MWCC NO. 98 01128-G-3345-B

LEE A. MILLER                                                                                                                                                                                                   CLAIMANT

VS.

KIMBERLY-CLARK CORPORATION
SELF-INSURED                                                                                                                                                                                                    EMPLOYER

APPEARING FOR THE CLAIMANT:
Scott Davis, Esquire, and Ben Logan, Esquire, Tupelo, Mississippi

APPEARING FOR THE EMPLOYER:
Wendell H. Trapp, Jr., Esquire, Corinth, Mississippi

On July 16, 1998, the claimant, Lee A. Miller, filed a petition to controvert alleging that on September 6, 1997, he received a work-related injury to his lungs, that is, an occupational lung disease. The self-insured employer denied the compensability of the alleged injury or disease and did not pay any workers' compensation benefits. Some medical benefits and also some short-term disability benefits were paid through group health and other insurance provided by the employer. A hearing was held in the Alcom County Courthouse in Corinth, Mississippi, on February 7, 2001. The matter was held in abeyance after the hearing to allow the parties time to submit memoranda of law.

The parties stipulated that the claimant's average weekly wage on September 6, 1997, was $643.00.

The issues to be resolved by the Administrative Judge are as follows:

1. Whether the claimant sustained a work-related injury or occupational disease on September 6, 1997, as alleged in the petition to controvert; and

2. If so, the extent of disability resulting from the work injury or occupational disease.

Lee A. Miller is forty years old and a resident of Corinth. He is a high school graduate and has had more than two years additional course work at Northeast Mississippi Community College in drafting, electronics, and business administration. He has a computer at home that he uses periodically. He testified at the hearing in a very articulate manner.

Mr. Miller has been married for twenty years, and he has four children, ages twenty, eighteen, sixteen, and fourteen. Currently his wife is not employed outside the home, although she has a home-based business. Before he became ill, Mrs. Miller was a supervisor/head teller for the People's Bank in Corinth. Mr. Miller said she stays home to take care of him.

In the past, Mr. Miller had some factory work experience. He also worked as an insurance agent for an insurance company. He sold life insurance to customers and earned commissions as well as a base salary. He did not qualify for a license because he did not do that work long enough.

For ten years Mr. Miller worked for TCI, a cable company. He started as a cable salesman and was promoted to cable installer, then was promoted to warehouse supervisor and purchasing agent. He ordered parts, received the parts, and completed the paperwork for the various transactions. He also purchased vehicles and saw that they were properly maintained. He was promoted to a division office in Birmingham as purchasing agent, then he was promoted to purchasing manager for the State of Florida at the company's office in Daytona Beach, Florida. He used a computer in his work with TCI.

There was restructuring at TCI that would have resulted in Mr. Miller having to relocate his family. Instead, because he and his wife had relatives in the Prentiss County, Mississippi, area, they moved to Corinth for him to take a position with Kimberly-Clark Corporation.

In 1995, Mr. Miller was hired at Kimberly-Clark. After a few weeks he became a machine operator. Then after a year he successfully applied for a special assignment job. This job involved machine analysis of waste reduction and drafting of operating procedures and training manuals, and he used a computer. He held this job for about nine months until he became sick.

To earn more money Mr. Miller also took a job on the weekends cleaning the dust removing system at Kimberly-Clark. In his weekend job, Mr. Miller was exposed to dust from the products made at the plant, primarily paper towels and industrial wipes. He said some of the products were fire retardant. Miller explained that if he wiped his face with one of the fire retardant napkins, his face would itch. Mr. Miller cleaned the dust systems every Saturday for approximately a year. He did this job by himself after being trained on one Saturday.

According to Mr. Miller, there was dust in the area where they converted large sheets of paper to smaller industrial wipes. The dust removing system included a container about eight to ten feet in height. Inside were ten filters, and a large motor pulled the air and dust through the filters. Over time, dust would accumulate inside the container. There was a hopper on the bottom that was lined with a plastic garbage bag. Much of the dust would fall into the hopper and the bag. Cleaning required the person to remove the plastic bag, close it up and throw it away. There would be four or five 55-gallon bags of dust to take out each week.

One of the dust systems in the boiler room, a room about eight feet by fourteen feet, did not work properly, however, and had to be cleaned manually once a week. It would take three to four hours to clean the dust system in the boiler room. Mr. Miller had to close the door to the room to lock in the dust. Then he would open up the door to the filter system. Very carefully he would knock down the dust that packed up around the filters before removing the filters. If he were not careful there would be a cloud of dust in the room so thick he could not see, and he would leave the room until the dust settled down. He would remove the filters from the room one at a time. He had to climb inside the container to remove the last three or four filters. After removing the filters, he vacuumed the remaining dust.

Kimberly-Clark provided Mr. Miller with safety goggles, gloves, head covering, paper coveralls, and a paper mask that covered the nose and mouth. There were respirators at Kimberly-Clark, and a document in the employer's file (a copy of which has been received into evidence as Exhibit 16) indicate he was trained in the use of a respirator. He did not ever ask for or use a respirator, however, and Mr. Miller testified that he was not provided one.

On Saturday, after cleaning the dust removal system, Mr. Miller would be covered with dust when he got home. He said he would have dust in his ears, eyes, and mouth. He had to take his shoes off before he went in the house. He would take his clothes off because they would be covered with dust, in spite of the fact that he wore the paper coveralls. Dust covered his hair and face, and he had to take a bath to remove the dust from his back. He would constantly clear his throat and have dryness in his mouth for a couple of days after doing the cleaning job. He would blow his nose and have the coloring of the dust on the tissue.

After working at Kimberly-Clark for two years, Mr. Miller began to get sick. He felt fatigue for several months, and he would fall asleep at his special assignment job at the computer. In September 1997. he and his wife and baby had diarrhea. The wife and baby were better after a day, but Mr. Miller continued to have the diarrhea. At that same time he stepped out of bed and noticed his ankles were swollen and painful. Then he noted swelling or nodes on the top of his hand, his forearms, and the sides of the lower part of his legs. It was a couple of months later before he experienced respiratory problems.

Mr. Miller called the office to notify Kimberly-Clark that he was not coming in, and he went to the doctor, Dr. Charles Parker, a family physician. Dr. Parker referred him to Dr. Daniel Griffin, gastroenterologist in Memphis, Dr. Mohan Gehi, internist in Memphis, Dr. James Nakashima, rheumatologist in Memphis, Dr. J. L. McGehee, pulmonary specialist in Memphis, and Dr. David Chase, pulmonary specialist in Booneville, Mississippi.

