The claimant, Tammy Moore Ransdell, worked in the Randolph County assessor's office since 1998 as a deeds clerk responsible for updating property records. On February 26, 2008, Ms. Ransdell was changing the property records cards, which were physically housed in file folders in file cabinets. Ms. Ransdell squatted down attempting to pull out a lower file drawer, which she described as too full. Ms. Ransdell reached into the back of the file drawer twisting to remove the file and experienced extreme low back pain. Ms. Ransdell finished the day but had too much low back pain the following day to get out of bed. Ms. Ransdell received initial medical attention from Dr. Tiede, who had treated her for neck pain before, and eventually
received medical care from Dr. Highland, who performed an anterior fusion in November of 2010. Ms. Ransdell described herself as doing well after the surgery until this past June when a broken screw was discovered; Ms. Ransdell believes that she will eventually need a refusion of her back. Currently Ms. Ransdell describes pain in her back causing her to be unable to sit comfortably for more than 45 to 50 minutes and be unable to stand for more than 30 to 40 minutes without an increase in low back pain. Ms. Ransdell described taking vicodin for pain, as well as medication for nerve pain and muscle relaxation, as well as Cymbalta for depression.
During cross-examination Ms. Ransdell admitted taking medication for nerve pain prior to 2008.
Dr. Thomas Highland, orthopedic surgeon specializing in treatment of the spine since 1985, testified by deposition that he initially saw Ms. Ransdell on May 5, 2008, as a referral from Dr. Foster for back pain originating from an injury on February 26, 2008. After he saw her in July of 2008, Dr. Highland performed a discogram on Ms. Ransdell and determined that Ms. Ransdell had degeneration in the discs at L3-4, L4-5 and L5-S1 and recommended a three-level fusion for those discs. Dr. Highland specifically noted that the disc above the three problematic discs was not painful when injected; he referred to the disc which was not painful as the control disc. When Dr. Highland next saw Ms. Ransdell in August of 2010, he took an x-ray of Ms. Ransdell and noted that the discs at all three levels had gotten worse, particularly at the L5-S1 level. An MRI confirmed the deterioration at the three discs mentioned. Dr. Highland described his surgery on Ms. Ransdell on November 3, 2010, as removal of the "bad' discs, a fusion, a bone graft using cadaver bone, and a plate anteriorly as well as a laminectomy and fusion posteriorly.
Dr. Highland said that the injury of February 26, 2008, in which Ms. Ransdell squatted and twisted to get a file, caused the condition for which he treated her, including the surgery. At the time of his deposition on March 4, 2011, Dr. Highland opined that it was too early to assess permanent partial disability. Dr. Highland was asked about the factors contributing to Ms. Ransdell's condition and replied that the lumbar strain was the primary factor in causing Ms. Ransdell's condition. Dr. Highland acknowledged that the lumbar strain alone would not have necessitated Ms. Ransdell's three-level fusion without the underlying degenerative condition.
In a January 25, 2012 report, Dr. Highland opined that Ms. Ransdell had an acute lumbar strain as well as internal disc disruption at L3-4, L4-5 and L5-S1 in February of 2008 resulting in anterior and posterior fusion at those levels resulting in 25 percent permanent partial disability of the body.
Ms. Ransdell has continued under Dr. Highland's care for treatment of her back other than the lumbosacral back, including her thoracic spine. When Dr. Highland saw Ms. Ransdell on July 9, 2012, he noted that Ms. Ransdell complained of increasing low back pain after falling off of a raft and twisting in the water two weeks prior to the time he saw her. Dr. Highland also noted that a June 2011 x-ray revealed a broken screw at the S1 level, but that Ms. Ransdell had no complaints of pain associated with the broken screw when it was discovered the year prior. When Dr. Highland saw Ms. Ransdell on September 4, 2012, he recommended the use of a bone stimulator, but did not relate it to the 2008 accident or to later events.
Dr. Michael Chabot, board certified in orthopedic surgery and a trained spine surgeon, testified by deposition that he evaluated Ms. Ransdell on October 16, 2008. Dr. Chabot testified that Ms. Ransdell may have suffered a back strain on February 26, 2008, but that her back pain is caused by her preexisting advanced degeneration of multiple levels of the lumbar spine. Dr. Chabot noted in his report that Ms. Ransdell had left lower extremity complaints prior to February 26, 2008; Dr. Chabot noted in his deposition testimony that "if it's associated with acute injury such as a disk herniation one would expect that, one, you would see a lesion or disk lesion on that same side of the complaints like the left side. You would also expect to see changes involving the extremity that would most likely corroborate with nerve entrapment or nerve irritation. An acute injury of any substantial merit you would expect to see changes involving the ligament where you could have sustained a ligament irritation or a ligament inflammation. None of those changes were noted. The disk changes to the L4-5 level were on the right, not on the left." (Chabot depo p14,15) Dr. Chabot opined that the majority of Ms. Ransdell's treatment was for her chronic degenerative condition and not her "simple" back strain injury. Dr. Chabot stated that Ms. Ransdell had a positive disc provocation on all three lumbar levels during her discogram and that a control level was never found. Dr. Chabot admitted that his reference to a lack of a control level was incorrect during cross-examination. Dr. Chabot went on to say that the presence of a control disc does not change his opinion with regard to the propriety of a fusion for Ms. Ransdell and said that the statistical odds are against a successful three-level fusion.