Claimant offered a medical deposition and numerous medical reports and records into evidence. Claimant's Exhibit K was the deposition testimony of P. Brent Koprivica, M.D. Dr. Koprivica testified that he received his M.D. degree in 1980 and that he had practiced occupational medicine since 1992.
Dr. Koprivica testified that he examined Claimant on March 31, 2009. He stated that the examination took approximately four hours and 45 minutes. He stated that he spent an additional hour reviewing her records and writing his report.
Dr. Koprivica testified that Claimant provided a history of injuring her neck and upper back at work on December 13, 2006 when she allegedly tripped on some empty cubes and foam on the floor. He noted that Claimant's medical records showed that Dr. Reintjes had evaluated Claimant for her neck complaints and suggested non-operative management. He noted that the MRI of Claimant's cervical spine showed stenosis and other degenerative changes.
Dr. Koprivica also testified that Claimant provided a history of injuring her left shoulder at work on June 5, 2006 when she awkwardly lifted a box and felt a pop in her left shoulder. That history differed from her testimony at the hearing where she alleged that she placed a box on a conveyor belt where it was caught and jerked her shoulder.
In addition, Dr. Koprivica noted Claimant's injuries and impairments which preexisted her alleged June and December 2006 injuries at work. He stated that only two of her preexisting injuries or impairments, a low back condition and her DVT problems, had resulted in any
permanent partial disability and which were also an obstacle or hindrance to her employment or reemployment. ${ }^{1}$
Dr. Koprivica testified that Claimant's preexisting low back impairment had resulted in a permanent partial disability of 15 percent to the body as a whole. He stated that her preexisting DVT problem had resulted in a permanent partial disability of 25 percent of the left lower extremity at the 207 week level. He stated that he rated her injuries from the June 2006 accident at 50 percent of the left upper extremity at the 232 week level. Claimant, however, settled her case against her employer involving the left upper extremity injuries on January 5, 2010, based on a permanent partial disability of 35 percent at the 232 week level. See Claimant's Exhibit B.
Dr. Koprivica testified that he rated Claimant's neck injury from the alleged December 2006 accident at 15 percent to the body as a whole. Claimant settled her case against her employer involving the alleged neck injury on January 5, 2010, based on a permanent partial disability of 12.5 percent to the body as a whole. See Claimant's Exhibit O.
Dr. Koprivica also testified that on examination Claimant had a reduced range of motion of her cervical spine. He admitted that she had spondylosis of the cervical spine or a degenerative process. He admitted that she had stenosis or narrowing of the spinal canal, a degenerative condition. He stated, however, that she did not have disabling symptoms prior to the December 2006 accident. He stated that her neck was asymptomatic prior to December 2006. He diagnosed her injury from the alleged December accident as a sprain or strain to her cervical spine. He stated that the sprain or strain led to an increase in the preexisting narrowing of her cervical spine, traumatized her ligaments and caused a greater bulging of the already degenerated disks.
The evidence showed that Dr. Koprivica may not have read the numerous medical records Claimant offered into evidence. Claimant's medical records showed that on April 29, 2002 she complained to her family doctor at the Seaport Family Practice Clinic that she had neck pain that was getting worse. That contradicted Dr. Koprivica's conclusion that Claimant's neck was asymptomatic prior to the alleged December 2006 accident. It contradicted his conclusion that Claimant did not have disabling symptoms prior to the alleged December 2006 accident.
Claimant also complained in April 2002 that her neck pain was made worse by just standing. She complained in 2002 that her neck pain was made worse by looking in a downward direction. She complained that her neck pain was made worse by any type of jarring motion. Claimant clearly had degenerative problems in her cervical spine prior to December 2006 and, contrary to Dr. Koprivica's assertion, her neck was symptomatic prior to December 2006.
In addition to the evidence referred to above which contradicted his opinion, Dr. Koprivica also admitted that he believed that there were psychological issues involved in
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[^0]: ${ }^{1}$ The statute provides that the Second Injury Fund is only liable for benefits if the preexisting impairments result in permanent partial disability and if the preexisting impairments are a hindrance or obstacle to the employee's employment or reemployment. See § 287.220 RSMo. 2005.
