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 August 8, 1997. The decision recites the record was closed on August 22, 1997 (all dates are in 1997 unless otherwise noted). With respect to the two issues before her, the hearing officer determined that respondent’s (claimant) “eye injury is a result of the compensable injury” and the appellant (carrier) had not waived its right to contest compensability of the right eye injury. The determinations on the timely contest of compensability of the eye injury have not been appealed and consequently, have become final under Section 410.169.
Carrier appeals the hearing officer’s determinations that the eye injury “naturally flows” from the original compensable injury (to claimant’s neck, wrist, low back and right shoulder) “as matter of law” citing several Appeals Panel decisions. Carrier requests that we reverse the hearing officer’s decision and render a decision in its favor. Claimant urges affirmance.
DECISION
We reverse and render a new decision that claimant’s right eye injury is not compensable.
Although much of the CCH dealt with whether carrier had timely contested compensability of the eye injury, other evidence, while somewhat sparse, is generally uncontradicted. The parties stipulated that claimant sustained a compensable injury on (first date of injury). How that injury occurred and the exact extent of that injury is not in evidence. Claimant testified, and is supported by the medical evidence, that he sustained a compensable injury to his right wrist, back, neck, and right shoulder in (first date of injury). Medical records indicate a right L5 diskectomy, exploration of the L3 disk and a spinal fusion in April 1994. Claimant “underwent anterior cervical fusion at the C6-7 level for ruptured cervical disk in May, 1995.” Claimant has also had “a posterior fusion at L5-S1 level.” Another report indicates that claimant “has undergone right wrist surgery in early 1996.” Claimant testified, and the evidence suggests, that he has had several other falls due to his weakened condition. The hearing officer recites that the evidence established that claimant “has experienced numbness in his legs, an unsteady gait, and severe back spasms which caused him to fall on (subsequent date of injury), while at home.”
Exactly what happened on (subsequent date of injury) is not clear. Claimant testified that as he went to the back door of his garage to throw out some trash “my back went out again, and my legs just completely buckled, and I tried to grab the counter. And I grabbed the counter that had a drawer on it that I didn’t know what was in it, and it all went right in my face, and I went down.” The drawer is variously described as a rack, tray, or drawer. Claimant is unsure of what hit him in the face. Reports variously refer to pieces of metal or plastic. One progress note dated April 22nd, states “a box junk [sic] (nails, paper clips, dirt, etc.) went in both eyes.” Exactly what happened next is unclear. Claimant apparently saw a nearby optometrist (an “eye doctor” who told claimant that he was only “a give-you-glasses kind of guy”); claimant then tried to wash the foreign objects out of his eyes, called his daughter and claimant’s daughter eventually took him to the hospital. A hospital emergency room (ER) chart note dated (subsequent date of injury) (at apparently 4:44 p.m.) notes that “Pt reports 2 days ago working in garage when hit container full of plastic and got particle in eye.” Complaints of blurred vision and loss of visual acuity were noted.
Most of the medical evidence deals with claimant’s rather extensive back, neck, and wrist problems. In a report dated April 22nd, Dr. S stated:
As you know, this patient continues to be under my care for his back and neck injury. He stated about two weeks ago his low back went out on him and he started falling he reached for something and metal went into his eyes. He was treated at the [ER]. I have since referred him to [Dr. NS] for treatment on his eyes. It is my understanding that [Dr. NS] is referring him to [Dr. F] for further treatment and this is satisfactory for me.
Since his eye injury is the result of his low back going out on him, it is my opinion his eye injury his [sic] subsequent to his low back injury.
In another report dated May 7th, Dr. S stated “In my opinion his eye injury is probably related to his back injury.” Dr. NS in a note dated April 9th refers to claimant’s back injury and recites the history of “grabbed a drawer” without comment on causation.
The hearing officer, in her statement of evidence stated:
The appropriate test to apply to determine compensability is whether the (subsequent date of injury) fall at home was the direct and natural result of the original compensable injury. As noted in Appeal No. 941575, decided January 5, 1995, the Appeals Panel rejected the concept that brings within the ambit of compensable injury every consequence that arguably may not have occurred “but for” the original injury. In Texas, there must be a direct relationship between the employment and the injury such that the one flows naturally from the other.
The hearing officer then goes on to state “Normally, this case might not be compensable, except for medical evidence that was dated March 4, 1997 which documented” complaints of “low back pain with unsteady gait . . . .” The hearing officer makes the connection between claimant’s original serious compensable injury “which caused increased back pain and an unsteady or altered gait, which caused him to fall at home . . . .” The hearing officer states that this is essentially a fact question whereby the hearing officer concludes that the (subsequent date of injury) “incident was caused by or directly related to the original . . . compensable injury.” Carrier contends that there are several Appeals Panel decisions which have applied the naturally flowing standard and concludes that as a matter of law the hearing officer erred in determining the fall at home flowed naturally from the compensable injury.
