Skip to content
Ott Law Firm

Kristine Hilgart v. Kabul Nursing Homes, Inc.

Decision date: July 25, 201221 pages

Summary

The LIRC modified the ALJ's award to grant enhanced permanent partial disability benefits against the Second Injury Fund for an employee who injured her low back in December 2009 while assisting another nurse moving a patient. The employee, who was never released to return to work and experiences constant pain radiating to her hip and leg, sought permanent total disability benefits, with medical evidence attributing her restrictions to both her work-related back condition and fibromyalgia.

Archive Notice

This archive contains published Missouri Labor and Industrial Relations Commission workers' compensation decisions reproduced for research convenience. Official source links remain authoritative where provided. Joseph Ott, Attorney 67889, Ott Law Firm - Constant Victory - Personal Injury and Litigation maintains these public legal archives to support Missouri case research and to help prospective clients connect that research to the firm's courtroom practice.

Related Legal Help

Practical guidance for this decision

Third-Party Injury Check

This workers' comp decision may point to a separate injury claim.

  • A driver, contractor, property owner, or equipment company may share fault.
  • The injury involved a vehicle, unsafe premises, defective equipment, or a non-employer vendor.
  • A serious injury or death may need both benefits review and civil-claim analysis.

Caption

FINAL AWARD ALLOWING COMPENSATION

(Modifying Award and Decision of Administrative Law Judge)

Injury No.: 09-100903

Employee: Kristine Hilgart

Employer: Kabul Nursing Homes, Inc. (Settled)

Insurer: Missouri Nursing Home Insurance Trust (Settled)

Additional Party: Treasurer of Missouri as Custodian of Second Injury Fund

This cause has been submitted to the Labor and Industrial Relations Commission (Commission) for review as provided by $\S 287.480 RSMo. { }^{1}$ We have reviewed the evidence and briefs, and we have considered the whole record. Pursuant to § 286.090 RSMo, the Commission modifies the award and decision of the administrative law judge (ALJ) dated January 3, 2012.

Preliminaries

On December 20, 2009, employee injured her low back at work while assisting another nurse moving a patient onto a bed. Employee settled her permanent partial disability claim against employer/insurer. Employee proceeded to final hearing of her claim against the Second Injury Fund.

The ALJ awarded enhanced permanent partial disability against the Second Injury Fund. Employee appealed to the Commission alleging that the ALJ erred in denying her claim for permanent total disability (PTD) benefits from the Second Injury Fund.

Findings of Fact

The findings of fact and stipulations of the parties were accurately recounted in the award of the ALJ and, to the extent they are not inconsistent with the findings listed below, they are incorporated and adopted by the Commission herein.

Following employee's December 20, 2009, work injury, she was never released to return to work again. Employee testified that she is presently in constant pain that she rates as an 8 to 10 on a scale of 1 to 10 . The constant pain that she had in her back before the December 20, 2009, work accident now also extends into her left hip and leg. Employee stated that she has pain if she sits in place for more than 15 minutes and she needs to frequently switch positions from sitting to standing.

Employee testified that prior to the December 20, 2009, work accident she would often have to lie down in the evening with a heated pad on her back to relieve her pain. Employee stated that immediately after the December 20, 2009, work accident she began having to lie down during the day. Employee testified that she currently has to lie down at least two or three times a day.

[^0]

[^0]: ${ }^{1}$ Statutory references are to the Revised Statutes of Missouri 2009 unless otherwise indicated.

Dr. Dale began seeing employee on April 15, 2010. He testified that employee's December 20, 2009, work accident caused an annular tear and back pain. Dr. Dale further testified that employee's degenerative disc disease was probably preexisting.

During Dr. Dale's deposition he was asked to go through each of employee's restrictions and provide his opinion as to whether each restriction was the result of employee's back condition or fibromyalgia. Dr. Dale attributed employee's restrictions of no climbing, stooping, kneeling, crouching, crawling, and reaching to employee's back condition. Dr. Dale attributed employee's restrictions associated with handling, fingering, and feeling to employee's fibromyalgia. Dr. Dale then testified, "the pain factors, the need to even lie down, essentially the fibromyalgia isn't causing that so much. And then the pain medication is pretty much for the back problem." Dr. Dale attributed employee's lifting restriction of less than five pounds to both the back condition and the fibromyalgia. In clarification, Dr. Dale affirmatively testified that the lifting restriction of less than five pounds was independently caused by both the back condition and the fibromyalgia.

