The Journal of The DuPage County Bar Association

Back Issues > Vol. 16 (2003-04)

NIU's Northern Exposure
Sisbro, Inc. v. The Industrial Commission: Why Aggravation of a Pre-Existing Medical Condition is Compensable Even If the Condition of Ill-Being Could Have Been Caused By Normal Daily Activity.
By Roxanne Sosnowski

In an opinion filed May 22, 2003, the Illinois Supreme Court in Sisbro, Inc. v. Industrial Comm’n ultimately changed the way pre-existing medical conditions are viewed in the area of workers’ compensation.  In Sisbro, the claimant who suffered from diabetes, twisted his ankle as he stepped out of a delivery truck and into a pothole while making a delivery for his employer, Sisbro, Inc.1 The Industrial Commission awarded claimant workers’ compensation, finding a causal connection existed between the work-related injury and the acute onset of a degenerative condition in the claimant’s foot, Charcot osteoarthropathy.2  The circuit court of Adams County confirmed the award, but the Appellate Court reversed.3  The Appellate Court ruled that the claimant’s condition was not compensable under the Workers’ Compensation Act because claimant’s health had deteriorated to such an extent that normal daily activity could have caused the injury (the “normal daily activity exception”). 4 This article aims to explore the holding of the Illinois Supreme Court by reviewing the facts and the analysis of the Sisbro case and its role in future Workers’ Compensation cases.

Sisbro, Inc. v. Industrial Comm’n5 
The claimant, George Rodriguez, filed an application for adjustment of claim seeking disability benefits from his employer pursuant to the Workers’ Compensation Act 820 ILCS 305/1 et seq. (West 2000).6  Claimant argued that his accidental injury, arising out of and in the course of his employment, was causally related to the onset of a degenerative condition in his right foot. This condition caused him to be disabled and thus unable to work.7  Sisbro, Inc. disputed the claim arguing (1) that the accidental injury did not arise out of and in the course of employment, and (2) that claimant’s disabling condition was not causally related to his injury.8

At the hearing, it was discovered that claimant was a 54-year-old male who had suffered from Type II diabetes for the past six years.9  Claimant was employed by Sisbro, Inc., as a delivery truck driver for the past 2 ½ years.10  Claimant’s job required him to drive an 18-wheeler truck to St. Louis to pick up dairy products and then deliver them to various grocery stores in Illinois.11 Claimant was further required to load the truck at St. Louis and un-load the truck at various grocery stores.12  Claimant testified that on March 26, 1998, after backing into the docking area of a dairy to pick up a load of products, he twisted his right ankle when he stepped down out of the truck and into a pothole.13  Claimant testified that at the time of the accident he felt pain and his right ankle swelled slightly, but resolved itself within a few days.14

Claimant visited a podiatrist, Dr. Reed, on April 6, 1998, for preventative foot care in relation to his diabetes.15  Dr. Reed began treating the claimant in 1995, when claimant suffered a broken toe.16  Since that time, Dr. Reed saw claimant every two to three months for preventative foot care in conjunction with claimant’s diabetes.17  Claimant informed the doctor of his prior accident, although he had no pain or swelling at his April 6th appointment.18  Claimant was advised to notify Dr. Reed if his condition changed.19  Over the next few weeks, claimant’s ankle began to swell repeatedly.20  Claimant saw Dr. Reed again on April 24, 1998, where x-rays were taken and several tests performed.21  Dr. Reed diagnosed claimant with Charcot osteoarthropathy and ordered claimant to stay off of his foot. 22

During discovery, Dr. Reed testified that diabetes causes accelerated vascular disease and neuropathy and, as a result, diabetics are susceptible to an increased risk of injury.23  Dr. Reed testified that he examined claimant’s feet on April 6th, 1998, as part of a regularly scheduled preventative care visit.24  At that time, claimant mentioned that he had twisted his ankle a few days earlier.25  Dr. Reed testified that he observed no evidence of swelling at the time of this exam and as such took no further action.26  On April 24, 1998; however, claimant contacted Dr. Reed’s office complaining of pain and swelling in his right ankle and foot.27  Dr. Reed saw claimant that same day and an examination revealed that claimant “had gross swelling, which is edema, and heat or erythema of the right foot, entire ankle, dorsal foot and his digits as well.28  The foot was also ruborous, which means red in coloration, and there was mild pain to deep palpation of dorsal mid-foot over what we call the Lis Francs.”29  X-rays performed on the claimant’s foot showed “marked chronic degenerative changes involving the ankle.”30

