Court of Appeals of Missouri, Western District, Second Division
APPEAL FROM THE LABOR AND INDUSTRIAL RELATIONS COMMISSION.
William D. Rotts, for Respondent.
Richard L. Montgomery, Jr., for Appellant.
Before Division Two: Victor C. Howard, Presiding Judge, James E. Welsh, Judge and Anthony Rex Gabbert, Judge. All concur.
VICTOR C. HOWARD, JUDGE.
Curators of the University of Missouri (Employer) appeal the Labor and Industrial Relations Commission's award of worker's compensation benefits to Deborah Beatrice. It claims that the award was not supported bye competent and substantial evidence and is against the overwhelming weight of the evidence. The award is affirmed.
Ms. Beatrice began working for Employer in 2004 as a labor and delivery nurse at Columbia Regional Hospital. In October of that year, one and a half years before the work-related injury at issue in this case, Ms. Beatrice slipped on water while walking into an operating room and fell on her right buttock. She sustained strains of her neck, back, right knee, and ankle and a gluteal contusion. The incident required minimal treatment, and no claim for compensation was filed.
On March 28, 2006, while assisting with positioning a struggling patient during a difficult delivery, she experienced immediate pain in her low back. She finished her shift and applied ice to her back at home that night. The next day, on March 29, 2006, Ms. Beatrice was pushing a patient in a hospital bed and experienced worsening back pain and spasms radiating down her left leg. She reported the injury to Employer, and Employer referred her to Dr. Robert Conway.
Dr. Conway ordered an x-ray of the lumbar spine, which showed no bony abnormalities. He diagnosed Ms. Beatrice with aggravation of lumbar spondylosis with possible left L5 radiculopathy, prescribed physical therapy and medication, and placed her on a ten pound lifting restriction at work with only occasional bending and twisting. When Ms. Beatrice continued to complain of pain in her low
back, Dr. Conway ordered an MRI, which he reported showed mild degenerative changes of the spine with possible mild stenosis at L5-S1 but no evidence of disc herniation or significant stenosis. He continued to prescribe physical therapy. On June 15, 2006, Ms. Beatrice reported to Dr. Conway that her back pain worsened as she increased work activities. Dr. Conway noted that she had made very limited progress in physical therapy, proclaimed her at maximum medical improvement, and released her from his care giving her permanent restrictions of lifting no more than twenty pounds and working no more than 8-hour shifts. He assigned a permanent partial disability rating of 4% of the body as a whole related to her work injury.
Because of her work restrictions, Ms. Beatrice was no longer able to perform her job, and Employer terminated her on June 22, 2006. She filed a claim for compensation on July 6, 2006. In August 2006, Ms. Beatrice began working full-time for Litigation Management reviewing medical records from home.
Continuing to have pain in her low back, Ms. Beatrice began seeing Dr. Thomas Highland, an orthopaedic surgeon with Columbia Orthopaedic Group, at her own expense in July 2006. Dr. Highland ordered a CT and myelogram of her lumbar spine. He prescribed epidural steroid injections in July 2006 and November 2006 for disc bulge at L4-5. Ms. Beatrice received some relief from the July injection but very little from the November injection.
In January 2007, Ms. Beatrice sought a second opinion on her own from Dr. Keith Bidwell, a spine specialist in St. Louis. Dr. Bidwell examined Ms. Beatrice and reviewed her medical records. He noted that her MRI showed only mild disc degeneration. He determined that surgical treatment was not advisable and recommended physical therapy. Ms. Beatrice also saw Dr. George Carr for an independent medical evaluation at the request of her attorney. After examining Ms. Beatrice and reviewing her records, Dr. Carr opined that the work accident on March 28, 2006, caused the development of her chronic back pain syndrome. He concluded that she was at maximum medical improvement and suffered a permanent partial disability of 15% body as a whole rated at the lumbosacral spine due to chronic low back pain. Dr. Carr agreed that surgery was not indicated.
Still experiencing persistent pain in her back and pain and weakness in her left leg, Ms. Beatrice saw Dr. Highland again in January 2007. She reported that she had begun to develop pain in her groin, right low back, and buttock area. She had also had several minor falls due to her left leg weakness. Dr. Highland referred Ms. Beatrice to Dr. Jennifer Clark, a physiatrist, to address the leg weakness. Dr. Clark's electrodiagnostic testing produced normal results. Believing that Ms. Beatrice's leg weakness was a result of her pain, Dr. Highland then referred her to Dr. Steven Street, a pain management specialist. Dr. Street administered an epidural steroid injection in February 2007.
In March 2007, Dr. Highland ordered another CT and myelogram of Ms. Beatrice's lumbar spine. After reviewing the test results, Dr. Highland opined that Ms. Beatrice had a bulging disc at level L4-5 that was directly related to her work injury in March 2006 and that surgical treatment of the bulging disc would give her relief of her back and leg pain, recommended a two-level vertebral fusion at levels L4-5 and L5-S1, and scheduled the surgery for March 8, 2007. Employer did not authorize the surgery, and it was cancelled.
In April 2007, Ms. Beatrice saw Dr. Dos Santos, a psychiatrist. Dr. Santos diagnosed
her with major depression, chronic back and leg pain, and history of abuse and prescribed antidepressants. He continued to treat Ms. ...