STATE BOARD OF WORKERS' COMPENSATION 601 Broad Street, SE Suite D Gainesville, GA 30501 www.sbwc.georgia.gov (770) 531-5625 REFERENCE ID: 16776483 DATE: December 23, 2016 CASE OF: THELMA C SANFORD CLAIM NUMBER: 2016-000691 DATE OF INJURY: 12/17/2015 EMPLOYER INSURER CLAIMS OFFICE PENELOPE MORRIS PO BOX 1343 CONYERS, GA 30012 COUNSEL FOR EMPLOYEE DAN C CHAPMAN III P.O. BOX 1343 CONYERS, GA 30012 COUNSEL FOR EMPLOYEE ADAM A LEVY 701 WEST AZEELE STREET, SUITE A, TAMPA, FL 33606 COUNSEL FOR EMPLOYER/INSURER DANIEL BAQUERIZO 701 WEST AZEELE STREET, SUITE A, TAMPA, FL 33606 COUNSEL FOR EMPLOYER/INSURER THELMA C SANFORD EMPLOYEE Claim Number: 2016-000691 Page 2 of 6 STATEMENT OF THE CASE The employee is seeking TTD benefits from December 18, 2015 through July 26, 2016 when the employee was released back to full duty. This is presently a medical only claim. The parties were able to stipulate the employer was subject to the Act on the date of accident; jurisdiction is proper with the court and venue is proper in Hall County, Georgia. The parties agree there was proper notice given and employment with an accident and injury on December 17, 2015. The employee’s average weekly wage is also in dispute as well as continued medical treatment. The employee has the burden of proof on all issues in this claim. After observing the witnesses, examining the admissible evidence, and reading the parties’ briefs, I make the following findings of fact and conclusions of law: FINDINGS OF FACT AND CONCLUSIONS OF LAW 1. The employee was called as a witness, sworn, and testified as follow: a) The employee stated she is twenty-six (26) years old and has lived in Jefferson, Georgia all of her life. (T-6) b) She said she got her job with the employer/insurer with the help of a staffing agency in October, 2015. (T-6) c) She thinks she started working for the employer/insurer as a permanent employee about October 22, 2015 as a gift wrapper. (T-7) d) She said she was paid $10.00 per hour and it was her impression that her job was through the peak season or through January, 2016. She said she worked forty (40) plus hours per week. When questioned, she specifically said she worked fifty (50) to fifty-six (56) hours per week. She said she wrapped different types of packages. She said she wrapped about fifty (50) packages per day in October, 2015 and one-hundred (100) or more during the peak season.(T-8, 9, 10) e) She testified that after she wrapped a package, she put it back on the conveyer belt. She said she did this work all day. (T-11) f) The employee testified that on December 17, 2015 she was lifting boxes and started feeling pain in her wrist. She said she told Lynn, one of her co-workers. Afterward, she said she went back to work but started getting a knot. She said she went to Janet, who applied ice and then called the nurse. (T-11, 12) g) She said the employer/insurer sent her to Athens Regional First Care the next morning. She said her wrist was swollen and she was given a brace, pain medication, and restrictions of two (2) pounds. (T-13) h) She said the next day she went back to work to tell the employer/insurer what was on her restrictions and was told they would call her when she could come back to work. She said she never received a phone call, so she called the employer/insurer and found out she had been terminated. Afterward, she said she got a termination notice. (T-13) i) She said when she picked up her paycheck she was told she would be receiving benefits. She testified she continued to have pain. She was later allowed to treat with Dr. Davis who injected her wrist. (T-14, 15) j) The employee said Dr. Davis restricted her from lifting over two pounds. She said at some point Dr. Davis referred her to a specialist but she has not seen a specialist. (T-16) Claim Number: 2016-000691 Page 3 of 6 k) She said she continued to treat with Dr. Davis several times and was sent to Dr. Hocker who checked her wrist, said the cyst went down, and removed her work restrictions. He also gave her pain medication. (T-16, 17) l) On cross-examination the employee said she expected to be employed until late January, 2016. She said she thought she was terminated because of her restrictions. (T-18) m) When shown the separation notice, she agreed it said lack of work because the peak seasonal employment was over. (T-19) n) The termination notice was dated December 23, 2015. (T-19) o) The employee was shown a WC-6 and testified it accurately reflected what she earned. (T-20) p) On redirect examination, the employee noted that line number nine on the WC-6 showed earnings from December 13 through 19, 2015 and her accident was on December 17, 2015. 