SouthernCare, Inc. v. Margaret Cowart

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REL: 09/06/2013 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 SPECIAL TERM, 2013 2120387 SouthernCare, Inc. v. Margaret Cowart Appeal from Calhoun C i r c u i t (CV-07-319) Court THOMAS, J u d g e . This this (Ala. i s the third court. time that this case has been before See S o u t h e r n C a r e , I n c . v . C o w a r t , 48 So. 3 d 632 C i v . App. 2 0 0 9 ) ; Ex p a r t e SouthernCare, Inc. (No. 2071026, A u g u s t 19, 2 0 0 8 ) , 30 So. 3d 474 ( A l a . C i v . App 2008) 2120387 (table) (denying a p e t i t i o n f o r the w r i t o f mandamus). In C o w a r t , we d e t e r m i n e d t h a t t h e t r i a l c o u r t ' s June 2008 i n t e r i m judgment, which determined that Margaret Cowart's back c o n d i t i o n a r o s e o u t o f and i n t h e c o u r s e o f h e r employment and o r d e r e d S o u t h e r n C a r e , I n c . ( " S C I " ) , t o be r e s p o n s i b l e f o r t h e c a r e and t r e a t m e n t o f t h a t c o n d i t i o n , was n o t a f i n a l j u d g m e n t and was t h e r e f o r e not a p p e a l a b l e . SCI s o u g h t c e r t i o r a r i Cowart, 48 So. 3d a t 633. r e v i e w of our d i s m i s s a l of i t s a p p e a l , w h i c h r e v i e w o u r supreme c o u r t g r a n t e d ; h o w e v e r , o u r supreme court ultimately quashed the w r i t of c e r t i o r a r i 2010. Ex p a r t e S o u t h e r n C a r e , I n c . , 48 So. 3d 635 on May ( A l a . 2010). The t r i a l c o u r t h e l d a s e c o n d t r i a l t o d e t e r m i n e disability on A u g u s t 12, 2012, and 14, Cowart's i t e n t e r e d a judgment on S e p t e m b e r 6, 2012, d e t e r m i n i n g t h a t C o w a r t was p e r m a n e n t l y and totally disabled. A f t e r i t s p o s t j u d g m e n t m o t i o n was d e n i e d by o p e r a t i o n o f l a w , SCI a p p e a l e d t h e S e p t e m b e r 6, 2012, j u d g m e n t to this The the court. f o l l o w i n g f a c t s were p r e s e n t e d t o t h e t r i a l November 2007 c o m p e n s a b i l i t y t r i a l . by SCI as a h o s p i c e n u r s e i n 1999. slipped and fell while on h e r way 2 Cowart was court at employed I n F e b r u a r y 2004, Cowart to recover patient files 2120387 f r o m a c o w o r k e r ; C o w a r t l a n d e d on h e r r i g h t h i p a n d i n j u r e d her back. C o w a r t was n o t a b l e t o work f o r f o u r o r f i v e months as a r e s u l t o f h e r i n j u r i e s ; SCI p a i d w o r k e r s ' c o m p e n s a t i o n benefits t o Cowart returned t o work p e r f o r m i n g h e r f u l l In A p r i l as a r e s u l t o f h e r i n j u r i e s . 2005, Cowart again back w h i l e a s s i s t i n g a p a t i e n t . helping the patient turn to stretch suffered an i n j u r y t o h e r C o w a r t e x p l a i n e d t h a t she was onto and e v e r y t h i n g r e a l l y b a d . " C o w a r t was a g a i n her side and tending a n d i t was h u r t i n g really, o u t o f work f o r a s h o r t f i r s t r e s u m i n g work on l i g h t - d u t y s t a t u s , C o w a r t l a t e r full the up " i t was l i k e y o u and SCI p a i d w o r k e r s ' c o m p e n s a t i o n b e n e f i t s t o C o w a r t . her later duties. p a t i e n t ' s wound a n d t h a t when she s t o o d have She time, After resumed duties. Cowart also injured her back November 2005, when she t w i s t e d s t e p a t t h e p a t i e n t ' s home. at a patient's home i n h e r b a c k when she m i s s e d a The r e c o r d does n o t i n d i c a t e t h a t C o w a r t m i s s e d a n y work as a r e s u l t o f t h a t t e s t i f i e d that the pain she h a d s u f f e r e d a f t e r t h e 2004 f a l l and t h e A p r i l 2005 i n j u r y o c c u r r e d b a c k a n d was t h e same t y p e o f p a i n . 3 i n j u r y , b u t she i n t h e same a r e a of her 2120387 In January 2007, p e r f o r m i n g wound c a r e t h a t she had had Cowart on again injured a patient. herself while A l t h o u g h Cowart r e l a t e d a s s i s t a n c e f r o m t h r e e p e o p l e t o r o l l and hold t h e p a t i e n t so t h a t C o w a r t c o u l d r e a c h t h e b a c k wound, C o w a r t s t a t e d she and had dress the something, I to stand and wound and said b e n d i n an t h a t when she snapped. It i t was patient. The awful." Cowart c o n t i n u e d However, she said, she supervisor. She said that like reach " i t was up to like electricity l e f t l e g and h e r w o r k and was next morning, Cowart t e s t i f i e d , to her stood was s o m e t h i n g , p a i n j u s t went t h r o u g h my and awkward way i n t o my saw her in excruciating she she reported was out the or hip next pain. incident o f work f o r a few months as a r e s u l t o f t h a t i n c i d e n t and t h a t she received workers' was working. Cowart compensation said that, benefits although J a n u a r y 2007 i n j u r y when SCI not w o r k - r e l a t e d , she was r e p o r t e d t h a t she had had b e c a u s e she could not "do r e s t i n the e v e n i n g s and she while she resumed not working after injury determined t h a t her working i n constant her was pain. She also t o r e l y on h e r s i s t e r s t o a s s i s t h e r anything" and that she had on weekends t o r e c u p e r a t e ; 4 had she to also 2120387 commented t h a t she h a d gone a month w i t h o u t grocery shopping because of her p a i n . On t h e m o r n i n g o f June 12, 2007, C o w a r t was g e t t i n g r e a d y for work. Cowart When she l i f t e d h e r l e f t testified, she felt J a n u a r y 2007, o n l y t h i s t i m e , excruciating. the l e g t o p u t on h e r same p a i n she had pants, felt in she s a i d , t h e p a i n was e v e n more When C o w a r t t e l e p h o n e d h e r s u p e r v i s o r t o r e p o r t t h a t she c o u l d n o t come i n t o work, C o w a r t s a i d , h e r s u p e r v i s o r i n f o r m e d h e r t h a t h e r i n j u r y , h a v i n g o c c u r r e d a t home, was n o t work-related. In a d d i t i o n t o Cowart's testimony, voluminous medical James W h i t e an MRI described as myleogram The medical i n 2004 and records i n June "unremarkable." i n May contains r e c o r d s and t h e d e p o s i t i o n t e s t i m o n y III. received the record 2006; the r e p o r t reflect that 2005; those Cowart also of Dr. Cowart MRIs were underwent from t h a t t e s t s t a t e d a that C o w a r t h a d a " p o s t e r i o r d i s k b u l g e a t L 2 - 3 , L 3 - 4 , and L 4 - 5 , w h i c h does n o t p r o d u c e r o o t s l e e v e c u t o f f o r s p i n a l s t e n o s i s " and " m i l d s p o n d y l o s i s a t C2-3 and C3-4, w h i c h does n o t p r o d u c e s p i n a l s t e n o s i s and no r o o t s l e e v e demonstrated." impingement o r entrapment A F e b r u a r y 2007 MRI w i t h o u t 5 contrast revealed 2120387 "moderate c e n t r a l s p i n a l c a n a l and b i l a t e r a l of L2 t o L4 secondary to disc bulging recess and stenosis osteoprolific disease" but "[n]o evidence of h e r n i a t i o n or acute i n t r a s p i n a l pathology." A l t h o u g h Cowart sought and r e c e i v e d a c o u r t order r e q u i r i n g S C I t o p a y f o r a m y l e o g r a m a n d a p o s t - m y l e o g r a m CT s c a n , t h o s e t e s t s w e r e , as f a r as t h e r e c o r d r e v e a l s , never conducted. Cowart's medical history s u f f e r e d a back s t r a i n employer. She reflects i n 1993 w h i l e had a l s o fallen that working when Cowart for a she was a had previous teenager. H o w e v e r , d e s p i t e b o t h a c c i d e n t s , C o w a r t was a b l e t o work f o r several years records also f o r SCI without reflect that incident. she f e l l Cowart's medical i n her bathtub i n July 2 0 0 4 ; C o w a r t t e s t i f i e d t h a t she d i d n o t r e c a l l t h a t i n c i d e n t , and the medical that Cowart records regarding complained of back that pain fall as do n o t i n d i c a t e a result of the incident. The medical records also indicate that Cowart was d i a g n o s e d w i t h f i b r o m y a l g i a b y D r . Gene W a t t e r s o n a t l e a s t as early as 2 0 0 2 . fibromyalgia Some o f t h e m e d i c a l diagnosis and records treatment 6 r e l a t e d to her reveal that Cowart 2120387 c o m p l a i n e d o f a c h i n g , s t a b b i n g , and b u r n i n g back. However, D r . reported notes Watterson's changes i n August 2002 m i l d Dr. endplates seen anteriorly Watterson's notes, "significantly significantly he an from the anterior L4 and refers symptomatic" to and Watterson's disk- "osteophytic vertebral body L5." Throughout Dr. Cowart's fibromyalgia as notes that i t had "not improved." C o w a r t saw February arising Cowart degenerative symptoms were a p p a r e n t a t T11-12 and t h a t are lower indicate that lower-back pain without r a d i a t i o n . indicate that disease notes p a i n i n her 2004 Dr. Steven Roberts fall. His notes i n March 2004, a f t e r indicate that Cowart p r e v i o u s l y been d i a g n o s e d w i t h f i b r o m y a l g i a , o s t e o p o r o s i s , osteoarthritis. B a s e d on his reviews of X-rays of her had and Cowart's