This is thе second appeal in this workers’ compensation case. In the first appeal, because the Commission conducted an extrajudicial review of documentation not introduced into evidence, this court reversed and remаnded the case to the Commission to make further findings. See Hope Livestock Auction Co. v. Knighton,
Johnny Knighton worked full time for appellant Hope Livestock Auction from 1978 until July 3, 1996. Rockwood Insurance Company was appellant’s workers’ compensation carrier until it went into receivership in 1991, at which time the Arkansas Property and Casualty Guaranty Fund took over the defense of any claims against Rockwoоd. Appellee CNA Insurance Company provided appellant’s workers’ compensation insurance from January 1, 1995, until December 31, 1995.
Knighton suffered several compensable work-related injuries during his employment with appellant. The first was аn injury to one of his knees in 1981 when a horse fell on him, necessitating surgery. He also suffered back injuries in 1985 and 1986. Each of the back injuries required surgery, which was performed by Dr. George Bohmfalk. In 1990, Knighton was experiencing nerve damage in his hip and lower back аs a result of his previous injuries, as well as numbness in his right shin. Dr. Bohmfalk performed yet a third back surgery, for which appellant paid. After the third surgery, Knighton continued to work for appellant, although Dr. Bohmfalk instructed him to stop riding horses and roping, and to scale bаck his activities at work.
In 1991, Knighton was treated at the Baptist Medical Center pain clinic for continuing back pain, and he was given medication to combat depression. He was also seen at a headache clinic in Houston, where a psychiatrist diagnosed him as having manic-depressive illness and placed him on Lithium. Dr. Edward Tobey, his treating psychiatrist since 1994, later amended the manic-depressive diagnosis to Bipolar I Disorder.
Knighton sustained another accident in November 1995, when a cow knocked him against a fence and stepped on his back and legs. He testified that he was “stove up” and in “absolute agony” due to the pain from this incident and that he consulted Dr. Bohmfalk after the accident. Dr. Bohmfalk told him that he wаs just shaken up. Knighton said that he suffered no new back or leg problems, missed no work, and was over the incident in about two days. In its first decision, filed July 24, 1997, the Commission determined that Knighton’s bipolar disorder was a compensable injury under Ark. Code Ann. § 11-9-113 because it was caused by his compensable 1990 injury, although it had not manifested itself or been diagnosed until 1994.
In reaching its decision, the Commission consulted information not contained in the record, specifically the most current issue of the Diagnostic and Statistical Manual of Mental Disorders (DSM), in determining that Knighton had satisfied the requirements of the statute. We reversed and remanded that decision, because the extrajudicial review of documentation not introduced into evidence was error. Hope Livеstock Auction Co. v. Knighton, supra.
On remand, the Commission ordered the administrative law judge (ALJ) to supplement the record with pertinent sections of the DSM. On August 24, 1998, pursuant to the Commission’s order, the ALJ supplemented the record, incorporating by referenсe the pertinent provisions of the DSM-IV concerning Bipolar I Disorder. In its October 6, 1998, opinion, the Commission again determined that appellee’s diagnosis met the criteria established in the DSM-IV and that his mental condition was compensable.
Aрpellant does not contest the diagnosis of appellee’s mental disorder as Bipolar I, but argues only that there was not substantial evidence that the diagnosis met the criteria established in the most current issue of the DSM. We disagree. In supрort of its finding that Knighton’s diagnosis met the DSM criteria, the Commission relied on Dr. Tobey’s progress notes and cited the portions of his deposition in which he opined that Knighton was suffering from Bipolar I Disorder, which he described as follows:
Bipolar I is classic manic-depressive illness with cyclic mood swings, a severe depressive illness, depressive described as feeling of dysphoria, low motivation, lack of energy, could have either sleeping too much or sleeping too little, appеtite changes, weight changes, problems with attention or concentration which are significant enough to either cause social, functional, or interpersonal impairment. The duration has to be of at least two weeks of duration. In manic-depressive illness you add on manic symptoms, which are severe difficulty with insomnia, racing thoughts, racing speech, increased kinetic activity or psychomotor activity, restlessness, pacing, it can have excessive spending, impulsivenеss that happens with people. They also can get grandiose, think that they are smarter than they are or they can do more things than their capabilities are. And again, it’s significant enough to cause social, occupational, аnd interpersonal impairment. Bipolar II Disorder is probably a lesser disorder where there’s cyclic mood swings downward and depressive illness, and little peaks of manic symptoms but not to the near severity or the significant impairment seen with Bipolar I Disorder.
