Maxim Healthcare Services, Inc. v. Debra Taylor Freeman

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REL: 04/13/2012 Notice: T h i s o p i n i o n i s s u b j e c t t o formal r e v i s i o n b e f o r e p u b l i c a t i o n i n t h e advance s h e e t s o f Southern R e p o r t e r . R e a d e r s a r e r e q u e s t e d t o n o t i f y t h e R e p o r t e r o f D e c i s i o n s , Alabama A p p e l l a t e C o u r t s , 300 D e x t e r A v e n u e , M o n t g o m e r y , A l a b a m a 3 6 1 0 4 - 3 7 4 1 ((334) 2 2 9 - 0 6 4 9 ) , o f a n y t y p o g r a p h i c a l o r o t h e r e r r o r s , i n o r d e r t h a t c o r r e c t i o n s may b e made b e f o r e t h e o p i n i o n i s p r i n t e d i n Southern R e p o r t e r . ALABAMA COURT OF CIVIL APPEALS OCTOBER TERM, 2011-2012 2101205 Maxim Healthcare S e r v i c e s , Inc. v. Debra T a y l o r Freeman Appeal from J e f f e r s o n C i r c u i t (CV-09-1182) Court THOMPSON, P r e s i d i n g J u d g e . Maxim H e a l t h c a r e S e r v i c e s , I n c . ("Maxim"), a p p e a l s from the judgment o f t h e J e f f e r s o n C i r c u i t C o u r t i n f a v o r o f Debra T a y l o r Freeman i n h e r a c t i o n a g a i n s t Maxim u n d e r t h e W o r k e r s ' 2101205 Compensation Act"). Act, § 25-5-1 e t s e q . , A l a . Code F o r t h e r e a s o n s s e t f o r t h h e r e i n , we In 2004, working Freeman, a 1975 ("the affirm. licensed practical f o r Maxim, a n u r s i n g - r e f e r r a l a g e n c y . nurse, began As p a r t o f h e r employment w i t h Maxim, she was r e f e r r e d t o v a r i o u s j o b s i t e s and facilities working t o work. On at a rehabilitation Maxim h a d r e f e r r e d h e r . a toilet i n Tuscaloosa the p a t i e n t into felt a burning extended i n t o her h i p s . was t o which W h i l e she was l i f t i n g a p a t i e n t f r o m t o place her i n a wheelchair, place Freeman 24, 2008, Freeman facility c a u s i n g Freeman t o o v e r e x t e n d to December the wheelchair h e r s e l f w h i l e she was the wheelchair. sensation i n her As lower A few m i n u t e s l a t e r , moved, attempting she d i d s o , back that the p a i n i n her b a c k and h i p s became e x c r u c i a t i n g and r a d i a t e d i n t o h e r l e g s , making i t difficult f o r her t o walk. shift, she went t o t h e e m e r g e n c y room where she c o m p l a i n e d o f b a c k p a i n and h i p p a i n . multiple given injections pain emergency room told her A t t h e e m e r g e n c y room, she r e c e i v e d of pain medication A f t e r completing relievers to take her to orally. follow doctor. 2 up and s t e r o i d s and The with doctor an was at the orthopedic 2101205 On A p r i l 17, 2009, Freeman f i l e d an a c t i o n a g a i n s t seeking July benefits 11, 2011, action. At stipulated, and c o m p e n s a t i o n p u r s u a n t the t r i a l the among court beginning other held of things, to the Act. a bench t r i a l the Maxim i n the trial, the Freeman that On parties received an i n j u r y t o h e r l e f t h i p and l e f t l e g a r i s i n g o u t o f and i n t h e course Maxim o f h e r employment with proper n o t i c e of her i n j u r y . was a dispute r e l a t e d to the as Freeman The p a r t i e s i n d i c a t e d t h a t t o w h e t h e r Freeman's b a c k p r o b l e m s were information. Freeman t r e a t e d b y Dr. W i l l i a m L u p i n a c c i on J a n u a r y 15, 2009. improving. there submitted i n t o evidence at the t r i a l the f o l l o w i n g p e r t i n e n t appointment, gave accident. The m e d i c a l r e c o r d s revealed and t h a t Freeman indicated that her was At that symptoms were He d i a g n o s e d h e r w i t h a b a c k s t r a i n and t o l d h e r to return f o r e v a l u a t i o n . A treatment note from Dr. L u p i n a c c i from January 22, 2009, i n d i c a t e d t h a t Freeman was c o n t i n u i n g t o e x p e r i e n c e b a c k p a i n and t h a t she was h a v i n g t o t a k e t i m e o f f work due t o t h e pain. He prescribed l i m i t e d her to l i f t i n g h e r 2 weeks of p h y s i c a l no more t h a n 20 p o u n d s . 