office of
Judges affirmed the claims administrator's decision on
June 2, 2016. The Board of Review affirmed the Order of the
Office of Judges on November 9, 2016. The Court has carefully
reviewed the records, written arguments, and appendices
contained in the briefs, and the case is mature for
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
Crites, a plant worker for Armstrong Hardwood Flooring
Company, injured her right knee at work on April 5, 2013,
when she stood up after kneeling. On April 12, 2013, Ms.
Crites sought treatment at Elkins Express Care for her
injury. An x-ray of the right knee demonstrated mild
osteoporosis and mild degenerative arthritis. Ms. Crites was
examined and diagnosed with bursitis of the knee. She was
given a wrap and was provided instructions to take
Crites was examined at Tygart Valley Orthopedics in June of
2013. She described the injury and denied prior knee
problems. Dr. Pavlovich recommended an MRI of the knee to
rule out a possible medial meniscus tear versus an articular
cartilage injury. A June 27, 2013, MRI revealed one
degenerative cartilaginous delamination in the medial and
lateral knee compartments and two small knee joint effusions,
a Baker's cyst, and likely ganglion cyst between the
anterior cruciate ligament and posterior cruciate ligament.
Dr. Pavlovich reviewed the MRI and confirmed a medial
meniscus tear. Dr. Pavlovich recommended proceeding with a
diagnostic arthroscopy. In a January 23, 2014, decision, the
claims administrator denied authorization for arthroscopic
surgery. In another decision dated April 11, 2014, the claims
administrator held the claim compensable for bursitis of the
9, 2014, Dr. Pavlovich performed surgery on Ms. Crites and
confirmed she suffered from a right knee meniscus tear. At
the time of surgery, Dr. Pavlovich completed a diagnosis
update asking that the conditions of internal derangement and
medial meniscus tear be added to the compensable conditions
in this claim. On June 20, 2014, Ms. Crites was seen by Dr.
Pavlovich for a follow-up. He noted that Ms. Crites continued
to have pain and swelling. Ms. Crites indicated that the
swelling is worse after she has been using her knee for a
while and felt that she was unable to return to work at this
time because of the continued problems. Dr. Pavlovich noted
that Ms. Crites should remain off work until July 7, 2014,
and then return to work with no restriction.
Jin, M.D., evaluated Ms. Crites on June 23, 2014, and
diagnosed pre-existing degenerative arthritis of the right
knee, history of acute flare-up of right knee; status-post
chondroplasty; and medial meniscal debridement. Dr. Jin noted
that from a medical perspective, Ms. Crites's
degenerative disease of the knee is not a result of the
compensable injury but a preexisting condition. She noted
that it is common for symptoms of degenerative arthritis to
manifest with or without obvious traumatic injury. Clinical
and medical evidence shows that Ms. Crites has had
degenerative knee arthritis, with symptoms that manifested
during work. She noted that Ms. Crites's work activities
on the day of the injury might be a trigger for the symptoms,
though it is not a cause or etiological factor. She noted
that the compensable condition for the claim was bursitis of
the knee and that medically it is more likely that Ms.
Crites's symptoms of degenerative arthritis manifested at
work rather than an injury. She found Ms. Crites to be at
maximum medical improvement with no whole person impairment.
Based upon this report, the claims administrator denied Ms.
Crites's request to add the diagnosis of internal
derangement and medial meniscal tear as compensable
conditions in the claim.
August 6, 2014, Ms. Crites returned to see Dr. Pavlovich. She
complained of continued pain and difficulty with kneeling,
squatting, and climbing. He recommended that Ms. Crites
return to work on a trial basis with restrictions of no
squatting, kneeling or climbing. Ms. Crites returned again to
Dr. Pavlovich on October 16, 2014, with similar complaints.
On November 10, 2014, the Office of Judges reversed the
claims administrator's January 23, 2014, decision and
approved the diagnostic right knee arthroscopy. On November
13, 2014, the Office of Judges reversed the claims
administrator's decision and held the claim compensable
for a right medial meniscus tear, which was later affirmed by
the Board of Review. The Office of Judges issued a November
26, 2014, Order denying internal derangement of the right
knee and approving medical meniscus tear.
Crites sought treatment from Dr. Pavlovich throughout
December of 2014 and January of 2015. Dr. Pavlovich noted
that Ms. Crites had pain with weight bearing and recurrent
effusion. She continued to work but has had pain, catching,
and swelling in the knee. On January 29, 2015, the Office of
Judges reversed the claims administrator's July 30, 2014,
decision denying the addition of the diagnosis of internal
derangement and medial meniscus tear to the claim and added a
medial meniscus tear in accord with the previous November 26,
2014, Order. The Board of Review affirmed the Office of
Judges' Order on April 27, 2015.
