Case Name: Margaret THOMAS, Appellant, v. The SALVATION ARMY and Liberty Mutual Insurance Co., Appellees
Court: Florida District Court of Appeal
Jurisdiction: Florida
Decision Date: 1990-05-14
Citations: 562 So. 2d 746
Docket Number: No. 89-1188
Parties: Margaret THOMAS, Appellant, v. The SALVATION ARMY and Liberty Mutual Insurance Co., Appellees.
Judges: WENTWORTH, J., concurs.
Reporter: Southern Reporter, Second Series
Volume: 562
Pages: 746–752

Head Matter:
Margaret THOMAS, Appellant, v. The SALVATION ARMY and Liberty Mutual Insurance Co., Appellees.
No. 89-1188.
District Court of Appeal of Florida, First District.
May 14, 1990.
Rehearing Denied July 5, 1990.
C. Randal Morcroff, Deerfield Beach, for appellant.
Anthony J. Beisler, III, P.A., Fort Laud-erdale, for appellees.

Opinion:
JOANOS, Judge.
Claimant in this workers' compensation case appeals an order of the judge of compensation claims denying payment of medical bills for treatment of claimant's high blood pressure and ulcer condition. The issues for review concern the propriety of the judge's rejection of medical testimony that claimant's high blood pressure is causally related to her industrial accident, and of the finding that claimant's ulcer condition is not related to her industrial accident. We reverse.
The record reflects that claimant suffered a back injury resulting from a fall on a cobblestone floor at work on April 15, 1988.' Because claimant did not think her injury was serious, she did not seek medical help until three weeks later, when one morning she found herself unable to get out of bed. When informed that claimant was unable to work, the insurance carrier had her examined by an orthopedic surgeon. However, claimant continued to see Dr. Preste, the internist who is her family physician.
On November 16, 1988, claimant filed a claim for benefits, seeking authorization of, and payment for, Dr. Preste's treatment of her high blood pressure and ulcer condition. The carrier defended on the ground that the blood pressure elevation and ulcer condition were not causally related to the industrial accident or its treatment.
Dr. Preste's deposition reflects that he treated claimant on May 16, 1988, one month after her fall at work. At that time, claimant had diffuse muscle spasms in her back and neck. Dr. Preste found claimant's blood pressure borderline at that time, i.e., elevated, but not requiring medication. He prescribed Darvocet, and a return visit if the problems persisted. Claimant continued to have pain, and new prescriptions were ordered.
On August 17, 1988, claimant returned to Dr. Preste for treatment of a cold. At that time, claimant advised Dr. Preste that she had been to an orthopedist and had been diagnosed as having lumbar disc disease. Claimant returned to Dr. Preste on September 19, 1988, complaining of an upper respiratory infection, and of severe epigastric pains. Dr. Preste's physical examination revealed epigastric tenderness that accorded with clinical findings suggesting gastritis, inflammation, or ulcer. In addition, claimant's blood pressure was significantly elevated, so Dr. Preste started claimant on medication for hypertension at that time.
A reading of Dr. Preste's testimony indicates a reluctance to use, or an unfamiliarity with,. the terminology normally employed in determining whether there is a causal relationship between a claimant's industrial injury and medical problems that develop afterward. For example, when claimant's counsel asked Dr. Preste whether he had an opinion, based on reasonable medical probability, as to whether claimant's ulcer problem and blood pressure problem were related to her industrial accident, the following responses were elicited:
If I might indulge you and let me paraphrase your question, you're asking me, could her elevation in blood pressure from the first time I have it recorded to September 19th have been elevated because of her conditions that we were seeing her for, and I would have to say yes, I [sic] could be. Let me just make a qualifier here. Whether it was acutely elevated that day because of her pain, and then the next day she was on pain medication and it was back down, it's for conjecture, but yes, stress, anxiety can aggravate blood pressure.
Q. I have to ask you to understand precisely the questions being asked because in the legal context, the use of the word could as you have answered the question, would denote possibility. It's possibly caused by or related to. My question is specifically: Could you state within reasonable medical probability which means more likely than not, that the blood pressure elevation was probably related to the history and the subsequent treatment or the medications. Can you say that within probability, or is it your testimony that it is merely possibility?
A. I hate to be into words. I think it's a little more than possible. I think it would be between sixty and ninety per cent that her blood pressure was elevated due to her condition. (Emphasis supplied.)