3 therapy and 2101205 A note from Dr. Lupinacci i n d i c a t e d t h a t Freeman's p a i n was experiencing radicular diagnosed her with and continued Dr. 2009. from February 2, 2009, h a d n o t i m p r o v e d a n d t h a t she pain into a lumbar s t r a i n h e r work r e s t r i c t i o n her left and lumbar regarding leg. He radiculopathy lifting. Andrew C o r d o v e r b e g a n t r e a t i n g Freeman i n F e b r u a r y A medical n o t e f r o m an a p p o i n t m e n t Freeman h a d w i t h Dr. C o r d o v e r on F e b r u a r y 18, 2009, i n d i c a t e d t h a t Freeman's c h i e f complaints He were b a c k p a i n , l e f t - h i p p a i n , a n d l e f t - l e g ordered limited an MRI of her lower her to l i g h t work t w i s t i n g at her waist o f Freeman's l e f t back with and l e f t no repetitive pain. h i p , a n d he bending a n d no s q u a t t i n g o r k n e e l i n g . The MRI hip indicated a possible labral tear. MRI o f Freeman's l o w e r b a c k r e v e a l e d bulges at m u l t i p l e l e v e l s without mild degenerative spinal stenosis or The disk or neural compression. I n a w o r k - s t a t u s f o r m p r e p a r e d b y Dr. C o r d o v e r a n d d a t e d March 25, restrictions 2009, Dr. Cordover he h a d p r e v i o u s l y continued assigned the same t o Freeman, work a n d he i n d i c a t e d t h a t he h a d r e f e r r e d h e r t o Dr. J e f f r e y C u s m a r i u , a n o t h e r p h y s i c i a n i n t h e same p r a c t i c e as Dr. C o r d o v e r . 4 2101205 A medical note indicated that restrictions f r o m Dr. C u s m a r i u d a t e d A p r i l Dr. Cusmariu i n place kept and added t h a t Freeman's 10, 2009, prior she s h o u l d be work sitting a b o u t 5 0 % o f h e r s h i f t w i t h no c l i m b i n g s t a i r s o r l a d d e r s . o r d e r e d a s e c o n d MRI o f h e r l e f t again indicated a labral A medical note hip, the r e s u l t s of which tear. f r o m Dr. C u s m a r i u d a t e d A p r i l i n d i c a t e d t h a t Freeman was c o n t i n u i n g 2 1 , 2009, to complain of pain i n her lower back and h i p t h a t r a d i a t e d i n t o h e r l e f t l e g . reviewing t h e MRI o f h e r l e f t examination, pain, Dr. C u s m a r i u left-hip sacroiliac disease, joint greater Freeman trochanteric mild left-hip with bursitis left-hip with lumbar d e g e n e r a t i v e labral tear. i n d i c a t e d t h a t he d i d n o t b e l i e v e t h a t a l a b r a l c a u s e o f Freeman's p a i n . After h i p and p e r f o r m i n g a p h y s i c a l diagnosed dysfunction, and a p o s s i b l e He left disk Dr. C u s m a r i u t e a r was t h e He o r d e r e d more p h y s i c a l t h e r a p y f o r Freeman a n d i n d i c a t e d t h a t , i f t h a t d i d n o t r e s o l v e h e r p a i n , he w o u l d r e f e r h e r b a c k t o Dr. C o r d o v e r f o r f u r t h e r management of her back pain. He kept t h e same place. 5 work restrictions in 2101205 A medical indicated her note from Dr. C u s m a r i u t h a t Freeman h a d o b t a i n e d pain dated significant symptoms f o l l o w i n g an i n j e c t i o n joint. He reduced h e r work June 16, note dated July restrictions t o no indicated distances that and that her j o b had that, along hip. He lifting waist, Dr. again more restricted than required with Michelle Turnley, indicated her to drive her having long to help a He i n d i c a t e d t h a t d i d not o r i g i n a t e w i t h her l e f t h e r t o l i g h t - d u t y work 50 p o u n d s , no and no s q u a t t i n g However, i n s i n c e he h a d l a s t s e e n h e r . h o s p i c e p a t i e n t , had exacerbated her p a i n . t h e p a i n she was e x p e r i e n c i n g from sustained 14, 2009, Dr. C u s m a r i u t h a t Freeman's p a i n had i n c r e a s e d He relief i n t o her s a c r o i l i a c s q u a t t i n g and no r e p e t i t i v e b e n d i n g a t t h e w a i s t . a medical 2009, with r e p e t i t i v e bending or kneeling, no at the a n d he r e f e r r e d h e r t o a p h y s i a t r i s t who practiced with Dr. C o r d o v e r and h i m . On a s e p a r a t e f o r m , Dr. C u s m a r i u i n d i c a t e d that l i m i t e d t o medium-duty Freeman was work rather than l i g h t - d u t y work. On A u g u s t 12, 2009, Dr. C u s m a r i u i n d i c a t e d i n a f o r m t h a t he filled out f o r what compensation insurance appears to be Maxim's workers' c a r r i e r t h a t h i s r e f e r r a l o f Freeman t o 6 2101205 a p h y s i a t r i s t was r e l a t e d t o t h e December 24, 2008, b e c a u s e Freeman h a d n o t e x p e r i e n c e d p a i n b e f o r e but had been experiencing pain since the accident the accident accident. He i n d i c a t e d t h a t t h e r e f e r r a l was n o t r e l a t e d t o a p r e e x i s t i n g degenerative condition and t h a t she c o u l d not