DAVIS v. REGIONS FINANCIAL CORPORATION, 2002 AWCC 207

CLAIM NO. F102533

Before the Arkansas Workers’ Compensation Commission
OPINION FILED OCTOBER 31, 2002

Upon review before the FULL COMMISSION in Little Rock, Pulaski County, Arkansas.

Claimant represented by HONORABLE J. T. SKINNER, Attorney at Law, Batesville, Arkansas.

Respondents represented by HONORABLE JAMES C. BAKER, JR., Attorney at Law, Little Rock, Arkansas.

Decision of the Administrative Law Judge: Reversed.

OPINION AND ORDER
Claimant appeals an opinion and order of the Administrative Law Judge filed December 13, 2001 finding that claimant’s injury was a non-compensable idiopathic fall. Based upon our de novo review of the entire record, we reverse the decision of the Administrative Law Judge.

Facts

On the morning of January 31, 2001, claimant was performing his work duties for respondent employer. He had begun his work day at around 7:00 a.m. See Hearing Transcript, page 8. He had already vacuumed some offices, unlocked the bank, and sorted mail. See Hearing Transcript, page 9. At approximately 10:30 that morning, he began “carrying the recycling stuff out to the recycling bin.”. See Hearing Transcript, pages 9-10. The “recycling stuff” consisted of cardboard boxes and newspaper . See Hearing Transcript, page 10. Claimant testified that he had made five or six trips to the bin, which is about 50 feet from the main building, when he experienced a fal . See id. He testified that he fell as he was starting out the door towards the recycle bi . See id. He states that the fall happened as he was bending over to pick some boxes up off the concrete floo . See Hearing Transcript, page 11. Claimant said that he got up, noticing that his hand was badly injured, but then he fell down agai . See id. Claimant testified that he has no idea what caused him to fal . See Hearing Transcript, page 16. He did say that the morning of the fall when he woke up, he “had a headache, and that’s it . . .”. See Hearing Transcript, page 15.

Adjudication

I. Compensability

It is undisputed in this case that claimant was injured when he suffered a fall while at work. This case turns upon whether or not the fall was idiopathic in nature. S.W.2d 415 (1997). An idiopathic fall is one which is caused by a condition personal in nature or peculiar to the individual. ee, e.g., ERC Contractor Yard Sales v. Robertson, 335 Ark. 63, 977 S.W.2d 212 (1998). An idiopathic fall is to be distinguished from an unexplained fall, which is of neutral or undetermined causation. ee Pack, 60 Ark. App. at 88. An idiopathic fall is not compensable unless it is shown that the employment contributed to the risk of injury. See id.

Thus, it must be determined whether claimant’s fall was caused by factors personal to the claimant and thus an idiopathic fall. A review of the medical evidence in the record leads us to conclude both that there is insufficient evidence from which to conclude that the claimant’s fall was caused by factors personal to himself, and furthermore that claimant’s work duties on the morning in question made an affirmative contribution in causing the claimant’s fall. Therefore, the claimant’s fall is compensable.

The respondents assert that claimant’s fall was an idiopathic fall attributable to the claimant’s hypertension. However, we note that Dr. Bob Slaughter, claimant’s primary treating physician, stated that he was unable to determine through diagnostic testing the etiology of claimant’s fall. Dr. Slaughter characterized the fall of claimant as being the result of a “syncopal episode[1] .” ee Claimant’s Exhibit One, page 11. He then states in the same Clinic Note that “we have not placed the etiology but it was probably related to blood pressure.” ee id. In a later clinic note, Dr. Slaughter acknowledges that claimant has had “two or three syncopal episodes.” ee Claimant’s Exhibit One, page 13. However, in a letter dated September 5, 2001, Dr. Slaughter stated as follows:

Lab studies and carotid doppler studies did not indicate a reason for this syncopal episode but it is my feeling that the repetitiveness of bending lifting and stooping resulted in vaso-vagal reflex which caused the syncope with resulting fracture to his hand.”

ee Claimant’s Exhibit Two, page 50.

Dr. Slaughter further clarified his opinion as to the etiology of claimant’s syncopal episode. First, he testified as to the definition of “vaso-vagal reflex.” He stated as follows:

Q: And you had a phrase, “vaso,” and I don’t know if it’s “vaa-gal” or “vagal” — “v-a-g-a-l reflex.”

