No. 87-263 

IN THE SUPREME COURT OF THE STATE OF MONTANA 

1987 

RITA MAE SNYDER, 

Claimant and Appellant, 

-vsSAN FRANCISCO FEED & GRAIN, Employer, 

and 

EBI COMPANIES AND ORION GROUP, 

Defendant and Respondent. 

APPEAL FROM: The Workers' Compensation Court, The Honorable Timothy 

Reardon, Judge presiding. 

COUNSEL OF RECORD: 

For Appellant: 

Trieweiler Law Firm; Terry N. Trieweiler, Whitefish, 

Montana 

For R.espondent : 

Garlington, Lohn & Robinson; Larry W. Jones, Missoul.a, 

Montana 

Submitted on Briefs: Nov. 13, 1987 

Decided: December 31, 1987 

Filed: \ii 1987 

Clerk 
Mr. Justice John C. Sheehy delivered the Opinion of the 

Court. 

Rita Mae Snyder appeals the judgment of the Workers' 

Compensation Court finding that her evidence did not 

establish a compensable industrial accident. San Francisco 

cross-appeals on the issue of the propriety of certain 

hypothetical questions. We reverse. 

The issues before the Court are: 

1. Was there substantial credible evidence to support 

the Workers1 Compensation Court's judgment that Snyder did 

not suffer a compensable industrial accident? 

(a) Does a stress related injury require a 

"psychological reconstruction?" 

(b) Does a compensable injury require a showing of 

physical impact? 

(c) Does a compensable injury have to arise from a 

single incident? 

-. Is the testimony of a treating physician entitled to 

greater evidentiary weight? 

3. Did Rita Mae's counsel pose improper hypothetical 

questions? 

Rita Mae was 47 years old at the time of her trial in 

August, 1986. She had been married to Vernon Snyder for 29 

years and had six children. Her youngest remained in the 

family home. Rita Mae can no longer care for her husband or 

family, however. 

On December 31, 1984, Rita Mae suffered a ruptured 

basilar tip aneurysm while performing her duties at San 

Francisco Feed & Grain (San Francisco) in Ronan, Montana. 

As a result of the ruptured aneurysm, Rita Mae suffered 
extensive brain damage; she is confined to a wheelchair; she 

has vision deficiencies; her memory has been affected; her 

reasoning process has been impacted; she engages in 

inappropriate behavior and laughs or cries for no reason; and 

she has had a guardian appointed. Her condition is 

permanent. 

Prior to the date of injury, Rita Mae's family did not 

have a history of aneurysms. She did not consume alcohol nor 

was she overweight. She had no history of high blood 

pressure. She alleges that her aneurysm ruptured as a result 

of job stress. 

Rita Mae began her duties as a bookkeeper with San 

Francisco in May, 1982. Her duties included helping 

customers, recording the weight of trucks, answering the 

phone, balancing the cash register, doing daily sheets, 

posting receivables, helping with the statements, posting 

inventory, totaling inventory books, helping total the cost 

of sales, and occasionally helping proof the computer 

printouts. She shared these duties with her 

sister/co-employee, Helen Teigen. 

Rita Mae was a conscientious, hard working employee. 

She was described as dedicated and concerned that her work 

was current and correct. She seemed. happy with her work and 

never complained. 

The situation at San Francisco changed dramatically in 

June, 1984, however. At that time, a new general manager 

assumed control of the San Francisco operation in Ronan. 

San Francisco employees described the new manager' s 

style as chaotic and antagonistic. The work place became 

disorganized. Management-employee relations deteriorated. A 

change in the procedure for dealing with customers resulted 

in slower service and unhappy customers. On one occasion, 

Rita Nae had to call the police to prevent violence between 
the manager and a disgruntled customer who had been forced to 

wait several hours. 

Rita Mae's work situation continued to deteriorate. The 

lack of organization and communication caused the work place 

to become more frantic. The changed procedures resulted in 

angry customers and employees. Although Rita Mae was the 

type of person who was bothered by bickering, she often had 

to deal with the unhappy customers and smooth employee 

dissatisfaction. 

