1 a : INDICATE : point out b : to manifest clearly, certainly, or unmistakably : show clearly the existence of
2 a : to make evident or reveal as true by reasoning processes, concrete facts and evidence, experimentation, operation, or repeated examples b : to illustrate or explain in an orderly and detailed way especially with many examples, specimens, and particulars[.]
Webster's Third New International Dictionary 367, 600 (2002).
The foregoing does not, in our view, imply or mandate any requirement that a medical expert in a workers' compensation case employ specific language in order to make a certification or demonstration of an employee's physical functioning. Rather, it would appear that so long as the medical expert is able to "attest authoritatively," "confirm," "manifest clearly," or "make evident or reveal" the extent of an employee's physical
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functioning by making findings on examination, rendering diagnoses as to the employee's medical conditions, and rendering restrictions on the employee's physical activities referable to those diagnoses, the medical expert may thereby "demonstrate" or "certify" an employee's permanent and totally disabled status, without using the exact phrase "permanent total disability."
The Second Injury Fund's argument to the contrary would require that medical experts use "magic language," without which their opinions (however persuasive) may never be relied upon by the fact-finder. The Missouri courts have never embraced this view, nor will we:
[Parties are] mistaken when [they] insist that "the substantial contribution factor" evidence requirement is not met unless a medical expert testifies in those exact words. There is nothing talismanic about the phrase in question. The words a medical expert uses when testifying are often important, not so much in and of themselves, but as a reflection of what impressions such witness wishes to impart.
Mayfield v. Brown Shoe Co., 941 S.W.2d 31, 36 (Mo. App. 1997)(citations omitted).
Whether or not the employment is a substantial factor in causing the injury is a question of fact. The Commission, and not the physician, is the trier of fact in workers' compensation cases. Therefore, even if a testifying physician fails to use the exact words of Section 287.020.3, we will affirm the Commission's award if the substance of the physician's testimony establishes that there is substantial evidence upon which to base the award.
Sanderson v. Porta-Fab Corp., 989 S.W.2d 599, 603 (Mo. App. 1999)(citations omitted).
In the words of the Mayfield court, there is nothing "talismanic" about the specific phrase "permanent total disability." Consequently, we read § 287.190.6(2) as permitting us to do as we have always done: consider the actual substance of the opinions from the testifying experts, weigh the persuasive value of those opinions, and then fulfill our factfinding duty to determine the nature and extent of an employee's disability. Here, we deem Dr. Stuckmeyer's expert medical findings on examination, his diagnoses, and his identification of permanent physical restrictions as amounting to a "certification" or "demonstration" of employee's permanent and totally disabled status as fully as if he had used those specific words in describing employee's condition.
Second, we note that § 287.020.6 RSMo provides, as follows: "The term 'total disability' as used in this chapter shall mean inability to return to any employment and not merely mean inability to return to the employment in which the employee was engaged at the time of the accident." The Missouri courts have identified the following test for permanent total disability:
The test for permanent total disability is whether the worker is able to compete in the open labor market. The critical question is whether, in the
ordinary course of business, any employer reasonably would be expected to hire the injured worker, given his present physical condition.
Molder v. Mo. State Treasurer, 342 S.W.3d 406, 411 (Mo. App. 2011)(citation omitted).
When the question is the nature and extent of permanent disability, the courts have consistently stated that the "degree of disability is not solely a medical question." ABB Power T \& D Co. v. Kempker, 236 S.W.3d 43, 52 (Mo. App. 2007).
The Commission may consider all the evidence, including the testimony of the employee, and draw all reasonable inferences in arriving at the percentage of disability. This is a determination within the special province of the Commission. The Commission is also not bound by the percentage estimates of the medical experts and is free to find a disability rating higher or lower than that expressed in medical testimony. This is due to the fact that determination of the degree of disability is not solely a medical question. The nature and permanence of the injury is a medical question, however, the impact of that injury upon the employee's ability to work involves considerations which are not exclusively medical in nature.
Elliott v. Kan. City School Dist., 71 S.W.3d 652, 657 (Mo. App. 2002)(citation omitted).
We note that the legislature, in 2005, did not abrogate the foregoing case law principles setting forth the test for permanent total disability and making clear that the question of employability is not solely a medical question. Consistent with the well-established test for permanent total disability in Missouri set forth above, a proper analysis of employability requires not only the expert medical identification of physical limitations but also consideration of issues such as job requirements, job availability, transferable skills, and prospects for retraining. In many (and perhaps most) cases, physicians do not possess the training, experience, or access to information necessary to render competent opinions regarding an injured worker's prospects for returning to any employment.
While we agree that $\S 287.190 .6(2)$ requires (at least in cases involving medical issues beyond the realm of lay understanding) that expert vocational opinions-as well as decisions from administrative law judges and this Commission-be fully supported by credible, competent, expert medical testimony, we do not believe the legislature intended, nor do we believe it would be reasonable to conclude, that expert medical testimony, particularly with regard to the issue of an injured worker's employability, cannot be supplemented (or refuted) by other expert testimony. We believe, and so hold, that the Commission maintains the authority to review evidence in the record in its entirety and to draw reasonable inferences therefrom. This position finds support in the recent case of Patterson v. Cent. Freight Lines, 452 S.W.3d 759 (Mo. App. 2015), wherein the court provided the following comments:
[T]he record need not contain a single expert opinion addressing the entirety of a claimant's conditions. Rather, the Commission may consider the opinions of multiple experts of differing specialties to arrive at its factual determination as to the parts and sum of a claimant's conditions.
Id. at 767 .
Third, assuming for the sake of argument that Dr. Stuckmeyer's opinions are deemed to fall below the threshold of "certifying" or "