A: It’s “vasovagal reflex.”

Q: Okay.

A: That’s sometimes, you know, if you suddenly come to a corner and somebody nearly crashes into you, and you suddenly feel sick at your stomach and the blood drains from your head, pools in your stomach and you feel like you are going to faint, that’s the vasovagal reflex, and it can happen from fright, fear, anxiety, or motion.

ee Deposition of Dr. Slaughter, page 9.

Dr. Slaughter testified as to the etiology of the syncopal episode as follows:

Q: So the lab tests and the Doppler studies didn’t give you any answer to the question of why did this syncopal episode occurred; is that correct?

A: That’s right.

ee Deposition of Dr. Slaughter, page 15.

Q: All right. On February 21, 2001, you have included in your report the sentence, “We have not placed the etiology, but it was probably related to blood pressure.”

A: That was February 12?

Q: Right. The opinion that you express on February 12 was —
A: It could have been related to his blood pressure, yes.
Q: Was that an opinion to a reasonable degree of medical probability or was that a speculation?
A: Well, it’s a speculation. Knowing his history, his pressure had been up and it’s been down. I’ve got some other records here older that his pressure was, like 130 over 70, which was normal on medication. It was up a little bit one day, and I would assume from the history and all that his pressure could have jumped up suddenly. We added another medicine to him at that time.

See Deposition of Dr. Slaughter, page 16.

Q: In the report that you wrote September 5, 2001, to Mr. Skinner, you pretty much review what we have talked about. Your last sentence, you said, “The lab studies and carotid Doppler studies do not indicate a reason for this syncopal episode.” As I understand it, you really don’t have the benefit of any diagnostic result that answers for you the question of why Mr. Davis had a syncopal episode on January 31, 2001?

A: No.

In sum, Dr. Slaughter’s statements and testimony as to the etiology of claimant’s syncopal episode resulting in the fall indicate that he simply cannot state within a reasonable degree of medical certainty that any particular medical condition personal to claimant caused the fall. He acknowledged that it would be speculation for him to opine that claimant’s high blood pressure caused the syncopal episode and resulting fall.

Furthermore, and in any event, we find that the fall is compensable because, in the opinion of Dr. Slaughter, the claimant’s work duties on the morning in question made an affirmative contribution in causing the claimant’s fall.

Dr. Slaughter stated his opinion as to the cause of claimant’s syncope and subsequent fall:

Q: But then you say it’s your feeling that the repetitiveness of bending and lifting and stooping resulted in a vasovagal — I probably mispronounced it agin — reflex, which caused the syncope with resulting fracture to his hand, and I would ask you the same question I asked earlier. Is that an opinion that you are stating to a reasonable degree of medical probability or is that just your best guess?
A: Well, I think it’s a reasonable degree of medical probability. We see a lot of people that we don’t have a carotid Doppler or blood studies or a MRI of the head, but they still have things that happen to them and we have to make a medical opinion on it and try some treatment, if indicated. Yeah, that’s my opinion.

ee Deposition of Dr. Slaughter, page 19.

Q: Very briefly, Dr. Slaughter, I just think I want to restate this question the way I believe you just said it. Is it your opinion and belief that Danny’s job duties, and this is to a reasonable degree of medical certainty, including the repetitiveness of his bending, lifting and stooping, resulted in the vasovagal reflex which caused the syncope which resulted in the fracture to his hand?

A: Yes.

ee Deposition of Dr. Slaughter, pages 20-21.

In short, Dr. Slaughter’s medical opinion, stated within a reasonable degree of medical certainty, was that claimant’s bending, stooping and lifting work duties caused the vasovagal reflex, which caused the syncope and resulting fall. We find no evidence in the record, medical or otherwise, which rebuts Dr. Slaughter’s opinion that claimant’s work duties contributed to the syncopal episode. Thus, we find that claimant has proven by a preponderance of the evidence that the claimant’s fall arose in the course and scope of his employment and is compensable.

