STATEMENT OF THE CASE
We are asked to decide whether, in light of recent developments in Indiana worker's compensation law concerning cumulative trauma injuries, an injury is compensable where a degenerative physical condition develops in the workplace and later manifests itself as a debilitating injury following an episode outside the workplace. Four Star Fabricators, Inc. appeals from a decision of the Worker's Compensation Board in favor its employee, Phillip E. Barrett, who sought benefits for an injury to his back. Four Star raises three issues for our review which we restate as follows:
1. Whether there was sufficient evidence to support the Board's determination *794 that Barrett's injury was causally сonnected to his employment at Four Star.
2. Whether the Board erred in its admission of a statement made by one of Barrett's physicians.
We affirm.
FACTS
Barrett was employed at Four Star from 1984 until 1992 as a burning machine operator. Barrett's position required that he maneuver and lift 100 to 200 pound steel plates from which he cut different items of heavy steel. In order to cut steel plates, Barrett had the aid of several lifting devices, including "pry bars" to maneuver steel plates on his burning table, "duck feet" which utilized hooks to lift the various, finished items onto a pallet on the floor next to his table, and magnetic "cranes" also used to lift steel items. It was often necessary that Barrett manually lift or move some steel pieces because the lifting devices were ineffective with those items.
In 1988, Barrett was injured when, while lifting a 1% inch piece of steel plate with duck feet, he lost control of the plate and the duck feet "swung around in a circle," striking him in the back. Barrett sought medical treatment for his pain from the injury and missed three days of work. Thereafter, Four Star obtained a contract with Alcoa in late 1991 or early 1992 which required a substantial increase in Four Star's output of fabricated steel products. Barrett's workload likewise increased in the wake of the Alcoa contract, which included an increase in his lifting and bending. Barrett once again began experiencing back pain while performing his work.
On April 27, 1992, Barrett was at home when hе stooped to pick up his infant child and felt a sharp pain and something "pop" in his back. Barrett was diagnosed with a herniated dise and did not return to Four Star until November of 1992. Four Star subsequently laid off Barrett, and Barrett applied for and was granted worker's compensation for his back condition. We will state additional facts in our discussion where needеd.
DISCUSSION AND DECISION
Standard of Review
In reviewing a decision of the full Worker's Compensation Board, we are bound by the Board's findings of fact and may only consider errors in the Board's conclusions of law. Duvall v. ICI Americas, Inc. (1993), Ind.App.,
Issue One: Sufficiency of Causation Evidence
The primary thrust of Four Star's appeal is that the evidence does not support the Board's determination that a causal relationship existed between Barrett's injury and his employment at Four Star. Specifically, Four Star contends there was insufficient evidenсe to establish that Barrett's back injury arose out of and occurred in the course of his employment with Four Star because Barrett simply "suffered an accident at home unrelated to his employment." Brief of Appellant at 16.
The Worker's Compensation Act authorizes the payment of compensation to employees for "personal injury or death by accident arising out of and in the course of the employment." IND.CODE § 22-3-2-2(a). Thus, for an injury to be compensable under the Act, the injury must both arise "out of" the employment and arise "in the course of" the employment. Both requirements must be fulfilled before worker's compensation is awarded, and neither alone is sufficient. See Olinger Const. Co. v. Mosbey
*795
(1981), Ind.App.,
Four Star places undue emphasis on the fact that Barrett's diagnosis with a herniated dise and resulting worker's compensation claim arose only after he suffered an episode of acute back pain in the home. We cannot agree that the place of this one episode of back pain determines whether Barrett's injury occurred in the course of his employment at Four Star. In Evans v. Yankeetown Dock Corp. (1986), Ind.,
In Union City Body Co. v. Lambdin (1991), Ind.App.,
Thus, our courts have recognized that the definition of an "accidental injury" under the Worker's Compensation Act includes those injuries which occur incrementally over time. In other words, the repetitive motions required by the employee's job functions may give rise to a compensable injury, even thоugh the injury is not attributable to any discrete and identifiable date, time or event. See Duwall,
In determining whether an employee's "cumulative trauma" injury aroge "in the course of" employment, the focus is not merely on the place where the injury manifested itself. Cf. Holland-St. Louis Sugar Co. v. Shraluka (1917),
The particular facts and circumstances of each case determine whether an injury arose out of and in the course of employment. Stanley v. Riggs Equipment
*796
Co. (1961),
Physicians who examined Barrett corroborated Barrett's claims and the Board's findings. Doctors Fenol, Kuric and Norris all diagnosed Barrett with a degenerative disc disease or a herniated disc. All three opined that Barrett's 1988 back injury and his repetitive lifting and bending while employed at Four Star either "contributed" to his herniated dise or that the dise injury was "related" to his work activities. Specifically, Dr. Fenol concluded that Barrett's repetitive lifting produced physiological changes in his back. Dr. Fenol characterized the incident in Barrett's home when Barrett felt his back pop as "the straw that broke the camel's back." Record at 116.
