On May 05, 1994, Claimant began working for Ford Motor Company on the assembly line. Claimant's initial position with Ford was a speaker installer wherein she installed speakers using small screws and a screw gun to affix speakers to the automobile. Claimant was later transferred to the position of panel servicer wherein she inserted door handles and tightened door mechanisms. During her time as a panel servicer, Claimant developed right carpal tunnel syndrome as well as right cubital tunnel syndrome. These conditions were treated through surgery by Dr. Bortnick on or about May 07, 1996. Claimant testified that she had ongoing sensitivity in her right medial elbow and ongoing loss of strength in her right upper extremity after her surgery, but she did return to work at Ford. Claimant was later transferred to the position of left-hand loom operator which is the position in which she sustained her primary injury of April 01, 2001.
On or about April 01, 2001, Claimant was in the employ of Ford Motor Company. While in the course and scope of her employment with Ford, Claimant slipped on a slick clear substance causing her to lose her balance and fall to the concrete floor. Claimant landed directly on her tailbone also injuring her left ankle. As she tried to regain her footing, Claimant slipped and fell again landing on her left wrist. A forklift driver witnessed the incident and assisted Ms. Nyberg to her feet. After the series of falls, Claimant began experiencing immediate pain in her low back and coccyx area.
Claimant treated initially through Ford medical with Dr. Buck. Dr. Buck attempted conservative treatment such as prescribing Motrin and physical therapy for approximately 6 months.
Prior to this time Claimant developed cumulative injury to her left upper extremity which appears to be unrelated to her fall occurring on April 01, 2001. Claimant was referred by Ford medical to Dr. Peter Vilkins who ultimately diagnosed left carpal tunnel syndrome on June 27, 2001. On July 17, 2001, Dr. Vilkins performed a left
carpal tunnel release operation. Claimant treated with Dr. Vilkins for her left upper extremity problems through October 2001. Claimant also suffered bilateral hand tremors which she had since childhood. These also were not related to her fall in April 2001.
For her ongoing back and coccyx complaints, Claimant was referred to Dr. David Paul with Orthopedic Surgeons, Inc. An MRI of Claimant's sacrum and coccyx was conducted on April 11, 2001, revealing no abnormalities at that time. On October 08, 2001, Dr. Paul diagnosed coccydynia, possible lumbar strain, and noted possible radiculopathy. Dr. Paul recommended an EMG of the lower extremities to rule out neurological involvement. During this time, Claimant had begun treatment with pain management specialist, Dr. Phillip Landers, for her mechanical back pain. On October 01, 2001, Dr. Lander's administered the first of several lumbar epidural steroid injections for possible lumbar radiculopathy. In addition to receiving multiple epidural steroid injections, Claimant also received SI joint injections under fluoroscopy by Dr. Landers. On October 24, 2001, Dr. Hu performed electrodiagnostic studies on both lower extremities which revealed no abnormalities. Claimant continued to complain of pain at the coccygeal region. On October 29, 2001, Dr. Paul diagnosed coccydynia and
discussed with Claimant the possibility of a coccygectomy if her condition did not resolve (i.e. having her coccyx removed surgically).
Ultimately, Claimant was referred back to Dr. Phillip Landers for pain management. Dr. Landers opined that Claimant had diskogenic pain for which he recommended a diskogram on December 04, 2001. The diskogram revealed concordant pain at the L3-L4 level with annular tears at the L3-L4 and L5 levels. On January 29, 2002, Claimant was referred to Dr. John A. Clough, neurosurgeon, for evaluation of her continued low back pain and treatment options. Dr. Clough reviewed the lumbar diskogram results and noted the annular tears at the L3-L4 and L4-5 levels. Upon examination, Dr. Clough associated Claimant's pain with a deep sacral or coccyx injury in addition to her positive L3-4 diskogram showing annular tear. Dr. Clough recommended an IDET procedure prior to any extensive posterior decompression and/or fusion operations. It is important to note that Dr. Clough concluded that he would not rule out the need for an anterior lumbar interbody fusion surgery in the future should conservative measures continue to fail.
On March 14, 2002, Claimant began treating with Dr. Patrick Griffith for control of her pain management and prescriptions. Dr. Griffith also recommended an IDET procedure. On May 20, 2002, Dr. Griffith performed an IDET procedure at Claimant's L3-L4 and L4-L5 levels. This procedure provided no benefit to Claimant.