Later, in February 1998, Mr. Miller consulted Dr. Joseph Pratt, family practitioner in Corinth and the company doctor for Kimberly-Clark. Dr. Pratt has not released Mr. Miller to work, and he has recommended restrictions. Dr. Pratt referred Mr. Miller to Dr. Robert Garver, pulmonary specialist in Birmingham.

Mr. Miller believes that he is permanently disabled because of a lung disease and arthritic type symptoms. He has aches and pains all the time, restless nights, and problems with reflux. He is limited in lifting and standing. He has an increase of pain in his joints and shortness of breath when he walks briskly. He has pain in his lower back. He takes Lodine and Prednisone every day, as prescribed by Dr. Pratt.

In November 1997, Mr. Miller returned to a trial of work at Kimberly-Clark. He had a relapse, however, and he has not worked since November 1997.

Mr. Miller has applied and been approved for social security disability benefits. He receives approximately $1,000.00 a month. Medicare pays for his doctors and hospitals, but he must pay for his drugs. Aetna has provided some medical services through group health insurance benefits at Kimberly-Clark. Kimberly-Clark provided short-term disability benefits to Mr. Miller. Mr. Miller purchased a long-term disability policy through Aetna at Kimberly-Clark, and he paid the premiums.

According to Mr. Miller, he is doing some preaching, for which he recieves about $300.00 a month. He has not reported to Kimberly-Clark to ask about work. He has not sought employment anywhere else., and he did not contact any of the prospective employers whose names were given to him by David Stewart, the employer's vocational rehabilitation consultant.

Mr. Miller said he is not physically able to return to Kimberly-Clark. He testified he could not do the walking or sitting in that environment. He said he could not return to the TCI job or insurance agent position. Also, he explained that Dr. Pratt has not released him.

Mr. Miller testified that he wanted to create a career path for himself with Kimberly- C lark. He was pleased to get the special assignmentjob, and he had hoped to be transferred to the purchasing department in the mill department. When he got sick, he could not complete the transfer. He has not been called to come back to the plant.

Until he got sick, Mr. Miller worked all his life. Before developing respiratory problems, Mr. Miller ran two miles a day and played basketball. He has not run since having the problems with his lungs. He said he is unable to play basketball with his son. He testified he could do anything he wanted to do, including heavy labor, before his employment at Kimberly-Clark.

Mr. Miller admitted, however, that his respiratory condition has improved. During the course of medical treatment, he has not undergone any surgery other than a biopsy of his lung. He has not been hospitalized overnight at any time.

In the past, Mr. Miller had one work-related injury while working for TCI. In that on-the-job accident, he received a laceration to his arm.

Mrs. Linnette Miller came to the hearing prepared to testify in her husband's behalf. The parties stipulated, however, that she would offer testimony that would be cumulative and corroborative of that already given by the claimant.

Jo Spradling, a vocational consultant in Birmingham, performed an examination of Lee Miller in an attorney's office in Birmingham for about two hours. There were no machines to measure grip strength and no exercise equipment. No one took his temperature or blood pressure, and no one performed a physical examination or took x-rays. No pulmonary function testing was done.

At the employer's request, Mr. Miller saw Dr. James Steven Hankins in Birmingham. Dr. Hankins took x-rays and did pulmonary function testing and talked with Mr. Miller at length. Dr. Hankins performed a physical examination and took his pulse and blood pressure.  Dr. Hankins watched Mr. Miller walk around, and Mr. Miller was taken to a different facility for functional capacities testing on various machines.  Dr. Hankins said Mr. Miller did no give maximum effort.  Mr. Miller explained that after undergoing the functional capacity evaluation he had a fever.  He said he was in bed for a week due to the stress they put him through and he had a recurrence of infection in his lungs.

Mr. Miller had not met with David Stewart, the employer's vocational rehabilitation consultant.  Mr. Stewart has not performed any testing.

Tony Haywood Harris testified for the claimant that he lives in Corinth.  He is a high school graduate, and he went to community college for about six months.  He has not had any medical training.

For about sixteen years, Mr. Harris has been employed at Kimberly-Clark's "Away From Home" plant in Corinth, the same plant where Lee Miller worked.  Mr. Harris has been a material handler and checker and feature specialist.  Mr. Harris said he has known Lee Miller, who is his brother-in-law, pastor, and good friend, since 1980 or 1981.  When he first met Lee Miller, Mr. Miller was in very good physical condition and he remained to until he got sick.  Mr. Harris never knew him to get a cold or be sick in the past.  He did not think Mr. Miller missed any work before 1997 except for when his father got sick.

Mr. Harris is familiar with the dust removal system at Kimberly-Clark.  He has cleaned the same dust removal system that Mr. Miller cleaned, doing that cleaning job on weekends from about 1989 until 1994, before Mr. Miller came to the plang.  Mr. Harris volunteered to do the cleaning job. Mr. Harris said there have been some changes made since then.

According to Mr. Harris, to clean the dust removal system, he cut off a fan. He dressed out in goggles, dust suit, and paper mask covering his nose and mouth, all provided by Kimberly-Clark. There was quite a bit of dust. There would be about three twenty- gallon bags full of dust, and there would be dust particles in the room.

Mr. Harris said he requested a respirator-type mask that worked better. He said employees who did that job received training in the use of respirators.

According to Mr. Harris, he stopped doing the job because it was "getting to him.~~ He began having sinus problems and nose bleeds. After he finished cleaning the dust system, it would take him about two days to recover. He did not report this to either the plant nurse or human resource department at Kimberly-Clark, however, although he said he talked to his immediate supervisor about it. Mr. Harris has not had any rash or joint pain. He has not had any knots on his arms or legs. He did not consult a pulmonary specialist or any other doctor about his problems after cleaning the dust removal system.

Edward Pollard, Jr. testified for both the claimant and the employer that he has been employed at Kimberly-Clark's "Away From Home" plant in Corinth for about fifteen years. He has been machine operator, lead operator, facility supervisor over distribution, human resource manager, and distribution team leader, the position he currently holds. He has known Lee Miller since 1995 when he was employed at the plant.

At first Mr. Miller was a machine operator working rotating shifts like everyone else. Then Mr. Miller applied for a special assignment and performed the project which was primarily office work. The special project involved writing training procedures.

Mr. Pollard knew Mr. Miller cleaned the dust system on weekends, and he remembered that Mr. Miller got sick. He said Mr. Miller is still an employee at Kimberly- Clark.

