Robert Badock v. R. P. Lumber

(Modifying Award and Decision of Administrative Law Judge)

Injury No.: 10-004961

Employee: Robert Badock

Employer: R. P. Lumber

Insurer: Regent Insurance Company

This workers' compensation case is submitted to the Labor and Industrial Relations Commission (Commission) for review as provided by $\S 287.480$ RSMo. We have reviewed the evidence, read the parties' briefs, and considered the whole record. Pursuant to $\S 286.090$ RSMo, we modify the award and decision of the administrative law judge (ALJ). We adopt the findings, conclusions, decision, and award of the ALJ to the extent that they are not inconsistent with the findings, conclusions, decision, and modifications set forth below.

The parties asked the ALJ to determine the following issues: (1) liability for past medical expenses in the amount of $\ 13,859.85; (2) liability for future medical expenses; (3) past temporary total disability benefits; and (4) nature and extent of permanent disability.

The ALJ determined as follows: (1) employer is liable for unpaid past medical expenses in the amount of $\ 13,859.85; (2) employer is ordered to provide all treatment necessary to cure and relieve employee from his post phlebitis syndrome, left lower extremity swelling, and history of deep vein thrombosis with pulmonary emboli; (3) employee is entitled to receive temporary total disability until June 5, 2011; employer is therefore ordered to provide employee with three additional weeks of temporary total disability benefits; (4) employee's claim for permanent total disability is denied; employee is awarded 15\% permanent partial disability of the left foot (110 level); 30 % permanent partial disability at the thigh ( 160 week level) and 10 % permanent partial disability of the body as a whole rated at the chest, plus a loading factor in the amount of 15 % permanent partial disability.

Employee filed a timely application for review with the Commission alleging the administrative law judge erred in failing to award permanent total disability compensation in that the weight of the evidence indicates that the employee is permanently and totally disabled.

For the reasons stated below, we modify the award and decision of the ALJ referable to the issue of the nature and extent of the employee's permanent disability.

As found by the ALJ:

While Claimant's initial injury, a foot fracture, seemed relatively straightforward, in fact the unforeseen complications that resulted were at the time life threatening, terrifying to Claimant and his family, and had a lifelong impact. The fracture with complicating DVT [deep vein thrombosis] and pulmonary emboli have all resolved, but Claimant takes anticoagulants to prevent a recurrence and deals with the disabling effects of post phlebitic syndrome in his left lower extremity. ${ }^{1}$

[^0]

[^0]: ${ }^{1}$ Award, p. 12.

The employee is 54 years of age. Prior to his January 4, 2010, injury, he was able to work and function normally. The employee was self-employed as a farmer for thirteen years, until 1994. He subsequently worked at a tractor repair facility, replacing clutches and other parts and handling 50-100 pounds of weight. For two years he was employed as a school janitor. He later performed landscaping work, involving planting and laying sod, and drove a concrete truck. At the time of the accident, the employee had worked for five years as a delivery driver and yard man at employer's lumber yard. His job involved loading trucks, delivering loads to work sites, and unloading them. He was also responsible for cleaning up the lumber yard, including straightening lumber piles. The employee has never had a sedentary job.

The employee testified that since his January 4, 2010, injury he has been unable to work on any normal basis "because my legs swell if I'm up on them too much and I get short of breath just walking a short distance, I get really short winded." ${ }^{2}$ He further testified that when he tries to be active "if I'm up on my legs a whole lot one day trying to do something all day long . . . the next day I'm in the chair all day because my feet and legs are swollen, and they hurt so bad." ${ }^{3}$

The employee misses being employed; he would prefer to be working because he likes being active. He has a high school education, cannot type and has no computer skills. On April 5, 2012, the employee told Dr. Armbruster, a general practitioner, "I can't play with my kids no more like I used to. I use to play ball with my kids, I use to play church softball, I can't do the work like I used to."4 On May 6, 2013, vocational rehabilitation expert James England noted that employee "was pleasant and cooperative but seemed tired and depressed. He admitted that he is really down about losing his home and his ability to support himself and his family."5

In December, 2014, the employee tried to help a neighbor get his crops out. He had to stop because "that killed my legs, they were hurting. I had a knot on my left knee from doing it on my legs. I just did it for about a week, and that's all I could do." ${ }^{6}$ It took employee about three or four days to recuperate from this effort. He told his neighbor he could no longer help him.

The employee cannot stand for more than thirty to forty-five minutes to an hour before his feet and legs begin to swell. He is unable to sit for more than about an hour before he starts to feel uncomfortable. There is no activity he can do for more than an hour before his legs begin to swell. If he drives, he has to stop about every hour and thirty minutes to get out of the car and walk around. He can ride a riding lawn mower for only a short time before his feet get cramped up.

The employee spends about twenty minutes each morning feeding rabbits and chickens at his home. He helps his wife with housework by putting dishes in the dishwasher and sweeping the floor. He checks e-mail and pays bills. For the remainder of a typical day, he sits and reclines with his leg elevated, reading and watching TV. The employee attends church but has to sit down during the service after about fifteen minutes. He tries to elevate his leg if there is room enough to do so. The employee acknowledged he

[^0]

[^0]: ${ }_{3}^{2} Transcript 29.

{ }^{3} Id.

{ }^{4} Id. 25.

{ }^{5} Id. 621.

{ }^{6}$ Id. 32.

may be up on his feet all day once a week to perform work such as repairing a rabbit cage or small carpentry work around the house. He stated "If I'm up on my legs a whole lot one day trying to do something all day long...then the next day I'm in the chair all day because my feet and legs are swollen and they hurt a lot."7

The employee takes Coumadin, a blood thinner to address his postphlebitic syndrome. The ALJ found employee's ongoing anticoagulation therapy reasonable and supported by the medical evidence. ${ }^{8} He is expected to need anticoagulation therapy for the rest of his life. { }^{9}$

The ALJ summarizes the evidence in support of a conclusion that the employee is not permanently and totally disabled as follows:

- Dr. Rao's independent medical examination resulting in a work release without restrictions as of March 15, 2011.

- Dr. Mankowitz's finding that the employee reached maximum medical improvement, no longer required Coumadin, that his shortness of breath was caused by obesity and deconditioning and that he could return to work with no restrictions

- Dr. Wieman's 9\% permanent disability rating as of October 2011.

