The Claimant is 60 years of age and last worked on March 31, 2006. Prior to March 31, 2006, he worked as a firefighter, paramedic, arson investigator and fire captain for the City of St. Charles Fire Department. The Claimant worked for this Employer for twenty seven (27) years, with the last twenty four (24) years in the position of Fire Captain. On March 31, 2006, the Claimant left the St. Charles City Fire Department and applied for duty related disability benefits, which were approved.
Claimant sustained a work related injury to his low back May 31, 2002 and another work injury affecting his right arm in November 2003. The history and treatment regarding these injuries are chronicled in the Awards in Injury Number 02-052025 and Injury Number 03113105. Following his 5/31/02 injury and his December 2002 back fusion Claimant was off for three months and then on light duty for three months. Claimant was released back to work full duty in June 2003 with the only restriction of no repetitive bending, twisting while lifting. Following his 11/07/03 wrist injury, Claimant was first put on light duty and released back to work full duty in July 2004. On 11/1/04 Claimant was put on light duty by Dr. Wagner following a flare-up of back pain.
Following his second fusion surgery on 3/18/05, he was off for 6 months and returned to light duty in early July 2005 conducting fire code inspections throughout St. Charles City until his retirement in March 2006. He has not filed for SS disability.
Claimant: Doug Nord Injury No. 06-129192
On 5/31/02, claimant was testing fire hydrants when he felt sharp shooting pains in his back. Before this injury, claimant was working full time without restrictions. Claimant went to see Dr. John Wagner who ordered x-rays and an MRI. Claimant was then referred to Dr. Michael F. Boland. Dr. Boland's impression was chronic intermittent back pain, activity related, with a normal neurologic examination, related to isthmic spondylolisthesis L5-S1. Dr. Boland concurred with Dr. Wagner to go ahead and perform a lumbar fusion L5-S1. On 12/10/02, claimant underwent a L5 Gill procedure with bone fusion and instrumentation. Following the December 2002 surgery, Claimant was off work for 12 weeks, on light duty for 12 weeks, after which Dr. Boland returned him to full duty on 6/10/03. X-rays showed Claimant's fusion mass to be solid.
In March 2004, Claimant told Dr. Wagner he was having more back pain especially when doing his workout. Dr. Wagner recommended an MRI and physical therapy. On 4/6/04 Dr. Wagner reviewed the MRI and noted that due to the bulging and degenerative disc disease there would be some decompression due to the fusion. Two weeks later Claimant was able to return to work without restrictions.
On 9/27/04 Claimant filed a report of injury, he had no specific injury, but had pains going from sitting to standing, and it took several steps and some hip rotational movements to loosen up before his leg would support him. Dr. Wagner saw him on 11/01/04 regarding increasing symptoms in his low back. Physical exam revealed slight loss of motion in the lower lumbar spine. An MRI on 12/22/04 showed some possible edema of the pedicle at L4 which prompted at CT of the lumbar spine. On 12/16/04 the CT showed that a solid fusion at L5-S1 was not present on either side. On 12/21/04 Dr. Wagner noted that the bone and CT scan showed what appeared to be pseudoarthrosis of the fusion mass and some evidence of looseness of the screws.
The doctor noted that on November 2003 Claimant had been involved in another accident at work where he was carrying a fire hose and was pulled into a moving truck. He had fractured his right wrist and torn his right rotator cuff. He also had onset of back pain after that injury, which had steadily gotten worse. The doctor's impression was failed fusion at L5-S1 with additional structural change involving the L4-5 facet on the right side that contributed to the foraminal stenosis affecting the course of the L4 nerve root.
On 3/21/05, Claimant underwent an L3-S1spinal fusion for treatment of pseudoarthrosis at L5-S1 and degenerative facet disease at L4-5. Post-op Claimant had relief of right hip and anterior thigh pain and his back was improving. He was walking 2-3 miles per day by 5/4/05 and wore a corset and bone stimulator. He continued with physical therapy and restrictions were relaxed to allow lifting up to 20 pounds but with no repetitive bending. Dr. Boland continued him off work.
