SUPREME COURT OF MISSOURI en banc ROBERT MARCH, ) Opinion issued July 26, 2022 ) Appellant, ) ) v. ) No. SC99381 ) TREASURER OF THE STATE OF ) MISSOURI – CUSTODIAN OF THE ) SECOND INJURY FUND, ) ) Respondent. )
APPEAL FROM THE LABOR AND INDUSTRIAL RELATIONS COMMISSION
Robert March (hereinafter, “Claimant”) appeals from the decision of the Labor and
Industrial Relations Commission (hereinafter, “the commission”) denying his claim for
permanent total disability (hereinafter, “PTD”) benefits from the Second Injury Fund
(hereinafter, “the Fund”). This Court holds the commission appropriately found it was not
persuaded the combination of his preexisting disabilities and his primary injuries entitled
him to PTD benefits because it was “equally likely” his preexisting disabilities alone
rendered him permanently and totally disabled. Further, the commission did not give the
Fund the benefit of the doubt in its determination Claimant’s evidence stood in equipoise—
even in the absence of any impeaching evidence—because Claimant bears the burden of
proving it was more likely true than not true that he was permanently and totally disabled due to the combination of his preexisting disabilities and his primary injuries. The
commission’s decision is affirmed. 1
Factual and Procedural Background
Claimant is a sixty-year old high school graduate who spent fifteen years working
as a meat cutter using a vibrating knife and pushing 1,800-pound racks of meat. During
this employment, Claimant had surgery to repair a tear to his left rotator cuff, an injury to
his right finger, and carpal tunnel. Claimant missed work due to these injuries but returned
to work without restrictions.
In 1996, Claimant began working for Milbank Manufacturing Company
(hereinafter, “Employer”). Claimant fabricated metal electrical boxes via metal inert gas
welding and stick welding followed by sanding with a twenty-pound grinder. Claimant
fabricated between 300 and 400 boxes per day, with the boxes ranging in weight from 10
to 500 pounds.
Before Claimant suffered the primary injuries underlying his workers’
compensation claim, he endured other health issues, including: morbid obesity, thyroid
issues, hypothyroidism, hypertension, a transient ischemic attack, atrial fibrillation,
asthma, a second left rotator cuff tear, and a left leg laceration. Claimant’s left leg injury,
inflicted during a hunting trip, eventually required treatment for stasis ulcers, affected his
ability to stand, and created blood flow issues. The most significant of Claimant’s
preexisting medical conditions was his bilateral lower extremity condition for which he
1 This Court has jurisdiction. Mo. Const. art. V, sec. 10. 2 was diagnosed in 2005 with edema and pain radiating down both legs into his ankles,
secondary to morbid obesity, and venous varicosities associated with obesity.
In 2015, Employer changed its electrical box fabrication method, requiring
Claimant to perform his job duties in a standing position rather than primarily in a seated
position. Claimant explained working in a standing position required him to reach farther
out, extend his arms above his shoulders, and to hold the boxes down. Claimant began
experiencing numbness, tingling, and cramping in both hands, which he attributed to using
a buffer and sander. Claimant also experienced bilateral shooting pains in his arms,
shoulders, and neck.
In April 2015, Employer referred Claimant to Dr. Thomas Winston (hereinafter,
“Dr. Winston”) for treatment. Dr. Winston diagnosed Claimant with carpal tunnel
syndrome in his right hand. Dr. Winston noted Claimant’s complaint he had leg pain and
venous stasis disease, which Dr. Winston stated were aggravated by standing but also
“probably due to his weight and situation other than work.” Dr. Winston recommended
Claimant be allowed to work from a seated position. Claimant was given an injection in
his right shoulder and released to return to work in May 2015. The parties stipulated
Claimant achieved maximum medical improvement (hereinafter, “MMI”) on May 15,
2015. Claimant subsequently sought and received an accommodation from Employer to
allow him to sit for two-hour intervals, followed by two hours of standing, during his shifts.
Claimant continued to experience bilateral leg pain, aching, swelling, edema, and
fluid leakage that he explained was due to being unable to sit to perform his work. Claimant
continued to receive treatment from his physicians for these conditions. Claimant’s
3 primary physician noted Claimant could not perform his job duties without special
scheduling due to his leg conditions and instructed Claimant to not stand or walk for more
than four hours per day and to elevate his legs. Dr. Michael Waldschmidt (hereinafter,
“Dr. Waldschmidt”), a vascular specialist, began treating Claimant. Dr. Waldschmidt
performed a bilateral saphenous vein endovascular laser ablation for severe bilateral lower
extremity venous insufficiency to relieve Claimant’s chronic ulceration difficulties.
