Employee, currently forty-eight years old, worked for the employer as a welder and mechanic. His work included maintenance and repair of semi-tractor trailer trucks.
The employee sustained a work injury in 2006 relating to the inhalation of carbon monoxide while welding for a former employer. In August 2007, Dr. Stephen Lindahl treated employee for work-related pulmonary bronchitis. The employee sustained no permanent disability related to the 2006 injury and returned to work without restrictions. In 2008 employee passed a Department of Transportation physical examination. In 2011 employee again sustained exposure to toxic fumes while working on a propane and ammonia anhydrous tanker. He suffered heat exhaustion and experienced trouble breathing. The employee testified, "[A]fter I no longer did any more tank work for awhile, I was good again. I went back to [work]-I never did have any other issues after that." ${ }^{4}$
The employee began working for the employer herein, Peoplease Corporation, as a welder and mechanic, in the fall of 2013. Employee diagnosed mechanical problems and performed repairs that routinely involved working underneath trucks parked over an unventilated pit in a cemented area while their engines were running. Employee's work regularly involved exposure to truck exhaust fumes. The employer neither required nor offered to provide the employee a mask or ventilator.
On January 13, 2015, the employer ordered employee to work on a loaded trailer with mechanical issues. The employee attempted to hook the vehicle up outdoors, but when
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[^0]: ${ }^{3} Award, p. 9
{ }^{4} Transcript, p. 18
Injury No.: 15-003742
Employee: Anil Mueller
-3-$
he did, "it didn't catch right . . . while I was trying to crank down the handle I was getting exhaust fumes off the tractor." ${ }^{5}$ The employee began to feel sick, spit up and threw up. He decided to move the tractor inside to perform further diagnostics. The tractor's exhaust was cracked, leaking and the truck was smoking. The employee started getting lightheaded and feeling sick. He recalled falling into the pit, climbing out, and then standing in a corner by a heater trying to warm up. A co-worker, Kenny Arnold, told the employee he looked unwell and suggested that he go outside and get some air. After the employee threw up again outdoors, his supervisor Paul Finney, told him to go in the breakroom to see if he would feel better. When the employee sat down at a table in the breakroom, he lost consciousness. In response, the employer summoned emergency medical services (EMS). EMS technicians put the employee on a stretcher and gave him nitroglycerin to revive him. They then transferred employee to Mercy Hospital Springfield's Emergency Department (ED). ED notes recorded employee's complaints of chest pain and shortness of breath. The employee told ED nurse Nicholas Locke that he had vomited and vaguely remembered passing out. ED provider Dr. Ted McMurry found no evidence of cardiac ischemia or injury by ECG or troponin and noted employee "stated he felt the problem was primarily his lungs." ${ }^{6}$ The employee refused admission to the hospital for further evaluation and treatment. He left the hospital against medical advice.
The employee subsequently sought follow-up treatment with his personal physician, Dr. Tarsney, and underwent a pulmonary function test at Ozarks Community Hospital at his own expense. On March 20, 2015, Dr. Tarsney released the employee to return to work at full duty. Dr. Tarsney described the employee's January 13, 2015, occurrence as a "carbon monoxide injury."
When questioned about the discrepancies in the accident description on the employee's original and amended claims, the employee testified that both versions were correct. The employee explained that he began working outside, felt lightheaded, and vomited. He then moved inside to work under the vehicle in the "pit," where he experienced exposure to large amounts of fumes. The employee testified that he could barely talk with EMS technicians after the January 13, 2015, work event and had no clear recollection of what he might have told them.
Employee produced bills he received in the mail from medical providers associated with his transfer by EMS and emergency room treatment at Mercy Hospital Springfield on January 13, 2015. The transcript includes medical records reflecting the treatment that gave rise to these bills. The employee also produced bills for follow-up treatment with Dr. Tarsney, pulmonary testing at Ozarks Community Hospital, and additional diagnostic evaluations at Mercy Hospital on February 20, 2015. The employee testified that, except for a bill for a pulmonary test through Ozarks Community Hospital, all of the statements he produced remained outstanding. The employee testified that the bills he produced were for treatment related to his January 13, 2015, injury.
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[^0]: ${ }^{5} Transcript, p. 23.
{ }^{6}$ Id., p. 158.
Employee: Anil Mueller
Employer's expert, Dr. Ted Leonard, opined that the employee's January 13, 2015, work event was not the prevailing factor in the onset of any respiratory conditions or illness. He considered the January 13, 2015, occurrence unrelated to the employee's preexisting pulmonary issues. Dr. Leonard opined that the employee had no functional limitations and no permanent partial disability resulting from the January 13, 2015 work event.
Dr. Myron Jacobs opined that the employee suffered occupational injury or injuries that have reduced his pulmonary function but did not declare employee's January 13, 2015 work event to be the prevailing factor in this condition. He stated that employee "felt as though he became essentially well after the January 2015 incident."7
Dr. Thomas M. Hyers opined, "[The employee's] workplace exposures on or about 12-29-2011, 08-02-2012 and 01-13-2015 are the prevailing factors in causing his disability as described in my report of 05-27-2016 [emphasis added]."8 Dr. Hyers' May 27, 2016, independent medical examination report found employee "has suffered progressive restrictive lung disease (smaller than normal sized lungs) as a result of occupational injury from welding and other workplace exposures dating back to at least 2007 [emphasis added]."9 Dr. Hyers assigned 75\% disability due to pulmonary injuries but could not attribute this injury directly or quantify the proportion of damage attributable to employee's alleged 2011, 2012, or 2015 exposures.