On 8/15/05, Dr. Boland reported Claimant had finished physical therapy and had returned to light duty after his last visit. Claimant told Dr. Boland most days were good days but would occasionally have a sharp brief pain at the belt line precipitated by a twist.
Claimant: Doug Nord Injury No. 06-129192
On 10/16/05, Dr. Boland noted Claimant was making excellent progress and was taking no pain meds. Light duty was continued. On 1/18/06 Dr. Boland stated Claimant was rapidly approaching MMI, was walking extensively, and would undergo a CT scan.
On 3/15/06 Dr. Boland reviewed the CT scan with Claimant and reported it showed a solid fusion from L3 to S1 without loosening of the pedicle screw instrumentation. He placed Claimant at MMI. Dr. Boland stated that given the nature of his injury in the past and the fact that he had a lumbar fusion, Claimant was not fit to perform the regular duties of a firefighter. He gave him work restrictions of 20 pounds lifting, no repetitive bending, no working at unprotected heights, no pushing or pulling greater than 20 pounds.
On 4/11/06 Dr. Boland rated Claimant's back at 20\% PPD in addition to whatever Dr. Wagner had ascribed in the past. At the time of his 2007 deposition Claimant's only medication was Aleve x 2 a day as needed.
On 5/25/11, Claimant returned to see Dr. Boland with complaints of right low back pain. Physical exam showed good lower extremity power, ability to walk on heels and toes, mild tenderness over the sacroiliac joints bilaterally. MRI in September 2010 showed no stenosis or disc herniation. X-rays of lumbar spine taken on 5/25/11 showed no instability or degeneration above the fusion. The sacroiliac joints showed little arthritis. There was no indication for any surgical intervention. Claimant needed to stay active and continue with his exercise regimen. Potential risk for requiring any additional surgery was 15 %.
On 8/1/11, five years after his retirement, Claimant went to see Dr. Graham, a pain management doctor. At that time, Claimant reported low back pain at the belt line without radiation with twisting activities such as fly-fishing and washing his fifth wheel. On examination Dr. Graham observed a normal gait, no limp, ability to stand on his toes, heels and squat. Claimant changed positions with ease and without assistance including getting on and off the exam table. Straight leg raising was normal, muscle tone in lower extremities. At that time Dr. Graham saw no need for a facet injection, epidural steroid injections or prescription for narcotic pain killers. Dr. Graham recommended continuation of home exercise program, continuation of Dr. Boland's restrictions, and provided Claimant with a prescription for Ultram 50 mg as needed.
On 3/13/07 Claimant filed an occupational disease claim through 3/16/06 for injury to his low back for injury occurring while in the course of his regular employment performing his duties as a firefighter.
Dr. Marvin Mishkin, a board certified orthopedic surgeon testified by deposition on behalf of the employer and the Fund. Dr. Mishkin saw Claimant on 10/13/08 to perform an independent medical examination at the request of the employer. Dr. Mishkin examined the Claimant, took a medical history, and reviewed his medical records and diagnostic tests. On 10/13/08 Claimant reported intermittent pain in his low and midback if he sat, stood or walked too long. But the pain was not constant. He took Naprosyn but not on a regular basis and had not taken it for at least a week. Claimant advised Dr. Mishkin that he currently walked up to two miles a day multiple times a week. He had a recurrence of knee pain while performing his activities and had a second arthroscopic surgery to his left knee in February of 2008. During the
physical examination Dr. Mishkin noted Claimant walked easily and without difficulty. His neck and back were straight. There was no swelling. Palpation of the regions of the back elicited no soreness or pain. Claimant was able to stand and touch his ankles. His right shoulder and elbow had good range of motion. Based on his examination, Dr. Mishkin concluded Claimant had excellent range of motion in his back and could bend and touch his toes without discomfort or pain.
