Employee's date of birth was July 1, 1950. He worked as a road truck driver for employer since about 2011. Employee was educated through the twelfth grade and attended 1.5 years of college. Aside from his decades-long career (approximately 43 years) as a truck driver, employee owned a construction company for three years. Employee did not return to work after the January 3, 2014 accident.
¹ June 16, 2015 is the date found by the administrative law judge as the date of maximum medical improvement. The judge identified the 235 weeks as the number of weeks of compensation reflected by the settlement amounts with the employer/insurer. Award, page 10, footnote 5.
Injury No.: 14-000493
Employee: Arthur Anttila
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**Acute Injury by Accident**
At the hearing, the parties stipulated that on or about January 3, 2014, employee sustained an accident which arose out of and in the course and scope of his employment with employer. Additionally, employee sustained an occupational disease which arose out of and in the course and scope of his employment with employer. *Transcript, page 6.* However, the Fund "disputes that employee's injury was compensable until after the last injury." *Award, page 3, footnote 1.*
On January 3, 2014, employee was delivering trailers from Joplin, Missouri to Kansas City. Upon arrival in Kansas City, he attempted to remove a pin from the fifth wheel trailer. In pulling the pin to dislodge it, he felt a crunch in his neck. He continued to work, but on the drive back to Joplin began experiencing severe pain in his left arm and neck.
The next day employee sought treatment from his chiropractor, who sent him to the emergency room. He was evaluated for left shoulder complaints. Employee notified the employer of his injury and was sent for treatment to Dr. Charles Mauldin on January 6, 2014. Dr. Mauldin, after ordering an MRI, determined employee's injury was related to a preexisting shoulder condition and released him from authorized care.
Employee treated on his own thereafter, undergoing a cervical fusion on June 12, 2014, to address a C5-6 disc herniation with severe nerve root impingement.² He also underwent a left carpal tunnel surgery at that time. Employee indicated that after surgery, his left arm pain was relieved, but his neck still bothered him. While undergoing physical therapy, claimant indicated some left arm pain, weakness, or coldness. *Transcript, pages 22-24.* He received a cervical injection on October 28, 2014. *Transcript page 1407.* He was released from neck treatment as of June 17, 2015.
Employee still experiences neck pain and has limitations on movement. He has difficulty standing for long periods and has limited lifting ability. He experiences weakness in his left arm, which causes problems gripping. He has difficulty sleeping and requires assistance from his wife with certain activities.
**Injury by Occupational Exposure**
At the hearing in October 2018, employee testified that he had experienced ongoing neck and arm pain for several years while working for employer. The roads which he traveled were often unpaved. Employee asserted the trucks were often old and needed new shocks; that he bounced around while driving, and the roads were hard on his body.
Employee treated with a chiropractor, Dr. David Mullin, beginning in October 2011 for left arm and right leg numbness and neck adjustment. Employee indicated that this was "maintenance," "to get realigned," "it helped me perform better," *Transcript, pages 26, 28-30, 50-54,* and that he had no problems doing his job prior to January 3, 2014. Employee did not miss any work for related to chiropractic appointments or pain. He denied having to work slower, take extra breaks or needing accommodation in any fashion by employer prior to his January 3, 2014 injury. He denied these conditions limited his ability to perform his work. *Transcript, page 29.*
² We note that the administrative law judge refers to right arm pain "at this time as well," implying that it was prior to the June 2014 surgery, at page 6 of the Award, paragraph 5. Dr. Chabot notes his opinion that any right shoulder complaints reported in January 2015, were not related to his alleged work injury but represented evidence of tendonitis. *Transcript page 956, 957.* The parties do not focus on right extremity complaints.
Injury No.: 14-000493
Employee: Arthur Anttila
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**Primary and Preexisting Conditions**
The administrative law judge found the traumatic injury by accident on January 3, 2014, to the neck/left extremity to be a preexisting disability. We disagree and find this injury to be the primary/last injury.