The seasonal increase in feed purchases during the 

winter months and a fire at San Francisco's main competitor 

further exacerbated the situation. During November and 

December, 1984, Rita Mae began working through her lunch hour 

and staying after hours in an attempt to stay current with 

her work. Although the overtime was not paid, she began to 

fear she would lose her job, the family's sole source of 

income. 

Rita Mae's job situation began to take a toll. She lost 

her cheerfulness about her job. Friends and family noticed 

she looked more and more wrung-out. She seemed to be under a 

lot of pressure from work and always appeared nervous. 

The day of her in jury was unusual. Since December 31 , 

1984 was a Monday sandwiched between two days on which the 

business was to be closed, business was expected to be brisk. 

Nevertheless, the work force was only 7, rather than the 

usual 10 employees. In addition, Rita Mae had 

end-of-the-month bookkeeping to complete. 

When she arrived at work that day, Rita Mae appeared 

fine. She soon looked fatigued, however. She had noted that 

an upsetting customer was scheduled for servicing that day. 

She also was having difficulty deciphering one of the 

manager's incomplete invoices. The unfinished invoice 

appeared to upset her. Shortly thereafter, Rita Mae was 
found slumped over her desk and was later diagnosed as having 

a ruptured aneurysm. 

The medical evidence received at trial consisted of the 

deposition testimony of 3 neurological specialists. The 

doctors were instructed to base all opinions on the medical 

standard of more likely than not. Generally, they are in 

agreement concerning Rita Mae's injury. 

It is agreed that an aneurysm is a weak spot in a blood 

vessel analogous to a weak spot in an inner tube which 

expands and develops a balloon-like appearance; that Rita 

Mae's aneurysm developed sometime during her teenage years; 

that not all aneurysms rupture; that psychological stress 

elevates blood pressure; that increased blood pressure places 

increased pressure on the aneurysm, often resulting in 

rupture; and that intracranial aneurysms can rupture 

spontaneously without change in vascular pressure. 

Dr. Richard Dewey is a neurological surgeon. Dr. Dewey 

examined Rita Mae upon her arrival in Missoula and confirmed 

that she had a ruptured aneurysm. Following a period of time 

necessary to stabilize Rita Mae's condition, Dr. Dewey 

performed a craniotomy in order to prevent a second rupture. 

Prior to his deposition, Dr. Dewey stated that in his 

opinion, "the claimant's work was not in any way causally 

related to [the ruptured aneurysm]." Dr. Dewey's opinion was 

offered in response to a written request by counsel for San 

Franciso. 

At his deposition, however, Dr. Dewey indicated that new 

information had since come to his attention. 

Q. And do you still hold that opinion today? 

A. Based on the information that I had as of 16 

July '86 regarding Mrs. Snyder's work or what my 

impressions were of her job at that time, my 

opinion is still valid. It would be unfair for 

me--or not unfair, but inappropriate, I think to 

change that opinion. That is what T stated, and 
that's what I believed at that time. And based on 

that same information, I would arrive at the same 

conclusion. 

Q. When you say "information", is that 

information--A. Well-- 

Q. --about Rita Mae Snyder's work? A. I have 

been informed of some circumstances which, in fact, 

may have some causal relationship subsequent to my 

dictating that letter. 

In addition, Dr. Dewey indicated that Rita Mae1 s stressful 

work environment could have aggravated the aneurysm. 

Q. Did Mr. Jones mention any unusual changes in 

the work place or stressors in the work place when 

he asked for your opinions? 

A. I do not see that [in the letter]. 

Q. Did Mr. Jones inquire whether it was medically 

possible that an increased work load or increased 

stress in the work place aggravated or accelerated 

Rita Snyder's pre-existing condition? 

A. No, he did not. 

Q. Would that information possibly have changed an 

opinion that you had given to Mr. Jones in response 

to his letter. A. I don't know. I guess it 

depends on what information he had given me. 

That's a question that's very difficult to answer 

even in retrospect. But, in practical terms, I 

think the more information that a physician has, 

the more appropriate and informed his answer may 

be. 

Q. Dr. Dewey, would you agree that the following 

work situations more likely than not cause workers 

to experience stress: One, a disorganized 

procedure for handling customers; two, angry 

customers; three, poor communications with 
management; four, increased work load; five, 

unusual and unpaid for overtime; and six, job 

duties that cannot be completed correctly? 

