This workers' compensation claim was heard in Springfield, Missouri, before the undersigned Administrative Law Judge on September 2, 2008. Carl Cantrell, the deceased employee, died as a result of an unrelated disease. His widow, Kim Cantrell, is the substituted party (Claimant). She is represented by Randy Alberhasky. Baldwin
| Transportation and its insurer, Cherokee Insurance Company (Employer), is represented by Patricia Musick. STIPULATIONS |
| The parties agree that the deceased employee suffered an injury that arose out and in the course ofemployment. Employee was covered by the Workers’ Compensation Law and Employer was subject to that Law.Employer was fully insured. Counsel for the Second Injury Fund signed an agreement as to the amount of its liability should the underlying claim be ruled in Claimant’s favor. There is no dispute with respect to notice, venue,jurisdiction, or statute of limitations. The deceased employee earned an average weekly wage of 814.72, which would yield a temporary total disability rate of 543.17 and a permanent partial disability rate of $376.55. There is no claim for additional medical or temporary total disability. The employee died as a result of causes unrelated to hiswork injury. |
| ISSUES |
| 1.Whether permanent partial disability accrued prior to Employee’s death? |
| 2.If permanent partial disability is due, what is the nature and extent of permanent partial disability? |
| EHXIBITS |
| The following exhibits were admitted on behalf of the claimant: |
| Exhibit B | Medical records – St. John’s Clinic Occupational Medicine |
| Exhibit C | Medical records – MRI of Springfield |
| Exhibit D | Medical records – St. John’s Clinic, Orthopedic Specialists |
| Exhibit E | Medical report – Dr. Kubick |
| Exhibit F | Medical report – Dr. Paff |
| Exhibit G | Claim |
| Exhibit H | Answer – Employer |
| Exhibit I | Answer – Second Injury Fund |
| Exhibit J | Notice – 6/3/2008 |
| Exhibit K | Notice – 6/10/2008 |
| Exhibit L | Notice – 7/24/2008 |
| Exhibit M | Report of Injury |
| Exhibit M | Memorandum of Agreement with Second Injury Fund |
| Exhibit O | Deposition – Dr. David Paff; including exhibits contained therein. |
| FINDINGS OF FACT |
| Carl Cantrell suffered a work-related injury on December 11, 2006, when he fell on both hands. On February15, 2007, Mr. Cantrell saw Dr. Nachtigal for evaluation of some preexisting knee problems. Surgery for the knee wasscheduled for March 6, 2007. A lung biopsy performed during that surgery due to a collapsed lung revealed cancer. Dr. Nachtigal also reviewed the MRI and opined that the employee suffered a rotator cuff tear. Dr. Kubiksubsequently noted a positive impingement sign on the left shoulder and pain in the scapholunate ligament. Dr. Kubikdiagnosed left shoulder impingement syndrome, left wrist ulnar impaction, and a triangular complex (TFCC) tear. Shenoted, however, that the employee had “other health issues.” She recommended conservative care. |
| After a few months of conservative care, Dr. Kubik saw no significant improvement. She indicated thatsurgery was appropriate treatment but because the employee was undergoing chemotherapy, the employee was not agood surgical candidate. She, therefore, suggested that employee continue on limited duty and return in six weeks for a repeat check. The employee did not return to Dr. Kubick as he died shortly thereafter as a result of the lungcancer. |
| After the employee’s death, Dr. Kubik issued a rating report to Claimant on July 19, 2007. Dr. Kubik statedthat it was difficult to render an opinion “given the fact that although [employee] had a diagnosis, treatment was not possible given his other medical issues.” Using “The Guides to Evaluation of Permanent Impairment,” 5th Edition, Dr. Kubik issued an “estimate” of the employee’s impairment (Ex. E). |
| Dr. Paff reviewed the medical records. He believed it was reasonable to stop treatment for the work injuries. Dr. Paff provided a disability rating, but he neither treated nor examined Employee. According to Dr. Paff, thedisability rating was based on “the amount of disability [Employee] would have had” due to his work-related injury. Dr. Paff continued, “I am rating his disability based on the minimum disability that would exist following propertreatment.” In Dr. Paff’s deposition, Dr. Paff admits that Claimant was in active medical treatment for his left wrist and left shoulder as of June 11, 2007, and that he was not placed at maximum medical improvement by his treatingdoctors. |
| In deposition, Dr. Paff testified: |
Q. Was he then at maximum medical improvement on June 11th, 2007, when he elected to decline further treatment?
A. Well, I don't think I would say that he was at maximum medical improvement because it's the best he ever got, but he could have had treatment for it that might have made him better.
Q. Well, absent further treatment he was not going to get better?
A. That's correct. But if I were seeing him when he was alive, I would have said that he had not reached maximum medical improvement and needed to have this treatment and this treatment and this treatment.
(Ex. O, p. 32 - 33).
Dr. Paff went on to state specifically that it would be mere speculation to provide an opinion as to the specific amount of permanent partial disability that the employee sustained. He states:
Q. It would be mere speculation to provide an opinion as to the specific amount of permanent partial disability. You can only give a minimum?
A. Yes. I couldn't tell you in his particular case what it would have been.
(Ex. O, p. 9).
With respect to Dr. Paff's findings as to permanency, Dr. Paff admits that his ratings could have been higher and possibly lower (Claimant's Ex. O, p. 28 - 29). He opined that, assuming the employee intended to seek no more treatment for his work injuries, then the minimum disability would be 15 percent to the left wrist at the 175 -week level and 20 percent to the left shoulder at the 232 -week level, with a 10 percent loading factor to the body as a whole as a result of all of the injuries, including the right knee. Dr. Paff said he was rendering his opinion within a reasonable degree of medical certainty.