2. Maria M. was called as a defense witness, was sworn, and testified to the following: a) She testified she is employed by the employer/insurer as senior human resources manager and has worked there since August 26, 2015. She said she was in charge of hiring and terminating employees. (T-23) b) Maria M. further testified the employee was terminated on December 23, 2015 because her assignment had ended because she was a seasonal employee. She said the peak period is from Black Friday through Christmas Eve, which is the final delivery commitment date due to delivery restrictions. (T-23) c) She testified the employee’s termination had nothing to do with the employee’s work accident or work restrictions. She agreed it was her understanding the employee had been released to full duty on December 23, 2015. She also said they had hired seven hundred (700) workers for the season. She testified forty-three (43) seasonal workers were let go on December 23, 2015 with the majority of the seasonal workers being terminated the first week of January, 2016. (T-24, 25) d) This witness was shown exhibit D-5 which Maria M. identified as the employee’s application for employment. She noted there is a stamp on the bottom of the application which indicates the job is seasonal employment only. She agreed the employee signed the form. (T-26) e) She also identified the termination notice which she explained indicated that the season had ended (T-27) 3. Counsel for the employee stated the employee was not claiming she was terminated due to her injury and admitted she knew it was the end of the seasonal work. (T-28) 4. Maria M. was cross-examined by the employee’s counsel and testified to the following: a) She agreed she had no personal or direct knowledge of the employee’s hiring, she testified it was regular practice of the employer/insurer to inform seasonal employees that their employment was temporary and seasonal. (T-29) 5. The employee was recalled a witness and continued her testimony as follows: a) She testified when she was on light duty she called around and sought employment with Hire Dynamics, Randstad, and Top Notch which are all temp agencies. (T-30, 31) b) She said she called every week and was offered a job which she could not accept because of her restrictions. (T-31) c) She testified she was called by Top Notch to ask if she could take a position for picking and Claim Number: 2016-000691 Page 4 of 6 packing. She said she let them know she had restrictions of two pounds and said they had nothing for her. (T-31) d) On reexamination by the defense the employee said she started contacting the temp agencies as soon as she received the termination notice. She said she started right after December 23, 2015 and was currently still contacting the agencies looking for work. (T-32) e) She testified she would call the agencies and ask if anything was available and she said they told her they would put her on the list for that week. She also testified Hire Dynamics had called her two weeks prior to the hearing with a job but due to transportation problems, she could not do the job. (T-33) f) The employee testified that now she tells the agencies she is available for anything but when she was on restrictions she told them she could only lift two (2) pounds. (T-34)’ g) She agreed that Dr. Hocker placed her on full duty around December 22, 2015 and at that point she was asking the temp agencies if anything was available because the knot was still on her wrist. She said she went back to Dr. Davis because of the pain and Dr. Davis put her back on restrictions of no lifting over two (2) pounds. (T-34, 35) h) The employee agreed that after seeing Dr. Hocker in July, 2016 she understood he placed her on full duty work again. She said that since that time she has told the temp agencies she was available for anything. (T-35) g) She agreed she was not able to take the job offer from Hire Dynamics because she needs transportation. (T-35) 6. The employee was examined by Dr. David Hocker with Primary Care Clinics of Georgia on December 22, 2015 for complaints of a knot on her wrist with tenderness. He opines the patient thinks it is work related because she works with her hands. He said she denied any blunt trauma. Dr. Hocker gives his medical opinion that the employee has a spontaneous cyst which is not related to her work activities and she had a work-related wrist sprain on December 17, 2015 which had resolved by December 22, 2015 when she presented for treatment. He released the employee to regular activities. (D-2, pp. 1-4) 7. Dr. Hocker examined the employee again on July 26, 2016. He opines in his report that despite his opinion that the cyst was incidental, the employee pursued treatment under workers’ compensation. On this occasion she was complaining of associated wrist pain. Dr. Hocker found no evidence of a cyst during his examination of the employee and further opined the employee’s exam is worrisome due to some symptom magnification behavior. He says she needs no further treatment and continued her on regular activities. (D-2, p. 2) 8. Dr. Hocker signed a letter from the employer/insurer dated October 6, 2016 in which he agreed the employee had, at worst, a wrist sprain which had resolved as of December 22, 2015 and her cyst was