Words Matter in Causation: Evidence Insufficient to Include Knee Injury

We are constantly dealing with causation issues. And understanding what evidence proves a causal relationship in a claim is an acquired skill that can be learned by reading how the Appeals Panel has treated such cases in the past.

One good example can be found in a 2015 decision where the Appeals Panel reversed a Hearing Officer’s determination that a claimant’s compensable injury extended to and included chondromalacia of the patella in the left knee. The Appeals Panel rendered a new decision that the compensable injury does not include the arthritic condition. The decision demonstrates the importance of carefully reviewing the language that purports to show causation. Words do matter. The decision was posted on the Division’s website on November 4, 2015 and is designated Appeals Panel Decision Number 151639.

The Hearing Officer found that the compensable injury extended to and included medial and lateral meniscus tears, as well as chondromalacia of the patella. The carrier contended that the injury was limited to a left knee strain. The claimant offered into evidence a letter of causation that from Dr. S. This doctor opined that while the claimant’s pre-existing arthritis was not caused by the compensable injury, she “could have” sustained that injury at the time of the compensable injury, and that her symptoms present after the injury were not present prior to the injury. Dr. S also opined that “[m]eniscus tears could aggravate an already arthritic knee” and result in the symptoms described by the claimant.

The Appeals Panel reversed the Hearing Officer’s decision of compensability.

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.

In APD 110054, decided March 21, 2011, the Appeals Panel stated that “[a]lthough the claimed conditions are listed in the record, there is not any explanation of causation for the claimed conditions in the record. We hold that in this case the mere recitation of the claimed conditions in the medical records without attendant explanation how those conditions may be related to the compensable injury does not establish those conditions are related to the compensable injury within a reasonable degree of medical probability.”

While Dr. S acknowledged the compensable injury “could have” aggravated the arthritis, Dr. S did not provide any explanation of how the compensable injury caused chondromalacia of the patella of the left knee, and there was no other record in evidence providing the necessary explanation. Because there is no explanation of how the compensable injury caused chondromalacia of the patella of the left knee, the Hearing Officer’s determination that the compensable injury of (date of injury), extends to chondromalacia of the patella of the left knee is not supported by the evidence. Therefore, we reverse that determination and we render a new decision that the compensable injury of (date of injury), does not extend to chondromalacia of the patella of the left knee.

An opinion that addresses causation in terms of “possibilities” will not support causation of an injury or condition that otherwise requires proof of expert opinion testimony. In addition, in such cases, the causation evidence must provide an “explanation” of how the compensable injury caused the claimed injury or condition.