Based on a comprehensive review of the evidence, including Claimant's testimony, the expert medical opinions and depositions, the medical records, the medical bills, and the Stipulation for Compromise Settlement in the pre-existing injury, as well as based on my personal observations of Claimant at hearing, I find:
1) Claimant is a 65-year-old, currently retired individual, who worked as an ironworker his whole career. He began as a union ironworker in 1973, became a journeyman ironworker in 1976 and continued working in that capacity until his retirement on June 1, 2011. He testified that he worked for Ben Hur Construction (Employer) for the majority of his career. Claimant explained that, as an ironworker, he worked with structural steel to fabricate buildings, including erection, bolting and welding.
2) Claimant denied any prior back injuries, despite his job duties, which included lots of heavy lifting and climbing.
3) Claimant testified that leading up to December 28, 2010, he was working on the Thomson Reuters building. He said that Employer was a subcontractor hired to build the mezzanine of the building using hollow structural tubes. Claimant was in charge of the job, which included scheduling, ordering materials, working with the general
contractor and supervising up to six other workers. He noted that everything for this job had to be moved by hand into the building, including the 250-1,400 pound tubes for the construction. He explained that they would load the tubes onto carts and move the carts into the building. He was actively involved in moving the tubes into the building as a part of this job. Claimant admitted that he had some pain in his low back for at least a week leading up to December 28, 2010, but he was adamant that he had no leg pain.
4) Claimant testified that on December 28, 2010, he was performing his regular job duties for Employer. On that day, he had to cut security screening because the screening they were given was 6 inches too long. Claimant performed all the cutting. He said that he had to take one screen (weighing 5-10 pounds), cut it with a grinder, and, then, move to the next one and do the same thing. He said that he had over 100 screens to cut on this date. He performed this job, lifting and twisting, all day long. He estimated that the most he lifted at any one time was approximately 30-40 pounds.
5) Claimant denied feeling anything out of the ordinary in his back, leg or otherwise during that particular day when he was performing this work for Employer. He said that he went home after work, went to bed and woke up in the middle of the night with excruciating pain in his back and down his left leg. He indicated that he had never experienced this type of pain before.
6) Claimant testified that he went to St. John's Mercy Medical Center, where he was given some pain injections and sent home. Medical treatment records from Mercy Hospital St. Louis (Exhibit B) confirm a visit on December 29, 2010 for rapidly worsening back pain that was radiating to the left thigh. The history contained in the record indicates that the current episode of back pain started more than one week prior to the visit. It indicates, "The pain is associated with no known injury (iron worker so does lots of heavy lifting at work but no specific event.)." Claimant was diagnosed with sciatica, given medications, and released.
7) Claimant testified that he called work the next morning and said that he would not be coming to work because of back pain. He said that he basically laid on the floor, but the pain never went away, so he sought further treatment.
8) Claimant returned to St. John's Mercy Medical Center (Exhibit C) on January 1, 2011, at which time he again provided a history of "no known injury," but complaints from his low back into his left leg. After an MRI showed a far lateral disc herniation at L3-4 on the left, consistent with his complaints, he was taken to surgery by Dr. Peter Yoon (Exhibit D), who performed a far lateral discectomy, minimally invasive, at L3-4 on the left. Following surgery, Claimant was found to have good pain relief and he was discharged from the hospital on January 5, 2011. Claimant continued to follow up with Dr. Yoon after surgery, through March 9, 2011. Although he reported some residual nerve pain, it was definitely improved from what he had prior to surgery. Dr. Yoon released Claimant to return to work with some weight restrictions on January 17, 2011.
9) Claimant submitted into evidence the certified medical bills (Exhibit E) from Mercy Hospital totaling $\ 1,606.50, from St. John's Mercy Medical Center totaling $\ 25,744.38 and from Dr. Peter Yoon totaling $\ 5,579.00, for a grand total of $\ 32,929.88 in medical bills for his low back treatment in this matter.
10) Claimant testified that he went back to work approximately two weeks after his surgery because he was out of money and was not getting any workers' compensation benefits. He said that he went back to a different job at Webster University directing traffic, but not lifting anything. He continued to work until May 27 or 28, 2011, and retired as of June 1, 2011. He said that he retired because he could not perform the job duties anymore, such as climbing ladders and lifting.
11) In terms of his current complaints, Claimant testified that his back hurts all the time. Activities such as sleeping, standing or sitting increase his complaints. He said that he has lost some muscle in his left leg. He has a constant ache in the lower middle back and if he sits the wrong way, his leg starts twitching. He said that after a couple hours of sitting, he has to stand up to relieve his back pain. He noted that picking up anything over 20 pounds is a problem, and he has limited bending and stooping, which limits his ability to do his hobby of working on old cars. He said that he does not cut firewood anymore, and fishing is difficult because he has to stand, even if he is in a boat, because of his back. Claimant noted that he used to take Aleve every day, but he stopped, so he just has to stand up and move around when his back starts hurting. He testified that the back pain is getting worse as time goes by.