not painful and did not interfere with function. He agreed to the content of the letter which characterized the employee’s complaints as not credible and agreed she was a malingerer. (D-3, p. 3) 9. There was an accident report filed on December 17, 2015 referencing a left wrist injury lifting boxes at work. (C-1, p. 1) 10. Dr. Davis examined the employee on January 15, 2016 opining the employee was complaining of pain at the left hand after lifting boxes at work. He said she was wearing a brace on her left wrist. He found a prominent cystic lesion over the radial aspect of the dorsum of the wrist. His impression Claim Number: 2016-000691 Page 5 of 6 was right hand ganglion cyst or lesion versus small lipoma over the radial dorsal of the wrist. He injected the lesion and gave the employee a two (2) pound lifting restriction. (C-2, pp. 5, 6) 11. On January 29, 2016 the employee returned to Dr. Davis who opined the wrist area looks better and the area of the previous cyst is completely flattened out after the Kenalog injection. He instructed the employee to continue wearing the wrist splint and return in two (2) weeks. 12. Dr. Davis examined the employee again on February 12, 2016 and recounted findings of the same tenderness as before. He opines the patient has pain with any motion of the wrist and is extremely tender on palpation. He says the reason for this tenderness is unclear. He recommends the patient be referred for a second opinion or for an IME exam as the continued complaint of pain is of unknown cause. He continued the employee on light duty. (C-2, p. 1) 13. Dr. Davis’s final report on the employee is in the form of a questionnaire sent to him by the employer/insurer on September 12, 2016 in which he agreed with Dr. Hocker the employee had a spontaneous ganglion cyst, unrelated to workers’ compensation, and that the injury from the accident had resolved. He also agreed with Dr. Hocker that the employee did not require further medical treatment; should have no work restrictions during the period of December 22, 2015 and July 26, 2016; the employee is engaged in symptom magnification; and needs no further medical treatment for the work accident. (D-3, pp. 4, 5) 14. The employee has the burden of proof to show that her injuries arose out of and in the course of her employment with her employer. See Holt Service Company v. Modlin, 163 Ga. App. 283, (1982); Zamora v. Coffee General Hospital, 162 Ga. App. 82. Essentially, the employee must prove a causal connection between the employee’s work and her injuries to show a claim is compensable (i.e. entitlement to workers’ compensation benefits). See O.C.G.A. §34-9-1(4). 15. I find that while working for the employer/insurer, the employee noticed a ganglion cyst on her wrist which was causing her pain. She was sent for treatment with Dr. Hocker who determined the cyst was of a spontaneous nature and was not related to her work. He released the employee back to full duty with no restrictions on December 22, 2015. The employee was terminated on December 23, 2015 as part of a reduction in force and the employee agreed the termination was unrelated to her wrist injury. 16. The employee later went to Dr. Davis and was treated with an injection in the cyst which resulted in the cyst disappearing after two (2) weeks. Dr. Davis put the employee on work restrictions for her wrist but never specifically opined as to causation. The employee treated with Dr. Davis a couple of more times and then later returned to Dr. Hocker on July 26, 2016. He opined he saw no evidence of a cyst and was worried due to the employee’s symptom magnification. Both Dr. Hocker and Dr. Davis agreed they suspected the employee of malingering and neither physician directly connected the employee’s wrist problems with her work injury other than a possible wrist strain which had resolved by the time she saw Dr. Hocker on December 22, 2015. I find the employee was unable to prove by a preponderance of the competent and credible evidence that her continued pain due to her cyst was work related and constituted an injury arising out of and in the course of her employment. Neither of her treating physicians related her continued wrist pain due to her cyst to her work injury. Consequently, I find the employee is no longer entitled to medical and/or income benefits under the Workers’ Compensation Act because her wrist strain had resolved by December 22, 2015 and her cyst was of a spontaneous nature and not found to be work related by her treating physicians. Claim Number: 2016-000691 Page 6 of 6 17. Having found the employee’s injury unrelated to her work duties, I find it unnecessary to address her job search. 18. I find from the evidence the employee’s average weekly wage is $436.12. The employee was shown exhibit D-4 and agreed the wages shown on the WC-6 were accurate and represented her wages while working for the employer/insurer. (D-4) AWARD 1. The employee’s request for temporary total disability benefits due to her alleged work accident is DENIED. 