Christopher Walters v. City of St. Joseph

-2-

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

Given at Jefferson City, State of Missouri, this $\qquad 14th \qquad$ day of May 2021.

LABOR AND INDUSTRIAL RELATIONS COMMISSION


Attest:


Employee: Christopher Walters

Injury Number: 15-018291

Dependents: $\quad \mathrm{N} / \mathrm{A}$

Employer: City of St. Joseph

Insurer: Self-Insured c/o Thomas McGee

Additional Party: Treasurer of the State of Missouri as Custodian of the Second Injury Fund

Hearing Date: February 27, 2020

Checked by: RSA/lh

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 15, 2015
5. State location where accident occurred or occupational disease was contracted: St. Joseph, Buchanan County, Missouri.
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: While in the course and scope of employment, Claimant was exposed to multiple traumatic events that aggravated, exacerbated, and accelerated Claimant's preexisting post-traumatic stress disorder.
12. Did accident or occupational disease cause death? No. Date of death? N/A

Issued by DIVISION OF WORKERS' COMPENSATION

Employee: Christopher Walters

Injury No: 15-018291

1. Part(s) of body injured by accident or occupational disease: Body as a whole, psychological

1. Nature and extent of any permanent disability: 25% of the body as a whole for psychological and permanent total disability as to the Second Injury Fund

1. Compensation paid to date for temporary disability: $0

1. Value of temporary total disability benefits not paid by employer/insurer: $0

1. Value necessary medical aid paid to date by employer/insurer: $0

1. Value necessary medical aid not furnished by employer/insurer: 0

1. Employee's average weekly wages: 889.71

1. Weekly compensation rate: $593.14 for TTD/PTD and $451.02 for PPD

1. Method wages computation: The parties stipulated to wage rates in post-trial briefs and submission of Employer wage records.

**COMPENSATION PAYABLE**

1. Employer shall immediately pay Mr. Walters permanent partial disability benefits in the amount of $45,102.00 (25% of the body as a whole at the 400 week level X $451.02 = $45,102.00) beginning March 28, 2015 through February 25, 2017, for 100 weeks.

1. The Second Injury Fund (SIF) shall immediately pay Mr. Walters, beginning October 1, 2017, $593.14 per week for 125.4 weeks for permanent total disability benefits, and thereafter $593.14 per week for the remainder of his life. As of February 27, 2020, the Second Injury Fund's liability for past due benefits equals 74,379.76. ((125.4wks x 593.14) = $74,379.76).

1. Future requirements awarded: Employer is directed to authorize and furnish additional medical treatment to cure and relieve Claimant from the effects of his January 15, 2015 occupational disease, in accordance with Section 287.140, RSMo.

The compensation awarded to the Claimant shall be subject to a lien in the amount of 25% of all payments hereunder, plus $15,177.65 for expenses, in favor of Ben Creedy, Employee's attorney, for necessary legal services rendered.

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Issued by DIVISION OF WORKERS' COMPENSATION

Employee: Christopher Walters

Employee: Christopher Walters

Injury Number: 15-018291

Dependents: $\quad \mathrm{N} / \mathrm{A}$

Employer: City of St. Joseph

Insurer: Self-insured c/o Thomas McGee

Additional Party: Treasurer of the State of Missouri as Custodian of the Second Injury Fund

Hearing Date: February 27, 2020

Checked by: RSA/lh

The above-referenced workers' compensation claim was heard before the undersigned Administrative Law Judge on February 27, 2020. The parties were afforded an opportunity to submit briefs or proposed awards, resulting in the record being completed and submitted to the undersigned on or about March 28, 2020.

The employee appeared personally and through his attorney, Ben Creedy. The City of St. Joseph appeared through its attorney Mark Hoffmeister. The Treasurer of the State of Missouri as Custodian of the Second Injury Fund appeared through Assistant Attorney General Candace Cole.

The parties entered into a stipulation of facts. The stipulation is as follows:

1. That the employer, City of St. Joseph, was an employer operating subject to the provisions of the Missouri Workers' Compensation law on January 15, 2015;
2. That, on January 15, 2015, Employer was self-insured c/o Thomas McGee
3. That Christopher Walters was Employer's employee and he was working subject to the law in St. Joseph, Buchannan County, Missouri;

1. Whether the employee sustained an injury by accident or occupational disease arising out of and in the course of employment.
2. Determining the employee's average weekly wage and compensation rates.
3. Whether the employee notified the employer of the injury as required by law.
4. Whether the employee's claim was filed within the time allowed by law.
5. Whether the employer must provide the employee with additional medical care.

Issued by DIVISION OF WORKERS' COMPENSATION

Employee: Christopher Walters

Injury No: 15-018291

1. Whether the employee suffered any disability and, if so, the nature and extent of the employee's disability and whether the employee is permanently and totally disabled.

1. Whether the alleged accident or occupational disease caused the disability the employee claims.

1. Whether the Second Injury Fund is liable to Employee.

1. Whether the employee must reimburse certain costs related to a missed vocational evaluation appointment.

Claimant Christopher Walters testified at the hearing in support of his claim. In addition, Claimant offered for admission the following exhibits:

1. Deposition Transcript of Christopher Walters dated October 7, 2015
2. Deposition Transcript of Christopher Walters dated January 24, 2019
3. Deposition Transcript of James Jackson, Ph.D.
4. Deposition Transcript of Michael Dreiling
5. Deposition Transcript of Terry Cordray
6. Medical records from the United States Department of Veterans Affairs
7. Personnel records of Christopher Walters from the United States Air Force and Missouri Air National Guard
8. Personnel records of Christopher Walters from the City of St. Joseph, Missouri
9. Affidavit of attorney's fees and expenses from counsel for Christopher Walters

Exhibits 1, 2, and 4-9 were received without objection and admitted into evidence. Exhibit 3 was admitted into evidence over the Second Injury Fund's objection. No "Exhibit 6" was offered for admission and there was no objection made to maintaining the numbering of Exhibits Claimant offered.

Employer City of St. Joseph, joined Claimant in offering Exhibits 1, 2, 4, 7, and 8. Employer also offered for admission the following exhibits:

A. Deposition Transcript of Patrick Caffrey, Ph.D.

B. Invoice from Michael Dreiling for missed vocational appointment

C. Counseling record of Nancy Piercy dated November 17, 2015

D. Wage Statement

Exhibit B was received without objection and admitted into evidence. Exhibit D was offered into evidence post-trial, while the record remained open. Receiving no objection, Exhibit D was admitted into evidence. Exhibit A was admitted into evidence over the Second Injury Fund's objection. Employer offered Exhibit C which, upon sustainment of Claimant's objection, was not admitted into evidence.

The Second Injury Fund did not offer any additional exhibits into evidence.

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Issued by DIVISION OF WORKERS' COMPENSATION

Employee: Christopher Walters

Injury No: 15-018291

All exhibits appear as the exhibits were received and admitted into evidence at the evidentiary hearing. There has been no alteration (including highlighting or underscoring) of any exhibit by the undersigned judge.

Christopher Walters (Claimant) was hired by the City of St. Joseph (Employer) as a fire fighter in October 2007. Exhibit 9, at 91. During his employment, Mr. Walters encountered multiple significant traumatic events. Exhibit 2, 29:3-7, 79:6-17, 83:24-84:2, 93:8-12. In 2013, Mr. Walters responded to an emergency call where a woman prematurely delivered her baby into a toilet. Exhibit 2, 77:11-78:16. Mr. Walters had to tend to the underdeveloped baby and was instructed to accompany the baby to the ambulance where the police officer on duty insisted on taking photographs exposing Mr. Walters to an in-depth examination of the deceased baby. Id.

Following this event, Mr. Walters immediately began experiencing nightmares, flashbacks, and loss of sleep. Exhibit 2, 78:17-79:22, 81:23-82:5. Mr. Walters began having flashbacks in mid to late 2013 after the first traumatic event. Exhibit 1, 43:19-44:1. He had flashbacks from the event at the fire department that would then take him back to military and personal experiences. Id. These flashbacks would include events from deployment including instances of children being injured or maimed. Id. Additionally, he began to dread going to work and had difficulty making himself go to work, occasionally calling in. Exhibit 2, 81:16-22, 83:6-14. He no longer wanted to be placed similar in traumatic situations. Exhibit 2, 81:16-22.

In the winter of early 2014, approximately six months after the first traumatic event, Mr. Walters again encountered a traumatic emergency call involving a toddler. Exhibit 2, 83:21-85:14. The power went out in town and a young couple placed quilts over their toddler's crib and positioned the crib over the floor furnace. Id. When the power came back on, the furnace and the quilts burned the child to death while asleep in its crib. Id. Mr. Walters responded to the scene and had to perform CPR on the child without success. Id. Mr. Walters again encountered the same police officer from the first event, who argued with him and was getting in the way of him performing his duties. Id.

Following this event, Mr. Walters did not remember riding back to the station or being at work the rest of the afternoon. Exhibit 2, 86:4-15. He was later told that his captain found him sitting on the back of the truck, crying. Id. Soon after, Mr. Walters became depressed. Exhibit 2, 85:15-20. He also began to isolate himself and had difficulty trusting his coworkers and superiors. Exhibit 2, 85:20-86:3. Mr. Walters' lack of trust was a result of insensitive co-workers rehashing the events, berating Mr. Walters for seeking help and treatment, and administrators telling his friends, and fellow coworkers of the details of Mr. Walters' claims. Exhibit 2, 86:16-87:6, 99:7-100: 11,100: 12-101: 13.

