Under Mo. Rev. Stat. § 287.190.6 (2000), "'permanent partial disability' means a disability that is permanent in nature and partial in degree..." The claimant bears the burden of proving the nature and extent of any disability by a reasonable degree of certainty. Elrod v. Treasurer of Missouri as Custodian of the Second Injury Fund, 138 S.W.3d 714, 717 (Mo. banc 2004). Proof is made only by competent substantial evidence and may not rest on surmise or speculation. Griggs v. A.B. Chance Co., 503 S.W.2d 697, 703 (Mo. App. 1973). Expert
testimony may be required when there are complicated medical issues. Id. at 704. Extent and percentage of disability is a finding of fact within the special province of the [fact finding body, which] is not bound by the medical testimony but may consider all the evidence, including the testimony of the Claimant, and draw all reasonable inferences from other testimony in arriving at the percentage of disability. Fogelsong v. Banquet Foods Corp., 526 S.W.2d 886, 892 (Mo. App. 1975)(citations omitted).
Pursuant to Mo. Rev. Stat. § 287.220.1 (2000), if an employee has a pre-existing disability of such seriousness to constitute a hindrance or obstacle to employment or to obtaining re-employment if the employee becomes unemployed, and if the pre-existing disability and the subsequent compensable injury each result in a minimum of 50 weeks of compensation for a body as a whole injury or 15 % permanent partial disability to a major extremity, and if the combined disability is substantially greater than that which would have resulted from the last injury alone, then Employer is only responsible for payment for the disability from the last injury, that disability and any amount of pre-existing disability is subtracted from the total, and the Second Injury Fund shall pay Claimant compensation based on the balance left (or greater combination).
Specifically, Claimant must prove that there was a pre-existing permanent partial disability whether from a compensable injury or otherwise and also prove that the pre-existing disability was of such seriousness so as to constitute a hindrance or obstacle to employment or reemployment should the employee become unemployed. Karoutzos v. Treasurer of the State of Missouri, 55 S.W.3d 493 (Mo. App. W.D. 2001) overruled on other grounds by Hampton v. Big Boy Steel Erection, 121 S.W.3d 220 (Mo. 2003). In determining liability for the Second Injury Fund, the nature and extent of the permanent partial pre-existing condition has to be proven by a reasonable degree of certainty. Messex v. Sachs Electric Co., 989 S.W.2d 206 (Mo. App. E.D. 1999) overruled on other grounds by Hampton v. Big Boy Steel Erection, 121 S.W.3d 220 (Mo. 2003). Expert opinion evidence is necessary to prove the extent of the pre-existing disability. Id. at 215 . Additionally, Claimant must prove that the primary compensable injury combines with the pre-existing disability to create a substantially greater overall disability than the sum of the disabilities considered independently. Searcy v. McDonnell Douglas Aircraft Co., 894 S.W.2d 173 (Mo. App. E.D. 1995) overruled on other grounds by Hampton v. Big Boy Steel Erection, 121 S.W.3d 220 (Mo. 2003).
The first step in the process is determining the amount of permanent partial disability Claimant sustained in connection with the primary neck, low back and psychological injury. Dr. Volarich, Claimant's rating physician, was the only doctor to provide an opinion on permanent partial disability for the neck and low back injury. He opined that Claimant had permanent partial disabilities of 25 % of the body as a whole referable to the cervical spine and 35 % of the body as a whole referable to the lumbosacral spine related to the April 18, 2003 accident. Dr. Richard Anderson was the only physician in the record to provide an opinion on Claimant's permanent partial disability related to the psychological injury. He opined that Claimant was 100 % psychiatrically disabled as to the body as a whole as a direct result of the 2003 work injury. Claimant then settled his Claim against Employer by Stipulation for Compromise Settlement for $\ 75,000.00, or 20 % permanent partial disability of the body as a whole referable to the cervical spine, 20 % permanent partial disability of the body as a whole referable to the lumbar spine and 26 % permanent partial disability of the body as a whole referable to psychological impairment.
Accordingly, based on the competent and credible evidence in the record, I find Claimant has 20 % permanent partial disability of the body as a whole referable to the cervical spine, 20 % permanent partial disability of the body as a whole referable to the lumbar spine and 26 % permanent partial disability of the body as a whole referable to psychological impairment, medically causally related to the April 18, 2003 injury at work for Employer.