A. Well, I don't think it requires a medical 

degree to answer those questions. Those all seem 

like stressful--that all seems like collectively a 

stressful work environment. 

Q. When a worker experiences a stressful situation 

in their work place, is it medically possible and 

probable that that situation could cause them to 

suffer elevation in blood pressure? 

A. Again, my feeling is that stress of any kind 

may lead to the transient--at least transient 

elevation of blood pressure. In our treatment of 

patients, once they arrive at the hospital, when we 

are attempting to reduce blood pressure, is to do 

the opposite. That is, to avoid all stressful 

circumstances. So, I can't say that a particular 

stress raises blood pressure; but it is possible 

and probable that stressful situations, regardless 

of their cause, may elevate blood pressure. 

Q. Dr. Dewey, testimony at trial was offered to 

the following facts: That through the fall months 

of 1984, Rita Snyder worked progressively more 

unpaid overtime. That through the fall months of 

1984, communication between the management and the 

employees at her place of work deteriorated. That 

during the fall months of 1984, the procedure for 

scheduling customers changed. The business 

operated in a less organized fashion, and further 

that one of Rita Snyder's job duties, that of 

balancing the till, became progressively more 

difficult because the manager would remove money 

from the till and not leave a note telling anyone 

how much or that he had done so. On December 6th, 

1984, the business's closest competitor was 

destroyed by fire, and within a week Rita Snyder's 

job duties were increased both in customers she had 

to wait on and the bookkeeping that she had to do. 
About this point in time Rita Snyder made comments 

about the job being a rat race. That she feared 

she would lose her job. 

If the Court finds as fact some or all of those 

incidents, as I have related them, do those sound 

like incidents that would cause Rita to feel stress 

in her work place? 

A. Those are, in my opinion and I think in most 

lay people's opinion--most lay people would agree 

are stressful. 

Q. Is it medically possible that that chain of 

incidents aggravated or accelerated the ultimate 

result of Rita Snyder's basilar artery aneurysm? 

A. If those--if that chain of events caused any 

significant change in blood pressure, then they 

would have a bearing; and that is an acceleration 

of the stress of the wall of the aneurysm. 

Q. At the time of trial, testimony was offered 

concerning the following facts about December 31st, 

1984: December 31st, 1984, was an unusually busy 

day. Rita Snyder's place of employment was short 

three or four employees of the normal number of 

ten. Rita had commented soon after coming to work 

that an unusually unpleasant customer was scheduled 

to come in and do business at her place of 

employment. The other bookkeeper that Rita Snyder 

shared duties with was busy with another job and 

couldn't help Rita with her customers and her work 

up in the front of her business place. When Rita 

came to work in the morning, she looked normal and 

fresh. And after approximately an hour, she looked 

tired and wrung out. And shortly before Rita's 

syncopal episode, Rita asked for help to decifer an 

invoice that had been incorrectly and incompletely 

filled out. 

Assuming the Court finds as fact some or all of 

those incidents, are those incidents occurrences 

that would cause Rita to suffer stress in her work 

place. 
A. What you're describing, again, sounds to me 

like it is entirely possible that that is a 

stressful circumstance, stressful situation. That 

that stressful situation could possibly have 

elevated blood pressure. 

Q. Could the elevation of the blood pressure 

aggravate or accelerate the ultimate rupture of her 

basilar artery aneurysm? A. Any elevation of the 

mean arterial pressure will accelerate the rupture 

of an aneurysm. Let me rephrase that. Any 

elevation in mean arterial pressure 

predispose--predisposes an aneurysm to rupture 

because it can be directly--it will directly 

reflect itself in tension of the wall of the 

aneurysm. 

Dr. Gary Cooney is a neurologist who practices in 

conjunction with Dr. Dewey. In his practice, Dr. Cooney 

regularly evaluates patients for stress-related conditions. 

He opined that he performs that type of evaluation more 

frequently than a neurosurgeon. Dr. Cooney initially 

reviewed Rita Mae's medical records at the request of a 

psychiatrist involved in Rita Mae's treatment. He also 

gathered additional information and continued to take part in 

Rita Mae's treatment. In his opinion, the rupture of Rita 

Mae's aneurysm was causally related to work stress. 

