Claimant introduced, and had admitted into evidence, the following Exhibits:
1) Missouri Baptist Medical Center records and bill
2) Midwest Radiological Associates bill
3) Tri County Family Practice Records and bill
4) St. Luke's Hospital records and bill
5) Diagnostic Imaging bill
6) Dr. James Lu Records and bill
7) First Capital Chiropractic records and bill
Issued by DIVISION OF WORKERS' COMPENSATION
Injury No.: 17-003266
8) Dr. Berkin IME report
9) Title of 2010 Ford F-150
10) Photographs of accident
Employer/Insurer introduced, and had admitted into evidence, the following Exhibits:
A) Missouri Uniform Police report
B) Calvin Flemons Deposition transcript
C) Dr. James Doll IME report
D) Screen shot map of area surrounding Employer's business
ISSUES
1) Whether the injury arose out of and in the course of employment.
2) Liability of the Employer for unpaid medical expenses, stipulated in the amount of $21,835.40.
3) Liability of the Employer for permanent partial disability.
FINDINGS OF FACT
Employee was born on October 31, 1971. He was 49 years old at the time of the hearing. Employee is married to Tonae Flemons. He testified that he has a high school education and a college degree in childcare. He resides, with his wife and two children, in O'Fallon, Missouri.
Employee and his wife are owners of Land of Oz Academy, the Employer. The Employer is a childcare center. Employee testified during his deposition that he has been employed by Employer since 2003. His job title is assistant director and his wife is his supervisor. Employee testified that his job duties as the assistant director include: managing, cooking, performing maintenance, and driving. His duties include: making sure children were in the classroom, preparing breakfast and lunch, and transporting children to and from the facility. He testified that he did every job associated with running the facility.
Employer is located at 1176 N. Kingshighway Boulevard, St. Louis, Missouri 63113. Kingshighway Boulevard is a busy roadway in the City of St. Louis. Employer is located near the intersection of Kingshighway Boulevard and Vernon Avenue.
Employee testified that Employer owns five vehicles which include three buses, one truck, and one van. Employer has no onsite parking at its location. Claimant estimated Employer's lot is 130 feet long. The vehicles owned by Employer would be parked on the street, on Kingshighway, in front of Employer's building.
Employee testified he and his wife would eat lunch while sitting in Employer's vehicle, parked on Kingshighway. Employee and his wife testified that they would eat lunch in the truck every day while working for Employer. There is a staff lounge located inside Employer's building, but Employee and his wife preferred to eat in the truck for privacy. Employee and his wife testified that they discussed business activities while eating lunch, including planning for the next business day, and to avoid phone calls or employee questions during the lunch hour.
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Injury No.: 17-003266
On January 10, 2017, Employee and his wife, were eating lunch in Employer's company truck. Employee testified he and his wife had gone to a nearby restaurant to pick up lunch and upon return to Employer's location, had parked directly in front of the building on Kingshighway. Employee testified he and his wife had been discussing business while they ate their lunch.
During lunch, they were rear-ended by a vehicle traveling on Kingshighway. Employee did not have an estimation as to how fast that vehicle was traveling. The crash report filed after the accident documented that neither Employee nor his wife reported being injured following the collision. Medical treatment was offered but Employee and his wife declined. Employee and his wife returned to work and completed their work shift following the crash.
Employee testified he began noticing symptoms from the lower part of the back of his head down to the lower part of his back, the day following the crash. His symptoms included: stiffness, tightness, soreness, and aching. He decided to seek medical attention the day following the crash.
Employee presented to Missouri Baptist Medical Center emergency department on January 11, 2017 for evaluation. The history of present illness documented complaints of head, neck, and chest wall pain that had gradually worsened since a motor vehicle accident 24 hours prior. X-ray of the cervical spine noted no acute bone abnormality with straightening of the spine. X-ray of the chest was negative. X-ray of the lumbar spine was negative. Employee was given a prescription for Flexeril and discharged.
Employee was evaluated by Nurse Practitioner Jenna Sanders at Tri County Family Practice on January 19, 2017. He presented with complaints of pain from his neck to buttocks, with more frequent headaches. He reported inability to lay on his stomach and had constant pain with spasms. NP Sanders diagnosed back pain, neck pain, and chest wall pain and provided a prescription for prednisone and physical therapy.
Physical therapy at St. Luke's Hospital began on January 25, 2017. During initial assessment, examination noted restricted cervical and lumbar mobility with tenderness along the spine. Employee was discharged from physical therapy after 12 visits, on March 21, 2017.