Dr. Waldschmidt recommended Claimant be restricted to twenty minutes of sitting or
standing consecutively, avoid standing or sitting for more than one hour at a time, and keep
his ankles elevated above his heart. Dr. Waldschmidt stated Claimant’s “problem is obesity
weight control,” which “will be the final answer to his lower extremity problems.”
Claimant left his employment with Employer on April 15, 2016. Thereafter,
Claimant attempted to work as a security guard, but left that employment after two shifts
because it required too much walking.
Claimant filed a workers’ compensation claim against Employer. 2 In his
November 2015 claim, Claimant alleged his primary work-related injuries were “bilateral
lower extremities – body as a whole.” In his June 2016 first amended claim, Claimant
sought PTD benefits from Employer. In his December 2016 second amended claim,
Claimant alleged his primary work-related injuries were “bilateral lower extremities and
2 The record reflects Claimant filed two claims against Employer and the Fund for compensation: Injury Number 15-022721 and Injury Number 15-088007. The claim for Injury Number 15-022721 is not included in the record, but Claimant’s motion to dismiss that claim with prejudice against Employer and the Fund is included. This appeal addresses only Injury Number 15-088007. 4 bilateral upper extremities – body as a whole.” In his third amended claim filed in
December 2017, Claimant alleged his primary work-related injuries were “bilateral upper
extremities” and, for the first time, asserted a claim against the Fund for PTD benefits due
to a prior injury to his bilateral lower extremities. Claimant settled his claim with Employer
for the primary bilateral upper extremity injuries and proceeded to a hearing against the
Fund on his third amended claim for PTD benefits.
At the hearing before the administrative law judge (hereinafter, “ALJ”), Claimant
provided live testimony, describing his employment history and responsibilities, his
medical conditions dating back to 1988, his job responsibilities, and his injuries sustained
while working for Employer. Claimant explained he was able to return to work after the
treatment on his arms was completed, but his arms hurt more when he had to work from a
standing position. Claimant further stated his leg conditions worsened due to standing.
Claimant testified about the impact his injuries had on his quality of life. Claimant
explained he must keep his legs elevated above his heart for 90 percent of the day.
Claimant cannot sit for less than two hours without having leg problems, and he can stand
for only approximately one hour without a problem. Claimant testified about the pain,
numbness, and swelling he experiences in his arms and legs. The Fund offered Claimant’s
deposition into evidence.
Claimant also submitted medical records and two medical reports. Dr. Waldschmidt
opined Claimant developed severe lower extremity tissue hypertension from a combination
of issues, including saphenous vein valvular incompetence, lymphedema, and extreme
pelvic congestion increasing the effect of the previously mentioned two issues.
5 Dr. Waldschmidt found that standing for long hours on the job accelerated Claimant’s
preexisting condition, necessitating operative treatments.
Dr. William Hopkins (hereinafter, “Dr. Hopkins”), an orthopedic surgeon,
performed an independent medical examination of Claimant and reviewed his medical
records in rendering his opinion. Dr. Hopkins stated Claimant sustained bilateral upper
extremity injuries during the course of his employment, resulting in a 30 percent right and
20 percent left permanent partial disability at the 175-week level. Dr. Hopkins found that
due to Claimant’s previous carpal tunnel syndrome, 5 percent of his permanent partial
disability is preexisting and the remaining 25 percent is due to his April 2015 work-related
injury.
With respect to Claimant’s bilateral lower extremities, Dr. Hopkins noted Claimant
had “a longstanding history of edema” and “an extended history of bilateral venous stasis
… compounded and added to by his weight ….” Dr. Hopkins agreed with
Dr. Waldschmidt that “standing for long hours during the course of employment
aggravated and necessitated Claimant’s need for ablation surgery, and aggravated his
preexisting venous stasis in his lower extremities, and increased his problem with …
[E]mployer not allowing him to work in a seated position, part of the day.” Dr. Hopkins
assigned a total of 45 percent right and 45 percent left lower extremity permanent partial
disability at the 160-week level. Due to Claimant’s preexisting disabilities prior to
April 2015, Dr. Hopkins assessed 15 percent of the total to preexisting medical factors, the
remaining 30 percent as the direct and prevailing factor of his cumulative work-related
injuries, and applied a 15 percent load factor due to the bilateral nature of the disabilities.
