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Rhonda Basford v. Whitmoor Country Club

Decision date: May 15, 2017Injury #13-06483713 pages

Summary

The Missouri LIRC reversed the administrative law judge's award of 5.225 weeks of permanent partial disability benefits to the Second Injury Fund, finding insufficient medical evidence that the right knee injury had reached maximum medical improvement by the time of the primary injury date. The Commission determined that the employee's right knee surgery in February 2014 and subsequent medical treatment occurred after the relevant injury date, undermining the basis for Second Injury Fund liability.

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Caption

FINAL AWARD DENYING COMPENSATION (Reversing Award and Decision of Administrative Law Judge)
Employee:Rhonda Basford
Employer:Whitmoor Country Club (Settled)
Insurer:Employers Preferred Insurance Company (Settled)
Additional Party:Treasurer of Missouri as Custodian of Second Injury Fund
This workers' compensation case is submitted to the Labor and Industrial Relations Commission (Commission) for review as provided by § 287.480 RSMo. We have reviewed the evidence, read the parties’briefs, and considered the whole record. Pursuant to § 286.090 RSMo, the Commission reverses the award and decision of the administrative law judge.
IntroductionThe parties asked the administrative law judge to resolve the sole issue of Second Injury Fund liability.
The administrative law judge determined that the Second Injury Fund is liable for 5.225 weeks of permanent partial disability benefits.The Second Injury Fund filed a timely application for review with the Commission alleging the administrative law judge erred because the record does not contain adequate medical or lay evidence to support an award of permanent partial disability benefits against the Second Injury Fund.For the reasons set forth below, we reverse the award and decision of the administrative law judge.
Findings of Fact
Preexisting conditions of ill-beingEmployee runs the concession service at employer’s private country club. In 1998, employee suffered a back injury at work pulling wine cases out of her vehicle. Treating physicians diagnosed a herniated L4-5 disc, and employee underwent a low back surgery performed by Dr. Robert Heim. Employee continues to experience some daily low back pain, which is worsened with lifting. Employee’s expert medical witness, Dr. Shawn Berkin, rated employee’s preexisting permanent partial disability referable to the low back at 35% permanent partial disability of the body as a whole referable to the lumbosacral spine.On April 5, 2013, employee suffered a right knee injury at work when she tripped on a loose piece of metal. Employee developed immediate pain and swelling in the right knee. An MRI of April 24, 2013, revealed a complete tear of the medial meniscus. On February 4, 2014, employee underwent a right knee partial lateral meniscectomy and

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Chondroplasty of the medial femoral condyle. Afterward, employee underwent a course of physical therapy. On April 22, 2014, Dr. Nogalski released employee to full-duty work.

On November 4, 2014, employee settled her claim against employer for the right knee injury consistent with a rating of 22.5% permanent partial disability of the right lower extremity at the 160-week level. On July 24, 2015, employee settled a claim against the Second Injury Fund for the combination of the right knee injury with her preexisting low back disability; this settlement agreement was also consistent with a rating of 22.5% permanent partial disability of the right knee.

In his award, the administrative law judge determined that the April 2013 right knee injury had not reached maximum medical improvement as of June 27, 2013, the date of the primary injury in this matter. Employee did not appeal this determination, and in her brief, provides no argument that her right knee injury of April 2013 had reached maximum medical improvement at the time of the primary injury. In his report, Dr. Berkin did not address the issue whether employee had reached maximum medical improvement with regard to the right knee injury as of June 27, 2013, or whether any disability referable to employee's right knee was permanent as of that date.

Employee credibly testified (and we so find) that the right knee surgery of February 2014 improved her symptoms by relieving her excruciating pain referable to the right knee injury, and that the physical therapy she underwent after the surgery helped to make her right leg a little bit stronger. We find that the right knee injury had not reached maximum medical improvement as of June 27, 2013, the date of the primary injury in this matter.

Primary injury

On June 27, 2013, employee suffered an injury at work when her left ring finger was crushed inside a garage door. Employee experienced immediate pain and swelling. Treating physicians diagnosed a left ring finger distal phalangeal fracture, and provided employee with a splint. Employee wore the splint for four weeks, and underwent some physical therapy.

Dr. Berkin rated the primary injury at 20% permanent partial disability of the left ring finger at the level of the metacarpophalangeal joint. Employee settled her claim against the employer consistent with a rating of 15% permanent partial disability of the left ring finger at the 30-week level. Employee continues to experience pain in her left ring finger with lifting. We find employee suffered a 15% permanent partial disability of the left ring finger at the 30-week level as a result of the primary injury.

Asked to describe any increased difficulties at work based on the combined effects of the primary injury to her left ring finger and her preexisting low back injury, employee testified that she now has pain in her finger, so she has to lift and carry things differently. Employee did not identify any way in which her difficulties referable to the left ring finger injury interact with any difficulty referable to the preexisting low back injury.

injury to result in any new or greater difficulty than that referable to the simple sum of limitations referable to both conditions.