Mr. Pollard said the Kimberly-Clark plant in Corinth is not a paper mill. The plant makes paper towels and other fabric-type wipes, basically paper products. The dust in the dust removal system is primarily paper dust. The goggles and coveralls and masks and so forth are to protect the employees. There were respirators at the plant from 1995 to 1997, but Lee Miller did not come to him and request a respirator. Mr. Pollard said Kimberly- Clark takes air samples periodically to make sure the air sample is below the recommended OSHA requirement.

The machines are running more often now which means the dust removal system cleaning is done according to a different schedule. Mr. Pollard has observed the cleaning of the dust removal system but has never cleaned the system. He did not dispute Mr. Miller's description of the cleaning process.

The report of Jo H. Spradling, Ed.S., vocational consultant of Spruce & Spradling, Licensed Professional Counselors in Birmingham, was received into evidence. Ms. Spradling did a vocational assessment of Mr. Miller on December 15, 1999, at the request  of his attorney.  Ms. Spradling began her report. "Mr. Miller is a 39-year-old African American male who reportedly suffered occupational exposure during the course of his employment with Kimberly-Clark Corporation." (Exhibit 11, p. 2). Mr. Miller told Ms. Spradling about cleaning the filtering ducts at work.

Mr. Miller also told Ms. Spradling about his medical history and that he had been approved for social security disability income. Mr. Miller advised Ms. Spradling he suffered

unresolved constant pain, inflammation, severe fatigue and shortness of breath which is exacerbated by any increased and/or prolonged physical activity, changes in weather, smoke and/or strong odors. The plaintiff advises that his overall condition continues to decline. He alternates positions frequently due to discomfort. Mr. Miller described a quite restricted, sedentary lifestyle now as a result of his symptomatology. He relates lying down on a daily basis due to pain and weakness.

Mr. Miller states that in or about November, 1997 he attempted to return to light work at the Kimberly-Clark Corporation office four hours daily. Unfortunately, due to significant swelling, pain and fatigue he was forced to discontinue work activities after approximately seven days. Obviously, such functional limitations not only prevent Mr. Miller from returning to his previous line of work, but also preclude him from many other employment alternatives.

Ms. Spradling administered the Wide Range Achievement Test-3rd Revision and the Gates-MacGinitie Reading Tests-3rd Edition. Mr. Miller's scores reflected an average achievement level. Ms. Spradling found Mr. Miller to be 100% permanently and totally disabled from any type of sustained gainful employment. She based her opinion on "objective medical evidence" and Mr. Miller's '~age, education, work history, transferable skills aptitudes, physical restrictions/functional limitations and ongoing subjective complaints." The only medical records she specifically referred to were those of Dr. Michael Mueller.

David Stewart, vocational rehabilitation consultant in Tupelo, testified for the employer at the hearing, and his vocational rehabilitation report dated July 19, 2000, was admitted into evidence. Mr. Stewart reviewed a report from Dr. J. S. Hankins, an FCE report from Grover Sheffield, physical therapist, a radiology report from Dr. Scott Loveless, a pulmonary lab report from Carraway Methodist Medical Center, job description and payroll records from Kimberly-Clark Corporation, a report from Jo H. Spradling, and the deposition of the claimant, Lee Miller.

In his report, Mr. Stewart found Lee Miller to be a thirty-nine-year-old male with one and a half years of college training and a skilled and semiskilled work background. He noted a functional capacity evaluation indicated Mr. Miller was at least capable of performing light exertional activities in the work place. Mr. Stewart conducted a labor market survey of employment opportunities and suggested suchjobs as a sales representative with a mobile home dealer, human resource assistant at a factory, manager trainee at a motel or fast-food restaurant or book store, sales person for a cable television company or cellular telephone company, or life insurance agent. The annual salary range for the various job opportunities was from $21,500 to $32,000, less than the $33,436 Mr. Miller earned at Kimberly-Clark.

Mr. Stewart testified that when he wrote his report about Lee Miller, he was not aware of Mr. Miller's adeptness at using a computer, a significant factor in today's work place. Mr. Stewart also found it important that Mr. Miller has had experience in dealing with budgetary items for a large corporation and that he had the writing skills to put together training manuals for Kimberly-Clark. He was impressed with Mr. Miller's presentation at the hearing and thought him obviously bright and articulate with good memory and excellent personal appearance. He opined Mr. Miller had a lot to offer a prospective employer from a vocational standpoint.

Mr. Stewart is convinced that Mr. Miller has good work abilities, traits, and skills. Mr. Stewart opined that Mr. Miller has a great deal more skills than the average person in North Mississippi who would appear for a job interview with a business or government entity.

Mr. Stewart relied in part upon the report of Jo Spradling. He said Ms. Spradling did not have a functional capacity evaluation before her when she did her evaluation of Mr. Miller, and Mr. Stewart thought that was a disadvantage to her.

Mr. Stewart did not check with Kimberly-Clark about available positions. Mr. Stewart said he would not send Mr. Miller back to Kimberly-Clark unless he could go back to an office job in an air-conditioned environment. Mr. Stewart noted that Dr. Hankins recommended Mr. Miller not go back to the same work.

Mr. Stewart opined Mr. Miller could perform light exertional work. Before he became ill, Mr. Miller did medium exertional work, lifting up to fifty pounds. The salesjobs Mr. Stewart identified in his report pay good salaries after two years. Mr. Stewart said Mr. Miller's average weekly wage would be lower than what he made at Kimberly-Clark, however.

The medical records of Dr. Mohan Gehi of the Memphis Internal Medicine Group were received into evidence. Dr. Gehi examined Lee Miller on October 17, 1997, at the referral of Dr. Charles Parker. Mr. Miller told Dr. Gehi he was employed at Kimberly-Clark and also was a pastor. Mr. Miller presented with multiple complaints, primarily weakness, fatigue, and arthralgia of the left and right ankles, wrists, knees and back.

Dr. Gehi examined Mr. Miller and suspected a rheumatological disorder related to some virus or an unusual infection such as Lyme disease. Dr. Gehi diagnosed polyarthritis of unknown etiology and history of recent apparent viral infection. He recommended various diagnostic tests and prescribed medication. On October 24, 1997, Dr. Gehi said the laboratory work reflected an acute inflammatory pattern, and he recommended a nonsteroidal anti-inflammatory medication on a regular basis. Dr. Gehi advised Mr. Miller to see a rheumatologist.

The medical records of Dr. John Lucius McGehee of the Pulmonary Medicine Group in Memphis were received into evidence. Dr. McGehee examined Lee Miller on December 29, 1997, at the referral of Dr. Jim Nakashima in Memphis. Dr. McGehee reviewed two chest x-rays.  Dr. McGehee noted Mr. Miller has a dry intrusive cough with an abnormal chest x-ray, and he wondered if Mr. Miller had sarcoidosis.¹ He recommended a transbronchial lung biopsy.

