MWCC NO. 98-14285-G4753
                      99-08607-G-5939

WILLIAM A. ROBERTS                                                                                                                     CLAIMANT

vs.

HUNTER ENGINEERING COMPANY                                                                                            EMPLOYER

AND

MIDWEST EMPLOYERS CASUALTY COMPANY                                                                           CARRIER
AND
AMERICAN MANUFACTURERS MUTUAL INSURANCE CO.                                                     CARRIER

REPRESENTING CLAIMANT:
Marc E. Brand, Esquire, Jackson, MS

REPRESENTING EMPLOYER/CARRIER:
Clifford Ammons, Esquire, Jackson, MS
 

This matter was heard by the Commission on October 30, 2000 pursuant to the Claimants' Petition for Commission Review. The Claimant seeks to overturn an Order of Administrative Judge dated May 30, 2000 which denied him benefits other than limited medical treatment for allegedly compensable injuries to his lower abdominal wall.
 

Mr. Roberts says he rested that following weekend, but by Sunday afternoon the pain had become so intense that he reported to the emergency room at Methodist Hospital around 4:00 p.m. He was released around midnight, with instructions to return at 6:00 a.m. the next morning to be examined by Dr. Tarver. By this time, there was bruising in the abdominal area and a knot had formed on his left side. According to Mr. Roberts, Dr. Tarver performed an exploratory procedure and discovered an internal infection. He sent Mr. Roberts home on medication and advised him to remain off work until further notice. Mr. Roberts testified that he notified his employer but receive no benefits for this time off. He saw Dr. Tarver once a week through May 11, 1998, at which time Dr. Tarver released him to return to work. Mr. Roberts returned to work for the Employer at the same job and pay as before his injury.

Mr. Roberts continued working with the Employer until sometime in September 1998 when he reinjured his left side. On this occasion, Mr. Roberts leaned over to move a heavy box of bolts that had been placed on the floor in his way. As he attempted to push this box of bolts out of his way, he noticed the box was much heavier than he anticipated and he felt a strain in his left side. He notified his supervisor of this incident and was able to finish his work day. As before, however, he continued to hurt the next day and on his way home from work he paid a visit to Central Mississippi Medical Center. He was taken off work and given medication, but after a few days he developed another knot in his left side. He contacted Dr. Tarver's office and was told to meet Dr. Rushton at Baptist Hospital. At Baptist, Dr. Rushton drained what turned out to be an abscess and sent Mr. Roberts home on medication.
 
Follow up testing by Dr. Tarver showed that Mr. Roberts was in need of surgery to repair what Mr. Roberts understood was a small hole in his colon. Mr. Roberts was released to go home about one week after surgery, but after three days at home he developed complications which required additional surgery and hospitalization. Mr. Roberts says he was finally released by Dr. Tarver on or about December 1, 1998. In the interim, Hunter Engineering terminated Mr. Roberts for failure to return to work after medical leave.
 
In his testimony, Mr. Roberts denied ever having had abdominal or gastrointestinal problems prior to these two incidents at Hunter Engineering in 1998.
 

The principal issue in this claim is whether the abdominal problems for which Mr. Roberts underwent surgery were causally related to the two incidents at work when he was struck in the left side and when he strained his left side while trying to move a heavy object. Put another way, the question here is how seriously did the two work connected incidents injure Mr. Roberts.  Incidentally, Hunter Engineering does not deny the accident described by Mr. Roberts as happening on March 17, 1998, and they admitted through the testimony of their Human Resources Director that Mr. Roberts sought first aid treatment for a strain to his left side in September 1998. We are, in the end, satisfied that both incidents occurred just as Mr. Roberts has described them.

After Mr. Roberts first injured himself on March 17, 1998 he sought treatment from Dr. Thomas E. Joiner. Dr. Joiner noted on March 19, 1998 that Mr. Roberts was complaining of pain in his left anterior lower abdominal wall where he apparently ran into a shelf or something at work." Dr. Joiner diagnosed a "mild contusion" and instructed Mr. Roberts to return if necessary.
 
Instead of returning to Dr. Joiner, Mr. Roberts instead came under the care of Dr. Robert S. Tarver, a physician practicing general and peripheral vascular surgery. Dr. Tarver initially suspected either a hematoma or incarcerated inguinal hernia and he performed surgery on March 23, 1998 to make appropriate repairs. What Dr. Tarver found during this procedure was "an inflammatory process in his colon which had ruptured into his internal inguinal ring and presented as a subcutaneous abscess after an injury which had occurred at work." He also identified an abnormal sigmoid colon. Dr. Tarver drained the abscess and referred Mr. Roberts to Dr. Paul Milner for a colonoscopy to rule out any significant colonic disease.
 
Dr. Milner reported on May 15, 1998 that Mr. Roberts was found during colonoscopy to have three colon polyps along with sigmoid and ascending diverticulosis. In a note to Dr. Tarver, Dr. Milner also said that Mr. Roberts had an ulcer in the ileocecal valve, but he suspected this ulcer was caused by Mr. Roberts' prior use of Lodine, a medication he had taken for unrelated back problems. With regard to the left colonic abscess, Dr. Milner felt it was "indeed related to diverticular disease."