r e t u r n to her p r e i n j u r y employment p o s i t i o n . A m e d i c a l n o t e f r o m Dr. T u r n l e y d a t e d S e p t e m b e r 2, 2009, i n d i c a t e d t h a t Freeman was c o n t i n u i n g that she had swelling i n her l e f t Freeman, had been p r e s e n t Dr. T u r n l e y pain, and experiencing point She to experience pain since l e g that, t h e December according 2008 and to accident. d i a g n o s e d Freeman w i t h p e r s i s t e n t l o w - b a c k and l e g she indicated sciatica. that she Dr. T u r n l e y thought Freeman administered was a trigger- i n j e c t i o n t o F r e e m a n and p r e s c r i b e d m e d i c a t i o n t o h e r . l i m i t e d Freeman bending at the waist In a medical t o medium-duty work w i t h and no s q u a t t i n g note dated October no r e p e t i t i v e or kneeling. 14, 2009, Dr. Turnley i n d i c a t e d t h a t Freeman h a d r i g h t - s i d e d s c i a t i c a and t h a t she did not think that lumbar surgery d e p o s i t i o n , w h i c h was a d m i t t e d a t t r i a l , was needed. Dr. T u r n l e y In her indicated t h a t some o f F r e e m a n ' s s c i a t i c a was p r e e x i s t i n g b u t t h a t she 7 2101205 was " s u r e " t h a t some o f t h e s c i a t i c a was r e l a t e d t o F r e e m a n ' s December 24, 2008, a c c i d e n t . was " e x t r e m e l y tender" Dr. T u r n l e y near the lower n o t e d t h a t Freeman region of her and near h e r s c i a t i c back, near her s a c r o i l i a c j o i n t , lumbar notch. She d i a g n o s e d Freeman w i t h s c i a t i c n e u r a l g i a and more t r i g g e r - p o i n t i n j e c t i o n s . trigger-point Turnley On she during December 14, evaluation 2009, Freeman ("FCE") as t e s t s were a d m i n i s t e r e d was performing with with Dr. ordered by Dr. Turnley. t o her t o determine whether effort; S e v e r a l t e s t s were those tests administered Freeman i n an a t t e m p t t o d e t e r m i n e how much she c o u l d and carry. to pain A l l of those Freeman t e s t s e x c e p t one were t e r m i n a t e d experienced. Those Freeman c o u l d : c a r r y 40 p o u n d s , l i f t to appointment underwent a f u n c t i o n a l - submaximal i n d i c a t e d t h a t she was n o t . to her received additional on November 4, 2009. capacity Several injections Freeman administered her waist, shoulder occasionally l i f t height, frequently l i f t shoulder height, o c c a s i o n a l l y l i f t shoulder indicated due that 20 pounds f r o m t h e f l o o r 60 pounds f r o m h e r w a i s t t o 40 pounds f r o m h e r w a i s t t o 40 pounds f r o m t h e f l o o r t o h e i g h t , and f r e q u e n t l y l i f t 8 tests lift 10 pounds f r o m t h e f l o o r 2101205 to shoulder Freeman was by height. A f t e r the administered the q u e s t i o n s p h y s i c a l p o r t i o n of the a questionnaire. contained i n the She became questionnaire FCE, offended and did not reviewing the complete i t . On December 23, r e s u l t s o f t h e FCE, 2009, Dr. assigned i m p a i r m e n t r a t i n g and restrictions. She Turnley, after F r e e m a n a 0% r e l e a s e d her s t a t e d i n her permanent-partial- t o r e t u r n t o work d e p o s i t i o n t h a t she without did not b e l i e v e t h a t Freeman had any r e s i d u a l d i s a b i l i t y o r i m p a i r m e n t as a r e s u l t o f h e r w o r k - r e l a t e d The deposition p h y s i c i a n , was of entered Dr. Bruce he Dr. P a v a t e s t i f i e d that 2004 f o r t r e a t m e n t r e l a t e d t o was not He complaining Dr. P a v a s t a t e d t h a t he saw occasions t h e r e a f t e r and accident, she Pava personal noted i n 2004 w i t h a h i s t o r y o f m i l d c h r o n i c b a c k a l s o n o t e d t h a t she pain at t h a t time. Dr. Freeman's r e c e i v e d i n an a u t o m o b i l e a c c i d e n t . t h a t she p r e s e n t e d p a i n , but Pava, i n t o evidence. he b e g a n s e e i n g Freeman i n A p r i l i n j u r i e s she had accident. d i d not that, before her complain of p a i n testified that he saw h e r on several December 24, i n her Freeman 2008, back. on January 2009, and t h a t she c o m p l a i n e d o f b a c k p a i n s i n c e t h e 9 of back 26, accident. 