- Dr. Goldberg's opinion that the employee can work in a sedentary desk job. ${ }^{10}$

The ALJ concluded:

I find Claimant has failed to establish a right to recover permanent total disability compensation because the TTD evidence either relies on the unsupported proposition Claimant must elevate his leg consistently throughout the day, or that Claimant's bilateral foot conditions render him a total disability candidate. ${ }^{11}$

A close analysis of vocational expert James England's opinion suggests he relied on employee's advice that he was off his feet most of the day with his leg elevated. ${ }^{12}$ We agree employee's testimony indicates this is not true of every day but we do not believe an individual is employable if this is true of most days, or even of a few days per week.

Based on his testimony, employee may not be entirely compliant with reasonable medical recommendations regarding keeping his left leg elevated. As a result, he may be placing himself at some risk. In terms of employability, however, the real issue is whether an employer is likely to disregard such medical advice with respect to deciding whether or not to hire him, not the employee's decision to try to maintain some modicum of quality of life, even though risky or painful.

[^0]

[^0]: 7 Transcript 28.

8 Award, p. 10.

9 Id. 445, 500.

10 Award, p. 13.

11 Id.

12 Id. 671-672.

There is no indication that the ALJ deemed the employee not credible. We find the employee entirely credible. Employee testified that he is unable to sit or stand for prolonged periods of time without increased pain and/or swelling. ${ }^{13} \mathrm{He}$ is unable to sustain any significant level of exertion on a prolonged or consistent basis. If he is active one day he spends the next day in a chair. ${ }^{14}$ Employee's ongoing anticoagulation therapy is an obvious significant risk factor that would further discourage any potential employer, especially when all credible evidence indicates the employee is not capable of seeking employment in any field he's worked in before.

In his report of November 29, 2010, Dr. Howard Goldberg stated, "[The employee] does appear to have chronic edema in his left lower extremity consistent with Postphlebitic Syndrome. I do not think that he can return to work unless he is sedentary with his leg elevated (emphasis added)."15 On May 17, 2010, Dr. Goldberg stated "Also, it should be noted that while on blood thinners, like Coumadin, the patient would have an increased risk of bleeding should he receive a contusion or laceration."16 On March 22, 2011, Dr. Goldberg reiterated, "From our standpoint, we do have work restrictions. He could only return to work if he is able to be sedentary at his job with his left leg elevated. . ."17

To the extent employer's other medical experts suggest that the employee is not seriously injured or restricted with regard to his thrombophlebitic condition, we find their opinions are not credible.

Vocational rehabilitation expert James M. England, Jr. reviewed medical records and doctors' reports relating to the employee's work injury provided by employee's attorney prior to meeting with the employee on April 29, 2013. Mr. England noted Dr. Ann Wieman's opinion, based on x-ray findings, that issues in the employee's leg "could cause pain with ambulation on a daily, continuing basis."18

Mr. England considered the employee's description of his typical daily activities including feeding rabbits and helping fix breakfast with his wife, helping with laundry, and doing a little bit of mowing on a riding mower while taking frequent breaks. After reviewing the employee's educational background and vocational history, Mr. England concluded:

Mr. Badock is a 50-year-old gentleman with a high school education who has worked in a variety of positions in the past all of which seem to have acquired [sic] at least light and usually medium to heavy exertion. He does not have any transferable skills usable for sit-down types of work.

. . . Certainly considering the restrictions noted by several of his treaters, it does not appear that he would be able to successfully compete for or sustain any type of work activity in the open labor market. Absent continued improvement in his ability to be up on his feet and to sit without his leg elevated through most of the day, I believe he is likely to remain totally disabled from a vocational standpoint. ${ }^{19}$

[^0]

[^0]: ${ }^{13} Id. 30, 31.

{ }^{14} Id. 29, 31-33.

{ }^{15} Transcript 445.

{ }^{16} Id. 453.

{ }^{17} Id. 442.

{ }^{18} Id. 632.

{ }^{19}$ Transcript 632.

We find that the positions Mr. England later offered as possibilities if the employee is limited to sitting for a half hour at a time, getting up every half hour to walk around--such as a office building security guard or parking lot attendant--to be positions the employee would be unable to compete for or sustain. There is no job identified in the record before us that we believe employee can compete for or sustain without added vocational training and/or education.

In an October 17, 2013 addendum to his independent medical examination of the employee on March 28, 2012, Dr. David Volarich concluded, after reviewing Mr. England's report of April 29, 2014, and the employee's Social Security Disability Award of July 27, 2012:

[I]t is my opinion that Mr. Badock is permanently and totally disabled as a direct result of the work related injury of 1/4/10 standing alone. . . . Any preexisting disabilities are minor compared to the disabilities that he sustained from the 1/4/10 work injury. I also note that he is 50 years (approaching advanced age), has an education limited to graduation from high school, has worked labor jobs the majority of his work career and has been unable to get back to work since 1/6/10. ${ }^{20}$

As noted in Molder v. Missouri State Treasurer as Custodian of the Second Injury Fund, 342 S.W. 3d 406 (Mo App. 2011), citing Pavia v. Smitty's Supermarket, 118 S.W.3d 228 (Mo. App. S.D. 2003) "total disability means the inability to return to any reasonable employment. It does not require that the claimant be completely inactive or inert. Id. (citations and internal quotations marks omitted)." Id. at 413. Molder further noted that an employee's limited activity does not mitigate against a finding of total disability, because to do so "would tend to encourage idleness of the part of injured employees and discourage them from making efforts to help themselves for fear that any activity on their part might furnish evidence against their right to the compensation which the law has provided for them." Id. citing Grgic v. P \& G Constr., 904 S.W.2d 464, 466 Mo. App. E.D. 1995).

Based on the credible and competent evidence in the record as discussed herein as well as the relevant case law, we find employee is permanently and totally disabled as a result of the effect of his work injury of January 4, 2010.

We therefore reverse that portion of the ALJ's award allowing the employee compensation only for permanent partial disability in connection with his January 4, 2010, work related accident. We instead conclude that employee is permanently and totally disabled as a result of injuries sustained on January 4, 2010, effective May 13, 2010, the day after he reached maximum medical improvement as determined by Dr. Weiman. ${ }^{21}$

We modify the award of the administrative law judge as to the issue of nature and extent of permanent disability. We find the employee is permanently and totally disabled as of May 13, 2010.

Employee is entitled to, and employer is hereby ordered to pay, permanent total disability benefits in the amount of $\ 433.35 per week beginning May 13, 2010, for employee's lifetime or until modified by law.

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[^0]: ${ }^{20} Id. 601.

