SUPERIOR COURT OF NEW JERSEY APPELLATE DIVISION DOCKET NO . A

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- 19 SANDRA MARTONE,
Petitioner

- Appellant ,

v. COMMUNITY MEDICAL CENTER, Respondent

- Respondent.

____ __ _____________________

Argued October 18, 2021

– Decided December 29 , 202 1 Before Judges Messano and Accurso. On appeal from the State of New Jersey Department of Labor and Workforce Development, Division of Workers' Compensation, Claim Petition No. 2013

- 34743. Danielle S. Chandonnet argued the cause for appellant (Shebell & Shebell, LLC, attorneys; Danielle S. Chandonnet, on the brief). Anne Hammill Pasqua argue d the cause for respondent (Capehart & Scatchard, PA, attorneys; Michael C. Rose, of counsel; Michael P. McCaffrey, on the brief).

NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION This opinion shall not "constitute precedent or be binding upon any court

. " A lthough it is posted on the internet , this opinion is binding only on the parties in the case and its use in other cases is limited

. R

. 1:36

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PER CURIAM Appellant Sandra Martone filed a w orkers' c ompensation petition alleging
that on November 15, 2013, while worki ng as an emergency room technician for respondent Community Medical Center (CMC), she fell sustaining an injury to her right knee. CMC acknowledged the claim was compensable. 1 After three
full

- and partial

- knee replacement surgeries, physical therapy, a nd other procedures over many years , Martone moved for temporary medical benefits, alleging a fourth full

- knee replacement surgery was reasonable and necessary to alleviate her pain and improve her range of motion. CMC filed o pposition , and

t he Judge of W orkers' Compensation ( JWC ) heard testimony to de cid e if CMC should be compelled to pay for Martone's surgery in accordance with N.J.S.A.
34:15

- 15 (Section 15), the relevant provision of the Workers' Compensation Act (Act), N.J.S.A. 34:15

- 1 to

- 142.
I.
The evidence at the hearing was largely undisputed

. Between the dates of
March 2014 and February 2015, Dr. Christopher Passariello performed multiple procedures on Martone's right knee because of continued complaints of pain,

1 Martone amended her complaint to include injuries relating to her shoulder, back, and mental health, but we limit this opinion to the order under review, which only pertain s to her claim of a compensable injury to her right knee.3 A

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including a total right knee replacement, bilateral knee manipulation under anesthesia, and a right knee arthroscopy. Following each surgery, Martone attended physical therapy and received other treatment , but eventually she was unable to continue working due to ongoing pain and her need for pain medication, which she could not take while working at CMC . Dr. Jennifer Yanow, a pain management specialist, began treating Martone in August 2015 , but released her from care in January 2016 after unsuccessful anesthetic blocks
to several nerves . Dr. Yanow conclud ed no other medical treatment could
alleviate Martone 's symptoms.
Martone sought a second opinion from Dr. Zachary Post, an orthopedic surgeon, who found she had "less than ideal motion." However, Dr. Post took

x - rays and found the knee replacement was well

- placed and well

- fixed, with no evidence of loosening or mechanical failure to the knee. Still, Martone complained of stiffness and limited range of motion. In May and July 2016, Dr. Arthur Mark, CMC's authorized workers' compensation
surgeon , performed a right revision of the total knee replacement, a scar revision, and manipulation under anesthesia, but these did not alleviate
Mart one's pain or improve her mobility. In December 2016, Dr. Mark performed4 A

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a revision of the tibial component of the total knee replacement and a synovectomy. Aside from her visits with Dr. Mark and Dr. Post, Martone saw various orthopedic surgeons who pr ovided independent re

