Medical treatment denied—Request for Total Knee Arthroplasty denied due to pre-existing condition

Administrative Law Judge (ALJ) denied Claimant’s request for a total knee replacement after a compensable injury and surgery to repair a torn meniscus.  Claimant had a significant pre-existing degenerative changes in his right knee at the time of the injury.

The initial injury and surgery was accepted to repair a torn meniscus.  Claimant’s recovery was hampered due to his severe osteoarthritis and several months later, his treating physicians recommended a total knee arthroplasty.

Respondents’ expert, Dr. Burris, opined the need for the total knee replacement, although reasonable, was not related to his initial injury, which was somewhat innocuous.  Dr. Burris opined the need for a total knee replacement was related to his prior degenerative condition, and was not exacerbated or aggravated by his initial injury. Claimant’s treaters based their opinions on the temporal relationship between the onset of symptoms and the original accident.

The ALJ denied the request for the total knee arthroplasty and found Respondents’ expert more persuasive than Claimant’s treating providers.  There were inconsistencies in Claimant’s medical records and history concerning the accident. None of Claimant’s treating providers testified at hearing, and the only medical testimony came from Respondent’s IME physician, Dr. Burris.

Claimant’s attorney filed a Petition to Review the ALJ’s decision, and a final Order is pending.  However, we feel strongly the decision will be confirmed, as there is evidence to support the ALJ’s decision, and the issue of which medical opinions are more persuasive is typically left to the ALJ.

Roel Revilla v. Sunrise Senior Living LLC. and Ace American Insurance Company, WC No. 5-094-725

Would you like to know more?  Contact Thomas P. Crowley at or 877-259-5693.


From the February 2020 Newsletter