John D'Angelo v Metropolitan St. Louis Sewer District and Treasurer of Second Injury Fund
Release Date: May 7, 2020 (Accident date March 1, 2015)
Venue: St. Louis County
Plot Summary: The Commission in a 2-1 decision denies PTD benefits against the SIF on a failure to prove with admissible evidence the extent of pre-existing disability for aortic stenosis to reach the minimum threshold disability without reaching the second prong if it meets a qualifying condition Claimant sustained a cardiac "event" about 10 months after a work injury to the humerus.
Inj. No. 15-012160
Cast
Denigan
Kister
Sides
Ricci
Schuman
Shea
Hughes
Gonzalez
Knight
Comments
The ALJ found expert opinion about a prior cardiac conditions was excluded based on a Seven Day Rule Objection and due to "well-taken mischaracterization objection" (testimony that a finding post accident concerning a cardiac condition was a finding prior to the accident). The ALJ concludes any cardiac disability was from post accident worsening but not caused by the accident and the need for cardiac surgery had nothing to do with the shoulder injury. The Commission majority agreed that the cardiac condition became spontaneously worse after the accident independent of any orthopedic injury.
Claimant's testimony about the magnitude of his cardiac problems after the accident appears largely undisputed including his testimony that around the time of his repair he "coded" multiple times and went into a coma. It is undisputed the cardiac condition put claimant at increased risk for orthopedic repair, which never occurred. The pivotal issue is whether the condition could be considered a disability for fund liability when the diagnosis of "severe stenosis" occurred 8 months after the primary injury. Despite medical evidence of a aortic stenosis at the time of the accident or predating the accident, claimant's denial of associated symptoms prior to accident made any claim of his disability more challenging, The evidence further did not include an admissible rating to define the degree of prior disability. The dissent indicated claimant had a aortic stenosis prior the accident and associated symptoms are not necessary to show disability.
Claimant must establish enough disability to trigger fund benefits. The SIF claim stumbled on a procedural issue as claimant's expert supplement his opinion in testimony with statements that he found 15% prior disability when he had rated the prior condition. It is not clear why the opinion was not defined prior to the deposition.
The Commission noted 287.220.3 applies (noting the ALJ identified the wrong section) and declined to reach the issue if the facts otherwise satisfied the .3 criteria (aggravation prong). The Commission adopts the ALJ's credibility finding that Dr. Schuman is more credible between the two experts and claimant failed to show disability from his cardiac condition pre-dating the accident. It affirms the seven day rule objection when claimant's expert had not expressed an opinion defining the amount of prior disability before testifying. [There is no reference about trying to reschedule the deposition to mitigate or cure the objection.]
A dissent felt prior cardiac disability could be inferred from the medical records based on the diminished size of his aortic valve prior to the primary accident and noted medical opinion stated such a diminished size qualified claimant for replacement. The problem is inferring the amount of prior disability to meet the minimum threshold. Although claimant denied prior symptoms, it is unclear what symptoms he may have had leading to the pre-accident evaluation and testing.
By comparison, the Commission in Atchison v Tyson Poultry, 2020 MO WCLR LEXIS 90, https://labor.mo.gov/sites/labor/files/decisions_wc/AtchisonJames07-08768710-16-19.pdf found a pre-existing spinal condition supported SIF liability on a new back case based on evidence the primary injury aggravated the prior condition and the effects of the pre-existing conditions rendered the primary condition inoperable. It was noted in that case "It is difficult to conceive of a more synergistic effect than one which renders the primary
injury inoperable. Claimant has provided credible testimony that his pre-existing disability has
become disabling as a result of the fall, which left him with chronic pain. It is also clear that the
pre-existing, and now debilitating and painful pre-existing condition, is a hindrance to Claimant's
re-employment."
What's it worth?
benefits denied on SIF PTD claim (employer settled)
