This appeal arises pursuant to the Texas Workers’ Compensation Act, TEX. LAB. CODE ANN. § 401.001 et seq. (1989 Act). A contested case hearing was held on November 5, 1998. With respect to the single issue before him, the hearing officer determined that the appellant’s (claimant) compensable injury does not extend to a cervical injury. In her appeal, the claimant essentially argues that that determination is against the great weight and preponderance of the evidence. In its response, the respondent (self-insured) urges affirmance.
DECISION
We reverse and remand.
The facts in this case, which are largely undisputed, were recited in detail in the hearing officer’s decision and will not be repeated here except as necessary to put the decision in context. The claimant has been employed with the self-insured for over 18 years. She has held various positions, but each one required her to use one or more computers. The self-insured accepted a repetitive trauma, carpal tunnel syndrome (CTS), claim, with a date of injury of ___________.
The claimant began treating with Dr. E on ___________. In treatment notes of that date, Dr. E noted that the claimant had numbness and tingling in her hands and “pain that radiates into her shoulder and neck areas.” Dr. E stated “[i]t is my impression that this lady, due to the fact of the kind of work she does with poor ergonomics is causing her thoracic outlet and most likely [CTS] on both of her hands.” The claimant continued to treat with Dr. E, whose diagnosis of CTS and thoracic outlet syndrome remained unchanged.
On June 23, 1997, Dr. G examined the claimant at the request of the self-insured. In his report, Dr. G states that the claimant sustained a repetitive use injury to her upper extremities. He continued:
There is no evidence of any neck or shoulder injury that would be sustained with operating a keyboard, in my professional opinion. There is no evidence of cervical radiculopathy at this time.
Dr. T examined the claimant as a Texas Workers’ Compensation Commission (Commission)-required medical examination (RME) doctor to consider whether the claimant’s thoracic outlet syndrome was related to the compensable injury. Dr. T noted that the claimant had complaints of pain in her back, both shoulders, and down both arms. Dr. T concluded that her examination of the claimant did not reveal evidence of thoracic outlet syndrome; however, Dr. T further noted that she “wonder[s] about the possibility of a fibromyalgia type disorder.”
On June 29, 1998, the parties executed a benefit dispute agreement, where they agreed that the “claimant’s compensable injury does not include a brachial plexus (thoracic outlet) injury.” (Emphasis in original.) On July 10, 1998, Dr. G examined the claimant a second time for the self-insured. Dr. G stated that the claimant had sustained a repetitive trauma injury to her upper extremities and further noted a possible diagnosis of fibromyalgia. Dr. G opined that the claimant reached maximum medical improvement (MMI) on June 22, 1997, with an impairment rating (IR) of zero percent.
On August 13, 1998, the claimant began treating with Dr. N, who noted complaints of severe pain and numbness in the claimant’s wrists and hands and neck pain, which radiates into the posterior aspect of her shoulders. The claimant filed under her group health benefits for Dr. N’s treatment. She explained that she filed under her group health because the self-insured had been consistently denying treatment for anything other than CTS. In addition, there is evidence in the record suggesting that Dr. N would not treat a workers’ compensation patient. Dr. N ordered a cervical MRI, which revealed spondylosis and a small central disc herniation at C5-6 and a mild bulge and spondylosis at C6-7. In his report of September 10, 1998, Dr. N discussed the MRI findings and noted that the claimant has “bilateral C6-C7 radicular symptoms probably related to a small herniated disc at C5-C6.”
On August 17, 1998, Dr. B, who was selected by the Commission to serve as the designated doctor, examined the claimant. Dr. B noted that the claimant’s cervical range of motion was reduced approximately 50% in all directions. Dr. B certified that the claimant reached MMI on June 22, 1997, with and IR of zero percent. He noted that the claimant might have a herniated cervical disc; however, he opined that it was unrelated to her compensable repetitive trauma injury. Specifically, Dr. B stated:
It is possible that she has a disc herniation in her cervical spine that is causing some of her symptoms. This is not a repetitive stress injury, and therefore, would not be compensable.
