Court of Appeals of Missouri, Western District, Second Division
Appeal from the Labor and Industrial Relations Commission.
Henry T. Herschel, Columbia, MO, for appellant.
Russell C. Still, Columbia, MO, for respondent.
Before Division Two: Gary D. Witt, Presiding Judge, Lisa White Hardwick, Judge and Alok Ahuja, Judge. Hardwick, Judge, joins in the majority opinion. Ahuja, Judge, dissents in separate opinion.
Gary D. Witt, Judge
Randolph County appeals the Labor and Industrial Relations Commission's final award of workers' compensation benefits to its former employee, Tammy Moore-Ransdell (" Moore-Ransdell" ). Randolph County contends the Commission erred in concluding that Moore-Ransdell suffered a compensable injury because: (1) the injury came from a hazard or risk to which she was equally exposed in her normal nonemployment life; and (2) the accident at work was merely a triggering or precipitating factor and not the prevailing factor in causing her resulting medical condition and disability. Because the Commission's determinations were supported by competent and substantial evidence and were not against the weight of the evidence, we affirm.
FACTUAL AND PROCEDURAL HISTORY
Moore-Ransdell, age fifty at the time of the accident, worked for Randolph County for ten years. As a " deeds clerk" in the Assessor's office, Moore-Ransdell worked with " property records cards," which were stored in filing cabinets. Her medical record as explained through her History and Physical at Boone Hospital Center indicates that she was " well with regard to her low back and lower extremities until Tuesday, February 26, 2008."
On that day, Moore-Ransdell was updating the property records cards. One of the file folders she needed was in the back of the bottom file drawer, which she described as " extremely full" and " jammed up." Because of defects in the filing system and the location of the file cabinet, Moore-Ransdell had to squat down and twist to remove a file from the tightly jammed bottom file drawer. She squatted down, reached into the back of the file drawer, and twisted her body as she tried to remove the file. She immediately experienced extreme pain in her low back. She could barely stand up and had difficulty
walking. Moore-Ransdell finished working the rest of the day but had too much low back pain the following day to get out of bed.
On March 1, 2008, Moore-Ransdell spoke to her supervisor about her injury. Her supervisor referred her to Kevin D. Komes, M.D., an orthopedic surgeon, for evaluation of her back pain for workers' compensation purposes. The record indicates that Moore-Ransdell told Dr. Komes that she had low back pain, pain in her buttocks, and numbness in her entire left leg, all of which began immediately after the file cabinet incident.
In April 2008, Moore-Ransdell filed a claim for workers' compensation benefits. Randolph County denied her claim and refused to authorize further medical treatment.
Moore-Ransdell then sought medical treatment on her own. Her primary care physician referred her to Thomas R. Highland, M.D. Dr. Highland is a board-certified orthopedic surgeon and professor who had been in practice for fifteen years as of the time of the hearing. He specializes " in the treatment of the spine, including cervical, thoracic, and lumbar spine." In examining Moore-Ransdell, Dr. Highland noted that she had diminished sensation in her left leg, buttock and back pain on the left, right leg pain, and tenderness in her low back. He initially referred her for physical therapy and pain management. She participated in physical therapy and received epidural steroid injections, nerve root injections, and facet blocks, but the pain worsened.
In July 2008, Moore-Ransdell underwent a lumbar discogram, which is a test that places a needle into the disc itself and injects a dye. According to Dr. Highland, the discogram showed degeneration in the discs at L3-4, L4-5, and L5-S1, which are the bottom three discs in the back. The discogram reproduced the pain that Moore-Ransdell had been having in her low back and down her leg. Dr. Highland recommended a three-level fusion of the discs. Moore-Ransdell did not have surgery at that time but attempted a more conservative treatment plan of further therapy, continued steroid injections and pain medication. Despite the additional pain management, she was unable to tolerate the pain.