Dr. Berkin, in his report, stated that the combination of employee's disabilities is significantly greater than their simple sum, and that a loading factor should be applied. However, Dr. Berkin did not specifically identify any new or enhanced difficulty or limitation that arose referable to an interaction of the effects of the primary injury and employee's preexisting low back condition, or quantify the extent of any such synergistic disability. In fact, apart from the wholly conclusory assertion that synergy exists and that a loading factor should be applied, Dr. Berkin did not provide any basis or explanation for these opinions. Consequently, we do not find Dr. Berkin's testimony on this point to be persuasive.

As noted above, employee's sole ongoing complaint referable to the left ring finger injury is that she occasionally experiences pain in her finger that has required her to change the way she lifts things at work. In our view, the effects of the primary injury are too minimal to combine in any meaningful way with employee's preexisting low back injury, or to produce a quantifiable measure of increased permanent partial disability referable to a synergistic interaction between these conditions. Ultimately, faced with a lack of persuasive evidence on this record, we find that employee's left ring finger injury of June 2013 does not combine synergistically with her preexisting disabling conditions of ill-being.

Second Injury Fund liability

Section 287.220 RSMo creates the Second Injury Fund and provides when and what compensation shall be paid from the Fund in all cases of permanent disability where there has been previous disability. The administrative law judge awarded permanent partial disability benefits to employee from the Second Injury Fund based upon a finding that her preexisting disability referable to the low back interacts synergistically with the disabling effects of her primary injury affecting the left ring finger. The administrative law judge excluded from his consideration any disability referable to the right knee injury of April 2013, based on his finding that the right knee injury had not reached maximum medical improvement as of the date of the primary injury in this matter.

We acknowledge employee's argument, in her brief, that she need not have demonstrated that her right knee injury had reached maximum medical improvement as of the occurrence of the primary injury. In support, employee cites case law holding that such a showing is not necessary in the context of a claim against the Second Injury Fund for permanent total disability benefits. See, e.g., Lewis v. Treasurer of Mo., 435 S.W.3d 144, 160 (Mo. App. 2014). We are not persuaded, as the claim presently before us is one for permanent partial disability benefits, and the applicable case law is clear that an employee must demonstrate the level of preexisting permanent partial disability referable to a prior condition existing as of the date of the primary injury in order to include such condition in any calculation of Second Injury Fund liability for permanent partial disability benefits. See, e.g., Miller v. Treasurer, 425 S.W.3d 218, 220-21 (Mo. App. 2014). Employee advances no argument why Miller and similar cases are not

Improve: Rhonda Basford

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controlling here, nor does she argue that any disability referable to her right knee injury was permanent and quantifiable as of June 27, 2013.

We have found that employee's right knee injury of April 2013 had not reached maximum medical improvement as of the date of the primary injury in this matter. We conclude that the April 2013 right knee injury is properly excluded from consideration for purposes of assessing Second Injury Fund liability.

Turning to employee's preexisting low back condition, we have found that the record before us fails to persuasively demonstrate a synergistic interaction as between this condition and the subsequent compensable injury affecting the left ring finger.

[T]he claimant must establish that the present compensable injury and his preexisting permanent partial disability combined to cause a greater degree of disability than the simple sum of the disabilities viewed independently. This is referred to as the "synergistic effect." If a claimant establishes that the two disabilities combined result in a greater disability than that which would have occurred from the last injury alone, then the Fund is liable for the degree of the combined disability that exceeds the numerical sum of the preexisting disabilities and the disability from the last injury, or the "synergistic effect" of the combined disabilities. In other words, the Fund is liable only for the amount attributable to the synergistic combination. Thus, the failure to prove a synergistic combination between the primary injury and a preexisting disability is proper grounds for denying Fund liability.

Winingear v. Treasurer of State, 474 S.W.3d 203, 207-08 (Mo. App. 2015).

In her testimony, employee did not describe any new or enhanced disability or limitation specifically referable to an interaction between her preexisting low back injury and the subsequent injury to her left ring finger. Employee does advance the expert medical opinion of Dr. Berkin that the combination of employee's disabilities is significantly greater than their simple sum, and that a loading factor should be applied, but we have deemed this opinion lacking persuasive force. We have long held that conclusory expert opinions, in the absence of any explanation or supporting evidence, are generally insufficient to satisfy the proponent's burden of proof; we are not persuaded to depart from this general policy here.

In sum, owing to the lack of persuasive evidence on the topic, we have not been persuaded to make a finding that the effects of employee's primary left ring finger injury and her preexisting low back disability combine in such a way as to result in greater or enhanced disability beyond the simple sum of disability referable to these conditions. Instead, we have found that there is no such synergistic interaction. We conclude, therefore, that the Second Injury Fund is not liable for permanent partial disability benefits.

Decision

We reverse the award of the administrative law judge.

Employee's claim against the Second Injury Fund is denied because employee

Full decision text continues in the plain-text archive copy.

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