The deposition of P. Brent Koprivica taken on April 30, 2009 was admitted in evidence as Exhibit H, with his report dated April 26, 2008 addressed to Claimant's attorney, his March 8, 2009 addendum report, and his Curriculum Vitae. Dr. Koprivica is a licensed Medical Doctor in Missouri and Kansas. He is Board Certified in Emergency Medicine and is Board Certified by the American Board of Preventative Medicine and Occupational Medicine.
Dr. Koprivica's April 26, 2008 report notes he reviewed copies of Claimant's claims for compensation, medical records, deposition of Claimant, and worker's compensation records identified in his report. He identified Claimant's educational and vocational history. His report discusses preexisting medical treatment and worker's compensation settlements that are consistent with the treatment records and worker's compensation settlement documents in evidence. He notes her left-sided L4-L5 disk herniation in 1984, and hemilaminectomy and discectomy done at that level. He notes she received a 15 % permanent partial disability to the body as a whole.
Dr. Koprivica's April 26, 2008 report notes Claimant's injury to the lumbar spine on January 1, 1986 with left L4-L5 hemilamnectomy, lysis of adhesions and recurrent discectomy surgery on May 5, 1986. He notes a second settlement of 15 % permanent partial disability to the body as a whole. He notes Claimant's arthroscopic partial lateral menisectomy and patellar chondroplasty for chondromalacia on February 23, 1995. He notes that Claimant had injections for left knee pain and left shoulder pain in 2003 and 2004. He notes Claimant's complaints in the right knee and left shoulder.
Dr. Koprivica's April 26, 2008 report identifies an injury to Claimant's back on August 2005 when she developed numbness and pain down her left leg while pulling a pallet jack to move a skid load of bottles of water. His report identifies persistent complaints of left shoulder problems up until August 16, 2005 and ongoing. He notes an MRI scan of the left shoulder on October 25, 2005 was consistent with impingement, and an MRI scan of lumbar spine of February 20, 2006 revealed a very large recurrent leftsided disk herniation of L4-L5.
Dr. Koprivica's April 26, 2008 report notes Dr. Smith performed surgery on the left shoulder on February 23, 2006, and that a degenerative tear of the glenoid labrum was debrided, the acromioclavicular joint was resected, and a partial rotator cuff tear with impingement was treated with decompression. He notes that Dr. Olson performed an L4L5 decompressive laminectomy and instrumented fusion from L4 to S1 on May 11, 2006. He notes Claimant's last date of work was May 9, 2006. He notes that Dr. Olson released Claimant on July 26, 2006.
Dr. Koprivica notes Claimant's loss of strength and motion in her left shoulder. He notes problems with the low back, including postural limitations, limited sitting tolerance, limited standing tolerance, and limited walking tolerance. He notes ongoing pain in the left buttocks area.
Dr. Koprivica performed a physical examination of Claimant. He notes Waddell's testing was negative for symptom magnification. He notes severe degenerative arthritis involving both hands. He notes significant pain in left shoulder and limitation of motion.
He notes very severe pain in the back with motion testing. He notes limited motion of the back.
Dr. Koprivica expressed several conclusions based on a reasonable degree of medical certainty. His report notes that prior to August 1, 2005, Claimant had significant preexistent industrial disability. He notes she had hindrance vocationally from her low back that would be a significant obstacle to reemployment. He notes her need to avoid constant bending at the waist, pushing, pulling, or twisting types of tasks, and she had limits in how much she could lift. He adopted the cumulative total of 30 % permanent partial disability to the body as a whole for the lumbar condition as existed prior to August 1, 2005.
Dr. Koprivica also described preexisting industrial disability to the left knee, and assigned a 20 % permanent partial disability of the left lower extremity at the level of the knee. His report also notes Claimant had MRI evidence of microfractures involving the right knee and patella femoral chondromalacia and degenerative involvement of the right knee, and assigned a 15 % permanent partial disability to the right lower extremity at the level of the knee. He restricted Claimant from extensive squatting, crawling, kneeling or climbing types of tasks.
Dr. Koprivica's report states that related to the primary injury to the low back, August 1, 2005 is the appropriate date for that injury. He states Claimant sustained repetitive injury up through August 1, 2005. His report further states:
At that point, with the onset of the left radicular symptoms and the subsequent identification of the large left-sided disk herniation on MRI scan of the lumbar spine on February 20, 2006, I believe that pathology was present as of August 1, 2005.