2101205 Dr. P a v a ' s t e s t i m o n y more t i m e s b e f o r e of pain i n her i n d i c a t e d t h a t he saw Freeman a t l e a s t t r i a l and lower t h a t she back to 10 c o n s i s t e n t l y complained him. At an appointment in S e p t e m b e r 2009, he n o t e d t h a t she had s w e l l i n g i n h e r l e f t l e g that had been p r e s e n t f o r the previous a p p o i n t m e n t i n O c t o b e r 2009, he l o w e r b a c k ; t h e MRI d i s k d i s e a s e , and In for May severe pain. At 2011, Dr. an MRI of At facet Dr. changing. Pava a d m i t t e d Freeman t o t h e hospital i n c o n t i n e n c e b r o u g h t on by the she was administered She was discharged hospital, 2010, completed restrictions to a at the form request i n which Freeman's a nerve a f t e r s i x days. o f Freeman's he ability listed to attorney, a work, number limited periodically pushing occasional kneeling, and climbing and alternating pulling ramps with and c r o u c h i n g ; no her stairs, sitting arms than 8-hour standing; legs; balancing, c r a w l i n g ; and 10 and and of including: 10 p o u n d s ; s t a n d i n g o r w a l k i n g l e s s t h a n 2 h o u r s i n an day; that block o c c a s i o n a l l i f t i n g o f 20 p o u n d s ; f r e q u e n t l i f t i n g o f l e s s work an Freeman's l o w - b a c k p a i n and J u l y 19, Pava ordered months. revealed mild spinal stenosis, generalized t h a t r e l i e v e d her p a i n . On nine limited only stooping, reaching 2101205 w i t h her arms. Dr. Pava o p i n e d t h a t Freeman was unable to t h e work o f a l i c e n s e d p r a c t i c a l n u r s e b e c a u s e o f t h e w i t h her back. Freeman and had He been p e r f o r m e d b a c k p a i n was Two had on not evaluation opinion prepared as to Gurley December 24, by Russ Freeman that Freeman's he work was had had a provided Dr. 2010, Michael Staff, submitted i n t o evidence. he had various with In reviewed work a first vocational Dr. Turnley's work without Dr. Pava's his second r a t i n g of 65% prepared rehabilitation that to on opinions report, Freeman 75%. August counselor, 4, was In that report, S t a f f indicated that Freeman's restrictions I n the Pava's o p i n i o n s , v o c a t i o n a l - d i s a b i l i t y report by licensed 0% v o c a t i o n a l - d i s a b i l i t y restrictions. i n d i c a t e d , b a s e d on that Freeman's a performed a to FCE on accident. Gurley, return w o u l d have a v o c a t i o n a l - d i s a b i l i t y A 2008, o p i n e d , b a s e d on could Freeman Later, Gurley that were s u b m i t t e d a t t r i a l . o f Freeman, and restrictions, r e s u l t s of the Pava o p i n e d i n d i c a t e d t h a t he that rating. Dr. r e l a t e d to her reports Gurley seen the her. p r o f e s s i o n a l counselor, report, problem i n d i c a t e d t h a t he d i d n o t p e r f o r m an FCE t h a t he do medical records, that been p l a c e d 11 had as well on as the Freeman. 2101205 Staff opined that Freeman's b a s e d on h e r l o w - b a c k vocational disability was 69% injury. Freeman t e s t i f i e d t h a t she l a s t w o r k e d f o r Maxim i n A p r i l 2009 and t h a t , from the time of the a c c i d e n t h e r employment work. she she left w i t h Maxim, she h a d been l i m i t e d t o l i g h t - d u t y She s t a t e d t h a t , s i n c e h e r employment had until worked at a rehabilitation p e r i o d ; she s t o p p e d w o r k i n g t h e r e w i t h Maxim ended, facility for a b e c a u s e she was perform the f u l l d u t i e s of that j o b . short unable to Freeman a l s o s t a t e d that she h a d w o r k e d f o r t h e U n i t e d S t a t e s C e n s u s B u r e a u f o r a s h o r t period during t h e 2010 census. She testified that she had a l s o w o r k e d as a h o m e - h e a l t h a i d e f o r a short p e r i o d but that she after could not perform that job her patients became bedridden. Freeman t e s t i f i e d t h a t s i n c e Dr. T u r n l e y h a d r e l e a s e d h e r f r o m h e r c a r e , Dr. Pava h a d c o n t i n u e d t o t r e a t h e r f o r p a i n i n her l o w e r b a c k , l e g , and h i p . She t e s t i f i e d that, since the December 24, 2008, a c c i d e n t , h e r p a i n h a d become p r o g r e s s i v e l y worse. for Freeman testified as f o l l o w s regarding a n o r m a l day her: by " I g e t up. H o p e f u l l y , I c a n g e t t o t h e b a t h r o o m m y s e l f ; sometimes I need a s s i s t a n c e . I can 12 2101205 prepare a l i g h t breakfast. I can l o a d t h e t o p p a r t o f t h e d i s h w a s h e r ; s o m e t i m e s my h u s b a n d has t o do that. You know, he does most o f t h e h e a v y s t u f f i n t h e house l i k e s w e e p i