Court of Appeals of Missouri, Western District, Second Division
JAMES C. BOWMAN, Appellant,
CENTRAL MISSOURI AVIATION, INC., and TREASURER OF THE STATE OF MISSOURI AS CUSTODIAN FOR THE SECOND INJURY FUND, Respondents.
from the Labor and Industrial Relations Commission
Before: Karen King Mitchell, Presiding Judge, and Cynthia L.
Martin and Gary D. Witt, Judges.
King Mitchell, Presiding Judge.
Bowman appeals from a decision of the Labor and Industrial
Relations Commission denying his claim for workers'
compensation benefits. Bowman raises three claims on appeal:
(1) the Commission erred in discrediting Bowman's medical
expert; (2) the Commission erred in finding Bowman's
preexisting psychological injury to be the prevailing factor
in his disability; and (3) the Commission erred in finding
that the Second Injury Fund had no liability to Bowman.
Finding no error, we affirm.
20, 2005, Central Missouri Aviation (CMA) hired Bowman as a
line technician. His duties were directing traffic on the
tarmac, cleaning and servicing planes, fueling planes,
putting planes up in the hangar or pulling planes out of the
hangar, catering, and attending to any other customer needs.
16, 2007, a pilot who had just arrived approached Bowman and
advised Bowman, "You need to get in there and do the
lav." Bowman responded, "There's already
somebody in there, you don't need to reiterate." The
pilot then pressed his left forearm against Bowman's
chest, placed his right hand around Bowman's throat, and
pushed Bowman against the nose of the plane. The incident
lasted approximately five seconds. Bowman suffered no
physical injuries as a result of the incident, but he felt
scared, confused, and helpless because everyone in management
at CMA had already left for the day, so there was no one to
whom he could immediately report the incident. That night,
Bowman had difficulty sleeping and trouble concentrating
because he felt violated. Bowman contacted the human
resources representative the following day to report the
incident, and he requested medical help to deal with the
situation. CMA refused to pay for any medical treatment
beyond the health insurance it was already providing for
Bowman. Bowman did not work again after that day. On December
14, 2007, CMA terminated Bowman's employment for lack of
sought out psychological treatment on his own at Green
Meadows Adult Psychiatry Clinic (Green Meadows). Bowman had
previously sought treatment at Green Meadows on May 4, 2007,
shortly before the incident with the pilot, because his
girlfriend and roommate had become concerned with his
behavior. Bowman had begun screening people as they came into
his home, and he was experiencing problems with intense
anxiety, agitation, feelings of insecurity, nervousness, and
paranoia. During the May 4, 2007 evaluation, Bowman revealed
that, in January 2003, an armed intruder entered his home,
struck him with a gun, forced him to drive somewhere, then
stole his money, kicked him out of the car, and drove away.
Bowman felt helpless and frantic during the incident,
believing that he would be killed. Afterward, he suffered
from acute sleep problems (resulting from fear) and felt
insecure, hopeless, afraid, and unsettled. He became isolated
and distrustful of people, but, as time passed, he found it
easier to leave his home and to work. Bowman also revealed,
during the evaluation, that he had been in a rehabilitation
program twice for marijuana usage. The evaluation resulted in
a diagnosis of generalized anxiety disorder.
the 2007 incident with the pilot, Bowman received therapy
from Linda Hodges. Ms. Hodges discussed the symptoms of
post-traumatic stress disorder (PTSD) with Bowman, and he
agreed that the diagnosis of PTSD "fits [him] to a
'T'" because he experienced many of those
symptoms following the 2003 kidnapping. Ms. Hodges suggested
to Bowman that his response to the 2007 work incident likely
would not have been so severe had he not experienced the 2003
January 24, 2008, Bowman filed a claim for workers'
compensation, claiming psychological injuries from the July
16, 2007 incident with the pilot. Bowman alleged that he was
permanently partially disabled. To support his claims, Bowman
underwent an evaluation by psychiatrist Dr. A. E. Daniel. Dr.
Daniel concluded that Bowman is permanently and partially
disabled and that the 2007 work incident was "the sole
prevailing factor in the causation of his disability."
CMA retained Dr. Wayne Stillings to conduct a separate
evaluation. Dr. Stillings concluded that Bowman was
"probably disabled from employment, " but
determined that the disability was "due to pre-existing
psychiatric problems." Specifically, Dr. Stillings
opined that Bowman's need for psychiatric treatment
"is prevailingly causally related to his pre-existing,
inherent psychiatric disorders and possibly the
life-threatening incident in 2003, neither of which was
aggravated by the 07/2007 work incident."
Administrative Law Judge (ALJ) found "Dr.