I would consider Ms. Moorman's workplace activities to be 'a' substantial factor resulting in progressive injuries as she worked up through August 2005, with the development of the identified leftsided disk herniation.
Dr. Koprivica's report notes he considered Claimant to be at maximum medical improvement in reference to the back injury. He notes Claimant's decompression and fusion and states that Claimant's workplace activities were "a" substantial factor necessitating the decompression and two-level fusion that had been performed. His report states that for Claimant's permanent injury of August 1, 2005, in isolation, he assigned a 25 % permanent partial disability to the body as a whole. He further states in paragraph 6 and 7 of his report on page 18:
- Following the work injury date of August 1, 2005, Ms. Moorman had an increase in restrictions based on her lumbar condition. I would point out that the prior industrial disability in the lumbar region contributes to the severity of the restrictions at this point.
Ms. Moorman should be allowed postural considerations. I would recommend captive sitting intervals of less than one hour with the flexibility of changing whenever necessary. Standing intervals should be limited to less than one hour with the flexibility of sitting more often as needed. Walking should be limited to less than thirty minute intervals with the flexibility of sitting whenever necessary.
Ms. Moorman would be restricted from lifting from floor level at this point.
I would recommend that Ms. Moorman limit physical demand activities to sedentary physical demand.
Ms. Moorman should avoid frequent or constant bending at the waist, pushing, pulling or twisting. She should avoid sustained or awkward postures of the lumbar spine as well.
- Realizing that there is an injury date subsequent to this of August 16, 2005, in reference to the left shoulder, I would consider a 10 percent enhancement factor to represent the synergism from combining the permanent partial disabilities I have outlined that predated August 1, 2005, with the additional permanent partial disability attributable to the August 1, 2005, injury date.
Dr. Koprivica's report further states that he did not believe the August 1, 2005 injury was totally disabling considered in isolation, in and of itself.
Dr. Koprivica's report also states, regarding Claimant's upper extremity:
- Ms. Moorman's upper extremity use activities represents an exposure to risk in terms of her shoulder which was unique to that employment. Ms. Moorman was doing heavy lifting, pulling and pushing types of tasks through her employment. She did not do those activities away from work. The general population is not exposed to that extent of risk.
I would consider Ms. Moorman's work place activities to represent ' a ' substantial factor in the development of the identified partial rotator cuff tear, chronic impingement syndrome, chronic acromioclavicular arthralgia based on degenerative disease and the labral tear that was identified and has been treated surgically.
- I would consider Ms. Moorman to be at maximal medical improvement in reference to the August 16, 2005, work injury claim date.
Dr. Koprivica's April 26, 2008 report further states that Claimant's permanent partial disability involving the left shoulder associated with August 16, 2005 injury "is not totally disabling considered in isolation." The report notes that in terms of disability, for the primary injury date of August 16, 2005, he would assign a 25 % permanent partial disability of the left upper extremity at the level of the shoulder ( 232 week level) in isolation.
Paragraph 11 of his report sets forth his restrictions as follows:
- In reference to the additional permanent partial disability associated with the impairment of the left shoulder, I would restrict Ms. Moorman from any weighted activities above shoulder girdle level on the left. She should avoid sustained or repetitive tasks above shoulder girdle level. She should do no types of climbing tasks. I would recommend she avoid repetitive reaching or pushing/pulling tasks with the left upper extremity at the shoulder level.
Dr. Koprivica's report also states:
- When one combines all of the permanent partial disabilities that pre-dated August 16, 2005, with the additional disability attributable to the primary injury of August 16, 2005, significant enhancement of the combined disabilities arises above the simple arithmetic sum of the separate disabilities.
Dr. Koprivica also states that the medical care and treatment which Claimant received for her low back following August 1, 2005 was medically reasonable and a direct necessity of the repetitive injury she sustained from employment at Employer associated with the August 1, 2005 claim injury date. The report also states that the medical care and treatment which she received for her left shoulder was medically reasonable and a direct necessity of the repetitive injuries she sustained from her employment activities with Employer through August 16, 2005.
Dr. Koprivica's report further states: "I would recommend a formal vocational evaluation. However, it would be my opinion that it is probable that Ms. Moorman is permanently totally disabled."
Dr. Koprivica's March 8, 2009 addendum report notes that he had reviewed Dr. Prostic's report of December 1, 2008. Dr. Koprivica states that review of Dr. Prostic's report would not materially change any of his opinions or conclusions.
