Title: Ray v. Shelnutt Nursing Home
Citation: 439 S.W.2d 41
Docket Number: 5-4863
State: Arkansas
Issuer: Arkansas Supreme Court
Date: April 7, 1969

439 S.W.2d 41 (1969) Hazzle Pauline RAY, Employee, Appellant, v. SHELNUTT NURSING HOME, Employer, et al., Appellee. No. 5-4863. Supreme Court of Arkansas. April 7, 1969. *42 McMath, Leatherman, Woods &amp; Youngdahl, and Silas H. Brewer, Jr., Little Rock, for appellant. Terral, Rawlings, Matthews &amp; Purtle, Little Rock, for appellee. JONES, Justice. This is a workmen's compensation case and the extent of permanent partial disability to the body as a whole is the question involved. The facts very briefly are these: On November 24, 1965, Mrs. Pauline Ray injured her back while in the course of her employment as a practical nurse by the Shelnutt Nursing Home. The injury occurred when Mrs. Ray fell partially to the floor while attempting to assist an aged patient into a wheel chair. The injury resulted in the surgical removal of an intervertebral disc at the lumbosacral angle followed by a spinal fusion from the fifth lumbar vertebra to the sacrum on December 21, 1965. Mrs. Ray was paid compensation benefits for temporary total disability from the date of her injury until the end of her healing period on March 3, 1967. The claim before the Workmen's Compensation Commission was for a determination of the extent or percentage of permanent partial disability. The employer and its compensation insurer carrier controverted the claim for any permanent partial disability in excess of 20%. The Commission awarded 40% permanent partial disability to the body as a whole and the employer and compensation insurance carrier appealed to the Saline County Circuit Court. The circuit judge held that there was no substantial evidence to sustain the Commission in awarding more than 20% permanent partial disability and Mrs. Ray brings this appeal, relying upon the following point for reversal: *43 We agree with the circuit court that there was no substantial evidence to sustain the Commission's award of more than 20%. We recognize the controlling legal standards expressed by this court in all the cases cited by the appellant. We recognize that evidence in a compensation case should be given its strongest probative force in favor of the action of the Commission. We recognize the responsibility of the Commission in drawing inferences from testimony open to more than a single interpretation. We recognize that the determination of the percentage of permanent disability in a workmen's compensation case is a function of the Commission not to be disturbed on appeal if supported by substantial evidence, and we also recognize that the degree of disability suffered by an injured employee is a factual question to be determined by the Commission as stated in Caddo Quicksilver Corporation v. Barber, 204 Ark. 985, 166 S.W.2d 1, cited by the appellant. The appellant cites the cases of Glass v. Edens, 233 Ark. 786, 346 S.W.2d 685, and Wilson &amp; Company, Inc. v. Christman, 244 Ark. 132, 424 S.W.2d 863, in support of her contention, but those cases are clearly distinguishable from the case at bar. The appellant argues in her brief that "the landmark decision in Glass v. Edens * * * firmly established the doctrine that the Commission must consider numerous factors, in addition to functional or anatomical impairment in determining an injured workmen's permanent partial disability." If such doctrine was firmly established in Edens, it only applies when such additional factors pertain to disability and are presented to the Commission by competent evidence. In the Edens case the Full Commission affirmed a referee's finding of a 40% permanent partial disability to the body as a whole based entirely on a medical rating of 40% under the erroneous assumption by the referee, that he was dealing only with scheduled injury and was limited to the consideration of medical evidence only under a former decision of the Full Commission. The referee in the Edens case said: In remanding the Edens case for further consideration, this court said: There is nothing startling or so unusual about the decision of this court in the Edens case that marks it as a "landmark decision." That decision would have really been a landmark decision had we agreed with the referee and, held that evidence *44 other than clinical findings could not be considered in determining the extent of permanent partial disability and that only the medical rating of functional disability could be considered for that purpose. If such had been our holding, we would have eliminated the need for a referee or a Commission in determining extent of permanent partial disability. While in so holding we would have greatly lightened our own task in determining the substantial nature of evidence submitted in a permanent disability case, we would have practically repealed the "other sections of the Workmen's Compensation Law," referred to in the Edens decision, including the statutory definition of disability. Only one disability, in all its degrees as to partial, total, temporary and permanent, is defined in Ark.Stat.Ann. § 81-1302(e) (Repl.1960) as follows: Our decision in the Edens case did not establish the doctrine that the Commission must consider numerous factors in addition to functional or anatomical impairment, in determining an injured workmen's permanent partial disability. We did not say in that case that the Commission must do anything. What we did say was that the Commission is not confined, in its consideration, to clinical proof or medical evidence alone, in arriving at the extent of permanent disability suffered by an injured employee under the Workmen's Compensation Law. In Edens we simply held, in effect, that the legislature had not placed the Commission in a medical strait jacket in determining disability as defined in the act, permanent or otherwise. We did not know then, and we do not know now, what substantial evidence, other than the medical evidence, was before the Commission and available for its consideration in the Edens case. If there was other evidence before the Commission, it erroneously failed to consider it. The purpose in sending that case back to the Commission was for consideration of such other evidence as may have been before the Commission in that case, but which the Commission concluded it had no right to consider. The substantial nature of the evidence other than medical, marks the distinction between Wilson &amp; Company, Inc. v. Christman, supra, and the case at bar. In the Christman case, Christman sustained a similar injury and had a similar education as the appellant in the case at bar. In that case 30% permanent partial disability was the highest amount by medical evidence and we affirmed the Commission's award of 60%. Two of Christman's former employers, for whom he had performed his lightest tasks, testified that they would not re-employ him on the basis of the medical reports. Aside from Christman's own testimony as to his constant pain, the medical evidence, with emphasis supplied, was as follows: Dr. William G. Lockhart, a neurosurgeon of the Holt-Krock Clinic in Fort Smith, who performed the surgery on Christman, reported as follows: In the Christman case we quoted from Larson's Workmen's Compensation Law, § 42.22, as follows: We also pointed out