WESLEY BRENT MATHIS, ET AL V. ADVANCE AUTO PARTS
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I1V~POR 'ANT NOTICE
NOT TO BE PUBLI
ED OPINION
THIS OPINION IS DESIGNA TED "NOT TO BE
PUBLISHED. " PURSUANT TO THE RULES OF
CIVI_L PROCED URE PROMUL GA TED BY THE
SUPREME COURT, CR 76.28 (4) (c), THIS OPINION
IS NOT TO BE PUBLISHED AND SHALL NOTBE
CITED OR USED AS A UTHORITY IN ANY OTHER
CASE INANY COURT OF THIS STA TE.
RENDERED : January 20,2005
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2004-SC-0146-WC
ADVANCE AUTO PARTS
V.
APPELLANT
APPEAL FROM COURT OF APPEALS
2003-CA-1303-WC
WORKERS' COMPENSATION BOARD NO . 02-0720
WESLEY BRENT MATHIS; HON . JAMES L . KERR,
ADMINISTRATIVE LAW JUDGE ; AND
WORKERS' COMPENSATION BOARD
AND
APPELLEES
2004-SC-0188-WC
WESLEY BRENT MATHIS ; HON . JAMES L. KERR,
ADMINISTRATIVE LAW JUDGE ; AND
WORKERS' COMPENSATION BOARD
CROSS-APPELLANTS
APPEAL FROM COURT OF APPEALS
2003-SC-1953-WC
WORKERS' COMPENSATION BOARD NO . 02-0720
ADVANCE AUTO PARTS
CROSS-APPELLEE
MEMORANDUM OPINION OF THE COURT
AFFIRMING
Affirming a decision of the Workers' Compensation Board (Board), the Court of
Appeals has determined that the claimant's award was supported by substantial
evidence but that the evidence did not compel an award of the temporary total disability
(TTD) benefits he requested. In a direct appeal, the employer maintains that the
Administrative Law Judge (ALJ) abused his discretion by failing to independently review
the validity of the claimant's AMA impairment rating. Cross-appealing, the claimant
asserts that the ALJ erred in determining that he was not entitled to TTD . We affirm .
The claimant attended approximately six and one-half years of college although
he did not receive a degree . His primary work experience was in retail management,
most recently as manager of an auto parts store. On January 23, 2001, he was injured
while working when he slid on some ice, fell, and landed on his back .
After the incident, the claimant continued to work as store manager but did not
perform all of his previous duties and sometimes missed work altogether . He last
worked in March, 2001 . Although he attempted to find less physically demanding work
in the retail field, he was unable to do so.
The claimant sought treatment from Dr. Lockstadt, a board-certified orthopedic
surgeon, complaining of back pain, with leg pain and a burning sensation in the right
foot. Based on the results of an MRI, Dr. Lockstadt diagnosed a small herniated disc at
L4-5 "just touching up onto the spinal cord or nerves at that level" and a very small
herniated disc at L5-S1, touching the nerve at that level but not compressing it. There
were also arthritic changes in the facet joints . In his opinion, the claimant's complaints
were consistent with the MRI findings . Although he thought the claimant did not have a
pinched nerve, he was convinced that something was irritating the nerve .
Dr. Menke evaluated the claimant for the employer on January 29, 2002. He
reviewed the MRI Dr. Lockstadt had obtained and stated there was a disc bulge at L4-5
with no impingement, disc dessication at L5-S1 but no bulge, and chronic low back pain .
He attributed the right leg pain to a nerve root irritation . Dr. Menke assigned a 5%
impairment based on the MRI findings, the claimant's symptoms, and a restricted range
of motion. Dr. Menke anticipated that the claimant would be at maximum medical
improvement (MMI) six weeks after starting physical therapy. If he was not offered
physical therapy or refused it, he would currently be at MMI.
When deposed in August, 2002, and questioned about the claimant's permanent
impairment rating, Dr . Lockstadt stated :
Well, I don't have the exact AMA guidelines with me, but I do know
them relatively well to make a judgment on that . And we do know
that he does have a herniated disc, as confirmed on the MRI scan ;
he does have radiculopathy; he has possibly two herniated discs
that could be causing these symptoms . We do know that according
to the guidelines, that if you have a herniated disc, and possibly two
herniated discs with radiculopathy, that this could have up to a 15
percent impairment rating, which is fairly significant.
Dr. Lockstadt also stated that if the claimant were treated successfully, his impairment
would decrease to 5-6% . On cross-examination, he explained that the term
.
1 radiculopathy" is descriptive and refers to a symptom rather than a diagnosis . He
repeated that the claimant had herniated discs at L4-5 and L5-S1 but did not have
actual nerve root compression.
When deposed on August 5, 2002, the claimant testified that he had not had
physical therapy. He stated that he had contacted the benefits department and his
health insurance carrier and was informed that they would not pay for an MRI or
physical therapy without a clear diagnosis. When the claim was heard, he continued to
experience constant and significant low back pain . He testified that he could not return
to work as a store manager because he could not be on his feet constantly .
After considering the evidence, the ALJ determined that the claimant's injury
caused a permanent partial disability . Finding Dr. Lockstadt to be more persuasive than
Dr. Menke, the AU determined that the claimant's permanent impairment was 15% .
