Workers’ comp claim for foot condition denied

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A man who suffered multiple injuries in a work-related fall from a tree in 2014 saw his claim for medical benefits for a foot condition denied by the Virginia Workers’ Compensation Commission, or VWCC.

The commission found “no causal connection between appellant’s work-related injuries and the left foot condition for which he sought surgery.”

The Court of Appeals of Virginia upheld the VWCC’s decision on appeal.

Two doctors “provided credible evidence in the record to support the Commission’s finding that employer met its burden to show the present injuries were not causally related to claimant’s compensable workplace accident,” the appellate panel explained. “Given the applicable standard of review, this Court will not disturb the Commission’s finding on that front.”

The per curiam opinion, Rankin v. Asplundh Tree Expert Co., et al. (VLW 022-7-092), was issued by Judges Randolph A. Beales, Glen A. Huff and Mary B. Malveaux.

Background

Russell Rankin was working for Asplundh Tree Expert Company in 2014 when he “sustained a compensable injury” after falling from a tree while working. The VWCC entered an award order later that year, granting Rankin temporary total disability benefits and lifetime medical benefits for his injuries. Per the opinion, Rankin’s compensable injuries included fractured left and right ankles, a L3 spinal fracture, a sternal fracture and injuries to his left knee and ribs.

Later, Rankin filed a claim for benefits seeking “authorization for left foot surgery” with his podiatrist, who he started seeing in 2015 for an ingrown toenail. At the time, the podiatrist noted that the work accident resulted in “multiple fractures and complications and infections” from which Rankin was still recovering.

At his initial visit and throughout 2015, his podiatrist noted that Rankin “exhibited good sensation in all toes as well as good motion and intact muscle strength in the left foot.”

In December 2016, Rankin reported increasing pain in his left big toe, noting stiffness, discoloration and progressive deformity, along with “clawing of the second through fifth toes.” Rankin’s podiatrist noted in July 2017 that she had evaluated him “for a painful left foot deformity that developed after his traumatic injuries” and added that his condition could worsen as time goes on and eventually require surgery.

Rankin visited his podiatrist again in April 2020 for the first time in more than three years. At this visit, his podiatrist noted that Rankin’s “initial injury, as well as the post injury complications caused neuromuscular damage to the foot, tendon imbalance, and muscle tone loss, resulting in contracted claw toes and a large hallux abducto valgus deformity.” She also added that his compensable lumbar spine injury could not be ruled out as contributing to the foot deformities.

The podiatrist noted that some of the deformities were a direct result of the 2014 work injury and recommended surgery because the deformities “limit his ability to walk, stand, and wear normal shoe gear.”

Asplundh challenged the podiatrist’s opinion on the cause of the foot injury, relying on an independent medical evaluation and a records review. After evaluating Rankin in August 2020, the physician who performed the independent medical evaluation determined that the left foot conditions were not related to the 2014 fall; rather the complaints were “common problems that many people develop as they get older” and that they would have shown up sooner if they were related to the fall.

A second podiatrist who performed a records review agreed with Rankin’s podiatrist on what Rankin’s conditions were and the need for surgery, but disagreed that the work accident caused them. The second podiatrist noted the length of time since the fall, as well as multiple occasions where Rankin “demonstrate[d] 5/5 normal muscle strength.”

Court history

Upon review before the VWCC, a deputy commissioner found that the employer “sustained its burden to show that a causal relationship was lacking between claimant’s left foot condition and his compensable work accident.”

The deputy commissioner noted that the records of Rankin’s podiatrist failed “to reveal any evidence of neuromuscular compromise, tendon imbalance, or loss of muscle tone.”

Rankin requested a review before the full commission, which unanimously affirmed the deputy commissioner’s ruling. Rankin then appealed to the Court of Appeals of Virginia.

In his appeal, Rankin claimed the VWCC weighed more heavily the opinions of the physicians who conducted the independent medical evaluation and the records review, rather than Rankin’s own podiatrist. He argued that his podiatrist’s opinion should be given greater weight, and that the VWCC erred in this matter.

The appellate judges disagreed, saying the “Commission’s contrary conclusion is supported by credible evidence in the record.”

They pointed out that, “Over the course of [Rankin’s podiatrist’s] treatment of claimant since January 2015… [she] made no prior mention of these causative conditions as a basis for claimant’s left foot deformities,” adding that Rankin’s physicians noted he had intact muscle strength and good sensation in every toe.

While Rankin’s podiatrist noted “a painful left foot deformity that developed after his traumatic injuries” in 2017, the physician who conducted the independent medical review of Rankin noted no tendon abnormalities and said the problems would have presented sooner if they stemmed from the work injury. The independent physicians also said the conditions present in Rankin’s left foot “were common findings in the general population.”

Ultimately, the independent physicians concluded that “there was no evidence of neuromuscular damage to the foot, tendon imbalance, and muscle tone loss, or any other diagnosis related to the work accident that could have caused claimant’s left foot deformities.”

As such, the court affirmed the VWCC’s unanimous judgment that the independent physicians offered credible evidence to support ruling in favor of the employer.