Dr. Dale testified that employee could only continuously walk for 15 minutes before she has an exacerbation of pain. He attributed this exacerbation of pain to both the back condition and the fibromyalgia, independently. With respect to this walking restriction, Dr. Dale further stated that if employee were to continuously walk for 15 minutes, day in and day out, he "would expect her to not be able to show up for work at least one day a week."

Dr. Dale also found that employee could not sit for more than 45 continuous minutes before experiencing an exacerbation of lumbar pain. Dr. Dale testified that employee could get away with more sitting if she lies down frequently, rests her back, and pays attention to her habits.

With respect to employee's pain factors, Dr. Dale testified that employee needs to lie down 15-20 minutes every 45 minutes during an eight-hour workday in order to prevent her from experiencing an exacerbation of pain that would preclude her from being able to go to work for the next several days. Dr. Dale listed in his Medical Source Statement that employee is only able to sit for two hours (total) throughout an eight-hour workday (with usual breaks) and only able to stand and/or walk for two hours (total) throughout an eight-hour workday (with usual breaks). Dr. Dale testified that without employee's fibromyalgia, her sitting, standing, and walking tolerances would be doubled to four hours during an eight-hour workday.

Dr. Swaim performed an independent medical evaluation of employee. Dr. Swaim never diagnosed employee with fibromyalgia or considered it in his reported limitations. During his deposition, however, Dr. Swaim did acknowledge that employee was diagnosed with fibromyalgia after the December 20, 2009, work injury.

Dr. Swaim testified that he believed "there are going to be times when [employee is] going to need to lie down in terms of treatment of her discomfort." Dr. Swaim noted in his report that he included that employee's "discomfort improved by changing positions, some limited improvement with Vicodin, and some limited improvement by lying down." Dr. Swaim went on to state that "there's going to be times when she may have to lie

Injury No.: 09-100903

Employee: Kristine Hilgart

-3 -

down longer or more frequent based on a lot of things, the amount of stress she puts on her back, or sometimes weather changes would cause the necessity for more treatment. So it would be more up to her. I wouldn't say you have to lie down half an hour every three hours or anything like that." (emphasis added).

Mr. Swearingin performed a vocational examination and evaluation of employee, and opined that employee is permanently and totally disabled as a result of the governing permanent restrictions caused by the work injury of December 20, 2009, and her preexisting low back condition. Mr. Swearingin testified that employee is unemployable due to her need to lie down throughout the day. Specifically, Mr. Swearingin stated, "people who have to lie down at the job are not going to hold employment, and that goes whether you have to lay down 30 minutes every day or whether you have to have a day or two a week that you lay down for a while. That just doesn't ... allow you to function in the labor market."

Lastly, Mr. Swearingin testified that it is employee's back pain that drives her need to periodically lie down throughout the day.

Employee settled her claim against employer/insurer. The settlement was based upon an approximate permanent partial disability of 12.5 % of the body as a whole referable to the lumbar spine. We find that this approximation is supported by the opinions of Dr. Swaim.

We find that as a result of the work injury, employee sustained permanent partial disability of 12.5 % of the body as a whole referable to the lumbar spine. We find employee reached maximum medical improvement on May 30, 2010, the date Dr. Swaim evaluated employee and opined the same in his independent medical evaluation report.

Discussion

The ALJ found that employee is permanently and totally disabled due to her need to lie down throughout the day. However, the ALJ denied employee's claim for PTD benefits against the Second Injury Fund because he found that "the restriction to lie down is causally related to, or at a minimum, requires consideration of the fibromyalgia/fibromyositis as a contributing medical condition causing such restrictions to be imposed upon [employee]." While we agree with the ALJ's finding that employee is permanently and totally disabled due to her need to lie down throughout the day, we disagree with the ALJ's finding that the restriction to lie down requires consideration of employee's fibromyalgia.

Based upon the medical expert opinions, vocational expert opinions, employee's testimony, and the record as a whole, we find that the prevailing factor in causing employee's need to lie down throughout the day is the combination of employee's December 20, 2009, work injury and the preexisting disability to her low back. While employee's subsequently diagnosed fibromyalgia may exacerbate her symptoms and contribute further to her need to lie down throughout the day, we find that the great weight of the evidence establishes that employee would need to lie down throughout the day without even considering her fibromyalgia.

Dr. Dale even testified that "essentially the fibromyalgia isn't causing [employee's need to lie down] so much." Dr. Swaim concluded that employee needed to lie down throughout the day, but did not even include fibromyalgia as part of his diagnoses in his independent medical evaluation report. Lastly, Mr. Swearingin specifically testified that employee's back pain, not her fibromyalgia, is what drives her need to lie down periodically throughout the day.