As previously noted, Mr. Roberts was released to return to work on May 11, and he did so until he reinjured himself in September 1998 while trying to move a heavy box of bolts. Mr. Roberts again sought treatment from Dr. Tarver and was found to have a recurrent abscess in his groin which was treated adequately by Dr. Fred Rushton, a partner of Dr. Tarver's. Mr. Roberts continued to have problems, however, and on October 15, 1998 Dr. Tarver performed additional surgery in order to carry out a sigmoid colon resection which was made necessary by localized diverticular disease in the sigmoid colon.
 
Mr. Roberts recovered from this procedure and was released by Dr. Tarver on December 1, 1998. Regarding the cause of Mr. Roberts' abscess, at least initially, Dr. Tarver wrote in a letter to the Carrier on December 8, 1998 that the cause was two-fold. He believed Mr. Roberts had a preexisting case of diverticular disease, and when he injured his left side at work on March 17, 1998, this event "perforated a diverticulum which presented itself as pain in his left side." As for the recurrent abscess, Dr. Tarver felt that Mr. Roberts had again ruptured a sigmoid diverticulum into his internal ring, and that both injuries at work were aggravating and contributing factors.¹
 
Dr. Joiner, on the other hand, a family medicine practitioner who only saw Mr. Roberts one time in March 1998, felt that his initial injury and the development of a rupture or abscess were purely coincidental events unrelated to one another.
 
Dr. Seshadri Raju, a physician practicing vascular surgery but also board certified in general surgery and thoracic surgery, testified by deposition on behalf of the Employer and Carrier. Dr. Raju has never treated or examined Mr. Roberts, but he did review the records of Dr. Tarver. His deposition testimony was solicited for the purpose of gaining his opinion as to the causal relationship between Mr. Roberts' abdominal complications and his injuries at work.²
 
Dr. Raju explained that, in his opinion, the abscess that was found following the first injury in March 1998 was preexisting, and that the blow to the abdomen Mr. Roberts sustained was merely a coincidental event which brought the abscess to everyone's attention. Concerning the strain injury in September 1998, Dr. Raju felt likewise that there was no connection between the strain and additional abdominal problems which he developed thereafter.
 
Dr. Raju was of the opinion that Mr. Roberts suffered from diverticular disease well before his first injury in March 1998 because this condition is one that takes years to develop. He also said that the trauma sustained by Mr. Roberts could not have possibly caused or contributed to the development of the diverticular disease or the abscess and other complications for which Mr. Roberts underwent treatment.

When asked, however, whether the trauma sustained by Mr. Roberts could have aggravated or exacerbated the underlying condition, Dr. Raju stated this was "possible but not really probable." He stated that Mr. Roberts' problems were most likely the result of spontaneous inflammation related solely to the underlying diverticular disease itself. Dr. Raju explained that in order for trauma to be considered an aggravating factor, Mr. Roberts should have exhibited some signs of trauma in the skin, subcutaneous tissue or abdominal wall, such as hematoma, and that no such findings were confirmed in this case. This he says, makes it only remotely possible that either of the injuries sustained by Mr. Roberts aggravated his condition.
 

We are faced with credible medical opinions from two obviously qualified physicians who are expert in this very complicated field of medicine. We also have the opinion of Dr. Joiner, although he saw Mr. Roberts only initially and he does not claim any expertise in the diagnosis and treatment of lower abdominal problems such as those suffered by Mr. Roberts. We are left to decide whether there is a preponderance of such evidence in favor of Mr. Roberts.
 
In deciding this question, we wish to make clear that we are concerned only with the problems for which Mr. Roberts sought treatment from Dr. Joiner and Dr. Tarver. The treatment rendered by Dr. Milner for colon polyps and an ulcer in the ileocecal valve is clearly unrelated to either of the subject injuries Mr. Roberts sustained at work, and to the extent Dr. Milner's treatment for these two conditions can be separated from the remainder of medical treatment Mr. Roberts has obtained, then the Employer and Carrier shall have no liability therefor.
 
It is also important to remember that the two injuries Mr. Roberts sustained at work need not be the sole cause of his lower abdominal problems. He is entitled to full compensation if the injuries at work either caused, contributed to or aggravated his condition. Miss. Code Ann. §71-3-3(b) (Rev. 2000). This means that if a preponderance of credible evidence shows the work place accidents are even "minimally causative" of the ultimate injury, then compensation is appropriate. KLLM. Inc. v. Fowler, 589 So.2d 670, 675 (Miss. 1991). Furthermore, if the lay testimony and other surrounding circumstances support a reasonable inference of causal connection, the fact that conclusive medical confirmation is absent will not bar an award of benefits. Futorian-Stratford Fur. Co. v. Dependents of Oswalt, 249 Miss. 35, 162 So.2d 645, 647-648 (1964).
 
Turning to the medical opinions in this case, Dr. Tarver, a specialist who treated the Claimant extensively, has given his firm opinion that the lower abdominal problems for which he treated Mr. Roberts were in part caused by the workplace injuries sustained by Mr. Roberts. Dr. Raju, an equally qualified specialist in the field, says, on the other hand, that the conditions treated by Dr. Tarver are wholly unrelated to any work place injury. He has not examined or treated Mr. Roberts, however, and only reviewed relevant medical records in preparation for his testimony in this matter. Finally, there is Dr. Joiner, a general practitioner who only saw Mr. Roberts once and who believes, as does Dr. Raju, that there is no connection between Mr. Roberts' lower abdominal problems and his work place injuries.
 
