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Fife v. Shoe Show, Inc.

Supreme Court of Appeals of West Virginia

November 1, 2019

TERESA G. FIFE, Claimant Below, Petitioner
v.
SHOE SHOW, INC., Employer Below, Respondent

          (BOR Appeal No. 2052621) (Claim No. 2017015187).

          MEMORANDUM DECISION

         Petitioner Teresa G. Fife, by Counsel Gregory S. Prudich, appeals the decision of the West Virginia Workers' Compensation Board of Review ("Board of Review"). Shoe Show, Inc., by Counsel Lindsay S. Brennan, filed a timely response.

         The issue on appeal is the authorization for medical treatment. The claims administrator denied Ms. Fife's request for a total knee replacement on December 6, 2017. The Workers' Compensation Office of Judges ("Office of Judges") affirmed the claims administrator's decision in an Order dated February 16, 2018. This appeal arises from the Board of Review's Final Order dated August 1, 2018, in which the Board of Review affirmed the decision of the Office of Judges. The Court has carefully reviewed the records, written arguments, and appendices contained in the briefs, and the case is mature for consideration.

         This 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 Procedure.

         Ms. Fife indicated in her Employees' and Physicians' Report of Occupational Injury or Disease that on December 13, 2016, she slipped and fell over boxes while working for Shoe Show, Inc. She sought medical treatment at Princeton Community Hospital. During treatment, Ms. Fife reported that she had injured the same knee a few months earlier. An x-ray of her right knee showed mild hypertrophic degenerative bony changes and narrowing on the medial femorotibial joint space, progressed in the interval. The X-ray also showed soft tissue swelling, but no fracture. The treating physician indicated that the injury on December 13, 2016, aggravated Ms. Fife's prior knee injury. On December 22, 2016, the claims administrator held the claim compensable for right knee strain.

         On January 23, 2017, Ms. Fife sought treatment with Gary McCarthy, M.D., from Bluefield Orthopedics. He treated her with a cortisone injection to her right knee. Ms. Fife returned to Dr. McCarthy on February 13, 2017, and reported that the injection helped for a little while. Dr. McCarthy diagnosed Ms. Fife with a tear of the medial meniscus of the right knee. She underwent a right knee MRI on April 12, 2017.

         On April 21, 2017, Ms. Fife was seen by Dr. McCarthy to discuss the results of her MRI. The MRI revealed moderate degenerative changes with joint space narrowing and osteophyte formation predominately involving the medial compartment. The MRI did not visualize the body of the medial meniscus, but the posterior horn of the medial meniscus was small. The radiologist conducting the study stated that the findings were compatible with a medial meniscus tear. Dr. McCarthy's assessment/plan was for Ms. Fife to continue her home exercise program.

         Dr. McCarthy treated Ms. Fife again on May 22, 2017. There was tenderness of the medial femoral condyle, lateral joint line, medial joint line, medial tibial plateau, lateral femoral condyle and lateral tibial plateau. The assessment was idiopathic osteoarthritis. Dr. McCarthy recommended a total knee replacement. On May 23, 2017, Dr. McCarthy requested authorization for a total knee replacement and the addition of idiopathic osteoarthritis as a compensable diagnosis.

         Ms. Fife was referred for an independent medical evaluation by Prasadarao B. Mukkamala, M.D. In his report dated September 21, 2017, he opined that Ms. Fife continues to have significant symptoms with relation to the right knee, and her ongoing symptoms are causally related to noncompensable underlying preexisting degenerative arthrosis. Dr. Mukkamala diagnosed Ms. Fife with sprain/contusion of the right knee and stated that she had reached her maximum degree of medical improvement. It was Dr. Mukkamala's professional opinion that the total knee replacement was requested to address preexisting noncompensable arthritis and is not required because of the compensable injury.

         Ms. Fife testified at deposition on September 22, 2017, that she had worked for Shoe Show for twenty-eight years. As a manager, her responsibility was to help unload trucks, move merchandise, and stock, all while constantly walking. She stated that she had no prior pain, issues, or limitations with her right knee before her compensable injury of December 13, 2016. She testified that her knee was not working and she missed a lot of work due to her injury. She also testified that she only had one prior workers' compensation claim for her back and shoulder.

         Dr. McCarthy was also deposed on September 22, 2017. When asked why Ms. Fife required a total knee replacement, Dr. McCarthy responded:

[w]ell, in addition to her meniscal tear, she has joint space narrowing with osteophyte formation. She has a degenerative marrow signal in that part of the knee. Now if I was just to treat the meniscal tear, it would probably be unsuccessful. In other words, she would still complain of pain over the medial side because of those degenerative changes.

         Dr. McCarthy further testified that he relates the meniscal tear to her work-related fall. He stated that the osteoarthritis in the knee was probably preexisting. He testified that her problem is compounded in that she has a meniscal tear on a degenerative knee in the medial compartment. Dr. McCarthy was of the opinion that if you do not treat everything, then you are not going to get a good result. He testified that but for the injury of December 13, 2016, Ms. Fife would not need a total knee replacement. He stated that without surgery, she could expect deterioration.

         Ms. Fife's prior medical records and the workers' compensation claim index demonstrate prior right knee injuries and diagnoses of preexisting degenerative osteoarthritis of the right knee. A medical report dated January 22, 2004, from Robert P. Kropac, M.D., of the Orthopedic Center of the Virginias, indicated a diagnosis of contusion of the right knee superimposed on preexisting degenerative arthritis and patellofemoral chondromalacia of the right knee. On April 3, 2008, Ms. Fife was treated at Bluefield Regional Medical Center for right knee pain and left heel pain after losing her balance ...


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