Opinion
CLAIM NO. F103361
OPINION FILED JANUARY 14, 2003
Upon review before the FULL COMMISSION in Little Rock, Pulaski County, Arkansas.
Claimant represented by HONORABLE ROBERT J. DONOVAN, Attorney at Law, Marianna, Arkansas.
Respondents represented by HONORABLE JEREMY SWEARINGEN, Attorney at Law, Little Rock, Arkansas.
Decision of the Administrative Law Judge: Affirmed.
OPINION AND ORDER
The respondents appeal an Administrative Law Judge's opinion filed May 28, 2002. The Administrative Law Judge found that the claimant was entitled to additional medical treatment, and that the evidence did not support an independent intervening cause relieving the respondents of liability. After reviewing the entire record de novo, the Full Commission affirms the opinion of the Administrative Law Judge.
I. HISTORY
Delores Ann Taylor, age 35, testified that she was employed with Carwell Elevator during the rice harvest seasons in 1999 and 2000. Ms. Taylor dried and processed rice for the respondent-employer, which work duties often involved strenuous manual labor. The parties stipulated that the claimant sustained a compensable injury on August 25, 2000. The claimant testified:
A. I was on top of the rail car loading it with rice in the trough of it, in the middle of it and a rail car on the north end, he pushed his down and it was going about 20 to 24 miles an hour and it hit ours solid and it slammed us on the you know, slammed me down on the catwalk and my knee and leg got pinned in between the catwalk and I had to force it out of the catwalk to be able to get it out.
The claimant testified that she continued trying to work following the compensable injury, but that she was unable to carry out her full-time work duties. The claimant was eventually referred to Dr. Jason C. Brandt, who reported on November 15, 2000:
Ms. Taylor is a 33 year old WF who injured her right knee 8-25-00 and states that it gave way as she fell between a cat walk and a rail car. She had immediate pain and swelling. She has re-injured this on numerous times, on 9-6, 9-18 and most recently on 10-23, all with either climbing or stepping in a twisting injury. She had repeated effusions. She has had continuous painful popping, swelling, catching and instability symptoms. She has had no previous injury prior to this injury in August. . . .
IMPRESSION: Right knee pain with internal derangement.
The claimant told Dr. Brandt in December 2000 that she had re-injured her knee "multiple times" since the compensable injury. Dr. Brandt reported on January 3, 2001:
Ms. Taylor returns today for follow-up of her MRI scan. I reviewed the MRI scan and it showed an anterior horn lateral meniscal tear. Cruciates appear to be intact. There is a question of some displacement of the meniscal tear. There also appears to be a benign bone tumor. I reviewed her plain films and I do not see evidence of this tumor. Most likely it is something very benign in nature. We can follow this in the future. We discussed treatment of the meniscus with arthroscopic surgery. . . .I gave her some Lortab and Valium and we will pick a mutually convenient time and do OP knee surgery.
After diagnosing "Right knee lateral meniscal tear," Dr. Brandt performed a "Right knee arthroscopy with partial lateral anterior horn meniscectomy" on February 9, 2001. The claimant testified that she continued to have problems after surgery, and the record indicates that she periodically followed up with Dr. Brandt.
The claimant treated at a medical center on April 9, 2001, complaining of right knee swelling and pain following an incident with her boyfriend. The claimant testified, "we had been arguing and I reached in to do the seatbelt to Shane his son's seatbelt and whenever he spun off, I was twisted around and my elbow is what got up and hit the tire, the wheel — My arm got caught up underneath the wheel and it bruised it." The claimant testified that she did not re-injure her knee in this incident.
Dr. Brandt reported on April 11, 2001:
She was injured by a vehicle that was pulling past her driveway and hit her causing multiple injuries. She possibly may have re-injured her knee. She was seen by Dr. Houchin.
I reviewed x-rays today. There is a forearm and elbow which show no fracture. Ankle and foot on the right which no (sic) fracture. . . .
Examination of the right knee, the portal sites look good. Trace effusion, full ROM. Her iliotibial band symptoms are improving.
At present, I see no evidence of new fracture or significant injury other than the contusions. . . .She will continue on her therapy as well and her light duty restrictions.