The medical records of Dr. Charles B. Bramlett, Jr. of the Pathologists' Laboratory in Columbia, Tennessee, were received into evidence. These records contain a pathologist report for a biopsy of Mr. Miller's right lung, dated January 17, 1998, and other test reports. The biopsy diagnosis was as follows:
 

Lung, Right Lower Lobe, Biopsy:

Fragments of Alveolar Lung Tissue Demonstrating Numerous Well Formed Non-Caseating Granulomas Which Demonstrate Rare Foreign Body Type Giant Cells.

Polarized Light Microscopy Reveals Rare Fragments of Polarizable Material Within Foreign Body Type Giant Cells.

Special Stains for Acid-Fast Bacilli and Fungi are Negative.

There is No Evidence of Malignancy.
 

Microscopically, there is no evidence of a vasculitis. Though the differential diagnosis for non-caseating granulomas within the alveolar parenchyma includes numerous entities, sarcoidosis does remain a distinct possibility; however, the presence of polarizable foreign material also raises the possibility of an inhalational exposure. Additionally, although our special stains for acid-fast bacilli and fungi are negative, direct cultures from the biopsy material are much more sensitive. Clinical correlation and follow-up are recommended.

(Exhibit 4, p. 3).

Dr. Joseph Leonard Pratt, board-certified family practitioner in Corinth, testified by deposition dated March 9, 2000, that he had been treating Lee Miller for two years, having first seen him in February 1998. Dr. Pratt opined Mr. Miller is disabled according to the definition of disability in the Workers' Compensation Act. He explained:

Mr. Miller has an inflammatory lung condition called granulomatous lung disease. It is by some specialists felt to be possibly caused by sarcoidosis; by other specialists, felt to be hypersensitivity pneumonitis,² possibly induced by occupational exposure.

*****

He does definitely have significant dyspnea,³ which is his primary - primary disability related to work. He has also developed some degree of arthritis that has been evaluated by a rheumatologist and is felt to be probably inflammatory in nature. He remains on medications, including steroids and anti-inflammatories, and seems to be close to his maximum medical improvement as far as the disabilities are concerned, and certainly at this point would be - would make him unable to work at this time.

(Exhibit 5, pp. 6- 7). Dr. Pratt thought Mr. Miller's incapacity was permanent and total because his breathing problem would interfere with most exertional activities. He thought Mr. Miller had reached maximum medical improvement.

Dr. Pratt admitted, however, that he was not a specialist in pulmonary medicine or occupational and environmental medicine or pathology. He had not researched or conducted studies dealing with hypersensitivity pneumonitis or sarcoidosis. Dr. Pratt stated that he was not rendering an opinion about the cause ofMr. Miller's condition, only the disability aspect of his case.

Dr. Robert I. Garver, Jr., board-certified internist and pulmonologist and professor at the University of Alabama Medical School at Birmingham, testified by deposition dated December 17, 1999. He examined Lee Miller on one occasion on April 7, 1998. He took the history that in the fall of 1997, Mr. Miller had a gastrointestinal illness followed by ankle swelling and joint pains, then a dry cough and an abnormal chest x-ray. Mr. Miller told Dr. Garver he had been exposed to dust at his workplace.

Dr. Garver thought it was pertinent that Mr. Miller had had symptoms of malaise, fever, sweats, bumps on his forearms and tibias, joint pain, chest pain and blurred vision. Dr. Garver thought all of these complaints consistent with sarcoidosis. Dr. Garver examined Mr. Miller and found his physical exam entirely normal. Dr. Garver ordered a chest x-ray, and the findings were consistent with sarcoidosis. Pulmonary function testing showed Mr. Miller had some pulmonary impairment that Dr. Garver described as mild to moderate.

Dr. Garver said that finding was typical of sarcoidosis, and he diagnosed sarcoidosis. He said there was nothing to lead him to think Mr. Miller had anything other than sarcoidosis. Dr. Garver defined this condition as follows:

Sarcoidosis is an inflammatory disorder that's characterized by an inflammation that's referred to as noncaseating granulomas. And what those are basically are little microscopic nodules of inflammatory cells and I won't bore you with the description. But it has a particular appearance that's very characteristic.

What is important is that that type of inflammation is not specific to sarcoidosis and that other inflammation, particularly infections, can cause the same thing. So we as pulmonologists, or anybody who works with sarcoidosis, it's somewhat a diagnosis of exclusion and the most important thing to exclude is tuberculosis or fungal infection because those are the two types of infections which are very treatable and are treated very differently than one would treat sarcoidosis.

This inflammation most commonly affects the lungs but can affect virtually any other organ system in the body. It's a disorder which is most common in the southeast and people of African descent and particularly women. So we see a fair amount of it in this part of the country.

And the lung symptoms are typically what Mr. Miller described. A shortness of breath, pulmonary function tests typically showing the restriction pattern I described. And in most cases, the prognosis is quite good. In fact, about two-thirds of folks with this will basically spontaneously remit and won't be bothered by it again. And among the remaining third there is a spectrum of disability that persists.

(Exhibit 6, pp. 19-20).

Dr. Garver said he requested the pathology slides from the biopsy Mr. Miller had undergone, and he had the University Medical School pathologist department overread them. He said the pathologists found noncaseating granulomas that were consistent with sarcoidosis and they were unable to find foreign body material in the lung tissue.

The medical report of Dr. Audrey J. Lazenby of the Department of Pathology at the University of Alabama Hospital were received into evidence. There is one report dated April 17, 1998, relating to a right lung biopsy. Dr. Lazenby said he received two slides from the Pathologist's Laboratory in Columbia, Tennessee, together with the original pathology report for Lee Miller's lung biopsy. Dr. Lazenby said he was "unable in our laboratory to identify refractile material with the giant cells of the granulomata (we received recut slides and do not have the originals)." (Exhibit 12, p. 3). He diagnosed:
 

Lung, right lower lobe, biopsy - Multiple non-caseating granulomata with giant cells. . . . Although not etiologically specific, the well-formed, non caseating granulomas are consistent with sarcoidosis.

(Exhibit 12, p. 3).

When asked about hypersensitivity pneumonitis, Dr. Garver said he was familiar with that condition. He did not diagnose Mr. Miller with that condition. He thought the granulomas in the biopsy and the rash, arthralgias, and visual changes fit best with sarcoidosis.

In regard to occupational exposure to dust, Dr. Garver opined:

wood dust exposure was very unlikely to have led to the constellation of findings, both physical symptoms, signs, and his laboratory findings. I thought it was very unlikely that this had caused the problem.