2. The employee’s request for continued medical treatment under the Act is DENIED. 3. The employee’s average weekly wage is set at $436.12. IT IS SO ORDERED , this the 23rd day of December, 2016. STATE BOARD OF WORKERS' COMPENSATION This order has been electronically signed and approved WARREN MASSEY ADMINISTRATIVE LAW JUDGE + STATE BOARD OF WORKERS' COMPENSATION 270 Peachtree Street NW Atlanta, Georgia 30303-1299 www.sbwc.georgia.gov (404) 656-2973 REFERENCE ID: 1798843 DATE: FEBRUARY 22, 2019 CASE OF: CHERYL JACKSON CLAIM NUMBER: 2018-003370 DATE OF INJURY: 01/05/2018 EMPLOYER INSURER SERVICING AGENT JONATHAN ROLNICK 2900 CHAMBLEE TUCKER ROAD, BLDG. 9 SUITE 200 ATLANTA, GA 30341 COUNSEL FOR EMPLOYEE DANIEL BAQUERIZO/ADAM LEVY 701 WEST AZEELE STREET, SUITE A TAMPA, FL 33606 COUNSEL FOR EMPLOYER/INSURER CHERYL JACKSON EMPLOYEE Claim Number: 2018-003370 Page 2 of 8 STATEMENT OF THE CASE This matter arises out of an accepted claim for a January 5, 2018 date of accident and resulting injuries to the Employee’s right hip and right knee. The case came on for hearing pursuant to WC-14, Request for Hearing, filed with the Board on August 14, 2018 on behalf the Employee 1 , whereby she is seeking additional workers’ compensation benefits, specifically, medical benefits for her lower back, right ankle and right arm. In addition, Employee is seeking an assessment of attorney’s fees and late payment penalties pursuant to O.C.G.A. §34-9- 108 and O.C.G.A. §34-9-221(e) based upon the Employer/insurer’s alleged unreasonable defense of this matter. Employer/insurer filed its’ own Request for Hearing on August 23, 2018 seeking authorization to suspend payment of benefits to the Employee based upon their assertion that Employee’s work-related injuries and/or aggravations have resolved, that she has undergone a change in condition for the better and that her current condition and any need for medical treatment are no longer related to her January 5, 2018 accident/injury. A hearing was held on December 19, 2018 in Atlanta, Fulton County, Georgia. At the conclusion of the hearing, the record was left open for the submission of briefs, which have been filed. Having reviewed and considered all admissible evidence and argument, I make the following findings of fact and conclusions of law. FINDINGS OF FACT AND CONCLUSIONS OF LAW 1. As an accepted claim, it has been stipulated or established that the Employer is subject to the Workers’ Compensation Act (the Act); that the State Board of Workers’ Compensation has jurisdiction in this matter; that venue lies in Fulton County, Georgia; that the Employer was properly insured for workers’ compensation purposes on the date of accident; that Employee was in the general employment of this Employer on the date of accident, earning an average weekly wage of $595.23, which, in the event further benefits are found to be owed, translates to a weekly temporary total disability (TTD) rate of $396.84; that on January 5, 2018 the Employee suffered a compensable accident and injuries to her right hip and right knee; and that proper notice was given of the accident. 2. At the request of the parties Judicial Notice was taken of the WC-3, Notice to Controvert, filed with the Board on May 14, 2018, whereby Employer/insurer denied liability for the Employee’s low back claim and the WC-3s filed on July 25, 2018 and August 13, 2018, denying further liability for the Employee’s right hip and right knee injuries, respectively, based upon their assertion that those injuries have resolved and that the Employee has undergone a change in condition for the better and has returned to her pre-injury condition. 3. The Employee has the burden of proof in this matter to establish the compensability of her lower back, right ankle and right arm injuries. She must prove each and every element of her claim. Argonaut Insurance Company v. King, 127 Ga. App. 566 (1972). Zamora v. Coffee General Hosp., 162 Ga. App. 82, 290 S.E.2d 192 (1982) and Dasher v. City of Valdosta, 217 Ga. App. 351, 457 S.E.2d 259 (1995); King v. Liberty Mut. Ins. Co., 126 Ga. App. 550, 191 S.E.2d 346 (1972). 1 Due to a change in the law which authorizes publication of Awards issued by the State Board of Workers’ Compensation, and in order to protect the privacy of the parties to Workers’ Compensation claims, initials or generic terms such as employee, employer and supervisor are used for identification in lieu of the names of parties or witnesses. Claim Number: 2018-003370 Page 3 of 8 4. In addition, the Employee/Claimant has the burden of presenting evidence that medical services for which she is seeking compensation are connected to her compensable accident before the condition in question can be considered related to employment. Jarallah v. Pickett Suite Hotel, 204 Ga. App. 684, 420 S.E.2d 366 (1992); Samples v. Roadway Express, Inc., 113 Ga. App. 391, 148 S.E.2d 198 (1966); Smith v. Mr. Sweeper Stores, Inc., 247 Ga. App. 726, 544 S.E.2d 758 (2001). 