disability before Second Injury Fund liability can even be considered: "All cases of permanent disability where there has been previous disability shall be compensated as herein provided ..." (emphasis added).
Employee injured his right shoulder in 2003, when he was working for a previous employer, Essex Contracting Incorporated (Essex). Employee filed a claim for compensation for that injury and recovered some benefits as a result of a settlement with Essex. Employee then proceeded to hearing on his claim against the Second Injury Fund, alleging that his right shoulder disability (resulting from the 2003 primary injury) combined with the preexisting condition of his left arm (which was weakened by childhood polio) to result in enhanced permanent partial disability. That claim was heard together with employee's claim in this matter. For the 2003 claim against the Second Injury Fund, the administrative law judge issued an award granting employee 17.94 weeks of permanent partial disability benefits, on a finding his right shoulder disability combined with his preexisting left arm condition to result in a greater disability than each of them would create considered alone. See *Award*, page 11.
Employee's claim for compensation in this matter is premised on a theory that he aggravated his left shoulder (which, as we mentioned above, was previously weakened by childhood polio) working for a subsequent employer, JH Berra, because he was overusing his left shoulder to compensate for the 2003 right shoulder injury. Employee alleges that his "left arm had gotten progressively worse as he worked for [JH Berra], as during his employment he was repetitively using his left arm, and trying to favor his right arm, which had been previously injured at the shoulder in 2003." *Employee's Brief*, page 2. Dr. Poetz, employee's medical expert, listed "left shoulder tendonitis, 7/8/05" as a diagnosis in his report, but did not otherwise discuss a 2005 injury, nor did he provide any explanation in his report or in his testimony as to what he believed caused an injury to employee on that date. Instead, Dr. Poetz merely recited employee's complaint that his left shoulder started hurting as a result of using it more and favoring his right shoulder after the 2003 injury.
Under the law in effect at the time employee sustained the alleged primary left shoulder injury, a change in pathology that resulted from a work-related aggravation of a preexisting condition was unquestionably compensable as a workers' compensation injury. See *Rono v. Famous Barr*, 91 S.W.3d 688, 691 (Mo. App. 2002) (pointing out that "aggravation of a pre-existing condition is a compensable injury if the claimant establishes a direct causal link between her job duties and the aggravated condition"). But here, employee is not really arguing that there is "a direct causal link"—or any kind of causation, for that matter—attributable to his work with JH Berra. Rather, he alleges that his left shoulder is worse off as a result of his favoring his right shoulder after the 2003 injury. So, the question before us is whether employee has established a 2005 primary injury where the only evidence on the question indicates that his left arm condition worsened (if at all) due to the residual effects of the 2003 work injury.
Where an employee sustains an injury arising out of and in the course of his employment, every natural consequence that flows from the injury, including a distinct disability in another area of the body, is compensable
as a direct and natural result of the primary or original injury. Every natural consequence that flows from the injury likewise arises out of employment, unless it is the result of an independent intervening cause ...
Cahall v. Riddle Trucking, 956 S.W.2d 315, 322 (Mo. App. 1997) (citations omitted), overruled on other grounds by Hampton v. Big Boy Steel Erection, 121 S.W.3d 220 (Mo. banc 2003).
We conclude that employee's claimed left shoulder condition does not amount to a 2005 primary injury. This is because employee has failed to prove that he sustained a new injury arising out of his employment with JH Berra, but rather a "natural consequence that flows from" his 2003 right shoulder injury. We reach this conclusion on the basis of both employee's testimony and the testimony and report from his medical expert. Employee's claimed mechanism of injury is that he worked harder with his left shoulder because of the disability to his right shoulder. Employee fails to identify any aspect of his work duties with JH Berra that caused him injury. Employee testified he worked harder in his work for JH Berra than in previous employments, but "working hard" does not fairly come within the most liberal reading of $\S 287.020 .2$ RSMo, which defines an "accident" as "an unexpected or unforeseen identifiable event or series of events happening suddenly and violently, with or without human fault, and producing at the time objective symptoms of an injury," or § 287.067.1 RSMo, which defines an "occupational disease" as "an identifiable disease arising with or without human fault out of and in the course of the employment."
Likewise, Dr. Poetz, the only medical expert who provided testimony, did not identify any mechanism of injury related to employee's work for JH Berra, but instead merely recited employee's theory that he aggravated his left shoulder as a result of favoring his right. To the extent that Dr. Poetz's unadorned diagnosis of "left shoulder tendonitis, $7 / 8 / 05$ " can be construed as a medical causation opinion, we find it lacking credibility, because it is conclusory and fails even to identify the event or disease that is supposed to have occurred or culminated on July 8, 2005.
An instructive case is Lahue v. Missouri State Treasurer, 820 S.W.2d 561 (Mo. App. 1991). There, the employee sought compensation from the Second Injury Fund alleging a primary injury resulting from her fall from a chair during physical therapy for a prior injury. Id. at 562. The court found that the employee failed to prove a primary injury and explained why the employee could not establish Second Injury Fund liability:
The law is well settled, that where a claimant sustains an injury arising out of and in the course of her employment, every natural consequence that flows from the injury, including a distinct disability in another area of the body is compensable as a direct and natural result of the primary or original injury. ... The fall from the chair was a part of the same injury as the ankle injury, and was therefore not a "subsequent injury" added to a "previous disability." In order to be a "subsequent injury," entitling the victim to compensation from the Missouri Second Injury Fund, the fall from
the chair must have been shown to be a separate and distinct injury from the ankle injury. This was not the case.
Lahue, 820 S.W.2d at 563 (emphasis added).
As we mentioned above, § 287.220 requires that employee prove a primary injury resulting in permanent disability before the question of Second Injury Fund liability can be reached. Because employee has failed to do this, it follows that employee has failed to prove that he is entitled to benefits from the Second Injury Fund.
We note once again that this claim was heard together with the 2003 right shoulder claim against the Second Injury Fund. If, as employee claims, his left shoulder worsened as a residual effect of that 2003 injury, nothing precluded employee from so arguing before the administrative law judge and thereby seeking additional Second Injury Fund liability in that claim. That claim is not before us, however, because, although the claims were heard together, employee only filed an Application for Review in this matter.
In sum, we find that employee failed to meet his burden of proving that he sustained a primary injury in 2005. All other issues are moot.