The administrative law judge determined that employee failed to establish his urinary incontinence resulted from his low back work injury. We disagree for the following reasons.
It is uncontested that employee now suffers from urinary incontinence. At the time of the accident on November 17, 2008, employee was 40 years of age. At oral argument in this matter, the parties agreed that there is no evidence on this record that would support a finding that employee had any problem with incontinence before the accident of November 17, 2008. In rendering his opinion that employee's accident did not cause him to suffer incontinence, employer's hired expert Dr. Cantrell diagnosed employee with a neurogenic bladder, suggested this condition was inconsistent with employee's diagnosis of disc pathology at L3-4, and pointed to a lack of documentation of employee's incontinence in the initial medical records generated in connection with employee's treatment following the work injury. Dr. Cantrell does not provide any alternative medical theory to explain why a 40-year-old employee developed a neurogenic bladder following the work injury, but rather has, in essence, appointed himself arbiter of employee's credibility. We note that the Missouri courts have declared that "[t]here is no requirement that the medical records report employment as the source of injury." *Daly v. Powell Distrib., Inc.*, 328 S.W.3d 254, 259 (Mo. App. 2010). Notably, Dr. Cantrell indicated he would defer to a urologist; the treating urologist Dr. Bullock ruled out prostate cancer, bladder cancer, diabetes, Parkinson's disease, multiple sclerosis, and other potential non-work-related causes of employee's incontinence.
We are not persuaded that we need the assistance of Dr. Cantrell in determining whether employee credibly reported the timing or onset of his symptoms following the work injury. Nor are we persuaded by Dr. Cantrell's testimony inviting us to find that employee's incontinence in the aftermath of this serious and disabling low back injury was the result of a mysterious coincidence. Especially in the absence of any alternative theory of medical causation on this record, we find most persuasive the opinion from Dr. Poetz that the accident was the prevailing factor causing employee to suffer urinary incontinence.
Section 287.020.3(1) RSMo sets forth the standard for medical causation applicable to this claim and provides, in relevant part, as follows:
> An injury by accident is compensable only if the accident was the prevailing factor in causing both the resulting medical condition and disability. "The prevailing factor" is defined to be the primary factor, in relation to any other factor, causing both the resulting medical condition and disability.
We conclude that the accident is the prevailing factor causing the resulting medical conditions of (1) a low back work injury in the form of new disc pathology at L3-4 and exacerbation of preexisting degenerative disc disease; (2) urinary incontinence; and
1 We note the absence of any evidence on this record that employee suffers from any neurogenic condition or diagnosis apart from that referable to his work injury affecting the lumbar spine.
Injury No.: 08-118098
Employee: Shelby Patterson
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(3) aggravation of employee's preexisting psychiatric issues, as well as permanent partial disability associated with each of these conditions. We deem appropriate the administrative law judge's finding that employee sustained an overall 45% permanent partial disability of the body as a whole as a result of the work injury. We find that employee reached maximum medical improvement on January 14, 2010.
**Future medical treatment**
Section 287.140.1 RSMo provides for an award of future medical treatment where the employee can prove a reasonable probability that he has a need for future medical treatment that flows from the work injury. *Conrad v. Jack Cooper Transp. Co.*, 273 S.W.3d 49, 51-4 (Mo. App. 2008). The administrative law judge denied employee's claim for future medical care, based on a finding that there is no objective evidence of any need for further treatment and on (implied) findings that the opinions of Drs. Cantrell and Graham provide credible support for this result. We disagree for the following reasons.
In Dr. Cantrell's report dated December 2, 2009, he opined that employee would have a need for ongoing treatment to manage his chronic low back pain. Dr. Cantrell later opined that he did not believe the accident caused any injury to employee's low back, but the administrative law judge rejected that opinion, and employer did not appeal that determination. We, like the administrative law judge, do not find Dr. Cantrell's causation opinions in this matter worthy of belief, but we do find probative his concession that employee will need ongoing care to manage his chronic low back pain. Meanwhile, Dr. Poetz opined that employee has a need for future medical treatment to cure and relieve the effects of his chronic low back pain resulting from the work injury, and this opinion was not directly challenged on cross-examination.
We acknowledge that the pain management specialist, Dr. Graham, opined in his report dated July 6, 2010, that he did not find any indication for continued treatment for low back pain. Dr. Graham pointed to what he perceived as inconsistencies among the various medical treatment records as to employee's account of the mechanism of injury. Again, we feel capable of determining employee's credibility without the assistance of Dr. Graham. We find Dr. Graham's opinion regarding future medical care lacking in probative value.
With respect to the condition of urinary incontinence, we have modified the administrative law judge's findings and conclusions with regard to the issue of medical causation of this condition, and determined that the accident is the prevailing factor causing employee to suffer urinary incontinence. The treating physician Dr. Bullock identified a number of treatment options for this condition, and Dr. Poetz persuasively opined that employee has a need for ongoing care to manage his urinary incontinence.
In light of the foregoing considerations, we find that employee has a need for future medical treatment to cure and relieve his chronic low back pain and urinary incontinence resulting from the work injury. We conclude, therefore, that employer is obligated under § 287.140.1 to furnish those future medical treatments that may reasonably be required to cure and relieve employee's chronic low back pain and incontinence. We affirm and adopt, however, the administrative law judge's determination that employee's need for psychiatric care is a product of his preexisting
TI3681-1899
Injury No.: 08-118098
Employee: Shelby Patterson
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psychiatric problems, and that employee has thus failed to meet his burden of proving that he has a need for future psychiatric care that flows from the work injury. Accordingly, employer is not required to furnish any psychiatric care to employee.
**Permanent total disability**
The administrative law judge determined that employee's testimony regarding his limitations lacks credibility, and that employee is not permanently and totally disabled. For the following reasons, we disagree.
Although we acknowledge that the administrative law judge had an opportunity to personally observe employee's testimony, we have carefully reviewed the record in light of the uncontested expert medical evidence suggesting that employee suffers from considerable psychiatric limitations and disability. After careful consideration of the record as a whole, we do not view employee's testimony ascribing numerous and amorphous complaints (such as upper extremity pain and numbness) to his low back work injury as evidence that employee is dishonest or is trying to mislead this Commission. Rather, we view it as wholly consistent with and supportive of a finding that employee does suffer from considerable psychiatric problems.
Employee's treating psychiatrist, Dr. Bassett, opined that employee's psychiatric symptoms are sufficient to keep him from being able to work, but did not offer an opinion as to the causation of employee's psychiatric disability. We find persuasive Dr. Bassett's opinion that employee suffers from considerably disabling psychiatric problems. Employer presented testimony from the psychiatrist Dr. Stillings, who opined that, at the time of the work injury, employee suffered from considerable preexisting permanent partial psychiatric disability. Dr. Stillings acknowledged the lack of any documentation that employee received psychiatric care before the work injury, but explained that the psychiatric testing he administered showed objective evidence of preexisting psychiatric problems. Dr. Stillings also pointed to employee's incarceration and frequent job changes as supportive of his ratings.
After careful consideration, we find persuasive Dr. Stillings's testimony to the extent that he identified significant preexisting permanent partial psychiatric disability. We find that, at the time employee suffered the work injury