Only the evidence necessary to support this award has been summarized. Any objections not expressly ruled on in this award are overruled. At the time of hearing Claimant was a divorced sixty-four year old woman. Claimant was not employed and was receiving Social Security Disability payments since January 2002. Claimant graduated from high school in 1958. She graduated in 1986 from St. Mary's College, O'Fallon with an Associates Degree in nursing and was certified as a registered nurse in 1986. She stated she had a troubled marriage and suffered from depression without seeking treatment throughout her marriage. After 1986 she supported herself as a registered nurse working part-time at DePaul Hospital for three months and full-time at Missouri Baptist Hospital for four years as a charge nurse on the medical/surgical floor.
In December 1987 she injured her low back while working at Missouri Baptist Hospital. The 1987 injury resulted in a L5-S1 herniated disc with radiating pain that required surgery by Dr. Kretteck. She was off work six months after the injury. She was released to return to work in June 1988, but continued off work due to temporomandibular joint surgery. She returned to Missouri Baptist Hospital in July 1988 and on cross-examination she stated she may have re-injured her back in May 1989 but she does not remember that injury or any restrictions from Dr. Kretteck. Dr. Kretteck's records reveal that Claimant re-injured her low back and was examined on June 5, 1989. His diagnosis was musculoligamentous strain on the opposite side of the prior disc rupture. She was treated with muscle relaxants, physical therapy and rest. Dr. Kretteck released Claimant to return to work with a restriction of no lifting greater than 30 pounds and no repeated bending, stooping or twisting on August 21, 1989. Claimant was released at maximum medical improvement on December 20, 1989 and it was noted she was unable to lift light loads without aggravating back pain and diagnosis included lumbar osteoarthritis. Missouri Baptist Hospital could not accommodate the light duty restrictions and required lifting that she could not accomplish therefore she left Missouri Baptist Hospital and sought a position in a nursing home where certified nurse assistants (CNA) could help with lifting. At that time Missouri Baptist Hospital did not employ CNAs.
Division of Workers' Compensation records reflect a stipulation for injury number 89-098894 with date of injury of May 28, 1989. The settlement is based upon 9.5 percent of the low back, legs and body as a whole. The stipulation in injury number 87163678, date of injury of December 29, 1987 reflects the settlement is based upon 15 percent of the low back, legs, nerves and body as a whole.
She went to work for Delmar Gardens Nursing Home as a charge nurse from December 1990 through October 1995. She had CNAs working for her to do lifting. She was a medication instructor and worked on the Alzheimer's Unit with no heavy lifting. Claimant testified on cross-examination that she did not recall low back pain and muscle spasms in July 1990. She then worked for Rosewood Nursing Home doing the same activities from October 1995 until July 1997. She began working part-time because of patient care and emotional issues. On cross-examination Claimant did not recall any injury in June 1997 at Rosewood.
She then worked at McKnight Place from 1997 until the end of 2001 and continued part-time in 2002. She limited her lifting to 50 pounds because of her low back problems. She was on arthritis medications at that time as well as pain medication for headaches. She has had severe headaches intermittently her entire life. Her headaches occurred two to three times per week and were associated with stress and fatigue. She has also had sinus infections for years. In December 2000 Dr. Pepper treated her for chest pain and anxiety while working full-time at National Healthcare in St. Charles. Claimant suffered a low back sprain in August 2001 while working at National Healthcare. She was treated with anti-inflammatory medications and she testified she might have had restrictions from this injury.
Claimant was hired on October 29, 2001 at St. Joseph Health Center and she told Employer at the time she could not perform heavy lifting and needed assistance lifting. She testified Employer agreed to provide assistance with lifting. Claimant was not a charge nurse. She worked eight-hour shifts providing primary care for four to five patients in the Skilled Nursing Facility at the Health Center. On cross-examination Claimant testified she experienced increased back and right hip pain and sought treatment in January 2002. The diagnosis was back, right hip arthritis; trochanteric bursitis right hip and shoulder. She was treated with Daypro and Advil. On re-direct Claimant testified that her visit to Dr. Pepper in January 2002 involved bursitis with no radiating leg pain. She also testified that she had family problems and depression prior to the April 2002 injury.
Claimant testified that on April 14, 2002 a 200 pound patient was falling and she bent and twisted to catch him and felt immediate pain across her low back and down her right leg. She reported to the Emergency Room that day and treated with Dr. Covert from April 15, 2002 until August 2, 2002. Dr. Covert's early impression was lumbar pain with possible radiculopathy; He limited her lifting and performed a steroid injection on April 26, 2002. She was also referred to Dr. Ahmed. Dr. Covert performed a trigger point injection on June 19, 2002. Claimant was also tried on physical therapy and medications. She was on light duty and in pain until she was released by Dr. Covert in August 2002. Dr. Covert ordered a functional capacity evaluation and noted that the study demonstrated that Claimant was only able to carry thirty pounds and lift twenty pounds on an occasional basis. She had difficulty lifting fifteen pounds from the floor to overhead. Dr. Covert noted that Claimant was not able to handle her tasks as a fulltime staff nurse. Dr. Covert recommended that Claimant remain on these restrictions on a permanent basis.
Following her release in August 2002 Claimant tried working in Senior Services at Employer for a few hours per day, answering phones and processing orders. She testified she was in a lot of pain and could not find a job at Employer that she could perform. She testified she could not work from August through November 2002. Claimant attempted to return to work at McKnight Place at the end of November 2002 but she testified she could not perform the work. Claimant testified the pain was worse with difficulty sleeping and walking so she sought treatment from Drs. Pierron and Taylor who performed epidural steroid injections on three occasions later in 2002 without relief.
