Court of Appeals of Texas,
Houston (14th Dist.).
Barbara AUCOIN, Appellant,
KLEIN INDEPENDENT SCHOOL DISTRICT, Appellee.
Jan. 2, 1997.
On Appeal from the 270th District Court, Harris County, Texas, Trial Court Cause No. 94-27962.
Before O’NEILL, JJ.
*1 This is a worker’s compensation case.1 Barbara Aucoin sustained personal injuries in the course and scope of her employment with Klein Independent School District (“Klein”). Aucoin took her case to the Texas Workers Compensation Commission, which rendered a final decision. See TEX.R.APP. P. 40(a)(4). We affirm.
On August 29, 1990, Aucoin, a cafeteria worker for Klein, injured the outside of her left ankle after hitting it on a milk cooler. Aucoin completed her shift and drove home. Upon her arrival, her foot was so swollen that she could not get out of her vehicle. That evening, Aucoin was treated with ice packs and X-rays at Cornerstone Medical Clinic, where she was diagnosed with a soft tissue, ligamentous, reflex sympathetic dystrophy (RSD),” a chronic pain condition involving both the central and peripheral sympathetic nervous system. Dr. True prescribed physical therapy and ordered Aucoin to stay off of her ankle.
On September 25, 1990, Aucoin saw orthopedist, Dr. J. Walter Anthony, who initially diagnosed a “second degree ligamentous strain of the left foot.” However, an EMG later revealed a diagnosis of “left spinal cord stimulator. During this time, Dr. Donald Hauser treated Aucoin for depression. Since July of 1993, Dr. Kimberly Henderson has assumed primary responsibility for Aucoin’s care at the Hermann Pain Center.
At the conclusion of the trial, Aucoin requested findings of fact and conclusions of law. The trial court found that Aucoin’s left ankle injury did not extend or spread to other parts of her body is against the great weight and preponderance of the evidence. Although the trial court’s findings do not distinguish between findings of fact and conclusions of law, Aucoin is clearly attacking findings of fact.
*2 In a non-jury case, the trial court’s findings of fact have the same force and dignity as does a jury verdict. Criton Corp. v. Highlands Ins. Co., 809 S.W.2d 355, 358 (Tex.App.-Houston [14th Dist.] 1991, writ denied). Findings of fact are reviewable for the legal and factual sufficiency of the evidence supporting them by the same standards as are applied in reviewing the legal and factual sufficiency supporting the jury’s answers to jury questions. Id. In the instant case, Aucoin raises only a factual sufficiency challenge. In addition, because she attacks the court’s findings on an issue where she bore the burden of proof, Aucoin’s complaint is properly stated as a “great weight” point.
In reviewing a “great weight” challenge, we must examine the entire record to determine if: (1) there is only “slight” evidence to support the finding; (2) the finding is so against the great weight and preponderance of the evidence as to be clearly wrong and manifestly unjust; or (3) the great weight and preponderance of the evidence supports its nonexistence. See Cain, 709 S.W.2d at 176.
The worker’s compensation act provides a schedule of compensation for specific injuries to certain extremities and members of the body. Western Casualty and Surety Co. v. Gonzales, 518 S.W.2d 524, 525 (Tex.1975). If the injury to a particular extremity or member extends to and affects portions of the body beyond the extremity or member, or if general health is impaired, the workman may recover for general disability. Id. The injury and disability do not become general by the mere fact that pain alone, originating in the condition or use of the injured extremity or member, travels beyond the margin of the extremity or member to the general body. Id. The site of the trauma and its immediate effects are not, however, necessarily determinative of the nature and extent of the compensable injury. Id. The full consequences of the original injury, together with the effects of its treatment, upon the general health and body of the workman are to be considered. Id.
The parties do not dispute that Aucoin suffers from RSD. Similarly, the parties agree that the actual cause of Aucoin’s RSD is irrelevant for purposes of this appeal.2 Rather, the parties disagree about what the evidence shows regarding the effects of Aucoin’s RSD. Aucoin contends the testimony of her expert, Dr. Kimberly Henderson, conclusively establishes that the RSD caused damage to other parts of Aucoin’s body.
*3 Responding in terms of reasonable medical probability, Dr. Henderson testified that RSD affects the peripheral nervous system and reflexes and may even cause structural changes in the spinal cord. Dr. Henderson testified that Aucoin’s RSD was progressive and would continue to progress if not properly controlled. While Aucoin’s RSD was initially confined to her foot, it progressed to her leg causing an abnormal gait and muscle spasms in her calves, buttocks and low back. Dr. Henderson testified that Aucoin’s RSD not only affected her nervous system, but also her circulatory system, evidenced in her left ankle and calf by discoloration, diminished pulses, decreased hair and nail growth, and increased sensitivity to the touch. Finally, Dr. Henderson testified that RSD can cause depression and anxiety due to the chronic pain and that in Aucoin’s case, RSD was a producing cause of her emotional disturbance, including depression, anxiety and withdrawal from others.
Dr. Henderson’s testimony, however, was not left uncontroverted. Klein offered the testimony of its own expert, Dr. John Cassidy, a psychiatrist. Unlike Dr. Henderson, who was Aucoin’s treating physician, Dr. Cassidy performed only a single, limited physical examination of Aucoin’s left leg below the knee. However, Dr. Cassidy reviewed Aucoin’s medical records as well as the literature on RSD. Like Dr. Henderson, Dr. Cassidy’s responses were in terms of reasonable medical probability. He testified that the cause of RSD is still unknown and therefore that diagnosis has been replaced by a diagnosis of causalgia; the condition earlier diagnosed by Dr. Cannon. Dr. Cassidy regularly treated patients with both CRPS 1 and CRPS 2 and acknowledged that CRPS has a significant psychological component.
