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conditions affecting the left hip, left shoulder, left knee, and body as a whole in the form of a cardiovascular disorder. Employee stopped working for employer during the summer of 2010. Thereafter, he provided some assistance to his wife with a daycare business that she operated from their home through the summer of 2015. The Second Injury Fund argues that this latter activity shows that employee is not permanently and totally disabled, and that it amounted to employment in the open labor market.
In her findings, the administrative law judge expressly credited the testimony from the employee describing his limitations stemming from the combination of his primary 2009 work injury and his preexisting disabling conditions. We are mindful that the administrative law judge was able to observe employee as he testified at the hearing, and we are reluctant to reverse her express credibility call in this regard absent a compelling reason to do so. After careful consideration, we do not find a reason to do so here. Accordingly, we defer to her finding and adopt it as our own. For this reason, and because we otherwise agree that the combination of employee's work injuries and his preexisting disabling conditions render him unable to compete in the open labor market in light of his age, education, and work history, we affirm the award of permanent total disability benefits.
However, we note that the administrative law judge determined that employee was not permanently and totally disabled until July 1, 2015, based on an implicit finding that employee's actions in helping his wife with her in-home daycare business demonstrated employee had an ability to compete for work in the open labor market until that business closed at some point in the summer of 2015. We disagree, for the following reasons.
Courts have used various terms to determine when an employee's condition has reached the point where further progress is not expected, including the term maximum medical improvement. Vinson v. Curators of the University of Missouri, 822 S.W.2d 504, 508 (Mo. App. E.D. 1991)(interpreting a doctor's testimony of employee's maximum treatment potential to mean maximum medical improvement); Cooper, 955 S.W.2d at 575 (using the term maximum medical progress to define the point where no further progress is expected for an employee's condition).
After reaching the point where no further progress is expected, it can be determined whether there is either permanent partial or permanent total disability and benefits may be awarded based on that determination. One cannot determine the level of permanent disability associated with an injury until it reaches a point where it will no longer improve with medical treatment. ...
Although the term maximum medical improvement is not included in the statute, the issue of whether any further medical progress can be reached is essential in determining when a disability becomes permanent and thus, when payments for permanent partial or permanent total disability should be calculated.
As the foregoing language from the Cardwell decision makes clear, the appropriate date for assigning liability for the payment of permanent total disability benefits will generally coincide with the date upon which an employee reaches maximum medical improvement from the effects of the work injury. This is because, at that point, the nature and extent of any permanent disability referable to the effects of the work injury may be calculated. By the same token, the fact-finder is then able to assess the nature and extent of any permanent disability that results from the combination of the primary injury with employee's preexisting conditions of ill-being. Stated another way, if employee was not permanently and totally disabled owing to his continued work for his wife's daycare, he did not suddenly become so disabled when she closed that business during the summer of 2015, as this event did not change employee's medical status, physical condition, or overall ability to compete for work.
As an aside, with regard to employee assisting his wife with her in-home daycare business, we are not persuaded by the contention from the Second Injury Fund that such represented gainful employment in the open labor market. First, as we have noted, the administrative law judge expressly credited employee's testimony with regard to his physical limitations; consequently, she implicitly determined that employee's physical activities for the daycare, such as sitting and watching children, holding infants, and walking children $1 / 2$ block to and from the bus stop, did not ultimately undermine his credible testimony with regard to the issue of permanent total disability. We have deferred to her determination in this regard. Second, the Missouri courts have never required that a disabled employee remain "completely inactive or inert" to receive an award of permanent total disability benefits, Grgic v. P \& G Constr., 904 S.W.2d 464, 466 (Mo. App. 1995), and have consistently held that post-injury work obtained through means other than competition in the open labor market (such as from a friend or family member) does not preclude an award of benefits. Minnick v. South Metro Fire Protection Dist., 926 S.W.2d 906, 910 (Mo. App. 1996).
Turning back to the issue when employee reached maximum medical improvement, we note that employee's treating surgeon for the primary right shoulder injury, Dr. John Havey, released employee from his care on April 5, 2010. This appears to be the date upon which employee reached maximum medical improvement from the effects of the work injury; the parties, in any event, do not argue otherwise. Consequently, it would appear that the Second Injury Fund's liability for permanent partial disability benefits began on April 5, 2010.
However, we note that employee, in his brief, requests an award of permanent total disability benefits beginning on August 7, 2010. We will not second-guess employee where he is willing to stipulate that he is not entitled to permanent total disability benefits until August 7, 2010. Accordingly, we modify the award of the administrative law judge regarding the date of commencement of permanent total disability benefits. The Second Injury Fund is liable for permanent total disability benefits beginning August 7, 2010.