In reviewing the Commission’s decision on a question of fact, we will affirm the Commission if its decision is supported by substantial evidence; substantial evidence is such relevant evidence as a reasonable mind might accept as adequate to support a conclusion. Branscum v. RNR Constr. Co.,
The question whethеr the diagnosis of a condition meets the criteria established in the DSM must ordinarily be one of fact, and the claimant has the burden of proof on this issue by a preponderance of the evidence. Branscum v. RNR Constr. Co., supra. The Commission has thе authority to accept or reject medical opinion and the authority to determine its medical soundness and probative force; it must use its experience and expertise in translating expert medical testimony into findings of fact. Oak Grove Lumber Co. v. Highfill,
Arkansas Code Annotated section ll-9-113(a)(2) provides:
Nо mental injury or illness under this section shall be compensa-ble unless it is also diagnosed by a licensed psychiatrist or psychologist and unless the diagnosis of the condition meets the criteria established in the most current issue of the Diagnostic and Statistiсal Manual of Mental Disorders.
While a bare diagnosis, without an explanation of the characteristics of the mental illness, might not be sufficient to meet the requirements of section 1 l-9-113(a)(2), here Dr. Tobey, in both his deposition and progress notes, described Knighton’s Bipolar I Disorder in such detail that the Commission could easily make the finding that the diagnosis met the DSM-IV criteria. Although it would be preferable in cases of mental injury or illness for a psychiatrist or psychologist to correlate the basis оf his opinion to the DSM criteria, we recognize the Commission’s expertise and ability to translate medical testimony into findings of fact. We cannot say that the Commission’s finding that Knighton’s Bipolar I Disorder was a compensable work-related injury is not supрorted by substantial evidence.
Appellant next contends that Knighton is not entitled to temporary total disability benefits. In its brief, appellant cites Arkansas State Hwy. and Transp. Dept. v. Breshears,
Arkansas Code Annotated section 11-9-113(b)(1) provides, “Notwithstanding any other provision of this chapter, where a claim is by reason of mental injury or illness, the employee shall be limited to twenty-six (26) weeks of disability benefits.” The term “healing period” is noticeably absent from this section. “Disability” is defined as “incapacity because of a compensable injury to earn, in the same or any other employment, the wages which the employee was receiving at the time of the compensable injury.” Ark. Code Ann. § 11-9-102(9) (Supp. 1997). With respect to the inability to earn wages, there was testimony from Knighton, his wife, Dr. Bohmfalk, and Dr. Tobey of Knighton’s problems being around people and functioning in society. For example, in one of his manic phases, Knighton did not sleep for eighteen days and had to be admitted to the hospital and sedated. Once the Commission is presented with medical evidence of physical impairment and funсtional limitations, it must use its superior knowledge of industrial demands, limitations, and requirements to determine how a disability will affect the injured worker’s ability to obtain or hold a job. Ark. State Hwy. Dept. v. Breshears, supra. There is substantial evidence to support the Cоmmission’s award of twenty-six weeks of disability benefits pursuant to Ark. Code Ann. § 11-9-113 (b)(1).
Appellant’s last argument is that there is insufficient evidence to support the Commission’s finding that Knighton’s November 1995 injury was a temporary subsequent aggravation. We disagree. An aggravation is a nеw injury resulting from an independent incident. Farmland Ins. Co. v DuBois,
In this case, although the employer remained the same, the workers’ compensation carrier changed. There is no question that there was an independent intervening cause for the November 1995 injury, and it is not disputed that appellee CNA is liable for all of the consequences naturally flowing from that incident, i.e., Dr. Bohmfalk’s bill for the office visit and any medication associated with that injury. However, there is no evidence in the record that this injury permanently aggravated Knighton’s preexisting conditions. Knighton testified that he did not miss a day of work due to the November 1995 accident, and he suffered no lasting physical repercussions from the incident. Moreover, Dr. Bohmfalk testified that Knighton had no lasting еffects from that accident. In short, there is nothing in the evidence to show that the November 1995 injury was anything other than a temporary aggravation, for which CNA is liable. Because the November 1995 accident was merely a temporary aggravation, Arkansas Property and Casualty Guaranty Fund remains liable for Knighton’s preexisting conditions.
Affirmed.