6 Dr. Hopkins noted Claimant would require additional care and treatment for his lower
bilateral extremities and was at a high risk of requiring bilateral below-knee amputations.
Dr. Hopkins found Claimant’s bilateral lower extremity condition prevented him
from engaging in gainful employment, opining, “It is my professional opinion that with his
bilateral leg condition [Claimant] cannot engage in gainful employment. I do not believe
any employer in the ordinary course of business could reasonably be expected to hire him
given his condition” rendering him permanently and totally disabled. Dr. Hopkins noted
Claimant’s history of bilateral knee pain and morbid obesity, which he believed were
additional factors contributing to his overall disability. Dr. Hopkins concluded Claimant’s
“[PTD] rises when one considers the residual physical disabilities and resultant restrictions
attributable to his work injuries and his allied physical inabilities.”
Claimant also offered vocational reports and deposition testimony from
Terry Cordray (hereinafter, “Cordray”) and Kristine Skahan (hereinafter, “Skahan”)
regarding his ability to compete in the open labor market. Cordray issued two reports.
Cordray’s initial report stated Claimant was “disabled due to his venous insufficiency and
obesity.” Cordray noted Claimant’s long history of treatment for his bilateral lower
extremities rendered him vocationally disabled. Cordray opined, “The primary reason
[Claimant] would not be able to perform this job is because of his pre-existing conditions,
and not his carpal tunnel injury sustained in April 2015.” Cordray issued a second report
seven months later, clarifying in his deposition, “[T]he current claim is the lower legs, the
venous insufficiency, the swelling in his legs, the need to elevate his leg but he had a
separate preexisting shoulder surgery and carpal tunnel surgeries and a claim and I just
7 ignored that. I didn’t catch it in my first report.” In his supplemental report, Cordray relied
on Dr. Hopkins’ report to find Claimant was vocationally disabled as “a result of the
underlying combination of his injury of April 2015, to the upper extremities in concert with
his injuries and limitations to the bilateral lower extremities.” Skahan also determined
Claimant was vocationally disabled “due to the upper extremity injuries of bilateral carpal
tunnel and injuries from repetitive use to right and left shoulders on or about [April 2015]
and the progressive disabilities from his venous stasis and aggravation from his work
activities to the bilateral lower extremities around the same time frame of April of 2015.”
The ALJ issued an award denying Claimant PTD benefits. The ALJ found
Claimant’s preexisting disabilities, “primarily the lower extremity condition, was actively
being treated and was disabling at the time of [his] work-related accident, which involved
[in]operable bilateral carpal tunnel injuries.” The ALJ stated the vocational testimony
supported a finding that a progression of Claimant’s bilateral lower condition rendered him
unable to compete in the open labor market. The ALJ determined the “greater weight of
the testimony leads me to conclude … Claimant has not met his burden of proof to establish
… Fund liability … [because] Claimant’s lower extremity condition which preexisted the
work injury was actively being treated and significantly deteriorated after the work-related
accident.” The ALJ further found “there was no aggravation or acceleration of the work-
related accident to combine to lead … Claimant to be permanently and totally disabled.”
Claimant sought review from the commission, which issued a supplemental opinion
affirming the ALJ’s decision. The commission supplemented the ALJ’s findings of fact
but did not comment on the credibility of the witnesses. The commission disavowed the
8 ALJ’s findings that Claimant’s bilateral lower extremity condition was being actively
treated and significantly deteriorated after the work-related accident and disavowed it was
the progression of his bilateral lower extremity condition that rendered him unable to
compete in the open labor market. Nevertheless, the commission agreed the Fund was not
liable for PTD benefits because Claimant failed to meet his burden of persuasion, stating:
[Claimant] presented evidence in the record to establish his theory of the case. However, we are not persuaded that the combination of [Claimant’s] preexisting injuries and the primary injury resulted in [Claimant’s PTD]. It was equally likely that [Claimant’s] preexisting injuries (without the addition of the primary injury) resulted in [Claimant’s PTD].
