Greg Rufer v. Monett Metals, Inc.

The above-entitled workers' compensation case is submitted to the Labor and Industrial Relations Commission (Commission) for review as provided by section 287.480 RSMo, which provides for review concerning the issue of liability only. Having reviewed the evidence and considered the whole record concerning the issue of liability, the Commission finds that the award of the administrative law judge in this regard is supported by competent and substantial evidence and was made in accordance with the Missouri Workers' Compensation Act. Pursuant to section 286.090 RSMo, the Commission affirms and adopts the award and decision of the administrative law judge dated August 6, 2008.

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. All parties should be aware of the provisions of section 287.510 RSMo.

The award and decision of Associate Administrative Law Judge Karen Fisher, issued August 6, 2008, is attached and incorporated by this reference.

Given at Jefferson City, State of Missouri, this 31st day of October 2008.

LABOR AND INDUSTRIAL RELATIONS COMMISSION

William F. Ringer, Chairman

Alice A. Bartlett, Member

John J. Hickey, Member

Employee: Greg Rufer

Injury No. 06-119130

Before the

DIVISION OF WORKERS'

COMPENSATION

Department of Labor and Industrial Relations of Missouri

Jefferson City, Missouri

Dependents: $\quad \mathrm{N} / \mathrm{A}$

Employer: Monett Metals, Inc.

Additional Party: N/A

Insurer: Wausau Insurance Companies

Hearing Date: March 28, 2008

Record Closed: April 27, 2008

Checked by:

1. Are any benefits awarded herein? YES
2. Was the injury or occupational disease compensable under Chapter 287? YES
3. Was there an accident or incident of occupational disease under the Law? YES occupational disease
4. Date of accident or onset of occupational disease: AUGUST 12, 2006
5. State location where accident occurred or occupational disease contracted: MONETT, MO
6. Was above employee in employ of above employer at time of alleged accident or occupational disease? YES
7. Did employer receive proper notice? YES
8. Did accident or occupational disease arise out of and in the course of the employment? YES
9. Was claim for compensation filed within time required by Law? YES
10. Was employer insured by above insurer? YES
11. Describe work employee was doing and how accident happened or occupational disease contracted:

EMPLOYEE WAS EXPOSED TO SAND AND SILICON IN THE WORK PLACE AND DEVELOPED AUTOIMMUNE DISEASES LABELED AS WEGENER'S GRANULOMATOSIS

1. Did accident or occupational disease cause death? NO

1. Parts of body injured by accident or occupational disease: BODY AS A WHOLE
2. Compensation paid to-date for temporary disability: NONE
3. Value necessary medical aid paid to date by employer/insurer? NONE
4. Value necessary medical aid not furnished by employer/insurer? $\ 265,133.18
5. Employee's average weekly wages: $\ 769.23
6. Weekly compensation rate: $\ 513.08
7. Method wages computation: AGREED

1. Amount of compensation payable:

Unpaid medical expenses: $\ 265,133.18

85 weeks of temporary total disability (or temporary partial disability) TO DATE OF HEARING

Future Medical:

Each of said payments to begin IMMEDIATELY and be subject to modification and review as provided by law. This award is only temporary or partial, is subject to further order, and the proceedings are hereby continued and the case kept open until a final award can be made.

IF THIS AWARD IS NOT COMPLIED WITH, THE AMOUNT AWARDED HEREIN MAY BE DOUBLED IN THE FINAL AWARD, IF SUCH FINAL AWARD IS IN ACCORDANCE WITH THIS TEMPORARY AWARD.

The compensation awarded to the claimant shall be subject to a lien in the amount of 25 PERCENT of all payments hereunder in favor of the following attorney for necessary legal services rendered to the claimant:

Attorney : William W. Francis, Jr.

Employee: Greg Rufer

Injury No. 06-119130

Before the

DIVISION OF WORKERS'

COMPENSATION

Department of Labor and Industrial Relations of Missouri

Jefferson City, Missouri

Dependents: $\quad \mathrm{N} / \mathrm{A}$

Employer: Monett Metals, Inc.

Additional Party: N/A

Insurer: Wausau Insurance Companies

Hearing Date: March 28, 2008

Record Closed: April 27, 2008

Checked by:

A hardship hearing was held before the undersigned Administrative Law Judge on March 28, 2008. The employee appeared in person and by attorney, William W. Francis, Jr. The employer/insurer was represented by attorney Lynn Curtis.

1. Employer was at all times an employer as defined in $\S 287.030$, RSMo., operating subject to the Missouri workers' compensation law.
2. Employer's liability was fully insured by Wausau Insurance Companies.
3. Employee's claim was filed within the time prescribed by $\S 287.430, RSMo.
4. Employee's compensation rate for temporary total disability is \ 513.08
5. No medical benefits have been paid.
6. No temporary total disability benefits have been paid.

