This appeal arises under the Texas Workers’ Compensation Act, TEX. LAB. CODE ANN. § 401.001 et seq. (1989 Act). A contested case hearing (CCH) was held on March 8, 1996, to determine whether claimant’s compensable injury of ______, extends to his right knee. The hearing officer held in claimant’s favor and the carrier has appealed, stating that the hearing officer’s decision is incorrect and inappropriate based upon the law argued at the CCH. The claimant responds that the hearing officer’s decision should be affirmed.
DECISION
We affirm.
There was no dispute that the claimant had suffered an injury to his left knee and back when he slipped and fell on ______, while in the course and scope of his employment. He had several surgical procedures on his knee, culminating in a total knee replacement on December 6, 1993. For an unspecified period of time following his injury, he used crutches or a cane to walk. At some point in time, which he believed was around the time of his third surgery in April of 1993, he began experiencing problems with his right knee. He attributed this to the fact that he “had no choice but to rely on” the right knee in getting around.
Few medical reports were in evidence. A January 28, 1994, report from a physical therapist to claimant’s doctor, Dr. B, states that claimant “ambulates with significant decreased weight bearing on the left lower extremity.” In January 1994, Dr. B reported that claimant was having continued inflammation and decreased motion in the knee “which is now causing ongoing ipsilateral hip pain, because of gait mechanics.” On May 23, 1995, claimant saw a referral orthopedist, Dr. M, because of right knee pain. Dr. M wrote as part of claimant’s history that “[o]ver time [he] has had to bear more weight on the right knee because of inability to fully load the left knee and he had felt progressive right knee pain and some noticeable increase in varus on the right side.” Dr. M performed an x-ray and stated his preliminary diagnoses as degenerative osteoarthritis of the knee, patella femoral degenerative disease, and varus deformity, all of the right knee. Both surgical and conservative treatment options were discussed with the claimant.
In June, Dr. B wrote that the claimant had “significant problems” in both knees, along with “significant arthritis in the right knee with symptomatology, swelling and pain.” On October 11, 1995, Dr. B wrote:
Because of the stresses on the unaffected knee, caused by his inability to use this knee properly, he started developing some problems in the unaffected knee . . . An aggressive exercise program was tried on his left knee, as well as the right knee initially, hoping that just as time went on, his left knee became stronger, his right knee would resolve. It has not resolved to this time, and after the evaluation of this right knee, it appears that he needs a total joint replacement on this side as well.
[Claimant] never had problems with his knee prior to his workers’ compensation injury, and because of the stresses placed on this right knee, because of the injury to his left knee, he has accelerated the problem there. The symptomology has been exacerbated by his left knee being unable to carry its share of the work load.
Obviously, this man has not been in a working situation or a creation situation where he could have injured his right knee after his left knee problem began, and the only logical conclusion is the left knee caused the right knee pain to start.
The hearing officer found that claimant’s right knee was aggravated by the compensable left knee injury; in her discussion, she wrote that the claimant’s testimony and the medical evidence showed that the left knee injury and subsequent surgery caused him to almost totally depend upon his right leg and knee. In its appeal, the carrier contends that the claimant alleged that his knee condition is a follow-on injury subject to compensation; it contends, however, that the right knee condition is more appropriately classified as an overuse injury, which is not compensable. It cites as authority two Appeals Panel decisions.
“Injury” is defined by the 1989 Act to include damage or harm to the physical structure of the body and a disease or infection naturally resulting from the damage or harm. Section 401.011(26). As the court stated in Maryland Casualty Company v. Sosa, 425 S.W.2d 871 (Tex. Civ. App.-San Antonio 1968, aff’d per curiam, 432 S.W.2d 515 (Tex. 1968)), “The law is well settled that where an employee sustains a specific compensable injury, he is not limited to compensation allowed for that specific injury if such injury, or proper or necessary treatment therefore, causes other injuries which render the employee incapable of work.”
In Texas Workers’ Compensation Commission Appeal No. 93414, decided July 5, 1993, the Appeals Panel found the medical evidence sufficient to affirm a hearing officer’s determination that the claimant’s compensable right knee injury caused later injury to her back and left knee because the right knee injury cause her to alter the biomechanics of her gait, which placed additional pressures on her back and other knee. In so doing, the panel cited Sosa, supra, in which a claimant’s compensable fracture caused his arm to be put in a cast, which in turn restricted movement of the shoulder joint, causing shoulder adhesions from such non-use.
