Opinion
[70 Ark.App. 308] Mark E. Ford, Fort Smith, for appellant.
William F. Smith, Russellville, for appellee.
JOHN B. ROBBINS, Chief Judge.
Appellant Mary Noelker Freeman appeals the denial of benefits by the Workers' Compensation Commission regarding her bilateral carpal tunnel syndrome and bilateral epicondylitis that she alleged arose out of and in the course of her employment with appellee Con-Agra Frozen Foods. Appellant contended that because of her overuse syndrome that developed over her two-year tenure as an assembly line employee, she had to discontinue working on November 21, 1997, was temporarily totally disabled until May 21, 1998, and was entitled to medical benefits for treatment of her conditions. Appellee contended that appellant's injuries were not causally related to her work and that her conditions were not proven to be related within a reasonable degree of medical certainty. The administrative law judge, and the Commission, which adopted the law judge's decision, concluded that these conditions did not arise out of her employment. We reverse and remand.
When reviewing a decision of the Workers' Compensation Commission, we view the evidence and all reasonable inferences deducible therefrom in the light most favorable to the Commission's findings and affirm if the decision is supported by substantial evidence. White v. Frolic Footwear, 59 Ark.App. 12, 952 S.W.2d 190 (1997). Substantial evidence is that evidence a reasonable mind might accept as adequate to support a conclusion. Mikel v. Engineered Specialty Plastics, 56 Ark.App. 126, 938 S.W.2d 876 (1997). A decision of the Commission is reversed only if we are convinced fair-minded persons using the same facts could not reach [70 Ark.App. 309] the conclusion reached by the Commission. Id. In our review, we recognize that this court defers to the Commission in determining the weight of the evidence and the credibility of the witnesses. Id. The issue is not whether we may have reached a different conclusion or whether the evidence might have supported a contrary finding. Harvest Foods v. Washam, 52 Ark.App. 72, 914 S.W.2d 776 (1996). Even though the Commission is insulated to a certain degree from appellate review, its decisions are not insulated to the degree that it would make appellate review meaningless. Jordan v. J.C. Penney Co., 57 Ark.App. 174, 944 S.W.2d 547 (1997).
Eligibility for benefits resulting from accidental injuries or death under the Workers' Compensation Act is governed by Ark.Code Ann. § 11-9-102(5) (Repl.1996). When a claimant requests benefits for an injury characterized by gradual onset, section 11-9-102(5)(A)(ii) controls, defining "compensable injury" as follows:
(5)(A)(ii) An injury causing internal or external physical harm to the body and arising out of and in the course of employment if it is not caused by a specific incident or is not identifiable by the time and place of occurrence, if the injury is:
(a) Caused by rapid repetitive motion. Carpal tunnel syndrome is specifically categorized as a compensable injury falling within this definition[.]
The supreme court has interpreted this statutory language such that a claimant is not required to prove that her condition was caused by rapid repetitive motion when the diagnosis is carpal tunnel syndrome. Kildow v. Baldwin Piano and Organ, 333 Ark. 335, 969 S.W.2d 190 (1998). However, the other statutory requirements to prove a compensable injury must be met. Specifically, a claimant must prove by a preponderance of the evidence that: (1) the injury arose out of and in the course of her employment; (2) the injury caused internal or external physical harm to the body which required medical services or resulted in disability or death; (3) the injury was a major cause of the disability or need for treatment; and (4) the injury must be established by medical evidence supported by objective findings. Ark.Code Ann. § 11-9-102(5). The claimant bears the burden to prove these elements by a preponderance of the evidence. Id. We recognize that epicondylitis, or "tennis elbow," has not been designated as a specifically recognized injury under "rapid repetitive motion." Consequently, [70 Ark.App. 310] appellant bears the burden of proving that rapid repetitive motion caused the bilateral tennis elbow.
The evidence presented by the parties revealed the following facts. Appellant testified that she began working for appellee on November 27, 1995, assembling frozen dinner trays. She generally worked more than forty hours per week. Her duty on the moving production line was to place the correct portion of food into the frozen dinner tray, making certain that there was not too much nor too little food in each triangle portion of the tray. Two to four employees worked each line, usually with two on each side of the line. In her estimation, she was responsible for filling approximately sixty-five dinners per minute. The employees rotated the duties of putting in a vegetable, an ice-cream scoop of rice, or the frozen meat. This was a job that required extensive use of her hands, wrists, and arms.
Her symptoms began about six months prior to leaving her employment, and she described the symptoms as aching and numbness in her hands and elbows accompanied by a loss of grip strength. The aching was severe enough to wake her at night. At that time, she was in her late forties. She admitted that she did not notify her employer of these problems until she left on November 21, 1997, because she thought that aching and pain was just "part of the job." On that date, she testified that before she reported to work, she was at home and, while wiping up tea that she had spilled on the kitchen counter, she experienced a shooting pain in her wrists. When she arrived at work that day, she reported to the nurse's station and requested that they wrap her wrists. After being on the job for about an hour, she could not work any longer due to the pain. She was sent, not to the company doctor, but to her family physician.
