Title: TIMMY S . PARRIS V. STAFFING ALTERNATIVE, INC . ; HON . KEVIN KING, ADMINISTRATIVE LAW JUDGE ; AND WORKERS' COMPENSATION BOARD
Citation: N/A
Docket Number: 2004-SC-000009-WC
State: Kentucky
Issuer: Kentucky Supreme Court
Date: November 15, 2004

IMPORTANTNOTICE NOT TO BE PUBLISHED OPINION THIS OPINIONISDESIGNATED "NOT TO BE PUBLISHED. " PURSUANT TO THERULES OF CIVIL PROCEDURE PROMULGATED BYTHE SUPREME COURT, CR 76.28 (4) (c), THIS OPINION IS NOT TO BE PUBLISHEDAND SHALL NOTBE CITED OR USED ASAUTHORITYINANYOTHER CASE INANYCOURTOF THIS STATE. $uyrrmt (~vurf of "t 2004SC-0009-WC -JAcr TIMMY S . PARRIS APPELLANT APPEAL FROM COURT OF APPEALS V . 2003-CA-0216-WC WORKERS' COMPENSATION BOARD NO . 98-59462 STAFFING ALTERNATIVE, INC . ; HON . KEVIN KING, ADMINISTRATIVE LAW JUDGE ; AND WORKERS' COMPENSATION BOARD APPELLEES MEMORANDUM OPINION OF THE COURT REVERSING AND REMANDING RENDERED : OCTOBER 21, 2004 NOT TO BE PUBLISHED After reviewing the evidence presented in a reopening proceeding, an Administrative Law Judge (ALJ) dismissed the claimant's request for greater income benefits, noting that there was no evidence of a worsening of impairment as required by KRS 342 .125(1)(d) and that the medical evidence showed a change in his symptoms but no objective change in his condition. The Workers' Compensation Board (Board) and the Court of Appeals determined that the ALJ's interpretation of the statute was correct and affirmed . Having concluded that the ALJ misinterpreted the effect of KRS 342 .125(1)(d) and conducted an inadequate analysis of the evidence, we reverse and remand this matter for further consideration. The claimant was born in 1969 . He completed high school but had no specialized or vocational training . Although he had worked as a stock clerk and cashier at a small grocery store and as a coal sampler, he spent the majority of his work-life as an underground coal miner. In 1997, he began working for the defendant-employer as a pin man. On October 20, 1998, he was injured when the pinner malfunctioned and pushed him through the corner of the mine wall and into a pile of boards . Taken by ambulance to the emergency room, he complained of right-sided abdominal pain and exhibited large abrasions over the right upper quadrant, extending laterally to the axillary area . He was hospitalized with diagnoses of blunt abdominal trauma to the right side and contusion of the abdomen. Chest and pelvic x-rays were normal as were CT scans of the abdomen and pelvis . No blood was found in the gastric fluid or urine. When discharged the next day, he continued to complain of generalized pain but was able to walk without difficulty and tolerate a regular diet . Dr . Rao gave him pain medication and advised him to return for follow-up in one week . The claimant returned on October 28, 1998, complaining of chronic low back pain . Later, he complained of lower back pain on the right side and of numbness in the right leg, for which he was treated by numerous physicians . A September 2, 1999, office note by Dr . Mick indicated that the claimant reported feeling better and becoming more active in terms of swimming and walking. It also indicated that he had apparently been told by Dr. MacGregor that he was at maximum medical improvement (MMI) but stated that he refused to return to work because he thought he was unable to do so. The note indicated, however, that Dr . Mick was releasing the claimant to return to work on September 6, 1999 . On September 7, 1999, Dr. MacGregor saw the claimant for a re-evaluation of his lower back and leg pain. He continued to complain of back pain and of difficulty walking . Dr . MacGregor's diagnoses were chronic low back pain, sciatic nerve contusion, and radiculopathy. In his opinion, the claimant continued to be at MMI and to have permanent restrictions that permitted only rare bending and twisting and prohibited lifting over 25 pounds, frequent lifting of 11-25 pounds, and constant lifting of between 1 and 10 pounds . He assigned a 10% AMA impairment under DRE category III with radiculopathy . He noted that the radiculopathy was documented by diagnostic testing and that the claimant had weakness in the toe extensors, right foot, in the L5 dermatome . The claimant's current medications were Amitryptyline, Neurontin, Lortab, and Ultram . Although the claimant consulted with legal counsel, no application for benefits was filed . He and the employer agreed to settle any potential claim on September 27, 1999, at which time he was not represented by counsel . As approved on November 16, 1999, the agreement provided for a lump sum payment of $17,924.01 that was based upon a 10% impairment, a statutory factor of 1 .0, a KRS 342.730(1)(c)1 multiplier of 1 .5, and an average weekly wage of $658.32 . It did not include a waiver of future medical expenses . At the time, the claimant had not returned to work . In February, 2001, the claimant was awarded Social Security disability benefits . On December 3, 2001, he moved to reopen his workers' compensation award, accompanying the motion with his own affidavit and an October 10, 2000, medical report from Dr. Mallari . Convinced that the claimant made an adequate prima facie showing, an AU granted the motion and permitted the parties to take additional proof. The evidence at