On September 05, 2002, Dr. Griffith recommended that Claimant visit Dr. Ira Fishman, a rehabilitation physician who deals with post IDET patients for an evaluation of further treatment options. On September 23, 2002, Claimant presented to Dr. Fishman for evaluation. Dr. Fishman's impression was that of chronic coccydynia. Dr. Fishman did not feel Claimant could tolerate the post IDET rehabilitation program because it would most likely exacerbate her coccydynia. Therefore, Dr. Fishman did not
recommend the post IDET rehabilitation program. Dr. Fishman instead felt that Claimant should proceed with additional steroid injections with Dr. Griffith.
Claimant also saw Dr. Dwayne E. Jones, M.D. in the Pain Management Clinic for consult on September 26, 2002. Dr. Jones' impression was one of left annular tears at L3-4 and L4-5 and coccydnynia. Dr. Jones recommended additional caudal epidural steroid injections under fluoroscopic guidance.
On October 17, 2002, Dr. Griffith recommended a surgical consult with Dr. Chris E. Wilson. Claimant was examined on January 13, 2003 by Dr. Wilson wherein Dr. Wilson ordered an updated MRI. Claimant saw Dr. Wilson in follow up on January 22, 2003 after completion of the MRI. Dr. Wilson did not feel Ms. Nyberg was a surgical candidate at that time but did assign work restrictions of no repetitive lifting of greater than 20 lbs and no repetitive bending or twisting activities.
Claimant presented to Dr. Mary Brothers on December 09, 2003, for purposes of determining Claimant's eligibility for social security benefits. Dr. Brothers assigned permanent work restrictions of no bending at the waist, no lifting or carrying in excess of 10 lbs frequently or 20 lbs occasionally. Dr. Brothers felt that much of Claimant's limitation was psychological in nature. She commented that employee was non compliant with her pool therapy despite the fact that such therapy has been shown to be beneficial. Dr. Brothers also suggested that Claimant avoid repetitive use of her upper extremities and working with vibrating and pneumatic equipment. She felt that claimant should continue with pain management for her narcotic pain medication usage. Similarly, Dr. Griffith assigned the following work restrictions in an office note dated September 23, 2003: no bending, twisting, stooping, crawling, no standing greater than twenty minutes without rest, no lifting greater than ten pounds, and remain off the production floor.
Claimant continued to treat on a regular basis with Dr. Griffith through 2004. On May 04, 2004, Claimant was seen by Dr. Steven Hendler, per Dr. Griffith's request, for purposes of an independent medical examination. At this time, Claimant continued to complain of continuous pain described as an 8 on a scale of 1 to 10. She complained of numbness and tingling on a continuous basis throughout the anterior left thigh. Claimant was taking narcotic medication including a 100 mcg Duragesic patch, Oxycodone, Zoloft, Zonegran, and Lactulose. Dr. Hendler expressed concern with Claimant's pain medication intake and recommended a comprehensive pain management program. Dr. Hendler also recommended a psychological assessment to examine Claimant's ability to cope with pain and to evaluate whether Claimant would benefit from an invasive pain management procedure
such as the installation of a intrathecal pump. In his December 03, 2004, narrative report, Dr. Hendler agreed with the physical restrictions assigned by Dr. Griffith and recommended no additional medical treatment other than continued narcotic medication. On July 09, 2004, Dr. Griffith recommended a behavioral pain management consultation to assist Claimant with pain coping skills and dealing with her pain. On September 27, 2004, Claimant returned to Dr. Griffith in follow up after attempting a work hardening program. Dr. Griffith recommended that Claimant stop work hardening due to her increased pain. Of particular importance, I note where Dr. Griffith diagnosed failed low back syndrome with lumbar diskogenic disk disease. Further, Dr. Griffith did not want to decrease her pain medication and stated clearly that this would not be of benefit to anyone and that decreasing her pain medications anymore would only serve to worsen her pain without really gaining much. Dr. Griffith continued to treat Claimant with aggressive physical therapy including pool therapy. Claimant attended multiple physical therapy sessions from August 2002 through October 2002 wherein physical therapy was stopped per Dr. Griffith due to Claimant's increased pain levels.
At one point Claimant and Dr. Griffith attempted to wean claimant off her narcotics. In April of 2005 Dr. Griffith changed her medications to try a different pain control. She was to try a course of methadone, which she did at home. She testified that she took her narcotic patch off and took the methadone. Within a short time she became very ill and painful in fact losing both bowel and bladder control. Her difficulties with changing medication are reflected in Dr. Griffith's medical notes of May 18 2005. Her bad reaction to the change in medication caused her great concern and apprehension about trying to do this again. Dr. Griffith noted that claimant felt she should be admitted to the hospital if they were going to try anything like that again.
