The parties asked the administrative law judge to resolve the following issues: (1) Did employee's preexisting condition of osteogenesis imperfecta constitute a hindrance or obstacle to employment for purposes of Second Injury Fund (SIF) liability; and (2) If so, is the SIF liable for permanent partial disability or permanent total disability.
In June 6, 2019, award, the administrative law judge made the following findings and conclusions:
- Employee was credible and worthy of belief.
- Employee sustained injury to his right knee as the result of the September 1, 2010, compensable injury. He settled his claim against employer for 45% permanent partial disability to his right knee plus consideration for future medical.
- Employee's preexisting osteogenesis imperfecta was not a hindrance or obstacle to his employment or reemployment prior to the September 1, 2010, injury and therefore did not constitute a preexisting permanent partial disability for purposes of SIF liability.¹
Employee filed a timely application for review with the Commission alleging the administrative law judge erred:
- By determining that employee's preexisting osteogenesis imperfecta and deformed right ankle were not a hindrance or obstacle to his employment for SIF purposes, in that the administrative law judge
¹ In dicta, the administrative law judge opined that if employee's preexisting osteogenesis imperfecta was considered a hindrance or obstacle to his employment or reemployment prior to the September 1, 2010, injury that the credible and substantial evidence showed employee capable of obtaining employment in the open labor market and therefore he would have awarded only permanent partial disability benefits.
Injury No. 10-069808
Employee: Anthony Davis
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should have determined whether these preexisting disabilities had the potential to be a hindrance or obstacle to employment.
- By finding there were no preexisting disabilities when the preponderance of the evidence established that the employee suffered fractured bones nearly thirty times, including while working and had physical and anatomical deformity to his right ankle caused by multiple fractures and that unrebutted expert medical testimony indicated that employee's osteogenesis imperfecta and deformed right ankle were preexisting disabilities that should have prevented employee from working at heights or from standing for prolonged periods, regardless of whether employee actually knew of or worked within those restrictions before his primary injury.
- In finding employee capable of employment in the open labor market where employee's claim involved a complex medical issue and the only medical opinion regarding employability was from Dr. Swaim, who opined that employee was permanently and totally disabled; in failing to consider pain, the synergistic interaction of employee's prior and work related disabilities, job availability within the relevant geographic location and the fact that employee was unable to return to work for nearly nine years at the time of hearing.
We reverse the administrative law judge's award and decision concluding that the SIF has no liability in this matter.
Findings of Fact
Employee has osteogenesis imperfecta, a genetic disorder, diagnosed when he was a child. He sustained twenty-two different broken bones between the ages of nine month and twenty-eight years. In the 1980's employee underwent Missouri Vocational Rehabilitation due to his osteogenesis imperfecta. Employee's right leg and ankle show marked deformity due to fractures that occurred prior to the September 1, 2010, work injury.² Employee limited the types of work he chose to pursue due to his brittle bone condition. For example, employee avoided jobs that would require him to run or jump.
Despite his physical limitations, employee performed all aspects of his heavy labor job in the plumbing field between 1995 and 2010, including climbing on ladders and lifting up to 100 pounds. Employee missed no time from work due to his ankle and had no broken bones in the twenty years before his September 1, 2010, work injury. However, employee remained constantly vigilant and cautious regarding his right ankle. Employee's right leg hurt when he stood or walked a lot or did a lot of carrying at work.
On September 1, 2010, employee sustained injury in the course and scope of his employment, when he slipped on some garbage on a basement floor and his right knee
2 Claimant's Exhibits 22, 23 and 24, Transcript 703-705.
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Employee: Anthony Davis
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went out of socket.³ After the injury, employee underwent surgery on his right knee. Following the surgery, he attempted to return to his former work but was unable to build up to his regular duties due to problems with his right knee. Employee's right ankle condition has worsened since the injury to his right knee. Subsequent to the work injury, employee obtained employment as an apartment complex maintenance man, but was unable to maneuver steps and found the job required more walking than he was able to do. He worked at that job for only about three weeks. Employee has not attempted or applied for any other jobs since his injury. He is certain he cannot return to his plumbing job but uncertain if he could return to any other job.
Medical Expert Opinions
Dr. Truitt L. Swaim
Orthopedic surgeon Dr. Truitt L. Swaim examined employee on November 21, 2011. Dr. Swaim's nine-page report documented his review of employee's medical history records and physical examination. He made the following conclusions regarding employee's permanent disability:
The occupational injury of September 1, 2010, Mr. Davis sustained working for Negri Plumbing, caused or was the prevailing factor to cause him to develop a 50% permanent partial disability of the right leg at the 160 week level or 80 weeks, due to the right knee condition.