Dr. Brandt wrote to a claims examiner on April 14, 2001:
Per our conversation recently, it is my opinion that the injury of her knee was sustained from her fall at work. As far as her return to full duty, I would hope that she would do this within approximately three months.
With regards to maximal medical improvement, I think nine months from her date of surgery should provide adequate time for her to have maximal medical improvement.
On April 18, 2001, Dr. Brandt reported effusion on the claimant's knee and a bruise on the anterolateral joint line. Dr. Brandt planned additional diagnostic testing and referrals.
Dr. Vonda Houchin reported "marked effusion" in the claimant's right knee on May 9, 2001.
The claimant presented to Dr. C. Lowry Barnes on May 14, 2001. Dr. Barnes planned additional diagnostic testing, and "It is my impression that her current symptoms are related to her previous work related injury." The impression from an MRI of the right knee taken May 15, 2001 was "Well-circumscribed bone lesion the inferior aspect of the femur. This is incompletely evaluated and limited MRI of the femur is recommended in the form of T1-weighted images before and after contrast."
An MR scan of the right knee was taken on June 13, 2001 and compared to the prior study taken May 15, 2001:
Well-circumscribed 1.5 cm focal area of abnormal signal intensity in the distal femur. There is peripheral rim enhancement lesion. The patient gives a history of some type of bone tumor removal in the knee. The differential diagnosis would include postoperative change in the right knee vs. a bone cyst. There is also evidence for joint effusion and synovitis.
Dr. Barnes reported on July 2, 2001:
Because of her significant symptoms, we are going to proceed with arthroscopic evaluation. I am concerned that she has a component of reflex sympathetic dystrophy. She understands that this will be a diagnostic and possibly therapeutic arthroscopy. If her symptoms continue after such, she may require significant pain management treatment.
Ms. Taylor very much wanted further narcotic management of her pain. I explained to her that I was concerned about doing this because of a possible reflex sympathetic dystrophy that she has at this stage and the fact that it is difficult to figure out her baseline pain with long-term narcotic management. I have explained to her that I am not a fan of long-term narcotic management. She is convinced that her previous surgeon will continue her narcotics, because he understands what is going on. She has asked to get a copy of her records, because she would like to change physicians.
The claimant testified that she did not want to undergo an arthroscopy from Dr. Barnes, "because I had surgery in February and it took me so long to get over that. I don't want to be cut on twice. I want to be cut on and fixed. I mean, I was going to have the surgery. I was going to let him do it because I was in pain. You know, I was going to go ahead and let him do that but he — I mean my appointment was cancelled."
The respondents controverted additional medical treatment after the claimant's office visit with Dr. Barnes on July 2, 2001. The respondents controverted additional temporary total disability after July 5, 2001.
The claimant returned to Dr. Brandt on September 12, 2001:
I reviewed her MRI scan of her ankle. There is a mass consistent with a ganglion off the flexor hallucis longus tendon. No other abnormalities are appreciated. She continues to have pain in her right knee and at one point have (sic) a period of subluxator iliotibial band. Otherwise, her knee exam is benign. She is feeling better. She is having some mild cramping. I have asked her to follow up with her local physician for electrolyte testing, potassium or calcium. It is possible electrolyte abnormality is causing difficulty. I have again made a recommendation that I would like for her to be evaluated by another surgeon and possibly for her surgical treatment as I do not have that much experience with snapping iliotibial band syndrome or tarsal tunnel masses.
The respondents denied payment for this visit to Dr. Brandt.
Ms. Taylor claimed entitlement to additional worker's compensation. The claimant contended that she was entitled to additional medical treatment, and that she was entitled to temporary total disability compensation from the time respondents ceased paying until a date to be determined.
The respondents contended that additional medical treatment was not reasonably necessary. The respondents alternately contended that the April 2001 automobile incident was an independent intervening cause relieving the respondents of liability.
The parties deposed Dr. Barnes on February 12, 2002. Dr. Barnes testified that he examined the claimant on two occasions, and that when he first saw the claimant in May 2001, he had not been aware of the April 2001 automobile incident. Dr. Barnes testified:
Q. Doctor, now that you are aware of the car accident, in which she injured her right knee, in which she reportedly sustained injury to her right knee, can you state to a reasonable degree of certainty, that her current symptoms, at the time of your evaluation, were related to her August of 2000, injury, as opposed to the more recent trauma in April of 2001?