5. The burden of proof in a change in condition case is on the party asserting that such a change has taken place, in this case, the Employer/insurer. Cornell-Young v. Mintor, 168 Ga. App. 325, 309 S.E.2d 159 (1983). A "change in condition" is defined as "a change in wage-earning capacity, physical condition, or status of an employee, which change must have occurred after the date on which the wage-earning capacity, physical condition, or status of the employee or other beneficiary was last established by award or otherwise." OCGA §34-9-104(a); Atlanta Hilton & Towers v. Gaither, 210 Ga. App. 343, 436 S.E.2d 71 (1993). 6. The Employee/Claimant in this matter is a 60-year-old woman whom was working through a “temp agency,” and began working for the named Employer in early August of 2017. She worked doing “wire assembly, making ...wire harnesses.” 7. On January 5, 2018, Employee was stepping over a short, seven inches high, landscape wall, when she slipped and fell on some ice. In addition to injuring her right knee, Employee contends she also injured her low back, right ankle and right arm as a result of her accident. She testified that on the day of the accident, she was wearing steel-toed ankle boots, which she was required to wear while working, and when she fell, she twisted her right ankle and it appears that she landed on her right side. Employee further testified that she felt pain in her knee, but also in her ankle and in her right hip and lower back. (D-1). 8. The record contains an Incident Report completed by the Employer following the accident. Although the Employer/insurer are denying that Employee injured her lower back, right ankle or right arm as a consequence on the January 5, 2018 accident, the report specifically states that Employee suffered bilateral arm injuries and a right leg injury. Additionally, the Form WC-1, Employer’s First Report of Injury, filed by the Insurer, states that Employee suffered “Multiple Physical Injuries,” as a result of the January 5, 2018 accident and under “Body Part Affected,” the Insurer listed “Pelvis.” (D-1, p.1; D-2). 9. Employee readily admitted that she had knee problems which pre-existed her January 5, 2018 slip and fall injury; but, she denied having any other pre-existing physical problems or conditions. The record reflects that Employee had been diagnosed with osteoarthritis in her knees prior to her January of 2018 slip and fall. She testified that she had been treating for her right knee for “a couple of years before,” and had treated with “Kaiser,” her personal medical providers, and with Dr. Reddy and Dr. Gupta, physicians with Peachtree Orthopedic Clinic. Employee further testified that she used to be what appears to have been a “serious” walker and runner, doing ten to fifteen miles at a time, and she had also participated in marathons, but eventually “messed up” her knee. She also testified, and I find that in approximately 2012, she had been involved in an automobile accident and injured her knee when it hit the dashboard. (D-9, p.67-68, 83, 95, 98-101, 107, 139, 141). 10. The record reflects that a year prior to the work-related injury, in January of 2017, Employee had presented to Kaiser with bilateral knee pain and difficulty walking and was again diagnosed with osteoarthritis. The doctor opined that her weight was contributing to her knee pain. The records indicate that Employee requested treatment in the form of the Supartz injections at that time; her doctor agreed, and she had the first in a series of three injections on February 24, 2017 and the third injection on March 10, 2017, some ten Claim Number: 2018-003370 Page 4 of 8 months prior to her work-related accident. (D-9, p.141-153). 11. The medical evidence also reflects that Employee sought treatment in March of 2010 with her personal physician at Kaiser Permanente (Kaiser) for left hip pain. She was diagnosed with left hip pain and knee pain and was treated with medication. As Employee stated, she has treated for bilateral knee issues. The medical evidence reveals that in October of 2014 the Employee asked for an orthopedic referral because of the bilateral knee pain. She has also been diagnosed as obese and has treated for high blood pressure and diabetes. (D-9; D-9, 76, 81, 108, 112, 116, 119, 121, 131). 12. Despite Employee’s denial of previous problems with any of the other body parts for which she now seeks compensation, the records from Kaiser reflect that she complained of neck and low back pain resulting from the November 2011 motor vehicle accident. I note however that Employee’s neck complaints were on her left side and were diagnosed merely as cervical pain and there does not appear to have been any diagnosis regarding her low back complaints, nor was any treatment rendered at that time. Four years later, in November of 2015, Employee again presented at Kaiser with low back pain which she reported began after doing “heavy lifting” while moving into a house. Again, it does not appear that any ongoing treatment was given for the low back complaints. On July 26, 2017 Employee sought treatment for low back pain which she reported having experienced “for several months.” She has diagnosed with “low back pain” and “lumbar radiculopathy” and the doctor recommended analgesics and muscle relaxers and released her to return “as needed.” (D-9, p.98-100,103-105, 129, 158-160). 