What happens when an injured worker gets a normal magnetic resonance image study after a work injury but later on a second MRI shows an operable tear? Can the findings on the second MRI be related back to the original injury?
The Appellate Division addressed that issue in Costanzo v. Meridian Rehab.
Patricia Costanzo slipped and fell on April 1, 2016, while working at Meridian Rehab as a recreational aide. She felt pain in her left knee and underwent an MRI, which showed no tear and no fracture. It did show some prior osteoarthritis in the knee.
Respondent paid for physical therapy and a series of injections, and petitioner returned to work thereafter. She had a subsequent injury in August 2017 while walking on a beach (unrelated to work) and injured her right knee, requiring a meniscectomy.
The issue arose when petitioner started feeling increased pain in her left knee in January 2018 and underwent a second MRI. She denied reinjuring the left knee in the beach incident that injured her right knee. On this new left knee MRI, an anterior cruciate ligament tear and a meniscal tear could be plainly seen.
Petitioner filed a motion for medical benefits for the left knee tear seeking payment from Meridian Rehab for surgery. Capehart shareholder Carla Aldarelli handled the case successfully for Meridian Health System.
Petitioner’s expert, Dr. Cary Skolnick, testified that the new tears in the left knee were related back to the original accident of April 2016. He stated that the action of striking the ground caused petitioner’s arthritis to worsen to the point where additional treatment was needed. Further, he opined that both the meniscus and ligament were stretched in the 2016 incident to the degree that only a few fibers were holding them together and eventually broke.
In contrast, the judge of compensation credited the testimony of Dr. Shawn Sieler, who diagnosed only a left knee contusion in the April 2016 fall. Sieler testified that petitioner fully recovered from this incident. He was of the opinion that the meniscal and ACL tears “can only be explained by some subsequent traumatic accident.”
He did not accept Skolnick’s theory about fibers in the knee being stretched to a breaking point. He noted that if arthritis was a factor, there was evidence before the April 2016 incident of arthritis in the knee.
Judge Salvatore Martino found Skolnick’s testimony to be lacking in both credibility and logic. The judge observed that Skolnick did not directly address some questions posed to him, and he became somewhat argumentative with respondent’s attorney.
Martino said, “While it is clear that more severe pathology currently exists as compared to the time period closer to the injury date, there does not appear to be a reasonable connection between the mechanism of the injury and the current state of her pathology.” The judge found Sieler’s testimony on lack of causation to be more credible because it was more consistent with the order of the MRIs.
Petitioner appealed and argued that Martino erred in assessing Skolnick’s credibility. The court wrote, “Contrary to petitioner’s contentions on appeal, there was ample evidence in the record to support the judge’s conclusion that the current condition of petitioner’s left knee was not related to the injury she suffered when she fell at work in April 2016. At that time, petitioner suffered only a contusion. The MRI taken in June 2016 revealed no meniscus tear and no ACL tear. Although the MRI showed that petitioner had arthritis in the knee, this was a preexisting condition.”
For these reasons, the Appellate Division endorsed the conclusion of Martino that there was no medical evidence that the arthritis in petitioner’s left knee had worsened as the result of the April 2016 fall.
The argument occurs quite frequently in workers’ compensation. While every case is fact-sensitive, the general rule for practitioners should be that when there are two MRIs that are vastly different from each other, the MRI closest in time to the work accident will generally control. If a subsequent MRI shows findings that did not appear in the first MRI close to the time of accident, it makes little sense to draw causation.
The analogy would be to a car that has a few tiny nicks on the windshield. A minor car accident occurs at some point and a photo taken a few weeks after the accident shows no change in the windshield at all. The nicks are exactly as they were. Two years later, the owner gets in the car one morning and is shocked to find that there are now giant cracks all over the windshield. The entire windshield needs replacement.
Under Skolnick’s theory, the minor car accident would be responsible as opposed to some other intervening event during the past two years. While anything is possible, the legal standard remains more likely than not. Under Sieler’s logic, the dramatic change in the windshield would be more likely due to some intervening event.
John H. Geaney is an attorney, executive committee member and shareholder with Capehart Scatchard, a defense law firm in New Jersey. This post appears with permission from Geaney's New Jersey Workers' Comp Blog.
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