JAMES MCCAULEY, JR. V. PPG INDUSTRIES, D/B/A/ PORTER PAINTS, ET AL.
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IMPORTANT NOTICE
NOT TO BE PUBLISHED OPINION
THIS OPINION IS DESIGNATED "NOT TO BE PUBLISHED."
PURSUANT TO THE RULES OF CIVIL PROCEDURE
PROMULGATED BY THE SUPREME COURT, CR 76.28(4)(C),
THIS OPINION IS NOT TO BE PUBLISHED AND SHALL NOT BE
CITED OR USED AS BINDING PRECEDENT IN ANY OTHER
CASE IN ANY COURT OF THIS STATE ; HOWEVER,
UNPUBLISHED KENTUCKY APPELLATE DECISIONS,
RENDERED AFTER JANUARY 1, 2003, MAY BE CITED FOR
CONSIDERATION BY THE COURT IF THERE IS NO PUBLISHED
OPINION THAT WOULD ADEQUATELY ADDRESS THE ISSUE
BEFORE THE COURT. OPINIONS CITED FOR CONSIDERATION
BY THE COURT SHALL BE SET OUT AS AN UNPUBLISHED
DECISION IN THE FILED DOCUMENT AND A COPY OF THE
ENTIRE DECISION SHALL BE TENDERED ALONG WITH THE
DOCUMENT TO THE COURT AND ALL PARTIES TO THE
ACTION.
RENDERED : May 24, 2007
NOT TO BE PUBLISHED
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2006-SC-000696-WC
JAMES MCCAULEY, JR.
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APPELLANT
APPEAL FROM COURT OF APPEALS
2006-CA-000141-WC
WORKERS' COMPENSATION NO. 02-67064
PPG INDUSTRIES, D/B/A
PORTER PAINTS,
HON. HOWARD E. FRASIER,
ADMINISTRATIVE LAW JUDGE AND
WORKERS' COMPENSATION BOARD
APPELLEES
MEMORANDUM OPINION OF THE COURT
AFFIRMING
An Administrative Law Judge (ALJ) found that the claimant failed to meet his
burden of proving his entitlement to future medical benefits based on medical evidence
that his work-related hand injury had healed and the absence of any medical evidence
that it caused a permanent harm or would require additional treatment . The Workers'
Compensation Board and the Court of Appeals affirmed, and the claimant appeals.
Because we are not convinced that the ALJ erroneously shifted the burden of proof or
that the absence of a medical opinion indicating that the claimant reached maximum
medical improvement (MMI) compelled an award, we affirm.
The claimant sustained a work-related injury to his right hand and thumb on
October 29, 2002 . His employer paid voluntary temporary total disability during the
three weeks that he missed work and $508.23 in medical benefits. The claimant
returned to work on November 19, 2002, and progressed from light to regular duty over
two or three weeks. He continued to work until August 1, 2003, when he was
terminated for reasons unrelated to the injury.
Among other things, the parties stipulated to a work-related injury, notice, and
the claimant's physical capacity to return to the work that he performed at the time of
injury . The sole matter at issue concerned his entitlement to future medical benefits.
The claimant testified that Occupational Physician Services (OPS) provided the
only medical care for his injury . He stated that the soft, fleshy part of his thumb
remained inflamed and tender. It bothered him in cold weather or when he attempted
to grab something with his right hand. He stated that it interfered with his ability to
engage in high-level tournament fishing, use spray nozzles on hoses, peel potatoes,
grab a coffee cup handle, and fire a pistol.
The medical evidence consisted of records from OPS . They indicated that the
claimant had pinched his thumb between a safety bar and a piece of steel plate. X-rays
revealed no evidence of an acute fracture, dislocation, or joint damage. The latest
progress note, from November 18, 2002, indicated that the injury was well healed and
that the claimant required Vitamin E. The claimant mentioned the thumb injury to his
family doctor subsequently, when seeking treatment for an unrelated condition, but
nothing indicated that the doctor treated it.
In a decision rendered on August 31, 2005, the ALJ noted that it was the
claimant's burden to prove every element of his claim . Yet, he failed to submit any
medical evidence that the injury had not reached MMI, that he had a permanent
impairment rating, or that he might need any future medical care for the injury . The ALJ
noted that the claimant relied on the absence of a medical opinion that he had reached
MMI to argue his entitlement to future medical benefits but was not convinced that an
employer must produce such evidence where there is no medical evidence "showing
any continuing need for medical treatment or permanent impairment ." In any event, the
ALJ found the November 18, 2002, treatment note and the absence of any subsequent
medical treatment to be sufficient under the circumstances to show that the claimant
had reached MMI .
Noting that he suffered only a soft tissue injury that had healed and
that he had required no medical treatment for 2'/2 years thereafter, the ALJ was not
convinced that he proved any permanent "disability" to justify an award of future
medical benefits .
KRS 342.020(1) entitles an injured worker to reasonable and necessary medical
treatment at the time of the injury and thereafter "during disability." We determined in
FEI Installation, Inc v. Williams , 214 S .W.3d 3 13 (Ky. 2007), that disability exists for the
purposes of KRS 342.020(1) so long as a work-related injury causes impairment,
regardless of whether the impairment rises to a level that it warrants a permanent
impairment rating, permanent disability rating, or permanent income benefits. The Fifth
Edition of the American Medical Association's Guides to the Evaluation of Permanent
Impairment, page 2, defines impairment as being "a loss, loss of use, or derangement
of any body part, organ system, or organ function ." We noted, therefore, that
impairment may or may not be permanent or rise to the level that warrants a permanent
impairment rating . Viewed in terms of KRS 342 .0011(1), objective medical findings of
impairment demonstrate that a harmful change in the human organism has occurred .
Under Robertson v. United Parcel Service, 64 S .W .3d 284 (Ky. 2001), a harmful
change that no longer exists when a claim is decided does not compel an award of
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future medical benefits .
It was undisputed that the claimant sustained a work-related injury . There was
no medical evidence that the injury caused disability that warranted permanent income
benefits (i .e. , a permanent impairment rating) ; however, KRS 342 .020(1) authorizes
medical benefits "during disability" without regard to whether impairment rises to a level
that warrants a permanent impairment rating . Therefore, as the party seeking future
medical benefits, the claimant had the burden to produce medical evidence that his
injury continued to cause impairment . That burden could not be satisfied by the mere
absence of a medical opinion that he had reached MMI . Nor could it be satisfied with
his own testimony regarding his present condition and limitations, for he was not a
medical expert . Because the claimant failed to offer medical evidence of continued
impairment, the ALJ did not err in finding that he failed to meet his burden of proof or
dismissing his claim .
The decision of the Court of Appeals is affirmed .
All concur.
COUNSEL FOR APPELLANT,
JAMES MCCAULEY, JR . :
WAYNE C. DAUB
600 WEST MAIN STREET
SUITE 300
LOUISVILLE, KY 40202
COUNSEL FOR APPELLEE,
PPG INDUSTRIES, D/B/A PORTER PAINTS :
MARK J . HINKEL
LANDRUM & SHOUSE, LLP
106 WEST VINE STREET
SUITE 800
P.O . BOX 951
LEXINGTON, KY 40588-0951
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