Lavon G. Cox, Petitioner,
Labor Commission, St. George Truss Co., and Workers Compensation Fund, Respondents.
Proceeding in this Court.
Virginius Dabney and Stony V. Olsen, Attorneys for Petitioner
W. Holm, Attorney for Respondents St. George Truss Co. and
Workers Compensation Fund
J. Frederic Voros Jr. authored this Opinion, in which Judges
Kate A. Toomey and Jill M. Pohlman concurred.
Petitioner Lavon G. Cox seeks judicial review of the denial
of his workers' compensation claim. We conclude that the
Labor Commission did not apply the correct medical causation
standard. We therefore set aside the Commission's order
and direct it to reconsider Cox's claim under the correct
In 2013 Cox worked as a maintenance mechanic for Respondent
St. George Truss Company. On May 7, 2013, while removing an
80-pound brake drum from a semi truck, Cox "felt a
burning, popping sensation" in his back. He
"dropped the drum and sunk to his knees for a couple
minutes." He "tried walking it off" and went
to the shop to take four 200mg tablets of ibuprofen. He asked
a coworker for help with the brake drum and completed his
shift doing "light maintenance" work.
The next day Cox "felt another burning, popping
sensation" in his back while removing another brake
drum. He again walked around, went to the shop, and took
ibuprofen. He struggled to complete his work because his back
hurt, with his pain at 4 on a scale of 1 to 10. He again
completed his shift doing lighter work. Cox worked the
remaining two days of the work week with "quite a bit of
pain, " rested in bed over the weekend, and worked the
On May 17, 2013, Cox first reported his pain to WorkMed, an
occupational health services clinic, after he fell to the
ground at work while picking up a hose. Four days later Cox
again reported to WorkMed when he blacked out while bending
down to tie his shoe. The WorkMed doctor diagnosed Cox with a
lumbar spine strain, prescribed pain medications, and
referred him to physical therapy. The doctor gave Cox a
light-duty work release with the following restrictions:
"No bending or twisting, [n]o lifting/working above
shoulder level, [and] [n]o lifting more than 15 pounds."
Cox's modified duty entailed operating a forklift, which
includes manually adjusting 60-to-70-pound forks and sitting
on a solid-axle forklift seat with no suspension. Cox worked
ten-hour days with his pain reaching 8 on a scale of 1 to 10.
After several follow-up visits throughout May and June, the
WorkMed doctor referred Cox to a physiatrist. In early July
the physiatrist ordered further work restrictions, limiting
Cox to four hours of work per day. Cox began working
half-days with pain varying from 4 to 8 on a scale of 1 to
10. During this time, Cox "started losing bowel and
bladder control . . . almost every day . . . for a
while." He also started blacking out and getting
During a two-week period beginning in late July, Cox went to
the emergency room three times because he was concerned about
his back. After his first visit, his physiatrist directed him
to get an MRI. The MRI revealed "severe spinal canal and
neural foraminal narrowing" as well as disc bulging on
four lumbar levels. He went to the emergency room again the
following week because he experienced lower-back pain at home
after bending over.
The following month Cox fell while getting out of his truck
at work. At the time he fell, his back pain level was 8 on a
scale of 1 to 10. Cox drove himself to the emergency room,
where a second MRI was taken. The MRI revealed "severe
spinal canal stenosis, " and the doctor recommended that
Cox obtain a neurosurgical consultation. The surgeon admitted
Cox to the hospital that same day and scheduled lower back
surgery for three days later. After surgery Cox spent three
days in the hospital and a week in a rehabilitation facility.
He wore a back brace for 8 to 10 weeks, continued treatment
with the surgeon, and participated in physical therapy
thereafter. Cox has not worked since his fall, and he
testified that he continued to have back pain varying from 4
to 8 on a scale of 1 to 10.
Cox experienced two prior incidents involving his back. In
1977 he injured his back in a car accident. He spent about
five days in traction before returning to work with no pain.
In 2009 he injured his back and ankle in an accident
involving an all-terrain vehicle. The ankle injury required
surgery. Cox's treating doctor made notes listing chronic
lower back pain as a symptom in at ...