Employee failed to demonstrate that her right shoulder condition and the pathology documented on the August 2, 2018, right shoulder MRI were caused by her July 2, 2018, work accident, or that the work event was the prevailing factor causing her right shoulder condition and the need for medical treatment. Since employee failed to satisfy her burden of proving that her right shoulder condition constituted a compensable injury under § 287.020.3, she is not entitled to recover any workers' compensation benefits, including future medical treatment, relating to that shoulder condition. Under these circumstances a final award denying employee's claim, rather than a temporary award granting medical care, was appropriate.
To recover benefits, including future medical care, the employee must show her right shoulder condition and pathology resulted from the July 2, 2018, accident to which she attributes them. *Dillon v. Architectural Materials Co.*, 419 S.W.3d 802 (Mo. App. 2013). It is not sufficient for employee to show only that the injury or medical condition complained of resulted from either one or the other of two causes, for one of which, but not the other, employer would be liable. Employee must produce evidence from which it may reasonably be found that her right shoulder condition resulted from a cause for which employer would be liable. *Griggs v. AB Chance*, 503 S.W.2d 697, 704 (Mo. App. 1973).
Further, where, as here there are conflicting medical opinions as to compensability, the Missouri Workers' Compensation Act (Act) mandates objective medical findings shall prevail over subjective medical findings. Within this context, objective medical findings are those findings demonstrable on physical exam, or by appropriate tests or diagnostic procedures. Section 287.190.6(2). An administrative law judge errs where, in the face of conflicting medical opinions on causation, he chooses to rely on subjective medical findings and ignore the objective medical evidence. Here, the administrative law judge chose to ignore the objective medical evidence showing employee's rotator cuff tear was not only preexisting, but also degenerative, chronic, and longstanding in nature.
First, the administrative law judge failed to acknowledge the findings on the April 24, 2017, right shoulder x-ray showing moderate arthritic changes at the AC joint. The humeral head was somewhat high riding in the glenoid, suggesting chronic rotator cuff injury. This objective medical evidence, documented on an x-ray taken more than fourteen months before employee's accident, demonstrated she had a high riding humeral head in the glenoid, indicative of chronic rotator cuff injury, and moderately severe arthritic changes in her right AC joint.
Injury No.: 18-050218
Employee: Georgetta Hull
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Second, the administrative law judge ignored the right shoulder x-rays taken on July 12, 2018, following the accident. Those studies likewise showed chronic, preexisting right shoulder pathology. Specifically, the July 12, 2018, x-rays revealed mild superior luxation of the humeral head relative to the glenoid, with narrowing of the acromiohumeral interval to a proximal 4.5 mm. There was sclerosis and irregularity involving the greater and lesser humeral tuberosities, as well as hypertrophic change along the glenoid rim. There was moderate degenerative osteoarthritis of the AC joint, with inferior osteophytic spurring. On reviewing the right shoulder x-ray, Dr. Cynthia Ruffolo noted it showed degenerative changes, but no acute findings or pathology.
Third, the administrative law judge ignored the August 2, 2018, right shoulder MRI, which revealed a large, full thickness tear of the supraspinatus tendon with retraction under the acromion. There was significant fatty atrophy of the supraspinatus muscle. There was no fracture or significant marrow edema. Degenerative changes were present in the AC joint. An August 20, 2018, right shoulder x-ray, likewise, demonstrated a high-riding humeral head. The objective medical findings and pathology documented on the x-ray and MRI studies of employee's right shoulder were preexisting, degenerative, chronic, and longstanding in nature. However, the administrative law judge chose to ignore this objective medical evidence, contrary to the mandate in § 287.190.6(2).
