Based upon the competent and substantial evidence, I find:
Claimant is a 56 year old man who did not complete high school. During the eleventh grade he dropped out of school and began working for his father in the construction business.
He worked as a machinist for Emerson Electric in the early 1980s. Starting in the 1980s, he began working as a truck driver hauling equipment, and has worked in that job ever since.
During his youth, Claimant performed auto work with his father. In the early 1980s, he opened his own body shop. This business lasted only a few months, because there was not enough work. Claimant maintained a great passion and hobby for working on cars. He has purchased, built, and repaired multiple cars including some rare or classic automobiles.
Claimant sustained injuries to his right knee in the early 1980s and to his right elbow in the early 1990s. Claimant testified he underwent surgeries for both, but stated he has no ongoing complaints regarding either his right knee or right elbow.
Claimant had several heart attacks. In 1996, he underwent a coronary angioplasty for treatment of an inferior myocardial infarction. He was hospitalized again in 2002 for acute inferior wall myocardial infarction. He underwent surgery for placement of aortic stents and regularly takes heart medications. Claimant testified that since his heart attacks he has been on daily medication. Claimant testified leading up to March 20, 2001, his heart attacks did not affect his work performance in any way, it just slowed him down a little bit.
On March 20, 2001, while working for Employer, Claimant picked up an air compressor. While twisting hoses from the compressor he felt a pop in his low back. He reported the injury to Employer, and was referred to BJC Corporate Health the next day for evaluation and treatment. The initial diagnosis was lumbar strain and right mild trapezius strain. After a couple of weeks of physical therapy, Claimant underwent an MRI of his lumbar spine on April 9, 2001. The MRI revealed disc dessication and a loss in height at the L5-S1 levels and subligamentous disc bulge at L5-S1. Claimant was referred to Dr. Sandra Tate for further evaluation.
Dr. Tate recommended additional physical therapy and epidural steroid injections, and continued Claimant's Vicodin prescription. Dr. Tate initially discharged Claimant from treatment on June 5, 2001. Claimant returned to Dr. Tate on July 23, 2001, because the pain in his left lower lumbar region had returned. Claimant underwent trigger point injections but experienced minimal resolution. On August 27, 2001, Dr. Tate referred Claimant for a surgical consultation.
Claimant was referred to Dr. Philip George on September 11, 2001, who recommended ongoing conservative treatment. Claimant was instructed to perform home therapy, to quit smoking and lose weight, and Dr. George prescribed Vicodin for pain management. Another MRI was performed on March 1, 2002, which was essentially unchanged. On June 12, 2002, Dr. George noted Claimant failed conservative treatment and stated Claimant could either seek another line of work or consider lumbar spine surgery.
Claimant was referred to Dr Robert Bernardi on April 10, 2002 for a second opinion. Dr. Bernardi concluded ongoing conservative measures would not likely benefit Claimant and recommended Claimant consider an anterior fusion at L5-S1. Dr. Bernardi stated Claimant would need to decide whether his current pain had persisted long enough and adversely affected his daily activities that he would be willing to accept the risks of surgery. Dr. Bernardi told Claimant he would need to quit smoking before surgery.
Claimant continued to receive prescriptions for Vicodin from Dr. George, and was referred by Employer to Dr. David Kennedy on June 20, 2002. Dr. Kennedy found Claimant's studies showed a fairly large significant disc abnormality at L5-S1 and pain which was substantially caused by his injury. Dr. Kennedy concurred with Dr. Bernardi and recommended surgery. Dr. Kennedy advised Claimant to stop smoking. On April 18, 2003, Dr. Kennedy and Dr. Robson performed a bilateral lumbar laminectomy from L4 to S1 with a posterior fusion utilizing cages, pedicle screw fixation and an iliac crest bone graft. Following his surgery, Claimant underwent physical therapy and pain management including trigger point injections.
After surgery, Claimant testified he was feeling pretty good. He received physical therapy and the notes showed he was improving. The physical therapy records reflect Claimant was able to work on cars, go to auto shows and do social activities. They reveal Claimant removed a dashboard from a car, played pool for three hours, attended a family reunion, was doing yard work, and took a vacation to Florida.
Dr. Mishkin performed an IME on behalf of Employer on October 29, 2003. Dr. Mishkin found Claimant to be at MMI, and found Claimant's subjective complaints did not correlate with his lack of objective findings. Dr. Mishkin opined Claimant was employable, and could perform occupational duties that did not involve lifting more than 10 pounds, and allowed him to sit, stand and/or walk intermittently as desired. Dr. Mishkin did not find Claimant's incident of March 20, 2001 caused his physical findings. Employer also referred Claimant to Dr. Yadava for another IME on January 29, 2004. Dr. Yadava recommended work hardening, followed by a Functional Capacity Evaluation.
On May 11, 2004, Dr. Kennedy released Claimant to full duty without restrictions. Dr. Kennedy found Claimant to be at maximum medical improvement on May 25, 2004. Employer discontinued TTD benefits on May 25, 2004. Claimant returned to full duty work on June 21, 2004. By the time he returned to full duty, Claimant's employment with Employer was taken over by NES Equipment Services, Inc. AIG Domestic Claims represented the third party administrator for Insurance Co. of the State of Pen