The hearing officer determined that the claimant’s compensable injury did not extend to a cervical injury and noted no medical reference to cervical problems until August 1998. We are concerned that the hearing officer’s determination in that regard is premised upon an incorrect application of the law in that he determined that medical evidence was required to prove causation in this instance. In his discussion section, the hearing officer stated:
The Appeals Panel has repeatedly held that the Claimant needs expert medical evidence based on reasonable medical probability to establish causation for this type of condition. The Claimant did not introduce testimony of written statements from any doctor that opined that she suffered cervical spine injuries due to her repetitive trauma at work. Without expert medical opinion establishing this causation, I am unable to find that the Claimant’s compensable injury extended to her cervical spine.
We cannot agree with the hearing officer’s statement that we have required expert medical evidence to prove causation in cases where a back/neck injury is claimed as a result of repetitively traumatic activities at work. To the contrary, in accordance with Texas Employers’ Ins. Ass’n v. Ramirez, 770 S.W.2d 896 (Tex. App.-Corpus Christi 1989, writ denied), we believe that expert evidence of causation is not required. In Ramirez, the plaintiff alleged that she had sustained a back injury as a result of engaging in repetitively traumatic activities at work. Specifically, she claimed that her back injury was caused by repetitive bending and twisting she was required to perform in order to iron on a low ironing board. The Ramirez court held that the testimony of the plaintiff and her co-workers was sufficient for the jury to find she suffered an injury in the form of an occupational disease resulting from repetitious trauma. In so finding the Court of Appeals stated:
Appellee’s testimony and that of her co-workers is sufficient to establish a causal connection between the specific activities of her work and her condition. The type of disease with which we are dealing is not one of unknown or mysterious etiology which requires expert medical testimony to establish causation; rather, it is a condition within the general experience and common sense of persons generally, so that it is appropriate to allow the jury, as fact finder, to know or anticipate that the condition could reasonably follow the specific events.
Id. at 901; see also, Texas Workers’ Compensation Commission Appeal No. 950025, decided February 21, 1995 (claimant’s testimony alone sufficient to support finding of a neck injury); Texas Workers’ Compensation Commission Appeal No. 93560, decided August 19, 1993 (noting that we were unaware of a requirement that back injuries be proven by expert medical evidence); and Texas Workers’ Compensation Commission Appeal No. 91124, decided February 12, 1992 (where we determined that a repetitive trauma back injury did not fit within the narrow exception requiring expert medical evidence of causation). Under the teachings of those cases, we believe the hearing officer erred in determining that medical evidence of causation was required in this case. In addition, this is not a case of “attenuated causation” where the lack of references to cervical complaints and the absence of cervical treatment counsels that medical evidence of causation might be required. Rather, this is a case where the diagnosis evolved after treatment of the claimant’s CTS failed to alleviate her cervical symptoms; thus, a cervical MRI was ordered to see if it could provide an explanation for the claimant’s continuing problems. See Texas Workers’ Compensation Commission Appeal No. 951101, decided August 17, 1995 (affirming determination on extent-of-injury issue, noting that delay in treatment was adequately explained). We reverse the hearing officer’s decision and remand for reconsideration of the question of whether, in his view as the fact finder and the sole judge of the evidence, the claimant has presented sufficient evidence to demonstrate a causal connection between her cervical injury and her repetitively traumatic activities at work, keeping in mind that expert evidence of causation is not absolutely required. While medical evidence of causation is not specifically required, we note that the hearing officer is free to consider that evidence in resolving the issue before him.
The hearing officer’s determination that the claimant’s compensable injury does not extend to a cervical injury is reversed and the case is remanded for further consideration of that issue in a manner consistent with this opinion. Pending resolution of the remand, a final decision has not been made in this case. However, since reversal and remand necessitate the issuance of a new decision and order by the hearing officer, a party who wishes to appeal from such new decision must file a request for review not later than 15 days after the date on which such new decision is received from the Texas Workers’ Compensation Commission’s Division of Hearings, pursuant to Section 410.202. See Texas Workers’ Compensation Commission Appeal No. 92642, decided January 20, 1993.
Elaine M. Chaney – Appeals Judge
CONCUR:
Joe Sebesta – Appeals Judge
Tommy W. Lueders – Appeals Judge