Claimant’s Causation Evidence Held Insufficient Where Accident Description was Wrong
The appeals panel has reversed the decision and order of a benefit contested case hearing officer and rendered a decision that the claimed injury did not extend to a series of disputed conditions, because the mechanism of injury described by the claimant’s treating doctor was demonstrably incorrect. The decision is posted in Texas Division of Workers’ Compensation Appeals Panel Decision No. 171082, decided July 12, 2017.
In that case, The claimant, an international flight attendant, testified that he injured his left wrist, arm and shoulder on (date of injury), when he placed his arm through a tight space on the side of an airline seat in an attempt to retrieve a passenger’s purse and shoes so that the seat could be placed in an upright position.
The carrier disputed the extent of the injury, arguing that the compensable injury was limited to a contusion. The claimant argued that the compensable injury extended to and included intersection syndrome of the left forearm, crossover syndrome of the left wrist and forearm, crush injury to the left wrist, forearm and elbow, dorsal and ulnar extensor tenosynovitis, short and long extensor tendon synovitis, open long extensor and tenolysis and tenosynovectomy (four tendons), short thumb extensor tenolysis and tenosynovectomy (two tendons), tenosynovial/muscle fascia release of short and long-extensor intersection, multicompartment dorsal forearm fasciotomy, and subcutaneous adhesiolysis.
The claimant offered the opinion of an expert, which the hearing officer credited as persuasive. The carrier appealed. The appeals panel first noted the standard of causation required for proving a causal relationship between an accident and disputed medical conditions.
The Texas courts have long established the general rule that “expert testimony is necessary to establish causation as to medical conditions outside the common knowledge and experience” of the fact finder. Guevara v. Ferrer, 247 S.W.3d 662 (Tex. 2007). The Appeals Panel has previously held that proof of causation must be established to a reasonable medical probability by expert evidence where the subject is so complex that a fact finder lacks the ability from common knowledge to find a causal connection. Appeals Panel Decision (APD) 022301, decided October 23, 2002. See also City of Laredo v. Garza, 293 S.W.3d 625 (Tex. App.-San Antonio 2009, no pet.) citing Guevara. Additionally, the claimant must show the mechanism of injury is a producing cause of the claimed injury, i.e., a substantial factor in bringing about an injury, and without which the injury would not have occurred. See Transcontinental Insurance Company v. Crump, 330 S.W.3d 211 (Tex. 2010).
Next, the appeals panel examined the medical report relied upon by the claimant to support causation. That report stated:
RATIONALE: The examinee indicated that he was attempting to close electronic seats on an airplane. He indicated that the chair closed on his arm and broke it. This mechanism of injury along with subsequent swelling and inflammation would be consistent with causing the [disputed conditions].
The appeals panel concluded that this report was insufficient to support a finding of a causal relationship between the accident and the disputed conditions. The appeals panel reasoned:
Dr. L’s report, including his causation analysis and opinion that the compensable injury extends to the disputed conditions, is based upon an inaccurate understanding of the mechanism of injury. The claimant testified that he was injured when he repeatedly placed his arm through a tight space in the side of the airline seat. The claimant did not testify, and there is no other evidence in the record, that the chair closed on the claimant’s arm and broke it. No other records in evidence provide expert evidence to establish that the mechanism of the injury was a producing cause of the disputed conditions. Therefore, the preponderance of the other medical evidence is contrary to the designated doctor’s opinion that the compensable injury extends to the disputed conditions.
The appeals panel rendered a decision that the injury did not extend to the disputed conditions.
FOLIO