An antigen is a protein that is large enough to initiate an immunologic response against it so that the way the immune system in our bodies eliminates foreign agents is by antigen detection and detecting that protein as being foreign or in some other way abnormal and eliciting and starting the immune response against that.

And the sarcoidosis is basically an ongoing inflammation and because we know that this type of inflammation occurs with several infections that we can identify like the fi.ingal inspections or TB, the leading speculation is that there is some other infectious agent or agents that we just haven't been smart enough to find yet that is responsible for sarcoidosis.

(Exhibit 6, pp. 29-31). He said it could be an environmental antigen in the workplace.

Dr. Garver said, however, "we can't link sarcoidosis to some specific exposure." (Exhibit 6, p. 35). He said the possibility that the cause of sarcoidosis was because of some exposure to an infectious agent was very speculative.

Dr. B. Wayne McAlpin, internist and pulmonary specialist in Corinth, testified by deposition dated December 14, 1999. Dr. McAlpin first saw Lee Miller on October 29, 1998, at the referral of Dr. Joseph Pratt, Mr. Miller's family physician. Mr. Miller complained of shortness of breath and chest tightness. Mr. Miller gave Dr. McAlpin a complicated medical history and several pages of medical records. Dr. McAlpin noted Mr. Miller had already been diagnosed with pulmonary sarcoidosis by a transbronchial biopsy by Dr. David Chase in January 1998. He also had had some ankle swelling and pain and some algias along with his chest tightness.

Dr. McAlpin examined Mr. Miller and noted:

Well, I really didn't find anything that out of the ordinary specifically to his lungs. He had good breath sounds, good excursion of his chest. His chest was resonant to percussion. I didn't hear any wheezes or any crackles, or anything.

Dr. McAlpin reviewed the chest x-ray taken on October 28, 1999, and it showed stage two sarcoidosis. He said it showed "classical pathopneumonic x-ray for sarcoidosis, is hilar adenopathy with interstitial infiltrates." (Exhibit 8, p. 10). Dr. McAlpin diagnosed pulmonary sarcoidosis. He said that the symptoms of arthritis in the ankles, fever, and myalgias are evidence of sarcoidosis and that Lee Miller had the classic signs and symptoms of sarcoidosis. Dr. McAlpin knew that hypersensitivity pneumonitis, an occupational lung disease, was another possibility, but he thought sarcoidosis was the correct diagnosis. He said, however:

I don't think that there's any way to concretely prove one or the other. This is one of those entities where there can be some overlapping of symptoms and presentation. So I don't think that anybody could say definitely, you know, this is one or this is the other. But that's what I felt, that it was probably secondary to sarcoidosis.

(Exhibit 8, pp. 12-13).

Dr. McAlpin next saw Mr. Miller on November 30, 1998. He sent Mr. Miller for pulmonary function tests at the Magnolia Regional Health Center. The results indicated that Mr. Miller had mild restrictive ventilatory impairment as well as an obstructive component. Dr. McAlpin described a restrictive lung disease as

a disease where a patient cannot, or has a less than normal total lung capacity. That means that all of the air, volumetrically in their lung is not what it would be normally. So it's not a problem with moving the air out, it's a problem of the total lung volume.

there's an obstruction either mechanically or otherwise in the airway, such that it's difficult to expire all of your air. You think of that in somebody that has something like COPD, or emphysema or asthma.

On January 19, 1999, Dr. McAlpin examined Mr. Miller. He also reviewed a chest x-ray done December 1, 1998. The x-ray was normal and indicated the prior abnormalities had resolved. Dr. McAlpin concluded Mr. Miller was responding to treatment with steroids. Mr. Miller complained of pain in his joints and chest and shortness of breath when walking 100 yards. The testing showed he was significantly improved, however. Dr. McAlpin did not see him after January 1999. Dr. McAlpin did not restrict Mr. Miller in his activities.

The medical records of Dr. Trev Spraybery (or Sprabery), specialist who is board- certified in rheumaiology at the Memphis Clinic of Internal Medicine and Rheumatology, were received into evidence, and Dr. Spraybery testified by deposition dated December 8, 2000. On December 10, 1998, Dr. Spraybery first saw Lee Miller at the referral of Dr. Pratt, Mr. Miller's family practitioner. Mr. Miller complained of pain in his joints, particularly the ankles. Dr. Spraybery found arthritis in his ankles, both wrists, both elbows, right knee, hips, and other joints.

He also saw him on January 20, March 24, May 20, and August 23, 1999. Dr. Spraybery said Mr. Miller was taking Prednisone and other medication at the advice of other doctors. Dr. Spraybery thought Mr. Miller's inflammatory process was improving when he saw him, depending on how much Prednisone he was taking. Dr. Spraybery said he was not treating Mr. Miller for pulmonary disease. He diagnosed Mr. Miller with inflammatory arthritis.

When asked if the work environment could have contributed to Mr. Miller's physical disorders, Dr. Spraybery responded:

I am trying to think of an environmental exposure contributing to inflammatory arthritis, and I really, frankly, am having a hard time coming up with one. It's possible that I just don't know, but at the moment I can't think of an inflammatory condition or an inflammatory arthritis that would be environmentally caused. I don't think I can relate those two at the moment.

Dr. Michael Mueller, assistant professor in the Department of Family Medicine, Division of Occupational and Environmental Medicine, at the University of Alabama at Birmingham, testified by deposition dated October 25, 1999. Dr. Mueller is board-certified in family medicine as well as occupational medicine, and he has a master's degree in public health. He said Lee Miller had been evaluated in his clinic initially by Dr. Forrester, then Dr. Forrester left, and Dr. Mueller took over his case. Mr. Miller first came to the clinic on May 14, 1998, and made other visits on November 24, 1998, and on January 25 and June 23, 1999.

At the time of his referral to the clinic, Mr. Miller was concerned about the possibility of a work-related condition. Mr. Miller told Dr. Mueller about cleaning the ventilation system that filtered dust at the Kimberly-Clark plant. Dr. Mueller noted Mr. Miller had been diagnosed with sarcoidosis and had undergone a lung biopsy and a lung leukocyte histamine release test. Dr. Mueller did not make a specific diagnosis about Mr. Miller. He thought it was either sarcoidosis or hypersensitivity pneumonitis.

Dr. Mueller defined hypersensitivity pneumonitis as "a disease of the lungs in a response to exposure to an antigen." (Exhibit 7, p. 36). He said further, "Hypersensitivity pneumonitis can be caused by a whole host or list of items, organisms, antigens if you would. And the list is quite long, even though I think we also know that the list is not exclusive." (Exhibit 7, p. 14). Dr. Mueller, however, was not able to find scientific support to connect the dust to which Mr. Miller was exposed at Kimberly-Clark to hypersensitivity pneumonitis or sarcoidosis.

