Section 287.020.3(1) RSMo sets forth the statutory test 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.
The parties dispute the particular medical condition(s) and disability that resulted from employee's accident of August 15, 2006, wherein she felt the sudden onset of increased neck pain while straining with a cheater wrench to change out a frozen propane valve. ${ }^{1}$ The administrative law judge found that employee met her burden of proving that the accident was the prevailing factor in causing a temporary increase in neck pain that resolved spontaneously with pain medication, but that employee did not ultimately suffer an "injury," because she did not suffer any "disability."
The administrative law judge did award past medical expenses from the employer, citing Tillotson v. St. Joseph Med. Ctr., 347 S.W.3d 511 (Mo. App. 2011), and finding that employee's need for medical treatment "flowed from" the work-related accident of August 15, 2006. We ultimately agree with the choice to award past medical expenses from the employer, but we wish to provide some clarification with regard to the issue of medical causation. ${ }^{2}$
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[^0]: ${ }^{1}$ The parties stipulated that "on or about August 15, 2006, [employee] sustained an accidental injury arising out of and in the course of her employment," Transcript, page 4, but did not stipulate the particular medical condition(s) or disability employee sustained in that accidental injury. Accordingly, we must resolve that issue herein.
${ }^{2}$ As an aside, we note that the administrative law judge might also have awarded employee's medical treatment following the August 15, 2006, accidental injury in her award in Injury No. 04-148423, as such treatment would seem to unquestionably flow both from the August 2006 accidental injury as well as from the effects of employee's prior June 2004 cervical spine injury.
A compensable injury is a prerequisite to the recovery of benefits under the Missouri Workers' Compensation Law, including disputed medical expenses. See § 287.120.1 RSMo and Armstrong v. Tetra Pak, Inc., 391 S.W.3d 466 (Mo. App. 2012). In the Armstrong case, the employee (relying on Tillotson) argued that the only prerequisite to an award of compensation was the existence of a work-related "accident." The Armstrong court rejected that argument as follows:
Based upon the plain language of [§ 287.020 RSMo], Claimant was not entitled to compensation unless he proved that: (1) he suffered an accidental workrelated injury; and (2) the accident was the prevailing factor in causing both the resulting medical condition and disability. ... [T]here is a material distinction between determining whether a compensable injury has occurred and determining what medical treatment is required to treat a compensable injury. Tillotson addressed the latter, while Claimant's case involves the former. Thus, Tillotson does not support Claimant's argument.
Armstrong, 391 S.W.3d at 472-73 (citations omitted).
Here, employee is not entitled to any compensation unless the accident of August 15, 2006, was the prevailing factor causing both a resulting medical condition and disability. ${ }^{3}$ It is not sufficient merely to show that employee suffered a work-related accident, or even that the accident was the prevailing factor causing employee to suffer a temporary neck strain (i.e. a resulting medical condition). Instead, a finding of resultant disability is a prerequisite to an award in favor of the employee.
Notably, however, the statute does not require that employee prove the accident was the prevailing factor causing any permanent disability. Instead, it is sufficient that some disabilityof whatever nature, duration, or extent-resulted from the accident. After careful consideration, we ultimately agree with the administrative law judge's finding that employee did not sustain any identifiable permanent disability as a result of the accident of August 15, 2006. This is largely because employee, in her testimony, failed to identify any new symptom, limitation, or other permanent disability specifically attributable to the accident of August 15, 2006. Absent supporting testimony from the employee, given the lack of any contemporaneous medical treatment record substantiating any permanent increase in her symptomatology or other limitation, and in view of the purely conclusory opinion from employee's medical expert, Dr. Robert Poetz, we are not persuaded that any permanent disability is attributable to the August 15, 2006, accident.
We do find, however, that employee suffered some temporary disability after and directly attributable to the accident, in that employee suffered a contemporaneous increase in pain so severe that she required immediate medical intervention. Employee first went to Concentra, but was referred to the emergency room owing to the severity of her symptoms. There, she received emergency pain control in the form of intravenous morphine. Employee then saw Dr. Barry Samson on August 18, 2006, for a follow-up evaluation.
The record reflects that employee missed some work in the course of receiving this medical treatment and evaluation, and she credibly testified (and we so find) that she had to expend
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[^0]: ${ }^{3}$ The 2005 amendments to Chapter 287 heightened the employee's burden of proof with regard to issues of medical causation from a showing that "work" was "a substantial factor in the cause of the resulting medical condition or disability" (pre-2005) to a showing that "the accident" was "the prevailing factor in causing both the resulting medical condition and disability" (post-2005).