Sanford is a 55-year-old gentleman who attended school through the $10^{\text {th }} grade. Sanford did not complete the 10^{\text {th }}$ grade, did not receive his GED, nor did he receive further academic training. Sanford has a work history including primarily heavy labor, including work on a sod farm as well as his last position as a loader/packer with ABC Moving \& Storage, for whom he had been employed eight years.
On or about July 18, 2003, Sanford sustained an injury to his left ankle that resulted in three surgeries. He was
initially taken to Lee's Summit Hospital where x-rays revealed a left ankle plafond/trimalleolar ankle fracture. He was then referred to an orthopedic specialist, Dr. Susan K. Bonar, who initially diagnosed a severe ankle fracture with evidence of fracture blisters. On July 29, 2003, Dr. Bonar performed a closed reduction and application of a left ankle external fixator. On August 22, 2003, Dr. Bonar removed the external fixator and performed an open reduction/internal fixation of the pilon fracture on the left. Sanford eventually underwent a third operation for removal of the hardware from his left ankle.
Prior to July 18, 2003, Sanford previously suffered a neck injury on or about June 1, 2002, while loading boxes weighing 75 to 100 pounds. Sanford complained of pain, numbness, and tingling in his left side from his shoulder to his long and ring fingers. Sanford was employed by the same employer, ABC Moving \& Storage, at the time of that injury.
An MRI of the cervical spine taken on October 17, 2002, revealed disc extrusion at C6-7 and an EMG revealed C8 radiculopathy. Sanford was initially treated conservatively with modification of his activities and medications and taken off work. On January 2, 2003, Sanford underwent an anterior cervical discectomy and fusion at the C5-6 and C6-7. Five months following the surgery, June 2, 2003, Sanford returned to Dr. Jackson, who stated, "He reports no discomfort in his neck, however, he continues to have numbness in his arm, has not improved remains stable. He denies any arm pain and feels that his strength is good." On this date, Dr. Jackson indicated his progress in work hardening paralleled the job demands of a driver for his employer; therefore, Sanford was allowed to return to work the following day without restrictions. The Work Hardening/Conditioning Progress/Discharge report prepared on May 28, 2003, indicated Sanford's exertional level began at light and had progressed to heavy, which is what was required of his employment. That same report indicated that Sanford reported "his pain is a non factor" but he continued to experience right forearm and fourth and fifth digit num