in the Christman case "there is evidence in the record that appellee suffered poor eyesight as an additional handicap to some types of employment." Now turning to the case at bar, the members of the Full Commission examined the record for the preponderance of the evidence whereas, this court, as well as a circuit court on appeal, must examine the record for substantial evidence to support the finding of the Commission. The referee, who heard the witnesses and observed their demeanor while testifying, summed up his impression of the appellant in the following language: There is nothing in the record to refute the referee's impression of the appellant, and therein lies part of the distinction between the case before us and the Christman case. Hysterical paralysis and partial blindness, as was evident in the Christman case, were not even suggested in the case at bar, and appellant agreed in oral argument that traumatic neurosis is not contended as a contributing factor. On direct examination the appellant gave her work history prior to her injury, but gave no testimony as to work history, attempts to work, or ability or inability to *46 work since her injury and surgery. On cross-examination the appellant testified as follows: Appellant testified as to what the doctors had told her relative to the work she could do and what she should avoid, and she testified as to the types of work she had done prior to her injury. She offered no testimony at all, of a substantial nature, pertaining to her ability to earn in the same or other employment, the wages she was receiving at the time of her injury. Dr. McKenzie, one of the orthopedic surgeons who performed appellant's spinal fusion, testified as follows: Dr. McKenzie re-examined appellant in October 1967, and as to this examination, he testified as follows: Dr. R. H. Whitehead, a specialist in psychiatry, testified as to neurotic overlay in appellant's condition upon his one examination. His testimony was not considered by the referee and it was stated in oral argument in answer to specific questions, that no claim was made for traumatic neurosis. Several medical reports were accepted in evidence, but they were all progress reports *48 and contribute nothing of a substantial nature to the evidence relative to permanent disability. Dr. Horace Murphy, an orthopedic surgeon, examined the appellant and although his x-ray examination failed to reveal the fusion between the fifth lumbar vertebra and the sacrum, his testimony on permanent partial disability is as follows: On cross-examination, Dr. Murphy testified as follows: Dr. Murphy sums up as follows: The appellee earnestly contends that a substantial portion of such residual disability as appellant does have, is a result of disease and accidental injuries suffered and sustained by the appellant prior and subsequent to the injury sustained in the course of her employment by the appellee. Dr. Murphy answers that argument with the observation that even Solomon could not differentiate one from the other. The record indicates that the appellant was doing her work in a satisfactory manner while employed by the appellee prior to her injury. As to prior injury resulting in noncompensated disability, industry takes an employee as is. Regardless of other falls or injuries subsequent to surgery in this case, the defective disc was removed by surgery, the defective disc space was spanned by surgical fusion and the fusion was found to be solid upon final examination and discharge by the attending physicians. One disc and one fusion were all that was involved in this case. There is considerable controversy between the parties in this case as to whether the medical testimony pertaining to a 20% permanent partial disability relates to functional disability consisting only of physical limitation in the normal functional use of the body, or whether the doctors considered, and were also talking about, the statutory definition of disability pertaining to loss in ability to earn in the same or other employment the amount of wages the appellant was receiving at the time of her injury. Be that as it may the medical evidence was the only evidence the referee or the Commission had to go on in arriving at their conclusions in this case. We recognize, as we did in Wilson &amp; Co. v. Christman, supra, that the Commission is in a better position than is the doctor, to evaluate a claimant's ability to earn in the same or other employment the same wages received at the time of injury. When the Commission once has before it firm medical evidence of physical impairment and functional limitations within the peculiar knowledge and specialty of the examining physician, the Commission then has the advantage *50 of its own superior knowledge of industrial demands, limitations, and requirements in weighing the medical evidence of functional limitations together with any other evidence of how the functional disability will affect the ability of the injured employee to obtain or hold a job and thereby arrive at a reasonably accurate conclusion as to the extent of permanent partial disability as related to the body as a whole. As an example, in the case at bar, Dr. McKenzie testified "well I don't know what a floor lady is." The Commission's knowledge and experience, however, is not evidence, and the Commission can only apply its own knowledge and experience of industrial requirements as a jury might do in weighing all the competent evidence pertaining to handicaps suffered by each individual claimant as a result of compensable injury, in arriving at the amount or percentage of overall permanent disability that individual has suffered as a result of the injury. There is substantial evidence in the record before us, that the appellant's physical condition was still improving when last examined by the doctors, and there is nothing in the record to contradict the referee's finding that the appellant was a good candidate for rehabilitation. Regardless of whether the 20% permanent partial disability established by the medical evidence pertained to loss of physical function, or pertained to the appellant's loss in wage earning capacity, there is no substantial evidence in the record that appellant's permanent partial disability exceeds the 20% estimate contained in the medical evidence. The evidence of permanent partial disability in this case, aside from medical evidence on limitation of motion, boils down to appellant's own testimony that she has to lie down a lot, and the doctors' testimony that she cannot lift heavy objects in general and bed ridden or elderly rest home or hospital patients in particular. While it is true that over $7,000.00 was spent in medical treatments for the appellant while she was receiving less than $2,000.00 in compensation payments, the amount and duration of compensation payments are limited by statute and medical expenses are not. Unless we could say as a matter of law, that in any industrial injury case a permanent loss in ability to earn must always follow, and exceed at least in some degree, the permanent loss in the functional use of the body as a whole, we must hold under the evidence in the case before us, that the judgment of the trial court must be affirmed. We are unable to announce such rule of law, so the judgment of the circuit court is affirmed. Affirmed.