The claimant, Marian Knisley, was 53 at the time of the hearing of this claim. Ms. Knisley initially dropped out of high school, but then graduated from high school in 1988.
Ms. Knisley began working for the Charleswood Corporation (Charleswood) in 1993. Prior to working at Charleswood, Ms. Knisley babysat, helped manage apartments and worked in a bowling alley. Ms. Knisley had a variety of jobs at Charleswood, including that of an embosser, which involved setting 50- to 70-pound brass dyes in machines which were then used to make impressions on wooden furniture pieces. Setting a dye involved two to two and one-half hours of work.
On April 6, 1999, Ms. Knisley had to set up and then replace the dyes just set up on an embossing machine, the equivalent of setting up two embossing machines, one right after the other. After completing the second set-up of the dyes, Ms. Knisley experienced intense back pain. Ms. Knisley received initial treatment for her back pain at Crossroads Regional Hospital and then saw Dr. Doumit, the physician for Charleswood. Ms. Knisley was then referred to Dr. Vellinga, who performed three epidural steroid injections without providing lasting relief to Ms. Knisley. Ms. Knisley was then referred to Dr. Piper who recommended a fusion in Ms. Knisley's back.
Ms. Knisley had to delay her surgery with Dr. Piper due to the recurrence of her breast cancer, located in 2000 in her left breast. In March of 2001, Ms. Knisley was released from her treatment for her cancer.
In November of 2001, Dr. Piper performed a lumbar fusion at the L4-5 level; specifically, Dr. Piper described Ms. Knisley's procedure as follows:
She underwent a decompressive laminectomy with decompression of the L5 nerve roots, as well as an instrumented L4-L5 posterolateral fusion with autogenous local bone. She was covered peri-operatively with antibiotic coverage and deep vein thrombosis prophylaxis. (From November 10, 2001 discharge summary from Barnes-Jewish St. Peters Hospital.)
After her release from treatment with Dr. Piper, Ms. Knisley saw her family physician, Dr. Cuellar, then Dr. Kennedy, a neurologist, Dr. Graham, a pain specialist, and then Ms. Knisley saw Dr. Nasrallah, a chiropractor, on her own. Ms. Knisley got only temporary relief of her symptoms from Dr. Nasrallah and discontinued her treatment with him.
Currently, Ms. Knisley suffers from nervousness, stress and exhaustion. Most recently, Ms. Knisley has been receiving psychiatric treatment from Dr. Riser for the past three months. Ms. Knisley can walk from 15 minutes to a half hour. She can sit, lie down or stand for limited periods of time.
Ms. Knisley's past medical history includes a 1985 right breast lumpectomy as the result of cancer, right hand carpal tunnel surgery in April of 1990, a 1990 left breast lumpectomy as the result of cancer, a 1994 right breast mastectomy as the result of cancer and a 1996 right breast reconstruction. Ms. Knisley was also diagnosed with mitral valve prolapse in 1998.
Ms. Knisley stated that the nervous breakdown in February of 1999 reflected in Dr. Cuellar's records was the result of her divorce.
Subsequent to April 6, 1999, Ms. Knisley had another bout of breast cancer, this time resulting in the removal of the left breast.
Dr. Thomas Musich, M.D., specializing in industrial medicine, evaluated Ms. Knisley on February 27, 2004. Dr. Musich opined to a permanent disability of 65 percent of the body referable to Ms. Knisley's accident while employed by Charleswood on April 6, 1999.
With regard to prior disabilities, Dr. Musich noted Ms. Knisley's history of bilateral breast cancer between 1985 and 2000, along with a right breast reconstruction resulting in "chronic fatigue, chronic intermittent chest
pain secondary to radiation, surgical scarring, and mitral valve prolapse which was diagnosed in 1998."
Dr. Musich also noted Ms. Knisley's surgical treatment of right carpal tunnel syndrome and "chronic depression and anxiety as a result of her metastatic breast cancer over the past twenty years," among Ms. Knisley's disabilities prior to April 6, 1999. Dr. Musich also noted prior disability due to hypertension. Without including the chronic depression and anxiety, Dr. Musich opined to a 35-percent permanent partial disability attributable to Ms. Knisley's prior disabilities. Dr. Musich went on to find Ms. Knisley permanently and totally disabled as the result of her 1999 low back injury, combined with her prior disabilities when viewed with her "limited education, lack of transferable skills, and her ongoing medical care and treatment."
Dr. Musich acknowledged that the restrictions he imposed on Ms. Knisley as the result of her April 1999 back injury alone would make it difficult to perform light, sedentary work.
With regard to Ms. Knisley's high blood pressure, Dr. Musich described it as "still mildly elevated despite the medication of Hyzaar." The mitral valve prolapse suffered by Ms. Knisley was described by Dr. Musich as not symptomatic enough that she was being treated with a beta blocker at the time that Dr. Musich evaluated her.
Mr. James M. England, a rehabilitation counselor who also does vocational evaluations, testified by deposition that Ms. Knisley's cancer, which has taken an emotional toll on her, her hands for "which she had had carpal tunnel treatment in the past" and which cramp after repetitive use and have negatively affected Ms. Knisley's handwriting and Ms. Knisley's back are the significant factors in causing Ms. Knisley to be unable to sustain employment on a consistent basis. However, Mr. England was unaware of any permanent restrictions on the use of her hands which Ms. Knisley had as the result of her carpal tunnel surgery. Likewise, Mr. England was aware of no permanent restrictions sustained by Ms. Knisley as the result of her cancer, citing only the worry of a recurrence of the cancer as a concern.
Mr. England's description of Ms. Knisley's restrictions or limitations in his report refers only to restrictions and limitations imposed by her back injury. Although Mr. England testified to Ms. Knisley's cancer as affecting her ability to complete for as well as to sustain work, he failed to both distinguish between the cancer pre-dating the April 6, 1999 injury and the bout of cancer after April 6, 1999, and to e