- evaluations, each conclud ing that in view of the multiple failed surgeries, Martone would be a poor candidate
for further surgical intervention. One noted, "[Martone]'s pain seems to be out of proportion to what [he] would expect in a typical patient." Martone was evaluated by another pain specialist in February 2017 who noted her presentation was "complex" and found Martone to be manipulative and
"volitive" towards obtaining continued high amounts of pain medication. A month later, Martone underwent a pain management psychological exam which
found she exhibited symptoms of Somatoform Pain Disorder and Prescriptive Opioid Dependence/Tolerance. 2 On April 21 , 2017, Dr. Mark stated he could
offer no further curative treatment and discharged Martone. In August 2017, Martone returned to Dr. Post , alleging she was still in pain. Dr. Post had not viewed Dr. Mark's notes nor his operative reports on the
last two revisions in 2016, but, nevertheless, he concluded Martone would be a

2 These findings were consistent amongst various medical professionals who evaluated Martone.5 A

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good candidate for a revision of her right knee. Martone sought an evaluation with Dr. Alan Nasar in May 2018 who opined he would consider revision of the right knee as recommended by Dr. Post. Using Dr. Nasar's medical report for support, Martone filed her motion for temporary medical benefits in October
2018. Given the extensive treatment and countering expert opinions, the JWC wisely ordered CMC to authorize a one

- time need

- for

- trea tment examination to render an opinion on the benefits of further surgery . Accordingly, Dr. Michael Sidor, an orthopedic surgeon, examined Martone in March 2019

. He concluded
Martone was at maxim um medical improvement and found there was no need
for furt her medical treatment. However, in April 2019, Martone revisited Dr. Post , who reiterated she would be a good candidate for total right knee reconstructive surgery. Martone
filed an additional motion and attached Dr. Post's report in support. CMC opposed , contending Martone was already examined by the authorized provider
as well as a second doctor at the court's request , both of whom concluded further surgery was unwarranted

. All three experts testified at trial. Dr. Post stated Martone's femoral
compo nent "appeared to be too distal, which contributed to her tightness and6 A

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tension . . . and her lack of ability to get full extension." He explained doctors

can "reposition the knee, proximalizing [the knee] . . . to open up the extension space giving [Mart one] more room for her knee to obtain full extension," or distalizing the knee, i.e., closing the extension space. The doctor acknowledged, however, that either procedure may lead to instability or tightness. Although
Dr. Post concluded Martone "clearly ha[d] arthrofibrosis , " "one of the more difficult problems [doctors] face in revision knee replacement , " he nonetheless was willing to operate

. Dr. Post could not guarantee the revision surgery would

cure Martone's condition , and h e admitted Martone's condition could worse n , resulting in further loss of motion

. Dr. Mark testified he intentionally placed the femoral component lower to ensure the kneecap tra ck ed into the implant , which he described as the standard
of care

. He concluded any further surgical revisions had a low probability of

success , because there was no evidence of loosening or mechanical problems with the artificial knee, Martone had arthro fibrosis , and pain management

treatments were ineffective.
Dr. Sidor opined the pattern following Martone's prior surgeries
demonstrated she would lose extension and flexion after surgery, which is consistent with a diagnosis of fibrosis. Dr. Sidor testified the location of the7 A

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femoral component of Martone's knee implant d id not contribute to her
condition. Dr. Sidor also testified that further surgery would likely result i n bone loss, because the existing implant was well

- fixed and difficult to remove

. If additional surgery w ere performed, Dr. Sidor expressed concern about possible infection, and that Martone would be " worse than she is now." In a cogent, comprehensive op inion, the JWC found all three experts were credible witnesses, but he disagreed with Dr. Post's opinion that the location of the implant was the cause of Martone's pain. Rather, the judge credited Dr.
Sidor 's conclusion that Martone's pain was caused by fibrosis , as evidence by a post

- surgery pattern in which Martone would lose extension in the joint . The

court expressed concerns regarding the risks associated with a fourth procedure , noting Martone underwent multiple surgeries and experience d additional symptoms afterwards, indicating she wa s "actually worse after surgery." The judge credited Dr. Mark 's opinion that further surgery will create
additional arthrofibrosis , contribut ing to Martone's pain and inability to move. The judge explaine d that if he "felt there was any reasonable likelihood surgery would help [Martone], [he] would have no hesitation," but that was "not the

case
. " He entered an order denying her motion for medical treatment.8 A

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- 19 II. On appeal , Martone urges us to reverse the order , arguing it was unsupported by the evidence and expert testimony in the record. Martone asserts
that b ecause the JWC found Dr. Post to be credible, it was improper to deny her

treatment the doctor recommended to help relieve her pain and improve he r function. We disagree. "Appellate courts approach the factual findings made by a workers' compensation court with ' substantial deference ' in recognition of the compensation judge's expertise and opportunity to hear witnesses and assess their credibility. " Goulding v. NJ Friendship House, Inc. , 245 N.J. 157, 167 (2021) (quoting Ramos v. M & F Fashions, Inc. , 154 N.J. 583, 594 (1998) )