{ }^{21}$ Transcript 340.

The award and decision of Administrative Law Judge Karla Ogrodnik Boresi, issued July 5, 2016, is attached hereto and incorporated herein to the extent not inconsistent with this decision and award.

The Commission approves and affirms the administrative law judge's allowance of an attorney's fee herein as being fair and reasonable.

Any past due compensation shall bear interest as provided by law.

Given at Jefferson City, State of Missouri, this $18^{\text {th }}$ day of September 2017.

LABOR AND INDUSTRIAL RELATIONS COMMISSION

John J. Larsen, Jr., Chairman

VACANT

Member

Curtis E. Chick, Jr., Member

Attest:

Secretary

1. Are any benefits awarded herein? Yes
2. Was the injury or occupational disease compensable under Chapter 287? Yes
3. Was there an accident or incident of occupational disease under the Law? Yes
4. Date of accident or onset of occupational disease: January 4, 2010
5. State location where accident occurred or occupational disease was contracted: Lincoln County
6. Was above employee in employ of above employer at time of alleged accident or occupational disease? Yes
7. Did employer receive proper notice? Yes
8. Did accident or occupational disease arise out of and in the course of the employment? Yes
9. Was claim for compensation filed within time required by Law? Yes
10. Was employer insured by above insurer? Yes
11. Describe work employee was doing and how accident occurred or occupational disease contracted: Claimant slipped while entering a truck, fractured his foot, and developed complications during treatment.
12. Did accident or occupational disease cause death? No
13. Part(s) of body injured by accident or occupational disease: Left lower extremity and body as a whole
14. Nature and extent of any permanent disability: 15 % PPD of the left foot ( 110 level; 30 % PPD at the thigh (160 week level) and 10 % PPD of the body as a whole rated at the chest.
15. Compensation paid to-date for temporary disability: $\ 26,681.35
16. Value necessary medical aid paid to date by employer/insurer? $\ 60,692.61

1. Value necessary medical aid not furnished by employer/insurer? $\ 13,859.85
2. Employee's average weekly wages: Not determined
3. Weekly compensation rate: $\$ 433.35 / \ 422.97
4. Method wages computation: Agreement

1. Amount of compensation payable:

Unpaid medical expenses: $\ 13,859.85

3 weeks of temporary total disability (or temporary partial disability): $\ 1,300.05

$1201 / 7 weeks of permanent partial disability from Employer: \ 50,816.82

1. Second Injury Fund liability: No

TOTAL: $\ 65,976.72

1. Future requirements awarded: Future medical treatment as per Award

Said payments to begin immediately and to be payable and be subject to modification and review as provided by law.

The compensation awarded to the claimant shall be subject to a lien in the amount of 25 % of all payments hereunder in favor of the following attorney for necessary legal services rendered to the claimant: Candice Burke

The matter of Robert "Bob" Badock ("Claimant") proceeded to hearing to determine the benefits due Claimant under the Missouri Workers' Compensation Act (the "Act"). Attorney Candice Burke represented Claimant. Attorney Peter Leritz represented R.P. Lumber ("Employer") and General Casualty, aka Regent Life Insurance Company ("Insurer").

The parties stipulated that on or about January 4, 2010, Claimant sustained an accidental injury to his left foot arising out of and in the course of employment. At the time, Claimant was an employee of Employer, and both were subject to the Act. Further, the parties agreed Employer received timely notice, Claimant filed his claim within the time required by the Act, and venue in St. Louis City is appropriate. ${ }^{1}$ Claimant earned an average weekly wage sufficient to qualify for rates of compensation of $\ 433.35 for temporary total disability ("TTD") and permanent total disability ('PTD") benefits, and $\ 422.97 for permanent partial disability ("PPD") benefits. Employer paid TTD of \26,681.35, from January 4, 2010 to March 8, 2011. Employer also paid \ 60,692.61 in medical benefits.

The issues are: 1) Is Employer liable for past medical benefits totaling $\ 13,859.85; 2) Is Employer liable for providing future medical care; 3) Is Claimant entitled to receive past total disability benefits; and 4) What is the nature and extent of Claimant's disability? Claimant is seeking PTD benefits, while Employer asserts only PPD benefits are due.

Claimant offered Exhibits 1 to 28, and Employer offered Exhibits A to C. All Exhibits were admitted with the exception of Exhibit 28, the SSA Final Decision, which was excluded on relevancy, hearsay and foundation grounds. Exhibits 9 to 21, which consist of some type of documentation related to medical expenses, were all reviewed but are mentioned in this award only to the extent the charges can be connected to a specific date of service or are otherwise competent and relevant evidence.

[^0]

[^0]: ${ }^{1}$ While the accident occurred in Lincoln County, the parties consented to holding the hearing in St. Louis.

Claimant is a married father of two who graduated from high school and has worked as a farmer, equipment repairman, landscaper, parts maker, and truck driver. He has never held a sedentary job and has no useful computer skills. In 2005, he began working for Employer as a delivery driver/yard man. His duties included unloading and delivering a range of building supplies, driving trucks, waiting on customers, and cleaning up the yard. While he broke his left little toe in 1984, and was treated for ingrown toenails in 2008, Claimant had no permanent disability of the lower extremities at the beginning of 2010. In 2009, Claimant had pneumonia, but had fully recovered without ongoing symptoms by the end of the year.

On January 4, 2010, while attempting to enter a truck, Claimant's left foot slipped on a step and he experienced a "kind of stinging" in his foot. He continued to work that day and the next, but the pain level increased. When his store manager, Tom Brian, noticed Claimant limping, Claimant told him about the accident. He sought treatment on January 6, 2010 from Dr. Wieman, who had previously treated him for ingrown toenails. Dr. Wieman diagnosed a broken $4^{\text {th }}$ metatarsal, applied a hard cast, and ordered Claimant to be non-weight bearing on the left foot for an initial period of one month. Claimant filled out an accident report immediately after his first visit. At the February $1^{\text {st }}$ follow up appointment, Dr. Wieman replaced the hard cast and extended the non-weight bearing order by two weeks. Claimant began to develop shortness of breath.