l u m b a r s p i n e , Dr. R o b e r t s n o t e d t h a t C o w a r t s u f f e r e d f r o m some s l i g h t l u m b a r s c o l i o s i s and in the upper impression the] was lumbar lumbar "some" d e g e n e r a t i v e d i s k region of t h a t C o w a r t had disk R o b e r t s o r d e r e d an area MRI; back. Dr. Robert's "degenerative disk disease [ i n without that her disease significant 2004 MRI 7 report collapse." indicated Dr. that 2120387 Cowart has "minor b u l g e s s t e n o s i s or nerve Dr. Perry continued his a t 2 - 3 , 3-4, a n d 4-5 without any impingement." S a v a g e , who treated Cowart i n May 2004 f o r symptoms a f t e r h e r F e b r u a r y 2004 f a l l , i n d i c a t e s i n n o t e s t h a t C o w a r t ' s 2004 MRI shows no s t e n o s i s , "no HNP," " m i l d b u l g i n g , " a n d d e g e n e r a t i o n a t L3-4 and L 4 - 5 . Dr. Thomas S t a n e r , who a l s o t r e a t e d C o w a r t a f t e r t h e F e b r u a r y 2004 indicates that Cowart's "unremarkable f o r age." continued "MRI scan films" are He o p i n e d t h a t C o w a r t was s u f f e r i n g from "mechanical low back Dr. M i c h a e l 2004 fall, K. M o r r i s pain." t r e a t e d C o w a r t i n O c t o b e r 2004 f o r p a i n i n her lower back. and X - r a y s a r e " u n r e m a r k a b l e . " He n o t e s t h a t C o w a r t ' s MRI Dr. M o r r i s ' s notes s t a t e that "a l o t o f [ C o w a r t ' s ] p a i n c a n be a t t r i b u t e d t o h e r h i s t o r y o f fibromyalgia." diagnosis i s not He further noted that, "[o]bviously, this o f h e r F e b r u a r y 2004 f a l l , e a c h time work-related." With the exception t h a t Cowart i n j u r e d h e r s e l f a t w o r k , S C I d i r e c t e d h e r t o seek medical treatment at Occupational records f r o m OHC Cowart w i t h reveal that a lumbar s t r a i n H e a l t h C e n t e r ("OHC"). Dr. N a t h a l l a in April 8 Elmore The diagnosed 2 0 0 5 , i n November 2005, 2120387 and i n J a n u a r y 2007. Cowart a l s o went t o OHC a g a i n , she was d i a g n o s e d w i t h a l u m b a r s t r a i n . records indicate considered that the t o be a f o l l o w - u p June 21, 2007, i n June 2007; The June 2007 appointment was v i s i t r e l a t e d t o Cowart's January 2007 i n j u r y . A f t e r h e r J a n u a r y 2007 i n j u r y , C o w a r t was r e f e r r e d t o Dr. Morris once Seymour f o r e v a l u a t i o n . on A p r i l 2 0 , 2007. F e b r u a r y 2007 MRI Dr. Seymour saw Cowart testified that Cowart only she t o o k h e r f i l m t o Dr. Seymour's o f f i c e w i t h h e r . Dr. Seymour's o f f i c e n o t e i n d i c a t e s , h o w e v e r , t h a t he r e v i e w e d an April 1 5 , 2 0 0 7 , MRI from B i o I m a g i n g of H u n t s v i l l e , which the p a r t i e s a g r e e was n o t an MRI o f C o w a r t ' s s p i n e . F u r t h e r , Dr. Seymour comments t h a t , upon r e v i e w o f t h e M R I , " I c a n n o t see any true amount of stenosis a t any level." Based on h i s e x a m i n a t i o n and h i s r e v i e w o f an M R I , Dr. Seymour s t a t e d that C o w a r t ' s MRI was b a s i c a l l y u n r e m a r k a b l e , t h a t C o w a r t d i d have some symptoms s u g g e s t i v e o f an L5 n e r v e - r o o t i r r i t a t i o n that a myleogram m i g h t be u s e f u l that he see attribute "cannot to her any for further diagnosis, i n j u r y that I would w o r k [ e r s ' ] compensation delineate event." In and and and Dr. Seymour's o p i n i o n , C o w a r t h a d s i m p l y a g g r a v a t e d h e r a r t h r i t i c 9 2120387 back and that aggravation should have resolved with conservative treatment. Dr. Seymour a l s o o p i n e d t h a t C o w a r t ' s s t e n o s i s , w h i c h he i n d i c a t e d was had n o t p r e s e n t , was not r e l a t e d to her on-the-job i n j u r i e s . A f t e r h e r June 2007 i n j u r y , C o w a r t s o u g h t t r e a t m e n t f r o m Dr. James W h i t e . Dr. W h i t e f i r s t In h i s deposition saw C o w a r t on J u l y 1 1 , 2007. t e s t i m o n y , Dr. W h i t e s a i d t h a t C o w a r t had e x p l a i n e d t h a t she h a d f i r s t i n j u r e d h e r b a c k i n F e b r u a r y 2004 and that putting pain h e r most recent injury on h e r p a n t s a t home. she was Dr. brought According experiencing White a had He occurred she was s a i d Cowart d e s c r i b e d the as " u n r e l e n t i n g . " r e c a l l e d at h i s deposition February when 2007 MRI film t o Dr. W h i t e ' s d e p o s i t i o n to that her Cowart had appointment. t e s t i m o n y , t h e 2007 MRI r e v e a l e d t h a t Cowart had m i l d t o moderate s t e n o t i c changes a t L2 t o L4. Dr. W h i t e a l s o r e v i e w e d C o w a r t ' s 2006 w h i c h , he s a i d , d i d n o t show any explained that Cowart's significant central-canal stenosis. stenosis t a k e n months t o y e a r s t o d e v e l o p and t h a t myleogram, He would have i t would not have d e v e l o p e d f r o m t h e June 2007 o r e v e n t h e J a n u a r y 2007 i n j u r y . Dr. W h i t e a d m i t t e d , h o w e v e r , t h a t he c o u l d 10 not t e l l whether 2120387 t h e p r o c e s s o f C o w a r t ' s s t e n o s i s began i n 1993 did note, however, that Cowart's s i g n i f i c a n t l y between the level of o r i n 2004. stenosis 2006 m y l e o g r a m and the changed 2007 MRI. Dr. W h i t e recommended t h a t C o w a r t u n d e r g o a m y l e o g r a m a p o s t - m y l e o g r a m CT what was that, causing without treatment severe plan enough scan her to that pain. further or so He cause her could testified testing, determine he he better in his could not deposition whether Cowart's stenosis symptoms. In Dr. e x p l a i n e d : " I d o n ' t know e i t h e r i f i t ' s j u s t s t e n o s i s her a symptoms. herniated unless thing." we She disk test may beneath the i t further. stenosis. It may MRI because there's You have t o do " c a n ' t a l w a y s see l e s s room t h e r e . more t e s t i n g t o I a may just White causing a l s o have can't totally White d e s c r i b e d d e v e l o p as one C o w a r t as walks because of [a separate t o r n d i s k ] on I t ' s not as see was an distinct. see." c l a u d i c a t i o n , " w h i c h , he e x p l a i n e d , canal. be she a was Dr. W h i t e s t a t e d t h a t he b e l i e v e d f u r t h e r t e s t i n g w a r r a n t e d b e c a u s e one Dr. have a s t e n o s i s b u t and determine formulate fact, He the having " e a r l y neurogenic causes p a i n i n the l e g s n a r r o w i n g of the to spinal He a l s o t e s t i f i e d t h a t a p e r s o n w i t h s t e n o s i s w o u l d be 11 2120387 more susceptible to adverse b e c a u s e , he e x p l a i n e d , space symptoms from a disk injury t h e s t e n o s i s w o u l d r e d u c e t h e amount o f a r o u n d t h e n e r v e and, as a r e s u l t , even a small disk i n j u r y c o u l d c a u s e symptoms b e c a u s e t h e n e r v e w o u l d have l e s s room t o accommodate White explained incident at testing. He pain that, work could for a bulging had in further explained be February caused 2004 opinion, contributed by complained of back p a i n the his that, the cause however, that of her a the indicating current back fibromyalgia On June 21, 2007, compensation b e n e f i t s . sought an order 2007 need for further a l t h o u g h Cowart's Cowart to him back had that symptoms. diagnosis was He a not before Cowart's t h e F e b r u a r y 2004 f a l l , e x c l u s i o n and t h a t he c o u l d n o t e x c l u d e o t h e r he h a d c o n d u c t e d f u r t h e r Dr. r a d i a t i o n i n t o her legs f i b r o m y a l g i a , which e x i s t e d before not to disk. January the fibromyalgia, with fall, or h e r n i a t e d was d i d admit, diagnosis of diagnoses u n t i l testing. Cowart sued SCI, seeking On A u g u s t 7, 2007, C o w a r t compelling SCI to pay for workers' specifically the testing recommended by Dr. W h i t e . SCI responded t o Cowart's r e q u e s t by a s s e r t i n g t h a t C o w a r t ' s c o n d i t i o n was 12 not compensable and 2120387 by arguing t h a t the responsible holding for an Markets, Cowart's testified court a to So. trial the on 2d 654 13, parte 2007, i t to without ( A l a . C i v . App. i n f o r m a t i o n and were i n t r o d u c e d , t h e t r i a l compel treatment u n d e r Ex November above c o u l d not medical evidentiary hearing I n c . , 963 After trial first P u b l i x Super 2007). at her be which Cowart medical c o u r t e n t e r e d an i n t e r i m records judgment c o n c l u d i n g t h a t C o w a r t ' s J u n e 2007 i n j u r y was related to her January injuries. The trial 2007 and February 2004 w o r k - r e l a t e d court f u r t h e r determined reasonable and necessary t h a t the t e s t i n g requested and ordered SCI to coordinate Dr. W h i t e r e g a r d i n g C o w a r t ' s c a r e and t r e a t m e n t . a b o v e , SCI a t t e m p t e d was with As e x p l a i n e d t o a p p e a l t h e J u n e 2008 o r d e r . However, t h i s c o u r t d i s m i s s e d S C I ' s a p p e a l b e c a u s e t h e J u n e 2008 o r d e r , having determined t h a t she