In August 2010, Moore-Ransdell returned to Dr. Highland and reported that the steroid injections had given her only short-term relief and that she was still having back pain and numbness and tingling in her left leg. She was having difficulty living with the pain. Dr. Highland took an x-ray and noted that the three problematic discs had gotten worse, particularly at the L5-S1 level. An MRI showed further degeneration at L3-4 and L4-5, inflammatory changes at L5-S1, increasing bulging of the L3-4 disc, and increasing compression of the nerves at that level. In examining Moore-Ransdell, Dr. Highland noted that she was experiencing more loss of sensation in her left leg than she had in 2008 and that she had a slight weakness to the dorsiflexion of the left foot, which she did not have in 2008.
Dr. Highland again recommended that Moore-Ransdell undergo surgery to treat her injury. In October 2010, he wrote in a letter that Moore-Ransdell had " continuing degeneration of all three segments in her back which were the source of her pain." He stated, " I clearly feel that her continuing symptoms and her need for surgery
are directly related to the work injury in February 2008." He stated that his impression of Moore-Ransdell's condition was: " (1) Acute lumbar strain in February 2008; (2) Internal disc disruption to L3-4, L4-5 and L-5-S1 secondary to work injury in February 2008; (3) Need for anterior lumbar fusion L3-4, L4-5 and L5-S1 secondary to work injury in February 2008."
In November 2010, Moore-Ransdell underwent anterior fusion surgery. Moore-Ransdell's back and leg pain improved post surgery.
On October 29, 2012, a hearing was held before an Administrative Law Judge (ALJ) on Moore-Ransdell's workers' compensation claim. During the hearing, Moore-Ransdell testified regarding the February 26, 2008 accident, the pain she felt afterwards, the treatment she received, and her condition after the anterior fusion surgery. Presently, she is unable to sit comfortably for more than forty-five to fifty minutes and to stand for more than thirty to forty minutes without having increasing pain in her low back and difficulty walking. She is prescribed Vicodin for pain, medication for nerve pain, muscle relaxers, and Cymbalta for depression.
In addition to her testimony and medical records, Moore-Ransdell offered Dr. Highland's deposition testimony and disability rating report. On direct examination, Dr. Highland testified in part:
Q. All right. Let me ask you a hypothetical question, Doctor. If you would assume that the history that Ms. Ransdell gave you when you first saw her was true and correct, that is, that she had back pain and leg pain after squatting down to get a file -- something out of a file cabinet and twisting, and that she did that on about February 26th, 2008. And then you saw her -- at the times that you saw her, do you have an opinion based on reasonable medical certainty as to whether or not that incident caused the conditions that you found when you examined her?
Q. What is your opinion?
A. That the injury caused the condition that I treated her for.
Q. Okay. All right. And do you have an opinion as to whether or not that injury that she described is what necessitated this course of treatment and surgery that you have now performed?
Q. And what is that opinion?
A. That it caused the injury and the problem for which we eventually did do the surgery.
Q. All right. And in your opinion, the surgery that was performed, was that the appropriate medical procedure to take in Ms. Ransdell['s] case?
On cross-examination, Dr. Highland agreed with defense counsel that Moore-Ransdell had a degenerative back before the February 26, 2008 accident. He also agreed that aging and normal activities of daily living can cause such degenerative problems to progress over time. Dr. Highland testified that, when he re-evaluated Moore-Ransdell in August 2010, he found that she had increasing stenosis and continuing degeneration of the three discs, which were the source of her pain. He agreed that, without her pre-existing disc degeneration, the lumbar strain she suffered at work on February 26, 2008, would not have necessarily required the three-level fusion procedure that he performed. Dr. Highland explained that the lumbar strain was an " injury to the muscles and ligaments, which is usually a more short-term issue" and that " the continued pain was from the deteriorating discs that she had" (emphasis added). Dr. Highland answered
affirmatively when asked whether the work accident " triggered a pain from the underlying discs" and when asked whether he had to " address the underlying condition ...