On February 8, 2010, Claimant presented to St. Joseph's Hospital West with severe shortness of breath, and upon testing he was diagnosed with multiple pulmonary emboli ("PE") and admitted for anticoagulation and pulmonary consultation. He remained in the hospital until February $12^{\text {th }}$, mostly in the ICU. His hard cast was replaced with a removable cast, he used a walker, and he started on blood thinners. Claimant said his lungs were "full of clots," and he understood his condition to be life-threatening at the time. From February 12, 2010 to December 20, 2010, Claimant incurred expenses of $\ 128.53 for prescription medication related to his blood and lung conditions. ${ }^{2}$

On March 2, 2010, Claimant returned to St. Joseph's Hospital West with increased dyspnea (shortness of breath) and leg swelling. Venous duplex exam of the left lower extremity ("LLE") showed partial vein thrombosis in the left posterior tibial and peroneal veins, likely chronic. In March, Claimant's fracture healed, but his left foot remained very swollen - he could not even get a shoe on and therefore could not work. He was discharged the same day. Claimant testified "workers comp" denied liability for the charges associated with this visit, but the only evidence of charges with a March 2, 2010 date of service is a $\ 651.00 bill for Lake Forest Emergency Group LLC ${ }^{3}$.

On March 15, 2010, Claimant consulted with Dr. Schneider for symptomatic bilateral lower extremity venous stasis disease and DVT/PE. He noted, "Duplex today shows only some calf vein thrombus left leg only normal on right. The cause for this is most likely secondary to his injury at work (fracture). DVT following any lower limb injury is fairly commonplace." He

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[^0]: ${ }^{2}$ Dr. Montgomery, the prescriber for most prescriptions, was an attending physician while Claimant was first hospitalized. Other prescribers included his hematologists and primary care physician.

${ }^{3} The total bill from Lake Forest Emergency Group is \ 1,003.00, but Claimant did not substantiate the charge related to a July 1, 2010 date of service.

further found no indication for IVC filter and thought it was okay for Claimant to return to work from a vascular standpoint, subject to Dr. Wieman's approval. At this time, Claimant had difficulty breathing, his legs were swollen and he could not work.

Also in mid-March, Dr. Wieman found the fracture to be clinically healed, but Claimant had continued problems with pain and swelling due to the DVT. He could not even get a shoe on and therefore could not work as of March 15. In April, Dr. Wieman started Claimant on TED stocking for the swelling, treated him for ingrown toenails secondary to swelling, and cleared him to ambulate on his left foot. She stated he could not return to work until medically cleared by his pulmonologist. On May 12, 2010, Dr. Wieman found both the left great toenail and the metatarsal fracture were well healed, and released Claimant to full duty, noting "[h]is biggest issue continues to remain swelling." Dr. Wieman rated Claimant with 0\% permanent partial impairment of the left $4^{\text {th }}$ metatarsal/left foot. There do not appear to be any unpaid charges from Foot Care Inc. (Dr. Wieman's office) through May 12, 2011.

On May 17, 2010, Dr. Goldberg wrote: "Robert Badock has been under my care for treatment of a Pulmonary Embolism since April 15, 2010. He is on continuing Coumadin therapy for this condition. He is released to return to work, however due to his left lower extremity swelling, he should remain in a position where he would be able to sit and elevate his left leg. Also, it should be noted that while on blood thinners, like Coumadin, the patient would have an increased risk of bleeding should he receive a contusion or laceration."

While he was under Dr. Goldberg's care and because he was on blood thinners, Clamant had regular blood tests. The statement associated with Dr. Goldberg's care (Exhibit 13) indicates charges of $\ 2,205.00 between February 8, 2010 and March 22, 2011, with payments of $\ 1,872.90, adjustments of $\ 323.90, and a balance of $\ 657.00. It appears the payments were from an insurance company, not Claimant.

In mid-October, 2010, Claimant began to experience an increase of chest pain and shortness of breath that required him to be taken by ambulance to St. Joseph Hospital West, where tests found no abnormalities and ruled out recurrent PE as the cause of his chest pain. The emergency room doctors thought Claimant's worsening diastolic heart failure probably explained fluid retention. The charges associated with this admission originally totaled $\ 17,693.40, but were adjusted to $\ 10,616.04. There is an unpaid ambulance bill of $\ 762.97 in evidence. The unpaid charge from Radiological Imaging for October 18 and 20, 2010 tests is $\ 282.44. At hearing, Claimant did not remember the details of this hospital admission.

At the authorization of Employer/Insurer, Claimant came under the care of Dr. Rao of Midwest Vascular and General Surgery. It was his impression Claimant suffers from a moderate to significant post deep vein thrombosis swelling or a post phlebitis syndrome. As of his first visit on November 30, 2010, he felt Claimant was not ready to return to work. On December 28, 2010, Dr. Rao interpreted an ultra sound as showing no evidence of deep vein thrombosis in the veins of the left leg, but felt there was evidence of venous insufficiency or venous valvular insufficiency in the popliteal vein. With respect to medication and causation, Dr. Rao stated that usually, "six months to a year of anticoagulation is all patients need once the initiating factor for the blood clot has been removed. In this case, it was his injury and his cast."

On January 26, 2011, at the recommendation of Dr. Rao, Claimant consulted with Dr. John Finnie of Mercy Medical Oncology-Hematology (Mercy Cancer Care), who provided guidance regarding Claimant's history of PE and DVT. Dr. Finnie's notes indicate Claimant was very reluctant to reduce or come off of his Coumadin therapy for fear of repeat episodes of pulmonary emboli. Claimant continued to see Dr. Finnie throughout 2011 and beyond. Claimant documented $\ 799.00 in charges from Dr. Finnie's office. ${ }^{4}$

On February 15, 2011, Dr. Rao noted, "I am going to release [Claimant] back on March $1^{\text {st }}$ for two week duty of reduced activity lifting nothing heavier than 30 lbs . On March 15, 2011...I will release him for full duty with maximum medical improvement." The Disability Certificate of 2/18/11 indicates no lifting over 50 lbs for 2 weeks with RTW full duty on 3/15/2011. Employer stopped paying TTD based on this opinion.

Sometime in early 2011 at Employer's request, Claimant saw Dr. Mankowitz, a cardiologist, who opined: 1) The October 2010 hospitalization was unrelated to the injury sustained on 4 January 2010, as there was no evidence of a recurrent pulmonary embolism. The cause for the chest pain and shortness of breath ("SOB") was unclear. There was no evidence of a cardiac or lung problem...: 2) SOB is probably due to deconditioning and sleep apnea...; 3) Coumadin treatment for one year is to treat blood clots in left leg and lungs, and thus is related to work injury. Swelling in left leg is related as it is caused by the damage caused by the blood clots. Long-term treatment consists of compression stockings. SOB and sleep apnea predate and are unrelated to the injury. A follow up Chest CT with contrast should be done to assess for residual pulmonary emboli; 4) Claimant appears to be at MMI.

