Claimant Awarded a Load on Unoperated Bilateral Shoulder Claim

Ferris v. Pajco Inc. d/b/a Rhodes and Zurich American Insurance Co, Injury No: 20-046178

FACTS: On or about June 4, 2020, the claimant sustained an injury to his bilateral shoulders while attempting to pull a 50-foot hose that was full of fuel across the grass. The case was accepted as compensable and the claimant was sent to Dr. Kostman at the employee’s request, who performed prior surgeries to the claimant’s shoulders, on the right in 2005 and on the left in 2009. Dr. Kostman diagnosed bilateral shoulder strains and recommended conservative treatment including physical therapy and a selective injection to each shoulder along with the anti-inflammatories. The doctor placed him at MMI on February 24, 2021and assessed 0% disability to each shoulder.

The claimant’s attorney obtained a report of Dr. Volarich, who assessed 25% disability to each shoulder as a result of the work accident.

The only dispute was the nature and extent of PPD. The judge assessed 10% to each shoulder along with a 10% load. The decision was appealed and the Commission affirmed.

Amputation Not Compensable as Work Accident Was Only a Triggering or Precipitating Factor in Causing Claimant’s Medical Condition and Disability

Hasselbring v. Macon County Nursing Home District and Treasurer of Missouri as Custodian of Second Injury Fund, Case No. WD87278 (Mo. App. 2025)

FACTS: In mid-2021, the claimant, who worked at a nursing home, began noticing pain in his left calf when he would walk long distances. In August 2021, after mentioning his pain to his cardiologist, the claimant was sent for a CT scan and a vascular surgeon told him he had a closed popliteal aneurysm in his leg, and because the aneurysm had completely closed off the condition was not acute, and the claimant developed some collateral blood flow to his foot. The doctor recommended that he undergo vein mapping and likely a vein bypass but did not insist that he do so immediately.

Then on November 3, 2021, the claimant was helping a resident out of a vehicle and the resident rolled her electric wheelchair over the claimant’s left foot. He immediately felt sharp pain going all the way down his left leg into his foot. The claimant went home and his wife looked at his foot and kept saying that his foot was white, which meant that he did not have any circulation, and she took him to the emergency room. At the hospital, the doctor noted that the claimant had acute ischemia and performed surgery to do everything possible to save his leg, but his left leg was amputated above the knee two days after the work accident. Thereafter, he was unable to return to work, had to use a wheelchair and was learning to use a prosthesis. The claimant took the matter to a hearing and the ALJ awarded benefits. The employer appealed to the Commission and reversed the Award, finding the employer’s expert credible, stating that the prevailing factor in the claimant’s loss of limb was an occluded left large popliteal artery aneurysm. The Commission found that the work accident was “merely a triggering or precipitating factor in causing employee’s medical condition and disability.” The claimant appealed.

HOLDING: The Court noted that an injury by accident is compensable only if the accident was the prevailing factor in causing both the resulting medical condition and disability. The Court noted that while both the treating physician and the employer’s expert agreed that the wheelchair accident was the prevailing factor of the “crush injury” to the claimant’s left foot, the employer’s expert, whose opinion the Commission found more credible, did not conclude that the crush injury was the prevailing factor in causing the claimant’s disability. The expert testified that absent the claimant’s preexisting popliteal aneurysm, the crush injury or soft tissue damage would have been a benign event which would have been treated with leg elevation, ice and anti-inflammatories. In other words, the soft tissue injury would not have resulted in disability. In light of this, the Commission’s denial of benefits was affirmed.

Occupational Diseases Are Not Compensable Pre-existing Injuries That Trigger Fund Liability

Treasurer of the State of Missouri Custodian of the Second Injury Fund v. Penney, Case No. SC100693 (S. Ct. 2025)

FACTS: The claimant worked as a pharmacy technician from 1980 to 2019. In June of 2018, the claimant filed an occupational disease claim involving her low back. In February 2019, she filed another occupational disease claim involving her neck and upper back. In March 2019, the claimant filed her final occupational disease claim involving right carpal tunnel syndrome and ulnar nerve entrapment at the elbow on the left side. The claimant sought PTD benefits from the Fund. At a hearing, the ALJ concluded the claimant was permanently and totally disabled and determined that the Fund was responsible for benefits. The Fund appealed, arguing that the ALJ improperly considered the claimant’s preexisting occupational diseases as they are not compensable injuries pursuant to the statute. The Commission disagreed and affirmed the ALJ’s award of PTD. The Fund appealed.