n g and m o p p i n g , p u t t i n g c l o t h e s i n and o u t o f t h e d r y e r , c h a n g i n g t h e b e d s . I do d u s t i n g , l i g h t m e a l s . He c l e a n s t h e b a t h t u b . " Freeman t e s t i f i e d t h a t she u s u a l l y has unload t o go the with groceries. sometimes d r i v e s but her to the She grocery stated that, c o n d i t i o n , she was past. in accident, job with On the to load her and physical o f t h e j o b s she testified that, had before her her Maxim. in 2, which 2011, the i t found trial court entered that Freeman a detailed suffered injuries r e s u l t i n g f r o m an a c c i d e n t a r i s i n g o u t o f and h e r employment, t h a t t h e i n j u r i e s she were t o h e r l e f t h i p and the caused chronic accident aggravated found disability the that Freeman benefits, and, was her pain a preexisting condition her l e f t l e g , and i n her i n her entitled because i n the course of s u s t a i n e d as a r e s u l t that accident court someone she had b e e n a b l e t o f u l l y p e r f o r m t h e d u t i e s o f August judgment She store given n o t a b l e t o p e r f o r m any performed that to lower or The temporary-total- injuries involved u n s c h e d u l e d member o f h e r b o d y , i t f o u n d t h a t she was an entitled to p e r m a n e n t - p a r t i a l - d i s a b i l i t y b e n e f i t s f o r a p e r i o d of 13 that back lower back. of 300 2101205 weeks, less the 12 weeks b e n e f i t s she had r e c e i v e d . of temporary-total-disability The t r i a l c o u r t f o u n d t h a t Freeman s u f f e r e d a v o c a t i o n a l d i s a b i l i t y o f 69%. The t r i a l c o u r t made an a w a r d t o Freeman i n a c c o r d a n c e w i t h t h o s e f i n d i n g s . Maxim appeals. S e c t i o n 2 5 - 5 - 8 1 ( e ) , A l a . Code 1975, p r o v i d e s t h e s t a n d a r d by w h i c h t h i s c o u r t r e v i e w s a p p e a l s i n c a s e s a r i s i n g u n d e r t h e Act. That section provides: " ( e ) R e v i e w . From an o r d e r o r j u d g m e n t , any a g g r i e v e d p a r t y may, w i t h i n 42 d a y s t h e r e a f t e r , a p p e a l t o t h e Court o f C i v i l Appeals and r e v i e w s h a l l be as i n c a s e s r e v i e w e d as f o l l o w s : "(1) I n r e v i e w i n g proof s e t forth herein issues, review by t h e A p p e a l s s h a l l be w i t h o u t correctness. the standard of and o t h e r l e g a l Court of C i v i l a presumption of "(2) I n r e v i e w i n g p u r e f i n d i n g s o f fact, the finding of the c i r c u i t court s h a l l n o t be r e v e r s e d i f t h a t f i n d i n g i s s u p p o r t e d by s u b s t a n t i a l e v i d e n c e . " Discussing this Inc. standard, t h i s c o u r t wrote i n Reeves Rubber, v. W a l l a c e , 912 So. 2d 274 ( A l a . C i v . App. 2 0 0 5 ) : "When t h i s c o u r t r e v i e w s a t r i a l c o u r t ' s f a c t u a l f i n d i n g s i n a w o r k e r s ' compensation case, those f i n d i n g s w i l l n o t be r e v e r s e d i f t h e y a r e s u p p o r t e d by s u b s t a n t i a l e v i d e n c e . § 2 5 - 5 - 8 1 ( e ) ( 2 ) , A l a . Code 1975. S u b s t a n t i a l evidence i s ' e v i d e n c e o f such weight and q u a l i t y t h a t f a i r - m i n d e d persons i n t h e 14 2101205 e x e r c i s e o f i m p a r t i a l judgment can r e a s o n a b l y i n f e r t h e e x i s t e n c e o f t h e f a c t s o u g h t t o be p r o v e d . ' West v. F o u n d e r s L i f e A s s u r a n c e Co. o f F l o r i d a , 54 7 So. 2d 870, 871 ( A l a . 1 9 8 9 ) . Further, this court r e v i e w s t h e f a c t s ' i n t h e l i g h t most f a v o r a b l e t o the f i n d i n g s of the t r i a l c o u r t . ' W h i t s e t t v. BAMSI, I n c . , 652 So. 2d 287, 290 ( A l a . C i v . App. 1 9 9 4 ) , o v e r r u l e d on o t h e r g r o u n d s , Ex p a r t e T r i n i t y I n d u s . , I n c . , 680 So. 2d 262 ( A l a . 1996) . This court has a l s o concluded: 'The [1992 W o r k e r s ' Compensation] A c t d i d not a l t e r the r u l e that t h i s c o u r t does n o t w e i g h t h e e v i d e n c e b e f o r e t h e t r i a l court.' Edwards v. J e s s e S t u t t s , I n c . , 655 So. 2d 1012, 1014 ( A l a . C i v . App. 1995) . However, o u r review as t o p u r e l y l e g a l i s s u e s i s w i t h o u t a presumption of correctness. See Holy Family C a t h o l i c S c h o o l v. B o l e y , 847 So. 2d 371, 374 ( A l a . Civ. App. 2002) ( c i t i n g § 2 5 - 5 - 8 1 ( e ) ( 1 ) , A l a . Code 1975)." 