Dr. Mueller said many individuals with hypersensitivity pneumonitis have symptoms of malaise, fever, weight loss, lack of energy, muscle or bone aches or flu-like symptoms, shortness of breath or cough. He said you would not typically see adenopathy in hypersensitivity pneumonitis, and that was more suggestive of sarcoidosis. He said that if a person who has hypersensitivity pneumonitis is removed from the offending agent, the person should improve.

Dr. Mueller testified that he thought there was substantial evidence to suggest Mr. Miller's problem was related to his work. He said Mr. Miller's symptoms were suggestive of sarcoidosis or hypersensitivity pneumonitis and there was a lot of overlap between the two conditions. He did say, however, that "for the most part this looks like sarcoidosis." (Exhibit 7, p.15).  He stated he had "not rendered a specific diagnosis." (Exhibit 7, p.35)

Dr. Mueller said:

I think the pulmonologist pointed out, you know, well, there is some other, you know, signs and symptoms outside of the lung system, the pulmonary system that would make you think that this could be sarcoidosis as opposed to other problems.

And I would have to say that, you know, as - you know, as presented, you know, with all the symptoms that Mr. Miller has had with the biopsy results, so and so forth, you know, for the most this looks like a sarcoidosis.

But because there is such a degree of overlap, and because of his occupational history that led down, you know, the road of considering it is possible that we may be seeing something else that mimics it.

Now, in addition to the work history and symptoms that could be compatible with hypersensitivity pneumonitis he also has with this transbronchial biopsy performed by a pulmonologist, which the pathologist read, and said contained, or at least some of the cells seem to contain some foreign material.

Now, as to exactly what that is, I don't know if I know that, or if anyone knows that, but it raised the idea or the suspicion that there could be an inhalational source, you know, to this problem.

The foreign material purportedly was encapsulated in some of the giant cells which made up the granuloma. So that raises the question of, you know, is that specific to the problem going on here, it is causing the problem going on here.

Now, I know - you know, in addition to that, maybe on the other hand, pulmonology at UAB had samples of that same biopsy sliced and sent down even though it did not represent the same slide, it was a different cut, but they were not able to reproduce that findings. But the question in my mind, you know, still remained.

Now, the other thing that we did was to go ahead and proceed with this Leukocyte Histamine Release Test wherein you get a sample of blood from the patient, Mr. Miller in this case, and you send that along with samples of the suspected item. In other words, items that we think you might be sensitive to. The laboratory, in a special reference lab, will go ahead and incubate the blood against that particular product.

******

The dust samples from the - you know, the duct system or the ventilation system that pulled off the dust from the process. And there were two of those tests out of three that were positive.

In the case where, you know, a person were naive or had not been exposed previously you would think that such a test would be negative.

In the case that you have a positive result that would suggest that there is an immunologic mechanism or immunologic reaction that is occurring suggesting that the body's blood cells recognize this protein.

The other thing here is that we might not know exactly what that item is, but the body recognizes it.

So I think between, you know, the history, you know, the correlation between his work and then the onset of the problem, the biopsy result, the initial biopsy report, and then the Leukocyte Histamine Release Test it gives us information that looks quite compelling.

The reason I say that, you know, it's not a hundred percent diagnostic is that, you know, there's not one test that I can do per se that points to one particular item.

If you would like to say that there is an antigen or there is a spore or there is this thing here that's causing this problem, and I'm not able to do that, but when you add all these things up, you know, it sure makes you think that something is going on here, you know.

The other issue, which is important to us today is that in the past we have always considered sarcoidosis idiopathic, which means that we don't really know why it occurs or what causes it.

But, however, the last years, you know, the thinking has changed somewhat to believe that — that, well, even though we don't know the specific cause we think that - well, actually, we know that sarcoidosis is a cell-mediated immunity, there's a cell-mediated process. The body is responding to an antigen, or more than one antigen, leading to this process of granuloma formation, which then results in the lung symptoms or maybe even other symptoms outside of the lungs.

It so happens that maybe this process occurs only in certain individuals and it might be that certain individuals are somehow more susceptible.

So I think you'll find that that is a prevailing consideration, even though it's considered idiopathic, many believe now that there probably is some trigger.

So even if one were to argue that this is not hypersensitivity pneumonitis, one may possibly argue that, you know, maybe there was a trigger that somehow led to this process.

(Exhibit 7, pp. 16-19).

Dr. Mueller said he reviewed only one chest x-ray, that taken in October 1998. Dr. Mueller said he did not look at the pathology slides but only read the pathologist's report about the slides.

Dr. Mueller said he was not a pulmonologist but a specialist in occupational medicine. He does perform pulmonary function studies, but he did not do any pulmonary function studies on Mr. Miller.

On May 14, 1998, Dr. Mueller had Mr. Miller undergo a blood test called a serum precipitin panel in an attempt to look at some of the classic causes of hypersensitivity pneumonitis. Dr. Mueller found no evidence of sensitivity to those items that are specific for hypersensitivity pneumonitis.

Dr. Kelly Patterson, board-certified internist and specialist in pulmonary medicine in August 25, 1999, at the referral of Dr. Leonard Pratt. Mr. Miller gave him a history that Dr. Patterson related as follows:
 

About two years prior to the time that I saw him, he woke up with swollen ankles and painful shins, and bumps on the skin, arms and legs, and had arthritis. He saw his family doctor and one thing led to another. He had an abnormal chest x-ray, and finally they did a bronchoscopy with a biopsy, a transbronchial biopsy, and came up with the diagnosis of sarcoid.

(Exhibit 10, pp. 5-6). Dr. Patterson reviewed Mr. Miller's chest x-ray and conducted a physical examination. He noted Mr. Miller was very short of breath that day. Dr. Patterson diagnosed pulmonary sarcoidosis.

Dr. Patterson said Mr. Miller was concerned that his pulmonary condition started when he was exposed to dusty conditions at work. He said further:

And the pathologist that read his transbronchial biopsies stated that this possibly could have been a dust-induced pneumoconiosis because of some small area that he saw on the biopsy.

It has been my feelings in talking with pathologists that transbronchial biopsies are not big enough, aren't large enough to make the diagnosis of pneumoconiosis. Most pathologists refuse to do that. They ask for larger biopsies so they can get a more representative idea of what the lung looks like. And I just really don't think that you can make that diagnosis on a transbronchial biopsy. It is a very minute biopsy, not a lot larger than the head of a pin many times.

