Sabre Marine v. Feliciano, AY-301

• Decision Date: 17 December 1984
• Docket Number: No. AY-301,AY-301
• Citation: 461 So.2d 985
• Parties: SABRE MARINE and Iowa National Mutual Insurance Company, Appellants, v. Vera Mae FELICIANO, Appellee.
• Court: Florida District Court of Appeals

Page 985

461 So.2d 985

SABRE MARINE and Iowa National Mutual Insurance Company, Appellants, v. Vera Mae FELICIANO, Appellee.

No. AY-301.

District Court of Appeal of Florida,

First District.

Dec. 17, 1984.

Bernard J. Zimmerman of Zimmerman, Shuffield, Kiser & Sutcliffe, Orlando, for appellants.

Thomas R. Mooney, Orlando, for appellee.

THOMPSON, Judge.

The employer/carrier (E/C) appeal an order awarding temporary total disability (TTD) benefits as well as past and future medical care and treatment. The principal contention of the E/C is that the claimant's present disability and need for medical treatment are not causally related to her industrial accident. We agree and reverse.

The claimant is a 42 year old mother of six children who is moderately overweight. She sustained a compensable injury on August 27, 1982, when a box of material she was attempting to remove from a shelf fell onto her left leg and hip, causing her to fall to the floor, striking her right knee. The authorized treating physician, upon initial examination of claimant, diagnosed lumbosacral strain and sprains of the knee and thumb. He noted that claimant had some diffuse swelling about the knee, and that there was also swelling in her lower leg and foot. A consulting orthopedic physician who saw claimant on October 27, 1982 felt that the problems with claimant's knee, back and thumb were resolving satisfactorily. However, he noted that claimant had a possible sprained ankle and a possible venous insufficiency of the right leg. Being uncertain as to the etiology of the swelling in claimant's lower leg and ankle, this orthopedist recommended that she receive a vascular evaluation. Although the precise date the vascular evaluation was performed cannot be ascertained from the record, there is evidence that such an evaluation was performed, and that it yielded negative results.

In an order entered on October 7, 1983, the deputy commissioner (deputy) found that claimant had reached maximum medical improvement from an orthopedic standpoint and that there was no evidence that she had any permanent impairment as a result of her industrial accident. Accordingly, he denied her claim for TTD benefits for the period after June 24, 1983. On October 9, 1983, the claimant was seen by Dr. Bowen, a general surgeon to whom she was referred by her authorized treating physician. Dr. Bowen hospitalized the claimant, with an admitting diagnosis of causalgia, "probably secondary to ... probable deep vein thrombophlebitis of the right leg." During the ensuing six day hospitalization, tests were administered for the purpose of diagnosing or ruling out thrombophlebitis or other vascular disease. Among these tests was a venogram, which, according to the testimony of Dr. Bowen, is the most accurate test for diagnosing thrombophlebitis. All of the tests, including the venogram, yielded negative results. Following the hospitalization, Dr. Bowen continued to provide care and treatment for claimant's causalgia syndrome.

The claim at issue in this appeal was for benefits for the TTD associated with claimant's causalgia syndrome, as well as for past and future medical treatment therefor. The only medical evidence which in any manner tended to establish a causal relationship between claimant's industrial accident and her causalgia syndrome was that given by Dr. Bowen in deposition. Dr. Bowen testified that although the causes of causalgia syndrome are unknown, the disease can be triggered by neural damage or by venous insufficiency. He indicated that the swelling in claimant's leg was the result of the causalgia syndrome. He testified that the negative test results obtained during claimant's hospitalization in October 1983 proved that she did not have thrombophlebitis at that time, but he opined that she had had thrombophlebitis at some point in the past and that the sequelae of the thrombophlebitis were chronic venous insufficiency and resulting causalgia. He testified that thrombophlebitis can be caused by trauma, by excessive standing, by obesity, or by venous anomolies, and he indicated that a 42 year old female who had had six children and was overweight would be more subject to episodes of thrombophlebitis than would the average person.

When first asked whether the thrombophlebitis which he believed claimant had suffered at some time in the past was caused by the accident, Dr. Bowen indicated that the doctors who treated claimant immediately after the accident would be in a much better position to answer the question. In his second response to questioning concerning a possible causal relationship between the accident and the condition for...