Mr. Davis had a 40% permanent partial disability of the right leg at the 160 week level or 64 weeks, due to the preexisting right knee, tibia, and ankle conditions.
Mr. Davis had a preexisting 20% permanent partial disability of the body as a whole or 80 weeks due to osteogenesis imperfecta.⁴
Dr. Swaim opined that combined effects of these disabilities rose to a level that created an enhancement of employee's overall disability and that employee's overall disability was enhanced by 9% of the body as a whole or 36 weeks.
Considering the severe disability related to employee's right leg condition, Dr. Swaim considered him permanently totally disabled from performing the essential duties of his previous occupation as a plumber. He further opined that employee was probably permanently and totally disabled, but acknowledged, "[A] vocational evaluation would be of benefit to determine if [employee] has transferable skills which will allow him to become gainfully employed.⁵
Dr. Swaim opined that employee should restrict occupational stresses to sedentary to light work, limiting his exertion of force to between ten and thirty pounds on an infrequent
³ On November 30, 2012, employee settled his claim against the employer and insurer for $30,000.00 based on approximate disability of 45% of the right knee at the 160-week level, plus a lump sum of 36,590.85 for future medical with yearly payments of 875.53.
⁴ Transcript, 489.
⁵ Id.
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Employee: Anthony Davis
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basis. He recommended that employee sit most of the time, have the ability to stand or walk for brief periods, avoid navigating uneven ground as well as climbing, repetitive stooping, twisting, squatting, kneeling, or crawling. He further recommended that employee significantly limit standing or walking.
Dr. John L. Putnam
On August 17, 2011, orthopedist Dr. John L. Putnam performed an independent medical examination of employee. His report of that date noted employee's past medical history as "Osteogenesis imperfecta type II". Dr. Putnam found employee's pathology consistent the mechanism of his workers' compensation injury, recommended life-long bracing and advised employee of the importance of avoiding any further injury due to his osteogenesis imperfecta.
Counsel for the SIF referenced a November 28, 2011 rating and restriction report of Dr. Putnam during her cross-examination of vocational expert Phil Eldred at hearing. Vocational expert James M. England also referenced Dr. Putnam's November 28, 2011, evaluation of employee in his December 12, 2012, vocational evaluation. The administrative law judge cited Dr. Putnam's November 28, 2011, report in his award. We note that the aforementioned report is not included in the Putnam Orthopaedic Center records admitted into evidence as Claimant's Exhibit 8 or any other exhibit produced at the hearing. That said, no party disputes that on November 28, 2011, Dr. Putnam rated employee at 10% permanent partial disability of the body as a whole and found employee capable of doing light deskwork with no working at heights, no climbing stairs, and no prolonged walking or standing.
Vocational Expert Opinions
Philip Eldred
Certified vocational rehabilitation counselor Phillip Eldred testified for employee at hearing. Mr. Eldred's March 9, 2018, vocational rehabilitation evaluation is also included in the record. Mr. Eldred based his evaluation on a review of employee's medical records and reports, interview and vocational testing of employee.
Mr. Eldred opined, based on his review of employee's medical records and Dr. Swaim's independent medical evaluation, that employee had an impairment which was vocationally disabling such as to constitute a hindrance or obstacle to employment before his September 1, 2010, work injury.
Addressing employee's functional capacity since his work injury, Mr. Eldred noted employee "stated that he doesn't believe that he can work as a plumber and doesn't know what he can do." Mr. Eldred's report noted that when completing a questionnaire
6 Transcript, 467.
7 Id. 840, excerpt from December 12, 2012 Vocational Rehabilitation Evaluation of James M. England.
8 Award, p. 11.
9 Claimant's Exhibit 8, Putnam Orthopaedic records, Transcript, 466.
10 Transcript, 840.
11 Id., 494.
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Employee: Anthony Davis
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designed to measure employee's self-perception of his functional limitations, when asked to rate his ability to return to work, employee responded, "Do Not Know."12
Employee tested at the 11.7 grade equivalent in word reading and at the 12.9 grade equivalent on math computation. Employee's math computation score was higher than 81% of persons in his age group. Mr. Eldred found employee's worker trait profile comparable to eleven sedentary jobs "if employee had the physical and academic ability to be retrained."13 In spite of these noted strengths, Mr. Eldred concluded that employee is not only unable to return to his prior work as a plumber but is further unemployable in the open labor market because of his age, lack of transferable skills, and physical restrictions.
James M. England
The SIF produced the deposition and report of vocational rehabilitation counselor James M. England. On December 12, 2012, after reviewing employee's medical records and doctors' reports, employee's April 2012 deposition and Dr. Swaim's June 2012 deposition, Mr. England noted,
[Employee] indicated that his pain is not severe and is generally in the 1-3 range on a 1-10 scale. Nevertheless he reported inability to continue working as a plumber because of his discomfort. He said that he has trouble being up on his feet very long, but was not specific.
