This appeal arises under the Texas Workers’ Compensation Act, TEX. LAB. CODE ANN. § 401.001 et seq. (1989 Act). A contested case hearing was held on December 11, 1995. The self-insured governmental entity which employed the claimant (hereinafter carrier or employer, as appropriate) files this appeal of the hearing officer’s determinations that the claimant’s current wrist condition is the result of her compensable injury of _____________, that claimant had disability beginning on ___________, and continuing to the date of the hearing, and that claimant is entitled to reimbursement for travel expenses for 696 miles at the state mileage rate of $.28 per mile for medical treatment at the direction of Dr. F (Dr. F), her treating doctor. In its appeal the carrier contends that claimant’s injury could not have credibly caused her current condition, and points to medical evidence which supports its position. It contends that the hearing officer’s decisions regarding disability and travel expense are flawed because both result from the condition which the carrier contends is not part of the compensable injury. The claimant responds that the hearing officer’s decision should be affirmed.
DECISION
Affirmed.
The claimant, who was employed as a temporary custodial employee by a school district, was injured on ____________ (all dates are 1995), when she struck her right wrist against a soft drink machine while cleaning. She first sought medical treatment on ___________ when she saw Dr. M (Dr. M), whose initial medical report indicates he x-rayed her wrist, diagnosed wrist sprain and lumbosacral sprain, and gave her medications and a wrist splint. The record further indicates that the claimant saw Dr. M on February 7th, at which time she reported “persistent pain” in the wrist and was diagnosed with tendinitis and a sprain and was referred to an orthopedist, Dr. R (Dr. R). On February 8th Dr. R reported that claimant’s wrist splint had been removed and she had returned to work (the claimant testified that Dr. M had given her a light duty release) but had begun to experience swelling and pain in her wrist. He noted that x-rays revealed no evidence of fracture or dislocation and an area “suspicious” for fracture near the distal radius did not correspond to the site of trauma.
In addition, Dr. M ordered a bone scan on February 22nd which showed increased osseous uptake in the wrist correlating with the region of the scaphoid, lunate, or possibly the radiocarpal joint and were found to be consistent with “traumatic/arthritis uptake.” Additional x-rays performed the next day showed a small cyst-like density which was explained as more suggestive of synovitis than a fracture. In a patient note dated March 8th Dr. R said that as a result of the bone scan Dr. M had placed claimant in a cast, which Dr. R removed, noting some tenderness about the first extensor compartment, which he injected. He also noted that the x-ray had shown “what appears to be a small cyst.”
In March the claimant changed treating doctors, to Dr. F. His initial medical report of March 16th stated that claimant “had no direct blow or direct twisting injury to the wrist, and her wrist did not really hurt right away, but began to bother her by the end of the day.” He noted that the claimant had changed doctors because her symptoms were not improving. His examination found tenderness over the first dorsal compartment on the right and tenderness of the navicular at the proximal pole, and stated that “any motion of the thumb causes pain.” He also noted the claimant’s complaints of shoulder stiffness and elbow discomfort. He read the diagnostic tests as showing a 2 millimeter cyst of the proximal pole of the right navicular. He diagnosed first dorsal compartment tenosynovitis, “most significant symptom;” carpal tunnel syndrome, right; ulnar neuropathy, right elbow; thoracic outlet syndrome with tenderness in the anterior scalene muscle; and adhesive capsulitis of the shoulder. Because he said claimant said she could not tolerate cortisone injections, which he recommended for the first dorsal compartment, the carpal tunnel, and the shoulder, he placed her in a short cast to immobilize her thumb. He also wrote, “This is a dangerous situation for her in that she may continue along this path with gradual stiffening and increasing pain and develop a reflex sympathetic dystrophy.”
On March 28th, responding to questions raised by the carrier, Dr. F wrote that claimant had told him she had had no direct blow or twisting to her wrist. He said, “It certainly is possible that she hit her ulnar styloid, but I am sure that was rather a small injury in a confined space between a Coke machine and a neighboring wall.” He also stated that the list of diagnoses he had given was correct; that “whether or not they correlate to the patient’s description of injury has no bearing on this matter as far as I can tell,” and that many times symptoms of multiple areas of inflammation or entrapment may develop “after a simple injury.” However, he said he believed the claimant “is attempting to make the most out of a small injury,” and that he would not recommend surgery at the present time.
On March 30th Dr. F wrote that claimant’s thumb pain had been “totally relieved” by immobilization, but that she continued to have tenderness over the first dorsal compartment, shoulder stiffness, and tenderness over the supraclavicular area and the radial tunnel. On April 28th he wrote that the claimant had worn her wrist and thumb brace faithfully, but had significant pain in the first dorsal compartment, numbness in the distribution of the carpal tunnel, and positive Tinel’s, Phalen’s, and Finkelstein’s exams, the latter for tenosynovitis of the first dorsal compartment. He recommended releases of the carpal tunnel and the first dorsal compartment. On August 18th he wrote that the claimant continued to be symptomatic, that she still had first compartment dorsal tenosynovitis, but that the carpal tunnel syndrome was improved and “some elements of reflex dystrophy” had resolved. He continued to recommend a first dorsal compartment release, stating that, “It is my belief that her symptoms are directly related to her injury sustained on her work related date of injury when she was dusting behind a Coke machine at work and struck her wrist.”
