In Dubose Construction v. Simmons, the Alabama Court of Civil Appeals revisited an employee’s burden for obtaining compensation outside the schedule based on a seemingly routine knee injury. 2013 Ala. Civ. App. LEXIS 239 (Ala. Civ. App. Dec. 20, 2013). The employee, James Simmons, injured his knee in a workplace fall. Medical examinations revealed a torn medial meniscus which was arthroscopically repaired. Several months later, Simmons presented to his personal physician with renewed complaints of knee pain. Diagnostic studies revealed a recurrent medial meniscus tear which was again surgically repaired.

Simmons continued to work for approximately six months after the second surgery. His physician noted a good recovery. Nevertheless, Simmons eventually stopped working and filed a workers’ compensation claim against his former employer. In his Complaint, Simmons alleged a loss of earning capacity based on his knee injury and alleged resulting low back issues. The trial court found that Simmons’ back issue was related to the initial accident and awarded permanent total disability benefits. The employer appealed, arguing that Simmons suffered a scheduled injury and that loss of earning capacity should not have been considered by the trial court.

Simmons argued that knee pain led to a limp, and that his altered gait led to low back pain. However, at trial Simmons did not testify that he suffered low back pain and there was no reference of back pain in his medical records. Testimony of Simmons’ treating physician revealed that Simmons had never complained of back pain.

The Court of Civil Appeals noted that substantial evidence of medical causation must be established through “the overall substance and effect of the whole of the evidence.” Expert testimony was not necessary and the employee’s testimony may or may not be sufficient to support an award of benefits. However, evidence establishing that a “mere possibility” that an injury was work-related is not sufficient to establish medical causation.

Following its review of the evidence, the Court of Civil Appeals held that the overall substance and effect of the whole of the evidence did not support the trial court’s finding that Simmons’ knee injury affected the efficiency of his low back. Thus, the case was remanded back to the trial court for a determination of the degree of disability, if any, to Simmons’ knee under the schedule.