He is not taking any medication at all.
He indicated that Dr. Putnam was seen for a second opinion and advised him that he did not believe Anthony could go back to work as a plumber, but did not rule out other forms of employment. In fact, [employee] did not recall any doctor telling him that he was totally unable to do some type of alternative work.14
Mr. England considered employee's successful completion of a two-year electronics course as evidence that he has "good basic academic abilities with regard to reading and math."15 Noting that employee takes no pain medication and qualifies as a younger worker under U. S. Department of Labor Guidelines, Mr. England concluded:
Although [employee] is restricted to work in the sedentary to light range of exertion with the need to be off his feet most of the day, he is not restricted to the point that I believe he would be unemployable. To the contrary, I believe that using the knowledge and skill he has acquired in the past he would be an ideal candidate for an inside sales position dealing with plumbing materials and supplies. He could also perform customer service work and work as an alarm monitor provided that he acquired some basic
12 Id., 498.
13 Transcript, 506.
14 Id., 841.
15 Id., 842.
Injury No. 10-069808
Employee: Anthony Davis
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keyboarding skills. There would also be some cashiering positions he could perform such as in a parking garage type setting. 16
**Nature and Extent of Employee's Permanent Disability**
Based on Dr. Swaim's expert opinion, we find that the accident of September 1, 2010, was the prevailing factor causing employee to suffer 50% permanent partial disability to his right leg at the 160-week level, consisting of 80 weeks due to the right knee condition.
We credit Dr. Swaim's opinion that employee had preexisting disability due to his right knee, tibia, and ankle conditions consisting of 40% permanent partial disability of the right leg, consisting of 64 weeks, and 20% of the body as a whole, consisting of 80 weeks, due to osteogenesis imperfecta. Based on Dr. Swaim's opinion and employee's hearing testimony, we further find that employee's permanent partial disability from his work injury synergistically combined with his preexisting osteogenesis imperfecta to result in greater overall permanent partial disability than their simple sum.
We credit Mr. England's vocational assessment, which considered employee's medical history, educational background, vocational history, functional restrictions and limitations, including employee's self-perceived functional limitations. Ultimately, in light of this evidence we are not persuaded to render a finding that employee is permanently and totally disabled, whether as a result of the combined effects of the primary injury and his preexisting conditions of ill-being, or for any other reason. We find Mr. England's assessment finding that employee is capable of working in some capacity in the open market more credible and persuasive than Mr. Eldred's conclusion that employee is permanently and totally disabled from any employment in the open labor market.
**Conclusions of Law**
**Second Injury Fund Liability**
Section 287.220 RSMo creates the SIF and controls the assessment of SIF liability in "all cases of permanent disability where there has been previous disability." Section 287.220 provides as follows with respect to SIF liability for enhanced permanent partial disability benefits:
If any employee who has a preexisting permanent partial disability whether from compensable injury or otherwise, of such seriousness as to constitute a hindrance or obstacle to employment or to obtaining reemployment if the employee becomes unemployed, and the preexisting permanent partial disability, if a body as a whole injury, equals a minimum of fifty weeks of compensation or, if a major extremity injury only, equals a minimum of fifteen percent permanent partial disability, according to the medical standards that are used in determining such compensation, receives a subsequent compensable injury resulting in additional permanent partial disability so that the degree or percentage of disability, in an amount equal to a minimum of fifty weeks compensation, if a body as a whole injury or, if
16 Id., 844.
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Employee: Anthony Davis
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a major extremity injury only, equals a minimum of fifteen percent permanent partial disability, caused by the combined disabilities is substantially greater than that which would have resulted from the last injury, considered alone and of itself, and if the employee is entitled to receive compensation on the basis of the combined disabilities, the employer at the time of the last injury shall be liable only for the degree or percentage of disability which would have resulted from the last injury had there been no preexisting disability. After the compensation liability of the employer for the last injury, considered alone, has been determined by an administrative law judge or the commission, the degree or percentage of employee's disability that is attributable to all injuries or conditions existing at the time the last injury was sustained shall then be determined by that administrative law judge or by the commission and the degree or percentage of disability which existed prior to the last injury plus the disability resulting from the last injury, if any, considered alone, shall be deducted from the combined disability, and compensation for the balance, if any, shall be paid out of a special fund known as the second injury fund, hereinafter provided for.
The administrative law judge found that *Loven v. Greene County*, 63 S.W.3d 278 (Mo. App. 2001), compels a finding that employee failed to prove that his preexisting osteogenesis imperfecta was a hindrance or obstacle to his employment for SIF purposes. We disagree.