On March 29th, Dr. R wrote to the carrier to express disagreement with Dr. F that the diagnoses of first dorsal compartment tenosynovitis, carpal tunnel syndrome, ulnar neuropathy, elbow problems, thoracic outlet syndrome, and adhesive capsulitis related to claimant’s original compensable injury. Because of this difference of opinion, the Texas Workers’ Compensation Commission (Commission) sent the claimant to Dr. Ananthakrishnan (Dr. A) on July 25th. In notes of that date he reported that claimant said she hit her hand while cleaning in a cramped space, first stating that she hit the whole dorsum of the hand, then ulnar border, and finally the ulnar side. After claimant’s treatment history, Dr. A stated that upon examination the claimant complained of diffuse pain to her hand and wrist, but stated that her responses to a sensory examination were not consistent. He believed the cyst was benign and preexisting. He also said he believed the claimant did have some symptoms of carpal tunnel syndrome but that he was “not convinced about the ulnar nerve entrapment or of the first dorsal compartment problems.” He believed her original wrist problems had “completely resolved” and that the only other diagnosis to consider would be very early reflex sympathetic dystrophy “which would really be the only diagnosis that could fit in with the minor trauma that she has had to the wrist.” He did not believe that the problems of first dorsal compartment, carpal tunnel syndrome, and ulnar nerve neuropraxia “can be explained on the basis of the incident of ________,” and said that there was “a rather severe functional overlay to this lady’s symptoms.” On September 21st he wrote the Commission to state that while he did not believe the carpal tunnel syndrome was related to the original injury, “I do believe that the tenosynovitis of the first dorsal compartment could be attributed to the injury of ____________.” But in a November 7th letter to the carrier he answered, by checking appropriate boxes, that he believed claimant suffers from first dorsal compartment tenosynovitis but he did not feel it was medically probable that this condition stemmed from the original injury.
The claimant testified, and it was apparently not disputed, that she was released to light duty work by Drs. M, R, and F, and that the employer provided such work until May 26th, the end of the school year, but did not rehire her for the summer. The claimant testified, however, that she has not been released to full duty, that she continues to have to wear a splint on her wrist, and that she continues to have pain and swelling. She also testified that she sought, and obtained, permission from the Commission to change to Dr. F, and contended she was entitled to mileage reimbursement for her trips to this doctor.
It was the carrier’s position, at the hearing and on appeal, that claimant’s original compensable injury had resolved and that the later-diagnosed conditions (as well as the alleged disability) did not result from the original injury. In its appeal it points to medical evidence, as summarized above, wherein Drs. A and R stated their opinions that conditions such as carpal tunnel syndrome and first dorsal compartment tenosynovitis are not related to claimant’s original injury; it also points out that photographs in evidence showing the small and confined space between the soft drink machine and the wall demonstrates the improbability that claimant could have struck her wrist with sufficient force to cause the ensuing problems. It also notes that claimant’s current doctor has stated that claimant’s problems, with the exception of the first dorsal compartment tenosynovitis, have resolved. It argues that the hearing officer’s determination that claimant’s current wrist condition, as diagnosed by Dr. F, is a result of her _____________, compensable injury is against the great weight of the evidence.
While this record clearly contains evidence that could have supported a different result, we are not prepared to agree with the carrier that the hearing officer took no notice of the opinions of Drs. A and R. While apparently selected by the Commission, Dr. A was not a designated doctor, and his opinion was entitled to no greater weight than that of the other doctors. Further, while Drs. A and R firmly believed that claimant’s condition was not related to her original injury, her treating doctor just as firmly disagreed. The evidence in this case presented a conflict for the hearing officer to resolve, as sole judge of the relevance and materiality of the evidence and its weight and credibility. Section 410.165(a). When presented with conflicting evidence, the trier of fact may believe one witness and reject the testimony of others, and may resolve inconsistencies in the testimony of any witness. McGalliard v. Kuhlmann, 722 S.W.2d 694 (Tex. 1986). This includes resolving conflicts and inconsistencies in the medical evidence. Texas Employers Insurance Association v. Campos, 666 S.W.2d 286 (Tex. App.-Houston [14th Dist.] 1984, no writ). An appeals level body is not a fact finder, and does not normally pass upon the credibility of witnesses or substitute its own judgment for that of the trier of fact, even if the evidence would support a different result. National Union Fire Insurance Company of Pittsburgh, Pennsylvania v. Soto, 819 S.W.2d 619, 620 (Tex. App.-El Paso 1991, writ denied). We will reverse a hearing officer’s decision only if it is so contrary to the overwhelming weight of the evidence as to be clearly wrong or unjust. Cain v. Bain, 709 S.W.2d 175, 176 (Tex. 1986). We decline to do so in this case.
As to the remaining issues, the carrier has argued that the hearing officer erred in awarding the claimant disability and mileage reimbursement because both are solely related to treatment for an injury it contended was not compensable. As we have already affirmed the hearing officer’s decision on this point, we also find no error in the hearing officer’s determination on those issues.
The decision and order of the hearing officer are affirmed.
Lynda H. Nesenholtz – Appeals Judge
CONCUR:
Thomas A. Knapp – Appeals Judge
Judy L. Stephens – Appeals Judge