Claimant's presentation. He stated that Claimant came to tears during the interview. He stated that she was "very tremulous" during the examination, which he attributed to anxiety. He did state that he believed that Claimant was genuine in her presentation and that her scores on the Waddell's testing were appropriate.
Finally, Dr. Koprivica testified that none of Claimant's four "significant" impairments, the neck strain from the alleged December 2006 accident, the left upper extremity injury from the June 2006 accident, the preexisting low back impairment and the preexisting DVT problem in isolation were sufficient to render Claimant permanently and totally disabled.
When asked whether Claimant was rendered permanently and totally disabled due to the combined effect of the disability Claimant sustained as a result of what he termed the four "significant" impairments, Dr. Koprivica refused to answer the question. Dr. Koprivica admitted that he had answered questions in other cases about whether a person was permanently and totally disabled. He stated that in Claimant's case he was going to defer to a vocational expert to answer the question.
Claimant's Exhibit A contained the records of Erich J. Lingenfelter, M.D. of Northland Bone \& Joint Orthopedic Surgery. Dr. Lingenfelter noted on September 12, 2007 that Claimant was now complaining of chronic cervical trapezius and scapular pain. He noted that he had performed a rotator cuff repair on Claimant in February 2007. He stated that Claimant's pain was "way out of proportion to what I would expect with rotator cuff pathology." He stated that "I think there are other issues that need to be addressed."
On August 10, 2007, Dr. Lingenfelter, in a letter to Patrick Griffith, M.D. of a pain management clinic, noted that Claimant complained of pain with neck rotation and lateral bending. He stated that her CT scan did not show any "concerning" findings. He stated that on examination, Claimant's complaints seemed out of proportion to what he would expect for someone even with severe scapular bursitis and scapular dyskinesis. He stated that Claimant's shoulder pain had essentially resolved since her surgery. He stated that he did not believe that Claimant's neck complaints were related to her shoulder surgery.
On June 8, 2007, Dr. Lingenfelter noted that Claimant was complaining of chronic neck, posterior scapular and thoracic-cervical pain. He stated that I do not think "this" is related to her shoulder. He stated that "she keeps relating this back to an injury." He stated that he believed it was reasonable to proceed with a trigger point injection as well as possible cervical epidurals.
On February 4, 2009, Dr. Lingenfelter noted that Claimant's complaints of pain were out of proportion to the findings from his examination of her. He stated that she complained of almost hypersensitivity. He stated that although she complained of problems in raising her left shoulder, when he passively performed range of motion exercises on her shoulder, she had a full functional range of motion of her left shoulder and equal to that of her right shoulder.
Dr. Lingenfelter concluded that no further intervention was needed. He stated that Claimant had a healed rotator cuff. He stated that her pain was way out of proportion to the
small tear she had in her shoulder. He stated that nothing on the examination suggested that her cuff had re-ruptured. He stated that Claimant had a significant amount of kyphosis (curvature) in her spine and that her body habitus could definitely be contributing to her complaints. He stated that he had no treatment recommendations for Claimant.
Claimant's Exhibit B contained the records of Stephen Reintjes, M.D. of the Kansas City Neurosurgery Group, LLC. In September 2008, Dr. Reintjes noted that a bone scan showed a significant uptake in Claimant's left AC joint consistent with degenerative changes. He also stated that there was an uptake associated with Claimant's feet and knees, greater on the left than the right. Dr. Reintjes indicated that although Claimant complained of neck pain, "I think that her primary complaints of pain and restriction of motion are related to her left shoulder. Coincidentally, she has some foraminal stenosis which is degenerative in nature at C6-7 on the left." He did not recommend any specific treatment other than weight loss.
Subsequently, Dr. Reintjes stated that Claimant continued to complain of pain, numbness and tingling across her left shoulder blade and around the left scapula and chronic neck pain. He stated that Claimant's continuing left shoulder problems were due to degenerative changes. He stated that radiographic studies of her cervical spine showed foraminal stenosis (narrowing) on the left at C6-7. He stated that he would not consider her a surgical candidate for the foraminal stenosis due to her size and body habitus. He did not even mention her alleged neck strain from the alleged December 2006 accident as a cause for any need for surgery, or any other treatment.