13. Six months after this last visit for any knee or back complaints, the Employee presented at Kaiser on January 22, 2018 reporting her work-related accident and complaining of left arm and right leg pain since the accident. The records from that visit appear to be incomplete as there is no assessment, diagnosis or treatment plan recorded. Employee contend that Kaiser refused to treat her at that time because it was “a workman’s comp case.” (D-9, p.165). 14. Thereafter, it appears that Employee requested medical treatment through the Employer for a work-related condition and was then seen at Nova Medical Center (Nova). The only records tendered into evidence from Employee’s treatment with Nova are some physical therapy notes dated January 25, 2018 which reveal that Employee was referred for therapy by a Dr. Ellis Efobi and presented at therapy with “Chief Complaints” of right knee and hip injuries, which were attributed to the January 5, 2018 accident at work and for which it appears she was treating with Dr. Efobi. The records confirm Employee’s testimony that she reported her pre-existing osteoarthritis in her knees and a previous motor vehicle accident where she injured her right foot. The notes also indicate that Employee had been placed on light-duty status by Dr. Efobi. It appears from the record, and I find that the only treatment authorized was for Employee’s right hip and right knee. (D-1, p.1; D-3; C-3, p.6, 45-46). 15. Employee testified that she reported her right ankle and right arm injuries to the medical providers who saw her following the accident and that she attributed her condition to the work-related accident. This testimony is largely supported by the medical evidence. The records reveal that Employee was seen at the Emergency Room at Gwinnett Medical Center on February 10, 2018 for complaints of lower back pain radiating into her leg, right hip pain and arm pain. She was diagnosed with a backache, acute sciatica and a right knee sprain and was treated with various prescription medications and an Ace Bandage for her right knee. (D-4). 16. An MRI Scan of the right knee was performed on February 26, 2018 and in addition to osteoarthritis, the findings included a possible anterior cruciate ligament (ACL) tear, and tendinosis in the quadriceps and patella. I find that these findings differ from the diagnosis given for Employee’s pre-existing knee Claim Number: 2018-003370 Page 5 of 8 problems, which was primarily osteoarthritis. (C-3, p.58-59; D-4, p.23-24; D-9). 17. The record reflects that Employee’s treatment for her pre-existing knee condition included a series of “Supartz injections.” She testified that she received one of the injections around the time she began working for this Employer, and further testified that prior to her work accident, the injections were working, her knees were much better, and she “felt great.” She described her pain level as only a “one” on a scale of one to ten, with ten being the worst pain, and testified that she was exercising again and able to be active. 18. In contrast, Employee testified that following her accident, she was in a great deal of pain and her gait was affected. She also testified that her knee got worse and worse and her pain was eventually a “nine” on a scale of one to ten. However, she continued working until she contends that she was no longer able to continue. Although she could not recall the exact date on which she ceased working, she testified that she got up one morning and “couldn’t make myself move.” 19. The record reveals that the Employer/insurer did not have a valid Panel of Physicians posted, so Employee was able to treat with the physician of her choice. Based upon Employee’s selection, Orthopedic Surgeon, Dr. Thomas Branch became the authorized treating physician and she began treating with him on March 8, 2018, approximately one month following her accident. Dr. Branch’s records contain a “Health History” completed by Employee at her initial appointment. At that time, she reported problems with her right foot/ankle, arm and leg pain and her right hip and knee, as well as reporting her osteoarthritis. I further find that Employee attributed her complaints to the January 5 th , 2018 slip and fall and that she reported a history and mechanism of injury that was consistent with that to which she testified at the hearing and reported elsewhere. (C-3, p.1-7). 