Q. Dr. Cooney, do you have an opinion to a 

reasonable degree of medical certainty whether Rita 

Snyder's current problems are causally related to 

the ruptured aneurysm and its treatment? A. I do. 

Q. What is your opinion? A. I believe that the 

rupture of the patient's aneurysm was related to 

the medical problems that she was experiencing at 

the time of the rupture which were exaggerated and 

aggravated by work stress which she had been 

experiencing for some time. 

Q. Dr. Cooney, can you state whether or not the 

following situations more likely than not would 

cause a bookkeeper who also waits on customers to 
experience stress: One, a disorganized procedure 

for handling customers; two, unsatisfied customers; 

three, poor communication with management; four, an 

increased work load; five, unusual and unpaid for 

overtime; and, six, job duties that cannot be 

completed correctly nor on time. 

A. All of those conditions would probably increase 

an individual's level of stress. 

Q. If each situation would increase an 

individual ' s level of stress, would several or all 

of those situations at the same time add additional 

stress? 

A. They would. 

Q. At the time of trial, Dr. Cooney, testimony was 

offered to the following facts concerning December 

31, 1984: December 31, 1984, was an unusually busy 

day at Rita Snyder's place of employment. Rita 

Snyder's place of employment normally operated with 

ten employees and had six or seven working on 

December 31. Early in the morning of December 31, 

Rita commented that an unusually unpleasant 

customer was scheduled to come in and do business 

at her place of employment. The other bookkeeper 

who normally worked with Rita Snyder was busy with 

other job duties and was unable to help Rita with 

waiting on customers and some of the other job 

duties that Rita had to do. That December 31, 

1984, was the day the end of the month bookkeeping 

was to be done on. The end of the month 

bookkeeping was an extra, additional duty in 

addition to Rita's normal job duties. When Rita 

Snyder came to work on the morning of December 31, 

she appeared normal. After one hour in the work 

place, she appeared wrung out. Shortly before 

Rita's syncopal episode at work, Rita asked for 

help from the other bookkeeper because she was 

unable to decipher some paper work that the manager 

had incorrectly and incompletely filled out. 
Dr. Cooney, if the Court finds as fact those facts 

substantially as I have related them to you, is 

it--are those incidents such as would normally 

cause a worker to experience unusual stress? 

A. I would think that those events would cause an 

unusual amount of stress. 

Q. Is it medically possible that these incidents 

aggravated or accelerated the ultimate result of 

Rita Snyder's pre-existing basilar artery aneurysm? 

A. Yes. 

Q. Is it medically probable that Rita Snyder 

experienced a stress reaction to her work place 

generally after being exposed to stressful 

experiences over a period of time? 

A. It's certainly possible that that occurred. 

Q. Dr. Cooney, do you have an opinion, to a 

reasonable degree of medical certainty, whether 

Rita Snyder's aneurysm would have ruptured when it 

did if she had not been exposed to unusual work 

stress? 

A. I do. 

Q. What is your opinion? 

A. I believe that it is more likely that the 

aneurysm ruptured when it did, presuming that she 

was exposed to the stresses that we have been 

discussing, than would have occurred had she not 

experienced that sort of stressful situation. 
Dr. Albert Joern is a neurosurgeon and former medical 

school professor. Dr. Joern examined Rita Mae's records and 

concluded that it is more likely than not that there is a 

causal relationship between the unusual stress in her work 

place and the rupture of Rita Mae's aneurysm. 

The central issues in the case at hand concerns the 

sufficiency of evidence presented by the claimant. It is 

well settled that decisions of the Workers' Compensation 

Court will be upheld upon a finding of substantial credible 

evidence. Tocco v. City of Great Falls (Mont. 1986), 714 

P.2d 160, 163, 43 St.Rep. 310, 314. "However, when the 

critical evidence, particularly medical evidence, is entered 

by deposition, we have held that 'this Court, although 

sitting in review, is in as good a position as the Workers' 

Compensation Court to judge the weight to be given record 

testimony . . . "' Jones v. St. Regis Paper Co. (1982), 196 

Mont. 138, 146, 639 P.2d 1140, 1144, citing Hert v. J. J. 