Mr. Walters continued to experience nightmares, including different and more intense nightmares following the second traumatic event. Exhibit 2, 87:25-88:8. In addition to his previous nightmares, he began personalizing the events where he would dream he was performing CPR on the child and the child would be his daughter. Id. He also began to have anger and frustration issues, being quick to anger, lacking intimacy, and isolating himself. Exhibit 2, 87:2224, 88:19-23. Mr. Walters began having verbal altercations at work. Exhibit 2, 89:15-23. His wife began noticing different behaviors in him. Exhibit 2, 90:16-18.

On January 22, 2015, Mr. Walters' psychiatrist, Dr. Pattison, wrote a letter to the fire chief stating Mr. Walters could no longer perform the duties of his job. Exhibit 9, p. 8. Dr. Pattison determined that his job as a fireman exacerbated his PTSD and major depressive disorders. Id.

After submitting Dr. Pattison's letter to the City, Mr. Walters was placed on light duty. Exhibit 2, 95:11-14. As he testified at the hearing, Mr. Walters was berated and treated poorly for disclosing to his employer his condition and his inability to continue performing his job. He was treated with contempt and ridicule. While placed on light duty, Mr. Walters went to provide support assistance at the scene of a fire where he witnessed the fire fighter that had to take his spot jump from a burning structure. These experiences also worsened Mr. Walters' PTSD. Claimant's employment as a fire fighter with Employer was terminated effective May 12, 2015 as a result of Dr. Pattison's January 22, 2015 letter saying he could no longer perform his job duties. Exhibit 9, at 2 and 8. Claimant's last day of work with Employer was March 27, 2015. Id.

After working as a fire fighter for Employer, Claimant worked for the St. Joseph School District as a substitute teacher and coach. Exhibit 2, 102:7-23. His hours varied but would be anywhere from 8 to 32 hours a week for teaching. Id. Claimant stated that he was able to work those jobs because "It's a totally different setting....those were things that made me feel better. Like, I, you know, felt useful again and that I could do something." Id. On 11/15/2016, Claimant met with Cecilia Iboaya-Woods with VA Heartland-West. In this meeting Claimant stated that "he continues to teach/couch (coach) kids of HS ages...for wrestling and football, and says he is looking forward to wrestling season coming up soon." Exhibit 7 at 471. Claimant testified that when he was working as a substitute teacher that he was able to substitute in a long-term capacity for up to three months.

On 10/27/2016 Claimant stated that "he needs to start attending treatment to help his attorney win his case for him etc. He says that he as a pending lawsuit against workman's comp with the Fire Dept. over his mental health injury/PTSD he suffered when he worked as a fireman etc. He said he believes that he does have combat related PTSD, but also believes that working at the Fire Dept./providing crisis intervention when he goes rescuing fire victims exacerbated his military PTSD conditions..." Exhibit 7 at 479. Claimant, however, never had a change to his psychological diagnosis and he continued to participate in treatment for PTSD. For example, on a later date, at the same meeting on 11/15/2016 referenced above, Claimant stated "he continues to have some issues with PTSD/depression, he says he believes increasing stressor from couching (coaching) work may have the tendency to increase his anxiety and problems with flashback. Exhibit 7 at 471 .

Beginning in 2016, Claimant's service dog Moose would accompany Claimant at school during his work as a substitute teacher and at wrestling practices. Exhibit 2, 112:23 - 113:18. Claimant had verbal altercations with a school administrator. Exhibit 7 at 629. Claimant terminated

his employment with the St. Joseph School District in September 2017. Exhibit 2, 113:19 - 21; Exhibit 7 at 611. Claimant reported to his Anger Management Support Group at VA HeartlandWest that "he did get fired. However, he was reinstated by the boss." Exhibit 7 at 629.

Mr. Walters rarely leaves the house due to his conditions. He feels as though he doesn't have control, he's fearful to leave his house empty, and he often has altercations with people when he does leave the house. Exhibit 2, 108:17-109:1. If he does leave the house, he always has his service dog Moose with him. Exhibit 2, 109:9-25. Moose helps with Mr. Walters anxiety; he watches doors and other people. Exhibit 2, 6:23-7:4. Moose is able to be hypervigilant so Mr. Walters does not have to be. Id.

Mr. Walters joined the Air National Guard in 1997 while he was in college. Exhibit 1, 12:2-3. After college, he received his commission to become an officer and completed officer training in 2001. Exhibit 2, 59:17-59:13. He then received training to be a navigator and continued his service with the guard until 2012. Exhibit 2, 62:7-20, 63:23-25. During his time in the Air National Guard, Mr. Walters was stationed in Saudi Arabia, Qatar, Oman, Uzbekistan, Kuwait, Afghanistan, and Germany. Exhibit 1, 16:11-17:15. Mr. Walters was involved in combat in all of these deployments except Germany. Exhibit 1, 16: 17-21. In 2012, Mr. Walters received medical retirement from the Air National Guard due to his sleep apnea. Exhibit 2, 63:23-25.

Following his medical retirement, Mr. Walters was evaluated at the VA hospital for VA benefits. Mr. Walters' evaluation was scheduled over a year after he received his medical retirement. Exhibit 1, 41:24-42:3. His evaluation was scheduled for March 6, 2014. At the evaluation, Mr. Walters was diagnosed with service-related PTSD, GERD, tinnitus, shoulder injury, and headaches. Exhibit 7, at 218, 219, 232, 246-247. Claimant's VA records from his initial "C\&P, Initial Evaluation" dated 3/6/2014 listed 3 stressors leading as part of his evaluation that were all related to traumatic experiences while serving on active duty in the United States Air Force. Exhibit 7, at 224-225. Claimant's evaluation in 2014 did not reference any of the traumatic events he experienced working as a fire fighter for Employer. Furthermore, the VA records state in relevant part:

"There were two statements in his file. One was from a childhood friend who stated that being in the Air Force took its toll on Mr. Walters, especially in regards to his relationships. The other was from his sister, Leslie, who is a social worker and works with PTSD. She stated that after returning from his first deployment, he sat in a room and cried for a half hour. She stated that interactions with family became limited. He became moody, frustrated and agitated and had several episodes where he lost his temper and was aggressive with family members. He had periods of excessive drinking and this led to legal problems." Exhibit 7, at 221.

Mr. Walters began seeking group and individual therapy for his PTSD. At many of these sessions, Mr. Walters expressed symptoms, experiences, and troubles with his employment at the city negatively impacting him. Mr. Walters was evaluated again in April of 2015 for his PTSD. Exhibit 7 at 89. Mr. Walters' PTSD had worsened. Id. 92-93, 99. This was attributed to his work with the city. Id.

Prior to his employment with the City of St. Joseph, Claimant did not experience nightmares. Exhibit 1, 39:13-18. These nightmares occasionally trigger flashbacks to his military

Issued by DIVISION OF WORKERS' COMPENSATION

Employee: Christopher Walters

Injury No: 15-018291

service. Exhibit 1, 44:10-45:15. Mr. Walters began having flashbacks in mid to late 2013 after the first traumatic event with the prematurely born infant. Exhibit 1, 43:19-44:1. The flashbacks from the events at the fire department cause flashbacks to military and personal experiences. Id. These flashbacks would include events from deployment including instances of children being injured or maimed. Id. However, Mr. Walters did not have these flashbacks prior to the traumatic events while working for the city. Exhibit 1, 39:13-18. Mr. Walters has been prescribed medications for his mental conditions including Sertraline for depression, buspirone for anxiety, prazosin for nightmares, lamotrigine for PTSD. Exhibit 2, 9-17; Exhibit 6, at 4. Prior to the traumatic events while employed with the city, Mr. Walters did not take any prescriptions for anxiety, depression, or nightmares. Exhibit 2, 29:10-12.

Kiffany Walters

Ms. Walters, the wife of Claimant Christopher Walters, testified at the hearing. She first met Claimant in May 2013 and they were married on 9/26/2014. She is a processor in the St. Joseph school District for special needs children. Ms. Walters testified that she met Claimant while he was a firefighter and was aware of the work incidents described above. She added that when she first met Claimant that he was very outgoing and social and would play softball. She testified that her husband changed after the incidents described above working for the City of St. Joseph. He became dark, gloomy and has a short fuse. She indicated that she told him that he had to seek help or she would leave him, which prompted Claimant to seek help. He was a ticking time bomb but noted that she has noticed some improvement.

Some of the behavior Ms. Walters noted in her testimony was that Claimant would slam his hands down on the stove, which prompted her to tell the children to leave the room. She recalled an incident with a neighbor, and that Claimant was involved in an altercation with a Home Owner's Association (HOA) Board member, causing Claimant's removal from the HOA Board. Ms. Walters also recalled arguments and altercations Claimant had with neighbors in their old neighborhood. These incidents included a verbal and physical altercation with an elderly driver.

Ms. Walters testified that Claimant does not leave the house often, and when he does it is usually only with her. Ms. Walters is aware when Claimant has nightmares because Claimant exhibits obvious physical effects that can cause the bed to shake and will occasionally wake her up. Ms. Walters also testified that Claimant has a short fuse that would impact his ability to work and that she cannot think of a job her husband is capable of having. She added that the St. Joseph School district told Claimant that he could not coach anymore and as a result of an altercation with school administration.