Dr. Koprivica testified regarding portions of his April 26, 2008 report. His testimony was generally consistent with his report. He testified that Claimant would have an expected ongoing need to take Lortab, and would need to be able to see a doctor for monitoring for pain purposes, and she would need some medication to cure and relieve her of the effects of either the back or left shoulder work-related injuries.
On cross-examination, Dr. Koprivica stated he could not answer specifically which of the conditions she was taking Lortab for. He did not attribute the disk herniation to a specific event in August 2005. He thought it was repetitive. He stated his restrictions for her back incorporated her overall lumbar condition.
Dr. Koprivica testified on cross examination that he agreed that Claimant had a great deal of degenerative change and arthritis in multiple joints in her body. He thought that Claimant's disk herniation was repetitive. He did not attribute it to a specific event in August 2005. He thought the onset of the radicular symptoms was August 1, 2005. He thought that was when she reported it. He acknowledged that her most recent stint of treatment started in October 2005 with Dr. Ahmad.
Dr. Koprivica was asked the following question and gave the following answer:
Q. (By Ms. Shine) If she is not - if she did not have to lie down during the day before August 1 of '05 but now she has to because of back pain, isn't the need to lie down attributable directly to the August 1, '05, injury, back injury?
A. And I - I don't know how that's interpreted legally. I - as an analogy, if - if the need to lay down structurally is like a rag being torn in two, you have to have the rag completely torn in two to have that need. The rag wasn't torn in two prior to August of 2005, but it was partially torn. This last - the last contribution tore it in two. And what I was saying earlier is that the fact that it's torn in two considers the contribution to the tear that occurred back in ' 84 and ' 86 , but that need to lay down didn't follow until after this last injury. And if the tearing of the rag is 50 percent due to this
event, that alone would not necessarily necessitate the need to lie down. It's the structural change where the rag is completely torn in two.
Now, factually, it is true. She wasn't laying down during the day as she is now prior to the - the last work injury claim. And how that gets interpreted, you know, I don't - legally, I'm not sure, but that's - but that's - that's how I would view it structurally, is that the severity of her situation incorporates what happened in ' 84 and ' 86 .
Dr. Koprivica also testified that the consequences of the back injury up through August 1, 2005 would not have been as extensive as they were had she not had the two prior injuries and surgeries. He also testified he did not issue a medical restriction that Claimant had to lie down unpredictably during the day in his report to Claimant's attorney.
Dr. Koprivica was also asked the following questions and gave the following answers:
Q. And if I understood your - your testimony, it was that this injury in isolation wouldn't result in the need to lie down, but because she had a history of multiple surgeries to the back in the past and continuing problems that all those things put together would result in the need to lie down?
MS. SHINE: I'm going to object to that. That misstates the evidence, and I don't believe that's what Dr. Koprivica actually testified to.
Q. (By. Ms. Moser) Is that fair to say, Dr. Koprivica?
A. That's what I was attempting to say. I thought it was a cumulative - accumulation of the structural changes that would be associated with all three of the back surgeries. And predicting that - the need to lie down from this injury alone, in isolation, I don't know that I could do that.
Dr. Koprivica was asked about a temporary total disability period following Claimant's back surgery in May 2006 and when she was at maximum medical improvement. He noted Dr. Olson released her from care on July 26, 2006, and stated she was at MMI that day based on the treatment records. He also stated he did not know at what point in her treatment Employer could have accommodated her restrictions "had she not voluntarily resigned her employment."
Dr. Prostic's deposition taken in this case on March 13, 2009 was admitted as Exhibit G with Prostic Deposition 1, his Curriculum Vitae, and Prostic Deposition 2, his December 1, 2008 medical report addressed to Claimant's attorney. Dr. Prostic is a Medical Doctor licensed in Missouri and Kansas. He is a Diplomat of the National Board of Medical Examiners, a Fellow of the American Academy of Orthopedic Surgeons, and a member of the American Board of Orthopedic Surgeons.
Dr. Prostic's December 1, 2008 medical report pertaining to Claimant recites Claimant's history of her injuries on August 1, 2005 to her back and August 16, 2005 to her left shoulder. He identified the records he reviewed, which include records of Dr. Smith, Open MRI of St. Joseph, Dr. Ahmad, Heartland Health, Dr. Olson, and Dr. Koprivica. His report discusses Claimant's course of treatment, her complaints, including pain in her left lower back, left shoulder, and numbness and tingling going down the ring and little finger since her traumatic fall in May 2008 with injury to her neck, and her past medical history. The results of Dr. Prostic's examination and interpretations of left shoulder and lumbar spine x-rays are noted.