Newberry Co. (1978), 178 Mont. 355, 584 P.2d 656. We find 

the medical evidence, together with other evidence is 

sufficient to establish a compensable injury within the 

meaning of the Montana Workers' Compensation Act. 

The Workers' Compensation Court found that Rita Mae was 

upset on the day in question; that stress causes an increase 

in blood pressure; and that an increase in blood pressure can 

cause an aneurysm to rupture. The court concluded, however, 

that there was insufficient evidence of work caused stress in 

the degree needed to elevate blood pressure. Such a 

conclusion is in stark contrast with the evidence presented 

at trial. 

The medical experts unanimously agreed that the average 

person would deem Rita Mae's work place unusually stressful 

in the months immediately preceding her injury. The experts 

also agreed that the work environment on the day of the 
injury was particularly stressful. San Francisco contends 

such evidence is not significant, however. 

San Francisco places great reliance on the fact that 

human beings react differently to environmental stimuli. It 

is alleged that this variation and our decision in Campbell 

v. Young Motor Company (Mont. 1984), 684 P.2d 1101, 41 

St.Rep. 1218, requires that a psychologist perform a 

"psychological reconstruction" demonstrating that R-ita Mae 

found her work environment stressful. We disagree. 

In Campbell, the issue was whether suicide is per se an 

independent, intervening cause which precludes the award of 

death benefits to an injured workers beneficiary. We held 

that suicide is compensable if the on-the-job injury produces 

post-injury trauma which causes the suicide. 684 P.2d at 

1103, 41 St.Rep. at 1220. We did not set forth an 

evidentiary rule requiring a "psychological reconstruction" 

if psychological factors are involved. The "psychological 

autopsy" performed in Campbell was merely recognized as a 

method of establishing a nexus between the injury and 

resulting suicide. 

In the instant case, Rita Mae's family and co-workers 

testified, inter alia, that Rita Mae was under a great deal 

of pressure from work; that she had been working 

progressively more unusual and unpaid overtime; that her job 

duties had become more difficult; that she had to deal with 

angry customers and employees; that the work place was 

disorganized; that there was poor communication with 

management; and, that she feared she would lose her job. 

There is no evidence that Rita Mae was an emotional zombie. 

The record discloses quite the opposite. 

The medical experts agreed that Rita Mae's work 

environment was very stressful. Rita Mae's co-workers and 

family confirmed that Rita Mae was affected by the stress. 
The testimony showed she appeared nervous all the time; she 

was thought to be under a great deal of pressure from work; 

and, she appeared wrung-out soon after arriving at work. We 

find the evidence is sufficient to demonstrate that Rita Mae 

found her work environment unusually stressful. As Dr. Dewey 

indicated, it does not take a medical degree to determine 

that the work environment was very stressful. 

In the alternative, San Francisco contends that S 

39-71-119, MCA (1983), which was controlling at the time of 

the rupture, precludes a finding of compensable injury absent 

a showing of physical impact. It provides: 

"Injury" or "injured" means: (1) a tangible 

happening of a traumatic nature from an unexpected 

cause or unusual strain resulting in either 

external or internal physical harm and such 

physical condition as a result therefrom and 

excluding disease not traceable to injury . . . 

By its terms, the statute does not require that an 

injury arise from a specific instance of physical impact. "A 

tangible happening must be a perceptible happening . . . Some action or incident, or chain of actions or incidents, 

must be shown which may be perceived as a contributing cause 

of the resulting injury." Erhart v. Great Western Sugar Co. 

(1976) , 169 Mont. 375, 381, 546 P. 2d 1055, 1058. The stress 

induced increase in blood pressure which gradually expands a 

blood vessel to the point of rupture is such a chain of 

incidents. The fact that the injury producing stimulus is in 

the form of sustained emotional stress or strain does not 

make the impact on the body any less harmful or real. We 

hold that the unusual and unexpected mental strain of a 

stressful work environment which causes a pre-existing 

aneurysm to rupture is a tangible happening of a traumatic 

nature from an unusual strain. See Rathbun v. Tabor Tank 

Lines (1955) , 129 Mont. 121, 283 P. 2d 966 (unusual stress 
and strain which causes injury is a compensable occurrence); 