Later she was sent by employer to a Dr. Brooks who it was explained to her specialized in weaning patients off of pain medication. She stated she went to one meeting with him. The first meeting was mainly a discussion wherein it appeared that he was not aware of her accident and mainly reviewed her medical records. She was concerned because she felt all he was offering was taking away her pain medication without any alternatives, to her understanding.
She stated that if someone offered her a medical course that would help her she would do it as along as the treatment was in the hands of a competent physician. That would include surgery.
Claimant presented the deposition testimony and the narrative report of Dr. P. Brent Koprivica dated April 24, 2004. Dr. Koprivica concluded that Claimant suffers from chronic mechanical back pain with a history of diskogenic source for pain based on the concordant discography. Dr. Koprivica further concluded that Claimant suffers from failed back syndrome. In addition to the physical impairments, Dr. Koprivica opined that Claimant developed chronic pain disorder with psychological factors involved in her pain presentation in addition to her medical condition. Dr. Koprivica ultimately opined that Claimant was permanently and totally disabled based solely on the injury of April 03, 2001, in isolation. Dr. Koprivica assigned the following permanent work restrictions: sedentary physical demand level activity, captive sitting intervals of forty-five minutes or less, standing and walking should be limited to thirty minutes or less, flexibility of changing postures from sitting to standing or walking and vice versa, and she should be afforded the opportunity to recline or lay down based on pain needs.
Claimant also presented the deposition testimony and narrative report of Dr. John D. Pro, M.D., psychiatrist, who examined Claimant on July 27, 2004. Dr. Pro testified that Claimant's overall level of functioning was extremely low. For example, Claimant no longer performs household chores or cooking. Claimant's husband and two children have taken over most household jobs. Claimant was recorded as spending 18-20 hours per day in bed. Dr. Pro described Claimant's mood as "discouraged". Dr. Pro diagnosed chronic pain syndrome causing impairment to Claimant both psychologically and medically. Dr. Pro further testified that Claimant's loss of her ability to work and the loss of her role function, self esteem, and losses of her hobbies, were all adding to the amplification of her pain experience. Dr. Pro also identified a history of childhood abuse which, he believed, predisposed her to chronic pain syndrome (as agreed by Employer's psychologist, Dr. Keenan). Dr. Pro testified that Claimant's April 03, 2001, injury caused her chronic pain syndrome. Dr. Pro assigned a Class III psychological impairment noting significant impairment in her activities of daily living (driving, sleeping, staying in bed, and difficulty with housework). Dr. Pro testified that Claimant would deteriorate in a work-like setting and that her pain would likely worsen if she were to return to work. Finally, Dr. Pro assigned a numerical rating of 35\% whole person psychological impairment attributable to her April 3, 2001 injury. Dr. Pro testified that, in his opinion, Claimant does not suffer from any pre-existing psychiatric impairment. Dr. Pro testified that Claimant could benefit
from ongoing treatment at a Pain Clinic such as aggressive treatment with antidepressants.
Claimant presented the deposition testimony and vocational report of Mary Titterington dated September 20, 2004. Claimant did not graduate high school but did obtain her GED. Ms. Titterington found Claimant's prior job history to include exclusively production type jobs either installing automobile parts, packing or operating machines. Ms. Titterington found all the these prior jobs required constant standing, reaching, handling, pushing and fingering as well as frequent bending and twisting. Ms. Titterington testified that the restrictions assigned by Drs. Koprivica, Brothers, Griffith, Wilson, Clough, and Weed preclude her from returning to any of these positions. Ultimately, Claimant's vocational expert, Mary Titterington, opined that Claimant is unemployable in the open labor market. The restrictions placed on Claimant by these doctors are all related to her last injury of April 1, 2001.
Currently, Claimant is treating with her family physician, Dr. James Linnick, D.O., with Family Care of Independence. According to Claimant's testimony, she treats with Dr. Linnick approximately once every three months primarily for regulation of her narcotic pain medication. On January 03, 2006, Dr. Linnick was asked to review Claimant's current work restrictions consisting of no assembly line work, no lifting above 5 lbs., occasional lifting of 5 lbs , frequent lifting of only $2-5 \mathrm{lbs}$, and no bending, twisting, stooping, kneeling, or crawling, occasional standing, walking or climbing stairs, frequent sitting with ability to change position every 30 minutes. Dr. Linnick opined that the above mentioned work restrictions are current and permanent and that he had no new restrictions to add. Dr. Linnick was also of the opinion that Claimant's use of a cane for ambulation and balance was medically necessary.
