BOARD No. 058757-90Commonwealth of Massachusetts Department of Industrial Accidents
Filed: April 16, 1996
REVIEWING BOARD DECISION
(Judges Fischel, McCarthy and Wilson)
APPEARANCES
Thomas J. Donoghue, Esq., for the employee
Thomas Costello, Esq., for the self-insurer
McCARTHY, J.
On September 14, 1990, while working as a teacher’s aide in the City of Chicopee School System, Alma Sacharczyk was pulled down onto the floor while assisting two special needs children. She suffered a disabling back injury which the self-insurer accepted as compensable. Two years later in September 1992, the employee began treating for complaints of pain in the right knee. Dr. Rizzo diagnosed the knee condition as a tear of the lateral meniscus as well as a degenerative medial joint space. Dr. Rizzo performed arthroscopic surgery on the knee and when the self-insurer resisted payment of the attendant medical expenses the employee filed claim under § 30 for payment of her medical bills for the right knee treatment. After a full evidentiary hearing the administrative judge filed a decision denying the employee’s claim for payment of medical expenses. We have the case on appeal by the employee.
Arguing for reversal of the hearing judge’s decision, the employee contends that the judge misunderstood the theory of the claim. The employee, says counsel, does not contend that there was a direct injury to her right knee when she was pulled to the floor on September 14, 1990. Instead she asserts that severe back pain radiating into her right lower extremity caused her leg to buckle on numerous occasions thus the knee injury is related to the pain which is present as a result of the accepted back injury.
The only expert medical opinion in this case is that of the attending orthopedic surgeon, Dr. Anthony A. Rizzo, M.D. When asked whether the employee’s knee condition was causally related to the industrial accident at work on September 14, 1990, Dr. Rizzo responded, “Yes, if you believe the history.” (Dep. Dr. Rizzo p. 6)
We agree with the judge that Dr. Rizzo’s testimony is less than a hallmark of clarity. The doctor seems to be working with two separate histories. In denying the claim the judge notes that Dr. Rizzo causally relates the knee injury “only because of the history given by the employee of falling on the right knee in 1990.” (Dec. 3.) But there is a second history appearing in Dr. Rizzo’s testimony and that is a history of neurological deficits and acute spasms causing her knee or knees to “give out” with resultant collapse and twisting of the knee. (Dep. Dr. Rizzo p. 14.) It appears that Dr. Rizzo would causally relate the employee’s knee problem to the September 14, 1990 incident on either a theory of direct insult to the knee on that day or subsequent falling and twisting of the knee as a result of radiating back pain.
We cannot tell from the record before us exactly when it was that Ms. Sacharczyk injured her knee. The hearing judge specifically found that on September 14, 1990 she injured her back (Dec. 2.) He also found that there was no treatment for the right knee until over two years after the September 14, 1990 industrial event. The judge notes that the employee testified that she also struck her right knee when she was pulled to the ground. There is no finding as to whether she injured her knee at that time. Neither are there findings on the employee’s testimony that her knee buckled on a number of occasions when pain radiated into her leg.
We believe it appropriate to return this case to the hearing judge for further findings with respect to whether the employee suffered a direct injury to her knee on September 14, 1990 and whether in the two years following there were incidents when her knee buckled and twisted. If the judge believes that the incidents testified to by the employee in fact occurred, he should re-examine Dr. Rizzo’s opinion on the issue of causal relationship. Since Dr. Rizzo’s is the only expert medical opinion in the case, if the judge elects to reject it he must give his reasons therefor.
We return this case to the senior judge with the request that he reassign it to the hearing judge for further proceedings consistent with this opinion.
So ordered.
______________________________ William A. McCarthy Administrative Law Judge
_______________________________ Carolynn N. Fischel Administrative Law Judge
_______________________________ Sara Holmes Wilson Administrative Law Judge
Filed: April 16, 1996