The claimant in the instant case cited Texas Workers’ Compensation Commission Appeal No. 951822, decided December 18, 1995, as involving facts similar to those herein. In that case, the claimant underwent surgery which resulted in complications and was on crutches for a period of time. As a result, he was required to bear more weight on the opposite leg, which caused knee problems in that leg. In reversing the hearing officer’s finding of non-compensability, the Appeals Panel cited a number of previous decisions and court cases involving follow-on injuries. It also distinguished Texas Workers’ Compensation Commission Appeal No. 950524, decided May 19, 1995, which reversed a determination that the claimant’s injuries, incurred when his compensably injured knee gave way while he was mowing his yard, were compensable. The panel in that case noted that cases in which a follow-on injury was held to be compensable “involved a direct flow of events in showing causal relationship [such as] a back condition caused by changed or altered gait following a knee injury. . . . Here there is a distinct non work-related activity involved in the subsequent injury, the injury is to a distinctly different body part, there is a lengthy period of time between the injury and the claimed subsequent injury, there was at most only a degree of weakening or lowered resistance, and there is a lack of reasonable medical a probability evidence establishing the necessary causation.”
The carrier has cited Texas Workers’ Compensation Commission Appeal No. 93725, decided September 28, 1993, in support of its position. In that case the claimant contended (and the hearing officer found) that she developed a ganglion cyst and carpal tunnel syndrome (CTS) when she had to rely solely on her right hand while the left hand was in a splint or cast from a compensable injury. After citing prior decisions, including Appeal No. 93414, supra, the panel stated that CTS of the non-affected hand “is simply too remote to the initial injury . . . to bring it within the definition of injury or cast it as a consequence of required medical treatment.” The majority (one judge dissented) further noted that the medical evidence showed not a direct causal relationship between the two conditions, but an independent, intervening cause, claimant’s overuse of her right hand.
The carrier also cites Texas Workers’ Compensation Commission Appeal No. 94532, decided June 15, 1994. In that case the hearing officer determined that the claimant suffered a left shoulder injury on the same date he fell or jumped from a crane and was compensably injured. The Appeals panel found the evidence sufficient to affirm, noting that the hearing officer did not decide that the injury occurred as an extension of the compensable right arm injury, and citing Appeal No. 93725, supra, as holding that overuse of an opposite limb to one in a cast will not give rise to a compensable injury.
Contrary to carrier’s argument, we believe that the facts of this case fit more nearly with those of Appeal Nos. 93414 and 951822, supra. As in those cases, it was undisputed that the claimant had a compensable knee injury requiring numerous surgeries, that he used crutches or a cane to ambulate, and that opposite knee pain and injury presented after more pressure was placed on that leg. The carrier argues that claimant, by his testimony, is a large man (5’9″ and 285 pounds) and that knee stress was due to his weight and size. However, as in the previously-cited cases, there is medical evidence that claimant’s knee injury was caused by added stress from his inability to bear as much weight on the opposite leg. The hearing officer, as sole judge of the relevance, materiality, weight and credibility of the evidence, Section 410.165(a), was entitled to rely upon this evidence. Where the medical evidence is conflicting, the hearing officer is entitled to resolve such conflicts. Texas Workers’ Compensation Commission Appeal No. 92234, decided August 13, 1992. We will affirm the hearing officer’s determination where, as here, it is supported by the evidence and is not so against the great weight and preponderance of the evidence as to be clearly wrong or manifestly unjust. In re King’s Estate, 150 Tex. 662, 244 S.W.2d 660 (1951).
The hearing officer’s decision and order are accordingly affirmed.
Lynda H. Nesenholtz – Appeals Judge
CONCUR:
Tommy W. Lueders – Appeals Judge
CONCURRING OPINION:
Based on evidence that claimant’s gait was affected, I concur, emphasizing Texas Workers’ Compensation Commission Appeal No. 93414, supra, which was cited in the foregoing opinion.
Joe Sebesta – Appeals Judge