Employer/insurer presented the live testimony at hearing and narrative report of psychologist, Dr. Kathleen Keenan, Ph.D. Dr. Keenan performed a psychological examination of Claimant on November 16, 2004. Dr. Keenan was asked by Employer to determine the degree to which psychological factors may be influencing the extent and/or expression of Claimant's pain as well as a determination of whether Claimant would be a candidate for Behavioral Pain Management. Dr. Keenan stated in her report that Claimant denied any personal history of mental disorder or treatment. Claimant had one sister with PTSD, but no other family history of mental disorder. Dr. Keenan's report states that Claimant's daily activities consist of watching TV and dozing off and on. Claimant is unable to wash her hair without assistance and she performs no housework. Dr. Keenan administered various psychological tests and ultimately diagnosed Claimant with somatoform pain disorder associated with both psychological factors and a general medical condition, major depressive episode (moderate), and obsessive compulsive personality traits with histrionic and narcissistic personality features. Ultimately, Dr. Keenan opined that there is a significant psychological component to Claimant's pain complaints. Dr. Keenan further opined that Claimant's psychological test results indicate that Claimant has an underlying personality style which relies on minimization, denial, repression, and somatization to cope with stress and emotional needs. Dr. Keenan further testified that it is Claimant's personality make-up and her underlying emotional needs that prohibit her from benefiting from medical treatment. Finally, Dr. Keenan did not feel Claimant would be a good candidate for Behavioral Pain Management. In an addendum dated December 08, 2004, Dr. Keenan assigned a numerical rating of 10 % whole person psychological impairment.
Dr. Keenan testified that her diagnosis was that claimant's psychological factors contributed to her physical symptoms and were interfering with her ability to benefit from medical treatment. This was due to her psychological makeup and was not caused by the accident of April 1, 2001 at Ford. Her diagnoses of claimant's somatoform pain disorder associated with both psychological factors and a general medical condition, major depressive episode (moderate), and obsessive compulsive personality traits with histrionic and narcissistic personality features were present prior to the accident of April 1, 2001. Further she felt that claimant was refusing to try to cure her complaints because of "secondary gain" which she identified as the attention and concern she gets from others plus the economic benefits she gets even while not working. During cross examination Dr. Keenan explained that her underlying psychological condition existed prior to the injury of April 1, 2001. She explained it was like a computer screen where the screen called psychological impairment is minimized. Then when the April 1, 2001 accident occurred it was as if someone had pressed the maximize box and brought the screen up on the computer. The accident merely triggered her underlying problems and brought them to full force.
Employer/insurer presented the live testimony at hearing and narrative report dated February 12, 2007, of
vocational expert, Jane Duebler-White. Ms. Duebler-White opined that Claimant would not be a good candidate for vocational rehabilitation in her
current condition. Ms. Duebler-White testified at hearing that in her current condition, Claimant was unemployable. Essentially, both vocational experts are in agreement that Claimant is unemployable. On cross reexamination by the Second Injury fund Ms. Duebler-White admitted that claimant's pain, her narcotic use and her need to lie down, all of which were due to her accident of April 1, 2001, alone was enough to deem her unemployable.
Finally Employer/Insurer presented the live testimony of Connie Arnold a registered nurse and case manager who worked on claimant's case. She testified that claimant was "non compliant" with her medical examiners specifically she refused to report to Dr. William Brooks who's title is a Certified Osteopathic Manipulative and Restorative Medicine Expert. An appointment had been scheduled for October 13, 2005. Claimant cancelled the appointment the night before. Further Ms. Arnold testified that claimant refused to report to Shawnee Mission Medical Center as suggested by Dr, Griffith in order to wean her off the narcotics.
On February 02, 2007, Claimant was evaluated by Dr. Dennison Hamilton, M.D., for purposes of an independent medical exam. Dr. Hamilton found that Claimant's physical examination was inconsistent with an injury. He opined that there were no objective orthopedic or occupational findings to support the diagnosis of a spinal injury. Ultimately, Dr. Hamilton opined that Claimant is not disabled and is able to return to work without restriction.