was Cowart e n t i t l e d to medical workers' judgment. t h a t C o w a r t ' s i n j u r y was compensation work-related care but not having benefits, was not awarded a final A f t e r SCI's p e t i t i o n f o r the w r i t of c e r t i o r a r i quashed, the case proceeded i n the t r i a l court. and was 1 C o w a r t f i l e d a s e p a r a t e a c t i o n i n 2009, i n w h i c h she c l a i m e d t h a t she had b e e n d i s c h a r g e d f r o m h e r employment s o l e l y b e c a u s e she had s o u g h t w o r k e r s ' c o m p e n s a t i o n b e n e f i t s 1 13 2120387 The t r i a l which court the only expert. witness Anderson 2 professional interview Cowart, a second t r i a l was E r i c According on J u n e Anderson SCI's that he was specializing in he In a d d i t i o n administered a c h i e v e m e n t t e s t s t o C o w a r t ; she s c o r e d Anderson considered testified that, as p a r t Cowart's d e p o s i t i o n from Dr. M o r r i s , vocational a licensed vocational t o A n d e r s o n , he met w i t h C o w a r t f o r 4, 2008. said, i n A u g u s t 2012, a t Anderson, testified counselor rehabilitation. an held to interviewing i n t e l l i g e n c e and i n the average range. of h i s assessment, t e s t i m o n y and m e d i c a l Dr. Watterson, D r . Savage, he h a d records and Dr. W h i t e , i n v i o l a t i o n o f A l a . Code 1975, § 2 5 - 5 - 1 1 . 1 . She a l s o amended her o r i g i n a l complaint i n t h i s a c t i o n t o a s s e r t a c l a i m of r e t a l i a t o r y discharge. The s e p a r a t e a c t i o n was c o n s o l i d a t e d w i t h t h i s a c t i o n , b u t t h e r e t a l i a t o r y - d i s c h a r g e c l a i m was l a t e r s e v e r e d a n d was u l t i m a t e l y s e t t l e d b y t h e p a r t i e s . Cowart admitted several exhibits into evidence, i n c l u d i n g , o v e r S C I ' s o b j e c t i o n , an e x h i b i t r e f l e c t i n g h e r Social Security d i s a b i l i t y determination. The t r i a l c o u r t , however, s t a t e d i n i t s judgment t h a t i t d i d n o t c o n s i d e r t h e d i s a b i l i t y determination i n i t s d e c i s i o n on t h e e x t e n t o f Cowart's d i s a b i l i t y . T h u s , i n s o f a r as SCI a r g u e s on a p p e a l t h a t t h e t r i a l c o u r t e r r e d i n a d m i t t i n g t h a t e x h i b i t , we c o n c l u d e t h a t any e r r o r t h e t r i a l c o u r t may have c o m m i t t e d was harmless e r r o r because i t d i d n o t cause s u b s t a n t i a l i n j u r y t o t h e r i g h t s o f S C I . See R u l e 45, A l a . R. App. P. We f u r t h e r n o t e t h a t we have n o t c o n s i d e r e d t h a t e v i d e n c e i n e v a l u a t i n g SCI's appeal o f t h e t r i a l c o u r t ' s d e t e r m i n a t i o n t h a t Cowart was p e r m a n e n t l y a n d t o t a l l y d i s a b l e d . 2 14 2120387 among o t h e r s ; A n d e r s o n s t a t e d t h a t he h a d a l s o c o n s i d e r e d D r . White's d e p o s i t i o n . A n d e r s o n n o t e d t h a t Cowart had n o t been assigned work permanent disability restrictions or r a t i n g b y any o f h e r p h y s i c i a n s been r e l e a s e d t o f u l l - d u t y work. any physical- and t h a t B a s e d on t h i s she h a d information, A n d e r s o n o p i n e d t h a t C o w a r t ' s v o c a t i o n a l - d i s a b i l i t y r a t i n g was zero percent; Cowart could that i s , Anderson explained, return to her usual and as a Anderson a l s o noted C o w a r t h a d many y e a r s o f e x p e r i e n c e as a h o s p i c e nurse transferable skills and customary that work r e g i s t e r e d nurse earning that he c o n c l u d e d t h e same wage. that could l e a d t o employment as an o f f i c e n u r s e , w h i c h he s a i d was c l a s s i f i e d as l i g h t work, o r as case manager administrative or in utilization p o s i t i o n s , which review he s a i d were or similar classified as sedentary p o s i t i o n s . Anderson stated that he d i d n o t f o r m u l a t e h i s opinions b a s e d on m e d i c a l r e c o r d s ; he e x p l a i n e d t h a t he d e f e r r e d t o t h e t r e a t i n g physicians t o i n t e r p r e t medical data. t h a t he d i d n o t c o n s i d e r a subject's performing a vocational evaluation. He a l s o s t a t e d c o m p l a i n t s o f p a i n when He e x p l a i n e d t h a t he was n o t q u a l i f i e d t o e v a l u a t e p a i n c o m p l a i n t s a n d t h a t he d e f e r r e d 15 2120387 to the p h y s i c i a n s ' assignment of l i m i t a t i o n s based on pain. He admitted individual's ability that pain or restrictions could affect t o work, n o t i n g t h a t i t c o u l d an interfere w i t h c o n c e n t r a t i o n , t h e a b i l i t y t o r e m a i n on t a s k , t h e p a c e o f an individual's also admitted considered performance, that an and work a t t e n d a n c e . advanced-age negatively by 2008 that housework. that he sometimes noted that as a p o s i t i v e when h i r i n g workers. Anderson's r e p o r t in was e m p l o y e r s ; however, employers a l s o considered experience older applicant Anderson time she His to t h a t she had had had the report drive F l o r i d a , w i t h her i n d i c a t e s t h a t Cowart r e p o r t e d also and sister, to take ability to do light indicates that that she although had she driven cooking was explained further breaks during the trip. The medications symptoms. 16 report a n a r c o t i c - l i k e pain A n d e r s o n ' s r e p o r t i n d i c a t e d C o w a r t t o o k was the over-the-counter at Orlando, had b u t t h e r e p o r t was and able r e l i e v e r , f o r her f i b r o m y a l g i a ; the o n l y other m e d i c a t i o n medications, him to she f u r t h e r r e v e a l s t h a t Cowart takes U l t r a m , to that over-the-counter not s p e c i f i c r e g a r d i n g whether were t o a d d r e s s p a i n o r other 2120387 On September 6, 2012, t h e t r i a l court entered a judgment d e t e r m i n i n g a g a i n t h a t C o w a r t ' s i n j u r i e s were c o m p e n s a b l e declaring t h a t Cowart was p e r m a n e n t l y and t o t a l l y and disabled. SCI f i l e d a p o s t j u d g m e n t m o t i o n , w h i c h was d e n i e d by o p e r a t i o n of law. SCI t h e n t i m e l y a p p e a l e d . Our review Compensation states, fact, if of this case A c t , A l a . Code i n pertinent i s governed 1975, part: "In the f i n d i n g of the c i r c u i t that finding § by 25-5-1 reviewing et pure the seq., which findings c o u r t s h a l l n o t be i s s u p p o r t e d by s u b s t a n t i a l Workers' reversed evidence." Ala. Code 1975, § 2 5 - 5 - 8 1 ( e ) ( 2 ) . T h e r e f o r e , t h i s c o u r t " w i l l the of view 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 t h e f i n d i n g s o f t h e trial court." (Ala. W h i t s e t t v. BAMSI, I n c . , 652 C i v . App. So. 2d 287, 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 Trinity Indus., Inc., Further, the t r i a l 680 court's So. 2d finding 262, 269 of f a c t 290 parte ( A l a . 1996) . 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 i f i t i s " s u p p o r t e d by ' e v i d e n c e o f s u c h w e i g h t and q u a l i t y t h a t f a i r - m i n d e d p e r s o n s i n t h e 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 . ' " Ex p a r t e T r i n i t y I n d u s . , 680 2d Founders a t 269 (quoting West v. 17 Life Assurance Co. So. of 2120387 F l o r i d a , 547 So. 2d 870, 871 ( A l a . 1 9 8 9 ) , a n d c i t i n g A l a . Code 1975, a § 12-21-12(d)). presumption of Our r e v i e w of l e g a l issues i s without correctness. A l a . Code 81(e) ( 1 ) ; s e e a l s o Ex p a r t e T r i n i t y I n d u s . , On appeal, determination supported SCI that by first argues that injury was Cowart's substantial 1975, § 25-5- 680 So. 2d a t 268. the trial court's c o m p e n s a b l e was n o t evidence; specifically, SCI c h a l l e n g e s whether Cowart e s t a b l i s h e d m e d i c a l c a u s a t i o n o f h e r back c o n d i t i o n . SCI a l s o a r g u e s t h a t t h e by o r d e r i n g SCI t o p r o v i d e m e d i c a l t r e a t m e n t r e g a r d t o whether such treatment r e l a t e d to the work-related the trial court's trial erred t o Cowart w i t h o u t i s reasonably injury. court Finally, necessary and SCI c h a l l e n g e s c o n c l u s i o n t h a t Cowart i s p e r m a n e n t l y and totally disabled. S C I ' s argument r e g a r d i n g t h e c o m p e n s a b i l i t y of Cowart's b a c k c o n d i t i o n i s b a s e d on i t s c o n t e n t i o n t h a t C o w a r t to present According established substantial to SCI, that the Cowart evidence evidence had a of before long medical the history failed causation. trial court of back pain a s s o c i a t e d w i t h o s t e o a r t h r i t i s , d e g e n e r a t i v e d i s k d i s e a s e , and f i b r o m y a l g i a , t h a t she h a d s u f f e r e d an e a r l i e r b a c k i n j u r y i n 18 2120387 1993 and had f a l l e n i n her bathtub p h y s i c i a n s who had that complaints Cowart's i n J u l y 2004, and t h a t t h e t r e a t e d C o w a r t had of pain consistently were indicated associated with her f i b r o m y a l g i a or her degenerative d i s k d i s e a s e . " ' [ F ] o r an i n j u r y t o be compensable under the Workers' Compensation Act, the employee must e s t a b l i s h b o t h l e g a l and m e d i c a l c a u s a t i o n . ' Ex p a r t e M o n c r i e f , 627 So. 2d 385, 388 ( A l a . 