A worker with ongoing knee pain can continue to pursue workers’ compensation benefits since the evidence wasn’t clear on whether his condition was caused by a pre-existing condition or his work injury.
The West Virginia Supreme Court of Appeals found that further review was necessary since multiple doctors couldn’t agree on whether the worker’s pain was being caused by his compensable injury or pre-existing bursitis and osteoarthritis.
A compensable knee injury followed by ongoing pain
Mark Ferrell was employed by Northwest Hardwoods. On March 20, 2013, while he was working, a strong wind blew a piece of tin into his leg and knocked him down.
Ferrell was diagnosed with a left knee contusion. He filed a workers’ compensation claim and the injury was held compensable on April 2, 2013.
However, Ferrell continued to experience persistent pain in his left knee. He was evaluated by a doctor on Feb. 11, 2014, and had to undergo arthroscopic surgery on his left knee one month later.
Ferrell continued to experience pain in his left knee after the surgery and a June 2015 MRI revealed a small cyst. He underwent a procedure on his left hip on Oct. 30, 2015, that was intended to relieve his knee pain.
In 2016, Ferrell was evaluated by another doctor for the ongoing pain in his left knee. A physical examination revealed no major problems but there was some tenderness near the joint. X-rays also revealed no major problems in the area of the knee. The doctor diagnosed minor arthritis and recommended physical therapy and a brace.
Doctors can’t agree on cause
Between September 2016 and November 2019, Ferrell saw four more doctors for his ongoing knee pain. Diagnoses included degenerative joint disease and osteoarthritis. Two of the doctors felt that these conditions were related to the 2013 work injury because Ferrell only began complaining of ongoing knee pain following that injury and didn’t have any problems before that time.
In 2018, Ferrell began undergoing injections to relieve his pain with some success and he attempted to add the injections and related expenses to his original workers’ compensation claim.
A claims administrator denied the request on May 31, 2019. Ferrell contested the denial while continuing to undergo treatment for his pain.
Ferrell underwent an independent medical examination on Jan. 9, 2020. The independent doctor found there was no causal connection between Ferrell’s ongoing pain and his 2013 work injury. Instead, she diagnosed pre-existing bursitis and osteoarthritis
‘Pain is a symptom, not a diagnosis’
On Oct. 9, 2020, the Office of Judges found that Ferrell failed to show by a preponderance of evidence that the requested diagnoses should be added to his claim. The Office of Judges also denied the addition of left knee pain as a diagnosis because pain is a symptom, not a diagnosis.
The medical evidence didn’t establish that Ferrell’s left knee osteoarthritis was causally related to the 2013 compensable injury, the Office of Judges stated.
The Board of Review adopted the Office of Judges’ decision on Feb. 19, 2021.
Medical evidence raised question of causation
On appeal, Ferrell argued that he had complained of left knee pain since his work-related injury on March 30, 2013, and there was no evidence that he’d ever been diagnosed or treated for bursitis or osteoarthritis prior to the date of injury.
The West Virginia Supreme Court of Appeals found that for Ferrell to successfully have his ongoing condition added to his claim, he had to prove that:
- before the injury, his pre-existing condition was asymptomatic, and
- following the injury, the symptoms appeared and continued to manifest.
There also must be sufficient medical evidence and other facts to show a causal relationship between the injury and the condition. Even if all of these conditions are met, the claim can be rebutted by the employer.
Since the evidence raised a possible inference of causation between Ferrell’s work injury and his diagnosis of bursitis and osteoarthritis, the court reversed the denial of benefits. The court remanded the case to the Board of Review for further review.