This case comes to us on certiorari to review an order of the Industrial Commission awarding compensation to an employee under the Workmen’s Compensation Act. We are asked to determine if disability resulting from aggravation of a preexisting physical infirmity is com-pensable under M. S. A. 176.021, subd. 1, as a personal injury under circumstances in which the preexisting physical infirmity is not causally connected with the employment but the aggravation of such infirmity is.
The employee has been employed for a period of more than 17 years as a saleslady by Harold, Inc., a ladies’ ready-to-wear store. Her compensation is on a commission basis. It appears that her earnings have averaged $115 per week. She worked a full 40-hour week and was necessarily required to be on her feet standing and walking most of the time. At the time of this litigation she was 53 years of age, weighed approximately 118 pounds, and was about 5 feet 3 inches in height. It appears from the record that she became aware of a painful condition in her left foot in January 1952 as a result of a chip fracture of the “lateral cuboid bone” of her left foot. There is also reference in the record to a gout condition from which she suffered at or about this time. The latter condition apparently cleared up and there was medical testimony to the effect that it had no relation to the condition of her foot which was found to be disabling. She continued to work until May 1957 when she was informed by an orthopedic surgeon that she had a permanent disorder in her left great toe that could be helped by surgery. The condition was diagnosed as a “deteriorative disorder of the metatarsal phalangeal joint of the left great toe,” which resulted in stiffness of that joint. There was no
It appears from the record that while the underlying condition from which the employee suffers is an identifiable infirmity, the origin and cause of it is not known. It is a condition which may originate in a normal joint and “it deteriorates in a microscopic amount daily until the condition becomes severe enough to produce symptoms.” The medical testimony was to the effect that the deteriorative condition progresses slowly over a period of time and “the patient doesn’t come to the doctor until it hurts.” There was evidence from which the commission could have found that it is not an arthritic condition, nor has the history of gout any particular bearing on it. It is a condition which occurs in men as well as women. “It does not seem related to heavy work and is not particularly common in laboring people.” There was medical testimony on both sides that the continual use of the foot in bearing the weight of the employee aggravated the condition resulting from the underlying cause. There was medical testimony that such aggravation of the underlying cause was disabling.
That the disability results from the continued use of the foot in walking or standing is established by the undoubted evidence that the employee’s toe became stiff and painful particularly toward the end of the workday. On the basis of the evidence submitted, the referee found—
❖ * * * *
“That as a further result of said injury, this employe has sustained a 35 per cent permanent partial disability of the left foot.” (Italics supplied.)
He awarded compensation to the employee. This award was upheld on appeal to the Industrial Commission and the decision of that body is now brought before us for review.
At the outset it may be noted that we are not dealing here with an occupational disease within the meaning of § 176.011, subd. 15, which defines “occupational disease” as one which arises out of and in the course of employment “peculiar to the occupation in which the employee is engaged * * There is nothing in the record to sustain a finding that this condition is peculiar to the occupation of a saleslady or due to causes in excess of the hazards of that employment. If the order is to be sustained, it must come within the purview of § 176.021, subd. 1, which provides:
“* * * Every such employer [one subject to the provisions of the act] is liable for compensation according to the provisions of this chapter and is liable to pay compensation in every case of personal injury or death of his employee arising out of and in the course of employment without regard to the question of negligence, * * *.” (Italics supplied.)
We must inquire if the employee’s disabling condition, which the referee and commission have found to be caused by the aggravation of the preexisting infirmity, is a “personal injury” compensable under the act.
“* * * Degenerative diseases such as arteriosclerosis which progress normally and exist independently of an accidental injury do not constitute a preexisting disability within the meaning of the compensation act.”
It is well recognized that a preexisting disease or infirmity of the employee does not disqualify a claim arising out of employment if the employment aggravated, accelerated, or combined with the disease or infirmity to produce disability for which compensation is sought. Common examples include hypertrophic arthritis (Casey v. Northern States Power Co.
The relators argue that the foregoing authorities have no appli
As we have already indicated, the Workmen’s Compensation Act of this state prior to 1953 provided for compensation for “personal injury * * * caused by accident arising out of and in the course of the employee’s employment * * (Italics supplied.) M. S. A. 1949, § 176.02. The 1953 revision removed the “accident” requirement from the act. M. S. A. 176.021. Under the law as it now exists the employee is compensated for “personal injury” arising out of and in the course of employment. We have never before been called upon to interpret the significance of this change. The employee contends that by this revision the legislature intended to extend the coverage of the act to cases in which the employee’s disability cannot be traced to an accident or to any single occurrence when the employee’s usual exertion resulted in a disabling injury to him. Riesenfeld, Contemporary Trends in Compensation for Industrial Accidents Here and Abroad, 42 Calif. L. Rev. 531, 544. Among the authorities which support this statement is Shoren v. United States Rubber Co. (R. I.) 140 A. (2d) 768, which involved injuries to the muscles in the hand of an employee who worked as a golf ball winder. While the disability arose out of and in the course of employment, it was not an occupational disease. The Rhode Island statute provided, as does ours, for compensation for personal injury. The court there held (140 A. [2d] 770):
“The injury which is now compensable thereunder need no longer meet the requirements of an accident.” (Italics supplied.)