James Jackson, Ph.D.

Dr. Jackson is a licensed psychologist, with a Ph.D. in psychology. Exhibit 6, at 96. Dr. Jackson evaluated Mr. Walters on November 2, 2017, to assess the status of his psychological functioning and determine how his psychological function is related to his injury. Id. at 2. Dr. Jackson administered several psychological tests to Mr. Walters and conducted a four hour in

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Issued by DIVISION OF WORKERS' COMPENSATION

Employee: Christopher Walters

Injury No: 15-018291

person interview. Id. at 3. Dr. Jackson found the results of these tests to be accurate and Mr. Walters' efforts valid. Exhibit 3, 12:1-3. Dr. Jackson diagnosed Mr. Walters with chronic and severe post-traumatic stress disorder (PTSD), and chronic and severe major depressive disorder with anxious features. Exhibit 3, 12:9-15. He was also diagnosed with an insomnia disorder. Exhibit 3, 12:16-17.

Mr. Walters was initially evaluated for service-connected disabilities in March 2014. Exhibit 7, at 219. He was diagnosed with PTSD and major depressive disorder; his depression was found related and secondary to his PTSD. Id. The symptoms of his PTSD included reexperiencing and avoidance of trauma memories and irritability. Id. at 220. Symptoms of his depression include depressed mood, low self-esteem, guilt and decreased motivation and energy. Id. Both his PTSD and depression have symptoms of sleep disturbance and difficulty concentrating. Id. Dr. Jackson agreed with the VA records which indicated Mr. Walters developed PTSD during the course and in response to his military experiences finding they were serviceconnected. Exhibit 7, at 107.

Dr. Jackson noted a second VA evaluation was performed by Dr. Lavish, a VA psychologist, in 2015. Id. Dr. Lavish evaluated Mr. Walters and diagnosed posttraumatic stress disorder, severe to extreme, and a major depressive disorder, recurrent, moderate. Id. In the evaluation it was noted that Mr. Walters' combat stress rating was significantly above the cutoff score. Id. Mr. Walters also reported suicide ideation and severe insomnia. Id. The 2015 evaluation was used in re-evaluating Mr. Walters' service-connected disability which was originally assessed in 2014. Id. The net result was a substantial increase to Mr. Walters' service-connected disability rating. Id. Dr. Jackson and all of Mr. Walters' medical and behavioral experts agree that Mr. Walters' work as a fireman and his exposure to traumatic events at work exacerbated his PTSD, depression and insomnia associated with his employment as a fireman. Id.

Mr. Walters' distressing symptoms were found to be in the clinical range. Id. The intensity of his distress is extremely high. Id. This result indicates that his psychological distress is multifaceted and that more than one psychological diagnosis is needed to account for his symptom report. Id. Mr. Walters listed forty-three symptoms as extremely distressing and twelve as quite a bit distressing. Id. Mr. Walters was administered the Beck Depression Inventory (BDI) which is a series of questions developed to measure the intensity, severity and depth of depression in patients with psychiatric diagnoses. Id. at 110. Scores of 30 to 63 indicate severe depression. Id. Mr. Walters scored 42 on the BDI which is classified as severe depression. Id.

Mr. Walters was also administered the World Health Organization Disability Assessment, Version 2 (WHODAS2) which evaluates; 1) understanding and communicating, 2) getting around, 3) self-care, 4) Getting along with people, 5) Life activities - household, 6) life activities school/work, and 7) participation in society. Id. at 113. Mr. Walters' results indicate he has severe disability regarding "remembering to do important things". Id. at 114. For example, he might completely forget to pick up his son, or he will get angry and, because of his emotional reactivity, and he will forget routine responsibilities, he will forget to pick up his wife's medicine. Id. He does not trust himself to remember to do important things. Id.

Mr. Walters' ability to "get along with other people" was evaluated under the WHODAS2 standards. Mr. Walters reported that he has suffered only mild disability with regard to people who are close to him versus in dealing with people that he does not know. Id. Mr. Walters hates to go

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Issued by DIVISION OF WORKERS' COMPENSATION

Employee: Christopher Walters

Injury No: 15-018291

grocery shopping. Id. He reported that he and his wife go in and out and that he stays with the cart and has difficulty going down the grocery aisles. Id. Dr. Jackson found the avoidant emotionally charged behavior is indicative of significant psychological disability in getting along with others, additionally he found Mr. Walters' road rage is severe. Id. Mr. Walters also reported that he is irritable much of the time which impacts his wife and friends. Id.

Mr. Walters reported that he is unable to get all of the housework done that he has traditionally been responsible for and that it takes him much longer to get the work done than needed. Id. Mr. Walters reported that he has low energy and that he is not "motivated to do anything". Id. He reported that he lays down and sleeps. Id. Dr. Jackson found that this reflects his depression and sleep disorder, and broader psychological deterioration and directly impact his family. Id. Dr. Jackson's impression was that this disability results in considerable open conflict within the family. Id.

Mr. Walters perceives himself as no longer able to work in any capacity at this time. Id. He resigned his part-time position of coaching, which he is passionate about, and reported the resignation was a new low for him. Id. Dr. Jackson found that psychologically Mr. Walters' inability to work forces him to re-integrate his identity. Id. At the time of the IME, Mr. Walters was unsuccessful and his identity continued to erode, rather than re-integrate. Id. Mr. Walters' occupational history indicated that he had a strong work ethic, frequently working at two jobs. Id.

Mr. Walters reported significant disability with regard to the WHODAS2 items that are used to evaluate broader disability. Id. Mr. Walters reported extreme disability to the question, "How have you been emotionally affected by this health condition?" Id. Dr. Jackson agreed that Mr. Walters has extreme disability. Id. at 115. Dr. Jackson notes that all the other licensed behavioral healthcare professionals who have evaluated Mr. Walters also agree Mr. Walters has an extreme disability. Id.

The amount of time Mr. Walters spends on his health condition is severe. Id. Dr. Jackson opined that evaluation indicates that the majority of Mr. Walters' daily purpose and activity is organized in relation to his psychological disability. Id. Dr. Jackson found that Mr. Walters' disability has created a severe impact on his family and while Mr. Walters is loving and committed to his wife and children, typical interactions are extremely volatile. Id. This has become the norm. Mr. Walters also reported that he has developed "bad road rage". Id. Dr. Jackson opined that "clearly this is a severe and dangerous disability." Id.

Dr. Jackson concluded that Mr. Walters' exposure to risk in the course of his employment as a fireman working for the City of Saint Joseph, Missouri Fire Department is the direct, proximate and prevailing factor in his development of Posttraumatic Stress Disorder, chronic, and a Major Depressive Disorder, recurrent, severe without psychosis, and insomnia. Id. He found Mr. Walters has reached maximum psychological improvement. Treatment going forward is only palliative not curative. Id. at 124.

Mr. Walters was diagnosed with "service connected" PTSD, major depressive disorder, recurrent and moderate, after his initial evaluation in March 2014. Id. at 116. Mr. Walters reached out to his supervisor regarding trauma related symptoms in January 2014 and later human resources. Id. Dr. Jackson found this reaching out behavior indicated Mr. Walters was having

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Issued by DIVISION OF WORKERS' COMPENSATION

Employee: Christopher Walters

Injury No: 15-018291

trauma-related symptoms from his employment as a firefighter. Id. Mr. Walters reached out for help from his supervisor and the City prior to being evaluated at the VA. Id.

Mr. Walters was evaluated in March of 2014 at the VA for service-related disabilities. Id. This evaluation occurred over a year and a half after his medical discharge from the Air National Guard. Id. Mr. Walters was not evaluated by a psychologist or psychiatrist but was given symptom checklists and inventories regarding service-related symptoms. Id. at 117. Mr. Walters reported that the symptoms he endorsed during these checklists and inventories were in fact true, but the service-connected psychological disabilities had become normal and had waned. Id. Dr. Jackson came to the same conclusion. Id.

Mr. Walters has consistently reported insomnia and nightmares associated with his traumatic experiences from his employment with the City. Id. Dr. Jackson noted that sleep disturbances are common among veterans suffering from PTSD and depression and these symptoms are difficult to eradicate. Id.

Both Mr. and Mrs. Walters reported that Mr. Walters' traumatic experiences as a firefighter resulted in immediate adverse symptoms. Id. Mrs. Walters reported that these symptoms and subsequent psychological disability were new to their relationship. Id. She also reported that since these events, she has watched Moose become necessary for Mr. Walters to regulate his psychological disability. Id. at 118 .

Mr. Walters' condition has severely deteriorated since his treatment in 2014 through the present. Id. Initially Mr. Walters' psychological disability through the VA was rated as a 50 % disability but has since been increased to 80-90 %. Mr. Walters was not diagnosed with insomnia until March 2014. Id. His medical retirement for sleep apnea is an unrelated sleep disorder.

While Mr. Walters never solicited help for a psychological disability during his fifteenyear career in the Air National Guard, he was diagnosed with PTSD and major depressive disorder, recurrent and moderated. Id. at 119. His depression was considered secondary to his PTSD which means that it is the natural consequence of his PTSD. Id. His pre-existing psychological disabilities developed while he was actively serving in the Air National Guard. Id.

