367 S.W.3d 137
Mo. Ct. App.2012Background
- Pace, a dangerous buildings inspector for the City of St. Joseph, sustained a December 9, 2002 knee injury at work.
- He developed a complex clinical picture post-injury, including CRPS, deep vein thrombosis, chronic back and shoulder pain, and carpal tunnel syndrome.
- Pace had falls in 2004 relating to knee weakness and later injuries in November and December 2004, with back and left-side symptoms.
- ALJ found a December 9, 2002 accident was a substantial factor in causing Pace’s medical conditions and disability, yielding permanent total disability attributable to that accident alone.
- The Labor and Industrial Relations Commission affirmed, and the City appeals arguing improper application of the substantial factor standard and insufficiency of evidence for the disability and causation findings.
- The court affirms the Commission’s determination that Pace was permanently and totally disabled and that the December 9, 2002 knee injury was a substantial factor in causing the later injuries and disabilities.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Was the December 9, 2002 knee injury a substantial factor in causing Pace’s 2004 injuries? | Pace contends work was a substantial factor in causing the 2004 back/hip/left arm injuries. | City argues the knee injury was not a substantial factor in the later injuries, relying on older caselaw. | Yes; the Commission properly applied the substantial factor test. |
| Was Pace permanently and totally disabled based on the December 9, 2002 knee injury alone? | Pace, supported by medical experts, contends the knee injury alone caused permanent total disability. | City argues disability arose from multiple factors; expert conflicting opinions preclude a finding based on the knee alone. | Yes; competent and substantial evidence supports disability based on the knee injury alone. |
| Was Pace’s back pain causally related to the December 9, 2002 knee injury? | Pace’s experts linked back pain to the knee injury through falls and CRPS sequelae. | City asserts prior back issues predated the knee injury and contradicts the causation. | Yes; substantial evidence supports back pain as a consequence of the knee injury. |
| Did Pace’s bilateral carpal tunnel syndrome stem from the December 9, 2002 knee injury? | Pace’s use of assistive devices and subsequent hand pain and surgeries are causally tied to the knee injury. | City contends no causal link between the knee injury and carpal tunnel. | Yes; substantial evidence supports the carpal tunnel link to the knee injury. |
| Did Pace’s chronic reactive depression and CRPS result from the December 9, 2002 knee injury? | Drs. Russell and Abrams connected CRPS and depression to the knee injury and resulting illness. | City challenges the foundation of CRPS and depression causation and disputes reliance on those experts. | Yes; substantial evidence supports CRPS and depression arising from the knee injury. |
Key Cases Cited
- Kasl v. Bristol Care, Inc., 984 S.W.2d 852 (Mo. banc 1999) (requires substantial factor, not merely triggering factor, to support compensability)
- Cahall v. Cahall, 963 S.W.2d 368 (Mo. App. 1998) (supports substantial factor theory for compensability when work is a substantial factor)
- Bloss v. Plastic Enterprises, 32 S.W.3d 666 (Mo. App. 2000) (recognizes that a substantial factor need not be primary; accident may be triggering and substantial)