As of March 11, 2011, Dr. Rao thought Dr. Mankowitz's recommendation for a repeat CT is reasonable "to close the definitive documentation of pulmonary embolism in this case." He "fully expects" the CT to be negative, in which case the ongoing issue is over. Dr. Rao wrote, "The more tests that come back normal will reinforce to Claimant hat he needs to get back into the workforce and resume a normal life." As predicted, two CT scans (one with contrast, one without) were negative for pulmonary emboli. Dr. Rao provided a rating of 10-15\% permanent partial disability for the vein damage sustained from a deep vein thrombosis following the injury on January 4, 2010. There is a March 24, 2011 bill from Lincare totaling $\ 781.46 for medical equipment.

According to a June 5, 2011, follow up exam and supplemental report, Dr. Mankowitz felt Claimant no longer needed Coumadin, but could take aspirin instead. He suggested Claimant could return to work, was at maximum medical improvement, and should exercise to lose weight and improve his shortness of breath and endurance.

In July 2011, Claimant was experiencing pain in his right foot, and an x-ray on July 2 found no fracture; findings suggestive of gout with superimposed osteoarthritis or cyst. On July 6, 2011, Claimant saw Dr. Armbruster of Troy Surgical, who noted increasing right foot pain of 3 weeks duration unlike old gout with a history of DVT of his LLE and pulmonary embolus. The left leg clot occurred due to a fracture of his left metatarsal. Positive findings include moderate to severe non-pitting edema of the lower extremities, tenderness of right foot at base of toes at mid foot. On February 20, 2012, Claimant saw Dr. Armbruster in follow up visit for

[^0]

[^0]: ${ }^{4} Of the \ 799, Claimant provided evidence $\ 645 was paid by Employer/Insurer. There is no evidence the balance is unpaid.

cellulitis and a staph infection for which he was hospitalized over a few days. At that time, the diagnoses included apnea, DVT, GERD and benign prostatic hyperplasia. ${ }^{5}$

On August 10, 2011 and February 16, 2012, Claimant saw Dr. Wieman for recurrent ingrown toe nails of both large toes. She thought the left foot was swollen because of previous injuries. She thought the right foot is swelling because he is overcompensating and doing more on his right foot. He cannot wear shoes. The charges for such treatment total $\ 300.00

When Claimant was seen for outpatient follow up at Dr. Finnie's office on March 20, 2012, he had developed gout in his right foot. The doctor noted, "It does appear that due to the patient's difficulty now involving his right foot, that he would not be eligible to continue to work. He does appear to be a good candidate for disability." There is a bill of $\ 897.62 from Mercy Hospital St. Louis for outpatient services from March 20, 2012 to April 18, 2012, which corresponds with his chart from Dr. Finnie.

On April 5, 2012, Claimant's primary care physician, Dr. Armbruster, noted patient presents for "disability papers." Complaints include decreased energy, anxiety, and chest pain due to pleural problems, cough, depression, fatigue and headache. Also, myalgia, indigestion, joint pains, pain, rash on legs, both feet hurt; pain averages 7; SOB w/ stairs and carrying 50 lbs for a few feet; left LE is atrophic, straight leg raising positive.

On May 7, 2012, Claimant saw Dr. Goldberg for evaluation of wheezing and postphlebitic syndrome. Dr. Goldberg wrote, "I suspect he can only return to work if he can be in a seated position such that he can keep his leg elevated." Recommendations include lifelong Coumadin and "wear support stockings as able and keep LLE elevated as much as possible." On August 20, 2015, Dr. Goldberg reiterated, noting Claimant "is here today to discuss worker's comp related to post phlebitis syndrome LLE. In the past I and other physicians have recommended to keep legs elevated as much as possible. This recommendation remains unchanged....Needs to keep LLE elevated as much as possible. The only appropriate vocation would be a desk job."

Like Dr. Goldberg, Dr. Wieman addressed Claimant's work-related disability. In her June 8, 2012 letter, Claimant's treating foot doctor wrote:

This [is] a letter to address the current limitation of [Claimant] regarding his feet. He sustained an injury at work on $1 / 4 / 10 to his left 4^{\text {th }}$ metatarsal which was treated with cast immobilization. During his treatment he developed a DVT leading to a pulmonary embolism for which he was hospitalized. Since that time he has had bilateral lower extremity pitting edema, leading to chronic ingrown toe nails and the inability to wear normal shoe gear. Because of this he cannot be on his feet for long periods of time. He has had multiple procedures for ingrown toe nails because of his edema... and continues to have lower extremity edema even with the use of compression stockings.

In a July 19, 2012 letter, she wrote a letter concerning Claimant's "right foot pain and limitations which dates back to 2004 for which he has been treated for gout and hallux limitus." She noted

[^0]

[^0]: ${ }^{5} Dr. Armbruster's charges included \ 160 for the 7/06/2011 visit for right foot pain; $\ 150 for eye infection on 10/7/2011; and $\ 195 for a 2/20/2012 follow up visit after a hospitalization for cellulitis. There is insufficient evidence connecting these charges with the work accident.

progression of osteoarthritis in multiple locations and pain with ambulation, inability to normally bend big toe, and swelling. This joint damage is permanent. These comments were made regarding Claimant's right foot, not the left foot injured in the work accident.

Dr. Volarich reviewed records, examined Claimant, and issued his first report on March 28, 2012. He diagnosed the following conditions: 1 . Left non-displaced proximal $4^{\text {th }}$ metatarsal fracture; 2. Left lower extremity deep vein thrombosis secondary to cast immobilization to treat left foot fracture causing pulmonary emboli and left lower extremity post phlebitic syndrome; and 3) Chest discomfort and shortness of breath with exertion. His ratings of disability were 15 % PPD at 110 level of the left foot for the fracture, 30 % PPD of the left lower extremity at the 160 week level, due to the deep vein thrombosis and resultant post phlebitic syndrome, and 10 % PPD of the body as a whole at the chest. He found the combination of his disabilities creates a substantially great disability than the simple sum or total of each separate injury/illness, and a loading factor should be added. In a subsequent report dated October17, 2013, after reviewing Mr. England's vocational assessment and social security administration award, Dr. Volarich wrote, "it is my opinion that [Claimant] is permanently and totally disabled as a direct result of the work injury of $1 / 4 / 10$ standing alone..."