1993) . 'Once l e g a l c a u s a t i o n has b e e n e s t a b l i s h e d , i . e . , t h a t an a c c i d e n t a r o s e o u t o f , and i n t h e c o u r s e o f employment, m e d i c a l c a u s a t i o n must be e s t a b l i s h e d , i . e . , t h a t the a c c i d e n t caused the i n j u r y f o r which r e c o v e r y i s s o u g h t . ' Hammons v. R o s e s S t o r e s , I n c . , 547 So. 2d 883, 885 ( A l a . C i v . App. 1989)." Ex p a r t e S o u t h e r n (Ala. 2003). Price, 555 E n e r g y Homes, I n c . , 873 So. 2d 1116, 1121 As o u r supreme c o u r t f u r t h e r s t a t e d i n Ex p a r t e So. 2d 1060, 1063 ( A l a . 1989), " l a y testimony may combine w i t h m e d i c a l t e s t i m o n y t o s u p p l y t h [ e ] r e q u i s i t e p r o o f [ o f m e d i c a l c a u s a t i o n ] ; and t h a t t h e m e d i c a l t e s t i m o n y , when v i e w e d i n l i g h t o f l a y e v i d e n c e , may amply s u p p o r t t h e m e d i c a l c a u s a t i o n element w i t h o u t the e x p e r t w i t n e s s ' s employing requisite 875 So. To language." 2d 1200, support See 1203-04 its first Ex p a r t e S o u t h e r n a l s o S w i f t Lumber, I n c . v. ( A l a . C i v . App. argument SCI E n e r g y Homes, 873 Ramer, 2003). relies primarily 2d a t 1123, upon in which o u r supreme c o u r t r e v e r s e d t h i s c o u r t ' s a f f i r m a n c e o f a trial 19 So. any 2120387 court's determination that an employee's c o m p e n s a b l e and t h a t she was p e r m a n e n t l y The employer had argued that the back injury was and t o t a l l y d i s a b l e d . employee had failed to p r o d u c e s u b s t a n t i a l e v i d e n c e o f m e d i c a l c a u s a t i o n ; o u r supreme c o u r t commented t h a t " [ n ] o n e o f t h e d o c t o r s who employee] degree stated with any e m p l o y e e ' s ] b a c k c o n d i t i o n was injury." As the Ex p a r t e S o u t h e r n due of certainty that to the a l l e g e d E n e r g y Homes, 873 So. supreme c o u r t e x p l a i n e d , e x p e r t m e d i c a l not always t r e a t e d [the [the workplace 2d a t 1122. testimony is r e q u i r e d t o e s t a b l i s h m e d i c a l c a u s a t i o n ; however, an e m p l o y e e ' s t e s t i m o n y , w h i l e n o t a l w a y s insufficient to establish establish medical causation, cannot alone medical c a u s a t i o n when " t h e e v i d e n c e as a w h o l e w e i g h s h e a v i l y a g a i n s t finding evidence the [employee's] testimony of m e d i c a l c a u s a t i o n . " alone t o be I d . a t 1122. substantial As o u r supreme court further explained: " I n Ex p a r t e P r i c e , 555 So. 2d 1060, 1061 ( A l a . 1989), t h i s Court h e l d t h a t e x p e r t m e d i c a l t e s t i m o n y is not r e q u i r e d to prove medical c a u s a t i o n by s u b s t a n t i a l e v i d e n c e . Thus, i t was n o t n e c e s s a r y f o r [the employee] t o p r e s e n t t e s t i m o n y from a m e d i c a l expert t y i n g her i n j u r y to her workplace a c c i d e n t . However, t h e C o u r t a l s o s t a t e d i n P r i c e t h a t ' [ i ] t i s i n t h e o v e r a l l s u b s t a n c e and e f f e c t o f t h e w h o l e o f t h e e v i d e n c e , when v i e w e d i n t h e f u l l c o n t e x t o f a l l t h e l a y and e x p e r t e v i d e n c e , and n o t i n t h e 20 2120387 w i t n e s s ' s use o f any m a g i c a l words o r p h r a s e s , t h a t t h e t e s t f i n d s i t s a p p l i c a t i o n . ' P r i c e , 555 So. 2d a t 1063 ( c i t i n g O d e l l v. M y e r s , 52 A l a . App. 558, 295 So. 2d 413 (1974)) ( e m p h a s i s o m i t t e d ; e m p h a s i s added)." I d . a t 1121-22. According t o t h e c o u r t , i n o r d e r t o amount t o s u b s t a n t i a l evidence of medical c a u s a t i o n , the tendency of a l l t h e e v i d e n c e must e s t a b l i s h more t h a n a mere p o s s i b i l i t y the e m p l o y e e ' s i n j u r y was c a u s e d by the workplace that accident. Id. The employee in Ex parte Southern Energy Homes testified " c o n c e r n i n g t h e t i m i n g and n a t u r e o f h e r i n j u r i e s as w e l l as t h e e x t e n s i v e t r e a t m e n t she s o u g h t f o r h e r p a i n . [She] s t a t e d t h a t h e r s u p e r v i s o r knew a b o u t t h e A p r i l 1996 i n j u r y as soon as i t h a p p e n e d , b u t she a d m i t t e d t h a t she n e v e r c o m p l e t e d t h e p a p e r w o r k f o r a workers' compensation c l a i m f o r t h a t i n j u r y . She c o n t e n d s t h a t t h e o n l y r e a s o n she c o n t i n u e d t o work a f t e r t a k i n g o n l y one day o f f f o l l o w i n g t h e A p r i l 1996 i n j u r y was f i n a n c i a l n e c e s s i t y , b u t she was unable to explain why [her primary-care p h y s i c i a n ] never mentioned t h i s i n j u r y or her back p a i n i n h i s n o t e s on t h e i r v i s i t s u n t i l l a t e J a n u a r y 1997. [She] t e s t i f i e d t h a t b e f o r e h e r i n j u r y , she c o u l d do ' a n y t h i n g I w a n t e d t o do,' b u t t h a t now she is not able t o work, c a n n o t go shopping, has d i f f i c u l t y d r i v i n g f o r l o n g p e r i o d s , and, as f a r as h o u s e h o l d c h o r e s , can o n l y wash c l o t h e s and cook a r o u n d h e r h o u s e . She s t a t e d t h a t she i s i n ' s e v e r e pain.'" n o w 21 had 2120387 I d . a t 1120. Thus, t h e e m p l o y e e a t t e m p t e d t o e x p l a i n away t h e inconsistencies her ability present i n h e r t e s t i m o n y by e x p l a i n i n g t o continue working paycheck; however, she c o u l d the fact physician The that was b a s e d on t h e n e e d f o r n o t p r o d u c e an e x p l a n a t i o n f o r she had n o t r e p o r t e d f o r months. that h e r back pain to her Id. e m p l o y e e i n S o u t h e r n E n e r g y Homes h a d b e e n e x a m i n e d by s e v e r a l p h y s i c i a n s ; h o w e v e r , h e r s e v e r a l p h y s i c i a n s h a d n o t been a b l e to testify that caused by h e r w o r k p l a c e t h e e m p l o y e e ' s b a c k c o n d i t i o n was injury. I d . a t 1122. The supreme c o u r t c o n c l u d e d t h a t t h e t e s t i m o n y o f t h e employee's at best, "established a p o s s i b i l i t y that doctors, [her] b a c k c o n d i t i o n was caused by h e r a l l e g e d on-the-job i n j u r y . " I d . B a s e d on the " ' w e l l e s t a b l i s h e d p r i n c i p l e t h a t evidence p r e s e n t e d by a [ w o r k e r s ' ] c o m p e n s a t i o n c l a i m a n t must be more t h a n e v i d e n c e o f mere possibilities employer Stores, into Inc., supreme c o u r t did that would liability,'" only serve i d . (quoting t o "guess" t h e Hammons v. Roses 547 So. 2d 883, 885 ( A l a . C i v . App. 1 9 8 9 ) ) , o u r c o n c l u d e d t h a t t h e employee's t e s t i m o n y , not s a t i s f a c t o r i l y explain her f a i l u r e which to report her a l l e g e d p a i n t o h e r p h y s i c i a n s , d i d n o t amount t o s u b s t a n t i a l 22 2120387 evidence that sufficient the pain, had Id. at argues the medical court's evidence trial court's of her the causation regarding conclusion that her Cowart's back Energy she More to established specifically, contends t h a t , because the e v i d e n c e i n d i c a t e d t h a t Cowart because several of pain, or her and Cowart's back p a i n to e i t h e r her degenerative disk disease physicians 2004 f a l l , f i b r o m y a l g i a , which causes widespread degenerative disk disease, and b e c a u s e no d o c t o r b a c k c o n d i t i o n was, because had b a c k a t t r i b u t a b l e t o one before of her insufficient work-related to the and a f t e r accidents 23 to accidents, overcome t h e evidence e s t a b l i s h e d that d i s c l o s e a l l of her p r e v i o u s had opined t h a t Cowart's evidence c o n t r a r y to a f i n d i n g of c o m p e n s a b i l i t y . complains that Cowart i n f a c t , c a u s e d by a p a r t i c u l a r i n j u r y C o w a r t ' s t e s t i m o n y was and a t t r i b u t e d Cowart's c o m p l a i n e d o f b a c k p a i n on numerous o c c a s i o n s her of employee i n S o u t h e r n back c o n d i t i o n . s u f f e r e d from f i b r o m y a l g i a her conclusion amount t o s u b s t a n t i a l e v i d e n c e s u f f i c i e n t medical causation SCI the t e s t i m o n y of Homes, does n o t the that proven trial 1123. like support support the employee condition. SCI to SCI medical further Cowart d i d t h a t m i g h t have had not an 2120387 i m p a c t on h e r b a c k t o h e r v a r i o u s d o c t o r s , w h i c h , i t c o n t e n d s , further weakens compensability the evidence that might of Cowart's back c o n d i t i o n . Cowart i s i n the same s i t u a t i o n as the support Thus, SCI says, e m p l o y e e i n Ex parte S o u t h e r n E n e r g y Homes -- u n a b l e t o e s t a b l i s h m e d i c a l because she has but her own t h a t h e r b a c k c o n d i t i o n was w h i l e she was indicating e m p l o y e d by that her testimony f i b r o m y a l g i a or her degenerative from w o r k - r e l a t e d went t o OHC her v i s i t is records to her disk disease. treatment f o r back p a i n The i n June 2007 i n d i c a t e t h a t t h e v i s i t was f o r her January 2007 i n j u r y . Elmore, the t r e a t i n g p h y s i c i a n a t OHC, thus was no information was regarding r e f l e c t s a medical c o n c l u s i o n drawn by Dr. it only were claim occurred attributable a f t e r each w o r k - r e l a t e d i n c i d e n t . there her resulting i n c i d e n t s i n 2007 f r o m t h r e e d o c t o r s . a follow-up v i s i t was support i n the face of medical condition Cowart sought m e d i c a l to causation c a u s e d by a c c i d e n t s t h a t SCI the reflective of Cowart's related. 