Claimant was married to Employee on May 30, 2002, when he sustained a work related injury. On that date Claimant came home complaining of severe back pain. He complained of pain in his lower back, and pain going down his leg. His symptoms became more severe over time, and continued leading up to surgery which was performed by Dr. Piper in April, 2003.
After his back surgery, Employee was uncomfortable, had problems sleeping, and was unable to work around the house. He was not allowed to lift. He was unable to sit for long, and lied down throughout the day. After his surgery, Employee's back complaints lessened, but he took pain medications. If he missed a dose it would take him half of the next day to catch up with the pain. Claimant had to help Employee tie his shoes and wash his hair. Employee never returned to work after his back surgery. Claimant testified Employee improved following
surgery. Claimant also testified Employee did not have treatment for low back pain, and did not miss time from work for back pain before May 30, 2002.
The medical records reflect Employee was moving 200 pound steel doors in May, 2002, when he began to experience low back pain radiating down his right leg. Dr. Pearson diagnosed acute low back pain with right lower radicular component on June 3, 2002. He prescribed medication and physical therapy, and put Employee on light duty. An MRI of the lumbar spine performed on June 27, 2002, showed degenerative changes with minimal annular disc bulge at L2-3, L3-4, and L4-5, with minimal annular disc bulge at L1-2 and small disc protrusion at L5S1.
Dr. Raskas examined Employee on July 10, 2002, and diagnosed mechanical low back pain. Additional physical therapy and light duty were recommended. Following physical therapy, Employee was sent to work hardening. When Employee did not improve, facet blocks were performed by Dr. Gresick, followed by aquatic therapy. On October 30, 2002, Dr. Raskas found Employee to be at maximum medical improvement and released him to full duty. He rated 3\% PPD of the spine secondary to lumbar sprain which caused facet syndrome. At that point, Employer terminated authorized treatment, and Employee sought additional medical treatment on his own.
A second MRI of the lumbar spine performed on November 27, 2002, revealed degenerative changes with facet arthropathy and multiple level disc bulges without spinal canal stenosis or neural foraminal narrowing. Epidural steroid injections were administered. Discography and a post discogram CT were performed, and revealed a radial tear of the annulus at L5-S1.
Dr. John Wagner, a board certified orthopedic surgeon examined Employee on March 31, 2003. Dr. Wagner diagnosed degenerative disc disease at L5-S1 with a back sprain. Dr. Wagner opined Claimant's low back pain was the result of a sprain injury occurring in May 2002, and he felt no surgery should be considered until after Employee had been worked up for a possible central nervous system problem. Dr. Wagner felt that operating on Employee would be fraught with problems.
On April 9, 2003, Dr. Piper performed an anterior and posterior discectomy at L5-S1, anterior lumbar interbody fusion at L5-S1 with allograft and autograft with instrumentation. Post operatively, Employee underwent aquatic therapy.
In July, 2003, Employee underwent a cervical fusion, which is unrelated to his work injury of May 30, 2002. Following his cervical fusion, Employee was diagnosed with Amyotrophic Lateral Sclerosis ("ALS"), and died in 2006.
In April 2008, Dr. Wagner prepared a report for Employer. He reviewed the medical treatment records related to the lumbar fusion performed by Dr. Piper, as well as treatment records related to Employee's ALS. Dr. Wagner noted that the ALS was not diagnosed until after the lumbar fusion was performed. He stated that had the ALS been diagnosed before the fusion, perhaps surgery would not have been recommended due to the mortality rate of ALS.
Dr. Wagner testified Employee's ALS is not related at all to his lumbar or cervical problems, nor did it cause his lumbar or cervical problems. The lumbar and cervical problems, and the ALS, are completely independent, and have no relationship at all to each other. Dr. Wagner rated Employee's disability at 10\% PPD of the body as a whole at the lumbar spine, with 5 % preexisting, and 5 % due to the sprain injury of May, 2002.
Dr. Wagner testified it was not unreasonable or unnecessary for Dr. Piper to have performed the lumbar fusion on Employee, although Dr. Wagner thought the patient should have been treated more conservatively, and should have been evaluated for his other problems.
Dr. Volarich examined Employee on December 8, 2004. Dr. Volarich diagnosed lumbar syndrome secondary to internal disc derangement syndrome at L5-S1 with annular tear and aggravation of degenerative disc disease and bulging at L2-3, L3-4, and L4-5 without radiculopathy, as a result of the work related injury of May 30, 2002. Dr. Volarich opined the work injury of May 30, 2002 was the substantial contributing factor causing the internal disc disruption syndrome at L5-S1 that required anterior and posterior fusions with instrumentation. He further indicated the injury also aggravated the degenerative disc disease and bulges at L2 through L5. Dr. Volarich rated 45 % PPD of the body as a whole at the limbosacral spine due to the internal disc disruption syndrome at L5-S1 that required the fusion.