OPALA, J.
¶ 1 The broader question presented for our review is whether the Court of Civil Appeals (COCA) failed to apply the proper standard of review when it vacated the three-judge panel’s award for medical treatment and compensation. The narrow issue before us is whether the trial tribunal’s order — that claimant’s injury was not idiopathic but com-pensable because it arose out of her employment — is supported by competent evidence.
L
ANATOMY OE THE LITIGATION
¶2 The facts are uncontested. Stephany Maurine Boucher (claimant or Boucher), a
cashier
employed by the Pauls Valley Travel Center (collectively with Compsource, the insurer, to be known as employer), pressed below two separate work-related injuries to her right knee. The first incident occurred in December of 2002 when she slipped on some grease while walking to the back of the store to place a recently-received gift with other personal belongings. Claimant did not fall but experienced some pain and swelling in her right knee. She did not seek medical attention, nor did she miss any time from work as a result of this injury. On 1 May 2003, Boucher was walking toward the cash register to serve customers when her right knee “gave way.”
She testified she was then walking a straight path, was not carrying anything, and encountered no obstacles. She did not slip, nor did she exert any undue physical effort. Although Boucher did not fall, because of ensuing severe pain in her right knee she secured emergency medical care. She sought compensation for temporary total disability and medical treatment. Employer denies claimant’s injury was job-related.
¶ 3 Boucher — the sole witness at the hearing-testified she had a non-work related injury to the same knee in 1999 (a possible internal derangement).
Her cross-examination testimony is confusing as to whether she periodically encountered problems with that knee after the 1999 injury.
Two medical reports were offered in evidence. Dr. H’s report (offered by employer and claimant) included Boucher’s history of her knee injury in 2002 as well as that of the May 2003 re-injury. He gives as his diagnosis a likely bucket handle tear of the medial meniscus with a locked knee.
He believes she needed further medical treatment and evaluates her work status as temporarily totally disabled. The medical report of Dr. E (offered solely by claimant) referenced all three knee injuries and included Boucher’s complaint that her right leg gave way causing the right knee to twist. The report includes a diagnosis of her injury as a strain of the right knee, a probable internal derangement. Dr. E concludes the injury was causally connected to Boucher’s accident.
Although employer in
terposed a probative-value objection to this report (on the grounds that it was insufficient to show the claimant’s second injury arose out of her employment), the report was admitted in evidence.
¶ 4 The trial judge found 1) the first incident not to be compensable because the worker was on a personal mission
but 2) the second injury, which was not occasioned by idiopathic harm, is compensable. Employer sought intra-court review. A three-judge panel of the WCC sustained the trial judge’s order.
Employer then sought further review in the appellate courts.
¶ 5 Employer challenged, as unsupported by competent proof, the trial tribunal’s finding that Boucher’s injury was not the result of an idiopathic condition and that it arose out of her employment. Employer asserts there was no evidence to show that claimant’s injury was anything else than an idiopathic episode.
Because the facts were deemed uneontested COCA reviewed the dis-positive question as one of law, applying the
de novo
standard of review. It determined that Boucher’s knee event was spontaneous and there was no work-related risk factor that contributed to, or occasioned, claimant’s injury. COCA vacated the panel’s order, holding Boucher’s injury was, as a matter of law, solely the result of an idiopathic condition which makes it noncompensable.
Claimant now seeks certiorari review.
II.
STANDARD OF REVIEW
¶ 6 Whether an injury arises out of and in the course of a claimant’s employment presents a question of fact to be determined by the trial judge.
Where there is no conflict in the evidence (and no opposite inferences may be drawn from undisputed proof),
the question is one of law.
The trial judge’s non-jurisdietional findings may not be disturbed on review if supported by competent proof.
Record proof, on the basis of which the trier could have reached a contrary conclusion, has no legal impact upon the review process by which a workers’ compensation "court’s finding is tested.
It is only the absence of competent evidence that makes the tribunal’s decision erroneous (as a
matter of law) and hence amenable to appellate vacation.