Employee filed his claim against employer in August 2015, identifying the body parts injured as "Left shoulder/arm/hand and cervical spine." *Transcript*, page 1465. He specifically identified the mechanism of injury as pulling a pin from the fifth wheel when he experienced pain and discomfort in the named areas. The initial claim included a claim against the Fund, identifying only left shoulder and left leg preexisting injuries from 1994. When employee amended his claim in May 2016, he added to the description of his injury, "Additionally employee was exposed to significant vibrations in the on-the-job operation of the vehicle. Resulting in injury to his cervical spine." *Transcript*, page 1440. However, the preexisting injuries remained the same.³
We set aside for the moment an examination of whether the occupational exposure to repetitive jarring resulted in a preexisting disability.⁴ The medical records showed that employee had a number of other prior medical conditions and surgeries, but the evidence did not establish any preexisting disabilities that met the requirements of § 287.220.3 RSMo. The preexisting injuries identified by employee in his initial and amended claims as left shoulder and left leg from 1994, did not result in any permanent disability.
**Expert opinions**
Employee sought an independent medical examination from Dr. Robert Paul on January 27, 2016. Dr. Paul identified two distinct injuries - a traumatic injury to the cervical spine with residual carpal tunnel syndrome on January 3, 2014; and an injury to the spine due to prior occupational exposure to constant jarring over the three years he drove for employer.
Dr. Paul rated the disability due to "all conditions relative to his employment" at the employer as 50 % body as a whole; with 15 % of this "apportioned to his exposure to the hazards of an occupational illness/disease in the form of cumulative trauma to his cervical spine" and 35 % to his cervical fusion with residuals. In addition, he found a 20 % disability at the 175 week level for left traumatic carpal tunnel syndrome. He found no disability for employee's alleged preexisting disabilities to his left shoulder or left leg. Although Dr. Paul lists other medical conditions evident in the records, he does not find any of them disabling. *Transcript*, page 1414.
Dr. Paul opined that employee was permanently and totally disabled due to the combined effects of disabilities from the January 3, 2014, injury "with prior disabilities." *Transcript*, 1414. Dr. Paul's opinion was premised on identifying cumulative trauma to employee's cervical spine as the prior disability. *Transcript*, pages 145 and 1414. The doctor suggested a functional capacity evaluation be performed.⁵ Employee reports his belief that he had the following restrictions or limitations from Dr. Paul: sitting four hours in a workday; standing/walking three hours in a workday; alternating positions every 20-30 minutes. *Transcript*, page 34. Other indications in the record suggest a weight lifting limit of ten pounds for no more than two and a half hours during an eight hour period. *Transcript*, pages 1382-84.
³ We note that the administrative law judge identified diabetes and hearing as preexisting injuries in her award, but that employee "did not testify to any restrictions from either condition at the hearing, however." *Award*, page 5.
⁴ See the discussion under the heading, Expert opinions.
⁵ We are unable to locate that report in the record. Mr. Philip Eldred summarizes various references to doctor restrictions in his report at *Transcript*, pages 232-34. The doctor's reference to the evaluation is at 1357.
Injury No.: 14-000493
Employee: Arthur Anttila
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Closer in time to the January 2014 injury, employer's expert, Dr. Michael Chabot examined employee on January 28, 2015. He later reviewed subsequent records of diagnostic testing and prepared reports dated August 5, 2015 and October 28, 2015. He opined that employee's acute cervical spine injury was work-related and rated the disability at 15 % (body as a whole) due to the injury and subsequent surgery. He identified 5 % of that disability rating as attributable to preexisting disease at C4-5 level. Transcript, pages 957-958. As of January 28, 2015, he opined that employee was able to return to full, unrestricted duty, noting that employee no longer complained of any significant neck or left upper extremity problems.
Both Dr. Paul and Dr. Chabot found that there was some evidence of a preexisting condition in employee's neck. Dr. Paul found this to have resulted from employee's work as a truck driver experiencing repetitive jarring and specifically related it to the last three years of work with the employer, apparently based on employee's report of the conditions of roads traveled during that employment. Dr. Chabot appears to have attributed any preexisting disability to degenerative processes. Both doctors also identified some mild degenerative changes at C3-4, evidence of stenosis and o