The dissenting Commissioner opines that the claimant’s fall was an idiopathic fall related to claimant’s hypertension, and also that it was not shown that claimant’s work activities contributed to the occurrence of the fall. In support of his contention that the claimant’s fall was an idiopathic fall related to claimant’s hypertension, the dissenting Commissioner sets forth testimony of Dr. Slaughter in which he acknowledged that hypertension can cause dizziness spells. While we concede that Dr. Slaughter did acknowledge that the claimant’s fall could have been caused by changes in his blood pressure on the day in question, we find that the whole of Dr. Slaughter’s testimony indicates that he was unwilling to conclude that the claimant’s high blood pressure caused the syncopal episode and resulting fall. As noted above, Dr. Slaughter stated both in a letter dated September 5, 2001, and in his deposition testimony that as a result of diagnostic testing, he was unable to ascertain the etiology of the claimant’s fall. Furthermore, in his deposition testimony, Dr. Slaughter clearly stated that for him to conclude that the claimant’s fall was caused by his hypertension would require speculation on his part. Thus, we do not agree with the conclusion of the dissent that the medical evidence in the record indicates that the claimant’s fall was more likely than not caused by his hypertension.

In support of his conclusion that the claimant’s work activities on the morning in question did not contribute to his fall, the dissenting Commissioner states that since vaso-vagal reflexes occur instantaneously, and since the claimant’s syncopal episode did not “occur instantaneously from the process of bending down or standing up,” it would be speculation to conclude that the fall was caused by the claimant’s work activities. While it is true that Dr. Slaughter did testify that the vaso-vagal reflex occurs instantaneously within the body, we find nothing in Dr. Slaughter’s testimony to indicate that in his opinion, the vaso-vagal reflex could have only been triggered in claimant immediately as he was standing back up from bending over to pick up a bag of newspapers. To the contrary, Dr. Slaughter clearly testified that he did not know the position of claimant at the time he first fell See Deposition of Dr. Slaughter, page 12. Since Dr. Slaughter testified both that in his opinion a vaso-vagal reflex caused the claimant’s fall, and that he did not know the position of the claimant at the time of the first fall, we cannot infer from Dr. Slaughter’s testimony that in his opinion a vaso-vagal reflex could only have caused the fall if the claimant fell “instantaneously” as he was raising back up from bending over. Therefore, we disagree with the conclusion of the dissenting Commissioner that the first fall could not have been caused by a vaso-vagal reflex, as Dr. Slaughter opined, because it did not “occur instantaneously” after bending over to pick up the bag of newspapers.

II. Benefits

As a result of his fall, claimant suffered a fracture to the middle finger and wrist of his right hand. ee Hearing Transcript, page 12. He testified that he was off work for 27 days as a result of his injuries. ee id. He also testified that on June 15th, he had surgery performed on the injured hand by Dr. Marcia Hixso . See Hearing Transcript, page 13. He testified that he missed two weeks of work as a result of his surgery. ee Hearing Transcript, page 14.

Claimant’s injuries to his right hand and wrist are scheduled injuries. ee Ark. Code Ann. § 11-9-521. Therefore, the claimant is entitled to temporary total disability benefits until his healing period ends or until he returns to work, whichever occurs first. ee Wheeler Construction Co. v. Armstrong, 73 Ark. App. 146, 41 S.W.3d 822 (2001). The medical evidence indicates that from the time of his injury on January 31, 2001 until he returned to work 27 days later, claimant’s healing period continued. The claimant continued to treat with Dr. Slaughter during this time period. Dr. Slaughter’s clinic notes during this time period indicate that he was still treating claimant with the goal of improving his condition. ee Claimant’s Exhibit One, page. Furthermore, the fact that claimant underwent surgery in June on his hand upon his doctors’ recommendations indicates that the healing period had not yet ended when claimant returned to work. Therefore, claimant is entitled to temporary total disability benefits from the time of his compensable injury on January 31, 2001, until he returned to work.

Furthermore, claimant is entitled to a second two-week period of temporary total disability benefits for recuperation from surgery performed on June 15, 2001. The clinic notes of Dr. Marcia Hixson indicate that she took claimant off work for two weeks in order to recuperate from his surger . See Claimant’s Exhibit Two, page 5. Her notes from June 28, 2001 indicate that the claimant was to return to work on July 2, 2001 . See id.

Finally, claimant is entitled to reimbursement for reasonably necessary medical treatment incurred and to be incurred for his compensable injury. We find that all treatment incurred by the claimant as of the hearing and reflected in the record to be reasonable, necessary and causally related to his compensable injury.