912 So. 2d a t 279. Maxim contends that Freeman failed December 2008 a c c i d e n t was t h e m e d i c a l she experienced Turnley opined i n her lower that there back. was t o prove that her c a u s e o f t h e symptoms I t points not a out that causal Dr. relationship b e t w e e n Freeman's December 2008 a c c i d e n t and h e r a s s e r t e d b a c k injury. I t argues qualifications treating and to physician's that Dr. disagree Pava with opinions, c o n c l u s i o n s on t h a t i s s u e . " "deferred" to the FCE, which 15 "admitted h i s lack [Freeman's] and d e f e r r e d of authorized to her opinions I t a l s o a r g u e s t h a t Dr. P a v a Maxim describes as having 2101205 demonstrated that Freeman could perform f u n c t i o n s as a l i c e n s e d p r a c t i c a l n u r s e In 678 Pair (Ala. v. Jack's Civ. App. Family 2000), a l l of job w i t h Maxim. Restaurants, this her court Inc., 765 described So. 2d medical c a u s a t i o n i n t h e f o l l o w i n g manner: " F o r an i n j u r y t o be c o m p e n s a b l e , i t must be ' c a u s e d by an a c c i d e n t a r i s i n g o u t o f and i n t h e c o u r s e o f ' t h e e m p l o y e e ' s employment. § 25-5-51, A l a . Code 1975. The p h r a s e ' a r i s i n g o u t o f ' an e m p l o y e e ' s employment r e q u i r e s a c a u s a l c o n n e c t i o n b e t w e e n t h e i n j u r y and t h e employment. D u n l o p T i r e & R u b b e r Co. v. P e t t u s , 623 So. 2d 313 ( A l a . C i v . App. 1993). The p h r a s e ' i n t h e c o u r s e o f ' t h e e m p l o y e e ' s employment r e f e r s t o t h e t i m e , p l a c e , and c i r c u m s t a n c e s under which the a c c i d e n t o c c u r r e d . Id. In a c c i d e n t a l cases, i . e . , those i n v o l v i n g a s u d d e n and t r a u m a t i c e v e n t , an e m p l o y e e must p r o d u c e substantial evidence tending t o show t h a t the a l l e g e d a c c i d e n t o c c u r r e d and must a l s o e s t a b l i s h medical c a u s a t i o n by showing t h a t the accident c a u s e d o r was a c o n t r i b u t i n g c a u s e o f t h e i n j u r y . Ex p a r t e T r i n i t y I n d u s . , I n c . , 680 So. 2d a t 266 n. 3. M e d i c a l c a u s a t i o n may be f o u n d by t h e t r i a l c o u r t w i t h o u t t e s t i m o n y from m e d i c a l d o c t o r s . Ex p a r t e P r i c e , 555 So. 2d 1060 ( A l a . 1989) . The t o t a l i t y o f t h e e v i d e n c e , i n c l u d i n g b o t h l a y and e x p e r t t e s t i m o n y , may s a t i s f y a s h o w i n g o f m e d i c a l causation. U.S. S t e e l , A D i v i s i o n o f USX C o r p . v. N e l s o n , 634 So. 2d 134 ( A l a . C i v . App. 1 9 9 3 ) . " 765 So. 681. Reviewing case, 2d a t the we indicating conclude totality of that there the evidence was i n the substantial present evidence t h a t Freeman's a c c i d e n t c a u s e d o r c o n t r i b u t e d t o 16 2101205 her back p a i n . in her back Her t e s t i m o n y was immediately upon t h a t she felt overextending a sharp p a i n herself as she a t t e m p t e d t o s e a t t h e p a t i e n t she was h o l d i n g i n a w h e e l c h a i r . She i m m e d i a t e l y s o u g h t t r e a t m e n t f o r t h e p a i n , and h e r m e d i c a l r e c o r d s i n d i c a t e t h a t she c o n s i s t e n t l y c o m p l a i n e d o f m o d e r a t e to severe lower-back pain after the a c c i d e n t . Although the m e d i c a l r e c o r d s i n d i c a t e t h a t Freeman had b e e n d i a g n o s e d w i t h chronic mild back pain before the accident, the evidence i n d i c a t e s t h a t Freeman d i d n o t c o m p l a i n o f l o w e r - b a c k p a i n a t a l l d u r i n g t h e f o u r y e a r s t h a t Dr. Pava t r e a t e d h e r b e f o r e t h e December 2008 a c c i d e n t and t h a t she was her job reflects at Maxim that substantially debilitating substantial before the the back more after the accident. pain severe fully The for accident. evidence thus experienced Freeman and, able to perform was the The first time, evidence change i n Freeman's s y m p t o m o l o g y and of a ability to work p r o v i d e s some s u p p o r t f o r a f i n d i n g o f m e d i c a l c a u s a t i o n in this case. C o m p e n s a t i o n § 7:24 In based addition, See Terry A. Moore, Alabama Workers' (1998). Dr. Pava testified that i n his opinion, on a r e a s o n a b l e d e g r e e o f m e d i c a l c e r t a i n t y , 17 Freeman's 