Workers Compensation Injury. Claimant is a 57-year-old diabetic laundry aide at a nursing home and weighs 262 pounds. She had a slip and fall injury and sustained a lumbar sprain/strain. She saw a physician and was sent to physical therapy, placed on anti-inflammatory medication and underwent two epidural injections. An MRI scan of the lumbar spine showed degenerative disc disease and some stenosis, but not much else. She occasionally reported some pain into the right buttock and leg but most of the pain was in the lower back. After five months of treatment, she reported that her right knee felt tight and she felt like it was going to give out on her. The physician obtained an MRI of the knee and it showed a tear of the medial meniscus. The report mentioned terms such as “macerated”, “degenerative” and “osteophytes”, etc. The physician felt that this was directly related to the slip and fall injury five months’ previously even though he had failed to document any complaints knee problems whatsoever on any of the office visits. Therapy notes did not document any problems or complaints with the knee at all but did mention the fact that she was able to perform squats and deep knee bends without an increase in her back symptoms. She was referred to an orthopedic surgeon, who felt that arthroscopy was indicated to repair the meniscal tear. The claims adjuster asked Joan to obtain an Independent Medical Examination by an orthopedic surgeon. Joan felt that in light of the fact that the claimant never mentioned any knee pain for five months after the slip and fall, and the results of the MRI scan, as well as her morbid obesity and diabetic condition, her meniscal injury was most likely chronic in nature. The IME physician reported no causal relationship existed between her slip and fall injury and her meniscal injury, especially since the physical therapist documented very clearly the fact that she was able to perform deep knee bends in physical therapy while receiving treatment for her lumbar spine complaints. She was placed at MMI regarding her lumbar spine sprain/strain type injury and her case was closed.