Claimant was born December 26, 1959 and is 53 years of age. Claimant has worked for the University of Missouri ("Employer") since June 2009 as a Hospitality Coordinator. For approximately the first two years of Claimant's employment with Employer, Claimant also worked part-time (approximately 26 hours) on the weekends at Menard's. Claimant's job as a Hospitality Coordinator requires her to run errands in the hospital for patients, move patients' belongings, charge their cell phones, retrieve items from surgery, and discharge patients. Claimant continues to work in this capacity.
On March 20, 2011, while engaged in employment and performing her work duties at University of Missouri Hospital, Claimant fell while walking quickly up a flight of stairs. She was bringing a cell phone from the ground floor to the fifth floor of the ICU tower to deliver the cell phone to a patient. Claimant testified that she navigates stairs at work approximately 8-12 times per work shift and that the area of the hospital she was walking to required her to use stairs as the new part of the building was added on. No elevator goes directly from the ground floor of the main hospital to the fifth floor of the ICU tower; Claimant had to use the elevator to the fifth floor of the main building, then walk down a hallway and ascend a partial flight of stairs to the fifth floor of the ICU tower. Claimant sustained the fall on this partial flight of stairs. Claimant was holding the patient's cell phone in her left hand; Claimant was not sure if she was holding anything in her right hand. She was wearing a radio on her right side. She was wearing rubbersoled flat shoes with no heel.
Claimant testified that she fell forward on the stairs and twisted her back. She felt immediate severe pain in her low back. Her immediate symptoms were a burning in her calf and toes, pain in the right hip, and radiating pain into her right thigh. Claimant was sent to Work Injury Services at University Hospital on the day of the accident. She then treated with Dr. Kevin Komes who made a diagnosis of lumbar strain and right hip pain. Physical therapy was ordered. Claimant continued with physical therapy through June when an MRI was finally performed. The MRI of July 14, 2011 showed T12-L1 broad-based disc herniation and L4-L5 disc bulge with compression on the anterior thecal sac. Claimant was referred to Dr. John Miles, an orthopedic surgeon.
Dr. Miles evaluated Claimant on August 2, 2011 and noted pain in her low back radiating into right hip, down into her right calf, and numbness into the right calf and foot. He interpreted the MRI as showing a bulge at L4-L5, T12-L1, and stenosis at L4-L5. He recommended an additional nerve conduction study. The EMG of August 9, 2011 was normal and Dr. Miles diagnosed early instability at L4-L5, with no significant stenosis and no herniations. He felt the
instability was "her prime problem facing her at this juncture, but it is very difficult to link that to her work place incident." He recommended a functional capacity exam.
Claimant was referred for an epidural steroid injection by Dr. Ebby Varghese. Claimant underwent two injections which did not alleviate her symptoms. In November, Dr. Varghese recommended a dorsal column stimulator. This was not done, however, and instead Claimant was sent back to Dr. Komes who said Claimant was at maximum medical improvement and returned her to full duty. Dr. Komes opined that Claimant had no permanent partial disability. He also indicated that he did not agree with the recommendation of Dr. Varghese for a spinal cord stimulator.
Claimant was evaluated by Dr. David Robson, a spine surgeon, on April 5, 2012. Dr. Robson indicated that Claimant's symptoms continued to consist of aching, stabbing and burning in the low back which radiated into her right buttock and down the right leg. He noted numbness in the right foot. Dr. Robson said the MRI of June 14, 2011, "shows a central disc bulge at L4-5 with a high intensity zone. This is producing bilateral foraminal stenosis. Additionally, it is noted that she has bilateral renal cysts." He assessed a "herniated nucleus pulposus at L4-L5 with an annular tear and bilateral foraminal stenosis." Dr. Robson further recommended an anterior lumbar fusion at L4-5. He stated, "due to the findings on the MRI of a disc herniation accompanied by a high intensity zone lesion it is likely this represents an acute lesion." Dr. Robson found that the work injury was the prevailing factor in the development of the herniation at L4-5.
Dr. Michael Chabot evaluated Claimant on July 26, 2012. Dr. Chabot also noted low back pain along with radiation into both sides of the thighs, burning and aching into the right leg to the right calf, and parasthesias into the right foot. He interpreted the MRI as showing spinal narrowing at L4-L5, no evidence of a disc herniation at L4-L5, but disc bulging associated with disc desiccation and degeneration. He also noted early instability at L4-L5. Dr. Chabot diagnosed chronic SI joint dysfunction with sacroiliitis and disc degeneration. He felt that her complaints were not related to the disc pathology at L4-L5 and that there was no indication for surgery at L4-L5. He did not feel there was any evidence of acute traumatic changes at the L4-5 level. He also stated that "any indication for surgical intervention at the L4-5 level is not causally related to her alleged March 20, 2011 injury." He stated that any surgery in the future for the L4-L5 disease was related to chronic degenerative changes. Dr. Chabot provided a permanent partial disability of 3 % of the body as t