A. I cannot. But, again, if I had known that information more at the time, I could — I would have asked more questions related to the differences between pre-injury and post-secondary injury, or thought about the second injury, et cetera. It's hard now, to go back and look at something from almost a year ago. . . .
Q. At the time of your July evaluation of the complainant, when you discussed the need for arthroscopic surgery and perhaps a therapeutic component to the arthroscopy, were you under the impression, at the time, that the need for the arthroscopy and the surgery and treatment, was related to her previous August 25th of 2000, work-related injury?
A. I was.
Q. Okay. With the new history that you've been given today, and the medical records discussing the April, 2001, car accident injury, if you want to call it that, can you state, to a reasonable degree of medical certainty, that the need for surgery, at the time of July of 2001, was related back to that August of 2000, injury, as opposed to the more recent April incident?
A. I cannot. At that time, I was giving my opinion based on the information that I had, at the time.
Hearing before the Commission was held on March 8, 2002. The claimant testified that she had suffered daily pain in her knee since the compensable injury. The claimant testified that she frequently experienced "popping" and swelling, and that she would have to stop and ice her knee for two to three days. The claimant testified that she was willing to undergo surgery from Dr. Barnes, "if he would fix it, yes."
After a hearing before the Commission, the Administrative Law Judge found that additional medical treatment was reasonably necessary in connection with the claimant's compensable injury. The Administrative Law Judge found that the claimant proved she remained within her healing period and had not returned to work from July 5, 2001 to an undetermined date. The respondents appeal to the Full Commission.
II. ADJUDICATION
An employer must promptly provide for an injured employee such medical treatment as may be reasonably necessary in connection with the injury received by the employee. Ark. Code Ann. § 11-9-508(a). The Administrative Law Judge found in the present matter that the claimant was entitled to additional medical treatment. The Full Commission affirms this finding. The claimant sustained a compensable injury to her right knee in August 2000. The impression of Dr. Brandt, the primary physician, was "Right knee pain with internal derangement." The record does not indicate that the claimant suffered from knee problems prior to the compensable injury. Dr. Brandt performed a "Right knee arthroscopy" in February 2001, but the claimant continued to experience chronic symptoms of pain as a result of her compensable injury and surgery.
The dissent contends that the claimant sustained a subsequent "independent intervening event," which operated to relieve the respondents from further liability for reasonably necessary medical treatment or temporary total disability compensation. Ark. Code Ann. § 11-9-102(4)(F)(iii) provides:
(iii) Under this subdivision (4)(F), benefits shall not be payable for a condition which results from a nonwork-related independent intervening cause following a compensable injury which causes or prolongs disability or a need for treatment. A nonwork-related independent intervening cause does not require negligence or recklessness on the part of a claimant.
In the present matter, the dissent opines that the respondents were relieved of responsibility following the incident occurring on or about April 9, 2001, where the claimant was struck in some fashion by a moving automobile. The dissent contends that the claimant re-injured her knee on this date, and that further treatment for the claimant's knee was related to this "re-injury" rather than the August 25, 2000 compensable injury. The record does indicate that there was some sort of automobile incident on April 9, 2001, but the preponderance of evidence shows that the claimant did not sustain structural damage to her knee in this incident. Dr. Brandt, the primary treating physician, examined the claimant's knee on April 11, 2001 and found "no evidence of new fracture or significant injury other than the contusions." Dr. Brandt stated on April 14, 2001, "the injury of her knee was sustained from her fall at work."
In Broadway v. B.A.S.S., 41 Ark. App. 111, 848 S.W.2d 445 (1993), the Court of Appeals outlined the test for when an independent intervening cause relieves an employer from liability:
In Guidry v. J.R. Eads Constr. Co., 1 Ark. App. 219 [ 11 Ark. App. 219], 669 S.W.2d 483 (1984), we said that the question is whether there is a causal connection between the primary injury and the subsequent disability; and if there is such a connection, there is no independent intervening cause unless the subsequent disability was triggered by activity on the part of the claimant which was unreasonable under the circumstances.