20. Based upon the history provided by Employee, a review of relevant medical records, including the MRI Scan and x-rays, and his physical examination of Employee, Dr. Branch’s opinion was that despite a partial ACL tear, her right knee was stable and not of immediate concern, but he felt that the majority of Employee’s knee pain was “radicular in nature, stemming from her low back.” The doctor further noted that the Employee’s “hip” complaints were not characteristic of true hip pain and opined that the pain was located “in the lateral hip and buttocks area, which is highly suspicious of radicular lumbar pain.” Dr. Branch stated that although he was not authorized to treat Employee’s right lower leg, he believed that her lower leg complaints “are directly related to her work-related injury.” He ordered an MRI Scan of the lumbar spine and right hip. He also prescribed medications, physical therapy and home exercises and disabled Employee from work. (C-3, p.1-7, 25, 40-43; D-6, p. 25-27, 28-38). 21. The Board’s file contains a WC-1, Employer’s First Report of Injury, and a WC-2, Notice of Payment of Benefits, dated and filed with the Board on April 9, 2018 reflecting commencement of TTD benefits effective March 8, 2018. It appears that as of the date of the hearing, the Employee was still being paid income benefits. 22. The MRI Scans ordered by Dr. Branch were performed on April 1, 2018. The MRI of the lumbar spine revealed mild or moderate “broad-based disc bulges” at multiple levels and the radiologist’s overall impression was of “multilevel degenerative disc disease, especially at L4-L5 and L1-L2.” The MRI of the hip revealed a “lesion in the subcapital femur on the right side,” which the radiologist opined “could represent a small enchondroma.” At the Employee’s April 5, 2018 appointment with Dr. Branch, and upon review of the MRI results, Dr. Branch diagnosed “Pain in Right Knee” and “Low Back pain.” Dr. Branch continued Employee on a no work status. His recommendations included the use of a walker to avoid weight bearing on her knee, continuation of physical therapy and use of an H-Wave device, exercise, Claim Number: 2018-003370 Page 6 of 8 medication and weight reduction. (C-3, p.8-10; D-6, p.37-41). 23. As stated previously, the records reveal that Dr. Branch was of the opinion that Employee’s complaints regarding her right hip were in reality indicative of a lumbar spine issue and further opined that “her L-spine complaints are an exacerbation of a pre-existing condition.” He also opined that Employee’s lower leg complaints “are directly related to her work-related injury.” Likewise, as evidenced by his request for authorization to treat Employee’s right ankle and leg, Dr. Branch also felt that Employee’s right ankle complaints were related to her work injury. (C-3, p.11, 20; D-6, p.42, 51). 24. Dr. Branch’s records reflect that by the time of Employee’s April 26, 2018 office visit, he had become concerned that Employee’s knee injury may be “more than a partial tear of her ACL,” and he recommended further diagnostic testing. Dr. Branch noted that Employee’s condition had worsened and that she reported that her pain had become “unbearable.” He also diagnosed Employee with spondylosis with radiculopathy and “other intervertebral Disc Disorders” in the lumbosacral region, and with “post-traumatic osteoarthritis” in her right hip and right knee. (C-3, p.11-15; D-6, p.42-46). 25. On May 14, 2018 Employee underwent an independent medical examination (IME) with Dr. Herdon Murray, a physician with Peachtree Orthopedics. The record reveals that at the time of the IME, Employee reported that her “main complaint by far” was her right knee. She reported pain in her knee as a “7-9” on a 10-point scale, which she compared with her pre-injury knee pain which she described as a “5-7” on a 10- point scale. Based upon the history provided by Employee, a review of medical records, x-rays and a physical examination, Dr. Murray’s impression was that Employee suffered from a right knee sprain. Further, he found “No clinical indication” of pain coming from a lumbar spine of right hip. That is, he did not find any work-related back or hip condition and opined that no further treatment or restrictions were needed for her back or hip. He made no mention of any arm or ankle complaints. Dr. Murray further opined that she likely suffered an aggravation of her pre-existing knee problems, did not believe that Employee had reached maximum medical improvement (MMI) and that, based upon her “subjective symptoms,” was “not back to her pre-accident baseline.” He also noted that she had pre-existing osteoarthritis in both knees and opined that she would likely have needed a total knee replacement “even without” her work-related injury. Dr. Murray recommended conservative treatment for Employee’s knees “to try to bring her subjective symptoms back to baseline” and further recommended that she work only at a “sedentary” level while she is under treatment. (C-2, p.11-23; D-7, p. 58-63). 