Dr. Patterson said the pathological findings indicated sarcoid, "an immunologic mediated disease and not a foreign body mediated disease," in other words, not 'something that is acquired from substances in the environment." (Exhibit 10, p. 9). Dr. Patterson said the lesions on Mr. Miller's arms and legs and his arthritic-type joint pain were symptoms of sarcoidosis.

The medical records of Dr. James Steven Hankins, Medical Director, Carraway Occupational Health - North in Birmingham, were received into evidence. Dr. Carraway performed an independent medical exam on May 30,2000, at the referral ofKimberly-C lark. He described Lee Miller as a thirty-nine-year-old Black male who had been employed with Kimberly-Clark for approximately four and half years as a machine operator.

Mr. Miller told Dr. Hankins about the dust cleaning job at Kimberly-Clark. He described an episode in September 1997 when he developed diarrhea and abdominal cramping that his wife and son were also experiencing at the time. Then he began to have swelling of the ankles, knots on his arms and legs, and more stomach cramping and more joint pain. Mr. Miller told Dr. Hankins he lost thirty-seven pounds and developed a dry- non-productive cough. He was treated with steroids, and his cough improved.

Dr. Hankins reviewed the reports of Drs. Parker, Griffin, Gehi, Nakashima, McGehee, Chase, Garver, Forrester, Mueller, McAlpin, Shipp, Pratt, King, Busch, and Patterson (which he erroneously dictated as Pratt). He also reviewed laboratory testing. He conducted a physical examination, pain status inventory, and respiratory testing.

Dr. Hankins noted that Mr. Miller "was not very positive about the possibility of returning to a full time work position at this time, and is content with part-time preaching."

(Exhibit 13, p. 12). He said also, "Patient perceives himself as being severe [sic] disabled" on the Owestry Back Disability Index. (Exhibit 13. p. 14). His score on the Obsessive Compulsive Disorder Screening test was highly suggestive of obsessive compulsive disorder. He showed mild depression on the Zung Depression Scale and moderate anxiety on the Beck Anxiety Scale.

Dr. Hankins diagnosed:

1. Chronic pain syndrome secondary to polyarthralgias.

2. Sarcoidosis vs. Hypersensitivity Pneumonitis.
 

His prognosis was that "Mr. Miller is approximately 2-1/2 years out from developing initial symptoms and in my opinion has become very deconditioned since that time and has lack of motivation." (Exhibit 13, p. 15). Dr. Hankins thought Mr. Miller had reached maximum medical recovery but needed continuing treatment of his respiratory and arthritic condition as well as some psychological counseling to help him deal with his pain behavior and perception of disability.

Dr. Hankins assigned a 0% permanent partial impairment, looking at both the chronic pain syndrome secondary to polyarthralgias and respiratory condition. He opined Mr. Miller could perform physical work at the light level.

Dr. Hankins did a physical examination and had a physical therapist do range of motion testing. The therapist noted inconsistencies in the range of motion testing and self limiting participation in the testing. Dr. Hankins offered his opinion in summary:

It is my medical opinion that this individual is capable ofperformingjob tasks which fall in the light level of work category for an 8-hour day. I also agree that work conditioning would probably improve this individual's stamina. I feel it is also important to state that during the individual's FCE there were no complaints of dyspnea mentioned during the tests. There were also no objective findings on physical exam ofjoint acute inflammatory deformity or gross decrease in ROM. Concerning hypersensitivity pneumonitis, Mr. Miller would need to avoid the plant atmosphere where there was tested antigen reaction to the dust (organic material) from Kimberly Clark.

(Exhibit 13, p. 16).

Dr. Carrie A. Redlich, specialist in occupational and environment medicine and pulmonary diseases and associate professor of medicine at the Yale University School of Medicine in New Haven, Connecticut, testified by deposition dated April 24,2000. She was hired by Kimberly-Clark to review records and provide opinions in the Lee Miller case. She reviewed the medical records of Drs. Parker, Griffin, Gehi, Chase, McGehee, Nakashima, Bramlett, Garver, Pratt, King, McAlpin, Busch, Patterson, Shipp, and Mueller.

Dr. Redlich was asked whether Mr. Miller's lung disease was most likely due to sarcoid or hypersensitivity pneumonitis and whether it was proximately due to exposures at the workplace. Dr. Redlich diagnosed Mr. Miller's condition as sarcoid. She explained:
 

Well, Mr. Miller presented with an illness that really appears quite classic for sarcoid in that he had both pulmonary involvement and nonpulmonary involvement.

And the pulmonary involvement involved symptoms, the abnormalities of his chest x-ray, and those abnormalities in particular with the hilar adenopathy are really classic for sarcoid. We don't see that adenopathy in hypersensitivity pneumonitis.

And then the other features that he had: he had involvement of his liver with abnormal liver function tests, and the pattern of liver abnormality was typical for what we would see with sarcoid, if the liver was involved.

He had reportedly skin lesions that would be typical for sarcoid. He had a lot of arthralgia and joint pain, which would be typical for sarcoid.

None of those would be features that I would expect to see in hypersensitivity pneumonitis, which really involves the lungs.

******

He had joint pains in a number of different joints, and that is one of the classic other organ that's involved with sarcoid.

Dr. Redlich said "sarcoid" is the same as "sarcoidosis," and she said the cause of sarcoidosis is not known. She said that joint or arthralgia symptoms, skin lesions, or enlarged lymph nodes in the hilar region (central area of the chest) are not generally seen in hypersensitivity pneumonitis.

When asked about Dr. Bramlett's conclusions from the small biopsy, Dr. Redlich said the foreign body found in the biopsy did not rule in or out any diagnosis. She said it would be common in anyone's lungs to have a little piece ofpolarizable asbestos or silica. She also said she put little weight on the leukocyte histamine release test. Dr. Redlich said just because Mr. Miller was exposed to dust at work did not mean that the exposure caused the disease. Dr. Redlich testified that she could not diagnose hypersensitivity pneumonitis.

Upon consideration of the pleadings, pretrial statements, stipulation about average weekly wage, lay and medical evidence, demeanor of the witnesses at the hearing, argument of counsel, and the applicable law, the Administrative Judge finds as follows:

1. There is no doubt that the claimant, Lee A. Miller, suffers from both a lung or respiratory condition and inflammatory arthritis. It is also unrefuted that his weekend job cleaning the dust filtering system at Kimberly-Clark required him to work every Saturday around a high level of paper dust. However, the medical evidence presented in this case does not connect either the lung or respiratory condition or the inflammatory arthritis to Mr. Miller's work at Kimberly-Clark or any other dust inhalation for that matter.

