- Permanent impairment {NEL} (degree of impairment) (knee)
- Prolapse (uterus)
- Permanent impairment {NEL} (rating schedule) (AMA Guides)
The worker injured her left knee on October 23, 2013, and her treatment included two surgeries and physiotherapy. In September 2014, she was diagnosed with pelvic organ prolapse (POP). The Board assessed the level of impairment for the knee at 14%, but reduced the award by 4% due to preexisting degenerative changes. The worker appealed an ARO decision confirming the reduction in NEL quantum for a preexisting condition and denying entitlement for POP.
The appeal was allowed. The NEL specialist's understanding that under Table 40 of the AMA Guides, knee arthritis was given a 10% rating was in error. The range for preexisting arthritis was zero to 20%, which meant that the proper rating would depend on the facts of the case and in some cases may be as low as zero. In this case, because the preexisting arthritis was either non-symptomatic or at most minimally symptomatic, a zero percent reduction was appropriate. The worker did have risk factors for POP, as she was 53 years old at the time her symptoms arose and had three children. However, the worker's physiotherapy for her knee and possibly her work over the years as a maintenance worker were likely a significant contributing factor in the onset of her POP. One medical specialist opined that the abdominal exercises she did in physiotherapy would have increased the intra-abdominal pressure and her risk of POP, and this opinion was consistent with that of the worker's treating gynecologist. The worker's testimony she felt the effects of the POP initially while doing the physiotherapy supported the medical opinions that physiotherapy was likely sufficiently intense to have played a role.