The Supreme Court has stated that in cases such as this where medical opinion conflicts, the credible opinion of a treating physician generally carries more weight than the opinion of other physicians who have not examined the claimant or who may not have examined the claimant as thoroughly or completely as the treating physician. Clements v. Welling Truck Service, Inc., 739 So.2d 476, 479 (Miss.Ct.App. 1999); South Cent. Bell Telephone Co. v. Aden, 454 So.2d 584, 593 (Miss. 1985); Johnson v. Ferguson, 435 So.2d 1191, 1195 (Miss. 1983). This view is in accord with two generally accepted, "fairly self-evident propositions: The attending physician's testimony should be given more weight than that of a doctor who has not examined the claimant for purposes of treatment, and testimony by a specialist in the particular field should be given more weight than that of a general practitioner." 8 Larson's Workers' Compensation Law § 130.05[4][b] (2000); Clements, 739 So.2d at 478, n. 1.

In our opinion, the credible expert opinion of Dr. Tarver prevails over the contrary opinions of Dr. Raju and Dr. Joiner. At worst we have a doubtful case, and it has been .. repeatedly stated that such doubts should be resolved in favor of a finding of compensability to the end that the beneficent purposes of the Workers' Compensation Act may be carried out." South Cent. Bell, 474 So.2d at 590. We therefore reverse the Order of Administrative Judge dated May 30, 2000 and find instead that:

1) Mr. Roberts sustained a physical injury on March 17, 1998 and again in September 1998;

2) These injuries each combined with and aggravated a pre-existing condition of diverticular disease to cause left lower quadrant abscesses which were treated by Dr. Tarver;

3) These complications of diverticular disease brought on by the two incidents at work caused Mr. Roberts to be temporarily and totally disabled from March 19, 1998 to May 11, 1998, and again from September 14, 1998 to December 1, 1998.
 
4) The colon polyps and ileocecal valve ulcer which were treated by Dr. Milner were neither caused, contributed to or aggravated by any work place accident and are therefore not compensable conditions;

5) Because the recurrence of disability in September 1998 was due to a second trauma or injury, and constituted "a new onset and injury at that time," the carrier at the time of this second injury is responsible for all medical expenses and temporarily disability benefits related thereto. The carrier at the time of the March 17, 1998 injury is responsible for all medical treatment and disability benefits related thereto. Mid-South Packers. Inc. v. Hanson, 178 So. 2d 689, 691 (Miss. 1965).

6) There is no credible evidence to establish any permanent disability as a result of either injury.

It is therefore ordered that the Employer and Midwest Employers Casualty Company pay Mr. Roberts temporary total disability benefits in the amount of $240.01 per week for the period March 19, 1998 to May 11, 1998, with interest and penalties as provided by Law on any installments of compensation not timely paid. These parties shall likewise pay all reasonable and necessary medical expenses incurred by Mr. Roberts for treatment of his March 17, 1998 injury.
 
It is further ordered that the Employer and American Manufacturers Mutual Insurance Company pay Mr. Roberts temporary total disability benefits in the amount of $240.01 per week for the period September 14, 1998 through December 1, 1998, with interest and penalties as provided by Law on any installments of compensation not timely paid. These parties shall likewise pay for all reasonable and necessary medical expenses incurred by Mr. Roberts for treatment of his September 1998 injury.

SO ORDERED this the 29th day of November, 2000.

MISSISSIPPI WORKERS' COMPENSATION COMMISSION
BARRETT SMITH
BARNEY SCHOBY
BEVERLY BOLTON

ATTEST:
Joann McDonald, Secretary
___________________________

MWCC NOS. 98 14285-G4753-E-21
AND               99 08607-G-5939-E-21

WILLIAM A. ROBERTS                                                                                                                   CLAIMANT

vs.

HUNTER ENGINEERING COMPANY                                                                                           EMPLOYER

AND

MIDWEST EMPLOYERS CASUALTY COMPANY                                                                       CARRIER #1
AND
AMERICAN MANUFACTURERS MUTUAL INSURANCE
COMPANY, A SUBSIDIARY OF THE KEMPER GROUP                                                            CARRIER #2

APPEARING FOR THE CLAIMANT:
Marc E. Brand, Esquire, Jackson, Mississippi

APPEARING FOR THE EMPLOYER, CARRIER #1, AND CARRIER #2:
Clifford Ammons, Esquire, Jackson, Mississippi
 

The claimant, William A. Roberts, filed two petitions to controvert in this matter. On January 29, 1999, he filed a petition to controvert alleging that on March 17, 1998, and in September 1998, he received work-related injuries to his left anterior lower abdominal wall. Because there were two alleged accidents and a different carrier at each alleged date of injury, the claimant filed a second petition to controvert on July 1, 1999, alleging a work-related injury in August 1998, in an effort to separate the second claim from the first. That latter date has since been amended to September 1998 without opposition from the employer and two carriers. At the request of all parties, these two claims have been consolidated for discovery and hearing purposes.
 