12) On cross-examination, Claimant confirmed that he was injured, in his opinion, because of the 8 hours of cutting and stacking security screens. However, he was presented with his deposition testimony from April 5, 2013 (Exhibit 4), wherein at page 28 , line 15 through page 29 , line 7 , he was asked about the cause of his low back condition and he responded that it could have been the steel erection, doing everything by hand, unloading the truck or moving the steel into the building by hand. Claimant confirmed that he did not injure himself (his low back) walking in a parking lot.
13) The deposition of Dr. Robert Margolis (Exhibit A) was taken by Claimant on February 4, 2013, to make his opinions in this case admissible at trial. Dr. Margolis is board certified in neurology, internal medicine and as a medical examiner. He examined Claimant on one occasion, December 21, 2011, at the request of Claimant's attorney and issued his report on January 10, 2012. Dr. Margolis took an extensive history from Claimant of his work activities, problems and complaints, as well as the medical treatment he received, and reviewed the medical treatment records. Interestingly, Claimant provided Dr. Margolis a history of developing pain radiating into his left thigh, when he was walking in the parking lot at work in December 2010. He, then, awakened from sleep on December 29, 2010, with pain in his low back radiating down his left leg and sought treatment. The report contains no history of cutting screens or lifting the heavy materials at work as the source of the onset of his complaints. However, at the deposition, Dr. Margolis was specifically asked about the other work activities of cutting steel tubes by hand, assembling them with screws and cutting security screens, including "bending, twisting, stooping and lifting
throughout the whole day," and he opined that those work activities were causative of the disc herniation (the prevailing factor) in this case. In this hypothetical that was given to Dr. Margolis during his deposition, Claimant's counsel specifically included the fact that, "He did not feel any significant pain on that day other than the walking episode that he described to you." Physical examination revealed full range of motion in the lumbar spine without spasm, intact sensory examination and normal gait, with some tenderness in the lumbar spine and some atrophy of the left quadriceps muscle.
14) Dr. Margolis opined that, "The activity that this patient performed at work was the substantial and prevailing factor in his suffering a herniated disc at L3-L4." He rated Claimant as having 30 % permanent partial disability of the body as a whole, referable to the herniated lumbar disc and subsequent surgery. Dr. Margolis rated pre-existing permanent partial disability of 25 % of the right knee. He opined that the conditions he rated were hindrances or obstacles to employment and that the disabilities combined to create a greater disability to the body as a whole, when compared to the simple sum, and, so, a loading factor should be added.
15) On cross-examination, Dr. Margolis confirmed that the history Claimant gave him was of waking up with back pain on December 29, but that the walking incident was approximately a week prior to that. Claimant was unable to give him a specific date. He confirmed that Claimant provided no history regarding the erection of the mezzanine floor or the steel tubes.
16) The deposition of Dr. Michael Chabot (Exhibit 3) was taken by Employer on July 12, 2013, to make his opinions in this case admissible at trial. Dr. Chabot is an osteopathic physician, board certified in orthopaedic surgery (Exhibit 1). He examined Claimant on one occasion, July 20, 2012, at Employer's request, and issued his report (Exhibit 2) on that same date. He took a history from Claimant, reviewed the medical treatment records and performed a physical examination of Claimant, in reaching his conclusions in this case. Claimant provided a history to Dr. Chabot of working on erecting a mezzanine floor on December 27, 2010, where everything had to be done by hand, including assembling steel tubes, which required him to drill approximately 800 holes. Claimant also reported walking about an eighth of a mile from his car to the work site, and developing an aching pain in his back while walking up hill to get to the work site. He said that he also had to cut security screening for a period of 8 hours. The report noted that he was unable to recount any specific injury. Claimant specifically denied having any back pain or complaints while he was drilling or performing the cutting activities. He said that he began experiencing the low back pain in the middle of the night. Dr. Chabot diagnosed a history of a lateral disc herniation at L3-4, status post L3-4 lateral discectomy, chronic back pain, disc degeneration and scoliosis. Dr. Chabot opined that there was insufficient documentation to show that Claimant sustained a work injury or that his alleged work duties were the prevailing factor in his disc herniation and leg complaints, because, by Claimant's own admission, he did not have a significant increase in his complaints following stacking the security mesh. It was not until he was at home, in the middle of the night, when he was sleeping, that the pain intensified. Dr. Chabot also did not think that walking from his vehicle to the work site would provide the physiologic
trauma necessary to result in a disc herniation. Dr. Chabot opined that Claimant's age and lumbar spine degeneration is the prevailing factor in him developing the disc protrusion at L3-4 and need for the subsequent surgery. He did not believe that Claimant sustained any permanent partial disability as a result of the alleged work injury.
17) On cross-examination, Dr. Chabot testified that generally, when someone develops a disc herniation, if it was traumatically related, the person would experience pain almost immediately, but in this case, Claimant never recounted a history of developing symptoms while he was performing the work activities. He also noted that disc herniations can occur in your sleep, and, in this case, he believes the herniation did occur while Claimant was sleeping. Dr. Chabot acknowledged that leg pain and symptoms could develop at a later date after an injury and be related to the injury, but there would still be some recognition that something happened or an injury occurred at a specific time, which is not the case here, since Claimant finished work, went home and only woke up with acute pain and complaints. He opined that that was not a typical mechanism for a traumatic injury.