Based on the x-rays, Dr. Reed diagnosed claimant’s condition to be “acute onset of diabetic Charcot osteoarthropathy.”31  Claimant’s leg was placed in a cast for support and claimant was advised to keep the leg elevated and to avoid placing any weight on the leg.32  Due to these restrictions, claimant was unable to work.  When questioned about what might have caused Charcot to develop in claimant’s right ankle, Dr. Reed explained that Charcot is typically brought on by some type of trauma.33  Dr. Reed admitted that the mere act of stepping off a curb and walking on uneven ground may trigger Charcot.34  However, in this particular case, it was Dr. Reed’s opinion, based on a reasonable degree of medical certainty, the trauma which initiated the onset of Charcot in claimant’s right ankle was the work-related accident on March 26, 1998.35 Dr. Reed testified that, in his opinion, claimant had the underlying neuropathy, but had not developed Charcot in his right ankle prior to March 26, 1998.36  Therefore, Dr. Reed’s opinion was that the accident triggered the acute onset of Charcot osteoarthropathy.

On the contrary, Sisbro, Inc.’s expert, Dr. John Gragnani examined claimant once on July 6, 1998.37  Based upon this exam and a review of the claimant’s medical records, Dr. Gragnani opined that the Charcot condition in claimant’s right ankle was a long standing condition, which pre-existed the March 26, 1998 accident.38  The Charcot joint developed slowly over time as a result of claimant’s poorly controlled diabetes, the related neuropathy, and “microtraumas” to the feet caused by everyday living.39

Prior History
Upon consideration of all evidence, the arbitrator ruled that claimant’s act of twisting his ankle was an accident, which arose out of and in the course of his employment with Sisbro.40  Additionally, the arbitrator held that based upon the evidence claimant’s condition of ill-being was causally related to his injury.41  Sisbro, Inc. filed a petition for review and the Industrial Commission affirmed and adopted the decision of the arbitrator.42  Sisbro, Inc. again sought review, this time in the circuit court for Adams County. The circuit court held that the decision of the Industrial Commission was not against the manifest weight of the evidence.43  Sisbro, Inc. appealed again. The Appellate Court of the Industrial Commission Division, in a split decision, reversed the decision of the Industrial Commission, finding that “[a]n employee whose preexisting condition was aggravated by an accident at work is not entitled to worker’s compensation benefits where his health has so deteriorated that any normal, daily activity could have caused the injury, or where the activity engaged in presents risks no greater than that to which the general public is exposed.”44  Claimant appealed this decision to the Illinois Supreme Court.

The Illinois Supreme Court began its analysis by recognizing that in order to obtain compensation under the Workers’ Compensation Act, a claimant bears the burden of showing, by a preponderance of the evidence, that he has suffered a disabling injury, which arose out of and in the course of his employment.45  “In the course of employment” refers to the time, place and circumstances surrounding the injury and in order for the injury to be compensable, it generally must occur within the time and space boundaries of the employment.46 The injury must “arise out of” the employment and the occurrence of an accident at the workplace does not automatically establish that the injury arose out of the employment.47 To satisfy the “arise out of” requirement it must be shown that the injury had its origin in some risk connected with, or incidental to, the employment so as to create a causal connection between the employment and the accidental injury.48

The Illinois Supreme Court noted the Industrial Commission finding that the claimant’s act of twisting his ankle as he stepped down from the truck was an accidental injury, which arose out of and in the course of his employment.49  Sisbro, Inc. did not dispute this finding. Instead, Sisbro, Inc. argued that the accidental injury was not causally-related to the claimant’s condition of ill-being. Sisbro, Inc. claimed that the evidence showed claimant’s condition, Charcot, was the result of a pre-existing condition, diabetes, and that his preexisting condition of diabetes was so “out of control” that Charcot developed as a result of normal daily activities.50  Additionally, Sisbro, Inc. argued that the appellate court correctly overturned the Industrial Commission’s decision because the Commission failed to consider whether the “normal daily activity exception” to compensability applied under the facts of this case.51 Thus, Sisbro, Inc. contended that even when a work-related accidental injury is shown to be an actual causal factor in bringing about an employee’s condition of ill-being, recovery should be denied if normal daily activity could have brought on the condition.52
The Illinois Supreme Court did not find Sisbro, Inc.’s argument persuasive. Rather, the Court held that the Industrial Commission’s finding of a causal relationship between the work-related injury and the claimant’s condition of ill-being was not against the manifest weight of the evidence, despite the conflicting medical opinions between the parties’ two medical experts.53  The Illinois Supreme Court noted that the factual determination of the Industrial Commission would not be disturbed on review when it did not go against the manifest weight of the evidence.  The Court stated that the law did not provide for compensation to be denied based on a finding that claimant’s diabetes had progressed to the point that any normal daily activity would be an overexertion.54

The Illinois Supreme Court noted that the prior cases on point did not stand for the proposition that where a causal connection between work and injury has been established, it can be negated simply because the injury might also have occurred as a result of some “normal daily activity”.55  Rather, the prior cases demonstrated that the issue of whether any normal daily activity is an overexertion or whether the activity engaged in presented no greater risk than that to which the general public would be exposed is an issue to be considered by the court when deciding whether a sufficient causal connection exists in the first place. The Sisbro Court felt this was not a case where the normal degenerative process of the claimant’s diabetes alone caused his injury. It could be legitimately inferred from the evidence that the claimant’s work-related activity was a causative factor in hastening his contraction of Charcot osteoarthropathy, and thus, the Industrial Commission properly awarded workers’ compensation.

