This appeal arises pursuant to the Texas Workers’ Compensation Act, TEX. LAB. CODE ANN. § 401.001 et seq. (1989 Act). A contested case hearing (CCH) was held on May 1 and June 25, 1996. On the single issue before him, the hearing officer determined that the claimant’s hiatal hernia, cardiac condition, and gastric problems were a result of the compensable injury sustained on _____________. The appellant (carrier) appeals urging that the evidence was insufficient to establish the medical causation based on reasonable medical probability and asks that the decision be reversed and a new decision rendered. No response has been filed.
DECISION
Affirmed in part and reversed and rendered in part.
Not in issue was the fact that the claimant sustained a back injury on _____________, in a fall from scaffolding. He was initially treated conservatively and prescribed various pain killers and anti-inflammatory drugs. Ultimately, he underwent back surgery on January 19, 1995, which he claims led to the injuries now in contention, namely hiatal hernia (aggravation thereof), cardiac condition (congestive heart failure), and gastric problems. He stated treating with Dr. H in June 1995, who testified that these conditions were causally related to the surgery for the injury of _____________.
On November 13, 1994, the claimant went to an emergency room (ER) with multiple somatic complaints of headache, difficulty breathing, fever, back pain, indigestion, and sour stomach. Apparently there was concern by the claimant’s wife of a heart attack. In any event, the claimant was given a “GI cocktail” which resulted in relief of his stomach symptom and “his entire chest felt better and he had no problems breathing.” The ER records indicate that the claimant was massively obese (evidence indicates he weighed 347 pounds at the time of injury and weight 328 pounds at the hearing), and that an EKG showed sinus tachycardia and evidence of an old septal infarct. Subsequently, the claimant was evaluated for surgery on his back. Medical reports indicate a history of a heart murmur, borderline cardiomegaly, and mild aortic valve stenosis and mild aortic regurge. His weight was referred to as his major problem; however, there was no strict contraindication to surgery although the claimant was told that he would have a difficult time and the surgery would have to be done in about half the normal time. The preoperative report also mentions the claimant’s frequent dyspepsia and gastroesophageal reflux.
A post-operative report dated January 23, 1995, notes that the claimant had a somewhat difficult course in that he developed nausea and vomiting and had a difficult intubation during surgery following which he coughed up dark brown sputum. Epigastric burning and burning in the throat was likely related to the difficult intubation during surgery and pre-existing reflux. The report also notes that the pre-op internist, Dr. W, followed the claimant during his hospitalization for possible medical complication, none of which developed.
The claimant was admitted to the hospital on March 27, 1995, for the evaluation of chest pains and was referred for cardiac catheterization which showed, according to Dr. W, a cardiologist, moderate aortic stenosis, with a valve area of approximately 1.7 sq. cm., and no epicardial coronary artery disease. Dr. T, a cardiologist, evaluated the claimant and had an electrocardiogram performed. A report dated March 28, 1995, contains the following conclusion: “cardiomegaly, obesity evident, no demonstration of acute pulmonary process.” Subsequently, in a report dated April 28, 1995, he was diagnosed with a small concentric sliding gastric hiatal hernia without spontaneous reflux.
The carrier introduce reports from two consulting doctors, Dr. RE and Dr. R, who opined that from their review of the claimant’s medical records that there was no linkage or relationship between the claimant cardiac situation, or the other conditions, and the compensable back injury.
