The sole issue is the liability, if any, of the Second Injury Fund for permanent partial disability enhancement as a result of the combination of the April 8, 2005, primary injury with any preexisting permanent partial disability. Section 287.220.1 RSMo provides for permanent partial disability benefits to be paid from the Second Injury Fund when an employee who suffers from preexisting permanent partial disability that constitutes a hindrance or obstacle to employment sustains a later injury that also results in permanent partial disability, so long as both the preexisting and the primary permanent partial disability meet the thresholds of 12.5% for a body as a whole injury or 15% for a major extremity injury.
> The Commission may consider all the evidence, including the testimony of the employee, and draw all reasonable inferences in arriving at the percentage of disability. This is a determination within the special province of the Commission. The Commission is also not bound by the percentage estimates of the medical experts and is free to find a disability rating higher or lower than that expressed in medical testimony. This is due to the fact that determination of the degree of disability is not solely a medical question. The nature and permanence of the injury is a medical question, however, the impact of that injury upon the employee's ability to work involves considerations which are not exclusively medical in nature.
*Elliott v. Kan. City School Dist.*, 71 S.W.3d 652, 657 (Mo. App. 2002) (citations omitted).
Dr. Berkin opined that the injury to employee's right finger is a hindrance and obstacle to employment and that it's impossible for employee to do a sit-down job using his hands for any extended period of time. Dr. Berkin opined that employee should be restricted from forceful gripping, squeezing, pinching, twisting, pulling, or reaching with his right hand, and should avoid high-impact tools. Dr. Berkin opined that employee
sustained a permanent partial disability of 12.5 % of the right wrist as a result of the primary injury.
After carefully weighing all of the evidence, we agree with the administrative law judge that the primary injury caused employee to sustain a 10\% permanent partial disability of the hand at the 175 -week level, and that employee is not entitled to permanent partial disability benefits from the Second Injury Fund in this matter because the primary injury does not meet the statutory thresholds.