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Bennie Johnston v. Arch Johnston Paving & Quarry

Decision date: November 1, 201337 pages

Summary

The Labor and Industrial Relations Commission modified the administrative law judge's award, finding that the employee sustained a work-related lumbar sprain but denying claims for myofascial pain syndrome, psychiatric injury, and permanent total disability. The employee was awarded 10% permanent partial disability referable to the lumbar spine with an overpayment credit of $1,157.47, and the Second Injury Fund was found to have no liability.

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Caption

FINAL AWARD ALLOWING COMPENSATION (Modifying Award and Decision of Administrative Law Judge)
Employee:Bennie Johnston
Employer:Arch Johnston Paving & Quarry
Insurer:Missouri Employers Mutual Insurance
Additional Party:Treasurer of Missouri as Custodian of Second Injury Fund
This workers’ compensation case is submitted to the Labor and Industrial Relations Commission (Commission) for review as provided by § 287.480 RSMo. We have reviewed the evidence, read the parties’ briefs, heard the parties’ arguments, and considered the whole record. Pursuant to § 286.090 RSMo, we modify the award and decision of the administrative law judge. We adopt the findings, conclusions, decision, and award of the administrative law judge to the extent that they are not inconsistent with the findings, conclusions, decision, and modifications set forth below.
Preliminaries
The parties asked the administrative law judge to resolve the following issues: (1) medical causation; (2) past medical in the amount of $14,734.13; (3) future medical aid; (4) additional temporary total disability; (5) permanent total disability against the Second Injury Fund or employer; (6) permanent partial disability against the Second Injury Fund and/or employer; and (7) whether there was an overpayment of temporary total and temporary partial disability in the amount of $1,157.47.
The administrative law judge rendered the following findings and conclusions: (1) employee’s work was a substantial factor in causing employee to suffer a lumbar sprain, but the work was not a substantial factor in causing myofascial pain syndrome or any psychiatric injury; (2) employee’s request for additional medical aid is denied; (3) employer is ordered to pay any unpaid bills from Dr. Klinginsmith as outlined in Exhibit U for dates of service from November 27, 2002, through February 14, 2003; (4) employer is not responsible for the payment of any other medical expenses outlined by the employee in Exhibit U; (5) employee’s request for payment of any medical expenses associated with psychiatric conditions is denied; (6) employee’s request for temporary total disability benefits after February 14, 2003, is denied; (7) employee’s reporting of his complaints is not credible in light of inconsistencies between employee’s complaints and the medical records; (8) the opinions of Dr. Tate and Mr. England are more credible than the opinions of Dr. Volarich and Mr. Dolan on the issue of permanent total disability; (9) employee did not prove that he was unemployable in the open labor market; (10) employee sustained a 10% permanent partial disability of the body as a whole referable to the lumbar spine from the November 27, 2002, work accident; (11) the Second Injury Fund does not have any liability for permanent partial disability because employee’s primary injury did not meet the statutory threshold; and (12) employer is entitled to a credit for overpayment of benefits in the amount of $1,157.47.

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Permanent total disability

The administrative law judge found that employee is not permanently and totally disabled, based on a finding that employee's testimony regarding his complaints lacks credibility, and a finding that Dr. Tate and Mr. England provided the more credible opinions regarding the issue of permanent total disability. Although the record certainly provides ample support for that result, we disagree for the following reasons.

Employee suffers from well-documented cognitive limitations and psychiatric difficulties. Employee attended special education courses in school until he entered the labor market after the fifth or sixth grade. Employee's testimony at the hearing reveals that he has a poor memory; employee was unable to recite his own Social Security number. Both psychiatric experts who testified agreed that employee suffers from an anxiety disorder, although the doctors disagree whether it was preexisting. We find particularly persuasive the testimony from Dr. Harbit that, although the primary injury did not cause employee's anxiety condition, the primary injury has certainly become the focus of employee's anxiety, to the extent that he now attributes all of his problems to that event. We interpret this as an opinion from Dr. Harbit that there is a synergistic interaction between employee's preexisting psychiatric disability and the effects of the primary injury.

Employee's denial of preexisting complaints and attribution of all of his problems to the primary injury thus appears to be a byproduct of cognitive and psychiatric difficulties, rather than any conscious attempt to mislead. Seen in this light, employee's poor memory and inconsistent testimony lend support to the opinions from both Drs. Harbit and Stillings that employee's cognitive and psychiatric problems significantly impact his employability. We note that Dr. Harbit went so far as to express her belief that employee is permanently and totally disabled on the basis of his preexisting conditions and lifelong cognitive limitations alone.