The employer and both carriers admitted that William A. Roberts, the claimant, had an accident on the assembly line at Hunter Engineering Company, the employer, on March 17, 1998, but denied that there was any work-related disability resulting from the accident. The employer and carriers denied the compensability of the second alleged accident in September 1998. The employer and carriers paid no workers' compensation benefits related to either alleged injury, but the employer provided medical benefits under a policy of group health insurance.
 
A hearing was held in Hearing Room B at the offices of the Mississippi Workers' Compensation Commission in Jackson, Mississippi, on May 11, 2000. Both claims were taken up at the hearing, by agreement of the parties.
 

The parties stipulated as follows:
 
1. The claimant's average weekly wage n March 17, 1998, and in September 1998 was $360.00.
 
2. The claimant missed work from March 19, 1998, until May 11, 1998, and again from September 14, 1998, until December 1, 1998, because of the physical problems experienced by the claimant in March and September 1998 and the surgeries he underwent.
 

The issues to be resolved by the Administrative Judge are as follows:
 
1. Whether one or both physical problems experienced by the claimant in March and September 1998 and resulting surgeries were causally related to his work at Hunter Engineering Company.

2. If so, the extent of disability resulting from the injury(ies)/surgery(ies).
 

William Arthur Roberts is fifty-six years old and a resident of Star, Mississippi. He is married. He went to the eleventh grade in high school when he Joined the United States Air Force. He was in the service three-and-a-half years, and during that time he earned his GED certificate. He was honorably discharged from the Air Force.

In the past, Mr. Roberts worked for Wackenhut Security Company in Miami. He subsequently went to New York, where he was from originally, and he was employed in security at General Electric. His mother became ill and he moved to the South to be near her, and he got a job with Stauffer Chemical Company. He started as a chemical operator and was promoted to assistant manager.
 
After that, Mr. Roberts moved to Meridian, Mississippi, where he went into the insurance business. He passed a test to obtain a license to sell insurance, and he worked in the insurance business for a few months. Subsequently, Mr. Roberts worked for a car dealership in Meridian for a short while. Then he started his own house painting business which he did for about a year before moving to Jackson where he started up the same kind of business. He supervised a paint crew and took care of payroll and other business aspects of house painting. Then he went to work for Parts, Inc. driving a truck at night, and he had this job for a year or so. For about two years after that he drove heavy equipment for Jackson Ready-Mix,
 
According to Mr. Roberts, he wanted to get into maintenance, and he found employment in the maintenance department at the City of Jackson. After a couple of years, however, in 1979, he injured his back while working for the City. This resulted in several surgeries, and he stayed completely off work from 1979 until 1985 or 1986. Then he worked a short while, about six months, for Coors Beer Distributing, with the physical help of his children. He found he was unable to do this work even with assistance, and he had to have more back surgery. Mr. Roberts has had a total of eight back surgeries, including two fusions.
 
Mr. Roberts did not work again until 1997 - eighteen years after his first back injury at the City of Jackson. During the approximately eighteen years he was off work, Mr. Roberts received Social Security Disability Benefits. He is on Social Security Disability now.
 
In November 1997, Mr. Roberts applied at Hunter Engineering Company in Raymond, Mississippi, where he had lived about ten years. Mr. Roberts underwent a preemployment physical by Dr. Thomas E. Joiner, family practitioner in Raymond, and he was cleared for employment at Hunter Engineering. Mr. Roberts testified that Dr. Joiner did not ask about prior surgeries.
 
At Hunter Engineering Company, Mr. Roberts worked as an assembler on the turn plate assembly line, making turn plates for use in the automotive industry. He put turn plates together and put tops on and adjusted them and moved them down the line to the packer for shipping. After Mr. Roberts started at Hunter Engineering, he received a wage increase.
 
On March 17, 1998, there was a problem with the turn plates at Hunter Engineering. The ones already made had to be retightened. About 11:00 a.m., Mr. Roberts tightened one just a little too much with his wrench, the rack of turn plates moved unexpectedly, and the steel arm of the rack hit him in the side. Mr. Roberts testified that it hurt so much it took his breath away, and he went to his knees. He said he tried to walk it off. He reported the incident to his supervisor, Kelly White, who wrote up an accident report.
 
At about 1:00 p.m., Mr. Roberts left the plant to see Dr. Joiner, the company doctor. He told Dr. Joiner what had happened, and Dr. Joiner checked his stomach and gave him some medication for pain and some muscle relaxers. The medical notes indicate that Dr. Joiner saw no bruising. Dr. Joiner returned Mr. Roberts to light-duty work the next day. Then Mr. Roberts went to the MEA Clinic in Pearl to see a family physician.
 
The next day, Mr. Roberts returned to work. He reported to his supervisor and turned in Dr. Joiner's excuse. The company had no light-duty work and sent him home. It was Friday. He said he stayed in the bed the whole weekend because his side was bruised black and blue and a knot arose there. On Sunday afternoon, his side was still hurting and he went to the Methodist Medical Center emergency room.
 