III.
A.
ARGUMENTS ON CERTIORARI
¶ 7 Boucher’s certiorari petition urges 1) COCA’s ruling violates the applicable review standard because there was competent evidence to support the trial judge’s order that her injury was not the result of idiopathic harm, 2) there was no evidence that her injury resulted from an idiopathic condition; on the contrary, the proof indicates it resulted from on-the-job walking — a risk factor peculiar to her employment,
and 3) even if the injury were occasioned by idiopathic harm it is nonetheless compensable.
¶ 8 Employer responds COCA’s ruling was correct because the record is devoid of evidence that claimant’s knee injury was anything other than an idiopathic episode.
Employer urges claimant failed to offer evidence of an employment-related strain that caused her injury; rather, her testimony and other evidence confirms her injury occurred because her knee simply gave way. Neither did she offer proof her injury resulted from an employment-related hazard that increased the risk of injury from an idiopathic harm.
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OPALA, J.
¶ 1 The broader question presented for our review is whether the Court of Civil Appeals (COCA) failed to apply the proper standard of review when it vacated the three-judge panel’s award for medical treatment and compensation. The narrow issue before us is whether the trial tribunal’s order — that claimant’s injury was not idiopathic but com-pensable because it arose out of her employment — is supported by competent evidence.
L
ANATOMY OE THE LITIGATION
¶2 The facts are uncontested. Stephany Maurine Boucher (claimant or Boucher), a
cashier
employed by the Pauls Valley Travel Center (collectively with Compsource, the insurer, to be known as employer), pressed below two separate work-related injuries to her right knee. The first incident occurred in December of 2002 when she slipped on some grease while walking to the back of the store to place a recently-received gift with other personal belongings. Claimant did not fall but experienced some pain and swelling in her right knee. She did not seek medical attention, nor did she miss any time from work as a result of this injury. On 1 May 2003, Boucher was walking toward the cash register to serve customers when her right knee “gave way.”
She testified she was then walking a straight path, was not carrying anything, and encountered no obstacles. She did not slip, nor did she exert any undue physical effort. Although Boucher did not fall, because of ensuing severe pain in her right knee she secured emergency medical care. She sought compensation for temporary total disability and medical treatment. Employer denies claimant’s injury was job-related.
¶ 3 Boucher — the sole witness at the hearing-testified she had a non-work related injury to the same knee in 1999 (a possible internal derangement).
Her cross-examination testimony is confusing as to whether she periodically encountered problems with that knee after the 1999 injury.
Two medical reports were offered in evidence. Dr. H’s report (offered by employer and claimant) included Boucher’s history of her knee injury in 2002 as well as that of the May 2003 re-injury. He gives as his diagnosis a likely bucket handle tear of the medial meniscus with a locked knee.
He believes she needed further medical treatment and evaluates her work status as temporarily totally disabled. The medical report of Dr. E (offered solely by claimant) referenced all three knee injuries and included Boucher’s complaint that her right leg gave way causing the right knee to twist. The report includes a diagnosis of her injury as a strain of the right knee, a probable internal derangement. Dr. E concludes the injury was causally connected to Boucher’s accident.
Although employer in
terposed a probative-value objection to this report (on the grounds that it was insufficient to show the claimant’s second injury arose out of her employment), the report was admitted in evidence.
¶ 4 The trial judge found 1) the first incident not to be compensable because the worker was on a personal mission
but 2) the second injury, which was not occasioned by idiopathic harm, is compensable. Employer sought intra-court review. A three-judge panel of the WCC sustained the trial judge’s order.
Employer then sought further review in the appellate courts.
¶ 5 Employer challenged, as unsupported by competent proof, the trial tribunal’s finding that Boucher’s injury was not the result of an idiopathic condition and that it arose out of her employment. Employer asserts there was no evidence to show that claimant’s injury was anything else than an idiopathic episode.