The inflammatory arthritis is clearly unrelated to Mr. Miller's employment at Kimberly-Clark. Dr. Trev Spraybery, specialist in rheumatology, testified that he could not relate the inflammatory arthritis to an environmental cause. The claimant did not offer any evidence that supports his claim of work-relatedness of the inflammatory arthritis.

The overwhelming majority of the medical experts offering opinions in this case about Mr. Miller's respiratory or lung problems diagnosed Mr. Miller with sarcoidosis, stating Mr. Miller had classic signs and symptoms of this condition. All the medical experts agreed that the cause of sarcoidosis is not known. It is a condition which is not known to be causally connected in any way to the occupational environment, even one involving exposure to paper dust.

The claimant has relied on the opinions of Dr. Michael Mueller as support for his allegation ofwork-connectedness of his respiratory or lung difficulties, but even Dr. Mueller talked in terms of possibilities — hunches and speculation — not probabilities. Dr. Mueller opined that Lee Miller suffered from either sarcoidosis or hypersensitivity pneumonitis, but he would not make a more specific diagnosis between the two. He implied that hypersensitivity pneumonitis could possibly be the result of exposure to environmental agents at Kimberly-Clark, saying that he had a suspicion that the dust had caused his problems. Furthermore, Dr. Mueller acknowledged that various of the symptoms exhibited by Mr. Miller were suggestive of sarcoidosis as opposed to hypersensitivity pneumonitis. Additionally, he ordered laboratory testing that did not support the possible diagnosis of hypersensitivity pneumonitis.

Dr. Mueller also admitted that he was not a pulmonologist. He is a family physician and specialist in occupational medicine. The four pulmonary specialists who testified in this case — Dr. Robert~Garver in Birmingham, Dr. Wayne McAlpin in Corinth, Dr. Kelly Patterson in Memphis, and Dr. Carrie Redlich at Yale University — diagnosed Mr. Miller with sarcoidosis and said the cause of sarcoidosis was unknown. The first three of the four named pulmonary experts were chosen by Mr. Miller, and none of them linked Mr. Miller's pulmonary problems to environmental causes. None of them thought he suffered from hypersensitivity pneumonitis. Dr. Patterson also cast doubt on the biopsy report that had led to the suggestion of hypersensitivity pneumonitis by saying that the transbronchial biopsy was too small to lead to a diagnosis of dust-induced pneumoconiosis.

One pulmonary expert was chosen by the employer - Dr. Redlich - who is also a specialist in occupational and environmental medicine. Dr. Redlich was unequivocal in her opinion that Mr. Miller's condition was sarcoidosis and was not caused by the employment. She also thought the small biopsy did not rule in or rule out any diagnosis.

2. The claimant's average weekly wage on September 6, 1997, was $643.00, as stipulated by the parties.

3. Even if Mr. Miller's lung problems were work-related, the great weight of the medical evidence does not support his allegation of permanent and total occupational disability. Only Dr. Pratt, a family practitioner in Corinth, has advised restrictions and said that Mr. Miller was occupationally disabled because of his shortness of breath. None of the pulmonary specialists indicated that Mr. Miller was unable to work. Those that did testing found Mr. Miller to have a mild to moderate problem that was improving. Dr. Garver noted that in most cases ~of sarcoidosis the prognosis is good, that two-thirds of the persons affected by the disease go into spontaneous remission, not to be bothered again.

Jo Spradling, a vocational consultant in Birmingham hired by the claimant, opined that Mr. Miller was unable to return to gainful employment. She based her opinion primarily on Mr. Miller's subjective complaints of his condition, however. The only medical report she mentioned reviewing was Dr. Mueller's; she apparently did not see any of the pulmonary specialists' reports.

Dr. James Steven Hankins at Carraway Occupational Health - North in Birmingham, expert engaged for an employer's medical evaluation, did a more thorough assessment of Mr. Miller. He reviewed the reports of all the physicians who had treated Mr. Miller, as well as the laboratory testing. Dr. Hankins also did a physical examination of Mr. Miller, respiratory testing, a chest x-ray, and other tests. He concluded that Mr. Miller had a 0% permanent impairment as to both the chronic pain syndrome related to polyarthralgias and the respiratory difficulties, and he opined Mr. Miller could perform physical work at the light level.

Relying on Dr. Hankins' report and on his own observations of the claimant at the hearing, David Stewart, vocational rehabilitation consultant hired by the employer, did ajob market survey of prospective employment available to Mr. Miller in the light exertional category. At the hearing, Mr. Stewart testified that Mr. Miller had many job skills, including writing skills and adeptness at using a computer, that would make him an excellent prospect for employment in North Mississippi. Mr. Miller has a high school diploma and two years of college and experience at desk jobs such as the special assignment he had at Kimberly- Clark Corporation, work selling life insurance, warehouse supervisory duties, and experience as a purchasing agent. Mr. Stewart thought Mr. Miller would have some loss of wage-earning capacity.

Additionally, Mr. Miller has not looked for ajob with any employer; he thus has not made reasonable job search efforts to prove a permanent partial occupational disability. Mr. Miller is able to work part-time as a preacher and pastor, and he has not exhibited interest in doing any other type of gainful employment.

IT IS THEREFORE ORDERED that Lee Miller's claim for workers' compensation benefits is hereby denied and dismissed.

SO ORDERED this the 13th day of April, 2001.

LINDA A. THOMPSON
ADMINISTRATIVE JUDGE

ATTEST:
Jo Ann McDonald
Commission Secretary

BY:  JANET A.SUMMERS, ASSISTANT SECRETARY
 
 

1 "Sarcoidosis" is denied in the ON-LINE MEDICAL DICTIONARY as a "disease of unknown aetiology in which there are chronic inflammatory g~anulomatous lesions in lymph nodes and other organs." "Pulmonary sarcoidosis" is defined in the ON-LINE MEDICAL DICTIONARY as "sarcoidosis affecting predominantly the lungs, the site most frequently involved and most commonly causing morbidity and mortality in sarcoidosis. Pulmonary sarcoidosis is characterized by sharply circumscribed granulomas in the alveolar, bronchial, and vascular walls, composed of tightly packed cells derived from the mononuclear phagocyte system."

2 "Hypersensitivity pneumonitis" is defined in the ON-LINE MEDICAL DICTIONARY as "chronic extrinsic allergic alveolitis," which is defined as a condition "in which inhalation of organic dusts results in hypersensitivity reactions at the alveolar level, associated with the production of precipitins."

3 "Dyspnea" is defined in the ON-LINE MEDICAL DICTIONARY as "Shortness of breath, difficult or laboured breathing."