Stillings'[s] opinions regarding the cause of
[Bowman]'s PTSD . . . much more persuasive than those of
Dr. Daniel." The ALJ noted:
While I would disagree with Dr. Stillings'[s] apparent
opinion that the July 16, 2007 incident did not
"exacerbate" (at least temporarily) [Bowman]'s
pre-existing PTSD, the remainder of Dr. Stillings'[s]
opinions appear much more in line with the facts of the case
than do Dr. Daniel's opinions.
bases for the ALJ's rejection of Dr. Daniel's
conclusions are as follows:
I find it very difficult to believe that Dr. Daniel did any
type of thorough review of [Bowman]'s treatment records,
particularly the records from Green Meadows Adult Psychiatry
Clinic. Dr. Daniel obviously did not know that [Bowman] was
having panic attacks 2-3 times a month prior to July 16,
2007. It is almost impossible to believe that Dr. Daniel
reviewed the August 1, 2007 [report] . . . where [Bowman] and
his therapist agree that [Bowman] suffered from classic PTSD
symptoms from and after the 2003 robbery/kidnapping incident.
As Dr. Daniel also states "(d)etailed inquiry did not
indicate that [Bowman] has any substance abuse-related legal
or occupational problems[, ]" it is extremely difficult
to see how he could miss the references to [Bowman]'s
daily marijuana use in the July and August 2007 records, and
how he could not see that [Bowman] was being treated for
"cannabis dependence" and how Dr. Daniel could miss
the many references to [Bowman]'s legal problems
involving marijuana possession, drug court[, ] and probation.
concluded that Bowman's "PTSD was caused by the 2003
robbery/kidnapping incident, and not by the July 16, 2007
incident[, ]" which "was nothing more than a
triggering or precipitating factor in an exacerbation of the
already-existing symptoms of the already-existing PTSD."
The ALJ expressly found the 2007 work incident "was NOT
the prevailing factor in the cause of [Bowman]'s PTSD.
The 2003 robbery/kidnapping incident WAS the prevailing
factor in the cause of [Bowman]'s PTSD." Upon
determining that the 2007 work incident was not the
prevailing factor in causing Bowman's PTSD, the ALJ found
"there is no 'compensable injury'" and
denied all of Bowman's claims.
applied to the Commission for review of the ALJ's
decision. The Commission upheld the ALJ's determination
but issued a supplemental decision, incorporating the
ALJ's decision "to the extent not inconsistent with
[the] supplemental decision." In the supplemental
decision, the Commission noted the starkly contrasting
opinions of Dr. Daniel and Dr. Stillings, but stated:
"[O]ur analysis does not turn on the simple either/or
question whether the 2003 or 2007 event caused [Bowman] to
suffer the medical diagnosis of PTSD . . . because it is
possible for [Bowman] to have suffered psychiatric injury
from both events." The Commission noted that
Bowman "had the burden of proving that the work accident
was the prevailing factor causing a resulting medical
condition and disability." It then pointed out that
"the term 'medical condition' is in no way
synonymous with 'medical diagnosis.'" The
There is evidence in this record which, if believed, would
support findings that [Bowman] suffered from PTSD in the
past, that (although he may have been left in a more fragile
state) this condition because quiescent for an extended
period of time leading up to the date of injury, and that the
sudden, violent assault at the workplace caused a permanent
worsening of the latent condition, a permanent increase in
disability, and a need for medical care that otherwise would
never have been required.
Commission then concluded that its "inquiry must begin
with the sole question whether Dr. Daniel persuasively
established that the July 2007 accident was the prevailing
factor causing [Bowman] to suffer a resulting psychiatric
condition and disability, regardless of whether
[Bowman] was also suffering (or had previously suffered) from
preexisting psychiatric conditions and/or disabilities."
Commission first noted that the only objective psychological
test Dr. Daniel administered (the MMPI-II) yielded invalid
results; thus, Dr. Daniel's analysis was based "on
[Bowman]'s subjective complaints and symptoms."
"As a result, " the Commission determined,
"the persuasive force of Dr. Daniel's opinion turns
to a substantial degree upon the extent to which [the
Commission] c[ould] rely upon [Bowman]'s subjective
description of his history, complaints, and symptoms."
The Commission then identified numerous "material
inconsistencies" in Bowman's testimony and
statements to evaluating and treating physicians involving
things such as his marijuana usage, his feelings about the
2003 kidnapping, and his interactions with the pilot after
the work incident. Based upon these inconsistencies, the
Commission found that Bowman "[wa]s an unreliable
witness, " and "[w]here [the Commission was] unable
to rely on [Bowman's] self-reported subjective complaints
and symptoms, it follows that [it] c[ould] not rely on the
causation opinions from Dr. Daniel that were substantially
derived therefrom." Accordingly, the Commission deemed
"Dr. Daniel's testimony insufficiently persuasive to
satisfy [Bowman's] burden of proof, " and,
therefore, "the accident of July 16, 2007, was not the
prevailing factor causing claimant to suffer any psychiatric
condition or disability." The Commission expressly
declined "to weigh the relative credibility of
[CMA's] contrary expert medical opinion evidence from Dr.
Stillings" in light of its determination that "the
opinions from Dr. Daniel [were] insufficient to satisfy
[Bowman's] initial burden of proof with respect to the
issue of medical causation." Bowman appeals.