Dr. Jackson found that Mr. Walters was directly exposed to new traumatic events while employed with the City that resulted in new PTSD and also aggravated his service-connected PTSD. Id. at 121. He opined that this new PTSD led to significant major depressive disorder and also insomnia. Id. When specifically asked, however, what brought him to the conclusion that Claimant suffered a new and distinct PTSD as opposed to an aggravation or exacerbation of his pre-existing military service-connect PTSD, Dr. Jackson did not provide a conclusive or effective explanation. Exhibit 3, 49:4-52:14. Dr. Jackson, at one point, seemed to tie Claimant's traumas while working for Employer with his "total permanent disability" before stating that he thought these traumas and subsequent humiliation "is what - what broke him, and it broke him to the degree that he went on to have failure experiences in the next two jobs he pursued - or at - at the time with the information that I held that's what I concluded." Exhibit 3, 51:19-52:14.

Dr. Jackson cited a study which indicates that a sense of workplace belongingness could promote the well-being of emergency workers despite route exposure to traumatic events. Id. at 122. Unlike in the Air National Guard, Mr. Walters reported well-founded fear for his job when

Issued by DIVISION OF WORKERS' COMPENSATION

Employee: Christopher Walters

Injury No: 15-018291

he reported his symptoms to the City. *Id.* He was subject to ridicule from his supervisor and co-workers and was threatened with loss of his job, which ultimately occurred. *Id.* Dr. Jackson opined that the culture in the Air National Guard likely promoted resilience and mitigated the effects of his service-connected disability, while his experience at the City significantly contributed to his psychological disability from his employment there. *Id.*

Mr. Walters first began receiving psychological treatment in March 2014 with diagnosis and counseling. *Id.* In June 2014, he was placed on psychotropic medication. Since his initial evaluation he has received medication, individual and group counseling treatments as well as began utilizing the help of his service dog. *Id.* Mr. Walters was reevaluated in 2015 by the VA and by Dr. Jackson in 2017. *Id.* He was found to suffer from major depressive disorder, chronic and severe, with anxious features without psychosis. *Id.* This diagnosis is more severe than initially diagnosed in 2014 and demonstrates deterioration in his condition. *Id.* Dr. Jackson opined that further psychological deterioration and poor outcome is probable and that Mr. Walters' psychological adjustment is not sustainable over time. *Id. at 123.* He notes that while Mr. Walters has not attempted suicide, he has suicidal ideations, plans, and impulses and has performed a dry run. *Id.* Mr. Walters presents significant risk factors for suicide. *Id. at 123-24.*

Dr. Jackson opined that Mr. Walters has a 20% preexisting psychological industrial disability. *Id. at 125.* These psychological disorders were first diagnosed in 2014; two years after Mr. Walters had received an Honorable medical discharge from the Air National Guard. *Id.* There is no dispute Mr. Walters developed "service-connected" psychological disability in the course of his active-duty service. *Id.*

Further, opined that Claimant has a 55% psychological disability due to his posttraumatic stress disorder, chronic and severe, his major depressive disorder, chronic and severe, without psychosis, and his insomnia based upon the traumatic events he experienced at work as well as a hostile work environment. *Id.* Mr. Walters reported that he was mocked by peers and was skeptically questioned by management for his March 2015 work-related injury. *Id. at 124-25.*

Dr. Jackson found that multiple facts indicate Mr. Walters' service-connected PTSD was much improved. *Id. at 126.* He had not been diagnosed or received treatment for psychological disabilities at the time of his honorable discharge and medical retirement. *Id.* He opined that taking a medical retirement, in part reflects Mr. Walters' yet to be diagnosed service-connected psychological disability. *Id.* Moreover, psychotropic medication to treat Mr. Walters' depression was not prescribed until he was in treatment for several months which indicates that his depression was on the low end. *Id.*

Dr. Jackson concluded that Mr. Walters' 55% psychological disability, isolation, is permanently and totally disabling. *Id.* Mr. Walters' presentation is one of overwhelming psychological disability. *Id.* Dr. Jackson noted that during his evaluation Mr. Walters' service dog, Moose, clearly had a calming and stabilizing effect. *Id.* Mr. Walters' psychological disabilities are chronic extreme and severe, and such that he will always pose a risk to the safety of himself or others. *Id.* His report of suicidal thoughts, plans and attempt are consistently documented. *Id.* Mr. Walters' proclivity to develop strong resentments and urges to harm others was also clearly evident in his evaluation. *Id.*

Page 12

Implys: Christopher Walters

Injury No: 15-018291

Dr. Jackson opined Mr. Walters poses a significant safety risk to himself and others and he is unable to adapt to the requirements of any full-time employment. Id. Dr. Jackson further opined that Mr. Walters would benefit from inpatient hospitalization and intensive counseling with a behavioral care provider. Id. at 128-29. Mr. Walters will need individual counseling, participation in PTSD support groups for the rest of his life. Id. at 129.

Dr. Caffrey has a Ph.D. in Vocational Education for the Handicapped, a Master's Degree in Psychology, and a Bachelor's Degree in Psychology and Rehabilitation. Exhibit A at 82. He is currently engaged in private practice at Caffrey Comprehensive Services and has a current staff appointment at North Kansas City Hospital. Exhibit A at 81 . He was retained by the Employer to perform an independent medical evaluation on Claimant on October 29, 2018. Id. 6:3-9. Dr. Caffrey did review the Independent Psychological Evaluation Report of Dr. Jackson. Id at 98.

Dr. Caffrey diagnosed Mr. Walters with post-traumatic stress disorder with dissociative symptoms. Id. at 22:6-21. He found the dissociative symptoms include thought dysfunction, thought disorder, having peculiar thoughts, and being unaware of spans of times. Id. He also diagnosed Mr. Walters with major depressive disorder, recurrent and severe with somatic symptom disorder and an insomnia disorder. Id. Dr. Caffrey found that Mr. Walters' trauma at the City was not the prevailing factor in relation to other factors causing disability. Id. at 23:5-24:4 and at 104. When later asked, however, Dr. Caffrey stated that the work incidents at the City of St. Joseph were the prevailing factor of Claimant's PTSD and Major Depressive Disorder. Id. at 37:6-38:2. He found that the work injury in isolation aggravated or compounded his preexisting conditions. Id. at 24:19-25. With regard to Claimant's PTSD, Dr. Caffrey added that the traumatic experiences Claimant had as a fire fighter, while working for Employer, "exacerbated or...made it worse." Id. at 76:24-77:6. Dr. Caffrey also stated that "What I'm saying in my report is that I think that PTSD was a preexisting condition and that the work incident exacerbated that condition or, you know, made it worse." Id. at 44:12-15. He apportioned twenty two percent disability to the body of the whole to the preexisting conditions and five percent of that to the work injury. Id. at 24:19-25.

Dr. Caffrey was unaware of any medications for psychological conditions Mr. Walters was given prior to the two traumatic experiences at the City and was unaware of many of the particulars of Claimant's psychological history. Id. at 31:18-21. Dr. Caffrey was unaware of any disability that Mr. Walters had from PTSD before the two traumatic experiences at the City. Id. at 31:2225. Dr. Caffrey didn't know if Mr. Walters was diagnosed with major depressive disorder prior to Dr. Caffrey's diagnosis at the IME. Id. at 33:8-12. Dr. Caffrey didn't know if Mr. Walters ever received treatment for major depressive disorder prior to the traumatic events at the City. Id. at 33:13-17. Dr. Caffrey did not know when Mr. Walters' insomnia disorder first began. Id. at 34:2224. Dr. Caffrey did not know if Mr. Walters had insomnia prior to the two traumatic experiences at the city. Id. at 35:6. Dr. Caffrey did not know if Mr. Walters took medication for insomnia prior to the two traumatic events. Id. at 35:9-13. Dr. Caffrey did not know when Mr. Walters' symptoms from military experiences arose. Id. at 41:17-42:9. Dr. Caffrey did not know of any symptoms regarding social or occupational impairment and functioning prior to the two work-related incidents at the City. Id. at 42:16-24. Dr. Caffrey did not know the nature and content of Mr. Walters' nightmares and flashbacks and if they were from the military or from his experiences at

Issued by DIVISION OF WORKERS' COMPENSATION

Employee: Christopher Walters

Injury No: 15-018291

the fire department. Id. at 63:5-23. Dr. Caffrey did not inquire about Mr. Walters' service dog at all. Id. at 70:11-20.

Dr. Caffrey did agree that Mr. Walters was not disabled prior to the traumatic work experiences at the City. Id. at 44:16-18. Dr. Caffrey also agreed that the traumatic work experiences at the City caused Mr. Walters' PTSD shift from nondisabling to disabling. Id. at 44:19-21. Dr. Caffrey did find that despite elevations in some of Mr. Walters' test scores, his test profile was considered valid. Id. at 45:22-46:1. Dr. Caffrey also agreed that some of the "dissociative symptoms" that he listed in his testing including thought dysfunction, paranoid delusional thinking, suspiciousness, alienation from others, lack of insight, tendency to blame others, hearing strange things, seeing visions, carrying on activities without knowing what he was doing can lead to conflicts in relationships and including in the work place. Id. at 47:17-48:1. Dr. Caffrey claims he had Mr. Walters list incidents in level of significance, but later retracts and says that is not true. Id. at 55:1-7. Dr. Caffrey did not ask if any of the events were the most significant, or compare Mr. Walters' work related experiences to his military experiences, nor did he view the traumatic experiences together or as building on one another but rather only in isolation. Id. at 55:16-56:25. Dr. Caffrey opined that the Claimant can return to employment but issued a restriction that he should not return to first responder work. He did feel he would be capable of finding employment in other vocational fields. Id at 105.