24 not She notes from considered However, Dr. deposed, and whether the note Elmore or whether opinion that the events 2120387 Cowart was 2007 i n j u r y p a i n was evaluated a t work; Dr. by Dr. Seymour Seymour o p i n e d t h a t n o t r e l a t e d t o any i n j u r y s u s t a i n e d a t work. dismissed after Cowart's t o her back t h a t t h e o p i n i o n o f Dr. Seymour, upon w h i c h SCI records of Cowart's other Dr. W a t t e r s o n and Dr. M o r r i s court that A review of the physicians traced had relies, r e f l e c t e d t h a t he h a d v i e w e d an MRI was n o t C o w a r t ' s as a b a s i s f o r h i s o p i n i o n . back she As n o t e d i n i t s j u d g m e n t , t h e t r i a l because h i s o p i n i o n medical her January indicates her complaints of that back p a i n t o h e r f i b r o m y a l g i a , t h a t Dr. R o b e r t s h a d d e t e r m i n e d t h a t C o w a r t was s u f f e r i n g from d e g e n e r a t i v e d i s k d i s e a s e , and t h a t Dr. Savage h a d c o n c l u d e d t h a t C o w a r t was s u f f e r i n g " m e c h a n i c a l low b a c k The causation pain." only was deposition. the detailed that opinion given Dr. W h i t e was by on the Dr. W h i t e not able subject of medical i n h i s November to s p e c i f i c a l l y c a u s e o f C o w a r t ' s symptoms; i n f a c t , 2007 pinpoint Dr. W h i t e a d a m a n t l y i n s i s t e d t h a t he r e q u i r e d f u r t h e r t e s t i n g t o p r o p e r l y d i a g n o s e and treat Cowart. He could not d e f i n i t i v e l y opine whether C o w a r t ' s s p i n a l s t e n o s i s was s i g n i f i c a n t enough t o c a u s e h e r pain stenosis or whether the spinal 25 on the 2007 MRI was 2120387 masking a possible C o w a r t ' s symptoms. stenosis time, would herniated disk that might be causing Dr. W h i t e t e s t i f i e d t h a t C o w a r t ' s s p i n a l have d e v e l o p e d o v e r a s i g n i f i c a n t amount o f and a l s o he n o t e d t h a t t h e amount o f s t e n o s i s r e f l e c t e d on t h e 2007 MRI was g r e a t e r than that r e f l e c t e d on t h e 2006 m y l e o g r a m ; h o w e v e r , Dr. W h i t e s a i d t h a t he c o u l d n o t d e t e r m i n e f o r c e r t a i n w h e t h e r C o w a r t ' s s t e n o s i s h a d begun t o d e v e l o p as a r e s u l t of her f a l l 1993, b e f o r e to i n 2004 o r as a r e s u l t o f h e r i n j u r y i n she was e m p l o y e d b y S C I . opine whether either Dr. W h i t e a l s o o f t h e 2007 incidents refused had caused Cowart's d i s a b i l i t y . A l t h o u g h Dr. W h i t e d i d n o t d e f i n i t i v e l y r e j e c t the suggestion t h a t C o w a r t ' s b a c k p a i n was r e l a t e d t o h e r f i b r o m y a l g i a , he n o t e d t h a t she h a d n o t r e p o r t e d b a c k p a i n w i t h r a d i a t i o n u n t i l t h e F e b r u a r y 2004 f a l l . Dr. White's testimony, considered C o w a r t ' s symptoms " m i g h t b e " Because as a SCI a r g u e s t h a t whole, was that work-related. Dr. W h i t e was u n a b l e t o t e s t i f y to a reasonable d e g r e e o f m e d i c a l c e r t a i n t y t h a t C o w a r t ' s symptoms were c a u s e d by a w o r k - r e l a t e d i n j u r y a n d b e c a u s e no o t h e r p h y s i c i a n o p i n e d t h a t C o w a r t ' s b a c k p a i n was r e l a t e d t o an i n j u r y she s u s t a i n e d a t work, we must d e t e r m i n e w h e t h e r C o w a r t ' s t e s t i m o n y , v i e w e d 26 2120387 in the the context trial medical that of a l l the court's had of been her able back to that form the Cowart condition. perform employment f r o m t h e t i m e she was She could determination causation she evidence, testified functions of her h i r e d u n t i l t h e f a l l i n 2004. a d m i t t e d t h a t she had s u f f e r e d f r o m f i b r o m y a l g i a p a i n , she t e s t i f i e d t h a t h e r f i b r o m y a l g i a p a i n had to miss work. After the fall in 2004, r e t u r n e d to p e r f o r m i n g her f u l l d u t i e s . several incidents of severe 2007 after incidents. each She i n j u r y was in n a t u r e as t h e p a i n she had she that explained the "something through her ... left Her 2007 was i t was J a n u a r y 2007 b u t two that the pain and the pain and the she same as the described pain pain "even more e x c r u c i a t i n g . " 27 described a feeling like d e s c r i p t i o n of the the after she she she she and felt same s u f f e r e d a f t e r t h e 2004 f a l l . hip; she 2005 i n c i d e n t s region s n a p p e d " and leg stated, Cowart a l s o r e c o u n t e d J a n u a r y 2007 i n j u r y , she excruciating. that Cowart indicated same but seldom caused her lower-back r e c o v e r e d f r o m t h e F e b r u a r y 2004 f a l l : two of established Cowart the basis in When feeling electricity the pain as f e l t i n June had felt in 2120387 Cowart said that, f u l l d u t y by Dr. pain. her She job, a f t e r she was released to return Seymour i n A p r i l 2007, she w o r k e d i n s a i d she had t r i e d to p e r f o r m a l l the i n c l u d i n g d r i v i n g long distances to until sleepless she went nights, to after bed; which f u r t h e r t e s t i f i e d t h a t she had her at home b e c a u s e , According she she constant functions see l i e on r e c a l l e d having she went to of patients. However, she e x p l a i n e d t h a t she w o u l d come home and couch to had work. the two Cowart r e l i e d on h e r s i s t e r s t o a s s i s t said, she "couldn't do anything." t o C o w a r t , she w o u l d r e s t and t r y t o r e c u p e r a t e e v e n i n g and o v e r t h e weekend so t h a t she despite each pain. her Cowart working for t h a t she may admitted another she physicians of a fall she to miss working court employer admitted a p p r o x i m a t e l y 16; trial she had in suffered 1993; she an that she she had had on her determined, a f f e c t e d Cowart's a b i l i t y family's neither of farm. those to p e r f o r m her 28 fall while admitted of t h a t i n j u r y . not suffered commented t h a t t h e injury further n o t have i n f o r m e d h e r p h y s i c i a n s Similarly, her that c o u l d manage t o work informed when had she not was caused However, as incidents duties her f o r SCI the had from 2120387 2000 t o 2004. As 2004 her fall in reflect t h a t she of t h a t n o t e d above, Cowart d i d not bathtub, but the r e c a l l the medical records July do fall. The trial Cowart to be c o m p l a i n e d o f i n j u r y t o h e r b a c k as a not court credible. testimony regarding pain, and stated The Cowart wanted to c o n t i n u e rise to her caused by court commented was found Cowart's i t believed that However, because Cowart's back p a i n degenerative d i s k t h a t was disk not disease, t h a t her s i n c e 2004 o r e v i d e n c e d on b a c k c o n d i t i o n was r e l a t e d i n c i d e n t s i n 2004, 2005, and that the appellate that serves only courts have o f t e n t o g u e s s an 2007. 1993, her MRI argues only work- agree w i t h repeated that employer i n t o 29 c a u s e d by We be spinal o r a c o m b i n a t i o n o f t h o s e p o t e n t i a l c a u s e s , SCI possibility the could t h a t , a t b e s t , C o w a r t e s t a b l i s h e d by t h e m e d i c a l e v i d e n c e the her of the i n c i d e n t s g i v i n g s t e n o s i s t h a t m i g h t have b e e n d e v e l o p i n g films, believed that logical. indicates that herniated i t t o work b u t c o u l d n o t b e c a u s e o f fibromyalgia, a possible that and p r o g r e s s i v e l y w o r s e n i n g Cowart's e x p l a n a t i o n condition medical evidence i t s judgment trial her continued i t specifically back c o n d i t i o n . in result SCI evidence liability is not 2120387 substantial evidence determination. 