Dr. Reintjes stated that Claimant was not having a true C7 radicular pain, numbness or tingling. He stated that he would reassess her radicular complaints after her weight loss. In his June 2008 notes, Dr. Reintjes noted that although Claimant complained of injuring her neck in a fall at work in December 2006, that she did not "hit her neck or her low back" in the accident. He stated that she complained that her neck felt stiff and sore the day after the alleged incident at work. He stated that she stood 5 foot 4 inches tall and weighed 285 pounds.
Claimant's Exhibit C contained physical therapy records. Exhibit D contained Claimant's records from Northland Family Care. On November 8, 2006 Claimant complained of left leg pain. On May 17, 2006 she complained of ankle and heel pain.
On February 17, 2006 Claimant complained of left shoulder and calf pain. Dr. Roney's diagnosis was left shoulder pain with an impingement syndrome. He indicated that an orthopedic consultation might be necessary. He noted that Claimant had indicated that her shoulder was better since she resumed the use of Celebrex. That was less than four months prior to the alleged June 2006 left shoulder injury at work where one of the diagnoses was impingement syndrome.
There were several notations in the records from 2005 showing that Claimant complained of left knee pain. There were records showing that she had a Baker's cyst and right middle finger trigger pain. In November 2004, Claimant complained of ankle pain, hand numbness and dizziness. Her doctor noted that findings were suggestive of carpal tunnel syndrome.
In September 2004 Claimant complained of dizziness. In May 2004 she complained of persistent low back pain. She complained of excessive perspiration. She complained of a sharp shooting pain into her right hip and buttock area. In April 2004 she complained of back and left hip pain. In January 2004 she complained of heart palpitations. It was noted that she had a tremor. She complained of hand numbness. She alleged that her job had aggravated her hand problems and numbness.
There were numerous notations where Claimant was complaining of colds and flu-type symptoms. She complained of ingrown toenails. She complained of discoloration of her toenail.
On May 6, 2003 Claimant had a lesion removed from her shoulder. In March 2003 she complained of back pain. In November 2002 she complained of Bell's palsy and facial pain. She was taking Percocet and Neurontin. In August 2002 Claimant complained of back pain and wrist tendonitis. An MRI showed a broad base disk bulge slightly symmetric to the left. In April and July 2002 Claimant complained of back pain.
Claimant's medical records also contained 2006 and later notations. A June 2007 imaging of her lumbar spine showed mild degenerative spurring at L4-L5. A January 2007 MRI of her left shoulder showed a small rotator cuff tear. She also had a mild impingement. A December 20, 2006 CT scan in three views of her cervical spine showed no acute abnormalities.
On December 16, 2007, Claimant saw Dr. Roney, her family physician with complaints of cold type symptoms. She did not mention any neck pain. The alleged injury at work allegedly occurred three days earlier. On September 24, 2007 she saw Dr. Roney for upper respiratory complaints. She told Dr. Roney at that that she had injured her left $5^{\text {th }}$ finger in a fall a week earlier.
On January 3, 2007 Claimant saw Dr. Pritchett. She described an injury at work a few weeks earlier. He diagnosed an acute myofaccial strain based on the history she provided to him. He offered no test results or any evidence to support the diagnosis other than Claimant's subjective complaints.
Claimant's records from Seaport Family Practice showed that on April 29, 2002, she complained of back pain, toenail discoloration and pain in her neck and upper and mid back. She told the doctor that she noticed the pain when she looked in a downward direction. She told the doctor that her neck was becoming increasingly painful by just standing. She told the doctor that her neck pain was made worse by any kind of jarring-type motion such as riding in a vehicle when it rolled over a bump in the road.
Claimant's Exhibit E also contained medical records. The records noted that she had significant osteoarthritis. She had knee surgery in 2008. She complained of ankle pain and right foot pain. Of note was that on September 6, 2006, prior to the alleged December 2006 accident at work, Claimant complained of right hip pain of several months duration increased with lying on her hip. Also of note was that in 1999 Claimant had a right rotator cuff repair.
Claimant's Exhibit I contained records showing that she had a right carpal tunnel release in January 2005. Exhibit P contained her Hallmark personnel records. The records were primarily medical and they were cumulative and duplicative of the other medical records.