The issues to be determined by this hearing are as follows:
(1) Accident
(2) Medical Causation
(3) Future Medical
(4) Temporary total disability
Based upon the evidence and the live testimony, I find the following:
Deborah Lynn Johnson is a 36 year old woman who lives in Warrensburg, Missouri with her two children. She is a high school graduate, has an associates degree, and is currently attending the University of Central, Missouri. Ms. Johnson is a smoker.
Ms. Johnson's work history includes mostly utilizing her CNA license. She procured that license in 1993 and has been certified in both Kansas and Missouri. She has always worked in nursing homes. Beginning in 2004, Ms. Johnson began working for the State of Missouri at the Veterans' Home in Warrensburg, Missouri. Her job duties included helping patients by cleaning and assisting with personal care which often required her to use a "gait belt" to assist her lifting immobile patients. She worked for the Veterans Home from 2004 through 2008. She was under no doctor's restrictions during that time.
Ms. Johnson does, however, have a history of physical problems. First when Ms. Johnson was a child, she was diagnosed with a bone disease called polyfybrosis displasia. This condition affected her right femur and her pelvis. She underwent three surgeries-one when she was ten years of age, one when she was 12 years of age and the final one in 1998. The condition did cause Ms. Johnson to have ongoing back pain and an altered gait. She also had a knee surgery in 1991.
In November of 2005 Ms. Johnson had an event while lifting a patient that caused back pain. Ms. Johnson underwent physical therapy following this incident.
Lastly, Ms. Johnson testified that her job duties would frequently cause her to strain her back resulting in back pain following her shifts. Muscle strains were an ordinary part of Ms. Johnson's job.
On June 11, 2008, Ms. Johnson indicates that she was toward the end of her shift when she injured herself while lifting a very large patient with a "gait belt". She indicates she felt immediate sharp pain in her upper back between her shoulder blades. She completed her shift while performing all of the requirements of her job the remainder of that day because she felt this incident was typical of past muscle strains. No one saw the incident Ms. Johnson described as her work related injury. She went home that day and did not tell her supervisor of the incident.
The next day Ms. Johnson told her supervisor about the incident, an accident report was filled out, and Ms. Johnson was sent out for treatment.
Initially Ms. Johnson complained of pain in her thoracic spine. Approximately three days after her alleged incident, Ms. Johnson began having low back pain and radiating pain down into her legs. Ms. Johnson initially saw Dr. Anderson, then was sent to see Dr. Alexander Bailey for her complaints. Her treatment was as follows:
On July 2, 2008 Dr. Anderson shows thoracic spine pain, and "now" into lumbar spine. It also shows a history of the three surgeries to the right femur and hip due to the polyfibrosis dysplasia. He sends Ms. Johnson for physical therapy.
Beginning on July 17, 2008 Ms. Johnson underwent three weeks of physical therapy.
The July 23, 2008 thoracic/lumbar spine X-ray showed no spondylolisthesis in the thoracic spine but showed decreased disc space with degenerative spurring in the lumbar spine.
The July 31, 2008 MRI showed disk desiccation at the L5-S1 level and a protrusion of the disc at that level as well.
On her own, Ms. Johnson saw Dr. Templeton for an opinion regarding her back and hip pain. Dr. Templeton saw Ms. Johnson initially on August 21, 2008. At that time the doctor stated that the etiology of her back pain is unclear if it was a fall or a lifting injury. Also during that visit, Dr. Templeton noted Ms. Johnson to have ongoing hip pain. (The note references a visit for ongoing hip pain in March of 2008-prior to the June 2008 injury)
The August 15, 2008 thoracic spine X-ray revealed no evidence of instability, no evidence of significant degeneration, no significant arthrosis. X-ray report of the lumbar spine showed evidence of bilateral spondylosis and listhesis of L5-S1. Adjacent levels appear to be maintained without significant abnormality.
The August 15, 2008 report from Dr. Bailey notes complaints of pain in her neck with numbness in her right arm, pain between her shoulder blades, pain in the mid and lower back and into her leg. She complained that physical therapy worsened her pain. He notes prior back pain when Ms. Johnson had other incidents at work before June of 2008. He diagnoses spondysislisthesis at the L5-S1 level and back strain. Dr. Bailey states at that time, "clearly, her spondylosis-listhesis is pre-existing in nature. Her minor lifting injury working for the Department of Veterans Affairs nursing home did not result in spondylosis or listhesis. She has this underlying condition that has been present for some time. Most likely, it has been present since her youth...This may represent an exacerbation of symptoms, but the vast majority of her overall condition appears to be pre-existing in nature. It is impossible to time her MRI findings and it is impossible to determine whether this truly happened on the job or not. This more likely than not was going to develop over her recent lifetime. Ultimately, the lysis and listhesis has been present for some time and there was a natural progressive degeneration and failure of the L5-S1."
On September 2, 2008 Ms. Johnson underwent her first epidural steroid injection.
On September 12, 2008 Dr. Bailey's notes indicated that "causation remains in question" regarding Ms. Johnson's back complaints. He states that "The patient has a known spondylosislisthesis that is not new and that is longstanding."
Issued by the DIVISION OF WORKERS’ COMPENSATION
Employee: Deborah Johnson
Injury No. 08-048118
Ms. Johnson underwent an MRI, and began seeing a neurosurgeon, Dr. Bailey, for treatment. He allowed Ms. Johnson to continue working on a light duty status. The MRI showed a bulging disc and degenerative conditions. Ms. Johnson had physical therapy and then had two epidurals. She continued to work light duty while under this care and treatment. Ms. Johnson refused the third epidural as the first two were very painful to her.
On September 16, 2008 Ms. Johnson underwent her second epidural steroid injection.
Dr. Templeton’s note of September 11, 2008 indicates that Ms. Johnson’s pain began between her shoulder blades in June of 2008… then eventually “went into” her lower back. Dr. Templeton advised her to continue getting conservative therapy, have a second set of epidurals and to have surgery only if those modalities failed. He also advised her that she would need to discontinue smoking.
At the request of the employer/insurer, on September 26, 2008 Dr. Bailey authored a report discussing the causation for Ms. Johnson’s back pain and need for surgery. He stated that Ms. Johnson has “clear evidence of a spondylosis-listhesis” that clearly pre-existed her June 11, 2008 incident. He goes on to note that Ms. Johnson had admitted to previous exacerbation of back pain prior to June 11, 2008. She had failed motion segment, failed for sometime, that was exacerbated in the past. The June 11, 2008 incident “more likely than not represented a minor exacerbation of her underlying personal medical condition.” Dr. Bailey went on to say that he did not believe Ms. Johnson’s employer was responsible for the spondylosis or listhesis, and that