Mr. Cordray conducted an interview and vocational tests on Mr. Walters on June 18, 2018. Exhibit 5, at 67. Additionally, he reviewed his medical records to determine his functionality and limitations. Id. He evaluated Mr. Walters' educational background. Id. 72-73. Mr. Walters has a Bachelor's Degree in Physical Education, an Associate's Degree in Fire Science, officer training, and navigation training. Id. Mr. Cordray noted that Mr. Walters never pursued a career as an educator and his degree is no longer marketable, and his military training is job specific. Exhibit 5, 10:7-14; 73. It is also noted that Mr. Walters is self-taught on the computer having basic skills such as Microsoft Office. Id. at 73.

Mr. Cordray noted that in Dr. Jackson's report, Mr. Walters has marked impairment in social functioning and extreme impairment in adaptation. Id. at 69. Marked impairment is defined as impairment level significantly impeding useful functioning. Id. at 83. Extreme impairment means impairment levels preclude useful functioning. Id. Marked and extreme impairment preclude all employment that require those skills. Id. at 8:8-24. Mr. Cordray concluded, Mr. Walters cannot work at jobs that require social functioning such as retail sales or high levels of interaction with coworkers, supervisors, or the public. Id. His extreme impairment in adaptation would actually preclude all jobs as it prevents Mr. Walters from going into a new environment, and learning new procedures. Id. at 43:9-21.

While Mr. Walters maintained employment as a substitute teacher and wrestling coach until 2017, Mr. Cordray finds this does not constitute gainful employment. Id. at 82; 13:19-14:6. Mr. Cordray opines that substitute teaching and coaching are odd lot jobs that can be turned down without repercussion and do not guarantee a minimum number of hours worked each week. Id. Moreover, his mental conditions including his social functioning have since precluded him from engaging in that work due to his interactions with students and administrators. Id. at 45:2-18. Mr. Walters' experiences at the City led him to have distrust with those in authority being unable to

Issued by DIVISION OF WORKERS' COMPENSATION

Employee: Christopher Walters

Injury No: 15-018291

trust the administration. Exhibit 2, 103:3-14. He no longer possessed the social skills to be in situations where he would become upset. Id. This included when he felt he had no support from his superiors as well as when kids would be yelling, cussing, or disrespectful. Id.

In his deposition, Mr. Cordray clarified that due to Mr. Walters' prior military experiences and service-related diagnosis, Mr. Walters is totally vocationally disabled due to the combination of the pre-existing psychological disability and the psychological disability from Mr. Walters' employment with the City. Exhibit 5, 14:17-18:10 and 19:20-25.

Michael Dreiling

The employer retained Michael Dreiling as a vocational expert to assess Mr. Walters to determine if he is employable in the open labor market. Exhibit 4 at 59. Mr. Dreiling reviewed the reports of both Dr. Jackson and Dr. Caffrey. Mr. Dreiling also reviewed the vocational report of Mr. Cordray. Exhibit 4, 13:9-11. Mr. Dreiling stated that Claimant told me that he filled-in on a full-time basis for three months as a substitute teacher.

Based on the report of Dr. Jackson, Mr. Dreiling found Mr. Walters does not have the vocational capacity to return to employment in the open labor market. Id at 67. However, based on the report of Dr. Caffrey, Mr. Dreiling found that Mr. Walters would not be vocationally disabled. Id. Mr. Dreiling recommends that Claimant should not work as a first responder. Exhibit 4 at 67. Mr. Dreiling opined that, if Claimant were permanently and totally disabled, it would be due to a combination of Claimant's work-related conditions with his pre-existing PTSD. Exhibit 4, 17:11-18:2.

Mr. Dreiling admitted that he is not qualified to determine whether Dr. Jackson or Dr. Caffrey was correct but rather that is an issue for the trier of fact. Exhibit 4, 21:6-20. From Dr. Jackson's report, Mr. Dreiling found that Mr. Walters' impairments in activities of daily living—specifically marked impairment in social functioning and extreme impairment in adaptation—would prevent Mr. Walters from adapting to a work environment and functioning with co-workers. Exhibit 4, 19:3-22.

Findings and Conclusion

Claimant has the burden of proving all material elements of his claim. Jefferson City Country Club v. Pace, 500 S.W.3d 305, 313 (Mo. App. W.D. 2016); Johme v. St. John's Mercy Healthcare, 366 S.W.3d 504, 509 (Mo. Banc 2012).

The Court finds Claimant Christopher Walters and Kiffany Walters to be credible witnesses. This includes consideration of Claimant's reference, as stated above, that on 10/27/2016 Claimant stated that "he needs to start attending treatment to help his attorney win his case for him etc." The Court finds that, while this statement by Claimant brings into question Claimant's motivation for attending medical and psychological services being provided by the VA for his PTSD and related conditions that particular day, it does not bring into question his need for those services or the existence of the PTSD or related conditions. This conclusion is supported by the fact that the VA has continued to offer and provide similar services continuously since Claimant made those statements and there has been no change to Claimant's medical diagnoses for which the VA is providing treatment.

Page 15

Issued by DIVISION OF WORKERS' COMPENSATION

Employee: Christopher Walters

Injury No: 15-018291

1. **Whether the Claimant sustained an injury by accident or occupational disease arising out of and in the course of employment.**

The Claimant alleged that he suffered a compensable psychological injury (post-traumatic stress disorder "PTSD") due to traumatic events he witnessed and experienced while working as a fire fighter for Employer City of St. Joseph. Section 287.120.8 sets out the general rule that disabilities arising from work related stress are subject to the "unusual strain" doctrine. However, Section 287.120.10 exempts fire fighters from this doctrine in cases of psychological stress under Section 287.067. *George v. City of St. Louis*, 162 S.W.3d 26 (Mo. App. 2005). The Commission and Missouri courts have repeatedly held that mental injuries fall within the category of "occupational disease." *Dubuc v. Treasurer of the State as Custodian of the Second Injury Fund*, 597 S.W.3d 372 (Mo. App. W.D. 2020). The PTSD asserted by Claimant is generally seen as an occupational disease under Section 287.067. See *George v. City of St. Louis*. The Court finds that Claimant is asserting his PTSD to be an occupational disease under Section 287.067 RSMo.

Section 287.067, RSMo, defines an occupational disease as:

1. An identifiable disease arising with or without human fault out of and in the course of the employment. Ordinary diseases of life to which the general public is exposed outside of the employment shall not be compensable, except where the diseases follow as an incident of an occupational disease as defined in this section. The disease need not to have been foreseen or expected but after its contraction it must appear to have had its origin in a risk connected with the employment and to have flowed from that source as a rational consequence.

1. An injury or death by occupational disease is compensable only if the occupational exposure was the prevailing factor in causing both the resulting medical condition and disability. The "prevailing factor" is defined to be the primary factor, in relation to any other factor, causing both the resulting medical condition and disability. Ordinary, gradual deterioration, or progressive degeneration of the body caused by aging or by the normal activities of day-to-day living shall not be compensable.

1. Disease of the lungs or respiratory tract, hypotension, hypertension, or disease of the heart or cardiovascular system, including carcinoma, may be recognized as occupational diseases for the purposes of this chapter and are defined to be disability due to exposure to smoke, gases, carcinogens, inadequate oxygen, or psychological stress of firefighters of a paid fire department if a direct causal relationship is established.

Furthermore, an injury is compensable as an occupational disease when repetitive trauma has aggravated a preexisting disease. A claimant alleging aggravation to a preexisting condition must adduce expert testimony of "a direct causal connection between the conditions under which the work is performed and the occupational disease." *Daly v. Powell Distributing, Inc.*, 328

Page 16

Issued by DIVISION OF WORKERS' COMPENSATION

Employee: Christopher Walters

Injury No: 15-018291

S.W.3d 254 (Mo. App. W.D. 2010) (internal citations omitted). As a general rule, disability sustained by the aggravation of a preexisting nondisabling condition or disease caused by a work-related accident is compensable even though the accident would not have produced the injury in a person not having the condition. *Kelley v. Banta & Studc Const. Co., Inc.*, 1 S.W.3d 43 (Mo. App. 1999) (internal citations omitted). In general, if a claimant can show that the performance of his usual and customary duties leads to a breakdown or change in pathology, the injury is compensable. *George v. City of St. Louis* at 32 (internal citations omitted). The worsening of a preexisting condition is a change in pathology and is a compensable injury. *Id.*

Thus, in order to have suffered a compensable psychological injury in this case, Claimant must prove that he suffers from PTSD, it must appear to have had its origin in a risk connected with the employment with Employer and to have flowed from that source as a rational consequence, that his work with Employer was the prevailing factor in his PTSD and any resulting disability, as well as establish a direct causal relationship between his PTSD and his employment with Employer.

It is undisputed that the Claimant suffers from, and was diagnosed with, PTSD and that he continues to suffer from the same. Additionally, PTSD is not an ordinary disease of life and the occupational exposure of repeated traumatic events and psychological stress creates an increased risk for fire fighters for PTSD and other psychological diseases as compared to the general public. Claimant's testimony, the testimony of the two medical experts, and the voluminous medical records admitted into evidence all detail several instances of traumatic experiences while serving on active duty in the United States Air Force (Air National Guard) and Claimant's subsequent diagnosis of service-connected PTSD by the U.S. Department of Veteran's Affairs. The testimony and records also reflect that, after his work with Employer ended, Claimant continues to suffer from PTSD, for which he continues to receive treatment. The Court finds that Claimant suffers from post-traumatic stress disorder.