In Kizior v. Trans World Airlines, 5 S.W.3d 195 (Mo. App. W.D. 1999), overruled on other grounds, Hampton v. Big Boy Steel Erection, 121 S.W.3d 220 (Mo. banc 2003), the Court set out a step-by-step test for determining Second Injury Fund liability:

Section 287.220.1 contains four distinct steps in calculating the compensation due an employee, and from what source, in cases involving permanent disability: (1) the employer's liability is considered in isolation 'the employer at the time of the last injury shall be liable only for the degree or percentage of disability which would have resulted from the last injury had there been no preexisting disability'; (2) Next, the degree or percentage of the employee's disability attributable to all injuries existing at the time of the accident is considered; (3) The degree or percentage of disability existing prior to the last injury, combined with the disability resulting from the last injury, considered alone, is deducted from the combined disability; and (4) The balance becomes the responsibility of the Second Injury Fund.

Kizior, 5 S.W.3d at 200.

In this case we have previously found employee's permanent disability from the work injury to be 12.5 % of the body as a whole referable to the lumbar spine. Based upon the aforementioned, we conclude employee is permanently and totally disabled due to the combination of her December 20, 2009, work injury with her preexisting low back condition. Relying on the analysis provided in Kizior, there is no need to consider employee's subsequently diagnosed fibromyalgia. For the foregoing reasons, we find the Second Injury Fund liable to employee for permanent total disability benefits.

Award

We modify the award of the ALJ. Employee is permanently and totally disabled due to the combination of the disability from her December 20, 2009, work injury with her preexisting disability to her low back.

Beginning May 31, 2010, and continuing for 50 weeks $^{2}$, the Second Injury Fund shall be liable for the difference between employee's PTD rate and her PPD rate. Because both employee's PTD rate and PPD rate are $\ 321.58, there is no difference for the Second Injury Fund to cover for the 50 weeks attributable to the last injury. However, after said 50 weeks, the Second Injury Fund shall be liable for employee's weekly PTD benefit of $\ 321.58 for the remainder of employee's life, or until modified by law.

[^0]

[^0]: ${ }^{2}$ The work injury resulted in permanent partial disability of 50 weeks (lumbar spine/

Full decision text continues in the plain-text archive copy.

Related Decisions

affirmed

The Labor and Industrial Relations Commission affirmed the Administrative Law Judge's award allowing workers' compensation benefits to Theresa Thompson for a low back injury sustained on July 20, 2010 while lifting and shelving copper coils. The claimant was entitled to temporary total disability benefits, permanent partial disability compensation, and medical aid totaling over $223,000, with additional underpayment and back pay amounts owed.

back12,259 words

Brown v. Noranda Aluminum, Inc.(2023)

February 3, 2023#16-027102

affirmed

The Labor and Industrial Relations Commission affirmed the administrative law judge's award granting permanent total disability compensation to Donald Brown for his work-related injuries to his back and left elbow. The Commission rejected the Second Injury Fund's argument that an anxiety disability should be considered in the PTD determination, finding that non-qualifying psychiatric disabilities need not be factored into the analysis.

back7,339 words

The Commission modified the ALJ's award to allow compensation for unpaid past medical expenses for employee Rodney Battles, who sustained a work-related back injury on October 5, 2016, requiring two back surgeries. The decision clarifies that an employer's duty to provide statutorily-required medical aid is absolute and unqualified under Missouri workers' compensation law.

back6,444 words

Gourley v. Cox Medical Center(2021)

December 15, 2021#07-031701

affirmed

The Labor and Industrial Relations Commission affirmed the administrative law judge's award allowing workers' compensation benefits for Carol Gourley's injury sustained on January 13, 2007 at Cox Medical Center. One commissioner dissented, arguing the ALJ erred in denying payment for unpaid medical bills ($173,896.25) and temporary total disability benefits ($109,574.64) related to the compensable 2007 injury.

back12,971 words

Comer v. Central Programs, Inc.(2021)

August 11, 2021#16-085212

affirmed

The Commission affirmed the Administrative Law Judge's award of permanent total disability compensation, finding the employee's November 1, 2016 back injury combined with qualifying preexisting disabilities met statutory requirements for Second Injury Fund liability. The employee's preexisting lower left extremity and thoracic disabilities, each exceeding fifty weeks of permanent partial disability, directly aggravated and accelerated the primary work-related back injury resulting in permanent total disability.

back14,532 words