Further, Dr. Kuric conceded that frequent lifting of items weighing approximately 100 to 200 pounds could be a contributing factor in Barrett's degenerative arthritis of the lower back. Record at 188 and 198. Dr. Kuric agreed that changes in the spine will develop from such heavy lifting over a period of time. According to Dr. Kuric, repetitive traumas or injuries are factors that hasten or contribute to degenerative arthritis. Dr. Norris similarly concluded that Barrett's degenerative dise disease was related in рart to his repetitive lifting activities at Four Star.
Accordingly, the evidence demonstrated that Barrett's herniated dise injury was produced at least in part by the cumulative effect that his work functions had on his back, despite the fact that the injury first manifested itself outside the workplace. Thus, Barrett's injury, arising from the cumulative effect of workplace trauma to his back, was an injury which arose out of and in the course of his employment at Four Star just as though the trauma had occurred as a discrete event in the workplace. See Duvall,
We conclude that the evidence was sufficient to establish that Barrett's injury both "arose out of" and occurred "in the course of" his employment with Four Star. Whether the requisite causal relationship exists between the injury and the employment is a question of fact for the Board and, based on the evidence, the Board properly concluded that Barrett met his burden of proof on that issue. See Donahue v. Youngstown Sheet & Tube Co. (1985), Ind.,
Thus, even though Dr. Fenol stated his opinion in terms of "probability,"
*797
his opinion was stated with sufficient certainty to establish causation.
1
A worker's compensation claimant is not required to negate all other causes for his injury. Estey Piano Corp. v. Steffen (1975),
Four Star's quarrel with the sufficiency of Dr. Fenol's opinion, and indeed with all of the Board's findings, is simply a request that we reweigh the evidence heard by the single hearing member. This we may not do. See K-Mart Corp. v. Morrison (1993), Ind.App.,
Issue Two: Admission of Dr. Norris' Written Opinion
Four Star also assеrts that the single hearing member, over its objection, erroneously admitted a medical report of Randall G. Norris, M.D. who examined Barrett. Four Star claims that unless Barrett or Dr. Norris furnished the report to Four Star at least 30 days before the hearing, the statement is inadmissible. See IND.CODE § 22-3-3-6(d). According to Four Star, in order to satisfy this foundational requirement, there must be some indicаtion in the record that Barrett complied with the statute and furnished the statement to Four Star. We do not agree.
Four Star is correct that either Barrett or Dr. Norris was required to furnish the report to Four Star 30 days before the hearing. However, we agree with Barrett that Four Star's objection at the hearing for lack of foundation was too general and wаs ineffece-tive to preserve error for appellate review of the hearing member's ruling. To preserve error in the admission of evidence over an objection based on inadequate foundation, the complaining party may not state the objection in general terms but must state the objection with specificity. See Coleman v. Stаte (1984), Ind.,
Nor, as Four Star contends, can we discern from the record thаt the single hearing member actually understood Barrett was objecting on the basis of this statute. See Jethroe v. State (1975),
We oncе again observe, and Four Star actually concedes, that its refusal to stipulate to Dr. Norris' report occurred prior to trial, *798 was not heard by the single hearing member and is not in the record. See Reply Brief at 5. Thus, the hearing member cannot be deemed aware of Four Star's objection to the admission of Dr. Norris' report. We conclude that Four Star has waived review of this issue.
Even if we were to conclude that Four Star properly preserved this issue for review, reversal of the Board's decision is not required. When incompetent evidence is admitted in a worker's compensation hearing, we will not disturb the Board's award if it is sustained by competent evidence. See Holliday v. National Malleаble & Steel Casting Co. (1982),
The decision of the Worker's Compensation Board is affirmed.
Notes
. We are not persuaded that Dr. Fenol's use of the phrase "I would like to think" when rendering his opinion substantially affects the certainty of his opinion that Barrett's lifting and bending contributed to his back injury. That phraseology is merely a manner of speaking which must be considered in the context of his entire testimony.