(Emphasis in original). The commission rejected Claimant’s argument the ALJ’s award
was not supported by factual evidence because the Fund failed to impeach his testimony or
the medical reports submitted, finding it was unnecessary for the Fund to put forth factual
evidence because Claimant bore the burden of proof. 3 Claimant appeals.
Standard of Review
“This Court reviews the commission’s decision to determine if it is ‘supported by
competent and substantial evidence upon the whole record.’” Cosby v. Treasurer of Mo.,
579 S.W.3d 202, 205 (Mo. banc 2019) (quoting Mo. Const art. V, sec. 18). This Court
may modify, reverse, remand for rehearing, or set aside a workers’ compensation award upon a finding that: (1) the commission acted without or in excess of its powers; (2) the award was procured by fraud; (3) the commission’s factual findings do not support the award; or (4) there was not sufficient competent evidence in the record to warrant the making of the award.
3 One commissioner dissented, finding Claimant met his burden of persuasion establishing his preexisting bilateral lower extremity injuries combined with his primary bilateral upper extremity injuries rendered him permanently and totally disabled and entitled him to PTD benefits. 9 Malam v. State, Dep’t of Corr., 492 S.W.3d 926, 928 (Mo. banc 2016) (citing
section 287.495.1(1)-(4), RSMo 2016). 4 “Although the commission’s decision is afforded
substantial deference, this Court must still ‘examine the whole record to determine if it
contains sufficient competent and substantial evidence to support the award, i.e., whether
the award is contrary to the overwhelming weight of the evidence.’” Id. (quoting
Hampton v. Big Boy Steel Erection, 121 S.W.3d 220, 222-23 (Mo. banc 2003)). “Only
factual findings that are necessary to make an award for the employee must be supported
by competent and substantial evidence on the whole record.” Annayeva v. SAB of TSD of
City of St. Louis, 597 S.W.3d 196, 200 n.8 (Mo. banc 2020).
Analysis
In his sole point on appeal, Claimant argues the commission erred in finding the
Fund was not liable for PTD benefits because the commission is mandated to weigh the
evidence impartially without giving the benefit of the doubt to any party. Claimant
contends the commission impermissibly gave the Fund the benefit of the doubt by: (1) not
finding his medical and vocational experts credible when they were unimpeached, and
(2) denying PTD benefits when the Fund failed to present any impeaching evidence
directed at his credible medical and vocational experts. Claimant believes the Fund must
present its own expert testimony challenging the credibility of a claimant’s experts to
prevail, especially when it is uncontested that a claimant’s primary injury is work-related.
Hence, Claimant asserts, because the Fund presented no evidence to counter or impeach
4 All statutory references are to RSMo 2016 unless otherwise indicated. 10 his experts—whom he alleges opined the combination of his preexisting disabilities and
primary injuries rendered him permanently and totally disabled and the commission did
not comment on the experts’ credibility—the commission should have awarded him PTD
benefits.
Section 287.220 was amended in 2013 to limit the number of workers eligible for
Fund benefits. Treasurer of Mo. v. Parker, 622 S.W.3d 178, 181 (Mo. banc 2021).
Because Claimant’s claim was made after the amendment, he must demonstrate two
conditions pursuant to section 287.220.3 to obtain compensation from the Fund. First,
Claimant “must have at least one qualifying preexisting disability.” Id.; section
287.220.3(2)(a). “[T]he preexisting disability must be medically documented, equal at
least 50 weeks of permanent partial disability, and meet one” of four additional criteria.
Parker, 622 S.W.3d at 181. Second, Claimant must demonstrate he “thereafter sustain[ed]
a subsequent compensable work-related injury that, when combined with the preexisting
disability ... results in a [PTD] ....” Section 287.220.3(2)(a)b.
The parties contest whether Claimant is entitled to compensation from the Fund
pursuant to section 287.220.3. 5 Section 287.808 places “[t]he burden of proving an
entitlement to compensation … on the employee ….” Further, “[i]n asserting any claim or
defense based on a factual proposition, the party asserting such claim or defense must
5 The Fund also asserts Claimant cannot demonstrate he has a preexisting disability that satisfies section 287.220.3(2)(a) in that he cannot satisfy any of the four additional statutorily mandated criteria. The Fund further contends Claimant does not have a basis for a section 287.495.1(4) challenge on appeal. Claimant does not address or refute these arguments in his reply brief; however, this Court need not reach these issues given disposition of Claimant’s sole point. 11 establish that such proposition is more likely to be true than not true.” Id. Claimant
correctly notes section 287.800.2 mandates the commission “shall weigh the evidence
impartially without giving the benefit of the doubt to any party when weighing evidence
and resolving factual conflicts.” Accordingly, Claimant believes he presented
unimpeached medical and vocational evidence, and, therefore, met his burden of proof
regarding his entitlement to Fund compensation and the commission’s decision to the
contrary violated section 287.800.2.