Dr. Prostic's report contains the following comments:
On or about August 1, 2005 and August 16, 2005, Donna L. Moorman sustained injuries during the course of her employment. She has been operated for subacromial decompression, excision of the lateral clavicle, and rotator cuff repair. By physical examination, she has recurrent tear of her supraspinatus. If she desires more treatment to the left shoulder, she should have repeat MRI or arthrogram and consideration of additional surgery. She has had excellent decompression and stabilization L4 to the sacrum. Additional treatment to the low back other than therapeutic exercises is not likely to be beneficial. Presently, she is unable to do any activity with the left hand above shoulder level or that requires forceful pushing or pulling or more than mild reaching left handed. She also should not frequently bend or twist at the waist or do activities below knee level. She needs to be able to change position for comfort. When combining all of the work restrictions, she seems fit only for predominately right handed predominantly sedentary activity. Based upon her education, training, and experience, she appears to be permanently and totally disabled from gainful employment. Permanent partial impairment is rated at 25 % of the left upper extremity for the shoulder and new impairment of 20 % of the body as a whole for the lumbar spine.
Dr. Prostic's report notes his opinions were reached within reasonable medical certainty.
Dr. Prostic testified that Claimant gave him a history of injury to her low back on or about August 1, 2005. She also described ongoing warehouse type duties loading things onto a cart, or moving boxes and containers of things essentially rotating with a load throughout the day. He said both of those were contributing factors to the condition that resulted in her low back and which resulted in surgery in 2006. He said the surgery of Dr. Olson, the fusion, was reasonably necessary to cure and relieve the effects of the back injury of August 1, 2005.
Claimant also described an injury to her left shoulder on or about August 16, 2005. He testified that Claimant's work activities of reaching and pulling for the materials and "again loading and doing warehouse type loading and unloading of containers and moving those containers through various stages of the warehouse in the shipping process" were a substantial factor in causing the injury to her left shoulder. He testified the surgery by Dr. Smith, the arthroscopic subacromial decompression and debridement of the rotator cuff and the resection of the lateral clavicle, were reasonably necessary to cure and relieve the effects of that injury to the left shoulder. He testified the work activities were a substantial factor in causing the need for that treatment and the injury to her left shoulder. He testified regarding his physical examination of Claimant. His testimony was consistent with his report. He noted in part that Claimant's shoulder examination "was suspicious for full thickness tearing of the rotator cuff."
Dr. Prostic defined spondylolisthesis as "a forward slippage of the upper spine through L4 and L5 in the sacrum." He did not think that was the source of Claimant's continuing pain. He said that should have been stabilized by the hardware in her back.
Dr. Prostic recommended that Claimant not be required to do activities with her left hand above shoulder level or that require forceful pushing or pulling or significant reaching left handed as the consequence of the August 16, 2005 injury. He restricted her against lifting weights greater than twenty-five pounds occasionally or ten pounds frequently as a consequence of the August 2005 injury to her low back. He stated that he would "ask her not to do activities below knee level, to minimize activities above shoulder level, to avoid forceful pushing or pulling, to avoid repetitious bending or twisting at the waist or use of vibrating equipment." He also hoped that "she would be in a position where she could change positions as needed for comfort for her low back." He thought she needed to be allowed to change positions every thirty to forty minutes.
Dr. Prostic testified that Claimant had 25\% permanent partial disability of the left upper extremity at the 232 week level by reason of her August 16, 2005 injury considered alone. He also testified that Claimant had 20\% permanent partial disability to the body as a whole for the injury to her low back with a claimed injury date of August 1, 2005 for the cumulative wear and tear on her back and the incident with the pallet jack and bottled water pallet.
Dr. Prostic also testified, "I did ask her at the time I met with her about her work history and based upon the work history that she provided I thought that she was essentially permanently and totally disabled from gainful employment." He restricted her from not doing any of the jobs that she described doing in the past, and that was because of the back injury of 2005 in combination with the shoulder injury. His testimony was stated to have been given to a reasonable degree of medical certainty.
Dr. Prostic testified that Claimant had disability related to her low back that preexisted August 2005.