Since this is a permanent partial disability claim against the Second Injury Fund, and not a permanent total disability claim, the thresholds referenced above are applicable. Accordingly, I find that the body as a whole disability at the level of the cervical spine, lumbar spine and referable to the psychological disability meets the applicable threshold for Second Injury Fund benefits. The issue then becomes whether the alleged pre-existing right shoulder and low back injuries/conditions resulted in disability that meets the applicable threshold to trigger Second Injury Fund liability, and whether the disability is of such seriousness so as to constitute a hindrance or obstacle to employment, or to obtaining re-employment, if the employee becomes unemployed.
Having thoroughly considered all of the evidence in the record, I find that Claimant has failed to meet his burden of proof to show an entitlement to a permanent partial disability award against the Second Injury Fund for the combination of the primary body as a whole disabilities and the alleged pre-existing right shoulder and low back disabilities. I further find that while Claimant had pre-existing disabilities to the right shoulder and low back, those disabilities cannot be included in any Second Injury Fund calculation because they do not meet the appropriate threshold of at least 12.5 % of the body as a whole ( 50 weeks) or 15 % of a major extremity, and they were not of such seriousness so as to constitute a hindrance or obstacle to employment, or to obtaining re-employment, if the employee becomes unemployed.
First, regarding the alleged pre-existing low back disability, I find that Dr. Volarich provided a credible opinion in his report of October 27, 2004 that Claimant only had 7.5\% permanent partial disability of the body as a whole referable to the lumbosacral spine leading up to the injury of April 18, 2003. Claimant provided no credible testimony at trial regarding any problems or complaints he had with his low back pre-existing the April 18, 2003 accident. Therefore, I find Claimant's pre-existing low back disability, 7.5 % of the body as a whole referable to the low back, does not meet the threshold of 12.5 % of the body as a whole ( 50 weeks), and cannot be included in any calculation of Second Injury Fund liability in this case.
With regard to the alleged pre-existing right shoulder injury, I find Claimant failed to provide credible testimony regarding the circumstances surrounding that injury, the effect it had on his ability to work, and any continued problems or complaints he may have been having with that right shoulder, leading up to the time of the April 18, 2003 injury.
I find that Claimant's credibility, with regard to the prior right shoulder disability, was first negatively impacted by his apparent inability to truthfully explain the nature of the injury that caused his right shoulder condition. At trial, Claimant testified that he injured his right shoulder in 1991 when he was working on the line and a bottler machine grabbed hold of his shirt and pulled him over the machine, resulting in right shoulder pain and problems. However, the medical records and reports contained in Exhibit D from the time of the 1991 injury indicate
that Claimant injured his right shoulder when he reached for bottles on the conveyor belt and felt something pop in his right shoulder. This same mechanism of injury is also contained in the Report of Injury for the 1991 injury in Exhibit D. Although a little different from these histories, Claimant's rating physician at the time, Dr. Raymond Cohen, included a history of injury in his report that Claimant's right shoulder pain developed during May of 1991 when Claimant was repetitively flexing and extending his arms while working with empty cases of soda bottles. Nowhere in any of these contemporaneous medical records or reports is there a history of Claimant's sleeve being grabbed by the machine and pulling him over the machine. Since this is a Second Injury Fund case, I acknowledge that having a consistent history of the mechanism of the prior injury is not necessarily dispositive of the outcome. However, this unexplained major discrepancy in the history of the right shoulder injury only served to further magnify other more important discrepancies in other areas of Claimant's testimony regarding the alleged prior right shoulder condition.
In addition to the discrepancy concerning the mechanism of the right shoulder injury, I find that Claimant also failed to provide credible testimony regarding the effect it had on his ability to work, and any continued problems or complaints he may have been having with that right shoulder, leading up to the time of the April 18, 2003 injury. Claimant testified at trial that after the shoulder injury in 1991 he suffered from stiffness, swelling and limited reaching overhead because of his right shoulder injury. He said that he would have to take over-thecounter medications to take the edge off the right shoulder pain. Claimant said that he did not have to perform any overhead work for Employer, but if he would have had to work overhead, he could not have done it, because of the right shoulder problems. Claimant testified that his right shoulder complaints and problems from this 1991 injury continued up until the time of the 2003 accident. I find Claimant's testimony in this regard was impeached by his prior deposition testimony from 2006 and from his failure to report any such shoulder problems, complaints or any impact they had on his work activities to Dr. Volarich at the time of his examination of Claimant in 2004.