The vocational expert, Mr. England, saw Claimant on or about May 6, 2013, reviewed records and opinions in the case and issued a report evaluating Claimant's vocational abilities. He found if he considered Dr. Mankowitz's outlook, Claimant could work. Assuming findings of other doctors, he would be much more limited. If one assumes that he needs to sit through the day with his leg elevated, Mr. England did not believe he is competitively employable. Certainly considering the restrictions noted by several of his treating doctors, it does not appear that he would be able to successfully compete for or sustain any type of work activity in the open labor market. Absent continued improvement in his ability to be up on his feet and to sit without his leg elevated through most of the day, he felt Claimant is likely to remain totally disabled from a vocational standpoint. Mr. England's opinion was unchanged on June 2, 2014 after reading Claimant's deposition and considering the social security award.

At his deposition, Mr. England summarized the medical opinions concerning Claimant's work limitations:

Dr. Goldberg thought he could work only if he were able to do a sedentary job with his leg elevated. Dr. Finney indicated that he thought [Claimant] would be a good candidate for disability because of the issues with his right foot. Dr. Volarich recommended avoiding repetitive stooping, squatting, crawling, kneeling, pivoting, climbing, impact maneuvers....Dr. Armbruster, who's his primary care physician filled out a form saying he thought he could sit for an hour in an eight hour day, could stand, walk and work a half an hour each in an eight hour day, [with some lifting restrictions].

Mr. England made further references to Dr. Armbruster's observations that standing or walking aggravated symptoms while elevating the leg was helpful, and to Dr. Wieman's note Claimant had "problems with ambulation on a continuous daily basis." Although Dr. Mankowitz's restriction would allow Claimant to return to full duty, he is "much more limited" by the other doctors' restrictions. Mr. England noted Claimant's lack of skills for sit-down jobs and testified "if he really does have to sit with his leg elevated most of the day...I don't believe that he's going to be able to go out and compete and sustain any kind of work...in the open labor market."

On cross examination, Mr. England made some concessions. He acknowledged other doctors besides Dr. Mankowitz released Claimant to full duty. But more importantly, Mr. England acknowledged his opinion is built on the truth of the proposition that Claimant "is off his feet most of the day with his leg elevated" up to the level of his heart. Yet, if he assumed Claimant was more active, could sit for 30 minutes at a time and just needs to get up and walk, then it is "probably true" Claimant is competitively employable in positions such as security work or parking lot attendant.

Claimant testified to his limitations. He continues to have severe swelling in both his right and left legs. He continues to have pain in his legs. This affects his ability to do things during the day, it affects his sleep, and it affects every area of his daily life. Claimant tries to live as normal of a life as he can. He helps with his children's rabbits by feeding them, he attempts to do general housework but at his own pace, and he has attempted to assist others with small tasks. He does drive but must take breaks. All of these activities cause him pain and swelling.

Although Claimant can check his email on a computer, he does not know how to use Word, Excel or PowerPoint, and cannot type fast or accurately. He has never worked at a desk nor does he have the skills required to do a desk job, at home or otherwise.

Claimant has the ability to be physically active, drive wherever he or his family needs to be, and do chores around the house. During the hearing, Claimant did not elevate his leg, but he did have to stretch his legs. He admitted he can be on his feet all day as often as once a week or two, can sit for up to 90 minutes at a time before he has to get up and stretch, and he does not sit with his legs elevated all the time. It is not necessarily easy or convenient for Claimant to raise his leg when he is out of the house.

Claimant understands Dr. Finnie and Dr. Armbruster to say he cannot work, and Dr. Goldberg said he could only do sedentary work. He continues on Warfarin/blood thinners, which requires medical checkups every three months. Claimant believes the factors which prevent him from doing any job on a normal basis are the swelling and pain in his legs and the fact he gets short of breath just walking a short distance.

Claimant seeks recovery for past medical treatment as well as an order for ongoing medical care. Section 287.140.1 RSMo governs the issue of medical expenses and provides, in relevant part, as follows:

In addition to all other compensation paid to the employee under this section, the employee shall receive and the employer shall provide such medical, surgical, chiropractic, and hospital treatment, including nursing, custodial, ambulance and medicines, as may reasonably be required after the injury or disability, to cure and relieve from the effects of the injury

To obtain future medical benefits, Claimant must show by a reasonable degree of medical certainty that the need for medical care flows from the accident. Sickmiller v. Timberland Forest Products, Inc., 407 S.W.3d 109 (Mo. App. S.D. 2013). Where legitimate disputes regarding the particular medical conditions and disabilities resulting from the accident exist, the "flows from" analysis requires application of the standard for medical causation of a compensable injury set forth in § 287.020.3 RSMo. Armstrong v. Tetra Pak, Inc., 391 S.W.3d 466 (Mo. App. 2012). Thus, the Claimant has the burden of proving that an accident was the prevailing factor in causing the resulting medical conditions and disability (i.e. the particular injuries) for which the employee claims compensation. Id. at 471 (as cited in Pamela Bertels Employer: Houghton Mifflin Harcourt Publ'g Co. Insurer: Am. Int'l Grp., Inc., Injury No. 09-072091, 2015 WL 1774296, at 2 (Mo. Lab. Ind. Rel. Com. Apr. 14, 2015).

The evidence establishes the work accident was the prevailing factor in causing the three medical conditions and disability for which the Claimant is entitled to compensation. Dr. Volarich most persuasively set forth the conditions and disability as follows:

1. L nondisplaced proximal $4^{\text {th }}$ metatarsal fracture - 15 % PPD at 110 week level;
2. Left lower extremity deep vein thrombosis secondary to cast immobilization to treat left foot fracture causing pulmonary emboli with resultant post phlebitic syndrome - 30\% PPD of the left lower extremity rated at the thigh ( 160 week level);
3. Complaints of ongoing chest discomfort and shortness of breath with exertion - 10\% PPD of the body as a whole rated at the chest. (It is noted that recent cardiopulmonary workups have failed to elicit an organic cause for these symptoms).

There is agreement among the experts Claimant's foot fracture has healed, but that as a result of the cast he wore to treat the fracture, Claimant developed DVT of the left lower extremity, which in turn caused him to have pulmonary emboli. The blood clots caused damage to the veins in his left lower extremity, which is the cause of persistent swelling (post phlebitic syndrome). Due to the blood clots, Claimant is required to take blood thinners for the rest of his life, ${ }^{6}$ and compression stockings are reasonably necessary to control the swelling. There is conflicting evidence as to the causal connections to the ongoing chest discomfort, which Claimant denied was a current problem, and shortness of breath with exertion, which Dr. Mankowitz attributes to sleep apnea and deconditioning.

