Stephen Butler v. St. Peters Cemetery Association, Inc.

cemetery. Employee's duties, which varied across seasons, included cleaning out flower beds, cultivating the land with tillers and augers, trimming bushes and trees, spreading mulch, planting, shoveling, digging, and raking. Employee worked forty hours a week, five days a week, forty-nine weeks a year. Employee was allowed two fifteen-minute breaks, in addition to a thirty-minute lunch break.

Employee began experiencing pain, numbness, and tingling in his left hand in the spring of 2004. Employee did not attribute his symptoms to a specific work event, but associated them with various work activities. Employee reported his symptoms to his supervisor; however no report of injury was completed, nor was any medical treatment authorized by employer. Employee continued to perform his regular job duties and began wearing a splint to support his left wrist while he worked.

Dr. Schlafly first examined employee on November 7, 2005. Dr. Schlafly performed a physical examination and took a medical history. Upon examination, employee was found to have thenar atrophy and was positive for Tinel's sign, both of which Dr. Schlafly believed were an indication of carpal tunnel syndrome. Dr. Schlafly opined that the symptoms experienced by employee in his left hand and wrist, including numbness and tingling, were due to carpal tunnel syndrome. Dr. Schlafly recommended employee undergo a carpal tunnel release on the left. Dr. Schlafly opined that employee's work was the substantial and prevailing factor in the development of the carpal tunnel syndrome.

Dr. Brown gave two diagnoses with regard to the left upper extremity. Dr. Brown diagnosed employee with SLAC, due to an unrepaired scapholunate tear and carpal tunnel syndrome on the left. He opined that there were two causes for employee's carpal tunnel syndrome. The SLAC was one possible cause; and work as a gardener was another possible cause. The doctor testified that both were significant or substantial factors of his condition, but he was unable to tell which one was the actual cause of the carpal tunnel condition. Dr. Brown recommended employee wear a splint on his left wrist as well as take anti-inflammatory medications for the carpal tunnel syndrome.

Section 287.067, RSMo 2000, states as follows:

1. In this chapter the term "occupational disease" is hereby defined to mean, unless a different meaning is clearly indicated by the context, an identifiable disease arising with or without human fault out of and in the course of the employment. Ordinary diseases of life to which the general public is exposed outside of the employment shall not be compensable, except where the diseases follow as an incident of an occupational disease as defined in this section. The disease need not to have been foreseen or expected but after its contraction it must appear to have had its origin in a risk connected with the employment and to have flowed from that source as a rational consequence.

The employee must prove by substantial and competent evidence that he has contracted an occupational disease and not an ordinary disease of life. Kelley v. Banta \& Stude Const. Co., Inc., 1 S.W.3d 43, 48 (Mo.App. E.D. 1999); Hayes v. Hudson Foods, Inc., 818 S.W.2d 296, 299-300 (Mo.App. S.D. 1991). This involves showing that there was an exposure to the disease which was greater than or different from that which affects the public generally, and that there was a recognizable link between the disease and some distinctive feature of the employee's job which is common to all jobs of that sort. Id.; Dawson v. Associated Elec., 885 S.W.2d 712, 716 (Mo.App. W.D. 1994). The probability that the claimed occupational disease was caused by conditions in the work place is generally established through medical expert testimony. Id.

A claim for benefits is not necessarily defeated by the mere possibility that multiple factors caused or contributed

to the cause of an occupational disease. Sheehan v. Springfield Seed \& Floral, Inc., 733 S.W.2d 795, 797-98 (Mo.App. S.D. 1987). Work conditions need not be the sole cause of the occupational disease, so long as they are a major contributing factor to the disease. Kelley, 1 S.W.3d at 48. A single expert medical opinion will support a finding of compensability even where the causes of the occupational disease are indeterminate. Id.; Dawson, 885 S.W.2d at 716.

After careful review, the Commission does not agree with the finding of the administrative law judge that employee's left carpal tunnel syndrome is not compensable. Employee met his burden by establishing that he contracted an occupational disease, carpal tunnel syndrome, and not an ordinary disease of life. He was able to demonstrate both that his exposure was greater than that which affects the public generally and that his work as a gardener was linked to the contraction of the disease. Additionally, through expert testimony, claimant was able to establish that his work conditions were a major contributing factor to the disease.

Employee was able to establish exposure, as both Dr. Schlafly and Dr. Brown testified that employee's work conditions exposed him to the contraction of carpal tunnel syndrome. Employee's testimony as to the repetitive nature of his duties allowed medical experts to conclude that his work exposed him to greater risk than that which affects the public generally. Dr. Schlafly testified that employee's duties exposed him to the contraction of an occupational disease, specifically carpal tunnel syndrome. Dr. Brown corroborated Dr. Schlafly's testimony by opining that employee's work conditions exposed him to the contraction of the disease.

Employee was also able to establish a link between the work conditions and the disease through competent expert testimony. Dr. Schlafly testified that after reviewing both employee's medical history and records and performing a complete physical examination, that employee's work for employer was a substantial factor in employee's development of left carpal tunnel syndrome.

Furthermore, Dr. Brown conceded that there was a link between employee's work conditions and the disease. On cross-examination, Dr. Brown opined that employee's work as a gardener was a substantial factor in the development of employee's carpal tunnel syndrome.

Employee satisfied his burden through expert testimony provided by Dr. Schlafly and Dr. Brown establishing work place exposure as well as a link between employee's left carpal tunnel syndrome and his employment. The testimony offered by employee as well as medical experts was sufficient in convincing the Commission that his employment was a substantial factor resulting in his left carpal tunnel syndrome. Therefore, the Commission finds that there was exposure in the workplace sufficient to conclude that his alleged repetitive motion was capable of producing his resultant medical condition, left carpal tunnel syndrome.

In cases involving the award of future medical benefits, the medical care must flow from the accident before the employer is to be held responsible. Landers v. Chrysler Corp., 963 S.W.2d 275, 283 (Mo.App. E.D. 1997). Both Dr. Schlafly and Dr. Brown opined that medical treatment was necessary with regard to employee's carpal tunnel syndrome. Therefore, the Commission finds that employee is entitled to, and employer/insurer shall provide, such future medical benefits as may be determined to be necessary to cure and relieve employee's carpal tunnel syndrome. In addition, employee is entitled to temporary total disability benefits to cover healing periods to be paid prior to the time when the employee can return to work, his condition stabilizes, or his condition has reached a point of maximum medical progress. Schuster v. Division of Employment Security, 972 S.W.2d 377, 381 (Mo.App. E.D. 1998).

Based on the foregoing, the Commission concludes and determines that employee did sustain an occupational disease arising out of and in the course of his employment and reverses the portion of the award of the administrative law judge concluding that employee's left carpal tunnel syndrome is not compensable. The portion of the award of the administrative law judge concluding that employee's right cubital tunnel syndrome is not compensable is affirmed.

We find that employee is entitled to future medical benefits as may be determined necessary to cure and relieve employee's work-related condition; as well as temporary total disability to cover healing periods associated with such treatment.

The case is remanded to the Division of Workers' Compensation with the employer being responsible to provide workers' compensation benefits as appropriate pursuant to the provisions of the Workers' Compensation Act due to this compensable accident.

This award is only temporary or partial, is subject to further order and the proceedings are hereby continued and kept open until a final award can be made.

Given at Jefferson City, State of Missouri, this $9^{\text {th }}$ day of February 2007.

LABOR AND INDUSTRIAL RELATIONS COMMISSION

William F. Ringer, Chairman

Alice A. Bartlett, Member

John J. Hi