Dr. Mishkin rated permanent partial disability of the low back L3-S1 area at 15\% BAW. Dr. Mishkin noted Claimant did return to work following the incidents of 11/7/03 and 9/27/04 and performed his occupational activities. Claimant advised Mr. Mishkin that no injury occurred on 3/31/06. It was Dr. Mishkin's opinion Claimant was employable and capable of performing occupational duties. Dr. Mishkin gave Claimant restrictions of no lifting over 20 pounds and avoid repetitive bending. In view of the fact that a firefighter may be put in a position where he had to do strenuous activities it was Dr. Mishkin's opinion Claimant should not return to work as an active firefighter, however he could do less strenuous jobs such as supervising others and inspections.
Dr. Volarich testified by deposition on behalf of the Claimant. Dr. Volarich performed an independent medical examination of Claimant on 10/26/09. Dr. Volarich obtained a medical history from Claimant; reviewed medical records provide by claimant's counsel and performed a general physical and neurological evaluation. Dr. Volarich noted Claimant could lift 20 pounds if he kept his arms close to his body. Claimant took Tramadol as needed though he tried to maintain without it. Claimant reported having to stand, walk and stretch if he sat more than two hours. He is able to dress himself, do the vacuuming, sweeping, mopping, shopping and drive 1-2 hours at a time.
For the 5/31/02 injury, which required two fusion surgeries, Dr. Volarich rated Claimant's back at 50\% PPD. For the 11/7/03 injury, Dr. Volarich rated 5\% of the spine, 35\% of the wrist, 40 % of the right shoulder and 20 % of the right elbow. It was Dr. Volarich's opinion that the claim of 9/27/04 was not a new injury to the low back but a progressive worsening of the back due to pseudoarthritis. It was further his opinion that the second surgical repair was a direct result of the first accident of 5/31/02.
It was Dr. Volarich's opinion that the repetitive trauma, including the trauma of riding in a fire truck leading up to $3 / 31 / 06$, was the substantial contributing factor as well as the prevailing or primary factor causing the progression of back pain syndrome that required conservative treatment. For the 3/31/06 claim Dr. Volarich rated 15\% PPD due to performing duties as a firefighter as well as impact trauma to his low back riding in the fire truck.
With regards to his back, Dr. Volarich gave Claimant restrictions of bending, twisting lifting, pushing, pulling, carrying, climbing, avoid handling weights greater than 15-20 pounds , changing positions every 30 minutes and pursue stretching, strengthening, and non-impact aerobic conditioning such as walking, biking, or swimming. With regards to his right elbow and shoulder Claimant was to minimize repetitive gripping, pinching, squeezing, pushing, pulling, and twisting rotary motions and similar tasks as tolerated. Use anti-vibration gloves and avoid overhead or prolonged use of right arm away from his body. Claimant could handle weight to
tolerance with the right arm extended away from the body, overhead or assuming proper lifting techniques.
Dr. Volarich opined Claimant was unable to perform in any substantial gainful activity. It was further his opinion he was unable to continue in his line of employment that he last held as fire captain, nor could he be expected to return full time in a similar job. Based on his medical assessment alone, Claimant was permanently disabled as a direct result of the work related injuries of 5/31/02, 11/7/03 and leading up to 3/31/06 in combination with each other and his pre-existing medical conditions.
On cross-examination from the Employer and the Fund Dr. Volarich agreed that regarding the alleged 3/31/06 claim, he rated the 15 % for additional symptoms developing between the time Claimant stopped active treatment with Dr. Boland in December 2005 and his retirement in March 2006. Dr. Volarich agreed the Claimant told him it was specifically the riding in the truck during that period that caused that injury. Dr. Volarich thought that 3/31/06 was the date Claimant stopped working. Dr. Volarich agreed Claimant stopped working because he could not return to full duty work. It was further his understanding that up until that date he was working light duty with no lifting over 20 pounds. Dr. Volarich agreed that prior to May 2002, Claimant was working full duty with no restrictions.