Q. Let me repeat my former question then. We now have the medical documentation in your own chart that she did have an acute peptic ulcer, correct?
A. Correct.
Q. The question is: Do you have an opinion whether or not the development or the aggravation of that peptic ulcer was in some way causally related to the industrial accident at work?
A. In my medical opinion, taking care of Margaret and getting to know her, yes, it could have causally been related.
Q. And again—
A. Let me—
Q. Okay.
A. And most likely was related to recent stress and tension from her accident — excuse me — from the pains involved secondary to her accident.
During cross examination, when asked whether claimant is a "high strung" individual, Dr. Preste said that she was more anxious in the period from May to September 1988 than he remembered her being from prior visits. Employer/carrier's counsel elicited the following responses from Dr. Preste concerning the causal relationship issue:
Q. During this entire time that you treated her, was the blood pressure at this slightly elevated stage?
A. When she was initially seen, it was slightly elevated, and it had that one peak, and we placed her — because of the elevation of the diastolic which is severe hypertension — meets the criteria for severe hypertension on a minimum, moderate, severe basis which is greater than one ten diastolic, and I treated her at that one peak, and she had normal blood pressure on several occasions after-wards.
Q. Now, you indicated that you felt that sixty to ninety per cent of this elevated blood pressure was due to her condition, and what do you mean by her condition? A. Her increasing and more recent stress and anxious state.
Q. And the ulcer, if I understand your testimony, you say that it could or that it medically probably is related to the industrial accident?
A. Probably related to the stress, anxiety from the pain secondary to the industrial accident.
Q. Has nothing to do in your opinion with the medications or anything else? If it has a relationship, it has a relationship through what you perceive as stress and anxiety this woman feels, is that it? Is that a fair summation of—
A. I'm not sure I follow what that summation represents—
Q. Stress, tension, anxiety and the lady is uptight, and that's probably what's causing her ulcer, and that's all because of this slip and fall at work?
A. Yes.
Claimant's testimony indicates that on one other occasion, some three to four years prior to the industrial accident underlying this appeal, she developed high blood pressure. At that time, claimant was a residential program manager for the Foundation of Independent Living, and was on call virtually twenty-four hours a day. On the advice of her physician, she left the position when her contract expired. Claimant said she took medication for her condition for a few months, and had experienced no further problem with blood pressure for the two to three year period prior to her compensable injury. Claimant further stated that she had never before had an ulcer.
The judge of compensation claims found that claimant had blood pressure problems "since three to four years before" the industrial accident, and expressly rejected Dr. Preste's testimony regarding causal relationship, due to "the overall vacillation and inconsistency of the testimony of this doctor." The judge further found no causal relationship between claimant's peptic ulcer and the industrial accident, concluding that it was highly questionable that a peptic ulcer could be developed within thirty days of the date of the accident.
It is an established rule that a workers' compensation claimant must prove the existence of a causal connection between the employment and injury for which benefits are sought, and the existence of causation must be based upon reasonable medical probability. Computer Products, Inc. v. Williams, 530 So.2d 1006 (Fla. 1st DCA 1988); Metric Constructors, Inc. v. Chiles, 429 So.2d 1292, 1293 (Fla. 1st DCA 1983); Scotty's, Inc. v. Jones, 393 So.2d 657, 658-659 (Fla. 1st DCA 1981). Medical evidence as to causation is particularly significant where, as in the instant case, the subject injury is not readily observable. In such instances, while medical evidence is a prerequisite to a finding of causation within reasonable medical probability, a single medical opinion is sufficient to establish causal relationship between claimant's condition and the employment. Computer Products, Inc. v. Williams, 530 So.2d at 1007.
In evaluating medical evidence, a judge of compensation claims may not reject uncontroverted medical testimony without a reasonable explanation. Andrews v. C.B.S. Division, Maule Industries, 118 So.2d 206, 212 (Fla.1960); Philpot v. City of Miami, 541 So.2d 680, 683 (Fla. 1st DCA 1989). In other words, "[wjhere the issue before the deputy commissioner involves essentially a medical question, the deputy commissioner should offer a sufficient reason for rejecting expert medical testimony, especially if such testimony is unrefuted." Curtis v. Florida Correctional Institute, 509 So.2d 1192, 1194 (Fla. 1st DCA 1987).