The next day Mr. Roberts saw Dr. Robert S. Tarver of Central Surgical Associates in Jackson on consultation. Dr. Tarver did a scope and found infection. After seeing Dr. Tarver, Mr. Roberts called Hunter Engineering Company and talked to the secretary in the human resources department. He continued to see Dr. Tarver on a weekly basis until May 11, 1998, when Dr. Tarver released him to return to work.
 
Mr. Roberts went back to his same job, making the same amount of pay. He said he did not have many problems between May 11 and September 14, 1998.
 
According to Mr. Roberts, there was a train that ran around the plant carrying materials to different work stations. Some time in September 1998, the train was in his way and he bent over to push it to slide it over. He testified that he strained his left side again in the same area. He said he notified his supervisor, Kelly White, and made an accident report.
 
The next day the same area in his side was hurting, and Mr. Roberts asked to be allowed to go to the doctor. Mr. Roberts saw a doctor at a Northeast Jackson clinic near his home at the time. The doctor gave him medication and kept him off work. Mr. Roberts turned in the doctor's excuse to Hunter Engineering Company.
 
That same week, Mr. Roberts noticed another knot. He called Dr. Tarver's office, but Dr. Tarver was out of town. Dr. Rushton, Dr. Tarver's partner, asked him to meet him at the emergency room. Dr. Rushton found another infection and drained the abscess, When Dr. Tarver came back, Mr. Roberts went to see him. Dr. Tarver recommended surgery on the colon, and he did the surgery. Mr. Roberts stayed in the hospital about a week. He was home three days when he coughed and dislodged a staple, resulting in another surgery. Dr. Tarver continued to follow him until releasing him on December 1, 1998.
 
In November 1998, while he was recovering from the colon surgery, Mr. Roberts was terminated from Hunter Engineering Company. He testified that he was unable to get any other employment because of his stomach surgeries and his prior back surgeries. In March 1999, however, Mr. Roberts went back to painting for a living.
 
Mr. Roberts testified that he occasionally has problems with his stomach now. He said it does not bother him too much but he does not do much. He helps a friend with a grocery store. He has to be careful with lifting because of his back problems and fusions.

Since he last saw Dr. Tarver in December 1998, Mr. Roberts has not been to the emergency room. According to Mr. Roberts, prior to 1998 he had never had any stomach problems. He had never sought medical attention for his stomach before, and he had never had any cramping or digestive problems other than indigestion after eating pizza. He said the medicine he took for his back difficulties did not cause him any stomach trouble. He had never had a lower GI test or colonoscopy in the past.
 
Elizabeth McClellan testified for the employer and carriers that she is employed by Hunter Engineering Company as the human resources director, a position she has held for thirteen years. She is familiar with the claimant, William A. Roberts, and his personnel file.

Ms. McClellan said Mr. Roberts was terminated in November 1998 for failure to return to work after a medical leave. Ms. McClellan said the company did not receive any medical excuse related to the alleged September 1998 incident until Dr. Tarver faxed a statement to Hunter Engineering on November 9, 1998, after Mr. Roberts was terminated. Mr. Roberts had requested medical leave for surgery in a telephone call on October 2, 1998. He was granted a medical leave of absence through October 23, 1998. He was to return to work on October 24,1998. He did not return to work, however, and on November 2,1998, he was terminated for failure to return from medical leave. Apparently Mr. Roberts called his physician, and Dr. Tarver faxed the statement to the company. The statement from Dr. Tarver did not mention a work injury in September 1998.
 
Ms. McClellan was aware of Mr. Roberts' March 17, 1998, accident with the rack. She received a statement from Kelly White, Mr. Roberts' supervisor, that on March 18,1998, Mr. Roberts reported that the day before he bruised his side while working on the turn plate line and that later that day he noticed his side was swollen and painful. Ms. McClellan said, however, that there is no incident report about the alleged accident in September 1998. On September 8, 1998, Mr. Roberts signed in on the list in the first aid room because of a "strain" in his side while sliding bolts. (Exhibit 7). Later that month, Mr. Roberts called in to say he had a stomach infection. Later he asked for leave of absence for surgery. Ms. McClellan said she received no notice about any work restrictions for Mr. Roberts.

The medical records of Dr. Thomas E. Joiner, family practitioner in Raymond, Mississippi, were admitted into evidence. Dr. Joiner's notes indicate William Roberts consulted him on March 2, 1998, for complaints of pain in his right shoulder, cough, congestion, and an upper respiratory infection. Dr. Joiner diagnosed "I. Status post back surgery - 8 times. 2. Bronchitis; upper respiratory infection. 3. Smoker." (Exhibit 2, p. 4). On March 19, 1998, Dr. Joiner noted that Mr. Roberts presented to him

with pain in his left anterior lower abdominal wall where he apparently ran into a shelf or something at work. This happened two to three days ago and has been quite sore ever since. Abdomen is otherwise soft, bowel sounds are positive; there are no masses or organomegaly; there is no bruising, etc.

Dr. Tarver also saw Mr. Roberts on March 26, 1998, because of the mass in his left groin. Dr. Tarver said Mr. Roberts

was noted to have an inflamed colon adherent to the area of the internal inguinal ring. A skin incision was made externally and fowl [sic] smelling purulent material was encountered. The abscess cavity was drained. The abscess cavity was explored. The colon was dissected off of the peritoneum and there appeared no hole in the colon.