Dr. H testified that in his opinion there was a causal relationship between the claimant’s surgery (necessitated by the compensable injury) and his current condition. Regarding aggravation of the hiatal hernia and gastric problems, he pointed to records showing the difficult intubations at surgery and the reports of multiple drug prescriptions for his back which had adverse effects. He indicated at one point that his opinion was based on reasonable medical probability, but, at another point, stated it as one theory. Dr. H acknowledged that the cardiologists did not opine there was a causal relationship, but states this is because they are not concerned with that. He also indicated that the claimant was in “great shape” for surgery but subsequently acknowledged that the pre-op cardiac reports showed the claimant was at risk and medical reports showed borderline cardiomegaly, a prior septal infarct, heart murmur, aortic stenosis, and obesity. Dr. H felt that the claimant’s “cardiac condition” worsened following the surgery but could not point to any cardiology report or tests to support that opinion. He stated that he did not do any tests of his own and agreed that the claimant was not ultimately diagnosed by the cardiologist as having congestive heart failure. Dr. H also acknowledged that none of the cardiologist and none of the tests support his theory but that the cardiologists are not concerned about causation. Dr. H also stated that his opinion that the claimant’s cardiopulmonary functioning decreased by 20% to 30% following the surgery was a “guesstimate” and that no tests were done since there were no presurgery test with which to make a comparison.
While there is some probative evidence in the medical records and testimony to support the hearing officer’s determination that the claimant’s hiatal hernia was aggravated by the surgical procedure as well as his ongoing gastric problems related to various medications, we do not find sufficient evidence in support of his determination that the claimant’s “cardiac condition” (apparently congestive heart failure) was causally connected to the back surgery or injury of _____________. To the contrary, we concluded that the determination regarding the “cardiac condition” to be so against the great weight and preponderance of the evidence as to be clearly wrong or unjust. Cain v. Bain, 709 S.W.2d 175, 176 (Tex. 1986). Clearly, the claimant had the burden of proof to establish a causal connection between the subsequently claimed heart condition and the injury. See generally Texas Workers’ Compensation Commission Appeal No. 951184, decided September 5, 1995; Reed v. Aetna Casualty & Surety Co., 535 S.W.2d 377 (Tex. Civ. App.-Beaumont 1976, writ ref’d n.r.e.). Where the injury or condition is outside the general or common experience or knowledge of laymen, expert medical evidence is necessary to prove causation. Texas Workers’ Compensation Commission Appeal No. 93774, decided October 15, 1993; Hernandez v. Texas Employers Insurance Association, 783 S.W.2d 250 (Tex. App.-Corpus Christi 1989, no writ). Such expert medical evidence must be based on more than mere possibility, speculation or surmise. Schaefer v. Texas Employers’ Insurance Association, 612 S.W.2d 199 (Tex. 1980). While no magic words are required, the medical opinion must be supported and based upon reasonable medical probability. Texas Workers’ Compensation Commission Appeal No. 960987, decided July 5, 1996. From our reading of the evidence of record and the testimony of Dr. H, we cannot agree that in substance it was sufficient to prove a causal connection between the current “cardiac condition” and the injury. To the contrary, we conclude that the great weight and preponderance of the evidence is so against the determination of the hearing officer on this point in the issue as to result in the determination being clearly wrong and unjust. Not only does the medical evidence of record show that the claimant had virtually the same “cardiac conditions” before any surgery on his back, there are no diagnostic or objective tests that he has a new or aggravated heart condition resulting from his surgery. While Dr. H did opine that his “cardiac condition” resulted from the surgery, it was apparent from the substance of his testimony that this was based more on speculation and conjecture or theory and “guesstimation” than on definitive medical evidence. And, there were expert medical opinions expressed by two doctors that there was no causal connection. In sum, we conclude that Dr. H’s testimony did not provide the necessary expert medical testimony to show causation regarding the “cardiac condition” and further that the determination of the hearing office regarding the compensability of the “cardiac condition” is so against the great weight and preponderance of the evidence as to be clearly wrong and unjust. Cain, supra; In re King’s Estate, 150 Tex. 662, 244 S.W.2d 660 (1951). Accordingly, we reverse so much of the hearing officer’s decision and order that holds the claimant’s “cardiac condition” resulted from the compensable injury sustained on _____________, and render a new decision and order that the claimant’s “cardiac
condition” did not result from the compensable injury of _____________, and that the carrier is not liable for benefits for the “cardiac condition.” The remainder of the decision and order is affirmed.
Stark O. Sanders, Jr. – Chief Appeals Judge
CONCUR:
Tommy W. Lueders – Appeals Judge
Elaine M. Chaney – Appeals Judge