The following issues were presented for determination:

1. Whether Employee sustained an injurious exposure while in the course and scope of his employment with Employer;

Employee testified at the hearing in support of his claim. Employee also presented deposition testimony of Norbert Belz, M.D. Employee offered for admission the following exhibits: Exhibit A. TTD calculations with wage statement Exhibit B. Medical bills(Ex. 1; from 03/25/08 Belz deposition) Exhibit C. MSDS information (Ex. 1; Rufer deposition) Exhibit D. Belz deposition-08/17/07 (with exhibits) Exhibit E. Belz deposition-03/25/08 (with exhibits) Exhibit F. Rufer deposition -05/10/07 (with exhibits) Exhibit G. Cox Family Medical Associates records (certified; 34 pages) Exhibit H. Cox Family Medical Associates records (not certified; 5 pages) Exhibit I. Cox Medical records (certified 08/09/07; 212 pages) Exhibit J. Cox Medical records (certified 05/21/07; 737 pages) Exhibit K. Cox Medical records (certified 02/23/07; 207 pages) Exhibit L. Cox Medical records (certified 09/26/06; 342 pages) Exhibit M. Cox Medical records (certified 07/10/06; 2 pages) Exhibit N. Cox Medical records (certified 06/12/06; 374 pages) Exhibit O. Family Medical records (certified; 3 pages) Exhibit P. Ferrell-Duncan records (certified 07/25/07; 69 pages) Exhibit Q. Ferrell-Duncan records (certified 05/01/07; 154 pages) Exhibit R. Ferrell-Duncan records (certified 03/08/07; 164 pages) Exhibit S. Ferrell-Duncan records (certified 09/08/06; 90 pages) Exhibit T. Ferrell-Duncan records(certified 06/16/06; 46 pages) Exhibit U. Ferrell-Duncan records (certified 05/23/06; 197 pages) Exhibit V. Mayo Clinic records (certified; 36 pages) Exhibit W. Dr. Troy Major records (certified; 6 pages) Exhibit X. Ozark Dialysis Services records (certified; 121 pages)

The primary issue in this case is that of medical causation. The primary focus of the award will be on that issue alone as it is the determining issue for those that remain. I will limit my discussion of the facts in this case to those that are strictly relevant to the issue of medical causation.

1. Employee worked in the foundry business for approximately thirty years performing duties involving sand molds and the pouring of molten metal.
2. During that time he was exposed to sand and silicone on a continual basis.
3. Employee was hired by Monet Metals, Inc. on February 11, 2003 to perform foundry work.
4. Within a few weeks of employment he noticed a dry, hacking cough.
5. In September of 2005 employee noticed his urine began to have a foamy appearance and began experiencing headaches.
6. Employee had no problems with his lungs or kidneys until October 2005.
7. In December 2005 he was diagnosed with **ANCA associated glomerulonephritis**, an autoimmune disease affecting the kidneys, with acute renal failure.
8. In May 2006 employee began to develop lung problems. Mr. Rufer was noted by Dr. Wolfe (pulmonologist) to have had “extensive exposure to silica as he worked in a foundry for many years.”
9. In June 2006 employee underwent a lung biopsy and was also diagnosed with **granulomatous lung disease** which when combined with the glomerulonephritis is known as **Wegener’s granulomatosis**, an autoimmune disease and a type of vasculitis.
10. Employee continued to work off and on until August 12, 2006, during which time he continued to be exposed to sand and silicone.

Dr. Allen Parmet, employer's expert: Dr. Parmet, is board certified in occupational medicine and performs IME’s for workers’ compensation. He performs approximately 40 percent for employees and 60 percent for employers. He became expert in clinical toxicology in the U.S. Air Force and has completed the course work toward a Ph.D. in toxicology at the University of Kansas. He has conducted clinical research with toxic chemicals and has published numerous papers. His clinical practice includes evaluating and treating chemical exposure from lead, pesticides, and other workplace agents. He has published articles in the area of toxicology and was a member of the United States military as a physician in the area toxicology.

Dr. Norbet Belz, employee's expert: Dr. Belz is certified in preventative and occupational and environmental medicine. He noted that as a part of the board certification for occupational and environmental medicine over 50 percent of the questions were related to toxicology. Therefore, while he is not certified in toxicology, his certification and practice in the area of occupational and environmental medicine qualify him as an expert in this area.

1. That the employee was exposed to silica dust at Monett metals, Inc.
2. That the employee suffers from Pauci-immune glomerulonephritis (an autoimmune disease where antibodies attack the kidneys) and is in end-stage renal failure.
3. That the employee also suffers from vasculitis and granulomas in the lungs.
4. That this autoimmune disorder affecting the kidneys and lungs is known as Wegener’s

granulomatosis.

1. That Wegener's granulomatosis is part of a group of vasculitis syndromes that all demonstrate an abnormal antibody called antineutrophic cytoplasmic antibodies (ANCA) that create inflammation in small and medium sized blood vessels and can manifest as a vasculitis or inflammation of the upper and lower respiratory tract.
2. That the cause of Wegener's granulomatosis is connected to environmental and genetic factors.
3. That one of the environmental factors known to be connected to the onset of Wegener's granulomatosis is the exposure to silica and that there do exist medical studies that connect the development of Wegener's granulomatosis with exposure t