On May 15, 1998, Dr. Joiner wrote a letter stating that he had not seen Mr. Roberts since his surgery [in March]. Dr. Joiner also said,

Although other physicians may disagree, I do not see any way that his contact with the rack could have caused a rupture, particularly of the type that he had. I think that the fact that the injury occurred at the same time the rupture was found is purely coincidental.

The medical records of Dr. Paul B. Milner of Gastrointestinal Associates in Jackson were received into evidence; one as attachment to Dr. Tarver's records. On May 15, 1998, Dr. Milner wrote Dr. Tarver a letter thanking Dr. Tarver for referring Mr. Roberts "for evaluation of recent colon abscess requiring surgical intervention." (Exhibit 1, p. 38). Dr. Milner went on to explain:

His colonoscopy revealed sigmoid and ascending colon diverticulosis and three colon polyps that were removed and found to be benign. In addition, a 1 cm. ulcer was seen in the ileocecal valve that I suspect is related to Lodine,⁴ the biopsies of which were negative, revealing nonspecific inflammation.

I placed him on Flagyl for seven days for treatment of his ileocecal valve ulcer and asked him to avoid Lodine for four weeks. With regard to his colon polyps, I plan repeat colonoscopy in two years for surveillance purposes. I suspect his left colonic abscess was indeed related to diverticular disease and fortunately there is no neoplasm in this segment. I have outlined a regiment for diverticulosis and gave him literature.

On June 5, 1998, Dr. Milner reported that he saw Mr. Roberts in follow up of his colonoscopy. He noted

the findings included hyperplastic polyps but not inflammation. Transverse colon polyp was biopsied. His ileocecal valve ulcer was, unfortunately, benign at biopsy. He states he has been feeling well, tolerated the Flagyl and has been avoiding Lodine.

1. Ileocecal valve ulcer.- Secondary to Lodine, clinically healed.

2. Colon polyp.

Mr. Roberts' surgeon, Dr. Tarver, saw Mr. Roberts again on September 16 and 23, 1998, noting the drainage had stopped. On October 6, 1998, Dr. Tarver stated that he suspected

that he continues to have ruptured diverticular into his inguinal canal which is probably related to local injury which he received at work initially and then again a few weeks ago. He states that while at work he strained to pick up something and developed severe abdominal pain in the left lower quadrant. We will plan on a siginoid colon resection.

Sigmoid colon (segmental resection)
- diverticulosis
- diverticulitis
- acute and chronic serositis with fat necrosis (RS/svr).

Dr. Tarver continued to see Mr. Roberts on October 27, November 10, and December 1, 1998, and noted he was doing well. Dr. Tarver told Mr. Roberts he could return to his normal activities but advised he not strain himself He released Mr. Roberts on December 1,1998.
 
On December 8, 1998, Dr. Tarver responded to a letter from a claims specialist, explaining that Mr. Roberts' current diagnosis was

well following a sigmoid colon resection for perforated diverticulosis and drainage of left lower quadrant abscesses related to his diverticular disease. He also has a diagnosis of a wound dehiscence and closure of this wound dehiscence following his colon resection.

Causation of this abscess, I believe, is twofold. I believe Mr. Roberts has had diverticular disease and when he was injured on his left side, that perforated a diverticulum which presented itself as pain in his left side.

Dr. Seshadri Raju, emeritus professor of surgery and honorary surgeon at the University of Mississippi Medical Center, testified by deposition dated March 10, 2000. He is board-certified in cardiothoracic surgery, thoracic surgery, and vascular surgery. Dr. Raju did not examine or treat William Roberts but reviewed the records of Dr. Tarver. Dr. Raju has treated other patients with left incarcerated inguinal hernia with abscess.
 
According to Dr. Raju, "Diverticula are not usually caused by trauma. It would be extremely unlikely that it was caused by trauma." (Exhibit 4, p. 8). When asked if he thought the work accident, that is, the trauma to the left side by the rack at Hunter Engineering Company, caused or aggravated the abscess, Dr. Raju answered:

Anything is possible, of course. There's always a 0.001 chance of something happening. But looking at the chronology of events, it's clear to me what this man has or has had is diverticular disease. And the abscess that was explored and drained by Dr. Tarver on the 23rd of March undoubtedly is related to his diverticular disease, and the trauma simply brought the matter to his attention, It is well known in several areas of surgery - particularly, for example, in pediatric surgery it's well established and well known in the literature that children and young adults would develop a tumor such as a bone tumor and often would relate it to some trivial trauma they received some months back. The prevailing opinion with regard to that kind of history is the tumor comes first. Of course, tumors are not always painful. In fact, most of them are not. And the patient is simply not aware of it until some trivial trauma that all of us sustain every day. You know, if you think back the last week of so, how many times do you stumble or hit something. It is a minor trauma that you might notice momentarily or may not even notice and you just pass on, But if there's an underlying process, such a trauma would simply bring your attention to it.
. . . .
It is my opinion that such occurred with regard to this particular patient. The abscess was there related to his diverticular disease and he sustained a minor trauma which simply in retrospect he - I'm sure he believes that it was caused by trauma, but I believe - my belief is that it simply brought his attention to the problem that was smoldering, that was there. He probably had been hit any number of times in the past in similar circumstances and wouldn't have paid attention to it, did not pay attention to it, but here there was a problem smoldering underneath that simply brought it to the surface. It is my opinion that trauma didn't cause the problem. It simply exposed the problem, brought it to the surface.

