Alexander, 851 S.W.2d at 528-29; McCormack v. Stewart Enterprises, Inc., 916 S.W.2d 219, 223 (Mo.App. 1995); Clancy v. Armor Elevator Co., 899 S.W.2d 123, 126 (Mo.App. 1995). See also Knipp v. Nordyne, Inc., 969 S.W.2d 236, 239-40 (Mo.App. 1998). In Alexander, the employee suffered a dizzy spell and fell.
Silman v. William Montgomery Assoc., 891 S.W.2d 173, 175 (Mo. App. 1995). See also Knipp v. Nordyne, Inc., 969 S.W.2d 236, 240 (Mo. App. 1998). However, an injury may be of such a nature that expert opinion is essential to show that it was caused by the accident to which it is ascribed.
Id. In Knipp v. Nordyne, Inc., 969 S.W.2d 236 (Mo. App. W.D. 1998), the Western District of this court reviewed a decision of the Labor and Industrial Relations Commission denying a plaintiff death benefits for her husband's death. The widow of the worker argued, in essence, that "when a person falls, hits his head, and dies of brain hemorrhaging, it is obvious that the fall caused or contributed to the hemorrhaging, and expert testimony to that effect is unnecessary."
. App. 1999); Davis v. General Elec. Co., 991 S.W.2d 699 (Mo. App. 1999); Reese v. Coleman, 990 S.W.2d 195 (Mo. App. 1999); Flanigan v. St. James Paseo Learning Center, 996 S.W.2d 524 (Mo. App. 1999); Putnam-Heisler v. Columbia Foods, 989 S.W.2d 257 (Mo. App. 1999); Messex v. Sachs Elec. Co., 989 S.W.2d 206 (Mo. App. 1999); Sanderson v. Porta-Fab Corp., 989 S.W.2d 599 (Mo. App. 1999); Van Black v. Trio Masonry, Inc., 986 S.W.2d 200 (Mo. App. 1999); Williams v. City of Ava, 982 S.W.2d 307 (Mo. App. 1998); Bryan v. Summit Travel, Inc., 984 S.W.2d 185 (Mo. App. 1998); Breckle v. Hawk's Nest, Inc., 980 S.W.2d 192 (Mo. App. 1998); George-Brewer v. Pen Mar Southwest, 980 S.W.2d 147 (Mo. App. 1998); Moriarty v. City of Kirksville, 975 S.W.2d 215 (Mo. App. 1998); Seyler v. Spirtas Indus., 974 S.W.2d 536 (Mo. App. 1998); DeLong v. Shop 'N Save, 972 S.W.2d 495 (Mo. App. 1998); Circo v. A-Cord Elec., 969 S.W.2d 228 (Mo. App. 1998); Lammert v. Vess Beverages, Inc., 968 S.W.2d 720 (Mo. App. 1998); Knipp v. Nordyne, Inc., 969 S.W.2d 236 (Mo. App. 1998); Wisely v. Sysco Foods, 972 S.W.2d 315 (Mo. App. 1998); Simpson v. Saunchegrow Const., 965 S.W.2d 899 (Mo. App. 1998); Avery v. City of Columbia, 966 S.W.2d 315 (Mo. App. 1998); Crabill v. Hannicon, 963 S.W.2d 440 (Mo. App. 1998); Esquivel v. Day's Inn of Branson, 959 S.W.2d 486 (Mo. App. 1998); Cahall v. Cahall, 963 S.W.2d 368 (Mo. App. 1998); Holaus v. William J. Zickell Co., 958 S.W.2d 72 (Mo. App. 1997); Landers v. Chrysler Corp., 963 S.W.2d 275 (Mo. App. 1997); Feltrop v. Eskens Drywall and Insulation, 957 S.W.2d 408 (Mo. App. 1997); Cooper v. Medical Center of Independence, 955 S.W.2d 570 (Mo. App. 1997); Walsh v. Treasurer of the State of Mo., 953 S.W.2d 632 (Mo. App. 1997); Coloney v. Accurate Superior Scale Co., 952 S.W.2d 755 (Mo. App. 1997); Carlson v. Plant Farm, 952 S.W.2d 369 (Mo. App. 1997); Hunsicker v. J.C. Industries, Inc., 952 S.W.2d 376 (Mo. App. 1997); Cahall v. Riddle Trucking, Inc., 956 S.W.2d 315 (Mo. App. 1997); Nichols v. Mama Stuffeati's, 965 S.W.2d 171 (Mo.