In light of the fact employee was working up to 60 hours per week performing heavy-duty work for employer at the time of the primary injury, and because "a test for probable future employment cannot change the fact of past employment" Laturno v. Carnahan, 640 S.W.2d 470, 473 (Mo. App. 1982), we do not find persuasive Dr. Harbit's suggestion that employee was permanently and totally disabled before the primary injury. We do, however, find persuasive her opinion that employee suffered from preexisting borderline intellectual functioning and an anxiety disorder at the time of the primary injury, and that these diagnoses amounted to permanent disabling conditions that significantly impacted his employability. We also accept Dr. Harbit's opinions that employee did not suffer any additional psychiatric disability due to the primary injury, that employer has no liability for future psychiatric care, and that there is a synergistic effect between employee's preexisting psychiatric disability and the effects of the primary injury.

Mr. Dolan opined that employee is permanently and totally disabled owing to a combination of his preexisting cognitive and psychiatric problems and the effects of the primary injury. Mr. Dolan pointed to decades of experience in working with individuals with low IQs, and explained that individuals with very low intellectual functioning are dependent upon their physicality to get through the world. A physical injury is thus far more devastating to such an individual, as they've lost their sole asset in terms of employability. Turning to the

Injury No.: 02-128697

Employee: Bennie Johnston

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opinions from Mr. England, we note that he opined that if the fact-finder accepts the opinions from Drs. Volarich and from Dr. Stillings (who, like Dr. Harbit, opined that employee suffers from considerable preexisting psychiatric disability) employee is permanently and totally disabled owing to a combination of his preexisting conditions with the effects of the primary injury. In this respect, Mr. England's testimony does not strike us as significantly inconsistent with that of Mr. Dolan.

In light of our findings with respect to employee's preexisting psychiatric and cognitive disabilities, we deem Mr. Dolan's ultimate opinions regarding permanent total disability to be the most persuasive on this record. Accordingly, we adopt Mr. Dolan's opinion that employee is permanently and totally disabled owing to a combination of his preexisting disabling conditions and the effects of the primary injury. We find that employee reached maximum medical improvement from the effects of the primary injury on February 14, 2003.

Medical causation

Section 287.020.2 RSMo sets forth the standard for medical causation applicable to this claim and provides, in relevant part, as follows:

> An injury is compensable if it is clearly work related. An injury is clearly work related if work was a substantial factor in the cause of the resulting medical condition or disability.

We have modified the credibility findings of the administrative law judge and found that Dr. Volarich is more credible than Dr. Tate on the issue of medical causation. We conclude that work was a substantial factor in causing employee to suffer the resulting medical condition of a lumbar strain, as well as permanent partial disability to the extent of 10% of the body as a whole referable to the lumbar spine.

Unpaid and authorized past medical expenses

The administrative law judge ordered employer to pay all authorized and unpaid medical expenses relating to treatment from Dr. Klinginsmith, but also concluded that employer is not liable for any of the other medical expenses reflected in employee's Exhibit U. See *Award*, page 26. We agree with this result, although we note that the administrative law judge applied the "substantial factor" test for medical causation in her analysis under § 287.140 RSMo. The courts have made clear that the appropriate test under § 287.140 is whether the disputed treatments were reasonably required to cure and relieve the effects of the work injury. *Tillotson v. St. Joseph Med. Ctr.*, 347 S.W.3d 511, 518 (Mo. App. 2011). We wish to make clear that we have applied the appropriate test in our analysis, and that we decline to award additional past medical expenses to employee because he has failed to persuade us that his self-directed medical treatments after February 14, 2003, were reasonably required to cure and relieve the effects of his lumbar strain injury.

We note that employee argues, in his brief, that the administrative law judge's award failed to include the costs of an MRI ordered by Dr. Klinginsmith. Employee fails to explain how the administrative law judge's award works that effect, and also fails to provide a citation to the record where the disputed bill and treatment records may be found.

To the extent that such a clarification appears to be necessary, we specifically conclude that employer is liable for all authorized and unpaid medical expenses incurred through February 14, 2003. This, of course, includes the aforementioned bill from Health South Diagnostic Center in the amount of $\ 1,100.00 for an MRI ordered by Dr. Klinginsmith on January 22, 2003.

Second Injury Fund liability

Section 287.220 RSMo creates the Second Injury Fund and provides when and what compensation shall be paid in "all cases of permanent disability where there has been previous disability." As a preliminary matter, the employee must demonstrate "a preexisting permanent partial disability whether from compensable injury or otherwise, of such seriousness as to constitute a hindrance or obstacle to employment or to obtaining reemployment if the employee becomes unemployed..." Id. The Missouri courts have articulated the following test for determining whether a preexisting disability constitutes a "hindrance or obstacle to employment":

[T]he proper focus of the inquiry is not on the extent to which the condition has caused difficulty in the past; it is on the potential that the condition may combine with a work-related injury in the future so as to cause a greater degree of disability than would have resulted in the absence of the condition.

Knisley v. Charleswood Corp., 211 S.W.3d 629, 637 (Mo. App. 2007)(citation omitted).

We have found that employee suffered from preexisting permanent partially disabling psychiat

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

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