Based on the medical records and testimony in this case as discussed above, Claimant's work for employer, as well as his service in the United States Air Force, (Air National Guard) resulted in Claimant being exposed to numerous traumatic events over the course of his employment, with two instances involving the death of children as discussed above, being noted throughout the records as being particularly traumatic for Claimant. This is supported by VA medical records and the testimony of all witnesses. It is undisputed that witnessing traumatic events is a risk connected with employment as a fire fighter. It is undisputed that Claimant's PTSD flowed from his exposure to, and witnessing of, traumatic events as a rational consequence. The Court finds that Claimant's work for Employer exposed him to an occupation (firefighting) in which the hazards of an occupational disease (PTSD) exist (in this case psychological stress and repeated exposure to traumatic events). The Court finds that Claimant's PTSD had its origin in witnessing traumatic events, that witnessing traumatic events is a risk connected with employment as a fire fighter, and that Claimant's PTSD flowed from his exposure to, and witnessing of, traumatic events as a rational consequence.

Dr. Jackson testified that Claimant's pre-existing PTSD which Claimant acquired while serving in the Missouri Air National Guard was aggravated and worsened by the traumatic events Claimant experienced while employed as a fire fighter with the City of St. Joseph. Dr.

Page 17

Issued by DIVISION OF WORKERS' COMPENSATION

Employee: Christopher Walters

Injury No: 15-018291

Jackson's expert psychological testimony that Claimant's PTSD aggravated his pre-existing military-connected PTSD, and that Claimant's occupational exposure was the prevailing factor in causing this aggravation or exacerbation is consistent with the evidence presented (including VA medical records), the testimony of Claimant, and the findings of Dr. Caffrey (inasmuch they both opine that Claimant's work-related traumatic experiences aggravated his pre-existing PTSD), and the letter from the VA's Dr. Pattison in which he stated that Claimant's job as a fireman exacerbated his PTSD and major depressive disorders. The Court finds this portion of Dr. Jackson's testimony to be credible.

Dr. Jackson also testified that Claimant sustained a new and distinct PTSD injury while working at the City of St. Joseph. This opinion, however, was not supported by the medical records, other evidence, or shared by any other medical experts. Furthermore, when specifically asked to explain what brought him to the conclusion that Claimant suffered a new and distinct PTSD, Dr. Jackson's explanation was inconsistent, disjointed, confused, and (at best) unclear and insufficient. The Court finds Dr. Jackson's testimony regarding his reasoning as to why Claimant suffered a new and distinct PTSD as opposed to an exacerbation of his pre-existing military-connected PTSD to be unreliable and not credible.

Dr. Caffrey diagnosed Mr. Walters with post-traumatic stress disorder and major depressive disorder, recurrent and severe. These diagnoses were consistent with Dr. Jackson's findings as well as the VA doctors. Dr. Caffrey, as stated above, shared in the consensus opinion that Claimant's work experiences as a fire fighter with Employer exacerbated or "made worse" his pre-existing military-connected PTSD. Dr. Caffrey's opinion as to whether Claimant's occupational exposure was the prevailing factor in causing this aggravation or exacerbation, however, is entirely unclear.

Dr. Caffrey's overall assessment was that Claimant's occupational exposure was not the prevailing factor. Yet, at a different point in his deposition he clearly stated that the work incidents at the City of St. Joseph were the prevailing factor of Claimant's PTSD and Major Depressive Disorder and he assigned a 5% disability rating for those psychological conditions. Dr. Caffrey did not clarify or adequately explain his inconsistent views on whether Claimant's occupational exposure to stress and traumatic events was the prevailing factor in causing the aggravation or exacerbation of Claimant's PTSD. The Court finds Dr. Caffrey's opinion as to whether Claimant's occupational exposure to stress and traumatic events while employed as a fire fighter with Employer was the prevailing factor in causing this aggravation or exacerbation to Claimant's pre-existing military-connected PTSD to be inconsistent, unclear, and not credible.

The VA medical records, entered into evidence without objection, note that the events at the City caused the Claimant to have flashbacks from his military events and exposure to combat experiences. Dr. Pattison opined that the events at the City exacerbated the Claimant's pre-existing PTSD. This opinion was echoed by both Dr. Jackson and Dr. Caffrey who also found that the events while working for Employer exacerbated the pre-existing PTSD.

As stated above, the worsening of a preexisting condition is a change in pathology and is a compensable injury. George v. City of St. Louis at 32 (internal citations omitted). All medical experts and evidence presented supports the conclusion that Claimant's work for Employer

Page 18

Issued by DIVISION OF WORKERS' COMPENSATION

Employee: Christopher Walters

Injury No: 15-018291

exacerbated and aggravated his pre-existing PTSD. The Court finds Claimant's work as a firefighter with Employer was the prevailing factor in exacerbating and aggravating his pre-existing PTSD and any resulting disability. Additionally, the Court finds that, with the expert psychological testimony of Dr. Jackson, supported by the medical records from treating physicians at the VA, Claimant established a direct causal relationship between the exacerbation and aggravation of his pre-existing PTSD and his employment with Employer.

The Court finds that the Claimant sustained an injury by occupational disease arising out of and in the course of employment.

1. What were the Claimant's average weekly wage and compensation rates.

In post-trial briefs submitted to the Court prior to the record being closed, Employer and Claimant stipulated that Mr. Walters' average weekly wage rate is $889.71. In support of this, Employer submitted a wage statement as Respondent's Exhibit 3 which details the Claimant's wages earned in the 13 weeks prior to January 15, 2015. The records reflect that the Claimant earned a total of $11,566.19 during the 13 weeks. Divided by 13, the wages reflect an average weekly wage of $889.71. This results in, and the Court finds that, Claimant's compensation rate for permanent total disability and temporary total disability is 593.14 per week and for permanent partial disability of 451.02 per week.

1. Whether the Claimant notified the Employer of the injury as required by law.

287.800 RSMo. requires that the "courts shall construe the provisions of this chapter strictly." *Allcorn v Tap Enterprises Inc.*, 277 S.W.3d 823, 829 (Mo. App. S.D. 2009). 287.420 RSMo. reads, in pertinent part: "No proceedings for compensation for any occupational disease or repetitive trauma under this chapter shall be maintained unless written notice of the time, place, and nature of the injury, and the name and address of the person injured, has been given to the employer no later than thirty days after the diagnosis of the condition unless the employee can prove the employer was not prejudiced by failure to receive the notice." This statute has six requirements that must be met by a claimant to notify his employer of an occupational disease or repetitive trauma: (1) written notice, (2) of the time, (3) place, and (4) nature of the injury, and (5) the name and address of the person injured, (6) given to the employer no later than thirty days after the diagnosis of the condition. *Id* at 828.

Missouri cases have held that actual notice of the injury by the employer is sufficient to show that the employer was not prejudiced by the absence of proper written notice to the employer that a work injury has occurred as required by RSMo. 287.420. See *Harley-Davidson Motor Company, Inc. v. Jones*, 557 S.W.3d 328 (Mo. App. W.D. 2018); *Sell v. Ozarks Medical Center*, 333 S.W.3d 498 (Mo. App. 2011). A person cannot be diagnosed with an "occupational disease or repetitive trauma" until a diagnostician makes a causal connection between the underlying medical condition and some work-related activity or exposure. *Allcorn* at 829.

Page 19

Issued by DIVISION OF WORKERS' COMPENSATION

Employee: Christopher Walters

Injury No: 15-018291

In the present claim, it is uncontested that Employer knew about the two incidents that the Claimant specifically alleges exacerbated his PTSD, as it has documented the emergency calls to which Claimant responded in his fire fighter and EMT capacity. Furthermore, the medical records (including from the VA) and testimony all reflect that the first causal connection by a diagnostician between the underlying medical condition (PTSD) and Claimant's work-related activity or exposure was the letter Dr. Pattison wrote to Employer on January 22, 2015. Therefore, the Court finds that Claimant's occupational disease did not become a compensable injury until January 22, 2015 when Dr. Pattison determined that Mr. Walters' job as a firefighter was worsening his psychological conditions and he could no longer perform his job duties. Based on the testimony provided, the Court finds that, after learning of the compensable occupational disease, Claimant provided Dr. Pattison's letter to Employer within 30 days and served as a "written notice."

Strictly construed, however, Claimant's "written notice" of his occupational disease (Exhibit 9 at 8) fails to meet the statutory requirements for a written notice of his occupational disease. The letter is written and provided to Employer within 30 days of learning of the compensable occupational disease, but it does not provide a time or time frame of the development of the occupational disease. Dr. Pattison's letter does reference Claimant's job as a fireman as exacerbating his diagnoses. Given the various locations of the trauma leading to exacerbation of Claimant's PTSD, the letter does provide enough information to meet the "place" requirement that would allow Employer to conduct an investigation into the circumstances of the alleged occupational disease. While the Claimant's name and the nature of the injury are provided, the Claimant's address is not on Claimant's "written notice." Therefore, for the aforementioned reasons, the Court finds that Claimant did not provide written notice of his work-related occupational disease as required by law.