That court was of the view that a gradual breakdown of a part of the employee’s body due to constant and continued use in performing duties of a particular job which caused disability is considered a personal injury. This holding is supported by Hurle’s Case, 217 Mass.
Section 176.011, subd. 16, defines “personal injury” as an “injury arising out of and in the course of employment and includes personal injury caused by occupational disease; * * It appears to us that the term “personal injury” is more inclusive and materially broader in its scope than is the term “accident” or the phrase “personal injury by accident” used in other statutes. The term “personal injury” was used in the Massachusetts act for many years, and that court has held that the term standing by itself comprehends a wide range of physical harm (Madden’s Case, supra) and is broad enough to include any bodily injury.
The Iowa Supreme Court has held that a “personal injury” within the Workmen’s Compensation Act need not arise out of an accident. In Almquist v. Shenandoah Nurseries,
“* * * the personal injury contemplated by the statute does not include metabolism. A metabolism * * * means ‘the sum of the processes concerned in the building up of protoplasm and its destruction incidental to the manifestation of vital phenomena; * * *.’ The result of changes in the human body incident to the general processes of nature do not amount to a personal injury. * * *
$ s$c
“* * * The injury to the human body * * * must be something * * * that acts extraneously to the natural processes of nature, and thereby impairs the health, overcomes, injures, interrupts, or destroys some function of the body, or otherwise damages or injures a part or all of the body.”
See, also, Black v. Creston Auto Co.
The term “personal injury” is not limited to a single definite act but may extend over a continuous period of time (Smith’s Case,
“* * * An injury is compensable whether it causes a disease or merely aggravates an existing infirmity.’’'’ (Italics supplied.)
In Brzozowski’s Case,
“* * * ‘aggravation and acceleration constitutes a personal injury within the meaning of the workmen’s compensation act.’ ”
It is well established by the authorities that when the inevitable effects of an underlying condition are hastened by an injury that is sudden and violent or the result of unusual strain or exertion, the injury and its disabling consequences are compensable. It should further be conceded, however, that injuries may arise out of and in the course of the employment which do not occur suddenly or violently. In the course of one’s ordinary duties injuries may occur daily which cause minimal damage, the cumulative effect of which in the course of time may be as injurious as a single traumatic occurrence which is completely disabling. We have been presented with no good reason why compensation should be paid in one instance and not in the other. In Golob v. Buckingham Hotel,
“* * * The unusual exertion rule often has led to peculiar results in the courts. The modern trend has been away from a strict interpretation of the rule.”
It is our view that these authorities warrant the conclusion that under our present statute it is no longer required that causes external to the employee himself which contribute to bring about the injury shall be in any way unusual. However, it is only when there is a direct causal connection between the employment and the injury that an award of compensation may be made, and if the injury is the proxi
The relators argue that the act of standing or walking, which is a part of everyday existence and is performed at home, at work, or at play, may not be considered as an occurrence which gives rise to a compensable injury. It seems to us, however, that the impairment of the ability to stand or walk is in no different category from the impairment of sight or hearing or the impairment of any other faculty of the human body. In her work as a saleslady the employee’s acts of standing and walking were vital and necessary to the performance of her usual tasks. The record indicates that for at least 7 hours in each workday she was constantly on her feet and that during an average workday she walked a distance of approximately 18 miles. We think the facts in this case bring it within the definition of personal injury approved by the Iowa and Massachusetts courts. The preexisting infirmity from which she suffered was aggravated as a result of the ordinary and necessary duties which she performed. The gradual process of the physical exertion required by her work resulted in weakness and pain, the accumulated effect of which is the disability from which she suffers.
Moreover, it is not within our province to inquire as to the weight of the evidence supporting the commission’s findings in a workmen’s compensation case. The findings of the Industrial Commission should not be disturbed unless a review of the evidence and the permissible inferences drawn therefrom clearly requires reasonable minds to adopt a contrary conclusion. Schoch v. Minnesota Min. & Mfg. Co.
Attorneys’ fees in the sum of $250 are allowed to the respondent.
Affirmed.
Notes
See, also, Breimhorst v. Beckman,
99 C. J. S., Workmen’s Compensation, § 170, note 64; Madden’s Case,
Pearson v. Ford Motor Co.
