This appeal is brought pursuant to the Texas Workers’ Compensation Act, TEX. LAB. CODE ANN. § 401.001 et seq. (1989 Act). A contested case hearing was held on February 6, 1998, with a hearing officer. The appellant (carrier) and the respondent (claimant) stipulated that the claimant sustained a compensable injury to her left knee on ________. The hearing officer determined that the compensable injury is a producing cause of the claimant’s right knee condition. The carrier appealed, urging that the claimant has not proved causation based on reasonable medical probability and requesting that the Appeals Panel reverse the decision of the hearing officer and render a decision that the claimant’s alleged right knee problems were not produced by the compensable injury sustained on ________. A response from the claimant has not been received.
DECISION
We affirm.
The claimant, who is five feet and four inches tall and weighs about 190 pounds, slipped, fell, and landed on her left knee on ________. She had arthroscopic surgery on her left knee on October 30, 1992, and used crutches for about three and one-half months. She again had arthroscopic surgery on her left knee on January 4, 1996, and used crutches for a week to a week and a half. The claimant had a total knee replacement in May 1996 and for almost 10 months used crutches, a walker, and a cane. On November 15, 1996, she began working for another employer at a job in which she could work sitting. In April 1997, the claimant had a debridement of the left knee and used crutches and a cane for about one and one-half months.
The claimant testified that she tried to keep off her left knee and that her right knee really started hurting after the total knee replacement in May 1996. She said that (Dr. R), her treating doctor who performed the last three surgeries, told her that he thought that the right knee was giving way due to overuse from using crutches and a walker; that her right knee was taking up all of the overuse from guarding the left knee; that the problem was not caused by age, but strictly from overuse; and that she needed arthroscopic surgery before it became worse. She testified that she did not remember having trouble with her right knee before the accident and that her right knee really began to hurt in June or July 1997, about a month or a month and one-half after the last surgery in April 1997. The claimant stated that her right knee swells, is sore, sometimes is hard to bend, and sometimes just gives away; that Dr. R said he could feel popping and grating in her right knee; and that Dr. R wanted to perform tests but that the carrier had denied the requests for tests.
In a letter dated November 10, 1997, Dr. R wrote:
[Claimant] to my knowledge has never complained of a problem with the right knee until recently. The patient has had a problem with the left knee for quite some time. This has resulted in arthroscopies with final knee replacement. The patient has been on crutches in the interim for quite some time and has been overloading the right knee. This has now resulted in pain that has developed in the right knee. I do not think the right knee is nearly as bad as the left knee but I do think that she has an overuse syndrome of the right knee. She may have had some preexisting conditions in there such as chondromalacia of some of the joint surfaces which I think now have been aggravated. Therefore I request treatment of the right knee. This would first include perhaps some physical therapy and or cortisone injections. If this is not adequate enough, the patient may ultimately have to have arthroscopy of the right knee. I think this is an aggravation of a preexisting condition secondary to the fact that she has overloaded the right knee and overused it in the process of getting the left knee treated.
(Dr. L) examined the claimant at the request of the carrier. In a letter dated January 7, 1998, he stated that the claimant had undergone a total left knee replacement for minimal degenerative arthritis; that she now complained of right knee pain; that he asked her what caused the right knee injury; that she responded she did not know, but that Dr. R had told her it was a result of her using crutches and a walker when she had her left knee replaced; that she had full range of motion of the right knee; that there was no joint line tenderness, effusion, clinical instability, or crepitation; and that x-ray examination revealed minimal narrowing of the right medial joint space compared to the left. Dr. L said that his diagnosis is right knee arthralgia due to minimal degenerative arthritis of the right knee; that, in his opinion, it is the result of her age and substantially overweight condition; that the time she spent on crutches or a walker, compared to the entire time of her life that she has spent walking on her right knee, is insignificant; that he did not feel her using crutches for a period of time would require a knee arthroscopy; and that he did not feel an arthroscopy of her right knee was required. In a letter dated February 3, 1998, Dr. R stated that the state of the claimant’s left knee was not at all minimal arthritis; that she had significant cartilage damage, with little or no hope of recovery; that during the last several years, she had been dealing with this problem; that she had to rely on her right knee; that even if minimal arthritis exists in the right knee, she at least aggravated it and perhaps caused it to progress faster by unloading her left knee; and it needs to be treated.