reopening consisted of the claimant's testimony; medical records from the Trover Clinic and Regional Medical Center in Madisonville ; reports from Dr . Popescu, the claimant's family doctor; and a vocational report from Dr . Wagner. Medical records documented the claimant's treatment from the date of the injury through May 24, 2002, for chronic back pain, depression, and anxiety . Neither party submitted an independent medical evaluation or deposed any of the physicians . Post-settlement treatment by physicians associated with the Trover Clinic included various diagnostic tests, physical therapy, acupuncture, nerve blocks and trigger point injections, and medication for pain relief, muscle spasms, numbness, anxiety, sleeplessness, and hypertension . Dr. MacGregor ordered a repeat EMG/NCV study of the right lower extremity on November 2, 1999, when the claimant complained of a worsening of his symptoms, of urinary frequency, and of occasional bowel urgency . At that time, Dr . McGregor's assessment was chronic low back pain and a questionable worsening radiculopathy of the right leg . Nerve conduction studies performed on November 24, 1999, were essentially normal, but the absence of an F-wave of the right common peroneal nerve and the presence of positive waves at the lumbar spine indicated that there might be nerve root involvement . On February 9, 2000, after a colleague determined that the claimant was not a surgical candidate, Dr. MacGregor referred him to Dr. Mallari for pain management therapy . Dr . Mallari treated the claimant with acupuncture, IMS, and medication . As of August 16, 2001, he diagnosed lumbosacral radiculitis, lumbar radiculopathy, myofascial pain, joint dysfunction, and spondylosis . A statement from Dr . Mallari, dated October 10, 2000, limited the claimant from sitting or standing for more than 30 minutes, from walking with a cane for more than 30 minutes, and from any bending or stooping . It also indicated that he could not complete an eight-hour work day performing even sedentary work, that his prognosis was fair, that whether his condition was expected to improve was undetermined, and that the duration of his condition was indefinite . On May 15, 2002, the claimant sought treatment for problems with urinary retention of several weeks' duration . Dr . Popescu noted that the claimant's current medications were Percocet, Valium, Neu~rontin, and Verapamil . He indicated that the urinary problems were probably due to the Percocet . His May 22, 2002, report enumerated restrictions that were nearly identical to those Dr . Millari imposed in 2000 and indicated that they were permanent . Dr . Wagner, a psychologist and vocational expert, reported on May 17, 2002, that the claimant would not be able to engage in any "substantial gainful work activity on a competitive basis ." The claimant testified that his symptoms worsened since the settlement despite the treatment . His present symptoms included numbness, muscle spasms, and coldness in his lower right leg and foot ; pain and pressure in his right knee ; pain, muscle spasms, and knots in his back and hip ; pain in his right arm and shoulder from relying on a cane to walk ; anger and depression. He stated that he was no longer able to return to work as a coal miner. When cross-examined, he stated that when he settled the initial claim he was experiencing constant pain in his right buttocks and right lower back and occasional numbness in his right foot . He also testified that he did not take all of the medication that was prescribed at that time . Addressing the merits of the reopening, the AU stated : KRS 342.125(1)(d) provides that a claim can be reopened upon a showing of a "change of disability as shown by objective medical evidence of a worsening or improvement of impairment due to a condition caused by the injury since the date of the award or order." This portion of the Act requires the moving party to show, with objective medical evidence, a change of disability and an increase in impairment . The medical evidence indicates that [the claimant] had a 10% impairment at or near the time he settled his claim . There is no evidence that his impairment has changed . Furthermore, the medical evidence since [his] settlement reveals a change in symptoms but does not show any objective change in his condition . Based on the above, the Administrative Law Judge must dismiss [his] claim for additional income benefits . The claimant petitioned for reconsideration, asserting that the ALJ failed to state reasons for rejecting uncontradicted lay and medical evidence . He argued that he was released to return to work shortly before the settlement, that his medical treatment had changed dramatically since the award, and that both his treating physician and vocational expert were of the opinion that his present disability was total . Denying the petition, the ALJ stated that the 1996 Act required evidence of increased impairment before the claimant's ability to work could be considered . The claimant asserts that the ALJ misinterpreted KRS 342 .125(1)(d) by requiring a greater AMA impairment rating and that the ALJ failed to state a basis for ignoring the uncontradicted lay and medical evidence . He maintains that the record compelled a finding that he was permanently and