. "An agency's interpretation of a statute, however, although entitled to some weight,
is not binding on the reviewing court." Ibid. (quoting Brock v. Pub. Serv. Elec.
& Gas Co. , 149 N.J. 378, 383 (1997) )

. "The Act r equires employers to provide treatment to injured employees
when the treatment is ' necessary to cure and relieve the worker of the effects of the injury and to restore the functions of the injured member or organ where such restoration is possible . . . . ' " Martin v. Newark Pub. Schs. , 461 N.J. Super. 330, 33 8 (App. Div. 2019) (quoting N.J.S.A. 34:15

- 15 ). Although the Act is9 A

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liberally construed in favor of providing coverage to injured workers, Goulding , 245 N.J. at 167, "[w] hether the treatment is charac terized as curative or palliative, [it] is compensable if competent medical testimony shows that it is

' reasonably necessary to cure or relieve the effects of the injury. ' " Ma rtin , 461
N.J. Super. at 33 8 (quoting Hanrahan v. Twp. of Sparta , 284 N.J. Super

. 327,
336 (App. Div. 1995)).
W hat is reasonable and necessary does not depend on a petitioner's
"desires or beliefs as to what treatment or service will be most beneficial

. " Hager v. M&K Constr. , 246 N.J. 1, 24 (2021)

. A p etitioner must show the treatment would "probably relieve petitioner's symptoms and thereby improve [her] ability to function." Hanrahan , 284 N.J. Super. at 336. Here, Martone ha d extensive treatment and a total of six right knee procedures which have been ineffective. Martone has been examined by over sixteen medical professionals, including treatments from multiple psychiatrists and pain specialists ; the record reflects many agree Martone suffers from a dependency on opioids. Martone's expert, Dr. Post, in accord with other d octors,
noted her pain appears to be out of proportion to a typical patient , thereby complicating an ability to properly assess i f her pain can be alleviated.10 A

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Martone contends the WCJ erred by according greater weight to the testimony of Dr. Sidor than t he testimony of Dr. Post. However, "[c] ompensation judges have ' expertise with respect to weighing the testimony
of competing medical experts. '" Martin , 461 N.J. Super. at 33 7 (quoting Ramos , 1 54 N.J. at 598 ). A " judge of compensation ' is not bound by the conclusional opinions of any one or more, or all , of the medical experts. ' " Kaneh v. Sunshine
Biscuits , 321 N.J. Super. 507, 511 (App. Div. 1999) (quoting Perez v. Capitol Ornamental, Concrete Specialties, Inc. , 288 N.J. Super. 359, 367 (App. Div. 1996)). "That [the judge] gave more weight to the opinion of one physician as opposed to the other provides no reason to reverse th[e] judgment." Martin , 461
N.J. Super. at 33 7 (alterations in original) (quoting Belli no v. Verizon Wireless , 435 N.J. Super. 85, 95 (App. Div. 2014)). Martone argues the JWC failed to articulate his reasons for crediting one doctor's testimony over another . However, the judge comprehensively reviewed
the medical records in evidence and considered the experts' testimony after having the opportunity to assess their credibility. The JWC concluded Martone
suffers from arthrofibrosis , a condition diagnosed by all three doctors. That
condition mad e any further surgery challenging, both in terms of its potential
success and in Martone 's recover y without additional scarring that would further11 A

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adversely impact her mobilit y. The JWC's factual findings and legal determinations are amply supported by th e record

. R. 2:11

- 3(e)(1)(D).
A ffirmed.