Employee returned to NP Sanders on March 28, 2017 following the conclusion of physical therapy. NP Sanders ordered MRI's of the lumbar spine and cervical spine and noted if studies were normal then Employee would continue pain management and physical therapy. The MRI of the lumbar spine was interpreted to reveal mild diffuse disc bulging at L5-S1. MRI of the thoracic spine revealed mild posterior disc bulging at C6-7 with a small left paracentral disc protrusion, small right paracentral disc protrusion at T3-4 which appeared to abut the cord, and tiny left paracentral disc protrusions at T5-6 and T6-7.
Claimant was evaluated by neurosurgeon Dr. James Lu on April 21, 2017. Dr. Lu reviewed the MRI's of the lumbar and thoracic spine. Dr. Lu noted the lumbar spine showed degenerative disc disease with disc desiccation at L5-S1, and the remainder of the lumbar discs appeared normal. He noted central annular bulging adjacent to the S1 nerve roots, but no significant stenosis or nerve impingement. Review of the thoracic spine MRI noted minor annular bulging at T3-4, without disc herniation and minimal degenerative change throughout.
Issued by DIVISION OF WORKERS' COMPENSATION
Injury No.: 17-003266
the remainder of the thoracic spine. Based on the imaging studies, Dr. Lu did not believe Employee was a surgical candidate. Dr. Lu believed Employee had musculoskeletal strain and recommended conservative treatment consisting of physical therapy and medications.
Therapy records from St. Luke's document Employee continued physical therapy until April 26, 2017. The formal discharge date from physical therapy was May 23, 2017.
Employee received chiropractic treatment with Dr. Daniel Geisler at First Capital Chiropractic & Rehab beginning May 3, 2017. Dr. Geisler provided spinal adjustments, EMS stimulation, and therapeutic exercise on Employee throughout treatment. Employee continued treatment until June 28, 2017. He was released on an as-needed basis with a reported pain level of 1/10.
Opinion Evidence
Shawn L. Berkin, D.O.
Claimant offered the report of Dr. Shawn L. Berkin dated February 11, 2018 (Exhibit 8). Dr. Berkin evaluated Employee on January 10, 2018. During the medical evaluation, he personally obtained a medical history, performed a physical examination, obtained the subjective complaints issued by Employee, and examined medical records and test results that were furnished to him.
Dr. Berkin's examination of the lower back revealed a normal lumbar curve without scoliosis. He demonstrated a normal station without pelvic asymmetry. The heights of the iliac crests were equal. His gait was not antalgic with fluid stride and cadence. Palpation of the lumbar spine failed to reveal any swelling, asymmetry, or step off deformity of the bony landmarks of the vertebral segments. There was tenderness to palpation over the paraspinal muscle lateral to the vertebral column. Provocative sacroiliac maneuvers were negative to pelvic rock and sacral compression.
Dr. Berkin offered the following final impressions:
1) Cervical strain.
2) Lumbosacral strain.
3) Facet arthropathy of the lumbar spine with bulging of the L5-S1 intervertebral disc.
He stated the accident that occurred on January 10, 2017 was the prevailing factor in causing cervical and lumbosacral strains associated with degenerative facet disease of the lumbar spine and a bulging disc. He rated the injury as 15% permanent partial disability of the body as a whole at the level of the cervical spine. Also, he rated the injury as 20% permanent partial disability of the body as a whole at the level of the lumbosacral spine.
James T. Doll, D.O.
Employer and Insurer submitted the report of Dr. James T. Doll, dated November 5, 2018 (Exhibit C). Dr. Doll examined Employee on November 5, 2018. His evaluation was compiled utilizing the available history, physical examination, diagnostic studies and medical records.
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Dr. Doll noted that on January 11, 2017, Employee was diagnosed with cervical, thoracic and lumbar strain injuries, as well as chest contusion. In addition, he noted that a March 31, 2017 MRI study of the thoracic spine revealed multilevel disc protrusions to the left and to the right. Also, a March 31, 2017 MRI study of the lumbar spine revealed mild diffuse disc bulging at L5-S1.
Dr. Doll noted that Employee reported ongoing diffuse neck and back pain, which he attributes solely to his January 10, 2017 occupational injury. Employee denied any prior occurrences of symptoms in his neck or back before the occupational incident. These diffuse subjective complaints were reported without correlating objective findings. Such inconsistencies suggest the possibility of a non-organic basis for his ongoing symptomatology such as symptom magnification. His diagnostic testing revealed mild degenerative changes and no acute structural abnormalities associated with his January 10, 2017 occupational injury.
It was Dr. Doll's opinion, within a reasonable degree of medical certainty, that Employee's January 10, 2017 occupational injury was the prevailing factor in the medical causation of his cervical, thoracic, and lumbar strain injuries and the need for treatment. Finally, Dr. Doll opined that Employee sustained no permanent partial disability attributable to this occupational injury.