Saban Saric v. Centaur Building Services, Inc.

corroborate this notation. We find that there is insufficient evidence to support a finding that employee operated a retail store or that he acquired vocationally significant skills through such an endeavor.

Since his arrival in the United States, employee has worked on a line sorting chemicals, as an assembler, as a janitor, and as a dish washer.

Employee cannot read, write, or speak English. He testified at the hearing through an interpreter. He primarily communicated with treating professionals and experts through a family member or friend acting as an interpreter. The record is rife with notations of various individuals having difficulty communicating with employee.

Before the primary back injury, employee sustained three lifting-related back injuries.

On February 28, 2001, employee suffered a work-related low back injury while lifting a cabinet. Employee reported low back and left leg pain. After an MRI, Dr. Lee diagnosed a herniated disc at L3-4, with diffuse radicular symptoms. Dr. Lee placed employee on light duty and prescribed pain medication and physical therapy. A follow-up MRI and a CT scan revealed that in addition to the herniation at L3-4, employee had a diffuse disc bulge at L4-5. Dr. Lee diagnosed degenerative disc disease at L3-4 and L4-5. Dr. Lee treated employee conservatively through May 23, 2001, at which time Dr. Lee released employee to return to work full-duty. Employee was still reporting persistent symptoms at that time.

On August 19, 2002, employee was admitted to the emergency room with low back pain. Employee reported he injured his back on August 16, 2002, lifting trash at work. An August 19th MRI suggested a central herniated disc at L3-4, asymmetric to the left. Dr. Backer recommended treatment with pain medications. A myelogram and CT scan were performed on August 26, 2002, after which Dr. Backer diagnosed a herniated nucleus pulposus at L3-4 central and slightly right. The CT scan also revealed bulging discs at L4-5 and L5-S1. Employee underwent a lumbar steroid injection. Employee was released from the hospital August 27, 2002. Dr. Backer examined employee again on October 1, 2002, at which time employee reported continued low back and left leg pain. On examination, employee displayed a decreased pin appreciation down his entire left leg in a non-dermatomal distribution. Dr. Backer requested a new MRI which showed no significant change from the earlier MRI. Dr. Backer last examined employee on October 25, 2002.

Dr. Chabot assumed treatment of employee. He initially examined employee on November 18, 2002, at which time he noted moderate spasm in the lumbar region and decreased sensation in the left lower extremity in a diffuse, non-dermatomal distribution. Dr. Chabot recommended pain medication, muscle relaxers, and physical therapy. Dr. Chabot next examined employee on December 16, 2002, at which time employee

Complained of persistent left buttock pain into his legs. Dr. Chabot did not think the October 2, 2002, MRI correlated with employee's complaints of radiating pain. Dr. Chabot diagnosed sacroiliitis, sciatica, and back pain. Employee received three trigger point injections of Mercaine, after which he reported a marked reduction in his symptoms. Dr. Chabot continued employee on pain medication and physical therapy. Dr. Chabot examined employee on January 13, 2003, at which time he released employee to return to work light duty with a 25-pound lifting restriction. Dr. Chabot recommended a functional capacity evaluation (FCE), which was conducted on January 20, 2003. The physical therapist reported that he was unable to accurately identify employee's abilities and limitations due to employee's self-limiting performance on the FCE. Dr. Chabot last examined employee on January 30, 2003. Dr. Chabot released employee from his care with a lifting restriction of 20 pounds and a recommendation that employee limit twisting and bending. Dr. Chabot opined that employee sustained a 5% permanent partial disability of the body as a whole as a result of the lumbar strain resultant from his August 2002, work injury.

On October 17, 2004, employee collapsed while lifting a trash can. Employee reported he was unsure what the trash can weigh, but it was heavy enough that two workers were needed to lift it. Employee reported to the emergency room on October 23, 2004, complaining of severe low back pain. An MRI was performed revealing a right paracentral disc herniation at L3. The MRI also revealed an annular tear or fissure at L4.