Compounding this error, the administrative law judge rejected the findings and testimony of Dr. Byron Tarbox, premised on the objective medical evidence. Drawing from the objective medical evidence, Dr. Tarbox found employee's rotator cuff tear to be chronic and preexisting. Specifically, Dr. Tarbox found the right shoulder pathology documented on the August 2, 2018, MRI represented chronic pathological changes, which took place over a period of time, and were not changes of an acute nature. Specifically, the August 2, 2018, MRI demonstrated employee had a tear of the supraspinatus, with retraction back to the glenoid. This was a significant retraction of the supraspinatus tendon. Moreover, the MRI showed employee had significant atrophy in the supraspinatus tendon, with fatty infiltration of the muscle tissue. As Dr. Tarbox explained, when muscle had not been used, because it was torn chronically, the muscle belly developed fatty infiltration and atrophy from lack of use. The combination of the objective medical findings of retraction back to the glenoid, along with atrophy and fatty infiltration into the supraspinatus muscle belly, led Dr. Tarbox to conclude employee had a chronic rotator cuff tear. Pathology such as the atrophy and fatty infiltration shown on the MRI were objective signs of a chronic, pathological change or process, which took place over years, rather than over days, weeks, or months. Dr. Tarbox found the MRI did not evidence any changes of an acute nature. Additionally, as Dr. Tarbox observed, x-ray studies demonstrated chronic pathological changes in employee's right shoulder. This included the April 24, 2017, right shoulder x-ray and the x-rays taken after the accident, including the August 20, 2018, x-ray. These x-rays demonstrated a high-riding humeral head-displacement of the head elevated higher in the shoulder joint. This was a sign there was a chronic tear of the rotator cuff, which allowed the humeral head to escape upward. These objective findings showed employee had a chronic, preexisting rotator cuff tear, which allowed the humeral head to migrate upwards over a long period of time. The objective findings documented on the x-ray studies, like those on the MRI, evidenced a chronic
Injury No.: 18-050218
Employee: Georgetta Hull
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pathological process, which took place over a period of time and which led Dr. Tarbox to find employee's right shoulder condition was not acute. As Dr. Tarbox observed, the objective medical evidence, including x-ray studies taken both before and after the accident, showed employee's rotator cuff had been torn and retracted for a long period of time before July 2, 2018. The work event did not cause an exacerbation or change of the objective pathology in employee's right shoulder, including her chronic rotator cuff tear. While the accident exacerbated employee's right shoulder symptomology, causing her to experience right shoulder pain, it did not cause the rotator cuff tear. Dr. Tarbox found the accident was not the prevailing factor causing employee's underlying right shoulder pathology.
The objective medical evidence, and Dr. Tarbox's findings and testimony based on that evidence showed employee's right shoulder condition and pathology were preexisting, degenerative, and chronic in nature. Had the administrative law judge engaged in the legal analysis required by § 287.190.6(2) and given effect to the objective medical evidence, she could have only reached one reasonable conclusion. Namely, the accident was not the prevailing factor causing employee's right shoulder condition and pathology and thus that condition did not constitute a compensable injury. Sections 287.020.3; 287.190.6; Bauer v. Indep. Stave Co., 417 S.W.2d 693, 696 (Mo. 1967). Moreover, a comparison of the diagnostic studies taken of employee's right shoulder, both before and after the accident, demonstrates that event did not result in a change in or worsening of the chronic, preexisting pathology in employee's right shoulder. The objective medical evidence shows employee's right shoulder condition and pathology were preexisting, chronic and degenerative in nature. The administrative law judge erred as a matter of law and violated § 287.190.6(2) in ignoring that evidence in determining whether the employee's right shoulder condition constituted a compensable injury.
Rather than rely on the objective medical evidence, as the Act required, the administrative law judge chose to rely upon employee's subjective complaints and the opinions of Drs. Chris Farmer and Michael Snyder. However, those physicians premised their opinions on employee's subjective complaints, rather than the objective medical evidence. It is undisputed employee had right shoulder problems for several years before July 2018, for which she received medical treatment, including an injection. The objective medical evidence, including the April 24, 2017, x-ray, demonstrated a preexisting rotator cuff tear and a high-riding humeral head in employee's right shoulder. Ignoring the objective medical findings documented in the April 24, 2017, x-ray the administrative law judge chooses instead to rely on employee's testimony that her shoulder complaints improved following Dr. Kenneth Tan's injection, and that employee reported shoulder pain to Dr. Aaron Trone over a year before the accident. Also significant to the administrative law judge was the testimony of employee's