We agree with the hearing officer that the “naturally flowing” standard is the appropriate standard to be used in this case. Texas Workers’ Compensation Commission Appeal No. 971314, decided August 25, 1997, stated that in construing the word “naturally” in the context of a predecessor statute, the Amarillo Court of Civil Appeals in Maryland Casualty Co. v. Rogers, 86 S.W.2d 867 (Tex. Civ. App.-Amarillo 1935, writ ref’d), stated: “By the word ‘naturally,’ as used in the statute, it is not meant that the disease which is shown to have attacked the victim of the accident is such disease as usually and ordinarily follows the accident; but it is only meant that the injury or damage caused by the accident is shown to be such that it is natural for the disease to follow therefrom, considering the human anatomy and the structural portions of the body in their relations to each other.” Id. at 871. The court in that case also stated that the cause of the injury “set in motion . . . operated continuously through a sequence of events, each flowing naturally from one to the other, . . .” Id. at 871. Texas Workers’ Compensation Commission Appeal No. 950524, decided May 19, 1995, contains a survey of cases in which the Appeals Panel has applied the naturally flowing language. In that case, which incidentally contains substantially more relevant medical evidence, the Appeals Panel reversed the hearing officer’s decision and rendered a new decision that the employee’s neck and shoulder injury was not compensably based on an earlier compensable right knee injury. Similarly in Appeal No. 941575, supra, the Appeals Panel reversed and rendered a decision that the employee has not sustained a compensable follow-on injury in circumstances where he had a compensable spinal fracture with residual paraplegia which left him with no motor or sensory function below the waist and he suffered a burn injury while sitting next to a hot grill. That decision stated that the Appeals Panel “has not indorsed a blanket concept that brings within the ambit of compensable injury every consequence that arguably may not have occurred ‘but for’ the compensable injury.” Perhaps most succinctly stated is the comment in a dissenting opinion in Appeal No. 971314, supra, which notes “that falls generally are not a naturally flowing result of spinal injuries.”
While a majority of cases may find follow-on falls due to spinal injuries not compensable, Texas Workers’ Compensation Commission Appeal No. 961055, decided July 19, 1996, cited several other decisions analyzing Appeal No. 950524, supra, and suggesting some factors to be considered in determining “a direct flow of events in showing causal relationship.” Appeal No. 961055, supra, held in determining the noncompensability of shoulder and back injuries due to a fall caused by a compensably injured knee:
Crucial to the determination of Appeal No. 950524, supra, however, was the fact that there was a distinct non work-related activity involved in the subsequent injury, the injury was to a distinctly different body part, there was 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 was a lack of reasonable medical probability establishing the necessary causation (as opposed to a doctor’s “but for” analysis).
(Those factors are also repeated in Appeal No. 971314, supra.) Applying those factors to the instant case, claimant had compensable back and neck injuries in (first date of injury), lumbar surgery in 1994, and cervical surgery in 1995, the claimed injury here is to the eye, a distinctly different body part, in (subsequent date of injury); claimant contends that his back injury caused an “unsteady or altered gait” although this is only presented as history by the claimant and the only medical evidence establishing causation is Dr. S’s report of May 7th which says “In my opinion his eye injury is probably related to his back injury.” While “magic words” are not required in expressing opinions on causation (Texas Workers’ Compensation Commission Appeal No. 94815, decided August 4, 1994,) reasons given for the opinions expressed are most helpful in resolving the issues of causation. Here, there are no reasons given and it is questionable whether Dr. S’s comment rises to reasonable medical probability.
We are mindful that we have many times stated that whether the required causation, in this type of case, has been established is generally a question of fact for the hearing officer to decide (Texas Workers’ Compensation Commission Appeal No. 93672, decided September 16, 1993), nonetheless, the hearing officer’s determination of causation must be supported by some evidence. In the case before us, the hearing officer only recites the history claimant gave to a hospital on March 4th of an “unsteady gait” to establish causation. In addition to that notion, we also have Dr. S’s vague comment that the eye injury “is probably related” to the compensable back injury. Under these circumstances we find that the hearing officer’s determinations that claimant’s compensable back injury, which may have caused an altered gait, which caused claimant to fall, which caused claimant to hit a tray or drawer which spilled and caused an unspecified eye injury, to be so against the great weight and preponderance of the evidence as to be clearly wrong and unjust. Cain v. Bain, 709 S.W.2d 175, 176 (Tex. 1986). The eye injury is simply too remote and removed from the compensable back injury combined with a lack of medical evidence of causality.
Accordingly, we reverse the hearing officer’s decision and render a new decision that claimant’s right eye injury of (subsequent date of injury) was not a naturally flowing consequence of the original compensable back injury.
Thomas A. Knapp – Appeals Judge
CONCUR:
Robert W. Potts – Appeals Judge
DISSENTING OPINION:
I dissent for essentially the same reasons I did in Texas Workers’ Compensation Commission Appeal No. 960021, decided February 15, 1996. Whether the claimant’s eye injury naturally flowed from the claimant’s compensable injury was a question of fact, and I believe that there was sufficient evidence to support the hearing officer’s finding that it did. I also note that we recently affirmed a hearing officer in making essentially the same finding under facts similar to the present case in Texas Workers’ Compensation Commission Appeal No. 971314, decided August 25, 1997. As I stated in my dissenting opinion in Appeal No. 960021, supra, “follow-on” injuries will generally involve different body parts than the original injury. The majority criticizes the evidence supporting the hearing officer’s finding that the eye injury naturally flowed from the compensable injury but fails to recite what the evidence is which constitutes the great weight and preponderance of the evidence contrary to her finding. What weight to give the evidence before her was clearly the province of the hearing officer. I am unable to fathom what legal doctrine, if any, the majority is applying. I do not find particularly persuasive the long recitation of our prior decisions without an explanation of how they dictate the result reached. The hearing officer is the fact finder and it is not our function to reweigh the evidence. I would affirm the decision and order of the hearing officer.
Gary L. Kilgore – Appeals Judge