Employee resumed treatment with Dr. Lee. On November 1, 2004, Dr. Lee examined employee. Dr. Lee diagnosed a right paracentral protrusion/herniated nucleus pulposus. He prescribed pain medications and physical therapy. Dr. Lee recommended restrictions of no lifting over 15 pounds, no bending, and no stairs. Dr. Lee saw employee on November 17, 2004, at which time employee's complaints included right gluteal pain and right sacroiliac pain. On December 1, 2004, employee complained of right lower extremity pain (thigh or whole leg) and right sacroiliac pain. Dr. Lee felt a new MRI revealed a more focal right-sided disc protrusion at L3. Dr. Lee raised employee's lifting restriction to 20 pounds. Dr. Lee recommended that employee undergo epidural injections, which were performed on December 3rd and December 14th. Employee continued with physical therapy. On examination January 3, 2005, employee reported improvement with pain medication. Dr. Lee last saw employee on January 17, 2005. Dr. Lee believed employee was self-limiting his activity. Dr. Lee found employee to be at maximum medical improvement. He raised employee's lifting restriction to 25 pounds and recommended employee refrain from repetitive twisting. He prescribed pain medication and muscle relaxers. Dr. Lee opined that employee sustained a 2% permanent partial disability of the body as a whole as a result of the October 17, 2004, lifting incident.

Employee testified that when he lived in Bosnia, he witnessed horrible atrocities including bombings and the brutal killing of individuals.

Dr. Ilina Moreno, a licensed psychologist and native speaker of Yugoslavian languages, began counseling employee in his home on April 15, 2006. She prepared a report dated

June 14, 2007, detailing her assessment of employee's mental health. Dr. Moreno's assessment was that employee suffered from severe depression and post-traumatic stress disorder (PTSD). Dr. Moreno noted that employee had significant impairments in social, occupational, and other important areas of functioning. She also reported that employee's cognitive functioning is impaired as is manifested by his memory loss, poor concentration, and short attention span. Dr. Moreno believes employee would have difficulty maintaining work and work relationships. Eventually, due to the seriousness of employee's diagnoses and his need for medication, Dr. Moreno referred employee to psychiatrist Dr. Marcu.

Dr. Marcu began treating employee on June 1, 2006. Dr. Marcu's assessment was that employee suffered from bipolar disorder and post-traumatic stress disorder (PTSD). Dr. Marcu assigned a GAF score of 40. Dr. Marcu prescribed an anti-depressant, an anti-anxiety medication, and therapy. Employee participated in therapy through Dr. Marcu's office once or twice monthly through March 2009.

Employee has long suffered from asthma for which he uses an inhaler. Dr. Lee's earliest record in 2001 reports a history of asthma. Employee's asthma causes him shortness of breath and loss of stamina. The shortness of breath is exacerbated by cold, damp, and humid weather.

While undergoing medical tests to determine if he was fit for surgery after the 2006 back injury, doctors determined that employee had markedly abnormal left ventricular function with a large region of fixed inferoposterior defect, which was consistent with a previous inferior infarct. Dr. Hess performed a cardiac catheterization which revealed coronary artery disease. Employee had an 80\% blockage of his proximal circumflex vessel and a 90 % blockage of his mid left anterior descending vessels. Dr. Hess placed stents in both vessels. After the procedure, both vessels were fully patent. Dr. Hess cleared employee for surgery but noted that employee would be at an increased risk for surgical complications. We find that this heart condition preexisted the primary injury. But since no medical expert offered an opinion regarding the disability associated with the preexisting heart condition, we make no findings regarding the nature and extent of any preexisting disability associated with the heart condition.

The medical records and expert testimony confirm that employee has had longstanding problems with his blood pressure. Again, no medical expert offered an opinion regarding the disability associated with the preexisting hypertension, so we make no findings regarding the nature and extent of any preexisting disability associated with his preexisting hypertension.

$4^{\text {th }}$ back injury--2006

On July 25, 2006, employee experienced sudden lumbosacral pain while lifting a trash can. On July $27^{\text {th }}$, employee reported to Concentra where he was seen by Dr. Raikar. Examination revealed tenderness in lumbosacral spine on the right. Employee denied radiating pain. The straight leg raising test was negative.