Claimant began her employment with Gordmans in October of 2003, and her duties included working as a cashier, and stocking items in the fashion accessories section of the store. Claimant would stock such items as perfumes, pajamas, purses, and so on. On 12/10/03 Ms. Roesler was unloading boxes of merchandise that were loaded into a shopping cart. When in the course of reaching into the cart to lift out a box, Ms. Roesler suffered a "pop" in her back and an immediate onset of pain as she lifted and twisted while removing the box from the cart. Ms. Roesler experienced right-sided low back pain with pain extending down into her calf.
Dr. Richard Covert prescribed physical therapy for what he believed to be a lumbar strain. Physical therapy records from SSM Corporate Health (Claimant's Exhibit C) reveal that the claimant received therapy through December of 2003 for an acute lumbar strain with right radicular symptoms. Dr. Covert documented in his notes that Ms. Roesler was suffering from pain traveling down right leg to mid-calf.
Physical therapy did not alleviate back pain, and the claimant suffered a worsening of leg pain. Ms. Roesler was then referred to Dr. Raskas, and an MRI of the lumbar spine taken on 3/19/04 (See Claimant's Exhibit B) revealed a large central disk herniation at L5-S1, lateralizing to the right and left at midline. Claimant was also found to have evidence of degenerative disc disease. Dr. Raskas referred the claimant for further therapy, which she had at Heritage Physical Therapy from 4/1/04 through 4/22/04 (See Claimant's Exhibit A).
On 4/23/04 Dr. Raskas determined that the claimant was not a surgical candidate; that further physical therapy was not likely to change her overall condition; recommended that claimant continue her home exercise program; advised the claimant to avoid heavy manual labor; and concluded that claimant was at maximum medical improvement (see Claimant's Exhibit D).
On July 23, 2004, Ms. Roesler, at the suggestion of her legal counsel, met with Dr. Fredric M. Simowitz for an independent medical evaluation. Dr. Simowitz elicited from the claimant the history as to back injury, elicited the claimant's complaints, reviewed certain medical records, and performed a physical examination. Dr. Simowitz opined that there was a medical causal relationship between the injury at work and the claimant's L5-S1 disk herniation. Dr. Simowitz did not believe the claimant to be a surgical candidate, but nonetheless did not believe the claimant to be at maximum medical improvement. Dr. Simowitz recommended that the claimant have further conservative treatment, without providing any specifics as to what he would recommend.
In November of 2004 Ms. Roesler suffered from further complaints of severe low back pain as a result of bending over to open a dryer door. Ms. Roesler sought medical attention at the emergency room of Missouri Baptist Medical Center (See Claimant's Exhibit F). Claimant was given pain medication, including a medrol dosepak, for what was believed to be an exacerbation of her prior low back complaints. The claimant visited with Dr. Raskas, who ordered the lumbar spine MRI taken on 11/30/04 at Professional Imaging. Dr. Raskas reviewed the MRI, and referred Ms. Roesler to Dr. Hurford, who provided the claimant with epidural steroid injection on 12/9/04 and again on 12/21/04.
Claimant returned to Dr. Raskas on 1/03/05 for further evaluation post the two epidural steroid injections. Although there are no further physical therapy records in evidence to document a third round of physical therapy, the testimony of Ms. Roesler, in conjunction with both the treatment records of Dr. Raskas and his deposition testimony, persuade that the claimant received therapy in the form of strengthening exercises. On 3/18/05 Dr. Raskas met with Ms. Roesler, performed a physical examination, and concluded that the claimant had reached maximum medical improvement. Dr. Raskas concluded that the neurologic exam was within normal limits; that her range of motion at the lumbar spine was good; that the claimant should be proscribed from any lifting, pushing, or pulling over 50 pounds, and from repetitive lifting, pushing, or pulling, bending, stooping, or twisting at the waist.
Ms. Roesler met with Dr. Simowitz on 6/28/05 for a second evaluation. Dr. Simowitz read the most recent records, including as to epidural steroid injection and the second lumbar spine MRI report. He further elicited a treatment history from Ms. Roesler; noted her physical complaints; and performed a physical examination. Dr. Simowitz noted that the condition was the same; disk herniation at L5-S1 and degenerative joint disease of the lumbosacral spine; agreed with the restrictions imposed by Dr. Raskas; agreed with Dr. Raskas to the extent that the claimant would not currently benefit from any further medical treatment; but disagreed with Dr. Raskas to the extent that Dr. Simowitz was convinced that Ms. Roesler would need a back surgery in the future. (Claimant's Exhibit E, at page 22).