21, 2015, Dr. Pavlovich examined Ms. Crites. Dr. Pavlovich
noted that a brace had been provided to her. He noted that
there was no evidence of instability. Ms. Crites followed up
with Dr. Pavlovich on July 16, 2015, and she reported that
the cortisone injection provided her complete pain relief for
one week. Her pain has since returned. Ms. Crites continued
to wear a brace, which did not seem to help her symptoms. Ms.
Crites denied any significant anterior or lateral knee pain.
It was stated that Ms. Crites had exhausted therapy with
cortisone injections. Ms. Crites also had an injection of
Synvisc, which aggravated her symptoms. She was advised to
return to discuss surgical options. Upon her return, Dr.
Pavlovich discussed surgical options including the option of
repeating an arthroscopy. He recommended a unicompartmental
knee replacement and Ms. Crites agreed with his request. Dr.
Pavlovich requested the surgery, as well as Percocet,
Vicodin, and Ultram as postsurgical treatment. Dr. Pavlovich
filled out an authorization for the same on August 27, 2015.
September 1, 2015, Dr. Jin evaluated Ms. Crites and
determined that she did not have any permanent impairment
attributable to the injury in the claim. Dr. Jin reviewed Dr.
Pavlovich's initial operative report, which noted that
Ms. Crites's meniscus tear was degenerative in nature and
not traumatic. After another follow-up with Dr. Pavlovich on
October 29, 2015, he suggested a total knee replacement of
her right knee. On November 4, 2015, the claims administrator
withheld authorization for the knee arthroscopy and the
requested medication pending an addendum report from Dr. Jin.
November 6, 2015, Dr. Jin issued a report that detailed her
examination of Ms. Crites. Dr. Jin noted that the medical
evidence in the record clearly shows pre-existing advanced
right knee arthrosis, which is the true indication for the
requested surgery. She found that Ms. Crites will eventually
need a total knee replacement but that such a request for
treatment is not related to trauma or an injury. She opined
that squatting or kneeling is not a trauma or injury to the
knee. She believed that the request for the surgery is not
for the compensable diagnoses of bursitis and medial meniscal
tear. Dr. Jin noted that the compensable condition of
meniscal tear which was treated with the partial
meniscectomy, will not progress, and opined that Ms. Crites
does not need to have another surgery. She also noted that
the first surgery did not provide relief which suggests that
the meniscal tear was probably not responsible for Ms.
Crites's current symptoms. In addition, there is no
medical rationale to have another surgery for a meniscal tear
that was surgically treated before. From a medical
perspective, Dr. Jin noted that the most likely etiology for
Ms. Crites's symptoms is degenerative arthrosis in the
knee. It is a chronic, progressive illness, and the requested
unicompartment knee surgery is not aimed at treating
compensable conditions in the claim. Based upon this report,
the claims administrator denied the request from Dr.
Pavlovich for right knee scope and the prescription
medications, Percocet 5/500, Vicodin 5/500, and Ultram 50 mg
for post-operative pain, as well as unicompartment knee
replacement surgery on November 12, 2015.
February 12, 2016, Dr. Pavlovich was deposed. Dr. Pavlovich
testified that he was requesting a unicompartmental knee
surgery and follow-up postoperative medication for Ms.
Crites, although there was some confusion regarding his
request. Dr. Pavlovich testified that he performed Ms.
Crites's first surgery on May 9, 2014. He repaired Ms.
Crites's torn meniscus and also smoothed down her
full-thickness articular cartilage injury at the femoral
condyle. Dr. Pavlovich testified that he did see some
degenerative changes in Ms. Crites's meniscus in the form
of horizontal tears. He also testified that these are usually
caused by wear and tear. He noted that Ms. Crites also had a
radial tear in her meniscus, which he repaired and opined
that it was likely related to the alleged mechanism of
injury. He testified that he believed that Ms. Crites's
compensable injury is causing her current symptoms. On cross
examination, Dr. Pavlovich testified that it is possible that
Ms. Crites's femoral condyle injury was possibly caused
by degeneration. Dr. Pavlovich was asked to describe Ms.
Crites's injury as he understood it and he described a
twisting injury. When asked further questions regarding Ms.
Crites's alleged twisting injury, he admitted that she
did not tell him that she twisted her knee, but he feels that
she must have to cause this injury. Dr. Pavlovich was unable
to confirm whether or not Ms. Crites had physical therapy as
a form of treatment. Dr. Pavlovich also confirmed that
physical therapy would have helped strengthen Ms.
Crites's knee after her initial surgery and would have
been an appropriate treatment before undergoing the second
surgery. Dr. Pavlovich testified that the two things that
were present on Ms. Crites's arthroscopic exam that could
have been related to her injury a radial tear of her medial