Dr. Prostic testified on cross examination that the history, as it related to Claimant's injuries, was based on the report that Claimant gave him. He agreed that Dr. Faisal, who ordered an MRI, did not make any admission of any work related injuries that Dr. Prostic recalled. He also testified that Claimant is unable to access the open labor market, that is based on a combination of her physical conditions, and not one single condition in isolation. He did not review medical records regarding injuries prior to August 2005. He did not review Claimant's personnel records. He further testified: "For the problems from her shoulder and her low back she is quite limited in the number of jobs that she could obtain and she is further limited by her age, education, and experience. So practically speaking, I think it's going to be most difficult for her to obtain reasonably gainful employment in the labor market."
Exhibit 1 is the deposition of Dr. Allan Parmet taken on October 9, 2009 with Dr. Parmet's Curriculum Vitae and medical report dated September 2, 2009. Dr. Parmet is a licensed Medical Doctor and is Board Certified by the American Board of Preventive Medicine and Aerospace Medicine and Occupational Medicine. His Curriculum Vitae notes numerous activities, awards, academic appointments, articles and lectures.
Dr. Parmet's September 2, 2009 report addressed to Employer's attorney notes that he performed an independent medical evaluation of Claimant on September 1, 2009. He reviewed medical records of Dr. Koprivica, Dr. Prostic, Dr. C. Daniel Smith, and records of Mary Titterington. His report recites the history of present illness. The report notes that Claimant told him that she had worked the last nineteen years in packaging and labeling at Employer. She stood at a turntable removing bottles as they came off a table. She had a maximum lift requirement of fifty pounds. She reported processing ten to twenty thousand bottles per day. She would take the bottles and put them into a package, box or tub, fill pallets, and pull pallets using a hand jack. She also did paperwork, but did not do over head work. He reported she did continual bending and twisting while standing.
Dr. Parmet's report notes Claimant's low back injury in 1984 with surgery and subsequent surgery two years later. She reported that she thought she had back pains beginning again in 2003. She described those as general aching and low back pain radiating into the buttocks and legs. She reported that she pulled a skid or something and twinged her back in August 2005. The report notes her seeing Dr. Ahmad in October 2005, and a referral to a neurosurgeon, Dr. Olson. She had a posterior fusion in 2006. The report notes that it was about that time when she reported it as a work injury. She was noted to have been released in August 2006 and was told not to return to work. The report notes Claimant complained that her back still hurt and notes her standing limitations.
Dr. Parmet's report also describes Claimant's report of a left shoulder injury that she thought was due to repetitive activities. The report notes she had no specific injury and was not sure of the onset of her symptoms. She had seen Dr. Smith and had shots for several years. She had shoulder surgery by Dr. Smith in February 2006. She was released in March 2006 and returned to work. She reported continued left shoulder pain. She stated it hurt to sleep and she could not lie on her shoulder. He reported restricted range of motion.
Dr. Parmet's report discusses the records he reviewed. The report contains the results of his physical examination of Claimant.
Dr. Parmet's report sets forth the following diagnoses: "1. Degenerative joint disease, lumbar spine, status post-1984 and 1986 surgical procedures resulting in additional degenerative changes and disk herniation status post-2008 posterior lumbar fusion. 2. Degenerative joint disease, left shoulder, with impingement syndrome and partial rotator cuff tear." Dr. Parmet's discussion recites that primary medical records of Drs. Smith, Ahmad and Olson should be obtained and reviewed. He notes that Claimant has been surgically post-menopausal for over twenty years "and has wide spread and multi joint findings of degenerative joint disease compatible with osteoarthritis, a nonoccupational degenerative disease." His report further states:
While she reportedly had an occupational injury in 1984 with recurrence in 1986, it would be anticipated that the same level would progress into degenerative changes over the ensuing 20 years magnified by surgical menopause as well as osteoarthritis. There is no reason to suppose that any occupational event precipitated either her shoulder or back problems. Clearly, these events were not of such an acute nature as to raise the specter of a work-related injury in Ms. Moorman, who delayed the initial evaluation for several months and subsequently reporting them as a work-related injury even longer. This is despite the fact that she had experience and first-hand knowledge with reporting of worker's
compensation injuries. Without objective evidence of a precipitating injury and with obvious degenerative changes, there is no information to support that her current condition is work-related. I will be happy to review the primary medical records when they become available.