Trauma could possibly aggravate it. It is not common. It is possible but not really probable considering that most such - diverticula itself is well known to set up spontaneous inflammation. They don't need any external help to do it. We see it all the time in patients who are not being subjected to trauma.

When asked where the abscess would have been located, Dr. Raju answered:

This is behind the belly wall. Somebody who is involved in a fair amount of manual labor like this particular patient would have a fairly well-developed abdominal wall. I don't know what his weight is. It's skin, fat, belly wall, and then behind that there's the colon, the peritoneum and colon. For trauma to have caused an abscess, usually the mechanism is that there is soft tissue injury. Local bruising or hematoma starts, and that gets infected after the hematoma had formed. In this case, a week after the injury, if that was the mechanism, should have seen some hematoma in the belly wall. Should have seen some hematoma in the soft tissues. From the operative note, that does not seem to be the case.

When asked about whether picking up a box of bolts [in September 1998] would have aggravated the abdominal condition and necessitated signioldectomy and anastimosis, Dr. Raju responded:

That is even more remote that the first instance. In the first instance when Dr. Tarver operated on him, he examined the colon. There was no hole in it. And in his operative note he said he didn't see any diverticular. And three months later, diverticular had formed. He saw several diverticular on sigmoidoscopy. Diverticular don't develop overnight. They typically take years and decades to form. And trauma does not caused diverticular. It couldn't have possibly happened in a matter of three or four months. After the trauma, diverticular would not have - it's virtually impossible for that to occur. So the conclusion is that the patient did indeed have diverticular during the first procedure. It was simply missed because it was a limited endoscopic laparoscopic type of procedure. I believe it was simply missed.

The second instance, certainly underlying disease is diverticular and he had a diverticuloma. And lifting a box of bolts - basically, again, he felt some abdominal pain and mistakenly attributed it to lifting something, whereas, in fact, it's due to the underlying disease.

It's diverticulitis. It's a chronic, slow evolving condition, and trauma has no part in it. And if it was not lifting the boxes, I think he was set up to develop a fever and become ill a week later. And it's something that brought his attention to the belly. I'm sure in the patient's mind the association is very real. I suspect that's one reason why this is being pursued legally because the patient is convinced that there was a relationship. Again, as I noted, that is a very well-known phenomenon. Association between trivial trauma and a serious condition is a well-known phenomenon.

Dr. Raju explained that the pathology report from the October 1998 surgery indicated a diagnosis of "sigmoid colon with diverticulosis and diverticulitis which means inflammation of those diverticular. Acute and chronic serositis with fat necrosis, which, again, means there's inflammation of the covering of the colon." (Exhibit 4, p. 14). Dr. Raju also said, "Diverticula perforate on their own and they rupture on their own without any help from outside at all." (Exhibit 4, p. 19).
 
Information from the National Digestive Diseases Information Clearinghouse, a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) established under the U. S. Department of Health and Human Services, has been marked as Exhibit 8 in this matter because it contains some helpful, basic definitions and descriptions relating to diverticulosis and diverticulitis. The information indicates that some physicians believe a diet that is low in fiber is the main cause of diverticular disease. Most people who have diverticulosis do not suffer any discomfort or symptoms. People with diverticulitis may experience abdominal pain, particularly tenderness in the left side of the lower abdomen. Diverticulitis can lead, to such complications as infections, perforations, tears, blockages, or bleeding.
 

After carefully considering the pleadings, pretrial statements, stipulations, lay and medical evidence, demeanor of the witnesses at the hearing, and the applicable law, the Administrative Judge finds as follows:
 
1. William A. Roberts received a work-related injury on March 17, 1998, as alleged in the petition to controvert. The weight of the medical evidence indicates, however, that the injury in and of itself was an misignificant one, not resulting in more than a few days from work or medical treatment beyond that rendered by Dr. Joiner on March 19, 1998, the emergency room at Methodist Medical Center on March 22,1998, and Dr. Tarver at his early examinations on March 23 and 26, 1998. Once the problem was discovered to be an inflamed colon and abscess on March 26, 1998, the problem became a purely personal one.
 
Likewise, even if Mr. Roberts suffered a strain in his side in September 1998 when he lifted or pushed a box of bolts or train carrying the box of bolts, the problem was underlying diverticular disease and colon troubles not related to his employment but to a purely personal derivation.
 
In the Mississippi Workers' Compensation Act, the definition of "injury" includes only those injuries that were "contributed to or aggravated or accelerated by the employment in a significant manner." Mississippi Code Annotated Section 71-3-3 (b) (1991) (emphasis added). The connection of Mr. Roberts' accident at work on March 17, 1998, to the colon and diverticular problems for which he was treated on subsequent dates in 1998 does not rise to the degree of significance required by the definition of injury under the Act. Neither would any work connection in September 1998, even if Mr. Roberts did strain himself while lifting or pushing a box of bolts.
 