HOLDING: The claimant alleged that her occupational diseases were a “direct result of the compensable injury as defined in Section 287.020.” The Fund argued that occupational diseases do not qualify under that subsection. The Court noted that there are two types of compensable injuries, injuries by accident and injuries by occupational disease. The Court noted that while occupational diseases are “compensable” under Section 287.067, the legislature chose to limit preexisting injuries that qualify under Category 2 to compensable injuries as defined in Section 287.020, the section pertaining to injuries sustained by accident. Therefore, the Commission’s decision was reversed and the claimant was not entitled to benefits from the Fund.

White v. Treasurer of the State of Missouri as Custodian of the Second Injury Fund, Case No. ED113099, Mo. App ED 2025

FACTS: In 2020 the claimant injured his chest while working on an overhead load spring on an industrial vacuum truck. He settled his chest injury for 12.5% disability. He had various preexisting conditions but relevant here was his October 2010 occupational disease claim involving his bilateral shoulders. He settled that claim for 23% of each shoulder or 106.72 weeks total. The ALJ determined that the Fund was liable for benefits based on his 2010 shoulder injury and the 2020 chest injury. The Fund appealed arguing that the claimant’s preexisting occupational disease claims did not qualify under the statute as occupational disease claims are not a compensable injury. The Commission affirmed the ALJ’s Award. The Fund appealed.

HOLDING: The Court noted that while this case was under appeal, the Supreme Court decided that occupational diseases are not compensable to trigger Fund liability and therefore are not covered by the Second Injury Fund. In light of this decision, the Commission’s decision was remanded for the Commission to consider whether the Fund had any liability as a result of any other qualifying preexisting disabilities.

All Pre-existing Disabilities Must Meet 50-Week Threshold for Fund Liability

Jarvis v. Treasurer of the State of Missouri as Custodian of the Second Injury Fund, Case No. ED113075 (Mo. App. 2025)

FACTS: The claimant worked as an iron worker and sustained multiple injuries throughout his employment. In 2001 the claimant sustained injuries to his right ankle and both arms and settled his claim for 57.75 weeks for the right elbow, 43.75 weeks for the left wrist, and 46.5 weeks for the right leg. He was awarded a 10% load and 21 weeks of disfigurement. In 2011 he sustained an injury to his right wrist and settled that claim for 20% disability. In 2015 he sustained his primary injury involving his bilateral legs and reached a settlement with the employer and proceeded with a Hearing against the Fund.

The claimant’s attorney obtained a report of Dr. Volarich who assessed disability with respect to the primary and preexisting conditions and opined that he was likely permanently and totally disabled as a result of the 2001 and 2015 injuries. He also obtained a vocational report of Mr. Lalk who ultimately concluded that if the claimant needed to elevate his leg as a result of the primary injury he would PTD as a result of the last injury alone. At a Hearing the ALJ determined that as a result of the 2001 injury the claimant sustained 57.5 weeks disability to the right elbow, 54.25 weeks for the right left and 43.75 weeks for the left wrist. The ALJ found the claimant failed to prove that he was entitled to benefits against the Fund as the left wrist injury did not meet the 50-week threshold. The claimant appealed and the Commission affirmed the ALJ’s decision denying benefits. The claimant again appealed.

HOLDING: The Court noted that it has been reiterated by the Supreme Court that a claimant may not rely on a non-qualifying preexisting disability to prove that he or she is PTD. The Court went on to note that Dr. Volarich’s PTD determination was based on the claimant’s primary injury combining with all three of his preexisting disabilities and since one of those was not worth 50 weeks, the claimant is not eligible for Fund benefits. The Commission’s decision was affirmed.

All Pre-existing Disabilities Must Meet 50-Week Threshold for Fund Liability; Load Factors Do Not Apply

Eckardt v. Treasurer of Missouri as Custodian of the Second Injury Fund, Case No. SC100784 (S. Ct. 2025)

FACTS: The claimant worked as an aircraft mechanic in 1976. He sustained multiple injuries over the years, the last or primary injury in October of 2015 which resulted in a spinal fusion. He retired as he could no longer perform his job. The claimant sought disability benefits from the Fund and the ALJ found the following preexisting permanent partial disabilities: right knee, 80 weeks; left knee, 80 weeks; left shoulder, 92.8 weeks; left wrist, 78.75 weeks; right wrist, 70 weeks; and right shoulder, 46.4 weeks. The claimant’s attorney presented three reports and in the last report the doctor stated that the claimant was PTD due to the primary injury in combination with all six of his preexisting disabilities. The ALJ acknowledged that the right shoulder injury did not reach the statutory threshold of 50 weeks, but found the doctor’s reliance on that injury “not significant when considering all of the qualifying preexisting injuries.” The ALJ did believe the claimant was PTD and the Fund was responsible for benefits. The Fund appealed, arguing that occupational diseases do not qualify and that the claimant’s right shoulder injury did not qualify.