Moreover, when medical evidence is presented by deposition, as it was in this ease, "the vantage point of this court is not inferior to that of the deputy commissioner in interpreting deposition evidence." McCabe v. Bechtel Power Corp., 510 So.2d 1056, 1059 (Fla. 1st DCA 1987).
The judge's characterization of Dr. Preste's deposition testimony as vacillating and inconsistent in this case, is analogous to the "contradictory, irreconcilable" language employed by the deputy commissioner [now judge of compensation claims] in Giaramita v. Dade County School Board, 484 So.2d 1312 (Fla. 1st DCA 1986). In Giaramita, the uncontradicted opinion of Dr. Epstein, endocrinologist, was that the claimant's hypertension, non-symptomatic before claimant suffered a compensable back injury, was aggravated by his back pain. In an August 1984 deposition, Dr. Epstein opined that claimant's hypertension could be controlled by medication, and if medication proved successful, claimant could return to some type of work. However, in his June 1985 deposition, Dr. Epstein stated that during the past year he had been unable to control claimant's blood pressure with medication, and recommended that claimant not return to work. The deputy rejected Dr. Epstein's testimony, terming it contradictory and irreconcilable, because in 1984, the doctor found claimant could return to work, while in 1985 he found claimant unable to work. The court found Dr. Epstein's testimony "totally consistent in logic and reason," and "that the deputy abused his discretion in rejecting Dr. Epstein's uncontroverted medical testimony without a reasonable explanation." Giaramita, 484 So.2d at 1314.
We conclude that Dr. Preste's testimony that claimant had borderline blood pressure on May 16, 1988, and August 17, 1988, with elevated blood pressure on September 19, 1988, is consistent with his opinion that claimant's elevated blood pressure was due to pain secondary to her back injury. The back injury occurred on April 15, 1988, and remained untreated for four weeks. Claimant's blood pressure was borderline on May 16, 1988, when Dr. Preste first saw her. At that time, claimant was in pain, and manifested muscle spasms in her neck and back. The record reflects that as claimant's back condition worsened, her blood pressure increased. Although Dr. Preste's deposition testimony was not phrased in the word formula common to the workers' compensation arena, his testimony indicates the existence of a causal relationship between claimant's hypertension and her back injury in terms which equate to reasonable medical probability, i.e., "it would be" between sixty and ninety per cent that her blood pressure was elevated due to her condition." Similarly, Dr. Preste said that claimant's peptic ulcer "most likely was related to . the pains secondary to her accident." Moreover, when employer/carrier's counsel asked Dr. Preste if it was his opinion that the stress, tension, and anxiety' claimant experienced due to her fall at work was causing her ulcer, Dr. Preste clearly answered, "Yes."
A comparison of the testimony contained in the record in this case with the judge's findings as set forth in the order leads us to believe that the judge misinterpreted some of the testimony, and that this misinterpretation resulted in legal error. Specifically, the order recites that claimant "had her trouble with blood pressure since three to four years before." This is a misstatement of claimant's testimony, which was that she had suffered one prior episode of blood pressure elevation three to four years before the subject accident and injury, and that the problem resolved itself within a few months. Similarly, the judge's statement that he found "it highly questionable that a peptic ulcer could be developed within 30 days of the date of the accident," is a misstatement of the pertinent testimony. Dr. Preste stated that on September 19, 1988, claimant complained of epigastric pains, which subsequently were revealed to be caused by a peptic ulcer. The peptic ulcer complaint occurred some five months after the April 15, 1988, accident — not thirty days.
In the circumstances, we conclude that the judge of compensation claims has failed to articulate a reasonable explanation for the rejection of Dr. Preste's deposition testimony. We further conclude that a proper construction of that testimony demonstrates a causal connection between claimant's compensable injury and her subsequently developed hypertension and ulcer condition, within the standard of reasonable medical probability.
Accordingly, the order finding no causal relationship between the industrial injury and claimant's high blood pressure and ulcer condition is reversed, and the cause is remanded with directions to require the employer/carrier to pay the medical bills associated with treatment of claimant's high blood pressure and ulcer condition after September 20, 1988.
WENTWORTH, J., concurs.
THOMPSON, FORD L. (Ret.), Associate Judge, dissents with written opinion.