In *Loven*, the court held that an employee's morbid obesity did not qualify as a preexisting disability for purposes of SIF liability. Employee testified that his obesity did not cause any hindrance or obstacle to employment and in fact was an asset in his work as an ironworker. The *Loven* court specifically noted that morbid obesity could qualify as a preexisting disability that would trigger SIF liability but found that the evidence in the record did not support such a factual finding in that case.
As we have found, in this case employee self-accommodated his osteogenesis imperfecta by avoiding jobs that presented certain physical risks, such as running or jumping. He proactively attempted to prevent further injury by vigilantly guarding his right leg, damaged and significantly deformed due to bone breaks prior to the work injury. Unlike *Loven*, there is no evidence that employee's osteogensis imperfecta was an asset to his employment.
*Loven* noted that the prior judicially established standard that required a preexisting "industrial disability," defined as a loss of earning capacity rather than physical impairment as such, was abrogated by the legislature's 1993 amendment to § 287.220.1 which added language requiring that a preexisting injury for purposes of SIF liability be "of such seriousness as to constitute a hindrance or obstacle to employment or to obtaining employment if the employee becomes unemployed." Under the new standard, courts have held the proper focus of the inquiry as to the nature of a prior disability is on the potential that the condition may combine with a work-related injury in the future so as to cause a greater degree of disability than would have resulted in the
TI3661-0301
Injury No. 10-069808
Employee: Anthony Davis
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absence of the condition. Employee in this case has satisfied the explicit statutory requirement of demonstrating a preexisting permanent partial disability that constituted a potential hindrance or obstacle to employment. See *Loven*, 287.
As stated by the court in *Wuebbling v. West County Drywall*, 898 S.W.2d 615 (Mo. App. 1995), under the law that applies to this case, a preexisting disability need not be shown to have caused the employee to miss work or to have reduced his earnings to trigger SIF liability. Rather, the key is whether a preexisting disability would cause a prospective employer to discriminate in hiring. *Id.* 619, 620.
In *Knisley v. Charleswood Corp.*, 211 S.W.3d 629 (Mo. App. 2007), the court reiterated that the standard for determining SIF liability related to a preexisting condition is "not on the extent to which the condition has caused difficulty in the past, it is on the potential that the condition may combine with a work-related injury in the future so as to cause a greater degree of disability than would have resulted in the absence of the condition [emphasis added]." *Id.* 636, citing *Wuebbling v. West County Drywall*, 898 S.W.2d 615, 620 (Mo. App. E.D. 1995).
We conclude that employee has satisfied each of the statutory requirements for proving SIF liability for permanent partial disability benefits. We find that the administrative law judge's focus on employee's ability to work in a physically demanding job prior to his work injury, notwithstanding his known preexisting congenital disorder, as a matter of law, was incorrect.
As we have found, based on employee's testimony, his medical and vocational history, and Dr. Swaim's expert opinion, employee's preexisting condition of osteogenesis imperfecta constituted a significant potential impediment to his employability and affected his ability to compete for jobs prior to the date of the primary injury. We have further found, based on Dr. Swaim's opinion and employee's credible testimony, that there is a synergistic interaction between employee's preexisting disability and the primary injury of September 1, 2010, that results in greater permanent partial disability than the simple sum of the conditions. We deem a 20% synergy factor appropriate to account for this enhanced permanent partial disability.
Accordingly, we calculate the SIF's liability as follows: 144 weeks (40% preexisting permanent partial disability rated at the right leg rated at the 160-week level (64 weeks) + 20% permanent partial disability of the body as a whole referable to osteogenesis imperfecta (80 weeks)) + 80 weeks (50% permanent partial disability of the right leg at the 160 week level) = 224 weeks x the 20% load factor = 44.8 weeks of enhanced permanent partial disability. At the stipulated permanent partial disability rate of 418.58, the SIF is liable for 18,752.38 permanent partial disability benefits.
**Decision**
We reverse the award of the administrative law judge.
The Second Injury Fund is liable to employee for enhanced permanent partial disability benefits in the amount of $18,752.38.
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Employee: Anthony Davis
The award and decision of Administrative Law Judge Kevin A. Elmer, issued June 6, 2019, is attached solely for reference.
For necessary legal services rendered to employee, Randy Alberhasky, Attorney at Law, is allowed a fee of 25% of the compensation awarded, which shall constitute a lien on said compensation.
Any past due compensation shall bear interest as provided by law.
Given at Jefferson City, State of Missouri, this 14th day of January 2020.
LABOR AND INDUSTRIAL RELATIONS COMMISSION
Robert W. Cornejo, Chairman
DISSENTING OPINION FILED
Reid K. Forrester, Member
Curtis E. Chick, Jr., Member
Secretary
Employee: Anthony Davis