She consulted with her physician, Dr. Jones, and his notes indicated a patient history of these problems for the past two to three months with an increase in the last week or two. Nerve conduction studies confirmed that she had bilateral carpal tunnel syndrome, worse on the left than the right. He diagnosed her with bilateral carpal tunnel syndrome and bilateral "tennis elbow." His notes dated November 25, 1997, stated "[t]his overuse syndrome type picture is consistent with the job description she gives me."
[70 Ark.App. 311] Appellant reported to her employer that these conditions were work related after her diagnosis by Dr. Jones. Appellee contested the claim since appellant had not initially reported that her symptoms were related to her work. Appellant completed an application for employer-sponsored disability, and in those forms she indicated that her condition was work related but that she was receiving no benefits. Appellant testified that the insurance coordinator at Con-Agra informed her not to list the injury as work related, or she would not receive disability benefits. In her visits for medical care, she assigned benefits under her group medical plan.
She was referred to Dr. Nix, a Little Rock orthopedic surgeon, who concurred in Dr. Jones's diagnosis. After unsuccessful conservative treatment, Dr. Nix performed carpal tunnel release with neurolysis on January 2, 1998. She continued to experience problems with the A-1 pulley on the right thumb, and Dr. Nix performed a release of the A-1 pulley on April 21, 1998. Along with her surgeries, appellant underwent a course of physical therapy to restore the use of her hands and elbows.
In response to a letter from appellant's counsel, Dr. Nix categorized appellant's problems as "usage related type injuries, often associated with repetitive motion and are most commonly seen in women." However, "whether this particular repetitive usage is associated with production line work or other outside activities, I cannot comment on with a reasonable degree of medical certainty. I expect your investigation could help clarify this." She was released to return to work on May 21, 1998, and continued in that employment until she found other work on October 12, 1998. Appellant denied engaging in any other rapid or repetitive activity and denied that she had any other injuries to her hands or arms before she developed carpal tunnel syndrome and tennis elbow. The Commission, by adopting the opinion of the ALJ, found that appellant failed to carry her burden of proof to demonstrate a causal connection between her employment and her injury because she did not indicate that her symptoms were work related until after she had seen her family physician and realized that her treatment might include seeing a specialist and undergoing surgery. In addition, the Commission found it significant that appellant experienced a dramatic increase in symptoms at home while wiping her kitchen countertop, and it was only after that incident that she [70 Ark.App. 312] could no longer work. The Commission also noted that Dr. Nix declined to render an opinion on the nexus between her condition and her work, and Dr. Jones' notes were barren of any report of the kitchen-cleaning incident. Therefore, the Commission denied benefits.
The Commission could not reasonably conclude that appellant's conditions did not arise out of and in the course of her work. All the evidence indicated that the sole cause of appellant's carpal tunnel syndrome and bilateral tennis elbow was her work activity on the assembly line. An administrative body like the Commission is not granted leeway to arbitrarily disregard the testimony of any witness, nor may it reach outside the record for facts that may or may not exist. See Boyd v. Dana Corp., 62 Ark.App. 78, 966 S.W.2d 946 (1998); Wade v. Mr. C. Cavenaugh's, 25 Ark.App. 237, 756 S.W.2d 923 (1988). However, it has done so in this case by presuming that some unknown outside activity caused these conditions. We are disturbed that the Commission was persuaded that wiping spilled tea off of a kitchen counter might have triggered bilateral carpal tunnel syndrome and bilateral tennis elbow. That is simply an unreasonable conclusion. The absence of any prior complaints to her employer was explained by appellant as her effort to continue to work through expected pain.
We also are concerned that the Commission disregarded Dr. Jones's opinion on causal connection because it did not state that her conditions were related to her employment within a reasonable degree of medical certainty and it did not reflect a consideration of the onset of pain after wiping up spilled tea. An expert opinion must be stated within a reasonable degree of medical certainty, but it is to be judged in view of the entirety of the expert's opinion and is not invalidated or validated solely on the basis of the presence or lack of "magic" words. See Tyson Foods, Inc. v. Griffin, 61 Ark.App. 222, 966 S.W.2d 914 (1998). Furthermore, the medical evidence referred to in Ark.Code Ann. § 11-9-102(16)(B) pertains to medical opinions as to the existence of an injury and the extent of physical impairment, matters about which the Commission needs the benefit of expert assistance in its fact finding. Whether the injury and resulting physical impairment, if any, occurred at work and was caused by such employment will ordinarily be outside the scope of matters within the professional expertise of the physician because it is unlikely that the physician [70 Ark.App. 313] will have been present when the injury occurred. Consequently, an opinion, such as Dr. Jones's in this case, which states that the injury or condition is consistent with the job description that was given him, is about as much as could be expected. Similar is the opinion of Dr. Nix who observed that "the injuries for which I have seen the patient are usage related type injuries, often associated with repetitive motion...."
Because the Commission's decision lacks a substantial basis for the denial of relief in this case, we reverse and remand for proceedings consistent with this opinion.
BIRD and MEADS, JJ., agree.