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 1, 2001. The hearing officer determined that the respondent’s (claimant) compensable injury extends to and includes the claimant’s right knee. The appellant (self-insured) appeals, arguing that the injury to the claimant’s right knee was not an injury which naturally flowed from the original compensable injury. The claimant replies, urging affirmance.
DECISION
Reversed and rendered.
The parties stipulated that the claimant sustained a compensable left knee injury on __________. The claimant testified that while walking out of a grocery store on __________, he fell and injured his right knee. He also testified that at the time of the fall, he was involved in an active physical therapy program three days per week, was wearing a knee brace “sleeve” on his left knee, and that the left knee remained unstable, which was what caused his fall.
The claimant placed in evidence the report of Dr. E, the carrier-selected required medical examination doctor (Claimant’s Exhibit No. 10). Dr. E was asked whether the right knee injury was related to the compensable left knee injury and opined:
It is certainly plausible that the right knee injury was secondary to giving way of the left knee, and without contradictory evidence or information available I would assume that the right knee is related to the injury in that the examinee collapsed secondary to pain induced by his incompletely healed compensable injured left knee.
This information is very similar to the medical evidence presented in Texas Workers’ Compensation Commission Appeal No. 981001, decided June 17, 1998. The doctor in that case provided medical reports from which the following quotes were extracted:
His right leg gave out from under him and he fell and sustained a couple of thoracolumbar compression fractures . . . I believe that these are related to his Comp injury because it was the weakness in his leg that caused him to fall, which caused him to have the fractures. He had the weakness in the leg as a result of the nerve injury that was sustained as a result of his injury. [Medical record, December 8, 1997.]
The bottom line is the injury you have has caused you to be more susceptible to falling due to weakness in the leg. . . . I think that the reason that you fell is because of the weakness you have in the leg and the reason you have the weakness in the leg is because of your work-related injury. It all relates in my opinion. [Letter to claimant, March 20, 1998.]
In affirming the hearing officer’s decision in Appeal No. 981001 that the second injury did not naturally result from the compensable injury, the Appeals Panel held that the hearing officer could consider the summary, conclusive nature of the doctor’s opinion and determine that there was insufficient expert medical evidence to establish to a reasonable medical probability that the claimant’s compensable injury naturally resulted in his fall and injury. We discern no appreciable difference in the facts of that case and this one which would warrant a different result.
We rely upon Appeal No. 981001, where the Appeals Panel discussed in great detail the concept of when damage or harm “naturally results” from an injury:
Section 401.011(26) defines “injury” to mean, in part, “damage or harm to the physical structure of the body and a disease or infection naturally resulting from, the damage or harm. [Emphasis in original.]” This case centers around the question as to whether claimant’s thoracolumbar compression fracture injury “naturally resulted” from the original damage or harm to the physical structure of the body. The court in Maryland Casualty Company v. Sosa, 425 S.W.2d 871, 873 (Tex. Civ. App.-San Antonio 1968, writ ref’d n.r.e. per curiam 432 S.W.2d 515) stated that “[t]he 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 therefor, causes other injuries which render the employee incapable of work.” The Appeals Panel, in Texas Workers’ Compensation Commission Appeal No. 94067, decided February 28, 1994, cited Maryland Casualty Company v. Rogers, 86 S.W.2d 867, 871 (Tex. Civ. App.-Austin 1935, writ ref’d) stated as follows:
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. However, the fact that an injury may affect a persons’s resistance will not mean that a subsequent injury outside the work place is compensable where the subsequent disease or infection is not one which flowed naturally from the compensable injury.
In Texas Workers’ Compensation Commission Appeal No. 951402, decided October 5, 1995, the Appeals Panel reversed and rendered a decision that the employee’s compensable right knee injury of January 21, 1994, did not extend to his left knee which he claimed to have injured on the day he was released from the hospital following right knee surgery when he slipped using crutches and turned or twisted his left knee. That decision noted that the Appeals Panel has many times considered cases in which instability, weakness, or lowered resistence from a compensable injury allegedly resulted in an injury to another body part. The decision then cited as instances where the Appeals Panel found the claimed follow-on injuries noncompensable, Texas Workers’ Compensation Commission Appeal No. 94067, decided February 28, 1994, and Texas Workers’ Compensation Commission Appeal No. 92553, decided November 30, 1992, involving injuries from an unstable or buckling knee, Texas Workers’ Compensation Commission Appeal No. 93672, decided September 16, 1993, involving an injury from a fall claimed to have been caused by a foot giving way, Texas Workers’ Compensation Commission Appeal No. 941575, decided January 5, 1995, involving a compensable spinal fracture with residual paraplegia which left the employee with no motor or sensory function below the waist and his leg was burned while sitting next to a hot grill at home, and Texas Workers’ Compensation Commission Appeal No. 93574, decided August 24, 1993, in which compensability was denied for knee and back injuries resulting from the employee’s slipping in a shower after swimming as a part of post-surgery therapy.
The claimant had the burden of proving that his right knee injury of __________, resulted from his compensable left knee injury of __________, and the issue was one of fact for the hearing officer to resolve. The hearing officer found that while the claimant was walking out of a grocery store, the claimant “fell due to continuing problems and or instability with his left knee.” We believe, however, that the facts of this case fall in line with the cases cited in Appeal No. 981001, supra, and that the injury to the right knee is not a direct and natural result of the original compensable injury. Rather, this is a case in which instability, weakness, or lowered resistence from a compensable injury allegedly resulted in an injury to another body part, and under the case law cited above, such injuries are not compensable.
Accordingly, and based upon the foregoing, we reverse the decision and order of the hearing officer and render a new decision that claimant’s compensable injury does not extend to or include a right knee injury. The claimant continues to be entitled to all appropriate medical and income benefits for the injury of __________.
The true corporate name of the insurance carrier is (a certified self-insured) and the name and address of its registered agent for service of process is
RM
(ADDRESS)
(CITY), TEXAS (ZIP CODE).
Michael B. McShane – Appeals Judge
CONCUR:
Susan M. Kelley – Appeals Judge
Thomas A. Knapp – Appeals Judge