At issue in this matter is whether employee, an assistant manager at one of employer's retail stores, suffered a compensable psychiatric injury when an assailant pointed a gun at her head during an armed robbery of the store on November 1, 2009. Employee had very serious psychiatric problems before this event, for which she was receiving social security disability benefits. Yet, employee was able to work for employer for about 4.5 years prior to the event on November 1, 2009, advancing from a cashier to an assistant manager position. Two days after the robbery, employee was admitted to Research Psychiatric Center owing to acute anxiety and distress stemming from the event, and she ultimately never returned to work for employer.
The administrative law judge denied employee's claim on the issue of medical causation, crediting the testimony of employer's expert, the psychologist Dr. Keenan, over that of employee's medical expert, the psychiatrist Dr. True. It is well-settled in Missouri that in workers' compensation cases involving injuries that are beyond lay understanding, "the question of causation [is] one for medical testimony, without which a finding for claimant would be based on mere conjecture and speculation and not on substantial evidence." Welker v. MFA Cent. Co-operative, 380 S.W.2d 481, 487 (Mo. App. 1964). We agree that employee's alleged psychiatric injuries are beyond lay understanding, and that in the absence of credible expert medical testimony, a finding for employee in this matter would be based on conjecture and speculation.
We note that the administrative law judge placed considerable emphasis on the fact employee's counsel asked Dr. True whether the accident was "a" prevailing factor resulting in injury, rather than "the" prevailing factor. At least in this case, we perceive this to be a distinction without a difference. Although we do not find Dr. True's testimony in this matter
to be persuasive, his response to counsel's question does not suggest that counsel's use of "a" versus "the" was in any way important to Dr. True, or that it caused Dr. True to misunderstand the applicable standard of medical causation. The problem with employee's case is not the fact her attorney used "a" instead of "the" in posing a question to Dr. True; it's the fact she simply failed to present any credible expert medical testimony.
We note also that the administrative law judge relied on the case of Gordon v. City of Ellisville, 268 S.W.3d 454 (Mo. App. 2008) for the proposition that aggravation of a preexisting condition is not compensable following the 2005 amendments to the Missouri Workers' Compensation Law. The Gordon court used the word "aggravation" as shorthand for "something less than the prevailing factor." Id. at 459-60. Subsequent cases have clarified that aggravation (as a medical condition) is compensable after the 2005 amendments where a medical expert credibly opines that an accident was the prevailing factor resulting in aggravation of a preexisting condition. See, e.g., Maness v. City of De Soto, 421 S.W.3d 532, 540-41 (Mo. App. 2014). If employee had presented a credible medical expert opinion that the event of November 1, 2009, was the prevailing factor causing an aggravation of her preexisting psychiatric conditions and additional permanent partial disability, we are of the opinion that such injuries would be compensable.
Likewise, we wish to make clear that we are not persuaded by the theory from Dr. Keenan that because employee suffered serious preexisting psychiatric problems, she cannot have suffered any additional injury. We fail to see why employee's numerous suicide attempts, psychiatric hospitalizations, and need for psychiatric medications rendered her any less likely to suffer additional permanent partial disability as a result of having a gun pointed at her head; if anything, it would seem that employee's psychiatric fragility rendered her more likely to suffer injury. And where § 287.190.6(2) RSMo requires that "permanent disability ... shall be demonstrated and certified by a physician," we have doubts as to whether testimony from a psychologist is sufficient to demonstrate and certify the absence of permanent disability. For these reasons, we must disclaim the administrative law judge's reliance on the opinions of Dr. Keenan.
On the other hand, the sole expert medical testimony that employee procured and presented in this matter derives from the treating physician Dr. True, and even the most generous reading of his testimony supports the administrative law judge's conclusion that employee has failed to meet her burden of proof. From a lay perspective, it appears obvious to us that employee suffered some permanent injury from having a gun pointed at her head during the course of her work for employer. This is especially so when we consider employee's work history, her hospitalization following the event, and her inability to return to work thereafter. But our lay perspective is not determinative in this matter, and Dr. True's testimony is so uncertain, so ambiguous, and at times so contradictory, that we simply cannot credit it.
Because employee has failed to make her case with the testimony from Dr. True, we must deny the claim for compensation.