Because the facts were deemed uneontested COCA reviewed the dis-positive question as one of law, applying the
de novo
standard of review. It determined that Boucher’s knee event was spontaneous and there was no work-related risk factor that contributed to, or occasioned, claimant’s injury. COCA vacated the panel’s order, holding Boucher’s injury was, as a matter of law, solely the result of an idiopathic condition which makes it noncompensable.
Claimant now seeks certiorari review.
II.
STANDARD OF REVIEW
¶ 6 Whether an injury arises out of and in the course of a claimant’s employment presents a question of fact to be determined by the trial judge.
Where there is no conflict in the evidence (and no opposite inferences may be drawn from undisputed proof),
the question is one of law.
The trial judge’s non-jurisdietional findings may not be disturbed on review if supported by competent proof.
Record proof, on the basis of which the trier could have reached a contrary conclusion, has no legal impact upon the review process by which a workers’ compensation "court’s finding is tested.
It is only the absence of competent evidence that makes the tribunal’s decision erroneous (as a
matter of law) and hence amenable to appellate vacation.
III.
A.
ARGUMENTS ON CERTIORARI
¶ 7 Boucher’s certiorari petition urges 1) COCA’s ruling violates the applicable review standard because there was competent evidence to support the trial judge’s order that her injury was not the result of idiopathic harm, 2) there was no evidence that her injury resulted from an idiopathic condition; on the contrary, the proof indicates it resulted from on-the-job walking — a risk factor peculiar to her employment,
and 3) even if the injury were occasioned by idiopathic harm it is nonetheless compensable.
¶ 8 Employer responds COCA’s ruling was correct because the record is devoid of evidence that claimant’s knee injury was anything other than an idiopathic episode.
Employer urges claimant failed to offer evidence of an employment-related strain that caused her injury; rather, her testimony and other evidence confirms her injury occurred because her knee simply gave way. Neither did she offer proof her injury resulted from an employment-related hazard that increased the risk of injury from an idiopathic harm. In short, employer insists claimant’s injury was clearly the result of an idiopathic harm, unrelated to the risk of her employment.
B.
CLAIMANT’S KNEE STRAIN IS IPSO FACTO AN ON-THE-JOB INJURY. EMPLOYER FAILED TO REFUTE THE CAUSAL NEXUS, ESTABLISHED BY CLAIMANT’S EVIDENCE, THAT HER INJURY WAS NOT THE RESULT OF AN IDIOPATHIC EPISODE.
¶ 9 A compensation claimant must satisfy a two-pronged statutory test by evi-dentiary showing that the bodily injuries for which benefits are sought 1) occurred “in the course of’ the employment
and 2) “arose out of’ the employment.
These elements are separate and distinct. Both must be established before recovery may be allowed. Not all injuries that occur on the job are compensable. This is so because a connection must be shown between the conditions of one’s employment and the encountered causative risk that resulted in the worker’s harm. Risks not reasonably connected with the claimant’s work — those which are purely personal- — are not compensable if they constitute the sole cause of the employee’s injury.
¶ 10 Neither party suggests that implicated here is the first prong of the statuto
ry test — that which requires the injury to have been “in the course of employment.” Today’s certiorari deals solely with the second prong’s requirement of compensation law’s evidentiary pattern — whether claimant’s injury arose out of her employment. To establish that an injury occurring on the job arose out of employment, a claimant must show 1) the nature of the work performed at the time of the injury, which may be established by lay testimony, and 2) a nexus between the work activity and the harm for which compensation is sought. The latter must be established by expert medical .opinion.
¶ 11 Harm suffered by a worker, which consists of a strain, constitutes an accidental injury if it occurred while one was going about one’s work performance in the usual and ordinary manner though nothing unusual occurred to • cause the strain.
Strain and exertion arising out of and in the course of employment constitutes ipso facto an accidental injury.
In short, the strain stands recognized as one’s accidental inju-n
/.
A claimánt with a pre-existing disease or infirmity may experience an internal injury of a sudden, unusual and unexpected nature which will nevertheless be deemed accidental in character, although its external cause is attributable to ordinary work performed in a üsual manner and without any connected untoward movement.
