Virginia Employee's Bowel Disease Tied to Puncture Wound in Foot

In a decision not designated for publication, a Virginia appellate court affirmed an award of workers' compensation benefits to a claimant who contended he developed Crohn's colitis — a type of inflammatory bowel disease ("IBD") as a result of taking medications prescribed for a work-related foot infection [Farrish of Fairfax v. Faszcza, 2020 Va. App. LEXIS 173 (June 16, 2020). Quoting Larson's Workers' Compensation Law, § 10.01, which sets out the so-called "compensable consequences doctrine," the court stressed that "all the medical consequences and sequelae that flow from the primary injury are compensable if a direct causal link connects the primary compensable injury with the additional injury for which claimant seeks compensation."

Background

Claimant worked for an auto dealer as a service manager. In that capacity, he regularly walked throughout the dealer's service bays, checking progress of the technicians who actually performed work on the autos. Claimant suffered from diabetic neuropathy and had little feeling in his feet. As Claimant was removing his shoes and socks at home on August 30, 2016, he noticed blood "spurting" from a puncture wound in his foot. He and his wife stopped the bleeding and Claimant proceeded to an emergency department for treatment.

Ultimately, because of the neuropathy and other co-morbid conditions, Claimant developed a severe infection in the foot, which required that he take antibiotic drugs on a long-term basis. He also developed the IBD and required other treatment. He presented expert medical evidence that tied his IBD condition to the initial foot injury; Claimant testified that upon returning from the emergency department on the day of his injury, he noticed an automotive fastener had punctured his shoe at the point where his puncture wound originated.

The Commission ultimately issued a decision finding that Claimant's injuries were compensable under Va. Code Ann. § 65.2-101 and the employer appealed.

Appellate Court Decision

The appellate court affirmed. It agreed that Claimant had shown an identifiable incident occurred when he stepped on a used fastener in the service bays where he worked that penetrated his shoe and the bottom of his foot, resulting in a puncture wound. This caused an obvious and sudden mechanical or structural change in claimant's body because the wound changed the anatomy of claimant's foot. The injury occurred at a reasonably definite time, at 4:00 p.m. on August 30, 2016.

Here, the Commission found that Claimant's IBD was a compensable consequence of his occupational accident, and the court stressed that it was bound by that determination since credible evidence supported it. That the IBD might have been caused by other factors, including other co-morbid conditions, was not relevant since credible evidence supported the Commission's finding that the IBD was caused by the prescription medications given to fight the infection that originally resulted from the puncture would to Claimant's foot.

While the employer produced a medical expert that disagreed with Claimant's own expert, the Commission was within its discretion to give the testimony of Claimant's expert greater weight.