All accrued benefits shall be paid in a lump sum without discount and with interest thereon at the lawful rate from the date of the Administrative Law Judge’s decision in accordance with Ark. Code Ann. § 11-9-809 (Repl. 1996). For prevailing on this appeal before the Full Commission, claimant’s attorney is hereby awarded an additional attorney’s fee in the amount of $250.00 in accordance with Ark. Code Ann. § 11-9-715 (Repl. 1996).

IT IS SO ORDERED.

______________________________ ELDON F. COFFMAN, Chairman
______________________________ SHELBY W. TURNER, Commissioner

Commissioner Yates dissents.

DISSENTING OPINION

JOE E. YATES, Commissioner

I respectfully dissent from the majority opinion finding that the claimant sustained a compensable injury. Based upon my de novo review of the record, I find that the claimant sustained a non-compensable idiopathic fall. In my opinion, the facts of this case establish that the cause of the claimant’s injury is idiopathic.

The majority has found that the claimant’s employment significantly added to the risk of a hypertension-related syncopal episode. My review of the evidence demonstrates otherwise. The claimant testified that he had walked halfway to the recycling bin before he became “woozy”. The testimony is enlightening:

Q. And then you start walking out, and about halfway in between the garage door and the bin is where you had the episode?

A. Yes, sir.

Q. And that’s the first time that episode had ever occurred?

A. Yes, sir.

Q. The first time you had ever felt lightheaded or woozy?

A. Yes, sir.

Q. Right there at the spot where you fell?

A. Yes sir.

Q. And you were standing upright and walking at that spot?

A. I was walking and standing upright.

By comparison, Dr. Slaughter testified:

Q. . . . The history, as you understand it, is that he was in the process of bending down or standing back up to pick up boxes or papers or whatever when he had the first episode?

A. That’s my understanding.

Vaso vagal reflexes occur instantaneously. A vaso vagal reflex is a reflex associated with the autonomic nervous system, over which the claimant had no control. Therefore, in my opinion, it cannot be concluded that this work-related task significantly added to the risk of a hypertension-related syncopal episode because it did not occur instantaneously from the process of bending down or standing up.

On the day of his injury, the claimant was admitted to the hospital, and it was noted that his blood pressure was elevated (168/100). His hypertension is an idiopathic condition that explains his dizzy spells and syncopal episodes. Dr. Slaughter testified:

Q. Can there be a relationship between hypertension and dizziness spells?

A. Yes, there can.

Q. And what is the relationship? What causes the relationship?
A. Well, some people, if their pressure is real high and they are not on a good control medication, can feel dizzy or weak or maybe have a little ataxia if they are moving about or sudden changes in position due to the blood pressure changes. Or if the pressure should get too low, if they are over-medicated, they could still feel a little dizzy from that.

* * *

Q. In a patient like Mr. Davis, who has a history of hypertension, what kind of things can cause his blood pressure to go up or down on one day, but not another day?
A. Well, stress can cause his blood pressure to go up. Dehydration, if he didn’t drink or eat anything, say he had some vomiting, diarrhea, or something like that, he could get a little dehydrated and his pressure could go down. It could be a volume depletion and it could go down, but most likely, activity, physical activity and stress could raise your pressure.

In my opinion, the claimant’s injury does not fall into the category of unexplained injuries because the most likely cause for the fall is his pre-existing hypertension. The claimant has failed to prove that his idiopathic injury falls into the category of a compensable idiopathic injury because the record lacks evidence demonstrating that his work activity significantly increased the risk of such an injury. The evidence shows that the claimant walked some 20-25 feet before he became dizzy. Therefore, it appears that he simply had an elevation of his blood pressure, which caused him to experience a syncopal or near syncopal episode while standing upright and carrying a trash liner full of recyclables. Dr. Slaughter testified that there are any number of reasons why the claimant’s hypertension might have suddenly elevated at that precise moment in time. Therefore, in my opinion, it cannot be concluded that some work-related event caused his blood pressure to elevate at that point. His injury can only be classified as an idiopathic injury which is not compensable under our Workers’ Compensation law.

Accordingly, for all the reasons set forth herein, I must respectfully dissent from the majority opinion.

_______________________________ JOE E. YATES, Commissioner