Total Knee Replacement

03/13/2022 By Justin Kallal

DJK partner and trial attorney Jason Johnson recently won a hard fought victory for his client in front of the Medical Commission. The Medical Commission is a panel of three doctors and a hearing examiner which hears medically complex contested cases for the Wyoming Division of Workers’ Compensation (“Division”).

Jason’s client was working as a server at a local restaurant in Cheyenne when she slipped on a slice of lemon on the floor. She fell forward and injured her right upper and lower leg and her left knee. The Division opened a claim and began paying benefits for the injuries to her right leg and left knee. Injured workers in Wyoming are referred to as Claimants.

There was no question that the Claimant was in the scope of her employment and that she had acute injuries to her right leg and left knee from the fall. The was also no question that the Claimant had no prior history of left knee pain or injury. However, the MRI of the Claimant’s left knee revealed that along with an acute medial meniscus tear the Claimant also had serious pre-existing Grade 4 Chondromalacia (serious degenerative arthritis in the knee).

Wyoming Worker’s Compensation typically will not pay for pre-existing medical conditions unless they are materially aggravated or exacerbated by the work injury. Workers’ Compensation paid for the Claimant’s surgery for the torn meniscus, but when that surgery was not successful and doctors recommended the Claimant receive a total knee replacement, then the surgery was denied on the basis it was related to the pre-existing arthritis in the Claimant’s knee and not the fall.

Both the Claimant and the Division presented competent medical testimony to support their arguments and the Medical Commission had to weigh the evidence and apply the law. Jason had the burden to proof the work injury had materially exacerbated and/or aggravated her pre-existing arthritis and causing her to need a total knee replacement. The Medical Commission correctly interpreted Wyoming law and found:

In this case, the Claimant’s knees were asymptomatic prior to her fall on November 12, 2017. It was not until after her fall that the Claimant was diagnosed with osteoarthritis. Until that time, she was not aware she had osteoarthritis. The Claimant first began wearing a knee brace on her left knee after she fell at work. The brace was to aid in stability and pain control. There were no medical records or testimony to indicate the Claimant had sought medical treatment for her knee(s) prior to her fall. The Panel finds that Dr. Bernton, Dr Snyder and Dr. Hale all conclude the Claimant suffered a material aggravation and exacerbation as a result of her work related fall on November 12, 2017.

Similarly, they all believe a total knee replacement is reasonable medical treatment for Claimant’s osteoarthritis. While Dr. Bernton opines a left total knee replacement is not needed due to the work-related aggravation, Wyoming law provides otherwise Wyoming law requires that the work injury combined with the pre-existing condition to create the present disability and need for treatment. Claimant’s work injury of November 12, 2017, combined with her pre existing unknown, asymptomatic osteoarthritis to create the need for physical therapy, injections, arthroscopic meniscal surgery and now, the need for a total knee replacement.

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