In the present matter, the Full Commission finds that the claimant's disability is causally connected to her primary injury. We recognize Dr. Barnes' testimony that he could not relate the claimant's need for surgery to the compensable injury. Nevertheless, Dr. Brandt examined the claimant immediately after the alleged independent intervening incident. Dr. Brandt found no evidence of a new fracture or significant injury, and opined that the claimant's knee problems were causally related to her compensable injury. The Commission is authorized to accept or reject medical opinion and is authorized to determine its medical soundness and probative force. McClain v. Texaco, Inc., 29 Ark. App. 218, 780 S.W.2d 34 (1989). We find that Dr. Brandt's opinion on causation is entitled to significant weight.
Therefore, the Full Commission finds that there is a causal connection between the claimant's primary injury and her subsequent disability, and that the incident occurring on April 9, 2001 did not act as an independent intervening cause. Nor does the record indicate that the claimant's activity on April 9, 2001 was unreasonable under the circumstances. Based on the record before us, to find that the claimant's activity was unreasonable under the circumstances would require speculation and conjecture, which cannot be substituted for probative evidence. Dena Construction Co. v. Herndon, 264 Ark. 791, 575 S.W.2d 151 [ 575 S.W.2d 155] (1980).
Based on our de novo review of the entire record, the Full Commission finds that the claimant proved she was entitled to additional reasonably necessary medical treatment, and that there was not an independent intervening cause. The Full Commission therefore affirms the opinion of the Administrative Law Judge.
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, the 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
Commissioner Turner concurs.
CONCURRING OPINION
I concur in the majority opinion which affirms the Administrative Law Judge's decision.
In noting the dissenting opinion's objection to this award of benefits, I concede that claimant's credibility is at issue. However, the Administrative Law Judge, who was in the best position to observe her demeanor, specifically found claimant to be a credible witness.
It is the exclusive function of the Commission to determine the credibility of the witnesses and the weight to be given to their testimony. Johnson v. Riceland Foods, 47 Ark. App. 71, 884 S.W.2d 626 (1994). When there are contradictions in the evidence, it is within the Commission's province to reconcile contradicting evidence and to determine the true facts. Arkansas Dept. of Health v. Williams, 43 Ark. App. 169, 863 S.W.2d 583 (1993).
I also note that while the dissenting opinion relies on certain medical records to sustain its point that claimant suffered a "new injury" so as to relieve respondents of all medical and indemnity liability, I found the same records to bolster the claimant's credibility and confirm her testimony that she injured her arm during the car incident with her boyfriend and not the affected knee.
On April 11, 2001, Dr. Brandt, with full knowledge of the car incident, noted no new fractures or other significant injuries to claimant's person.
I reviewed x-rays today. There is a forearm and elbow which show no fracture. Ankles and foot on the right which no (sic) fracture.
On exam today, she has tenderness in the shoulder, but has full ROM. Normal motion strength. Marked bruising on the elbow region, although she has full ROM. She is neurovascularly intact. Examination of the right knee, the portal sites look good. Trace effusion, full ROM. Her iliotibial band symptoms are improving.
At present, I see no evidence of new fracture or significant injury other than the contusions. (Emphasis added).
The dissenting opinion uses the latter portion of this record to find that these contusions represent an independent intervening cause which terminates respondents' liability for additional medical care to the claimant. Conversely, I find that the contusions of which Dr. Brandt spoke clearly relate to claimant's elbow, not her knee. Claimant admits that she injured her arm in the car incident and these medical records reveal that she suffered no additional trauma to her knee.
In my view, claimant's medical records consistently indicate that she continues to suffer from the knee injury she sustained while working. On April 18, 2001, just a few days after Dr. Brandt's examination of the claimant and his opinion that claimant sustained no new injuries from the car incident, Dr. Brandt noted that claimant appeared to be "quite symptomatic from her meniscectomy."
From a review of all of claimant's medical records and her testimony, I find that claimant satisfied her burden and that respondents should continue to provide medical care for her compensable knee injury.
For these reasons, I concur in the majority opinion to affirm the Administrative Law Judge's award of benefits.
______________________________ SHELBY W. TURNER, Commissioner
Commissioner Yates dissents.
DISSENTING OPINION
I respectfully dissent from the majority's opinion finding that the claimant has proven by a preponderance of the evidence that additional medical treatment is reasonable and necessary and related to her compensable injury. In my opinion, a review of the evidence indicates that the claimant sustained an independent intervening event that relieved the respondents of responsibilities for further medical treatment, as well as temporary total disability benefits.