She was referred to Dr. Martin, a neurosurgeon who recommended surgery. After ordering a lumbar myelogram, Dr. Martin on January 28, 2003 diagnosed mild to moderate stenosis at L4-5 due to a combination of facet hypertrophy and mild spondylolisthesis with a right L5 nerve root, which did not fill as well as the left. He recommended a complete decompression, fixation and fusion. On February 28, 2003 Drs. Martin and Merenda performed bilateral L4 laminectomy, bilateral L4-5 facetectomies and bilateral L4-5 fixation and fusion with Steffee plates and left iliac crest autograft. Claimant testified she felt better for six weeks when she was not engaged in any activity and someone was able to help her at home. When she increased her activity level the pain recurred and she came to believe that the surgery did not help at all.
Following the low back fusion she did not undergo physical therapy. She testified she wanted to return to work but could not do so because of the pain. She was mostly confined to her house at this time. She became depressed and saw Dr. Ilivicky, a psychiatrist five times for treatment and prescription medication. Dr. Ilivicky noted on December 17, 2002 that Claimant had a past history notable for depressive episodes, which were untreated. He diagnosed Claimant with a major depressive episode.
At the time of hearing Clamant testified that her pain remained stable and that she was never without pain. She could not sit or stand for any length of time and could not perform housework. She did not lift over ten pounds, or bend or stoop. Her current medications were Lidocaine patch; Neurontin; Extra-Strength Tylenol and Advil. She took no narcotics due to allergies.
Dr. Jerome Levy testified by deposition that he examined Claimant on her behalf on September 2, 2003 and assigned pre-existing permanent partial disability of 24.5 percent body as a whole and 25 percent body as a whole permanent partial disability due to her April 14, 2002 injury. Dr. Levy testified that Claimant should not lift over ten pounds on an occasional basis or over five pounds repetitively. She should not work in an upright position for over thirty minutes and she not perform any repetitive lifting. Dr. Levy testified (SIF objection overruled) that he considered Claimant permanently and totally disabled based upon the combination of Claimant's pre-existing and primary back disabilities. Dr. Levy testified that the fusion of February 28, 2003 was necessary and that the findings at the time of surgery included instability. Dr. Levy also testified that the accident on April 14, 2002 caused or contributed to Claimant's low back problems, which resulted in the fusion. He explained that Claimant had an instability problem and degenerative disc disease that had worsened due to the April 14, 2002 accident.
Dr. Levy admitted on cross-examination that he was unaware of any treatment to Claimant's low back immediately prior to April 14, 2002. However he testified (SIF objection overruled) that the diagnosis of right trochanter bursitis immediately prior to the accident involved Claimant's hip.
Dr. Wayne Stillings testified by deposition that he examined Claimant on her behalf on March 18, 2004. Dr. Stillings diagnosed Claimant with dysthymia; mood disorder due to a medical condition; pain disorder. Dr. Stillings testified that Claimant suffered from pre-existing dysthymia. He assigned permanent partial disability of 35 percent body as a whole for the mood disorder, related to the primary injury and 35 percent body as a whole for the pain disorder, related to the primary injury. Dr. Stillings assigned 15 percent body as a whole for the pre-existing dysthymia. Dr. Stillings testified that Claimant was permanently and totally disabled due to her psychiatric disorders alone. He testified that Claimant would require "ongoing open-ended indefinite psychiatric treatment" which would consist of pharmacotherapy for sleep and depression.
Dr. John Wagner testified by deposition that he evaluated Claimant at Employer's request on November 1, 2004. Dr. Wagner testified that Claimant suffered a sprain injury from the April 14, 2002 accident and that she also had pre-existing degenerative disease and spondylolisthesis. Dr. Wagner testified the need for the fusion was due to pre-existing spondylolisthesis. He assigned permanent partial disability of 15 percent lumbar spine due to pre-existing degenerative disease and 15 percent permanent partial disability of the lumbar spine due to the April 14, 2002 injury.
Dr. Wagner testified Claimant was at maximum medical improvement from an orthopedic standpoint and would be capable of nursing supervisory work, which he considered sedentary and occasionally light duty. Dr. Wagner testified Claimant should be restricted to lifting no more than 10 to 15 pounds with some bending and stooping, not frequently. On cross-examination Dr. Wagner testified that Claimant had trouble working due to back pain prior to the April 14, 2002 accident. Dr. Wagner continued that the fusion procedure was necessary for treatment of spondylolisthesis. On cross-examination Dr. Wagner admitted that spondylolisthesis and stenosis can be aggravated by trauma.
Dr. Gregg Bassett testified by deposition and evaluated Claimant on August 6, 2004 on behalf of Employer. Dr. Bassett diagnosed pre-existing dysthymic disorder and pre-existing dependent personality traits; pain disorder and depression. He recommended better pain control and agreed with the treatment plan outlined by Dr. Stillings. Dr. Bassett assigned 15 percent psychiatric disability overall with one-half attributed to the April 14, 2002 injury. Dr. Bassett testified that Claimant's psychiatric condition alone does not preclude her from working; instead it is the pain and decreased abilities associated with the pain that precludes Claimant from working.
Vocational Rehabilitation Counselor James M. England, Jr. testified on behalf of Claimant by deposition taken July 8, 2004.
After interviewing Claimant and reviewing her medical reports he testified that Claimant possessed transferable skills, which included nursing skills, medical terminology knowledge and some basic computer skills, which would transfer to the sedentary level if it were not for Claimant's degree of problems. Mr. England testified he believed based on the combination of problems Claimant had, that she would not be employable in the open labor market. He testified that the combination problems were her back problems and surgeries and her past and recent problems with depression.