Opinion ID: 1767053
Heading Depth: 1
Heading Rank: 1

Heading: Major cause of the knee injury

Text: For his first point on appeal, Hickman argues that the Commission erred in finding that he failed to prove by a preponderance of the evidence that he sustained an impairment rating of 30% to his lower extremity as a result of his compensable knee injury. Specifically, Hickman asserts that the Commission incorrectly concluded that he failed to prove that, but for his knee injury in 2002, he would not have required a total-knee-replacement surgery. In response, Kellogg argues that the Commission properly ruled that Hickman's compensable knee injury was not the major cause for his knee-replacement surgery. Kellogg contends that Hickman's preexisting condition, not the April 26, 2002 incident, was the major cause of his right-knee replacement, and he should not have been entitled to permanent-disability benefits. The Second Injury Fund requests that we affirm the Commission's rulings, as Hickman only proved a contusion, or bruise, that he sustained from the April 28, 2002 compensable injury. In appeals involving claims for workers' compensation, our court views the evidence in a light most favorable to the Commission's decision and affirms the decision if it is supported by substantial evidence. Moncus v. Billingsley Logging, 366 Ark. 383, 235 S.W.3d 877 (2006). Substantial evidence is evidence that a reasonable mind might accept as adequate to support a conclusion. Id. The issue is not whether the appellate court might have reached a different result from the Commission; if reasonable minds could reach the result found by the Commission, the appellate court must affirm the decision. Id. Where the Commission denies a claim because of the claimant's failure to meet his burden of proof, the substantial-evidence standard of review requires that we affirm the Commission's decision if its opinion displays a substantial basis for the denial of relief. Id. Questions concerning the credibility of witnesses and the weight to be given to their testimony are within the exclusive province of the Commission. Patterson v. Ark. Dep't of Health, 343 Ark. 255, 33 S.W.3d 151 (2000). When there are contradictions in the evidence, it is within the Commission's province to reconcile conflicting evidence and to determine the true facts. Id. The Commission is not required to believe the testimony of the claimant or any other witness, but may accept and translate into findings of fact only those portions of the testimony that it deems worthy of belief. Id. Thus, we are foreclosed from determining the credibility and weight to be accorded to each witness's testimony. Arbaugh v. AG Processing, Inc., 360 Ark. 491, 202 S.W.3d 519 (2005). A compensable injury, found in Arkansas Code Annotated section 11-9-102(4)(A)(i), is defined as [a]n accidental injury causing internal or external physical harm to the body ... arising out of and in the course of employment and which requires medical services or results in disability or death. An injury is `accidental' only if it is caused by a specific incident and is identifiable by time and place of occurrence[.] A compensable injury must be established by medical evidence supported by objective findings, which are findings that cannot come under the voluntary control of the patient. Ark.Code Ann. § 11-9-102(4)(D) and (16) (Supp.2007). Additionally, permanent benefits shall be awarded only upon a determination that the compensable injury was the major cause of the disability or impairment. Ark.Code Ann. § 11-9-102(4)(F)(ii)(a) (Supp.2007). The term, major cause, means more than fifty percent of the cause, which must be established by a preponderance of the evidence. Ark.Code Ann. § 11-9-102(14)(A) & (B) (Supp.2007). Thus, in order for Hickman to be entitled to permanent benefits, he was required to show: (1) that he suffered an injury arising out of and in the course of his employment; (2) that the injury was caused by a specific incident; (3) that the injury caused internal or external physical harm to his body; (4) that the injury is supported by objective findings; (5) that the injury was the major cause of the disability or need for medical treatment. Ark.Code Ann. § 11-9-102. Here, the first four factors are supported by the evidence and the parties' stipulations. First, Hickman suffered the compensable injury while at the workplace. Second, the injury was caused by slipping on the oil spill. Third, the accident caused an injury to his knee that required him to seek medical treatment. Fourth, this injury was stipulated by the parties as compensable. With regard to the fifth factor, the key issue is whether, pursuant to Ark. Code Ann. § 11-9-102(4)(F)(ii)(a), Hickman's compensable knee injury, stemming from his work-related April 26, 2002 accident, was the major cause of his resultant impairment rating. In the case sub judice, there was substantial evidence that Hickman had a preexisting degenerative knee condition. Dr. Sid Bailey, Hickman's treating physician, testified that he examined Hickman's right knee on June 5, 2002, and Hickman had significant past history of a previous injury to that knee from a dump-truck accident in 1984. Hickman had a previous right-knee surgery, a healed surgical scar, and mild to moderate synovitis [inflammation] and pain with any attempted active or passive range of motion. According to Dr. Bailey's testimony, Hickman's range of motion was restricted to thirty percent estimated overall. Dr. Bailey also testified that x-rays revealed moderate to severe post-traumatic degenerative arthritis with no fracture. He further testified that Hickman's arthritis, as shown on the x-ray, would have existed prior to his April 25, 2002 injury. The arthritis shown on the x-ray included bone spurs and narrowing. Dr. Bailey also testified about the findings of the MRI to Hickman's right knee. According to Dr. Bailey's interpretation of the MRI, the medial meniscus and also the ACL [anterior cruciate ligament] were absent from the knee prior to the accident on April 25, 2002. He speculated that they were removed by surgery or the knee was injured prior to that time. He added that [t]he ACL ... gives stability to the knee so that you don't plant, pivot, turn and collapse with a trick knee that you've seen. And the medial meniscus also gives stability and functions as a pad, if you will, cushion or support between the two bones the femur and the tibia. Based upon these findings, Dr. Bailey concluded that Hickman had a painful and very inefficient right knee. Dr. Bailey read the report of Dr. John Ledbetter, an anaesthesiologist with a fellowship in pain management, who testified that the contusion and all physical evidence from Hickman's work-related injury resolved itself by the time Hickman's knee-replacement surgery took place on September 29, 2004. Finally, in the following colloquy, Dr. Bailey admitted that Hickman's severe preexisting degenerative changes in his knee were the major cause of his surgery: Q: Doctor, using Mr. Giles's definition of major cause supplied to you in this letter as being more than fifty percent of the cause it remains your opinion today as you told me earlier that Mr. Hickman's severe preexisting degenerative changes of the right knee was the major cause of the surgery and his impairment rating, is that correct. A: Yes. Q: And this is in your opinion to a reasonable degree of medical certainty? A: Yes. Hickman relies upon Pollard v. Meridian Aggregates, 88 Ark.App. 1, 193 S.W.3d 738 (2004), for the proposition that [t]he major cause requirement is satisfied where a compensable injury aggravates an asymptomatic preexisting condition such that the condition becomes symptomatic and requires treatment. However, Hickman's argument is misplaced because, unlike the appellant in Pollard , there was evidence that his knee caused him problems prior to the April 2002 compensable injury, particularly in light of his prior knee surgery, degenerative arthritis, and absence of the medial meniscus and the ACL prior to the surgery. Further, there is no evidence that the need for Hickman's knee-replacement surgery and the resulting impairment would not have occurred but for the work-related injury. [1] Based upon the foregoing analysis, as well as our standard of review in viewing the evidence in a light most favorable to the Commission's decision, we conclude that there was substantial evidence to support the Commission's finding that Hickman failed to prove that the April 2002 incident was the major cause of his total-knee-replacement surgery and resulting impairment rating. Accordingly, we affirm the Commission's decision on this point.