2101205 b a c k p a i n was Dr. Pava [had] r e l a t e d t o t h e December 2008 a c c i d e n t . also testified that "to the extent that opinions are licensed p r e v i o u s l y b e e n o f f e r e d by p h y s i c i a n s who to p r a c t i c e medicine i n e i t h e r p h y s i c a l medicine, or o r t h o p e d i c surgery," neurosurgery he w o u l d d e f e r t o t h o s e never presented own r e g a r d i n g m e d i c a l c a u s a t i o n and a s k e d w h e t h e r he his own regarding Pava's t e s t i m o n y a specific medical opinion opinions, was opinion with Although contrary to causation. of g e n e r a l deference his rescinded At most, Dr. to doctors i n p a r t i c u l a r s p e c i a l t i e s goes m e r e l y t o t h e w e i g h t o f h i s t e s t i m o n y , its admissibility. he A d d i t i o n a l l y , although t h a t he d i d n o t have a b a s i s t o d i s a g r e e any FCE t h a t may not s p e c i f i c a l l y asked about the Dr. Pava w i t h the not to testified results have b e e n p e r f o r m e d on Freeman, Dr. of was that r e s u l t s o f t h e FCE Pava was p e r f o r m e d on Freeman, and he l a t e r t e s t i f i e d t h a t he s t o o d the restrictions ability he had placed on s u b s t a n t i a l evidence of medical Ex regarding t o p e r f o r m work t a s k s s u c h as b e n d i n g and Maxim c i t e s t h r e e c a s e s i n s u p p o r t case: Freeman parte ( A l a . C i v . App. that i s lacking in this S o u t h e r n E n e r g y Homes, I n c . , 873 So. 2d 2 0 0 3 ) ; J a c k s o n L a n d s c a p i n g , I n c . v. Hooks, 18 her lifting. of i t s c o n t e n t i o n causation by 1116 844 2101205 So. 2d 1267 ( A l a . C i v . App. 897 So. 332 those 2d 2 0 0 2 ) ; and V a l t e x , I n c . v. Brown, ( A l a . C i v . App. c a s e s do not support 2004). Maxim's As discussed contention. I n Ex p a r t e S o u t h e r n E n e r g y Homes, I n c . , 873 (Ala. Civ. worker's App. own 2003), testimony substantial evidence our supreme d i d not, r e l a t e d t o an a c c i d e n t a t work. however, the supreme evidence before court court standing indicating below, that So. 2d concluded alone, her back 1116 that constitute injury was In reaching t h a t c o n c l u s i o n , relied on i t t h a t are not p r e s e n t two aspects of i n the present the case. F i r s t , t h e supreme c o u r t n o t e d t h a t " [ n ] o n e o f t h e d o c t o r s treated [ t h e w o r k e r ] s t a t e d w i t h any d e g r e e o f c e r t a i n t y [ t h e w o r k e r ] ' s b a c k c o n d i t i o n was injury." 873 previously Second, the at 1122. discussed, Dr. Pava supreme court worker's doctor So. 2d a noted due who that to the a l l e g e d workplace In the present testified that to the f o r t h e n i n e months he had such case, a records as link. of t r e a t e d her the after the a l l e g e d a c c i d e n t d i d not mention the a c c i d e n t or t h a t the w o r k e r had Id. In the complained of back p a i n d u r i n g present i n d i c a t e t h a t she case, however, immediately Freeman's that period. medical records complained of p a i n i n her 19 back 2101205 after her document December that her throughout the In (Ala. did 2008 accident, complaints course of her not begin 2002), the her back medical pain were records consistent treatment. Jackson Landscaping, C i v . App. of and Inc. v. Hooks, 844 So. 2d i n j u r e d worker t e s t i f i e d to experience p a i n i n h i s back u n t i l 1267 that 16 he months a f t e r t h e a c c i d e n t t h a t he a l l e g e d had c a u s e d h i s b a c k i n j u r y . 844 So. 2d at 1270. Furthermore, one of the doctors who t r e a t e d the worker t e s t i f i e d t h a t the worker's back i n j u r y not who r e l a t e d t o h i s o n - t h e - j o b a c c i d e n t , and treated the "probability" worker that there r e l a t i o n s h i p between the So. pain 2d a t 1271. i n her accident, she treated the that have and case, after consistently there been" the a doctor was 844 Freeman c o m p l a i n e d the December complained of 24, back case, Dr. o p i n i o n , Freeman's b a c k p a i n was 20 of of 2008, In a d d i t i o n , u n l i k e the d o c t o r s one a causal back i n j u r y . worker i n Jackson Landscaping, p h y s i c i a n s i n the present his accident immediately throughout her treatment. only "could In the p r e s e n t back and testified the other was pain who Freeman's Pava, t e s t i f i e d that, in r e l a t e d to her accident. 