26. There is a conflict in the evidence regarding if, when, and why Employee stopped treating with Dr. Branch. Based upon the available evidence, it appears that Employee continued conservative treatment with Dr. Branch through August of 2018. At her appointments in July of 2018, Dr. Branch stated that based upon a lack of “significant MRI findings” as to Employee’s hip, he felt that only “conservative care and weight reduction” were needed at that time. Also at that time, in response to questions posed by the Employer/insurer, Dr. Branch stated that Employee had not reached maximum medical improvement (MMI) for her back and that her back problem had not been treated and it “has worsened/progressed over time.” The doctor also noted that Employee would need a total knee replacement, “as this is the only possibility of her being able to return to her pre-injury level of physical activity,” although he conceded that Employee would need a formal weight loss program or weight loss surgery before she could proceed with the recommended surgery. (C-3, p.21-25). 27. In regard to the Employee’s complaints about her right arm and right ankle, Dr. Branch opined that “it is more likely than not” that the “complaints about the right shoulder/arm and right ankle ARE causally related to her reported work related injury and as such should be accepted as part of her WC injury.” Based Claim Number: 2018-003370 Page 7 of 8 upon the uncontradicted description of Employee’s accident, I agree with Dr. Branch’s opinion in this regard. Employee has been diagnosed as being morbidly obese and the medical evidence reflects that she weighs between 300 and 350 pounds. Dr. Branch opined, and I agree that there is “no doubt” that the Employee’s weight is contributing to her ongoing multiple musculoskeletal conditions. (C-3, p. 31). 28. On July 25, 2019, at the behest of the Employer/insurer, the Employee underwent an IME for the right knee with Dr. Ashok Reddy, at Peachtree Orthopedics. Dr. Reddy took a history of injury from Employee, reviewed diagnostic tests results and her other medical records and performed a physical examination. His impression was that Employee had “right knee advanced tricompartmental osteoarthritis with contusion/ACL sprain and synovitis and morbid obesity.” Dr. Reddy opined that Employee’s treatment to date had been appropriate. He noted that she had a “clearly documented” history of “pre-existing advanced osteoarthritis” in her right knee for which she had been regularly treating for several years prior to her work accident and opined that she had aggravated her pre-existing condition as a result of the January 5, 2018 accident. Dr. Reddy further opined “with a high degree of medical certainty,” and I find, that her work- related aggravation had resolved, that she has returned to her pre-injury baseline with no permanent impairment, and that any further need for medical treatment and/or physical restrictions would be “due to her pre-existing advanced osteoarthritis and morbid obesity and not due to her work injury.” On October 18, 2018, in response to a questionnaire posed by Employer/insurer, Dr. Murray stated his agreement with Dr. Reddy’s opinions. (C-2, p.1-8; D-8, p.64-65, 66-69). 29. On November 21, 2018 Employee was again evaluated by Dr. Reddy, this time for her right arm/should and right ankle complaints. Dr. Reddy noted that records of the Employee’s initial medical care following her fall did not include complaints of shoulder, arm or ankle pain, and that thee was minimal and only sporadic mention of complaints to these body parts throughout the medical records. Dr. Reddy opined “with a high degree of medical certainty,” that neither the ankle or the shoulder/arm complaints were related to her work- related accident. As was the case with Employee’s knee complaints, Dr. Reddy opined, and I find, that her complaints and any physical limitations or need for medical treatment regarding the arm, shoulder or ankle were unrelated to her work injury and he attributed her ankle complaints to her pre-existing advanced osteoarthritis and morbid obesity and not due to any work accident/injury. (D-8, p. 74-75). 30. Employee disputes Employer/insurer’s contention that she has recovered from her work-related injuries. She testified that she is still experiencing problems with her knee and that since the accident her ankle isn’t working, and she has trouble with lack of mobility and weakness in her legs. She further testified that although she has improved since the accident, she walks much slower and is unable to do several of the activities that she could do. Despite some inconsistencies in her testimony, overall, I found Employee to be a credible witness and I believe that she is and has been in pain. 31. As stated above, based upon the Employee’s mechanism of injury, it appears more likely than not, that Employee hurt her right arm/shoulder and lower back when she fell, and she aggravated her pre-existing knee and ankle problems in the fall. However, I find insufficient evidence