The carrier contends that the claimant did not establish that she has an injury to her right knee. “Injury” is defined as “damage or harm to the physical structure of the body and a disease or infection naturally resulting from the damage or harm.” Section 401.011(26). Aggravation of a preexisting condition may result in a compensable injury. Texas Workers’ Compensation Commission Appeal No. 92241, decided July 24, 1992. In Texas Workers’ Compensation Commission Appeal No. 951313, decided September 20, 1995, the Appeals Panel addressed aggravation and wrote:
Injury means damage or harm to the physical structure of the body and such diseases or infections as naturally resulting therefrom, or the incitement, acceleration, or aggravation of any disease, or infirmity or condition, previously or subsequently existing, by reason of such damage or harm. (Citations omitted.)
In Texas Workers’ Compensation Commission Appeal No. 951822, decided December 18, 1995, the claimant only testified to increased pain in his left knee and did not testify to a change in the condition as opposed to its manifestation in pain. However, unrefuted medical evidence indicated that the claimant’s degenerative joint disease was aggravated by the change in gait and increased weight bearing on the left leg resulting from the compensable right knee injury and treatment for that injury. The Appeals Panel found the hearing officer’s determinations that the altered gait and increased weight bearing on the claimant’s left leg resulted only in pain and not in an injury to the left knee to be so contrary to the great weight and preponderance of the evidence as to be clearly wrong and manifestly unjust, reversed the decision of the hearing officer, and rendered a decision that the claimant’s left knee injury was part of the compensable injury.
The hearing officer is the trier of fact and is the sole judge of the relevance and materiality of the evidence and of the weight and credibility to be given to the evidence. Section 410.165(a). The trier of fact may believe all, part, or none of any witness’s testimony because the finder of fact judges the credibility of each and every witness, the weight to assign to each witness’s testimony, and resolves conflicts and inconsistencies in the testimony. Taylor v. Lewis, 553 S.W.2d 153 (Tex. Civ. App.-Amarillo 1977, writ ref’d n.r.e.); Texas Workers’ Compensation Commission Appeal No. 93426, decided July 5, 1993. This is equally true regarding medical evidence. Texas Employers Insurance Association v. Campos, 666 S.W.2d 286 (Tex. App.-Houston [14th Dist.] 1984, no writ). The hearing officer’s determination that the claimant sustained an injury to her right knee is not so against the great weight and preponderance of the evidence as to be clearly wrong or unjust. In re King’s Estate, 150 Tex. 662, 244 S.W.2d 660 (1951); Pool v. Ford Motor Co., 715 S.W.2d 629, 635 (Tex. 1986).
The Appeals Panel has many times stated that the compensability of a follow-on injury presents the hearing officer with a question of fact to resolve. Texas Workers’ Compensation Commission Appeal No. 951108, decided August 23, 1995. In that decision, the Appeals Panel affirmed a determination that the claimant sustained a compensable injury to her arm while using a walker as part of her treatment and recovery from a compensable injury. See Appeal No. 951822, supra, for a case in which a compensable injury to one knee and a change in gait and weight bearing resulted in the injury to the other knee becoming part of the compensable injury. In Texas Workers’ Compensation Commission Appeal No. 970626, decided May 16, 1997, the Appeals Panel commented on altered gait and simple overuse and affirmed a determination that an altered gait caused by injury to one knee resulted in a compensable injury to the other knee. The carrier cited Appeals Panel decisions in which considerable time lapsed between the original injury and the claimed follow-on injury. In the case before us, the claimant had four surgeries on her left knee after the compensable injury in ______. She had the knee replaced in May 1996; used crutches, a walker, and a cane for about 10 months; had another surgery in April 1997; used crutches for about one and one-half months; and soon thereafter complained that the other knee really began to hurt. There was not a significant lapse of time between the surgery and use of walking aids and the onset of pain. The determination of the hearing officer that the claimant’s compensable left knee injury is a producing cause of the claimant’s right knee condition is not so against the great weight and preponderance of the evidence as to be clearly wrong or unjust. King, supra; Pool, supra.
We affirm the decision and order of the hearing officer.
Tommy W. Lueders – Appeals Judge
CONCUR:
Stark O. Sanders, Jr. – Chief Appeals Judge
Christopher L. Rhodes – Appeals Judge