At the hearing, the parties stipulated that: (1) Thyssenkrupp Stahl Company was an employer operating under the subject Missouri Workers' Compensation Law on February 21, 2007; (2) on February 21, 2007, an employer/employee relationship existed between Thyssenkrupp Stahl Company and Claimant; (3) the employer was self-insured under the law; (4) the employee filed a claim for compensation within the time prescribed by law; (5) notice was properly given; (6) the employee sustained an accident on February 21, 2007 that arose out of and in the course of his employment; and (7) the claimant's average weekly wage was $\ 599.01 and the applicable compensation rate is $\$ 399.36 / \ 376.55.
The issues to be decided are as follows:
(1) The nature and extent of permanent disability and the liability of the Employer for same;
(2) The liability of the Second Injury Fund;
(3) Future medical treatment.
Claimant testified on his behalf. He also offered the following exhibits, all of which were admitted into evidence:
C Annual Employee's Performance \& Compliance Review
D Medical records-Central Family Medicine
E Medical records-Western Missouri Bone \& Joint Clinic
F Medical records-Saul Trevino, M.D.
G Medical records-Stanley Bowling, M.D.
H Medical records-Columbia Regional Hospital
I Medical records-Greg Horton, M.D.
J Deposition—James Stuckmeyer, M.D.
K Deposition—Allan Schmidt, Ph.D.
L Deposition—Mary Titterington (2009)
M Deposition—Mary Titterington (2010)
O Photographs of Claimant's feet and right ankle
The Employer offered the following exhibits, all of which were admitted into evidence:
1 Deposition—Claimant
2 Deposition—Eden Wheeler, M.D.
3 Deposition—Greg Horton, M.D.
4 Deposition—Terry Cordray
The Fund offered no witnesses or exhibits.
Claimant testified that he was born on August 5, 1960 and is 50 years old. He attended Warrensburg High School and dropped out after the $9^{\text {th }}$ grade. He struggled in school and got poor grades. He never obtained his GED.
In 1978, Claimant went to work for the Employer as a buffer. He continued to work there until 2009. When his accident occurred on February 21, 2007, he was a cell leader. On that date, he was pushing a heavy mold cart when the cart got stuck in a crack. He squatted and then lifted and pushed the cart to get it out. In the process of doing this, he heard a pop in his right ankle.
He reported the injury to his supervisor and eventually filled out an accident report. He got treatment on his own until the Employer began authorizing medical treatment. He saw his family physician, Dr. Dyer, who referred him to an orthopedic surgeon, Gregory Bliss, M.D.. Dr. Bliss referred him to another orthopedic surgeon, Saul Trevino, M.D.. Dr. Trevino performed surgery on his ankle in September, 2007. During Claimant's treatment with Dr. Trevino, the Employer began authorizing treatment for the injury.
The Employer then referred Claimant to Gregory Horton, M.D. at K.U. Medical Center for further treatment. Dr. Horton treated Claimant until February, 2009. Dr. Horton performed surgery on Claimant in August, 2008.
Claimant testified that he has the following medical problems from the accident:
- Constant swelling in the right foot, which worsens as the day progresses. If there is significant swelling, his skin will split.
- Constant aching in the right foot.
- Constant popping in his right ankle and knee.
- Difficulty sleeping.
- Frequent knee pain.
- Frequent back pain.
- Constant feeling of being tired.
- Depression
Because of the pain in his right ankle and back, he cannot be on his feet for more than an hour. He then has to elevate his leg. He will elevate his leg four or five times a day. He typically rests his leg for an hour each time.
It is difficult for him to get a decent night's sleep. Because of that, he takes naps during the day.
He testified that he feels depressed because he is not able to financially provide for his family as he did before his injury.
Claimant testified that he worked light duty in early 2009 before being laid off. He sat down and inspected parts. He was laid off in January or February, 2009. After that, he applied for Social Security disability benefits. He was approved for those and is currently receiving them. He does not feel capable of working anywhere.
At the request of the Employer, Claimant saw Terry Cordray, vocational expert. Claimant's attorney informed Claimant that Mr. Cordray initially believed that he was capable of performing some jobs in the Warrensburg area. That included a cashier's job at a convenience store like Casey's. Claimant applied for those jobs and received no job offers.
Employer's Exhibit 1 was Claimant's deposition. In that deposition, Claimant testified that he normally wears a size $101 / 2$ shoe. Because of the constant swelling in his right foot and ankle, he has to wear a size $131 / 2$. (p. 58). He puts inserts in his left shoe to compensate. (p. 58). He also testified that his right foot swells every day. (p. 59). The swelling goes down when he sleeps. (p. 60). To relieve the swelling, he elevates his foot. (p. 60).
He also testified in his deposition that he can drive a car, but does not drive for long distances. (p. 91). He only drives in or near his home in Warrensburg. (p. 92).
He also testified in his deposition that he did light duty work for the Employer until early 2009. (p. 65). He sat down and inspected parts. (p. 65). This was just a temporary, light duty job that the Employer created for him. (p. 66). It was a made up job for him. (p. 67).
James Stuckmeyer, M.D. testified by deposition. His deposition was marked Claimant's Exhibit J. Dr. Stuckmeyer is a board certified orthopedic surgeon. (p. 48). He evaluated Claimant on March 19, 2009. (p. 50). The medical records he reviewed indicate that the work accident caused a possible navicular fracture and a posterior tibial tendon rupture in Claimant's right foot. (p. 52). On September 6, 2007, Claimant underwent his first surgery for his ankle.
(p. 52). On August 21, 2008, he underwent a second surgery. At that time, Dr. Horton performed a triple arthrodesis on his right foot and ankle. (p. 54).
Dr. Stuckmeyer reviewed the treatment records of Dr. Horton. Those records were marked Claimant's Exhibit I. The last office visit with Dr. Horton was on February 10, 2009. (Exhibit I, p. 2). At that time, Claimant had a loud popping in his ankle when he stepped down. (p. 2). Claimant also complained of swelling in his ankle. (p. 2). Dr. Horton commented that Claimant's foot and ankle would never be the same, that he had some substantial limitations and that he should resume activities as tolerated. (p. 2). Dr. Horton felt that Claimant would need long-term management of the swelling. (p. 2). This long-term management would include a brace and a doctor to manage his pain medication needs in the long term. (p. 2).
Claimant told Dr. Stuckmeyer that he had significant pain in his right foot and ankle. (p. 55). He had difficulty with prolonged standing, walking and traversing steps. (p. 55). He has difficulty walking on uneven surfaces. (p. 55). He has significant swelling in his right foot and ankle, which requires him to frequently elevate his leg. (p. 55). He has difficulty with shoe wear. (p. 55).
Claimant also to