Hoehne v. Granite Lumber Co. (1980), 189 Mont. 221, 615 P.2d 

863 (tangible happening need not be a single, isolated 

incident) ; Jones, supra (claimant need not identify specific 

incident which causes injury) ; Wise v. Perkins (Mont. 1983) , 

656 P.2d 816, 40 St.Rep. 1 (excessive work week which results 

in phlebitis constitutes a tangible happening of a traumatic 

nature from an unusual strain) ; Tocco, supra, (emotional 

stress contributing cause of injury). By so holding, we join 

the overwhelming majority of jurisdictions which recognize 

aggravation of an aneurysm as a compensable injury. We note, 

however, that this opinion may be unique in light of the 

Legislature's subsequent modification of the injury statute. 

See S 39-71-119 (3) (a). 

The second issue before the Court concerns the 

evidentiary weight to be given the testimony of the treating 

physician. Rita Mae contends that the Workers' Compensation 

Court improperly gave the deposition testimony of Dr. Dewey, 

the treating physician, greater weight. As a general rule, 

we agree that the testimony of a treating physician is 

entitled to greater evidentiary weight. See generally 

Drescher v. Liberty Mutual Fire Insurance Co., WCC No. 

8509-3254, decided February 11, 1986; Goodman v. Liberty 

Mutual, WCC No. 8502-2897, decided September 3, 1985. Logic 

indicates that the treating physician will normally have had 

more contact with, and greater knowledge of, the injured 

worker. As a result, the treating physician should generally 

be in the best position to give an informed opinion. 

However, the treating physician rule is not cast in 

stone. In the instant case, Dr. Dewey indicated that his 

initial opinion was, in effect, based on incomplete 

knowledge. The court ignored Dr. Dewey's subsequent 

acknowledgement that it is possible and probable that the 
unusually stressful work environment resulted in elevated 

blood pressure and that elevated blood pressure can cause an 

aneurysm to rupture. 

In addition, Dr. Cooney also took part in the care and 

treatment of Rita Mae. He concluded that Rita Mae's 

unusually stressful work environment was causally connected 

to the subsequent rupture of the aneurysm. His opinion, 

which was affirmed by Dr. Joern, was also ignored, however. 

Under these circumstances, we agree that the court improperly 

relied upon Dr. Dewey's initial conclusion. 

The final issue before the Court is the propriety of the 

hypothetical questions posed to the medical experts by Rita 

Mae ' s counsel. Although San Francisco objected to the 

hypothetical questions, the Workers ' Compensation Court did 

not rule on the matter in light of its decision on the 

merits. We address the issue in the interests of judicial 

economy and final resolution of the controversy. 

Although the Workers' Compensation Court was not 

generally bound by the rules of evidence at the time in 

question, the court has often looked to the Montana Rules of 

Evidence for guidance. San Francisco contends that the 

hypothetical questions, reproduced infra, were improper 

because the questions contained improper characterizations of 

the evidence, the facts relied upon were not proven at trial, 

and Dr. Joern relied upon information not communicated to the 

Court. Assuming, argumendo, that the stricter standard of 

the Montana Rules of Evidence did apply, we find no error. 

A review of the record indicates that the alleged 

mischaracterization of the record did not occur. The facts 

contained in the hypothetical questions posed by counsel 

accurately reflect the testimony presented. We will not 

require counsel to engage in a verbatim regurgitation of 

prior testimony. See Gra.ham v. Rolandson (1967), 150 Mont. 
270, 435 P.2d 263. San Francisco's contention that the facts 

relied upon were not proven is similarly without merit. 

Finally, we call San Francisco's attention to Rule 705, 

M.R.Evid. It provides: 

Disclosure of facts -- or data underlying expert 

opinion. The expert may testify in terms of 

opinion or inference and give his reasons therefor 

without prior disclosure of the underlying facts or 

data, unless the court requires otherwise. The 

expert may in any event be required to disclose of 

the underlying facts or data on cross-examination. 

As Rule 705 indicates, an expert need not delineate the 

complete basis for his or her opinion prior to offering that 

opinion. Counsel for San Francisco thoroughly investigated 

the matter on cross-examination. We find no error. 

The judgment of the Workers' Compensation Court is 

reversed with instructions to enter - judgment in favor of Rita 

Mae Snyder. 

We Concur: /