When the primary injury is shown to have arisen out of and in the course of the employment, the employer is responsible for any natural consequence that flows from that injury. The basic test is whether there is a causal connection between the two episodes. Wackenhut Corp. v. Jones, 73 Ark. App. 158, 40 S.W.3d 333 (2001). The determination of whether the causal connection exists between the injury and a disability and whether there is an independent intervening cause are questions of fact for the Commission to determine. Oak Grove Lumber v. Highfill, 62 Ark. App. 42, 968 S.W.2d 637 (1998). The claimant still has the burden of proving the causal connection between his compensable injury and his subsequent condition. See Crudup v. Regal Ware, Inc., 69 Ark. App. 206, 11 S.W.3d 567 (2000).
The claimant testified that on or about April 7, 2001, she fell to the ground and landed on her right side when her boyfriend intentionally drove his car over her. At the hearing, the claimant testified that she only hurt her right elbow in this incident and did not injure her right knee. However, the medical evidence indicates that within the same week, the claimant's right knee had swollen to the point that the claimant asked Dr. Vonda Houchin to drain her knee.
The claimant's denial of re-injuring her knee in the car incident involving her boyfriend is contradicted by the medical records. On April 9, 2001, the claimant sought treatment from her primary care physician, Dr. Houchin, for right knee and leg injuries stemming from the car trampling incident. Dr. Houchin's treatment note states:
Right foot was run over by ex-boyfriend over the weekend. Really bruised and swollen, left lateral lower leg and ankle hurting, was getting better with her right knee following surgery, now after this injury, right knee swelling worse, pain is worse. Very tender over the knee, no ability to ambulate without pain, too painful to cooperate with anterior or posterior testing of the knee, marked effusion in the right knee. (Emphasis mine.)
The Administrative Law Judge's opinion relied excessively on Dr. Jason Brandt's April 11, 2001, treatment note which states:
She has been injured by a vehicle that was pulling past her driveway and hit her causing multiple injuries. She possibly may have re-injured her knee. Examination of the right knee, the portal sides look good. Trace effusion, full ROM. Her iliotibia band symptoms are improving. At present I see no evidence of a new fracture or significant injury other than the contusions . (Emphasis mine.)
In my opinion, Dr. Brandt's findings of contusion and swelling reinforce the fact that the claimant re-injured her knee in the car incident involving her boyfriend.
Dr. Barnes' testimony corroborates the fact that the claimant re-injured her knee in the incident with her boyfriend. In his deposition, Dr. Barnes testified that the claimant's contusions would be indicative of a recent traumatic injury. He stated:
Q. Would the term contusion be indicative of an acute, traumatic injury, or something that is more long-term?
A. Acute traumatic.
Dr. Houchin's April 17, 2001, treatment report reflects that the claimant's knee symptoms had persisted after the car incident despite nearly two weeks having passed. The treatment note reflects:
right knee pain, right knee still hurting, cannot bend or walk on it, still with marked swelling.
The claimant testified and Dr. Houchin's records confirm that the claimant wanted her doctor to aspirate her right knee due to the severity of the swelling. Dr. Houchin referred the claimant back to Dr. Brandt to reduce the increasingly severe swelling. On April 18, 2001, Dr. Brandt notes:
On her knee she has a 2+ effusion. Motion is from 0-50. She has a bruise on the anterolateral joint line, approximately 2 cm in length.
Dr. Brandt's report noted no resolution of the acute knee re-injury the claimant sustained following the car incident.
When the claimant was seen over a month after the car incident, Dr. Lowry Barnes noted in his treatment notes from May 14, 2001:
There is significant effusion about her right knee. She is diffusely tender as well. There is pain with motion. Range of motion is from 0-110.
However, conspicuously absent from the treatment note was the claimant's history of how she suffered a fall and injury to her right side and knee on April 7, 2001, when her boyfriend ran over her.
Dr. Barnes recommended that the claimant receive additional medical treatment for the problems in her knee. When Dr. Barnes opined that the claimant needed additional medical treatment related to her August 25, 2000, compensable injury, he did so without any knowledge of the April 7, 2001, incident with the claimant's boyfriend. When Dr. Barnes was made aware of this incident, he could not state to a reasonable degree of medical certainty that the claimant's current condition was related to her August 25, 2000, compensable injury.
