ADJ14746138 · June 13, 2022

The WCJ and WCAB found that the applicant sustained an industrial injury to the left knee based on credible testimony and the QME Dr. Chen's medical opinion, which was more persuasive than the defense's treating physician.

From the decision · page 5In September 2021, Applicant had a QME evaluation by orthopedic surgeon Dr. Chen. Applicant reported working as park maintenance for the City of Sacramento for 21 years. He did not recall a specific injury but his left knee started hurting during his work duties. Dr. Chen performed a record review and physical exam. There was left knee crepitus globally. Dr. Chen diagnosed Applicant with left knee industrial exacerbation of underlying degenerative ar1hritis. However under causation, Dr. Chen found an industrial injury to the left knee within a reasonable medical probability. Dr. Chen opined there is a large contribution of left knee pain due to obesity arid degenerative arthritis but found Applicant s work duties to be quite physical. Dr. Chen clarified that he found some contribution of the left knee pain is due to work duties. Dr. Chen found no evidence of an industrial injury to the low back. Dr. Chen indicated

Based on the QME Dr. Chen's findings and recommendations, the applicant was found to need further medical treatment to cure or relieve the effects of the industrial injury.

From the decision · page 6Based upon the findings of QME Dr. Chen, it is found that Applicant is in need of further medical treatment to cure or relieve from the effects of the industrial injury.

Applicant's credible testimony about physical job duties and worsening left knee symptoms

Favours Applicant prevailed

Supported the finding of industrial injury and need for further medical treatment.

From the decision · page 4At trial, Applicant testified credibly. He testified in pertinent part as follows: He worked for the City of Sacramento for 22 years as a maintenance worker and is now a maintenance worker two. He physically works in the parks and walks all of the parks on foot. He picks up paper, empties garbage cans, mows the lawn, trims and cuts trees, digs holes, replaces benches, reseeds the grass, and prepares baseball fields. He lifts heavy garbage cans into the trucks if the truck does not have a lift. He uses a blower backpack daily. He edges the parks and then blows the walkways and parking lots. He works eight hours a day and has been doing this job for a long time. He has left knee problems currently. His left knee is always burning and is very painful. His left knee had been bothering him for years but it really started bothering him last year when he could not walk. Twice while on the job, his friends had to walk him to the parking lot and put him in his vehicle. He went to Kaiser. The sudden increase in symptoms happened last year. They use a lot of rental trucks that do not have a lift so you have to jump in and out of the truck. He is short and this twisted his knee over the years. His left knee hurt a little before but he did not take it seriously.

QME Dr. Chen's medical opinion diagnosing industrial exacerbation of degenerative arthritis and causation by work duties

Favours Applicant prevailed

Found more persuasive than defense's treating provider and supported injury and treatment need findings.

From the decision · page 5In September 2021, Applicant had a QME evaluation by orthopedic surgeon Dr. Chen. Applicant reported working as park maintenance for the City of Sacramento for 21 years. He did not recall a specific injury but his left knee started hurting during his work duties. Dr. Chen performed a record review and physical exam. There was left knee crepitus globally. Dr. Chen diagnosed Applicant with left knee industrial exacerbation of underlying degenerative ar1hritis. However under causation, Dr. Chen found an industrial injury to the left knee within a reasonable medical probability. Dr. Chen opined there is a large contribution of left knee pain due to obesity arid degenerative arthritis but found Applicant s work duties to be quite physical. Dr. Chen clarified that he found some contribution of the left knee pain is due to work duties. Dr. Chen found no evidence of an industrial injury to the low back. Dr. Chen indicated

Diagnosed left knee industrial exacerbation of underlying degenerative arthritis and found industrial injury to the left knee within a reasonable medical probability, with work duties contributing to the knee pain. Recommended physical therapy, cortisone injections, and anti-inflammatory medications. Deferred apportionment until permanent and stationary status.

Dr. Chen's opinion was found more persuasive than the defense's treating provider and supported the finding of industrial injury and need for further medical treatment.

From the decision · page 5In September 2021, Applicant had a QME evaluation by orthopedic surgeon Dr. Chen. Applicant reported working as park maintenance for the City of Sacramento for 21 years. He did not recall a specific injury but his left knee started hurting during his work duties. Dr. Chen performed a record review and physical exam. There was left knee crepitus globally. Dr. Chen diagnosed Applicant with left knee industrial exacerbation of underlying degenerative ar1hritis. However under causation, Dr. Chen found an industrial injury to the left knee within a reasonable medical probability. Dr. Chen opined there is a large contribution of left knee pain due to obesity arid degenerative arthritis but found Applicant s work duties to be quite physical. Dr. Chen clarified that he found some contribution of the left knee pain is due to work duties. Dr. Chen found no evidence of an industrial injury to the low back. Dr. Chen indicated

Labor Code

Burden of proof on applicant to establish injury arising out of and in the course of employment by substantial medical evidence.

The WCJ and WCAB applied this standard to find the applicant met his burden based on the QME's opinion and credible testimony.

From the decision · page 3Defendant contends the Appeals Board acted without or in excess of its powers by the WCJ's Order, Decision, or Award, and that the evidence does not justify the Findings of Fact, and the Findings of Fact do not support the Decision or Award. Specifically, Defendant contends Applicant failed to meet his burden of proof and AOE/COE is not supported by substantial medical evidence.

Applicant's credible testimony describing physical work duties and knee symptoms worsening over time

From the decision · page 4At trial, Applicant testified credibly. He testified in pertinent part as follows: He worked for the City of Sacramento for 22 years as a maintenance worker and is now a maintenance worker two. He physically works in the parks and walks all of the parks on foot. He picks up paper, empties garbage cans, mows the lawn, trims and cuts trees, digs holes, replaces benches, reseeds the grass, and prepares baseball fields. He lifts heavy garbage cans into the trucks if the truck does not have a lift. He uses a blower backpack daily. He edges the parks and then blows the walkways and parking lots. He works eight hours a day and has been doing this job for a long time. He has left knee problems currently. His left knee is always burning and is very painful. His left knee had been bothering him for years but it really started bothering him last year when he could not walk. Twice while on the job, his friends had to walk him to the parking lot and put him in his vehicle. He went to Kaiser. The sudden increase in symptoms happened last year. They use a lot of rental trucks that do not have a lift so you have to jump in and out of the truck. He is short and this twisted his knee over the years. His left knee hurt a little before but he did not take it seriously.