totally disabled at reopening . The employer asserts, however, that the claimant was required to prove a greater AMA impairment, that he failed to do so, and that the lay and medical evidence showed a continuation of the condition that existed at settlement but no worsening of the condition . Having determined that the ALJ misinterpreted the effect of KRS 342 .125(1)(d) and failed to adequately analyze the evidence, we have concluded that the decision should have been reversed and that the claim should have been remanded for further consideration . In Dingo Coal Co . v. Tolliver, Ky ., 129 S .W.3d 367, 370 (2004), we explained that KRS 342 .125(1)(d) is procedural and addresses the necessary prima facie showing in order to prevail on a motion to reopen . It does not govern the substantive requirements for proving a worker's right to additional benefits under KRS 342 .730 in a claim that has been reopened . KRS 342.125(6) . The claimant's injury occurred on October 20, 1998 ; therefore, his entitlement to income benefits is governed by the version of KRS 342.730 that became effective on December 12, 1996 . The terms "impairment" and "disability" are not synonymous for the purposes of awarding income benefits . When enacting the 1996 amendments, the legislature employed different standards for measuring total and partial disability . Although an AMA impairment is a prerequisite to a finding of total disability under the 1996 Act, some of the Osborne v. Johnson , Ky., 432 S.W.2d 800 (1968), factors also remain relevant . KRS 342 .0011(11)(c) ; Hill v . Sextet Mining Corp . , Ky., 65 S.W.3d 503, 508 (2001) ; Ira A . Watson Department Store v . Hamilton , Ky., 34 S.W.3d 48 (2000) . Awards under KRS 342 .730(1)(a) are based upon the existence of an AMA impairment and a proper finding of permanent total disability. KRS 342 .0011 (11)(b) provides that injured workers who retain the ability to work but have a disability rating are partially disabled . KRS 342 .730(1)(b) measures partial disability due to an injury by multiplying the resulting AMA impairment and a corresponding statutory factor that is weighted to favor greater impairments . KRS 342.0011(36) . In other words, KRS 342 .730(1)(b) bases the amount of a partial disability award on the amount of AMA impairment . Among other things, reopening addresses post-award changes that affect the injured worker's entitlement to income benefits . The difference in the way partial and total disabilities are measured is significant when analyzing whether a worker is entitled to additional income benefits at reopening . A worker who retains the ability to work but asserts that he is more disabled since the initial award must show increased impairment in order to obtain additional income benefits under KRS 342.730(1)(b) . However, a worker who seeks an award under KRS 342 .730(1)(a) must show that his disability has increased since the initial award and has become total . KRS 342 .125(7) [formerly KRS 342 .125(3)] provides that where an award is the product of a settlement, no statement contained in the agreement is considered an admission against the interests of any party at reopening . Regardless of the figure for which the claim was settled, benefits are awarded at reopening based upon the difference between the actual disability the injury caused at the time of the settlement and the disability it causes at reopening . See Newberg v . Davis , Ky., 841 S .W .2d 164 (1992) . This appeal was taken from a decision on the merits of the claimant's right to additional benefits at reopening ; therefore, KRS 342.125(1)(d) is no longer applicable . Dingo Coal Co . v. Tolliver , supra . The settlement provided for an income benefit that was based upon a 10% disability (i .e ., a 10% impairment and a factor of 1 .0) . The claimant alleged a post-award change of disability; therefore, the ALJ must begin the analysis by determining the actual disability the injury caused as of the settlement . If the ALJ determines under KRS 342.0011(11)(c) and Ira A . Watson Department Store v. Hamilton , supra, that the injury caused a total disability at settlement, additional income benefits are not permitted, and no further analysis is required . If the ALJ is convinced that the injury did not cause a total disability at settlement, the ALJ must determine the claimant's actual disability based upon the impairment the injury caused at that time . Then, turning to the claimant's condition at reopening, the ALJ must determine whether his disability due to the injury was total under KRS 342 .0011(11)(c) and Ira A . Watson Department Store v. Hamilton , supra . If so, the claimant is entitled to income benefits for total disability regardless of whether his impairment increased after the settlement. If not, the claimant's failure to present any evidence of a post-award increase in AMA impairment would preclude a greater partial disability award . The decision of the Court of Appeals is reversed, and the claim is remanded to the ALJ for additional findings that are consistent with this opinion . All concur. COUNSEL FOR APPELLANT : Dick Adams Thomas Elmus Springer, III Adams Law Firm 28 Court Street Madisonville, KY 42431 COUNSEL FOR APPELLEE : Stephen B . Lee 227 St . Ann Street, Suite 308 P .O . Box 308 Owensboro, KY 42302