¶ 12 Whether exertion from a worker’s physical effort is sufficient to produce, and did in fact produce, the strain which culminated in disability, does not present a question of law, but one of fact to be determined by the trial tribunal from expert medical opinion based on relevant facts and circumstances adduced by the proof.
Through her testimony and the medical report of Dr. E, Boucher has met the burden east on her by the law’s imposed pattern of
proof. Walking is one among many hazards in the employment-related cluster of on-the-job activities, just as is moving one’s hands, back or legs is related to work performance. That walking was incidental to her work as a cashier is established by Boucher’s testimony. Dr. E diagnoses Boucher’s injury as a knee strain which he opines is causally connected to claimant’s accidental event. In short, claimant’s testimony, and other evidence, though perhaps appearing meager to a casual reader, clearly and fully meet the quantum of proof necessary to establish the
factum
of an accidental injury by strain.
¶ 13 Once claimant has established that injury arose out of employment, the burden shifts to the employer to refute work-related causation. Proof of an idiopathic harm that caused the injury is a liability-defeating defense: a mere legal conclusion of injury from an idiopathic condition will not suffice. Employer has not made here the required showing. Dr. H’s report provides a diagnosis of claimant’s injury but offers no opinion as to its cause.
Neither did employer show any risks extraneous to Boucher’s employment that might have been the cause of her injury. The record is barren of evidence that would counter claimant’s proof. Where claimant has met her burden and there is no competent evidence in the record to refute compensable causation, a trial judge’s determination that the injury arose out of and in the course of employment must be sustained.
Because there is here competent evidence in the record to sustain the trial judge’s findings, and employer proffered no proof that counters the causal nexus, we are compelled to sustain the trial tribunal’s order.
¶ 14 From early tort teachings the compensation law has borrowed the notion that an employer takes a worker as it finds him, including all of his bodily flaws.
Yet a distinction is to be made between one’s proneness toward a particular injury and one’s injury solely from an idiopathic episode.
Compensation law treats the two situations differently — the former is deemed compensable but not the latter. Proneness is not synonymous with idiopathy. An idiopathic condition is internal. It spontaneously precipitates a worker’s injury.
Proneness, on the other hand, means that one is predisposed toward a particular occurrence.
To produce harm, proneness requires that external forces be at work in conjunction with its presence. An examination of an injury’s genesis helps keep the distinction clear. Where an untoward movement (or some other “normal” external force) co-operates in producing the injury, the resulting harm cannot be said to be idiopathic in origin. Here, claimant’s knee did not give way spontaneously; rather, an untoward step precipitated the harm that ensued.
Even if employer did establish Boucher’s proneness to injure herself because of a pre-existing defect, it does not follow, as a matter of law, that her on-the-job injury stems solely from idiopathic harm that is not compensable.
¶ 15 There is competent evidence to support the trial tribunal’s order. COCA’s analytical scheme presses its review- of the record far beyond the boundary line drawn by the standard of review; allowed by law for appellate-court re-examination of the trial tribunal’s findings.
IV.
SUMMARY
¶ 16 Claimant’s knee strain is
ipso facto
an on-the-job injury. Once a claimant, as this one did here, has established a
prima facie
case, the burden shifts to the employer to refute the presence of a causal nexus between the worker’s injury and her employment. To effectively refute this burden, employer must prove idiopathic harm is the sole cause of employee’s injury. A mere legal conclusion of idiopathy is not enough. Employer’s proof does not meet the required showing. There is competent evidence to support the order of the three-judge review panel. Our statutory duty
clearly
calls for its sustension.
¶ 17 On certiorari previously granted, COCA’s opinion is vacated and the review panel’s order is reinstated.
¶ 18 WINCHESTER, V.C.J. and LAVENDER, HARGRAVE, KAUGER, EDMONDSON, TAYLOR and COLBERT, JJ., concur.
¶ 19 WATT, C.J., dissents.