2101205 In V a l t e x , 2004), t h i s I n c . v. Brown, 897 court w o r k e r b a s e d on arm reversed her So. 2d 332 (Ala. Civ. a judgment a w a r d i n g b e n e f i t s t o a complaints of head, s h o u l d e r , neck, aches because of a l a c k of e v i d e n c e of m e d i c a l In t h a t case, because there the worker e x p e r i e n c e d have s e r v e d was as t h e required medical to causation. was no evidence a sudden o r t r a u m a t i c cause of her produce 897 App. So. causation. indicating and 2d convincing a t 334. that event that alleged injuries, clear and could the worker evidence A l t h o u g h the of record c o n t a i n e d t h e r e s u l t s o f some d i a g n o s t i c t e s t i n g t h a t revealed mild worker's degenerative neck, the was her until only evidence testimony working changes that f o r the and a relating she bone her d i d not employer. spur pain begin 897 in to her So. 2d testified t h a t he with certainty what t h e degree of symptoms w e r e . the worker's medical 897 traumatic So. testimony causation. Unlike medical 897 in Valtex, 2d a t 334. alone So. employment to experience worker's t r e a t i n g p h y s i c i a n any the at 337. could The not say of her cause This court concluded was not 2d a t to that 337. the p r e s e n t sufficient pain c a s e i n v o l v e s a sudden e v e n t , i . e . , Freeman's December 2008 a c c i d e n t . 21 prove or Not 2101205 o n l y does Freeman's t e s t i m o n y r e g a r d i n g and a f t e r t h e December evidence of a causal 2008 accident her c o n d i t i o n before constitute substantial c o n n e c t i o n between t h e a c c i d e n t and h e r back p a i n , see Moore, A l a b a m a W o r k e r s ' C o m p e n s a t i o n § supra, Pava's d e p o s i t i o n Dr. f i n d i n g of medical causation. inapposite to the present testimony 7:24, l i k e w i s e supports Thus, t h e h o l d i n g i n V a l t e x i s case. I n a s i n g l e p a r a g r a p h a t t h e end o f i t s b r i e f , Maxim contends that insufficient evidence supported the also trial c o u r t ' s f i n d i n g o f a 69% v o c a t i o n a l d i s a b i l i t y by Freeman. note that citation Maxim to has any failed legal I n v . Co., appellant fails particular that 722 issue, support this also Court may for i t i s neither f i n d Maxim's with violates Rule ( A l a . 1998) ("When an f o r her i n j u r i e s this Court's legal duty nor i t s research."). Dr. h a d t r e a t e d Freeman f o r o v e r arising 22 on a a f f i r m t h e j u d g m e n t as t o argument t o be u n p e r s u a s i v e . P a v a , who, by t h e t i m e o f t r i a l , two y e a r s which argument any a u t h o r i t y f o r an argument f u n c t i o n t o p e r f o r m an a p p e l l a n t ' s We that We See C i t y o f B i r m i n g h a m v. B u s i n e s s So. 2d 747, 752 to cite issue, to authority, 28(a) ( 1 0 ) , A l a . R. C i v . P. Realty a o u t o f t h e December 2008 2101205 accident, assigned particular work limitations activities. to her a b i l i t y Those limitations l e a s t i n p a r t , t h e b a s i s o f t h e two o p i n i o n s counselors, loss o f 69% a n d t h e o t h e r o f whom opined of the vocational had been p e r f o r m e d n o t e d , he was n o t c o n f r o n t e d that she had a Maxim p o i n t s o u t t h a t Dr. P a v a t e s t i f i e d t h a t he h a d no b a s i s t o d i s p u t e that formed, a t one o f whom o p i n e d t h a t Freeman h a d a v o c a t i o n a l v o c a t i o n a l l o s s o f 65% t o 75%. FCE t o engage i n t h e f i n d i n g s o f any on Freeman, b u t , as p r e v i o u s l y w i t h t h e f i n d i n g s o f t h e FCE a n d he t e s t i f i e d s p e c i f i c a l l y t h a t he s t o o d b y t h e r e s t r i c t i o n s he had assigned any legal authority f o r theproposition, that the t r i a l was Freeman. required to Maxim h a s n o t a r g u e d , n o r h a s i t c i t e d reject Dr. Pava's testimony court regarding Freeman's work l i m i t a t i o n s b e c a u s e o f what i t r e f e r s t o as h i s " d e f e r e n c e " t o t h e FCE t h a t was p e r f o r m e d on Freeman. B a s e d on t h e f o r e g o i n g , we c o n c l u d e t h a t Maxim h a s f a i l e d t o d e m o n s t r a t e a b a s i s on w h i c h t o r e v e r s e judgment. As a r e s u l t , the t r i a l t h e judgment i s a f f i r m e d . AFFIRMED. Pittman, B r y a n , Thomas, a n d Moore, J J . , c o n c u r . 23 court's

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