Claimant is in need of ongoing treatment to cure and relieve him from the post phlebitic syndrome. Although there is no evidence of ongoing DVT or emboli, the history of such conditions justifies lifetime treatment with prescription anticoagulants. Employer/Insurer is ordered to provide Claimant with all treatment necessary to cure and relive Claimant from his post phlebitic syndrome, left lower extremity swelling, and history of DVT with pulmonary emboli. This includes, but is not limited to prescriptions, blood work, doctor's visits, compression stockings and other treatment related to the diagnoses. I do not find there is compelling evidence of a need to provide future treatment for the diagnosis and condition of ongoing chest discomfort and shortness of breath with exertion.

In addition to future medical treatment, Claimant seeks recovery of expenses he has incurred in the past. The courts have consistently held that an award of past medical expenses is supported when the employee provides (1) the bills themselves; (2) the medical record reflecting the treatment

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[^0]: ${ }^{6}$ While several doctors suggested a more limited course of anticoagulants was called for, Claimant's preference to remain on lifetime medications is reasonable and supported by the medical evidence.

giving rise to the bill; and (3) testimony identifying the bills. Martin v. Mid-America Farm Lines, Inc., 769 S.W.2d 105, 111-12 (Mo. 1989). If employee does so, the burden shifts to employer to prove some reason the award of past medical expenses is inappropriate (such as employee's liability for them has been extinguished, the bills are not reasonable, etc.). Farmer-Cummings v. Pers. Pool of Platte County, 110 S.W.3d 818, 822-23 (Mo. 2003). Claimant testified he received treatment and bills from St. Joseph Hospital West in the amount of $\ 10,992.36, Foot Care Inc. for $\ 360.00, Lake Forest Emergency Group for $\ 1,003.00, Radiological Imaging for $\ 674.92 and Lincare, Inc. for $\ 781.47, for a total of $\ 13,811.75. When his attorney asked if the bills were related to the PE, the DVT and the continued foot problems, Employer's attorney objected, stating "[w]e stipulated to that anyway, but he is not qualified." The stipulated amount of the medical bills was $\ 13,859.85.

Upon review of all the bills, the medical records reflecting the treatment giving rise to the bill, and testimony or other evidence identifying the bills, I find Employer is obligated to compensate Claimant for these past medical expenses:

1. Prescription medication
2. Lake Forest Emergency Group LLC.
3. St. Joseph's Hospital West (October 2010) ${ }^{7}

\ 128.53

$\ 651.00

$\ 10,616.04

$\ 762.97

1. Ambulance bill
2. Lincare
3. Foot Care, Inc.
4. Mercy Hospital St. Louis

Radiological Imaging

\781.46

\ 300.00

$\ 897.62

There is a small discrepancy between the total medical expenses stipulated to by the parties and the bills listed above. Although I find the total of the bills to be $\ 14,420.07, because Claimant sought and the parties stipulated to past medical expenses of $\ 13,859.85, the past medical awarded herein is limited to the stipulated sum. Spacewalker, Inc. v. American Family, 954 S.W.2d 420, 424 (Mo.App. E.D.1997)(Stipulations are controlling and conclusive, and the courts are bound to enforce them).

Sections 287.149 and 287.170 RSMo provide for the payment of temporary total disability benefits while an employee is engaged in the rehabilitative process following a compensable work injury. Greer v. Sysco Food Servs., 475 S.W.3d 655 (Mo. 2015). Claimant received his last TTD payment as of March 14, 2011, based on Dr. Rao's February 15, 2011 letter wherein he declared he would return Claimant to work on March 15, 2011.

I find Claimant was actively participating in the rehabilitative process under the care of authorized treating physician after Employer cut off TTD. At some time after February 15, $2011^{8}$, Dr. Mankowitz recommended a CT to check for pulmonary emboli, and on March 11, 2011, Dr. Rao agreed the recommendation was reasonable "to close the definitive documentation of pulmonary embolism in this case." The CT was done without contrast, and when repeated on

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[^0]: ${ }^{7}$ I specifically find this hospitalization flows from the accident because Claimant was still under active treatment; it was required to rule out the recurrence of the causally related conditions; and it involved a condition diagnosed by Dr. Volarich. Even though there is no need for future treatment for chest discomfort and SOB, at the time these charges were incurred, the hospitalization was reasonable and necessary to treat Claimant's work related condition. ${ }^{8}$ His report is undated, so this date is implied.

April 21, 2011 with contrast showed no evidence of pulmonary embolism. After reading the final CT results, Dr. Mankowitz issued his last report on June 5, 2011 stating, among other things, Claimant was at MMI, and can return to work without restrictions. Claimant was actively engaged in the rehabilitative process under the care of authorized treating physicians, and is entitled to receive TTD until June 5, 2011. Employer shall provide Claimant with three additional weeks of TTD benefits.

Claimant seeks permanent total disability. Permanent total disability means an employee is unable to compete in the open labor market. Forshee v. Landmark Excavating and Equip., 165 S.W.3d 533, 537 (Mo. App. E.D. 2005). This means the inability to perform the usual duties of the employment in a manner that such duties are customarily performed by the average person engaged in such employment. Gordon v. Tri-State Motor Transit Co., 908 S.W.2d 849 (Mo. App. S.D. 1995). "The central question is whether in the ordinary course of business, an employer would reasonably be expected to hire the claimant in his present physical [or mental] condition reasonably expecting him to perform the work for which he is hired [citations omitted]." BAXI v. United Tech. Auto, 956 S.W.2d 340, 343 (Mo. App. E.D. 1997). While "total disability" does not require that the Claimant be completely inactive or inert, Sifferman v. Sears Roebuck and Co., 906 S.W.2d 823, 826 (Mo. App. S.D. 1996) ${ }^{9}$, it does require a finding that Claimant is unable to work in any employment in the open labor market, and not merely the inability to return his last employment. Sullivan v. Masters Jackson Paving Co., 35 S.W.3d 879, 884 (Mo. App. S.D. 2001) In determining whether a claimant can return to employment, the Administrative Law Judge may consider the employee's education, ability to be re-trained, and academic and vocational testing. Grauberger v. Atlas Van Lines, Inc., 419 S.W.3d 795, 801 (Mo. App. S.D. 2013).