The written notice requirements of Section 287.420, however, contain an exception to a claimant providing his or her employer with the required written notice when there is no resulting prejudice to the employer." Sell v. Ozarks Med. Ctr., 333 S.W.3d 498, 509 (Mo. Ct. App. 2011). "Failure to give timely written notice may be excused if the Commission finds that the failure did not prejudice the employer." Id. at 510. "The purpose of section 287.420 is to give the employer timely opportunity to investigate the facts surrounding the accident and, if an accident occurred, to provide the employee medical attention in order to minimize the disability." Id. After the claimant presents substantial evidence that employer had actual notice of the relevant injury, however, the burden of showing prejudice then shifted to employer. Id. at 511.

The record and evidence reflect that Employer had actual knowledge of all emergency calls and potentially traumatic events (including the two involving children) to which Claimant would have been exposed during his time working at the Fire Department that were the basis of the claimed occupational disease. This record included the time and place of each call for emergency service and the time range of Claimant's work with Employer. The record also reflects that, upon receipt of Claimant's letter, Claimant was immediately put on light duty. Additionally, there is no dispute that Employer had a current address for Claimant at the time they received the written notice of January 22, 2015. The Court finds that substantial evidence exists that Employer had actual knowledge of the Claimant's occupational disease and the circumstances leading to that diagnosis that would allow them to conduct an effective

Issued by DIVISION OF WORKERS' COMPENSATION

Employee: Christopher Walters

Injury No: 15-018291

investigation. Furthermore, the Court finds that Employer was not prejudiced by Claimant's failure to provide written notice as required by law.

1. Whether the Claimant's claim was filed within the time allowed by law.

Section 287.430 requires a claim for workers' compensation to be filed "within two years after the date of injury." Section 287.063.3 provides that the "statute of limitation shall not begin to run in cases of occupational disease until it becomes reasonably discoverable and apparent that an injury has been sustained related to such exposure."

As stated above, Claimant's occupational disease began on January 22, 2015. Mr. Walters' original Claim for Compensation was filed June 8, 2015, and his claim was subsequently amended on October 2, 2017 and again on April 29, 2019. The original claim was filed less than six months after Mr. Walters' occupational disease became compensable. Therefore, Mr. Walters' claims against the Employer were filed timely filed under section 287.430.

With respect to the Second Injury Fund, section 287.430 provides that "[a] claim against the second injury fund shall be filed within two years after the date of injury or within one year after a claim is filed against an employer or insurer pursuant to this chapter, whichever is later."

Missouri courts have held that this language applies to any claim filed against the employer, even if that claim is an amended claim. *Elrod v. Treasurer*, 138 S.W.3d 714, 716-17 (Mo. 2004). Therefore, so long as the claim is filed against the second injury fund within one year of any claim against the employer, even if that is an amended claim, the claim against the second injury fund is timely. *See id.* at 717.

The first amended Claim for Compensation added the Second Injury Fund as a party. The second amended claim for compensation amended the claim for compensation against the employer and again included the Second Injury Fund as a party. Accordingly, the Court finds Claimant's Claim for Compensation against both Employer and the Second Injury Fund was timely filed.

1. Whether the City of St. Joseph must provide the Claimant with additional medical care.

Missouri Law requires that employers provide injured employees with medical treatment. Specifically, § 287.140.1 reads: 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. Treatment must be provided even if while comforting and relieving the claimant's pain, the underlying condition cannot be cured. *Mathia v. Contract Freighters, Inc.*, 929 S.W.2d 271 (Mo. App. 1996). The threshold for determining if additional treatment is needed is reasonable probability. *Downing v. Willamette Industries, Inc.*, 895 S.W.2d 650, 655 (Mo. App. 1995). Probable means founded on reason and experience which inclines the mind to believe but leaves room to doubt. *Tate v. Southwestern Bell Telephone Co.*, 715 S.W.2d 326, 329 (Mo. App. 1986). This is not to say that if an injured worker is taking medication or receiving treatment for a pre-existing condition, simply because a work injury would require the

Issued by DIVISION OF WORKERS' COMPENSATION

Employee: Christopher Walters

Injury No: 15-018291

same treatment both as to type and extent, the treatment then becomes compensable. The treatment must be due to the work injury and not the pre-existing condition. O'Donnell v. Guarantee Elec. Co., 690 S.W.2d 190 (Mo.App. E.D.1985).

In the present claim, all of the Claimant's treatment has been directed and provided by the VA due to the Claimant's undisputed pre-existing PTSD from his experiences in active military combat. The VA and their physician, Dr. Pattison, have prescribed medications for the Claimant and he continues to treat with periodic meetings with his VA psychiatrist and attendance at military PTSD support groups. All evidence and medical/psychological expert testimony (including both Dr. Jackson and Dr. Caffrey) prove with reasonable probability that Claimant requires future treatment for his PTSD and major depressive disorder. The Court finds that Claimant is in need of ongoing future medical treatment to cure and relieve him of the effects of occupational disease that was aggravated and accelerated as a result of Claimant's work for Employer, and that Employer must provide Claimant with additional medical care.

1. Whether the Claimant suffered any disability and, if so, the nature and extent of the Claimant's disability and whether the Claimant is permanently and totally disabled.

In this claim, the Claimant alleges and seeks recovery for permanent total disability benefits. Section 287.020.6 RSMo defines "total disability" as the "inability to return to any employment and not merely [the] inability to return to the employment in which the employee was engaged at the time of the accident." An employee is permanently and totally disabled if no employer in the usual course of business would reasonably be expected to employ the employee in his or her present physical condition." *Pennewell v. Hannibal Regional Hosp.*, 390 S.W.3d 919, 924-25 (Mo. App. E.D. 2013) (citing *Clark v. Harts Auto Repair*, 274 S.W.3d 612, 616 (Mo. App. W.D. 2009)).

It is well established that the test for determining whether a claimant is permanently and totally disabled "is whether the worker is able to compete in the open labor market." *Molder v. Mo. State Treasurer*, 342 S.W.3d 406, 411 (Mo. App. 2011) (internal citations omitted). "The ability to compete in the open labor market hinges on whether, in the ordinary course of business, any employer would be reasonably expected to hire the individual given his or her present physical condition." *Archer v. City of Cameron*, 460 S.W.3d 370, 375 (Mo. App. 2015). The burden is on the claimant to establish he is permanently and totally disabled. *Id.* Whether a Claimant is permanently and totally disabled is a factual question, not a legal question. *Id* at 376 (citing *Rader v. Werner Enters., Inc.*, 360 S.W.3d 285, 301 (Mo. App. E.D. 2012)).

As stated above, Vocational expert Terry Cordray opined that the Claimant was permanently and totally disabled due to a combination of his pre-existing PTSD and not due to the events at the City in isolation. Vocational expert Michael Dreiling opined that, based on the report of Dr. Jackson, Claimant does not have the vocational capacity to return to employment in the open labor market. Based on the report of Dr. Caffrey, however, Mr. Dreiling found that Mr. Walters would not be vocationally disabled. Based upon the record as a whole, including having the opportunity to observe Claimant's demeanor, mannerisms, and behavior in the courtroom

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Issued by DIVISION OF WORKERS' COMPENSATION

Employee: Christopher Walters

Injury No: 15-018291

during his live testimony, the Court finds that Dr. Jackson's psychological assessment of Claimant's capacity to return to employment to be more credible than Dr. Caffrey's.

One additional factor that led to the finding that Dr. Jackson's psychological assessment of Claimant's capacity to return to employment to be more credible than Dr. Caffrey's is that Dr. Jackson is found to have a more clear and informed understanding of Claimant's psychological issues and how they impact him on a daily basis, including from a potential employment perspective. Additionally, Dr. Jackson's assessment more accurately describes Claimant's courtroom demeanor (Claimant appeared easily angered and dissociative - at one point having to be reminded of appropriate behavior in the courtroom). Lastly, Dr. Jackson is found to take into greater account the effect that Claimant's PTSD would have on others in the work place.

Finding that Dr. Jackson's psychological assessment of Claimant's capacity to return to employment to be more credible than Dr. Caffrey's, and based on their testimony both Mr. Cordray and Mr. Dreiling would agree, and the Court finds, that based on his age, education, and level of transferable skills, Claimant is permanently and totally disabled and unable to compete in the open labor market and that no employer would be reasonably expected to hire Claimant given his present psychological condition. Furthermore, as discussed below, and in agreement with the opinions of Dr. Caffrey, Mr. Cordray, and Mr. Dreiling, the Court finds that Claimant is permanently and totally disabled as a result of the combination of the pre-existing disability directly resulting from Claimant's active duty military service in the Air National Guard and the compensable occupational disease that resulted from his work as a fire fighter for Employer.

While the Court finds that Claimant is now permanently and totally disabled, the evidence establishes that, considering his age, education, and level of transferable skills, the Claimant still had the ability to work and compete in the open labor market prior to leaving employment as a coach and substitute teacher in September 2017. This was demonstrated, not only in the hours Claimant was able to work (including full-time, five days a week for up to three months) and Claimant's statements as described above that teaching and coaching jobs made him feel better and that he looked forward to them (specifically coaching wrestling), but by the very nature of the work. For approximately 2 years, Claimant was entrusted with the supervision and safety of large numbers of children. The Court finds, considering his age, education, and level of transferable skills at the time, this to be an ability and skill that, through September 2017, still allowed Claimant to compete in the open labor market regardless of whether he chose to work a part-time or "odd-lot" job. To be clear, based on the aforementioned medical and vocational evidence, Claimant no longer possesses those skills and is now unable to compete in the open labor market and is unemployable by any reasonable employer. The Court further finds that, based on the record and discussion above, that Claimant's occupational disease in combination with his pre-existing psychological disability continued to deteriorate from the time he left the employment at the City of St. Joseph to the point where he ultimately became permanently and totally disabled in September 2017.