Although noting that the claimant had requested a period of TTD benefits, the ALJ
3
determined that the medical evidence did not support a finding of TTD under KRS
342.0011(11)(a), stating as follows :
While Dr. Lockstadt ordered physical therapy on April 26, 2001,
there is no notation that plaintiff could not work. Likewise, Dr.
Lockstadt's office notes thereafter do not reflect that plaintiff cannot
work. Review of the November 27, 2001 note does indicate that
plaintiff has restrictions but these alone are insufficient to conclude
that plaintiff was temporarily totally disabled . Further, Dr. Lockstadt
does not address plaintiffs ability to work in his deposition .
Relying on Caldwell Tanks v. Roark, 104 S.W .3d 753 (Ky. 2003), the employer
maintains an ALJ is obliged to consult the American Medical Association's Guides to the
Evaluation of Permanent Impairment (Guides) independently to be certain that the
impairment rating a physician assigns is valid. The employer asserts that it takes no
medical expertise to review the chart regarding the ranges of impairment for lumbar
injuries and compare it with the impairment rating a physician assigns . According to the
employer, the 15% impairment Dr. Lockstadt assigned does not correspond to any of
the DRE categories in the Fifth Edition; therefore, it is both invalid and not in conformity
with the Guides . For that reason, the ALJ erred in relying on it.
Contrary to the employer's argument, we are not convinced that the ALJ erred in
relying upon Dr. Lockstadt .
In Kentucky River Enterprises v. Elkins, 107 S.W.3d 206
(Ky. 2003), we were asked to determine whether an ALJ had relied on impairments that
were determined in conformity with the Guides . Rejecting the employer's reference to
certain pages in the Guides in an attempt to show that the impairments in question were
erroneous, we explained that "the proper interpretation of the Guides and the proper
assessment of an impairment rating are medical questions ." Id . at 210. Noting the
absence of any medical testimony to establish that the method the physician had used
was erroneous, we concluded that the ALJ's reliance on the physician's testimony was
reasonable . Caldwell Tanks v. Roark, supra, stands only for the principle that an ALJ is
required to read the table that converts a binaural hearing impairment into an AMA
impairment if a medical expert fails to do so . Id. at 757. Our rationale was that a
medical expert had determined the hearing impairment, and reading the table that
converted it into an AMA impairment required no medical expertise .
The claimant maintains that it was patent error for the ALJ to refuse to award
TTD benefits . He asserts that the only physician who testified regarding when he
reached MMI was Dr. Menke. Based on Dr. Menke's testimony and the fact that he did
not undergo physical therapy, the claimant argues that he did not reach MMI until
January 29, 2002, when Dr. Menke evaluated him. Relying on Central Kentucky Steel
v. Wise , 19 S.W.3d 657 (Ky. 2000), he also argues that because the physical
restrictions that Drs . Lockstadt and Menke imposed prevented him from performing his
customary work, he was entitled to TTD benefits.
Kentucky does not recognize the concept of temporary partial disability . As
defined in KRS 342 .0011(11)(a) :
"Temporary total disability" means the condition of an employee
who has not reached maximum medical improvement from an
injury and has not reached a level of improvement that would
permit a return to employment.
The term "total disability" refers to a complete inability to perform any type of work. See
KRS 342 .0011 (11)(c) .
In Central Kentucky Steel v. Wise , supra , the worker fractured his left arm on
April 28, 1997 . On July 11, 1997, his treating physician released him to return to work
with a restriction against lifting more than five pounds with his left hand . On September
30, 1997, he returned to work. His physician testified that he did not reach MMI until
October 28, 1997. Interpreting KRS 342.0011(11)(a) to favor itself, the employer
5
asserted that if a worker has either reached MMI or been released to return to work,
TTD must be terminated . Nonetheless, the ALJ rejected the argument and awarded
benefits through September 30, 1997 . The decision was affirmed on appeal and stands
for the principle that if a totally disabled worker has not reached MMI, a release to
perform minimal work is not the equivalent of "a level of improvement that would permit
a return to employment ." It does not alter the definition of total disability or stand for the
principle that workers who are unable to perform their customary work after an injury are
always entitled to TTD.
Unlike the situation in Wise, the ALJ was not convinced from the medical
evidence that the claimant was totally disabled for a period of time after his injury.
Although the claimant was unable to work as a store manager after his injury, evidence
of an inability to perform his usual work did not compel a finding that he was totally
disabled . The claimant had several years of college-level education and years of retail
and managerial experience . Despite his restrictions, it could not reasonably be said that
the evidence compelled a finding that he became totally disabled due to his injury .
Absent such evidence, questions regarding the duration of total disability such as were
addressed in the Wise decision do not arise .
The decision of the Court of Appeals is affirmed .
All concur.
COUNSEL FOR APPELLANT/CROSS-APPELLEE,
ADVANCE AUTO PARTS:
Jo Alice Van Nagell
Clark & Ward
333 W. vine Street, Suite 1100
Lexington, KY 40507
Jonathan David Weber
706 Franklin Avenue, Apt. 1
Lexington, KY 40508
COUNSEL FOR APPELLEE/CROSS-APPELLANT,
WESLEY BRENT MATHIS :
Terry L . Yewell
114 Dennis Drive, Suite B
Lexington, KY 40503
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