220 a t 885) App. So. ("Our to Wal-Mart S t o r e s , (Ala. Civ. Homes, 873 sufficient 2009) support a Inc. (quoting 2d a t 1122, quoting supreme c o u r t Ex Orr, parte 29 So. 3d Southern Energy i n t u r n Hammons, 547 So. 2d i s a well e s t a b l i s h e d p r i n c i p l e t h a t e v i d e n c e p r e s e n t e d by a [workers'] claimant possibilities into be would only more than evidence serve to 'guess' the w e l l - s e t t l e d that an of mere employer liability."'"). However, suffers from Cowart's her i t i s also a preexisting degenerative recovering or that must stated that 210, '"[i]t compensation has v. compensability disk existed rise workers' to a C o n s t r . Co. v. A l l d a y , 3d ( A l a . C i v . App. , disease, like, is not for who example, precluded from workers' compensation b e n e f i t s merely because h i s condition giving condition, employee [Ms. before the work-related compensation claim. 2110461, A p r i l 2013). As we 19, have incident See McAbee 2003] So. explained: "A w o r k e r who has a p r e e x i s t i n g c o n d i t i o n i s n o t precluded from c o l l e c t i n g workers' compensation b e n e f i t s i f t h e employment a g g r a v a t e s , a c c e l e r a t e s , or combines w i t h , a l a t e n t d i s e a s e or i n f i r m i t y t o p r o d u c e d i s a b i l i t y . Ex p a r t e L e w i s , 469 So. 2d 599 (Ala. 1985). A p r e e x i s t i n g c o n d i t i o n t h a t d i d not a f f e c t t h e [ w o r k e r ' s ] work p e r f o r m a n c e b e f o r e t h e d i s a b l i n g i n j u r y i s not c o n s i d e r e d , p u r s u a n t t o the 30 2120387 Act, t o be a pre-existing F o r e s t M a t e r i a l s v. K e l l e r , C i v . App. 1988)." condition. 537 So. 2d W a t e r s v. A l a b a m a F a r m e r s Coop., I n c . , 681 (Ala. "'[a] Civ. infer App. 1996). medical indicating working causation that, before normally immediately persisted with afterwards, ever s i n c e . ' " Waters Bros. C o n t r a c t o r s , (Ala. C i v . App. The had Furthermore, from the no 2d 622, trial the disabling Allday, So. evidence but appeared 3d was that, and at have (quoting I n c . v. W i m b e r l y , 20 So. 3d 125, 134 2009)). evidence i n the been p e r f o r m i n g her present case indicates that j o b r e s p o n s i b i l i t i e s f o r SCI preexisting conditions. After the February Cowart from t i m e she became e m p l o y e d u n t i l h e r F e b r u a r y 2004 f a l l , her may [employee] symptoms symptoms 623-24 court circumstantial accident, those So. Associated 957 (Ala. despite 2004 fall, C o w a r t had p e r i o d s o f d i s a b i l i t y c a u s e d by r e c u r r i n g s t r a i n her back. She returned t o work a f t e r from each i n c i d e n t , u n t i l the a l t h o u g h she in after w h i c h was which of on recovery i n c i d e n t i n J a n u a r y 2007, when, r e t u r n e d t o work, C o w a r t r e p o r t e d constant pain, incident, a period the intensified Cowart 31 could no t h a t she a f t e r the longer worked June 2007 work. The 2120387 medical evidence, supportive resulted of although the from her conclusion undermine the causation p r e s e n t e d to the able to that work-related completely not certainly completely f i b r o m y a l g i a m i g h t be not unequivocally Cowart's accidents, back does n o t c i r c u m s t a n t i a l evidence trial court; r e j e c t the Dr. of to medical White, possibility although that Cowart's indicated t h a t the p a i n Cowart r e p o r t e d a f t e r her w o r k - r e l a t e d accidents d i f f e r e n t i n nature than her included radiating pain. evidence before due t o any it pay "pay treatment n e c e s s a r y f o r the Code 1975, provided f o r any t r e a t m e n t by for on our view of the Dr. i t s u b s t a n t i a l evidence to trial court's [Cowart] and incurs White" i n s t e a d of r e q u i r i n g is reasonable and t r e a t m e n t of the w o r k - r e l a t e d article with i n t e r i m judgment m e d i c a l expense that § 25-5-77(a) in this to to produce Cowart's d i s a b i l i t y . next argues t h a t the i t to based t h a t Cowart's c o n d i t i o n combined preexisting conditions requires Ala. Thus, c o u r t had b e f o r e support i t s conclusion SCI f i b r o m y a l g i a p a i n because i t t h e t r i a l c o u r t i n t h e l i g h t most f a v o r a b l e Cowart, the t r i a l her source of her serve back p a i n , was the condition ("In a d d i t i o n t o t h e Article 32 4 of this that medically injury. See compensation chapter, ... 2120387 the employer, act, e x c e p t as o t h e r w i s e p r o v i d e d i n t h i s amendatory s h a l l p a y an amount n o t t o e x c e e d t h e p r e v a i l i n g r a t e o r maximum s c h e d u l e o f f e e s as e s t a b l i s h e d h e r e i n o f r e a s o n a b l y necessary physical medical and surgical rehabilitation, treatment medicine, supplies, crutches, a r t i f i c i a l medical and attention, and surgical members, a n d o t h e r a p p a r a t u s as t h e r e s u l t o f 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 the employment, ...."). as may be o b t a i n e d b y t h e i n j u r e d F u r t h e r , SCI a p p e a r s i t s right employee t o argue t h a t t h e i n t e r i m to seek utilization order deprives i t of review of treatment i t m i g h t f i n d q u e s t i o n a b l e u n d e r A l a . Code 1975, § 25-5-293(k). The i n t e r i m j u d g m e n t states: " I t i s h e r e b y o r d e r e d , t h a t [SCI] i m m e d i a t e l y t a k e s t e p s t o c o o r d i n a t e w i t h t h e o f f i c e s o f [Dr. White] t o a u t h o r i z e Dr. White t o t a k e a l l s t e p s n e c e s s a r y f o r t h e c a r e a n d t r e a t m e n t o f [Cowart] f o r t h e i n j u r i e s a n d / o r c o n d i t i o n s t h a t she h a s s u f f e r e d t h a t have d e v e l o p e d as a r e s u l t o f h e r i n j u r i e s t h a t o c c u r r e d w i t h i n t h e l i n e a n d s c o p e o f h e r employment with [SCI]." The t r i a l c o u r t ' s f i n a l j u d g m e n t a l s o a d d r e s s e s f u t u r e m e d i c a l benefits: " I t i s f u r t h e r o r d e r e d , a d j u d g e d and d e c r e e d t h a t [Cowart's] r i g h t t o f u t u r e m e d i c a l b e n e f i t s s h a l l remain i n f u l l f o r c e and e f f e c t c o n s i s t e n t w i t h t h e 33 2120387 Workers' Compensation A c t of the S t a t e of Alabama and t h a t [SCI] s h a l l c o n t i n u e t o r e m a i n l i a b l e t o [Cowart] f o r a l l r e a s o n a b l e and n e c e s s a r y m e d i c a l expenses i n c u r r e d through her a u t h o r i z e d treating p h y s i c i a n [ , ] w h i c h t h i s c o u r t does f i n d t o be Dr. James W h i t e , I I I , o r s u c h o t h e r m e d i c a l p r o v i d e r s r e q u i r e d f o r the purpose of p r o v i d i n g m e d i c a l case and t r e a t m e n t f o r [ C o w a r t ' s ] j o b i n j u r i e s . " To t h e e x t e n t t h a t t h e i n t e r i m judgment does n o t state that SCI's duty Cowart i s c o n d i t i o n e d t o pay m e d i c a l expenses incurred by on t h o s e e x p e n s e s b e i n g r e a s o n a b l e , m i g h t have a t e c h n i c a l p o i n t . i n t e r i m judgment, clearly however, The overall substance of the i n d i c a t e s t h a t SCI i s r e q u i r e d p a y f o r n e c e s s a r y c a r e and t r e a t m e n t o f i n j u r i e s a r i s i n g Cowart's w o r k - r e l a t e d SCI accidents, and t h a t to from l a n g u a g e does not a p p e a r t o l e a v e SCI e x p o s e d t o t h e d u t y t o p a y f o r any and a l l medical treatment Enters., I n c . v. Lawshe, 16 So. 3d 96, 103-04 ( A l a . C i v . App. 2009) (reversing judgment stating employee], that Cowart that portion that "'[the might a t i t s expense, of a undergo. workers' employer] and u n t i l Cf. shall Fluor compensation provide f u r t h e r Order of [the this court, m e d i c a l treatment provided, ordered, or p r e s c r i b e d , [a particular exposed expenses physician,]'" the employer the employee 16 So. to l i a b i l i t y might incur). 34 3d at f o r any 99, and Moreover, because by i t a l lmedical because the 2120387 f i n a l j u d g m e n t i n d i c a t e s c l e a r l y t h a t SCI for reasonable and necessary medical Cowart to t r e a t her w o r k - r e l a t e d i s responsible expenses only incurred by i n j u r i e s and a l s o s t a t e s that Cowart's r i g h t to f u t u r e m e d i c a l b e n e f i t s i s " c o n s i s t e n t with the Workers' Compensation A c t , " i n t e r i m j u d g m e n t , w h i c h was of no consequence F u r t h e r m o r e , we and any technical error in subsumed by t h e f i n a l j u d g m e n t , i s cannot form conclude that the an appeal. i n e i t h e r the nothing basis of interim j u d g m e n t o r t h e f i n a l j u d g m e n t w o u l d s e r v e t o p r e v e n t SCI exercising i t s right to utilization decline to reverse the t r i a l Finally, challenges that SCI Cowart i s permanently above, the disability Anderson, disability only witness p o r t i o n of the who as testified a result the court's the trial court's totally at the that was Cowart her We therefore j u d g m e n t on t h i s and trial of review. ground. determination disabled. 