As previously stated, Claimant must prove every material element of his case. Claimant testified credibly that he worked as a substitute teacher until September 2017 and the Court finds that Claimant did work for the St. Joseph School District as a substitute teacher and coach until September 2017. The record does not reflect, however, a specific date in September 2017 as

Page 23

Issued by DIVISION OF WORKERS' COMPENSATION

Employee: Christopher Walters

Injury No: 15-018291

Claimant's last day of employment with the St. Joseph School District. Since Claimant has the burden to prove every material element of his case, and the exact date is material in that an earlier date could entitle Claimant to additional benefits, the Court finds that Claimant became permanently and totally disabled on September 30, 2017 (the latest possible day that is reflected in the record).

Dr. Jackson opined that the Claimant had a 20% pre-existing Permanent Partial Disability (PPD) due to his psychiatric condition of PTSD resulting from his military service in the Air National Guard. Dr. Caffrey found the Claimant to have a 17% PPD due to his psychiatric condition due to the pre-existing military condition. The Court finds, based on the evidence, record as a whole, and medical and psychological experts as described above, that Dr. Jackson's assessment is more credible and accurate and that Claimant had a 20% pre-existing Permanent Partial Disability (PPD) due to his psychiatric condition of PTSD resulting from his military service.

Dr. Jackson assigned 55% PPD to Claimant due to his psychiatric conditions resulting from his employment with Employer. The Court finds this assessment to be too high, not in accordance with the evidence, record as a whole, and medical and psychological experts as described above. Dr. Caffrey assigned 5% PPD to Claimant due to his psychiatric conditions resulting from his employment with Employer. The Court finds this assessment to be too low, not in accordance with the evidence, record as a whole, and medical and psychological experts as described above. The Court finds that Claimant suffered 25% Permanent Partial Disability (PPD) to the body as a whole due to his psychiatric conditions resulting from his employment with Employer.

1. Whether the alleged accident or occupational disease caused the disability the Claimant claims.

In section 1, under "Findings and Conclusions" of this Award, the Court provided its analysis that Claimant sustained an injury by occupational disease arising out of and in the course of employment and that Claimant's work as a firefighter with Employer was the prevailing factor in exacerbating and aggravating his pre-existing PTSD and any resulting disability. Additionally, the Court finds that Claimant established a direct causal relationship between the exacerbation and aggravation of his pre-existing PTSD and his employment with Employer. That analysis is also applicable to the issue of causation and no further discussion is necessary. The testimony and evidence, including voluminous medical records, demonstrate that Claimant's work for Employer caused his occupational disease of PTSD to be exacerbated and aggravated. The Court finds that the alleged occupational disease caused the disability the Claimant claims.

1. Whether the Second Injury Fund is liable to the Claimant for benefits.

"The Second Injury Fund compensates injured workers who are permanently and totally disabled by a combination of past disabilities and a primary work injury." Treasurer v. Cook, 323 S.W.3d 105, 111 (Mo. Ct. App. 2010). "If a claimant establishes either that the preexisting partial

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Issued by DIVISION OF WORKERS' COMPENSATION

Employee: Christopher Walters

Injury No: 15-018291

disability combined with a disability from a subsequent injury to create a permanent and total disability or that the two disabilities combined result in a greater disability than that which would have occurred from the last injury alone, the Second Injury Fund is liable." Id.

The Missouri Legislature amended section 287.220, effective January 1, 2014. Section 287.220.3 now reads, in pertinent part, as follows:

1. (1) All claims against the second injury fund for injuries occurring after January 1,2014 , and all claims against the second injury fund involving a subsequent compensable injury which is an occupational disease after January 1, 2014, shall be compensated as provided in this subsection.

(2) . . . Claims for permanent total disability under section 287.200 against the second injury fund shall be compensable only when the following conditions are met:

(a) a. An employee has a medically documented preexisting disability equaling a minimum of fifty weeks of permanent partial disability compensation according to the medical standards that are used in determining such compensation which is:

(ii) A direct result of a compensable injury as defined in section 287.020 ; or

(iii) Not a compensable injury, but such preexisting disability directly and significantly aggravates or accelerates the subsequent work-related injury and shall not include unrelated preexisting injuries or conditions that do not aggravate or accelerate the subsequent work-related injury;

b. Such employee thereafter sustains a subsequent compensable work-related injury that, when combined with the preexisting disability, as set forth in items (i), (ii), (iii), or (iv) of subparagraph a. of this paragraph, results in a permanent total disability as defined under this chapter.

As discussed above, Claimant's preexisting conditions of PTSD and major depressive disorder constitute preexisting disabilities that were a direct result of active military duty in the United States Air Force while he was a member of the Air National Guard (a branch of the United States Armed Forces). The Court has found a pre-existing 20\% permanent partial disability to the body as a whole from his active duty military service-connected psychological conditions. This is supported by the record and supported by the findings of Dr. Jackson that Claimant's preexisting psychological disabilities are medically documented and meet a minimum of fifty weeks of permanent partial disability compensation according to the medical standards that are used in determining such compensation. The Court's rating of twenty-five percent permanent partial disability to the body as a whole would equate to 100 weeks.

As noted above, Claimant's disability would qualify for second injury fund liability under subsection (i) as his disability is a direct result of active military duty in the United States Air Force, and it would qualify under subsection (iii) because there is evidence that his preexisting disability directly and significantly aggravated or accelerated the subsequent work-related injury. Dr. Jackson added:

Issued by DIVISION OF WORKERS' COMPENSATION

Employee: Christopher Walters

Injury No: 15-018291

...it is my opinion that Mr. Walters is permanently and totally disabled based on the combination of the aggravated and accelerated psychological disabilities he incurred during the course of his employment for the City of St. Joseph with the fire department with a claim date of March 2015 and his pre-existing active military service-connected psychological disability. Mr. Walters is permanently and totally disabled when the psychological disabilities predating his work-related occupational disease are considered in combination with the psychological disability resulting from the March 2015 primary claim. His presentation is one of overwhelming disability.

As explained above, in agreeing with Dr. Jackson, the Court finds that Claimant is only permanently and totally disabled when the combined effects of the occupational diseases from his work with Employer is combined with Claimant's pre-existing disabilities resulting from active duty service in the United States Air Force. The Court further finds that Claimant's preexisting partial disability in combination with the disability from the subsequent work-related occupational disease create a permanent and total disability and that the two disabilities combined result in a greater disability than that which would have occurred from the last injury alone.

1. Whether the Claimant must reimburse certain costs related to a missed vocational evaluation appointment.

Employer seeks reimbursement for $1,000 billed to the City by vocational expert Michael Dreiling for an appointment that was scheduled for Claimant's vocational testing and vocational rehabilitation assessment on April 24, 2019 as allowed by Section 287.143 RSM, and for which Claimant did not attend. Claimant testified at the hearing that he missed the appointment due to the funeral of his close friend and fellow firefighter and no evidence to the contrary was presented. The Court finds Claimant's testimony as to why he missed the appointment to be credible and that the missed appointment was reasonable. The Court further finds that Claimant is not required to reimburse Employer for costs related to the missed vocational evaluation appointment.

Conclusion

Employer shall immediately pay Mr. Walters permanent partial disability benefits in the amount of $45,102.00 (25% of the body as a whole at the 400 week level X $451.02 = $45,102.00) beginning March 28, 2015 through February 25, 2017, for 100 weeks. In addition, an award of future medical treatment for PTSD, is hereby entered in favor of Christopher Walters and against employer to cure and relieve the effects of the January 15, 2015 occupational disease.

Wherefore this Court finds Mr. Walter's permanently totally disabled due is to his occupational disease of January 15, 2015 in combination with his medically documented preexisting disability that was a direct result of active military duty in the United States Air Force, a branch of the United States Armed Forces. The Court further finds that Claimant became permanently and totally disabled on September 30, 2017, his last day at work as a substitute teacher for the St. Joseph School District. The Second Injury Fund therefore is liable to Mr.

Page 26

**Improved Employees: Christopher Walters**

**Injury No: 15-018291**

Walters for permanent total disability benefits. The Second Injury Fund (SIF) shall immediately pay Mr. Walters, beginning October 1, 2017, $593.14 per week for 125.4 weeks for permanent total disability benefits, and thereafter $593.14 per week for the remainder of his life. As of February 27, 2020, the Second Injury Fund's liability for past due benefits equals 74,379.76. ((125.4wks x 593.14) = $74,379.76).

The Court finds that the terms of the fee agreement between Claimant and Ben Creedy, Attorney for Mr. Walters, are fair and reasonable as are the expenses advanced on behalf of Claimant in the amount of $15,177.65 as described in Exhibit 10. The compensation awarded to Mr. Walters shall be subject to a lien in the amount of 25% of all payments hereunder, plus $15,177.65 for expenses, in favor of Ben Creedy, Attorney for Mr. Walters, for necessary legal services rendered.

I certify that on 7-21-20 I delivered a copy of the foregoing award to the parties to the case. A complete record of the method of delivery and date of service upon each party is retained with the executed award in the Division's case file.

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