The Commission reversed the ALJ’s award and denied the claim. The claimant appealed, arguing that the Commission misconstrued the evidence by finding the doctor relied on a non-qualifying right shoulder injury and in the alternative argued that a load factor should apply to enhance the amount of PPD attributed to his right shoulder injury, pushing it over the 50-week statutory threshold.

HOLDING: The Court disagreed with the claimant’s argument that a load factor is appropriate, as they noted that as of January 1, 2014, the legislature eliminated claims for PPD and in doing so also eliminated the load factor analysis. The Court went on to further note that nothing in the statute permits or even suggests a load factor may be applied to increase the amount of PPD attributed to a preexisting disability. Therefore, the Court rejected the argument that a load factor should apply. Also since the doctor’s opinion with respect to perm total disability included the claimant’s non-qualifying right shoulder injury, the claimant did not meet his burden in establishing Fund liability. The Commission’s decision was affirmed.

Pre-existing Condition Must Be Medically Documented but Documentation of Medical Condition and Rating for That Condition Can Come From Different Sources

Wetzel vs. Treasurer of Missouri as Custodian of the Second Injury Fund, Case No. WD87372 (Mo. App. 2025)

FACTS: The claimant sustained his primary injury on March 23, 2018 which involved a crush injury to both legs which required surgery. Thereafter he never returned to work. He settled his case against the employer for 33.5% PPD to his left and right lower legs at the 160-week level. He proceeded to a Hearing against the Fund for PTD benefits based on a 1989 work injury. At the Hearing he testified that he suffered compression fractures to his spine at L1, L2, and L3 and following that accident he settled his case for 17.5% disability to the body referable to the low back. The Stipulation was admitted into evidence. He testified that he continued to suffer back pain, and he visited an orthopedics practice in September and October of 2017 to seek treatment for his low back. He did admit those records into evidence at the Hearing. The Fund objected to admission of those records, but it was overruled by the ALJ. The records included a summary of the claimant’s description of his 1989 low back workplace injury, the reported lingering effects of that injury, and treatment he reported receiving since that time. Also, it included a physical examination, x-ray, and MRI imaging which showed that the claimant did have chronic vertebral compression fractures along with moderate degenerative disc disease and other degenerative conditions. At these 2017 visits, physical therapy was recommended along with medications. The ALJ concluded that the Second Injury Fund was liable for perm total benefits. The Second Injury Fund appealed arguing that the claimant’s self-reported history communicated to doctors to support the low back disability related to the 1989 prior work injury did not establish that the claimant’s low back disability was “medically documented” as to qualify as a preexisting disability. The Commission agreed and reversed the decision of the ALJ. The claimant appealed.

HOLDING: The claimant argued that the medical records from September and October from 2017 contained much more than unsupported statements of preexisting disability in that it provided clear and undisputed evidence of the claimant’s preexisting back injury, including diagnosis and treatment and the court agreed. The Fund argued that this case was similar to Dubuc, and it was determined in that case that the claimant’s own statements about his prior hernias although recorded by doctors and medical records do not conclusively support that any doctors have medically documented the claimant’s preexisting condition. However, the Court distinguished this case noting that the statute nor Dubuc prohibit a doctor from providing a competent and admissible disability rating for self-reported preexisting disability without having reviewed medical documentation of that disability. Instead, as long as there is medical documentation of a preexisting disability and a disability rating for the same preexisting disability equaling 50 weeks or more, it is immaterial that the evidence comes from different sources. The Court went on to note that the records clearly document the claimant’s report of a prior back injury and there was also medical documentation of fractures including a physical exam and diagnostic testing and therefore the medical records qualify as medical documentation of the claimant’s preexisting low back injury. Therefore, it was determined that the claimant was PTD, and the Fund was liable for benefits.