2012 As noted determination-of- SCI's v o c a t i o n a l suffered work-related from no expert, vocational accidents. SCI c o n t e n d s t h a t t h e r e c o r d does n o t c o n t a i n s u b s t a n t i a l e v i d e n c e from Cowart's t e s t i m o n y t h a t would support the c o n c l u s i o n she i s u n a b l e t o p e r f o r m g a i n f u l employment o r t h a t she 35 that i s not 2120387 a candidate f o r v o c a t i o n a l r e h a b i l i t a t i o n , both of which f a c t s the trial court s p e c i f i c a l l y found. " W i t h r e g a r d t o d e t e r m i n i n g w h e t h e r an e m p l o y e e i s p e r m a n e n t l y and t o t a l l y d i s a b l e d , t h i s c o u r t has stated: "'"The t e s t f o r t o t a l and p e r m a n e n t disability i s the i n a b i l i t y to perform one's t r a d e and t h e i n a b i l i t y t o find gainful employment." Fuqua v. C i t y of F a i r h o p e , 628 So. 2d 758, 759 ( A l a . C i v . App. 1993) . See a l s o L i b e r t y T r o u s e r s v. K i n g , 627 So. 2d 422, 424 ( A l a . C i v . App. 1993) . A "permanent t o t a l d i s a b i l i t y " i s d e f i n e d as i n c l u d i n g "any p h y s i c a l i n j u r y or m e n t a l i m p a i r m e n t r e s u l t i n g f r o m an accident, which injury or impairment p e r m a n e n t l y and t o t a l l y i n c a p a c i t a t e s t h e employee from working at and being retrained for gainful employment." § 2 5 - 5 - 5 7 ( a ) ( 4 ) d . , A l a . Code 1975; R u s s e l l v. B e e c h A e r o s p a c e S e r v i c e s , I n c . , 598 So. 2d 991, 992 ( A l a . C i v . App. 1 9 9 2 ) . ' "Alabama C a t f i s h , I n c . v. James, 669 So. 2d 917, 918 ( A l a . C i v . App. 1995) . See a l s o B o y d B r o s . T r a n s p . , I n c . v. Asmus, 540 So. 2d 757, 759 ( A l a . C i v . App. 1988) ( s t a t i n g t h a t § 2 5 - 5 - 5 7 ( a ) ( 4 ) d . , A l a . Code 1975, ' r e q u i r e s t h a t t h e e m p l o y e e be u n a b l e t o perform h i s trade or unable to obtain reasonably gainful employment')." CVS Corp. v. Smith, 981 So. 2d 1128, 1136 (Ala. Civ. App. 2007). Cowart's trial was t e s t i m o n y a t t h e November 2007 c o m p e n s a b i l i t y not aimed a t e s t a b l i s h i n g her d i s a b i l i t y . 36 She d i d 2120387 t e s t i f y t h a t she had w o r k e d i n c o n s t a n t returned p a i n from the time t o work i n A p r i l 2007 t o t h e day p a n t s and she stepped i n t o f u r t h e r i n j u r e d h e r b a c k on June 12, t h a t between A p r i l 2007 and June 2007 she s i s t e r s f o r a s s i s t a n c e b e c a u s e she s a i d t h a t she testified, included r e s t e d i n t h e e v e n i n g s and however, patient that care she and, at d i s t a n c e s , d e s p i t e her p a i n . what m e d i c a t i o n s she Anderson's June had 2007. had "couldn't relied do a n y t h i n g " and on weekends. her indicates driving only medication underlying use t h a t use. what e x t e n t her had she once gone one after report Cowart d i d not r e q u i r e d the returning assistance month w i t h o u t t o work i n A p r i l indicates that Cowart regarding back p a i n , that specifying she took over-the- the reason other of her than to s i s t e r s and shopping for to state that groceries 2007; A n d e r s o n ' s June 2008 performed light cooking h o u s e k e e p i n g d u t i e s r e g u l a r l y and t h a t she had d r i v e n w i t h s i s t e r to F l o r i d a . and specifically testify a c t i v i t i e s were l i m i t e d , t h a t she had without which significant U l t r a m f o r f i b r o m y a l g i a p a i n and v a g u e l y r e f e r e n c e d counter Cowart job, Cowart never t e s t i f i e d report said her m i g h t have t a k e n f o r h e r 2008 She her on performed times, she and her A n d e r s o n ' s June 2008 r e p o r t a l s o i n d i c a t e d 37 2120387 that Cowart November had 2007 trouble trial sleeping; that she had b e t w e e n A p r i l 2007 and June 2007. could return including to some sort administrative utilization review, positions. Cowart had two sleepless nursing-related positions she did h o w e v e r , as not SCI the nights case employment, management classified or as sedentary f r o m C o w a r t ' s November 2011 Excerpts are in deposition a t t a c h e d t o SCI's p o s t t r i a l b r i e f c o n t a i n e d that at Anderson o p i n e d t h a t Cowart of which commented think points as an e x h i b i t a t t r i a l she out, and could Cowart's t e s t i m o n y perform those excerpts were n o t b e f o r e l i g h t - d u t y work; were n o t the t r i a l admitted court as evidence of Cowart's d i s a b i l i t y . We agree with SCI that the record does not contain s u b s t a n t i a l e v i d e n c e t h a t Cowart c o u l d not p e r f o r m her o r be r e t r a i n e d f o r g a i n f u l employment. i n d i c a t e d t h a t she employment desired her pain. She return to work, which to t h a t she pointed testimony been a b l e t o p e r f o r m the d u t i e s of despite specifically testimony had Cowart's trade out indicated that in its C o w a r t had also fact testified the that trial her she court judgment. Anderson's transferable skills and c o u l d r e t u r n t o work i n an o f f i c e n u r s i n g p o s i t i o n o r 38 2120387 an a d m i n i s t r a t i v e p o s i t i o n l i k e c a s e manager, w h i c h p o s i t i o n s would not r e q u i r e lifting patients. W i t h o u t more specific e v i d e n c e i n d i c a t i n g t h a t C o w a r t w o u l d be u n a b l e t o p e r f o r m t h e duties required o f h e r p o s i t i o n o r be t r a i n e d f o r another n u r s i n g - r e l a t e d p o s i t i o n l i k e t h o s e m e n t i o n e d b y A n d e r s o n , we cannot conclude Cowart i s permanently substantial the trial that evidence. court's the t r i a l court's and t o t a l l y We therefore September determination that disabled i s s u p p o r t e d by reverse that p o r t i o n of 2012 j u d g m e n t determining that C o w a r t i s p e r m a n e n t l y a n d t o t a l l y d i s a b l e d , a n d we remand t h i s cause to the t r i a l court f o r i t to reconsider the evidence p r e s e n t e d and d e t e r m i n e Cowart's l e v e l o f d i s a b i l i t y . AFFIRMED I N PART; REVERSED I N PART; AND REMANDED. Thompson, P . J . , a n d P i t t m a n a n d D o n a l d s o n , J J . , c o n c u r . Moore, J . , c o n c u r s i n p a r t part, with w r i t i n g . 39 and c o n c u r s i n t h e r e s u l t i n 2120387 MOORE, J u d g e , c o n c u r r i n g i n p a r t and c o n c u r r i n g i n t h e in result part. I concur i n that aspect of the main o p i n i o n d i s c u s s i n g the n a t u r e of the m e d i c a l b e n e f i t s awarded t o Margaret Cowart. I c o n c u r i n t h e r e s u l t as t o t h e r e m a i n i n g a s p e c t s o f t h e m a i n opinion. Medical Before the Compensation 1975, workers' legislature Act i n 1992, Causation ("the the amended Act"), § the 25-5-1 Alabama et seq., a p p e l l a t e c o u r t s of t h i s compensation Workers' Ala. state reviewed judgments under the s t a n d a r d of a p p l i c a b l e to p e t i t i o n s f o r a w r i t of c e r t i o r a r i . A. 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 § 26:12 Code review See 2 T e r r y (West 1998). Under t h a t s t a n d a r d , f a c t u a l f i n d i n g s o f t h e t r i a l c o u r t w o u l d be c o n c l u s i v e on the appellate court i f supported by "any e v i d e n c e , " see Ex p a r t e S l o s s - S h e f f i e l d S t e e l & I r o n Co., Ala. 219, view of t h a t evidence." 575 So. 221, 2d eliminated judgments, 91, 92 So. 93 458, (1922), or "any reasonable Ex p a r t e E a s t w o o d F o o d s , ( A l a . 1990). certiorari replacing See 460 review In of 1992, workers' i t w i t h r e v i e w by 40 the appeal 207 Inc., legislature compensation and p r o v i d i n g 2120387 t h a t f a c t u a l f i n d i n g s w o u l d be s u s t a i n e d o n l y i f s u p p o r t e d " s u b s t a n t i a l evidence." Our See § 25-5-81(e)(2), A l a . Code supreme c o u r t l a t e r d e f i n e d " s u b s t a n t i a l e v i d e n c e " r e l a t e s t o w o r k e r s ' c o m p e n s a t i o n c a s e s as by 1975. as i t "'evidence of such w e i g h t and q u a l i t y t h a t f a i r - m i n d e d p e r s o n s i n t h e e x e r c i s e o f i m p a r t i a l j u d g m e n t can fact 680 s o u g h t t o be So. 2d 262, A s s u r a n c e Co. 269 reasonably proved.'" Ex ( A l a . 1996) o f F l o r i d a , 547 i n f e r the e x i s t e n c e of parte Trinity Indus., the Inc., ( q u o t i n g West v. F o u n d e r s L i f e So. 2d 870, 871 ( A l a . 1989), c i t i n g § 1 2 - 2 1 - 1 2 ( d ) , A l a . Code 1 9 7 5 ) . " I t i s w e l l s e t t l e d t h a t when t h e l e g i s l a t u r e makes a ' m a t e r i a l change i n t h e l a n g u a g e o f [an] o r i g i n a l a c t , ' i t i s 'presumed t o i n d i c a t e a change i n l e g a l r i g h t s . ' 1A Norman J . S i n g e r , S t a t u t e s and Statutory Construction § 22:30 ( 6 t h ed. 2002) ( f o o t n o t e o m i t t e d ) . I n o t h e r w o r d s , t h e 'amendment o f an unambiguous s t a t u t e i n d i c a t e s an i n t e n t i o n t o change t h e l a w . ' I d . ( e m p h a s i s a d d e d ) . See S t a t e v. Lammie, 164 A r i z . 