The majority of the medical evidence establishes that the claimant suffered an acute injury to her right knee on or about April 7, 2001, when a car drive by her boyfriend ran over her. Dr. Houchin's treatment reports directly following the April 7, 2001, incident, Dr. Brandt's April 18, 2001, treatment report, and the May 14, 2001, treatment report of Dr. Lowery Barnes clearly establish that the claimant suffered an injury to her right knee in this incident which caused her knee condition to worsen significantly. This independent intervening incident is the cause of the claimant's alleged disability and need for additional treatment.
The claimant's failure to provide credible testimony regarding the events on or about April 7, 2001, and her failure to provide an accurate and complete medical history to her physicians undermines her ability to bridge the causal gap between her August 25, 2000, injury and her current disability and need for treatment. Her version of the car incident does not coincide with her medical records. Furthermore, she failed to accurately report her medical history to Dr. Barnes. Dr. Barnes was then required to provide an assessment of the claimant's health without the benefit of the knowledge of her recent incident.
The claimant's testimony regarding her treatment, recollection of events and the history she provided to her treating physicians was incredible. In the present case, the claimant failed to provide Dr. Barnes with an accurate medical history concerning why and how her knee became severely and painfully swollen, though it had been improving after surgery. Dr. Barnes' recommendation of surgery and additional medical treatment for the claimant's knee were based on his clinical evaluation couched in the context of the history the claimant provided. Dr. Barnes initially was of the opinion that the claimant's need for future treatment (including surgery) was related to her compensable knee injury. However, Dr. Barnes was without the benefit of an accurate and complete history. The claimant admitted at the hearing that she failed to inform Dr. Barnes of the trauma to her leg from the April 7, 2001, incident, because she did not believe it was necessary, even though Dr. Barnes specifically asked her. She testified:
Q. When you saw Dr. Barnes on May 14, 2001, you didn't bother telling him about that incident just a month prior to your evaluation, did you?
A. No, I did not.
Q. Did he ask you about whether how you had hurt your knee or about your past medical history or injuries?
A. Yes, he did.
The claimant's concealment of the crucial history of the car incident involving her boyfriend prevented Dr. Barnes from initially being able to make an informed opinion based on accurate and complete information.
Further, it is of note, that Dr. Barnes' initial opinion on causation was made without the knowledge of the claimant's injury on April 7, 2001.
Q. Doctor, at any point during your evaluation of the Claimant, did she ever indicate to you a history of having an accident, in which she was run over by her boyfriend with a car?
A. No.
Q. Okay. If that injury involved her right knee on or about April 7th of 2001, would that have been relevant history that you would have wanted?
Objection by the Claimant's attorney.
A. Certainly, any other possible trauma to an area of the body that I am examining, would be important to know.
Q. If the Claimant does not give you a complete history of a recent trauma, or injury involving the particular area of the body that you are treating; more specifically, if you treat the Claimant on May 14th, and she doesn't tell you about an injury to her right knee just a month earlier. That caused increased swelling and pain, could you say that you had been given a complete and accurate medical history, regarding that particular area of the body that you were treating?
A. No.
Q. And consequently, Doctor, would your ability to state an informed opinion, without that relevant history of injury a month earlier, would your ability to state an informed opinion be affected by that lack of information?
A. It could be.
Dr. Barnes emphasized that he needed all the relevant history of trauma to any part of the body he was examining to give an informed medical opinion. A medical opinion based solely upon claimant's history and own subjective belief that a medical condition is related to a compensable injury is not a substitute for credible evidence. Brewer v. Paragould Housing Authority, Full Commission Opinion filed Jan. 22, 1996 ( E417617). The commission is not bound by a doctor's opinion which is based largely on facts related to him by claimant where there is no sufficient independent knowledge upon which to corroborate claimant's claim. Roberts v. Leo-Levi Hospital, 8 Ark. App. 184, 649 S.W.2d 402 (1983).
Therefore, after I consider the evidence, I find that the claimant sustained an independent intervening cause that relieved the respondents of liability for additional medical treatment and temporary total disability benefits. Accordingly, I must respectfully dissent from the majority's opinion.
___________________________ JOE E. YATES, Commissioner