The claimant has offered the narrative notes and letters of Dr. Tarver, the general surgeon, as support for his claim of work-relatedness. But Dr. Tarver had no explanation in his notes about how he came to an opinion that there was any work connection with the colon and diverticular disease problems. He did not quantify the work connection to which he alluded in very brief statements. Because of the unusual nature of the physical condition experienced by Mr. Roberts, proving a work connection would take more explanation and description than the brief notes written by Dr. Tarver.
 
The employer and carriers have presented considerable contradictory medical evidence. First, there are the reports of Dr. Joiner, the family practitioner, who saw Mr. Roberts immediately after the March 17, 1998, incident. At the initial visit, Dr. Joiner noted that there was no bruising of the abdomen, and he diagnosed a mild contusion. In a letter written in May 1998, Dr. Joiner opined the condition was not work-related.
 
Dr. Milner's records are interesting in that Dr. Milner, a gastrointestinal specialist who examined Mr. Roberts after the March 1998 surgical procedure, discussed the ulcer on Mr. Roberts' ileocecal valve and stated that in his opinion it was likely caused by Lodine, an anti-inflammatory medication that Mr. Roberts had been taking for an osteoarthnitic condition. It is well known that non-steroidal anti-inflammatory medication can cause gastrointestinal problems. He attributed the left colonic abscess to diverticular disease. Nothing in Dr. Milner's records indicates any sort of work relation of Mr. Roberts' condition nor is there a mention of a work accident of any sort.

Dr. Raju, a specialist in surgery and esteemed professor emeritus at the University Medical School, agreed with Dr. Joiner and offered the most logical explanation about the cause of Mr. Roberts' physical problems. He testified that the claimant had an underlying diverticular disease which had not manifested itself in symptoms or discomfort, apparently not an unusual occurrence, until the trivial blow to his side at work on March 17, 1998. In other words, Mr. Roberts had the underlying problem which was not in any way workrelated, and the mild contusion to the side just brought the diverticular disease and colon abscess to the attention of Mr. Roberts and his medical providers.
 
2. The average weekly wage of the claimant on March 17, 1998, and in September 1998 was $360.00, as stipulated by the parties.
 
3. Also as stipulated by the parties, Mr. Roberts missed time off work from March 19, 1998, until May 11, 1998, and again from September 14, 1998, until December 1, 1998, when Dr. Tarver released him as having reached maximum medical improvement. Those dates define the two periods of temporary total disability relating to the physical problems experienced by Mr. Roberts in March and September 1998.
 
4. Regardless of whether the physical problems experienced by Mr. Roberts in March and September 1998 and during the related periods of temporary total disability were workrelated or not, there is no medical evidence to support a finding of permanent occupational disability. The Mississippi Workers' Compensation Act requires that all claims for disability be supported by medical findings. Mississippi Code Annotated Section 71-3-3 (1) (1991). None of the medical providers made reference to a permanent impairment or work restrictions.
 

IT IS THEREFORE ORDERED that the employer, Hunter Engineering Company, and its carrier on March 17, 1998, Midwest Employers Casualty Company, provide the claimant, William A. Roberts, the following workers' compensation benefits:

The medical services and supplies related to the treatment rendered Mr. Roberts by Dr. Joiner on March 19, 1998, by the emergency room at Methodist Medical Center on March 22, 1998, and by Dr. Tarver on March 23 through March 26, 1998,

IT IS FURTHER ORDERED that Mr. Roberts' claim for additional workers' compensation benefits is hereby denied and dismissed.

SO ORDERED, this the 30th day of May, 2000.
 
LINDA A. THOMPSON
ADMINISTRATIVE JUDGE

ATTEST:
Brenda H. Goolsby, Secretary
___________________________

1. Dr. Tarver wrote in an October 6, 1998 note that I suspect that he continues to have ruptured diverticula into his inguinal canal which is probably related to the local injury which he received at work initially and then again a few weeks ago."

2. Dr. Raju conceded that he did not review Dr. Tarver's records in detail, but he felt nonetheless that he seen enough of these records to adequately address the issue of causation.

3. The peritoneum is the membrane lining the abdominal cavity, according to Adam.com (hnttp://www.adam.com).

4. Lodine is a non-steroidal anti-inflammatory drug prescribed for both acute and long-term management of the signs and symptoms of osteoarthnitic and for the management of pain. The drug carries the risk of gastrointestinal ulceration, bleeding, and perforation. Http://www.druginfonet.com/lodine.htm.

5. According to the National Digestive Diseases Information Clearinghouse (http://www.niddk.nih.gov/health/digest/pubs/divert/divert.htm), "diverticular disease" is defined as follows:

Most people have in their colons small pouches that bulge outward through weak spots, like an inner tube that pokes through weak places in a tire. Each pouch is called a diverticulum. Pouches are diverticula. The condition of having diverticula is called diverticulosis. About half of all Americans age 60 to 80, and almost everyone over age 80, have diverticulosis.

When the pouches become infected or inflamed, the condition is called diverticulitis. This happens in 10 to 25 percent of people with diverticulosis.

Diverticulosis and diverticulitis are also called diverlicular disease.