377, 379, 793 P.2d 134, 136 ( A r i z . Ct. App. 1990) ('when t h e legislature amends s t a t u t o r y language, i t i s presumed t h a t i t i n t e n d s t o make a change i n e x i s t i n g l a w ' ) ; M a t t e r o f S t e i n , 131 A.D.2d 68, 72, 520 N.Y.S.2d 157, 159 (App. D i v . 1987) ('When t h e L e g i s l a t u r e amends a s t a t u t e , i t i s p r e s u m e d t h a t t h e amendment was made t o e f f e c t some p u r p o s e and make some change i n t h e e x i s t i n g l a w By e n a c t i n g an amendment o f a s t a t u t e and c h a n g i n g t h e l a n g u a g e t h e r e o f , t h e L e g i s l a t u r e i s deemed t o have i n t e n d e d a m a t e r i a l change i n t h e l a w M o r e o v e r , a s t a t u t e w i l l n o t be h e l d t o be a mere reenactment of a prior statute i f any other reasonable interpretation is attainable '), 41 and 2120387 a p p e a l d i s m i s s e d 72 N.Y.2d 840, 526 N.E.2d 46 ( 1 9 8 8 ) . " Pinigis v. Regions B a s e d on the changing the legislature 977 So. 2d foregoing p r i n c i p l e s , standard intended f i n d i n g s w o u l d be any Bank, reasonable of to N.Y.S.2d 446, 452 555, ( A l a . 2007) . i t i s apparent review alter 530 in the § that, 25-5-81(e)(2), prior law that the factual c o n c l u s i v e i f s u p p o r t e d by any e v i d e n c e view of that evidence. The by or legislature e v i d e n t l y i n t e n d e d t h a t f i n d i n g s o f f a c t must be s u p p o r t e d by more t h a n of evidence just one reasonable i n o r d e r t o be Nevertheless, court, I as cannot i n f e r e n c e from c o n c l u s i v e on currently discern appeal. construed any a scintilla by our distinction supreme between the s u b s t a n t i a l - e v i d e n c e s t a n d a r d of review c o n t a i n e d i n § 81(e)(2) supreme weigh and the old c o u r t has clarified appellate court 3d a p p e l l a t e c o u r t must judgment i f the factual limited cannot So. an the The See Ex p a r t e M c I n i s h , 47 Rather, for review. ascertaining i t s substantiality. ( A l a . 2008). even t h a t an of of 767 evidence, standard purpose the the certiorari 25-5- f i n d i n g s of the t r i a l affirm court are " r e a s o n a b l y s u p p o r t e d " by t h e e v i d e n c e , see Ex p a r t e Hayes, 70 So. 3d 1211, 1215 (Ala. 2011), 42 even i f the testimony 2120387 s u p p o r t i n g the f a c t u a l f i n d i n g s appears s e l f - c o n t r a d i c t o r y or i m p l a u s i b l e i n l i g h t o f common human e x p e r i e n c e . See Ex p a r t e Caldwell, that 104 deferential So. 3d standard 901 of (Ala. review, 2012) . By i t appears to me highly that an a p p e l l a t e c o u r t cannot d i s t u r b a f i n d i n g of f a c t i n a workers' compensation judgment u n l e s s i t i s t o t a l l y u n s u p p o r t e d reasonable inference record, which is seems t o essentially Homes, I n c . , 873 supreme otherwise So. 2d 1116 at to constituted substantial 2d a t 1122 (Ala. case to from i s Ex certiorari o u r supreme c o u r t parte ( A l a . 2003). the the Southern 1989)). link her "'overall back evidence injury substance' to her of medical ( q u o t i n g Ex p a r t e P r i c e , 555 The Energy In t h a t case, when a s c e r t a i n i n g w h e t h e r Emma R i d d l e ' s purporting So. identical lone looked court evidence" The state any t a k e n f r o m some s h r e d o f e v i d e n c e i n t h e standard of review. that by of the testimony employment causation. So. our 873 2d 1060, 1063 court further held that, although Riddle's t e s t i m o n y t h a t she c o u l d no l o n g e r work c o n s t i t u t e d "a modicum of evidence" 1123, the of i t d i d not permanent total disability, amount t o s u b s t a n t i a l absence of p h y s i c a l restrictions, 43 873 evidence So. 2d at in light of the unanimous medical 2120387 opinions that she could return t o work, exaggerated claims of d i s a b i l i t y . only questionable been d e c i d e d 906-07 an her documented However, t h a t c a s e retains p r e c e d e n t i a l v a l u e g i v e n t h e c a s e s t h a t have s i n c e 2003. See Ex p a r t e C a l d w e l l , 104 (Murdock, J . , c o n c u r r i n g Ex p a r t e and i n the S o u t h e r n E n e r g y Homes, I n c . , result) should So. 3d (arguing be at that overruled as aberration). G i v e n t h e manner i n w h i c h o u r supreme c o u r t has our standard of review, I have no choice but the judgment of the Calhoun C i r c u i t C o u r t must be affirmed insofar as i t compensation b e n e f i t s f o r her back i n j u r y . trial court, see Ex parte c i r c u m s t a n t i a l evidence, White I I I , although clarity, is McInish, trial Cowart to a supra, paragon support at the in the joints aggravated by i n j u r y was a direct of work-related and compensable i n j u r i e s . her lumbar trauma and of Ex parte 44 Pike workers' lay least a the and James consistency and reasonable arthritic vertebra that were that June 2007 her n a t u r a l consequence of her See court") o f Dr. i n f e r e n c e t h a t Cowart's back c o n d i t i o n r e s u l t s from changes that As w e i g h e d by along w i t h the t e s t i m o n y hardly sufficient to concur ("the awards construed original C o u n t y Comm'n, 740 2120387 So. 2d 1080 an ( A l a . 1999). inference that nonoccupational T h a t same e v i d e n c e may Cowart's injuries back injury also support results from process, or the n a t u r a l aging solely but t h i s c o u r t may n o t r e v e r s e a judgment f o r t h a t r e a s o n . parte Caldwell, supra. Permanent T o t a l The c a s e was initial hearing compensability evidence w h i c h was the Disability b i f u r c a t e d and t h e t r i a l held in 2007 of Cowart's from t h a t h e a r i n g establishing See Ex Cowart's to the injury. was admitted At c o n d u c t e d i n 2012, t h e t r i a l i s s u e of the d i s a b i l i t y issue back disability. resulting court l i m i t e d i t s regarding Thus, none o f t h e f o r the purpose the second of hearing, court adjudicated only from the back Remarkably, Cowart e l e c t e d not t o a t t e n d the h e a r i n g , did the injury. so she n o t t e s t i f y on h e r own b e h a l f as t o t h e e f f e c t o f h e r b a c k injury records on her e m p l o y a b i l i t y . from t h a t Cowart the Social Cowart's attorney introduced Security Administration indicating had b e e n d e c l a r e d d i s a b l e d , b u t t h e t r i a l court concluded t h a t i t would not consider t h a t evidence i n d e c i d i n g the d i s a b i l i t y issue. 45 2120387 Eric Anderson, a licensed professional t e s t i f i e d t h a t no p h y s i c i a n h a d a s s i g n e d t o C o w a r t as a r e s u l t counselor, any work r e s t r i c t i o n s of h e r back i n j u r y . Those physicians t h a t h a d e x p r e s s e d an o p i n i o n on t h e p o i n t h a d r e t u r n e d t o work f u l l d u t y . Accordingly, from Anderson's Cowart perspective, C o w a r t d i d n o t have any m e d i c a l l i m i t a t i o n s t h a t w o u l d p r e v e n t her from resuming h e r r e g u l a r d u t i e s , and e a r n i n g h e r r e g u l a r wages, as a n u r s e . any loss Thus, he o p i n e d t h a t she h a d n o t s u s t a i n e d of earning capacity, vocational-disability Cowart's p a i n assigned cross-examined Anderson. Anderson admitted that 0% During that he h a d n o t t a k e n i n t o c o n s i d e r a t i o n when o p i n i n g r e t u r n t o work. her a rating. Cowart's a t t o r n e y cross-examination, a n d he t h a t she c o u l d A n d e r s o n t e s t i f i e d t h a t he was n o t q u a l i f i e d to rate pain, but, instead, l e f t that matter t o the physicians who he assumed w o u l d t a k e pain restrictions to a patient. Anderson conceded t h a t p a i n limit employability i f i t was However, that cross-examination evidence that Cowart suffered 46 into severe a c c o u n t when assigning and f r e q u e n t d i d not e l i c i t continuing, could enough. any unrelenting actual pain 2120387 affecting her employability due to her compensable back injury. Ultimately, proceedings and second h e a r i n g , due to the bifurcated the d e c i s i o n the record of Cowart contains no nature not to evidence of the attend the indicating t h a t C o w a r t s u s t a i n e d any p e r m a n e n t l o s s o f e a r n i n g due to her compensable d e f e r e n t i a l standard back of review injury. Even capacity under the s e t out above, t h e judgment o f t h e t r i a l c o u r t must be r e v e r s e d . I w o u l d go f u r t h e r t h a n t h e main that opinion, enter a however, judgment disability not award, capacity, disability Champion vacating denying any the t r i a l the court must permanent-total- permanent-disability W i t h o u t e v i d e n c e of a permanent l o s s of Cowart benefits Int'l hold only but benefits altogether. earning and Corp., cannot f o r her 693 back So. 2d recover injury. 24 any See permanentBrown ( A l a . C i v . App. v. 1996) ( h o l d i n g t h a t , i n absence of evidence t h a t neck i n j u r y caused l o s s of earning c a p a c i t y , c i r c u i t court d i d not e r r i n denying claim for permanent-disability benefits). 47

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