Claimant’s argument that his unimpeached evidence essentially constitutes a
presumptively valid claim misunderstands the burdens a claimant must meet to compel the
Fund to pay PTD benefits. Claimant’s “burden of proof is made up of two separate
burdens, the burden of persuasion and the burden of production.” Annayeva, 597 S.W.3d
at 200 n.8. “The burden of [production] is a party’s duty to introduce enough evidence on
an issue to have the issue decided by the fact-finder.” Id. (quoting Kinzenbaw v. Dir. of
Revenue, 62 S.W.3d 49, 53 n.6 (Mo. banc 2001) (internal quotations omitted)). Claimants
meet their burden of production when they “introduce[] competent and substantial evidence
on the whole record sufficient to support a finding on each of the facts necessary to that
award.” Id. The burden of persuasion requires claimants “actually ‘to convince the fact-
finder to view the facts in a way that favors” them. Id. (quoting Krispy Kreme Doughnut
Corp. v. Dir. of Revenue, 488 S.W.3d 62, 67 (Mo. banc 2016)).
The commission recognized Claimant presented evidence to support his theory of
the case, meaning Claimant met his burden of production in submitting evidence regarding
his preexisting disabilities and his primary work-related injuries. Claimant then had the
12 burden of persuading the commission his compensable work-related injuries combined
with his preexisting disabilities rendered him permanently and totally disabled to be
entitled to PTD benefits from the Fund. Claimant contends Dr. Hopkins, Dr. Waldschmidt,
and both vocational experts offered unimpeached testimony that his preexisting disabilities
combined with his primary injuries rendering him permanently and totally disabled.
Because the commission did not comment on the credibility of this evidence, Claimant
argues the Fund carries a burden of non-persuasion, so to speak, or is compelled to
introduce credible impeaching evidence to prevail. Yet section 287.808 contains no
language mandating the Fund present evidence, impeachment or otherwise, unless the Fund
wishes to assert an affirmative defense. See Poach v. Treasurer of Mo. – Custodian of
Second Injury Fund, 365 S.W.3d 638, 642 (Mo. App. W.D. 2012) (holding the Fund was
not obligated to present evidence to refute the claimant’s testimony an accident occurred
entitling him to benefits); Hazeltine v. Second Injury Fund, 591 S.W.3d 45, 63 (Mo. App.
E.D. 2019) (recognizing the commission can issue a decision against a claimant for failing
to meet the burden of proof even when the Fund presents no evidence at the hearing to
contradict the claimant’s evidence).
Claimant further argues, when the commission determined his evidence
demonstrated it was “equally likely” either the combination of his preexisting injuries and
the primary injury resulted in his PTD or his preexisting injuries alone resulted in his PTD
and ruled in the Fund’s favor, it erroneously gave the Fund the benefit of the doubt. Instead,
Claimant urges this Court to find “equally likely” means he has met his burdens of
production and persuasion to establish it was more likely to be true than not true that he
13 was entitled to PTD benefits. To so find would require this Court to tip the scale in
Claimant’s favor and give him the benefit of the doubt, which section 287.800.2 prohibits.
Claimant contends the commission cannot be said to have weighed the evidence
impartially when the Fund foregoes presenting any impeaching expert testimony and
prevails. Claimant’s assertion his evidence established entitlement to PTD benefits
“necessarily includes the converse proposition that no medical evidence supports the
[c]ommission’s findings.” Guinn v. Treasurer of Mo., 600 S.W.3d 874, 880 (Mo. App.
S.D. 2020) (emphasis omitted). Claimant does not allow for the possibility that the
commission was not weighing his evidence against the Fund’s evidence, but rather, the
evidentiary basis for its decision came from Claimant’s own evidence and expert
testimony, which presented equivocal findings.
