There is a dispute between the parties as to whether the Fund is liable for permanent partial or permanent total disability benefits for the June 3, 2008 work injury. The Court finds that the Second Injury Fund is responsible for permanent total disability in this case due to a combination of the employee's pre-existing disabilities and those disabilities created by the June 3, 2008 work accident.
In reaching this finding, the Court first established that Employee was permanently and totally disabled. As previously stated, the employee has undergone extensive surgical and nonsurgical care for his pre-existing and primary injuries. Moreover, there is no dispute or medical evidence that contravenes this determination. Upon finding that Employee was permanently and totally disabled, the Court then determined that the Fund was liable for permanent total disability benefits based on the combination of the June 3, 2008 primary work related injury and those injuries that pre-existed, which included his prior low back injuries.
The uncontradicted evidence established the following:
- Employee suffered from low back injuries which resulted in a surgical fusion of the L3/4 and L4/5 levels in 2000. The employee continued to treat this condition with his primary care physician and by home exercise, which included a regimen of using a treadmill to strengthen his low back.
- On June 3, 2008, Employee suffered a traumatic crush injury to his right leg which also twisted the employee and resulted in a fractured fibula, disruption of the sural nerve, chronic ankle instability and chronic swelling of the right lower leg.
- Dr. Aubuchon also noted from the employee's history that Employee had previously injured the right ankle approximately 30 years prior and a review of the MRI scan showed that the work injury had aggravated the pre-existing arthritis of the Os trigonum.
- Drs. Trueblood, Aubuchon, Guidos and Woiteshek all opined that Employee would require compression stockings permanently to control the chronic swelling of his right leg.
- Dr. Aubuchon, Select Physical Therapy, Dr. Guidos and Dr. Woiteshek all recorded that the employee's gait was also altered as a result the work injury.
- Employee testified that his persistent swelling and abnormal gait prevented him from continuing his home exercise for his low back or using a treadmill. Dr. Guidos testified
that the employee's inability to exercise and use a treadmill to exercise had exacerbated his pre-existing low back pain.
- Employee testified that he was demoted to lighter duty work, which allowed him to sit through the day, but during the course of his treatment he was unable to continue doing so as a result of his low back and right lower extremity injuries and symptoms.
- Dr. Guidos believed that the employee could only stand or walk as tolerated and should limit lifting, bending, twisting and stooping. Dr. Guidos prescribed a TENS unit and heel lift along with narcotic medication for his low back symptoms. Dr. Guidos also opined that Employee was permanently and totally disabled from his current occupation due to a combination of the low back and right lower extremity injuries.
- Dr. Woiteshek believed that Employee was permanently and totally disabled due to the combination of his right lower extremity and low back conditions. Dr. Woiteshek prescribed restrictions for both body areas.
- Employee and his wife testified that Employee is limited in his daily activities and that he spends most of his day in a recliner to both relieve his low back pain and keep his right leg elevated to minimize the swelling.
- Dr. Magrowski opined that Employee was unemployable in the open labor market. Dr. Magrowski identified that the serious nature of Employee's limitations including sitting in a recliner with his legs elevated, use of support hose, pain medication (Lortab) and use of TENS unit supported this conclusion that he was unemployable. Dr. Magrowski also believed that no employer would hire the employee for a job reasonably expecting him to perform the full range of the job with his low back and right leg conditions.
- The employee testified and the contemporaneous medical records show that he applied for and was approved for Social Security Disability prior to his maximum medical improvement date of February 10, 2010. It is also noted that the employee was 57 years old as of his MMI date.
This is a clear case of a serious primary injury, the crushing and twisting of the employee's right leg, combining with old injuries to the low back and right ankle to create a greater overall disability. The primary injury made the low back condition worse by causing constant swelling in the right leg and altering the employee's gait. Logically, the employee's inability to walk for any length of time or in a normal stride prevents him from being able to continue exercising his low back as he did prior to the work accident and led to greater low back pain (i.e. the diagnosis of SI joint dysfunction).
The Court had the opportunity to observe and assess Employee at the hearing and found his testimony and behaviors to be persuasive in reaching the conclusion that he is permanently and totally disabled. The Court found Employee's testimony to be honest and credible. The Court noted that Employee used a lumbar support cushion to assist while seated and that by the end of
direct testimony the employee appeared to be in great discomfort with a reddened face and perspiring. Further, the Court notes that the Fund failed to offer any evidence to discredit the opinions of Drs. Guidos, Woiteshek or Magrowski. Therefore, the Court should not substitute its own opinion for uncontroverted medical evidence.
In considering all of the evidence, the Court finds that Employee is permanently and totally disabled due to the combination of the June 3, 2008 work related injury with the pre-existing low back and right ankle conditions. Because the Court finds that it is the synergistic combination of the pre-existing and primary injuries that render Employee permanently and totally disabled, and the Fund is therefore liable for permanent and total disability benefits.
The parties stipulated that Employee reached maximum medical improvement for his primary injury on February 10, 2010. Further, the Court concurs with the previously approved stipulation for compromise settlement and finds that the permanent partial disability resulting from the June 3, 2008 work injury is 25 % of the right knee and 2 % of the body as a whole, which translates to 48 weeks of benefits.
Second Injury Fund liability for permanent total disability begins on February 10, 2010 when Employee was determined to be at maximum improvement for his work related injury. However, the Second Injury Fund is entitled to a credit of 48 weeks for the permanent partial disability benefits paid by the employer. By calendar, 48 weeks after February 10, 2010 is January 12, 2011. Employee's rate for permanent total disability benefits is $\ 466.67 and his rate for permanent partial disability benefits is $\ 389.04. The Fund is entitled to a credit for the 48 weeks of permanent partial disability paid by the Employer/insurer. The Missouri State Treasurer as Custodian of the Second Injury Fund is therefore responsible to pay the difference between the two rates for a total of $\ 3,726.24 for the period of February 10, 2010 through January 12, 2011. Thereafter, the Missouri State Treasurer as Custodian of the Second Injury Fund is ordered to pay Employee $\ 466.67 per week beginning January 13, 2011 for the remainder of his lifetime or until suspended if he is restored to regular work or its equivalent as provided in $\S 287.200$.