While Claimant's initial injury, a foot fracture, seemed relatively straightforward, in fact the unforeseen complications that resulted were at the time life threatening, terrifying to Claimant and his family, and had a lifelong impact. The fracture with complicating DVT and pulmonary emboli have all resolved, but Claimant takes anticoagulants to prevent a recurrence and deals with the disabling effects of post phlebitic syndrome in his left lower extremity. The issue of whether the lasting effects of the accidental injury render Claimant unable to work in any employment in the open labor market is addressed by several experts.

At the heart of Claimant's PTD argument is Dr. Goldberg's assertion Claimant could only return to work in a sedentary position or desk job where he could keep his left leg elevated. Vocational expert Mr. England relied on this assertion and Claimant's lack of skills in finding Claimant totally disabled. Dr. Volarich, who initially did not address the PTD issue, found Claimant totally disabled after reviewing Mr. England's opinion. After Claimant developed gout in his right foot in 2012, Dr. Finnie noted, "It does appear that due to the patient's difficulty now involving his right foot, that he would not be eligible to continue to work. He does appear to be a good candidate for disability." Also in 2012, Dr. Wieman wrote two letters addressing Claimant's foot disability, one indicating he cannot be on his feet for long periods of time due to the work injury to his left $4^{\text {th }}$ metatarsal, and the other describing the right foot pain with

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[^0]: ${ }^{9}$ This is one of several cases cited in support of other principles of law not affected by the Hampton ruling, which overruled many workers compensation cases only with respect to the proper standard of review. See Hampton v. Big Boy Steel Erection, 121 S.W.3d 200, 224-32 (Mo. banc 2003). No further note will be made of such Hampton cases.

ambulation on a daily and ongoing basis due to gout and hallux limitus. In addition to the medical and vocational evidence, Claimant and his wife have testified to Claimant's limitations regarding his ambulation, stamina, computer skills, education and vocational experience.

In support of the idea Claimant's permanent disability is only partial in nature and extent, Employer relies on Dr. Rao's independent medical examination which resulted in a work release without restrictions as of March 15, 2011. In addition, Dr. Mankowitz felt Claimant reached MMI and could return to work without any restrictions, no longer required Coumadin, and his shortness of breath was caused by obesity and deconditioning. With Dr. Wieman providing a 0 % permanent disability rating as of October 2011, and Dr. Goldberg saying Claimant can work in a sedentary desk job, Employer contends the evidence compels an award of partial disability.

Based on a careful review of all the evidence, including the live testimony, expert deposition and all records, I find Claimant has failed to establish a right to recover permanent total disability compensation because the PTD evidence either relies on the unsupported proposition Claimant must elevate his leg consistently throughout the day, or that Claimant's bilateral foot conditions render him a total disability candidate.

I would credit Mr. England's opinion that "if he really does have to sit with his leg elevated most of the day... he's [not] going to be able to go out and compete and sustain any kind of work...in the open labor market," but the evidence shows Claimant does not have to elevate his leg as Mr. England envisioned. Claimant testified he is able to sit in one place for over 90 minutes before he has to get up to stretch his leg, and that he would "probably not" have to have his leg propped up the whole time if he had a sit down job, only sometimes. Claimant's current lifestyle is fairly active and does not include sitting with his leg elevated most of the day. Because Dr. Goldberg's suggestion to keep the leg elevated has proven to be unnecessary, Mr. England's reliance on the suggestion is not sound, and renders his PTD opinion untenable. It follows Dr. Volarich's PTD opinion ${ }^{10}$ is also flawed. Because Mr. England was able to identify jobs for which Claimant could compete assuming his leg did not have to be continually elevated, the conclusion that flows is Claimant is not PTD.

Claimant also relied on the suggestion of Dr. Finnie that Claimant would not be eligible to continue to work and appeared to be a good candidate for disability. The reliance is misplaced because it is clear Dr. Finnie reaches this conclusion after and because Claimant developed right foot problems. The right foot problems, as described by Dr. Wieman, result from gout and hallux limitus, date back to 2004, and became disabling in 2011, after the primary injury. Whether the right foot disability preexisted or arose subsequently, Missouri law holds the liability of the employer is limited to the amount of disability resulting from the last injury alone. See Lewis v. Treasurer of State, 435 S.W.3d 144, 159 (Mo. Ct. App. 2014). Evidence Claimant's right foot disability contributes to his inability to compete in the open labor market cannot be used to support a PTD finding against Employer.

Although Claimant has not met his burden of establishing he is totally disabled as a result of his work injury alone, there is ample credible evidence he has significant permanent partial disability. It is within the province of the Administrative Law Judge to determine the extent of

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[^0]: ${ }^{10}$ I find Dr. Volarich's initial report, wherein he advised Claimant to work within certain reasonable restrictions, compelling and consistent with the medical evidence. For the reasons stated above, his subsequent addendum is ill supported.

any permanent disability. Landers v. Chrysler Corp., 963 S.W.2d 275 (Mo. App. E.D. 1998). The fact finder is not bound by the exact percentages of the expert witness and is free to find another percentage of disability. Ransburg v. Great Plains Drilling, 22 S.W.3d 726, 732 (Mo. App. W.D. 2000). I credit the opinion of Dr. Volarich, who provided the following ratings: 15 % PPD at 110 week level due to the fracture; 30 % PPD of the left lower extremity rated at the thigh ( 160 week level) due to deep vein thrombosis, pulmonary emboli, and resultant post phlebitic syndrome; and 10 % PPD of the body as a whole rated at the chest. I also find the unique facts of this case justify a loading factor as suggested by Dr. Volarich, and exercise my discretion to enhance the extent of the disability by 15 %. Claimant has permanent partial disability equal to $1201 / 7 weeks. { }^{11} Employer is liable to Claimant for \ 50,816.82 in permanent partial disability compensation.

Employer/Insurer shall provide medical treatment, pay past due medical bills and TTD benefits, and compensate Claimant for his permanent partial disability as set forth herein. Attorney for Claimant shall have a lien of 25 % for legal services.

Made by: $\qquad$

Karla Ogrodnik Boresi

Administrative Law Judge

Division of Workers' Compensation

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[^0]: ${ }^{11}[(15 \% \times 110=16.5)+(30 \% \times 160=48)+(10 \% \times 400=40)]=104.5 \times 115 \%=1201 / 7$ weeks