With respect to Claimant’s primary injuries, the parties stipulated Claimant
achieved MMI for his primary injuries in May 2015 after Dr. Winston gave him an
injection. The evidence demonstrated Claimant continued to work for almost a year after
that point, despite his testimony he continued to have pain, numbness, and swelling in his
bilateral upper extremities. Moreover, Cordray’s initial report explicitly disavowed
Claimant’s primary injury prevented him from performing his job duties and relied solely
upon Claimant’s bilateral lower extremity conditions to opine Claimant was permanently
and totally disabled. Skahan’s report contained no reference to Claimant’s primary injury
when summarizing her observations and Claimant’s current status. Skahan’s report also
relayed that Claimant told her he retired because he could not tolerate standing during his
shift. Dr. Waldschmidt’s report made no mention of Claimant’s primary injuries or
14 whether they combined with his bilateral lower extremity condition to render him
permanently and totally disabled. The commission could have found these facts, although
not an exhaustive list, supported a finding Claimant’s primary injury did not combine with
his preexisting disabilities to entitle him to PTD benefits.
Claimant also presented evidence regarding his bilateral lower extremity conditions,
which predated his primary injury by at least a decade with copious medical records.
Claimant’s evidence documented his inability to stand, sit, or walk for long periods of time.
Claimant’s primary physician noted Claimant could not perform his job duties without
special scheduling due to his leg conditions and instructed Claimant to not stand or walk
for more than four hours per day and to elevate his legs. Dr. Winston noted Claimant’s
complaint he had leg pain and venous stasis disease, which Dr. Winston stated were
aggravated by standing, but also “probably due to his weight and situation other than
work.” Dr. Hopkins and Dr. Waldschmidt both offered detailed findings regarding
Claimant’s bilateral lower extremity condition, the restrictions this condition had on his
ability to stand, walk, sit, and work, the requirement Claimant remain seated or lying down
throughout the day with his legs elevated to alleviate this condition, and their
recommendations for further treatments and the likely outcomes. Ultimately,
Dr. Waldschmidt concluded Claimant’s bilateral lower extremity condition rendered him
permanently and totally disabled. The commission could have found these facts, although
not an exhaustive list, supported a finding Claimant’s preexisting disabilities alone
rendered him permanently and totally disabled.
15 There was also evidence Dr. Hopkins, Skahan, and Cordray opined Claimant’s
preexisting bilateral lower extremity disabilities combined with his primary injuries to
entitle him to PTD benefits. Claimant asserts the commission found Dr. Hopkins credible
when it supplemented its opinion with some of Dr. Hopkins’ findings and when it
disavowed the ALJ’s findings his bilateral lower extremity condition was actively being
treated and significantly deteriorated after the work-related accident and disavowed it was
the progression of his bilateral lower extremity condition that rendered Claimant unable to
compete in the open labor market. Disavowing these specific findings did not amount to a
credibility determination because “[t]he [c]ommission is free to believe some, all or none
of any witness’s testimony.” Williams v. Treasurer of Mo. – Custodian of Second Injury
Fund, 588 S.W.3d 919, 931 (Mo. App. W.D. 2019) (quoting Dierks v. Kraft Foods,
471 S.W.3d 726, 737 (Mo. App. W.D. 2015) (internal citation omitted)).
The parties attribute different meanings to Dr. Hopkins’ ultimate finding, “It is my
professional opinion that with his bilateral leg condition [Claimant] cannot engage in
gainful employment.” Claimant asserts “with” means his primary injury combined with
his bilateral leg condition, while the Fund states “with” means Claimant was afflicted with
the bilateral leg condition, rendering him permanently and totally disabled based on that
condition alone. This dispute underscores the commission’s finding Claimant’s evidence
stood in equipoise because reasonable minds may differ as to Dr. Hopkins’ conclusion and
the evidence on the whole record as set forth previously, even in the absence any Fund
evidence to the contrary.
16 Based on the foregoing, this Court finds Claimant failed to carry his burden of
persuasion in demonstrating he was entitled to PTD benefits. The commission did not act
beyond its authority or violate chapter 287 in finding Claimant’s evidence was equivocal
about the issue of whether it was more likely true than not that his preexisting disabilities
and primary injuries combined to render him permanently and totally disabled such that
the Fund was liable for PTD benefits.
Conclusion
The commission’s decision is affirmed.
____________________________ GEORGE W. DRAPER III, Judge
All concur.