On cross-examination by the Second Injury Fund at trial, Claimant testified that he reported all of his complaints to Dr. Volarich at the time he was examined. He believed he told Dr. Volarich about the right shoulder injury. However, after a thorough review of Dr. Volarich's report, I was unable to find any reference at all to a prior right shoulder accident or to any problems or complaints he had with the right shoulder that impacted his ability to work leading up to the 2003 injury. Claimant was clearly able to remember prior injuries to his neck from 1989 and to his low back from 2002, but made no reference to his right shoulder from 1991. Since Claimant never reported his prior right shoulder condition to Dr. Volarich, the report contains no physical examination of the right shoulder, no rating of pre-existing disability to the right shoulder, and no indication that it was a hindrance or obstacle to Claimant's employment leading up to the 2003 accident.
At trial, the Second Injury Fund also cross-examined Claimant regarding his prior sworn deposition testimony from February 2006. Apparently in his deposition, Claimant testified that he did not remember his prior shoulder injury. At trial, when Claimant was presented with that prior testimony, he said that he did not remember saying that in his deposition. He explained that his other injuries hurt worse, so he may not have remembered the prior shoulder. He also testified that he may have been "on a defensive mode of thinking" that someone was trying to
railroad him or relate the shoulder problems to his work injury from 2003. He admitted that his testimony at trial was different than the testimony he provided in 2006. Further, Claimant apparently testified in his 2006 deposition that he had minimal problems with everything, just normal soreness from his job, but he was fine before 2003. Even though at trial he now testified that he was in consistent pain before the 2003 injury, he refused to agree that his trial testimony was different from his deposition testimony. Additionally, in his 2006 deposition, when he was asked specifically about the right shoulder problems leading up to the 2003 injury, he apparently responded, that he was not having any particular problems and that, "it's been pretty good to me." Claimant testified that he did not remember that answer and he did not believe his trial testimony was any different than what he had said in his deposition in 2006.
In comparing Claimant's trial testimony, which contained his recitation of the significant ongoing complaints and problems he had with the right shoulder, to his prior sworn deposition testimony where he failed to remember the shoulder injury and admitted he was not having any particular problems with it leading up to the 2003 injury, I am left to conclude that Claimant was not honest and forthright with his testimony. Given his failure to mention the shoulder to Dr. Volarich in 2004, and given his deposition testimony in 2006 that mentioned virtually no problems with the right shoulder, I find that Claimant's trial testimony regarding the right shoulder was not credible. Therefore, I find that Claimant has failed to prove that his right shoulder condition was a hindrance or obstacle to employment, or re-employment should Claimant become unemployed. Claimant's belated recollection of significant right shoulder problems from the 1991 injury, just in time for his trial testimony in his Second Injury Fund case, is not competent, credible or reliable testimony, and cannot be used as a basis for an award of compensation in this matter. Further, without such testimony on the prior right shoulder from Dr. Volarich, Claimant also has no medical report or opinion contemporaneous with the last injury to help meet his burden of proof.
I further find, that while there is no doubt Claimant apparently had a right shoulder injury in 1991, I do not believe, based on the evidence in the record, that the prior right shoulder injury reaches the applicable threshold of 15 % of a major extremity, thus, providing another independent reason why the Second Injury Fund case must fail. While it is true that Claimant apparently settled that 1991 case for 15 % of the right shoulder, I would note that the statute only requires that disability to continue undiminished, if the new injury is to the same body part. We do not have that situation here, since the more recent injuries are to the neck, low back and body as a whole. Therefore, I am not bound by the amount of disability listed in that stipulation as being referable to the right shoulder. After considering the prior shoulder treatment records, the diagnosis of right shoulder bursitis and osteoarthritis of the right acromioclavicular joint, and Claimant's failure to provide credible testimony regarding any ongoing problems or complaints, he may have had with the right shoulder following the 1991 injury, I find that, at most, Claimant sustained 10 % permanent partial disability of the right shoulder on account of the 1991 injury. Therefore, I find Claimant's pre-existing right shoulder disability, 10 % of the right shoulder, does not meet the threshold of 15 % of a major extremity, and cannot be included in any calculation of Second Injury Fund liability in this case.
Having found, for the reasons described in detail above, that Claimant's alleged preexisting low back and right shoulder disabilities do not meet the appropriate threshold for Second Injury Fund benefits, and were not hindrances or obstacles to employment, or re-employment if
Claimant became unemployed, Claimant's claim for Second Injury Fund benefits in this matter, thus, fails.
Accordingly, the Second Injury Fund Claim in this matter is denied.