Based on his review of Aucoin’s medical history and physical examination, Dr. Cassidy diagnosed Aucoin with “CRPS 2 with evolution to CRPS 1.” Dr. Cassidy explained that Aucoin initially had CRPS 2 related to her nerve conduction studies showed no nerve damage. Nevertheless, Aucoin continued to suffer pain, leading to a diagnosis of CRPS 1 or the “old” RSD.
While his physical examination of Aucoin was limited, Dr. Cassidy testified that Aucoin’s CRPS did not involve other extremities, but was limited to the left leg below the knee. According to Dr. Cassidy, CRPS does not cause physical harm or damage to other parts of the body and in Aucoin’s case, CRPS did not cause damage to her nervous system, circulatory system, or other parts of her body. Similarly, Dr. Cassidy testified that Aucoin’s pain in her buttocks, hip and low back was not related to the RSD. Dr. Cassidy testified that while RSD symptomology can spread through an extremity, it does not spread from one extremity to another. Dr. Cassidy acknowledged that RSD often causes secondary changes to the circulatory system, which is controlled by the sympathetic nervous system. While Aucoin’s treatment was directed toward her nervous system, Dr. Cassidy disagreed there was nervous system involvement. In fact, Dr. Cassidy specifically disagreed with Dr. Henderson’s hypothesis that CRPS involves some type of disease process in the central nervous system. Calling it just that, a hypothesis, Dr. Cassidy testified there is simply no general consensus in the medical literature about the cause of RSD. Dr. Cassidy testified that doctors may have overlooked Aucoin’s tarsal tunnel syndrome and subsequent surgery and it was erroneous for them to assume there was no disease process in Aucoin’s extremities.
*4 Aucoin points to various portions of Dr. Cassidy’s testimony which she contends destroys its probative value. First, she refers to the fact that Dr. Cassidy did not know the cause of, or cure for, RSD. According to Dr. Cassidy, these problems have yet to be solved by the medical community at large. Therefore, Dr. Cassidy’s knowledge or lack of knowledge regarding the answers to these problems does not affect the probative value of his testimony. Second, Aucoin notes that Dr. Cassidy’s physical examination was very limited. However, this fact goes to Dr. Cassidy’s credibility and the weight to be given his testimony, not its probative value. The trial court was free to weigh this fact against the fact that Dr. Cassidy had reviewed Aucoin’s medical history, the medical literature on RSD, and had regularly treated patients with RSD. Third, Aucoin asserts that disability from the anesthetic procedures is compensable as a general injury. See Western Casualty, 518 S.W.2d at 525. As we described, Dr. Cassidy testified that Aucoin’s pain in her buttocks, hip and low back were from the anesthetic procedures directed toward her nervous system, an area which was unaffected by her RSD. Dr. Cassidy concluded that Aucoin’s RSD did not cause damage to her circulatory system, nervous system, or other parts of her body.
While there may be weaknesses in Dr. Cassidy’s testimony, we cannot say it lacked probative value. Clearly, there is conflicting expert testimony regarding the effect of Aucoin’s RSD on other parts of her body. Dr. Henderson testified that the RSD affected Aucoin’s nervous system, circulatory system, and other parts of her body, including the buttocks, hip and low back. She also testified the RSD was a producing cause of Aucoin’s emotional disturbance. Dr. Cassidy, on the other hand, testified that the RSD cannot, and did not, affect Aucoin’s nervous system, circulatory system or other parts of her body. As the trier of fact, the trial court was the sole judge of the credibility of the witnesses and the weight to be given their testimony. 516 U.S. 822, 116 S.Ct. 85, 133 L.Ed.2d 42 (1995). Faced with conflicting expert testimony regarding the effects of Aucoin’s RSD, the trial court was free to resolve that conflict giving due consideration to each expert’s credibility and the weight of his or her testimony. See id. Therefore, even if we were to disagree with the court’s findings, we cannot substitute our judgment for that of the trial court’s. See id. Accordingly, Aucoin’s points of error are overruled and the trial court’s judgment is affirmed.
Do Not Publish. TEX. R.APP. P. 90.
This case is governed by the law in effect at the time of injury. See generally TEX.REV.CIV. STAT. ANNN. art. 8306 (Vernon Supp.1997), arts. 8307, 8309 (Vernon Pamph.1997), repealed by Act of January 1, 1991, 71st Leg. 2nd C.S., ch. 1, § 17.18 1989 Tex. Gen. Law 1, 122, repealed by Act of September 1, 1993, 73rd. Leg. R.S., ch. 269, 1993 Tex. Gen. Laws 987, 1273 (current version at TEX. LAB.CODE ANN. § 401.001 et seq. Vernon 1996).
The medical experts disagreed about the cause of Aucoin’s RSD. Aucoin’s expert testified that her ankle injury was a producing cause of her RSD. Klein’s expert, on the other hand, testified that the tarsal tunnel release surgery and related invasive anesthetic procedures, which were not related to the original injury, caused Aucoin’s RSD. It appears from the findings of fact that the trial court attributed Aucoin’s RSD to her ankle injury: “The injury to [Aucoin’s] left ankle and resulting [RSD] ....” (emphasis added). However, the trial court found that the RSD had not harmed Aucoin’s central nervous system or circulatory system, thus producing a general injury, nor had the RSD harmed her left hip and buttocks. These findings form the basis of the parties’ dispute on appeal.