The Missouri Supreme Court has indicated otherwise: "[W]e see no reason why a proper expert medical opinion contained in a hospital record should not be accorded dignity equal to that of a similar opinion from the witness stand[.]" Allen v. St. Louis Public Serv. Co., 285 S.W.2d 663, 667 ; see also Knipp v. Nordyne, Inc., 969 S.W.2d 236, 240 (Mo. App. W.D. 1998) (noting expert opinions contained in medical records agreed regarding causation), overruled on other grounds by Hampton v. Big Boy Steel Erection, 121 S.W.3d 220 (Mo. banc 2003). We note that one set of medical records are included in the legal file as an exhibit to Bangert's initial petition, which he later abandoned by filing an amended petition that attached no exhibits.
Meadows, 238 S.W.3d at 213. Examples of conditions that have been found to be outside the realm of lay understanding include carpal tunnel syndrome, Decker, 974 S.W.2d at 669; a brain aneurysm, Knipp v. Nordyne, Inc., 969 S.W.2d 236, 240 (Mo.App. W.D. 1998) (overruled on other grounds by Hampton, 121 S.W.3d 220); ventricular fibrillation, Carter v. Jones Truck Lines, Inc., 943 S.W.2d 821, 826 (Mo.App. S.D. 1997) (superseded by statute on other grounds as stated in Kasl v. Bristol Care, Inc., 984 S.W.2d 852, 853 (Mo. banc 1999)); lead poisoning, Matzker v. St. Joseph Minerals Corp., 740 S.W.2d 362, 363 (Mo.App. E.D. 1987) (overruled on other grounds by Hampton, 121 S.W.3d 220); and appendicitis, Rexroad v. Schultz Folding Box Co., 261 S.W.2d 493, 496 (Mo.App. 1953). On the other hand, a claimant's testimony alone was sufficient to establish causation between an accident and a herniated disc.
"'When the condition presented is a sophisticated injury that requires surgical intervention or other highly scientific technique for diagnosis . . . the proof of causation is not within the realm of lay understanding nor — in the absence of expert opinion — is the finding of causation within the competency of the administrative tribunal.'" Knipp v. Nordyne, Inc., 969 S.W.2d 236, 240 (Mo.App. 1998) (quoting Silman, 891 S.W.2d at 175-76); see Irving v. Missouri State Treasurer, 35 S.W.3d 441, 445 (Mo.App. 2000). Likewise, the Commission "'may not arbitrarily disregard and ignore competent, substantial and undisputed evidence of witnesses who are not shown by the record to have been impeached, and the Commission may not base their finding upon conjecture or their own mere personal opinion unsupported by sufficient competent evidence.'"
Further, an idiopathic injury or condition, such as a heart attack, that precipitates an accident is not compensable if that heart attack or other idiopathic injury or condition is not triggered by conditions of employment. Knipp v. Nordyne, Inc., 969 S.W.2d 236, 239 (Mo.App. 1998), overruled in part on other grounds by Hampton, 121 S.W.3d at 227. Thus, for example, even though a heart attack itself may not be compensable, injuries sustained in a fall as a result of the heart attack would be compensable as long as there is a causal connection between the fall and the workplace, i.e., falling from a ladder being used in the course of employment.
The only expert medical evidence offered was the testimony of Dr. Childers, who testified that Mr. Irving's death was caused by his diabetes and by heart disease that was poorly controlled over the years, rather than by the stress caused by his employment. Our analysis in a similar situation in Knipp v. Nordyne , 969 S.W.2d 236 (Mo.App.W.D. 1998), is applicable here. There, as here, there was more than one possible cause of the employee's injury and ultimate death.
In contrast, the sudden onset doctrine will not apply where there is specific medical evidence suggesting that the cause of the injury was contrary to that suggested by the lay person's testimony. See, e.g.,Knipp v. Nordyne , 969 S.W.2d 236, 240 (Mo.App.W.D. 1998) (uncontradicted medical evidence supporting the finding that an aneurysm caused the worker's death, rendered inapplicable plaintiff's lay testimony that her husband's death was caused by a recent fall that caused the brain to hemorrhage); Brickey v. Concerned Care of Midwest, Inc. , 988 S.W.2d 592, 597 (Mo.App.E.D. 1999) (unopposed medical evidence indicated respiratory failure as the immediate cause of death. Plaintiff's lay testimony alleging a head injury was not applicable as the issue of causation was beyond the lay person's understanding).