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February 1, 1994


Appeal from the circuit Court of Sangamon County. No. 91MR294. Honorable C. Joseph Cavanagh, Judge Presiding.

Released for Publication March 2, 1994. As Corrected March 16, 1994.

Honorable Philip J. Rarick, J., Honorable John T. McCULLOUGH, P.j., Honorable Thomas R. Rakowski, J., Honorable Alfred E. Woodward, J., Honorable Kent E. Slater, J.

The opinion of the court was delivered by: Rarick

JUSTICE RARICK delivered the opinion of the court:

Claimant, Gerald L. Meredith, a construction laborer, sought benefits pursuant to the Workers' Compensation Act (Act) (Ill. Rev. Stat. 1989, ch. 48, par. 138.1 et seq.) for injuries he sustained to his right ankle while employed by American Insulated Structure (American) on an asbestos-abatement project at the Illinois Attorney General's Building in Springfield. Meredith had worked in construction since 1969 and had worked at American from November 13, 1987, until February 23, 1988, the date of his accident.

On February 23, 1988, Meredith was carrying bags of wet debris down an outside staircase when he slipped on a patch of ice and fell down several steps, twisting his right ankle. After reporting the accident to his superintendent, Meredith was taken to the emergency room at Memorial Medical Center. His ankle was wrapped and he was told to see a doctor in one week if his condition did not improve. When it did not, Meredith saw Dr. Clifford Lynch, an orthopedic surgeon, on March 1, 1988. Meredith told Dr. Lynch that he had experienced difficulty with his right ankle dating back to 1968 when he had suffered a twisting injury to it. Dr. Lynch opined that Meredith had early degenerative osteoarthritis involving the ankle as well as a sprain. Dr. Lynch x-rayed Meredith's leg and gave him an elastic support to wear. Meredith saw Dr. Lynch again on March 8, 1988, at which time Dr. Lynch released him to return to work.

Meredith related this to Julie Carroll, the insurance adjuster for Cigna Property and Casualty Company (Cigna), and she suggested he see another doctor. Meredith then saw Dr. Rupert Winston, a podiatrist. After four treatments without improvement, Carroll suggested Meredith see yet another doctor. Meredith then saw Dr. Nicholas Ruvarik, who treated Meredith until Cigna assigned the case to its subsidiary, Intracorp. Carroll then arranged for Mary Watts, a rehabilitation nurse, to visit Meredith. Watts met with Meredith and took a medical, education, and work history from him. Watts told Meredith that Carroll wanted him to be examined by another doctor, so Watts arranged an appointment with Dr. James Strickland for October 14, 1988. In a letter dated October 18, 1988, Dr. Strickland stated that upon examination, Meredith complained of aching and tenderness of his right ankle. Dr. Strickland also noted that Meredith had a previous ankle injury which he described as "quite severe" and that it apparently was not treated. Dr. Strickland concluded that Meredith's accident had aggravated a preexisting degenerative arthritic condition. A subsequent CAT scan revealed "an extra bony fragment in the medial aspect of the tibia near the medial malleolus" and "cystic changes in the distal tibia on the medial side."

Dr. Strickland saw Meredith again on November 11, 1988. Meredith complained of aching, intermittent catching, and popping in his ankle. Dr. Strickland also noted signs of "severe tenderness over the medial aspect of the medial malleolar area of the extosis." On November 29, 1988, Dr. Strickland surgically removed the extosis over the medial aspect of the right distal tibia and performed a diagnostic arthroscopy, removing several loose chondral bodies and one large osteochondral body.

Dr. Strickland provided follow-up care until June 19, 1989, and subsequently referred Meredith to the Spine Center in Springfield for work-hardening therapy. The staff there evaluated Meredith and recommended against work hardening because he would not benefit from it, and it would probably exacerbate his symptoms.

Dr. Strickland last saw Meredith on June 19, 1989, at which time he imposed the following permanent medical restrictions:

"minimal walking, sedentary job with occasional lifting limited to 50 pounds, no carrying of weight for any significant distance, and patient cannot return to heavy construction labor type employment."

In his report of the medical examination he performed for Cigna, Dr. Strickland indicated that Meredith had aggravated a preexisting degenerative arthritic condition in his right ankle. Between December 2, 1988, and June 23, 1989, Dr. Strickland submitted seven additional reports to Cigna, each of which indicated that the accident was the sole cause of Meredith's condition. After Carolyn Habryl took over as Cigna's adjuster, she wrote Dr. Strickland regarding the causal relationship between Meredith's accident and his condition. Dr. Strickland responded that the sprain had "a significant exacerbating effect on Mr. Gerald Meredith's previous degenerative arthritic changes in his ankle." Dr. Strickland indicated that the surgery was necessitated by the sprain.

Dr. David Fletcher was then hired by Cigna to perform another independent medical examination. Dr. Fletcher examined Meredith on November 3, 1989, and Effie Tennat, a job placement specialist for Intracorp, attended. Dr. Fletcher indicated that based upon his review of the medical records and his examination, Meredith's work-related injury was not related to the previous ankle injuries. Dr. Fletcher opined that even absent the accident, Meredith's degenerative ankle condition would have required surgery.

Meredith received vocational rehabilitation services from Linda Kreuger, a certified rehabilitation counselor employed by the Department of Rehabilitation Services. She testified that it was unlikely that Meredith could obtain a job for which there was a stable job market consistent with his age, education, ...

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