Currently, Ms. Moorman has a good surgical response in her left shoulder, which is not quite as good as her right shoulder, but neither shoulder is normal as they both suffer degenerative changes. I would rate her left shoulder disability at 20 % at the 232 -week level and her low back, which had two prior surgeries before the fusion, at 25 % of the body as a whole. I note that she previously had a 30 % permanent partial disability attributable to her low back, but I find that difficult to accept as a degree of disability followed by over 20 years of subsequent employment at the same position of medium labor.
Ms. Moorman can return to the light level of labor but should avoid frequent kneeling, crawling, or overhead work.
Dr. Parmet testified regarding his report. His testimony was generally consistent with his report. He testified that he thought in 2008,47 % of his time doing medical/legal evaluations was for plaintiffs or claimants, 42 % was for defendants, and the remainder was neutral. He also testified that after he initially prepared his report, he reviewed additional treatment records related to Claimant. He also testified that his opinions were to a reasonable degree of medical certainty.
Dr. Parmet testified that Claimant had surgery to remove her ovaries and that disturbs female hormone status and accelerates bone demineralization and bone aging. He testified regarding some of the findings of his examination of Claimant. He noted there were a lot of osteoarthritic changes in Claimant's hands and swelling of the joints and nodes-much more than you would expect for average. He also noted Claimant had a lot of degenerative changes in her lower extremities as well. He testified that the prevalence of osteoarthritis in multiple parts of Claimant's body is degenerative process that takes place over time. He testified that Claimant's ovary removal surgery, which causes surgical menopause, would have accelerated the degenerative process further.
Dr. Parmet was asked the following questions and gave the following answers (pp 16-18):
Q. Doctor, in your medical opinion, to a reasonable degree of medical certainty, what was the substantial contributing factor or factors in Ms. Moorman's low back condition as she presented it to you?
A. Well, first, she had an acute injury back in the early 1980's and had two surgeries at that time. These accelerate the degenerative process that occurs in everybody. She has generalized osteoarthritis. Change - degenerative changes throughout her whole body. Virtually all her joints are involved and she had surgical menopause.
So these together are very synergistic. So you have her genetic background, the surgical changes and time add up to cause accelerated degenerative changes and a collapse of the lumbar spine, degenerative changes of the left shoulder and rotator cuff.
Q. In your opinion, to a reasonable degree of medical certainty, was her work that - was claimed was a work-related injury in this case at Boehringer-Ingelheim, either the substantial contributing factor - a substantial contributing factor or the prevailing factor in the development of her low back condition?
A. I don't believe so.
Q. And how about her shoulder condition?
A. I also don't believe so. At most we might have had a minor contribution, but in general, the work makes you aware of the injury without causing it. It's like you break your leg and then you get up and walk on it. Well, you know, walking doesn't break your leg but it sure makes you aware of it.
Q. Was her work at Boehringer-Ingelheim over time, which is the claimed injury in this case, was that a substantial contributing factor in her need for either the low back surgery or the left shoulder surgery?
A. I don't believe so.
Q. In your medical opinion, Doctor, would her work over time at Boehringer-Ingelheim be the - a substantial contributing factor in the need for any future medical treatment as it related to either her low back or her shoulder - left shoulder?
A. I don't believe so.
Dr. Parmet also testified that he rated her overall back condition at 30 % permanent partial disability to the body as a whole. He also stated he would have rated the prior two surgeries together at 25 % and subsequent surgery an additional 5 %.
Dr. Parmet testified he would limit Claimant to light labor which would be a frequent ten pound lifting or occasional twenty pound lifting. She should avoid crawling, bending and overhead work above the shoulder level.
Dr. Parmet thought Claimant probably would have been a zero on the Waddell test. He did not see any evidence of exaggeration.
Dr. Parmet noted that according to Dr. Olson's note, Claimant was planning to work another five years when she saw him in 2006. He noted Dr. Olson commented on Grade 2 spondylolisthesis at L4-5.
Dr. Parmet agreed there may have been some effect by her work activities on the already vulnerable spine, but he said it would not have been significant enough to cause spondylolisthesis. He said that was just degenerative breakdown of that condition. He was asked about the pallet jack incident where Claimant was pulling a pallet in August 2005. He said that was a strain, and there was nothing severe at that time that triggered an evaluation.
Dr. Parmet discussed Dr. Ahmad's record of February 20, 2006 and noted the clinical history recorded was low back pain with left leg radiculopathy for three months, no recent injury. Dr. Parmet thought Claimant could sit and change position and would probably be able to do so all day.