This is an important case in the area of Workers’ Compensation law. According to Sisbro, it is no longer sufficient to show that the claimant’s condition of ill-being could have been caused by normal daily activities. To this end, the Illinois Supreme Court states:
[w]hen an employee with a preexisting condition is injured in the course of his employment, serious questions are raised about the genesis of the injury and the resulting disability. The Commission must decide whether there was an accidental injury, which arose out of the employment, whether the accidental injury aggravated or accelerated the preexisting condition or whether the preexisting condition alone was the cause of the injury. Generally, these will be factual questions to be resolved by the Commission. However the Commission’s decision must be supported by the record and not based on mere speculation or conjecture. If there is an adequate basis for finding that an occupational activity aggravated or accelerated a preexisting condition, and thereby, caused the disability, the Commission’s award of compensation must be confirmed. 56 
It remains to be seen how this case will affect further Workers’ Compensation cases involving the aggravation of a pre-existing medical condition. However, one thing is clear, the Court will not bar recovery simply based on a “normal daily activity exception” or a “greater risk exception” when a causal connection exists between work and injury. The real issue exists in the element of causation and such element will be the determining factor with regard to compensation.

1 Sisbro, Inc. v. Industrial Comm’n, 2003 Ill. LEXIS 776, at *1, *8 (Ill. May 22, 2003).
2 Id. at *1.
3 Id. at *1.
4 Id.
5 2003 Ill. LEXIS 776, *8 (Ill. May 22, 2003).
6 Id. at *1.
7 Id. at *2.
8 Id.
9 Id.
10 Id.
11 Sisbro, Inc. v. Industrial Comm’n, 2003 Ill. LEXIS 776, at *2, *8 (Ill. May 22, 2003).
12 Id.
13 Id.
14 Id
15 Id.
16 Sisbro, Inc. v. Industrial Comm’n, 2003 Ill. LEXIS 776, at *2, *8 (Ill. May 22, 2003).
17 Id.
18 Id.
19 Id.
20 Id.
21 Id.
22 Sisbro, Inc. v. Industrial Comm’n, 2003 Ill. LEXIS 776, at *4, *8 (Ill. May 22, 2003).
23 Id. at *5.
24 Id.
25 Id.
26 Id.
27 Id.
28 Sisbro, Inc. v. Industrial Comm’n, 2003 Ill. LEXIS 776, at *5, *8 (Ill. May 22, 2003).
29 Id.
30 Id.
31 Id.
32 Id.
33 Id.
34 Sisbro, Inc. v. Industrial Comm’n, 2003 Ill. LEXIS 776, at *6, *8 (Ill. May 22, 2003).
35 Id.
36 Id.
37 Id at*5.
38 Id.
39 Sisbro, Inc. v. Industrial Comm’n, 2003 Ill. LEXIS 776, at *5, *8 (Ill. May 22, 2003).
40 Id.
41 Id.
42 Id.
43 Id.
44 Sisbro, Inc. v. Industrial Comm’n, 327 Ill. App. 3d at 874, quoting General Refractories v. Industrial Comm’n, 255 Ill. App. 3d 925, 931 (1994).
45 Id. at 4, quoting Baggett v. Industrial Comm’n, 201 Ill.2d 187 (Ill. 2002).
46 1 A. Larson, Worker’s Compensation Law § 12.01 (2002).
47 Caterpillar Tractor Co. v. Industrial Comm’n, 129 Ill.2d 52, 62 (Ill. 1989).
48 Sisbro, Inc. v. Industrial Comm’n, 2003 Ill. LEXIS 776, at *4, *8 (Ill. May 22, 2003), citing Caterpillar Tractor Co. v. Industrial Comm’n, 129 Ill.2d 52, 58 (Ill. 1989).
49 Id.
50 Id.
51 Id.
52 Id. at 6.
53 Id.
54 Id.
55 Id. at 7, citing National Malleable & Steel Castings Co. v. Industrial Comm’n, 32 Ill.2d 184, 189 (Ill. 1965); Illinois Bell Telephone Co. v. Industrial Comm’n, 35 Ill.2d 474 (Ill. 1966).
56 Id. at *8.

Roxanne Sosnowski is a third year law student at Northern Illinois University College of Law. Ms. Sosnowski is the External Publications Editor of the NIU Law Review and a member of Delta Theta Phi Law Fraternity.

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