BNSF Railway Company v. Ronald Nichols ( 2012 )


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  •                         COURT OF APPEALS
    SECOND DISTRICT OF TEXAS
    FORT WORTH
    NO. 02-10-00375-CV
    BNSF RAILWAY COMPANY                                               APPELLANT
    V.
    RONALD NICHOLS                                                      APPELLEE
    ----------
    FROM THE 17TH DISTRICT COURT OF TARRANT COUNTY
    ----------
    OPINION
    ----------
    This is an appeal from a jury verdict in favor of Ronald Nichols in his
    Federal Employer’s Liability Act (FELA) suit against BNSF Railway Company.1
    In three issues, BNSF contends that there is no evidence that Nichols’s
    degenerative disc disease was caused by getting on and off moving railcars, that
    1
    During the period relevant to this suit, Nichols worked for the Atchison,
    Topeka & Santa Fe Railway (the Santa Fe), which in 1995 became BNSF
    through merger. Thus, all references to Nichols’s employer are to BNSF unless
    stated otherwise.
    the trial court erroneously denied BNSF’s requested jury instructions on general
    and specific causation, and that the jury’s negligence finding is not supported by
    the evidence because a cumulative trauma injury was not foreseeable.          We
    affirm.
    Background
    Nichols worked as a switchman between 1979 and 1995.2 A switchman
    separates railcars from a train coming into the yard and moves them to different
    tracks based on their ultimate destination. While Nichols was employed as a
    switchman, he was required to mount and dismount moving railcars about twenty
    times per day on a slow day, or thirty to thirty-five times on a busy day.3 He was
    trained in doing so safely and was provided a rule book describing how to do so.
    Nichols became an engineer in 1995 and from that time until 2007 no longer
    mounted and dismounted moving rail cars.
    In 2004, Nichols began having knee pain; in conjunction with his treatment,
    the doctor took a lumbar x-ray of Nichols’s spine, which showed no
    abnormalities. Nichols began having neck and shoulder pain in 2005 and went to
    see a different doctor in 2006. Because an MRI of his neck showed some disc
    herniation and degeneration, that doctor prescribed Advil.
    2
    During 1983–85, Nichols was furloughed and intermittently worked for the
    company’s bridges department instead; he also attended engineer’s school, so
    he was not continuously working as a switchman during the entire period.
    3
    Sometimes, Nichols also worked as a brakeman, which involved getting
    on and off moving railcars, but to a much lesser extent.
    2
    In 2007, Nichols began seeing Dr. Dan Eidman for his neck and back pain,
    and he eventually had surgery to repair the discs in his neck. Nichols stopped
    working for BNSF that same year; Dr. Eidman had already “pulled [him] out” of
    work before the surgery.
    Nichols sued BNSF under FELA, alleging that he had suffered “cumulative
    trauma injuries” because of BNSF’s negligence in allowing him to “mount and
    dismount moving equipment.” A jury awarded Nichols $1,560,740, including an
    award of $399,000 for past medical expenses; the trial court granted a motion to
    exclude the past medical expenses and rendered judgment for Nichols for
    $1,163,960.4
    Causation
    In its first issue, BNSF contends that there is no evidence that getting on
    and off moving equipment (GOOME) caused Nichols’s injuries.             Included in
    BNSF’s discussion of its first issue is the argument that the testimony of Nichols’s
    expert, Dr. Eidman, was unreliable.
    Applicable Law
    Under FELA, every railroad engaging in interstate commerce is liable in
    damages to any employee injured during his employment when such injury
    results in whole or in part from the railroad’s negligence or by reason of any
    defect or insufficiency due to its negligence. See 45 U.S.C.A. § 51 (West 1988);
    4
    The final judgment award includes $2,220 in court costs.
    3
    Union Pac. R.R. v. Williams, 
    85 S.W.3d 162
    , 165 (Tex. 2002); Neloms v. BNSF
    Ry., No. 02-09-00281-CV, 
    2011 WL 944434
    , at *1 (Tex. App.––Fort Worth Mar.
    17, 2011, no pet.) (mem. op.). To prevail on a FELA claim, a plaintiff must show
    that the railroad did not use reasonable care when it could have reasonably
    foreseen harm. Union 
    Pac., 85 S.W.3d at 165
    –66; Neloms, 
    2011 WL 944434
    , at
    *2. The defendant’s duty is “measured by what a reasonably prudent person
    would anticipate as resulting from a particular condition.” Union 
    Pac., 85 S.W.3d at 166
    (quoting Gallick v. Balt. & Ohio R.R., 
    372 U.S. 108
    , 118, 
    83 S. Ct. 659
    ,
    665–66 (1963)).
    The test for causation under FELA is more relaxed than the common law
    standard. CSX Transp., Inc. v. McBride, 
    131 S. Ct. 2630
    , 2636 (2011); see
    Union 
    Pac., 85 S.W.3d at 168
    . The test of causation under FELA is whether the
    railroad’s negligence “played any part, even the slightest, in producing the injury
    or death for which damages are sought.” CSX Transp., 
    Inc., 131 S. Ct. at 2636
    ,
    2644 (citing Rogers v. Mo. Pac. R.R., 
    352 U.S. 500
    , 506, 
    77 S. Ct. 443
    , 448
    (1957)); Union 
    Pac., 85 S.W.3d at 168
    ; Neloms, 
    2011 WL 944434
    , at *2. Despite
    the lower burden under FELA, a plaintiff still bears the burden of presenting
    evidence from which a jury could conclude the existence of a probable or likely
    causal relationship as opposed to merely a possible one. Abraham v. Union Pac.
    R.R., 
    233 S.W.3d 13
    , 17 (Tex. App.––Houston [14th Dist.] 2007, pet. denied)
    (citing Edmonds v. Ill. Cent. Gulf R.R., 
    910 F.2d 1284
    , 1288 (5th Cir. 1990)), cert.
    denied, 
    522 U.S. 1312
    (2008). The causal link between an event sued upon and
    4
    the plaintiffs’ injuries must be shown by competent evidence.       
    Abraham, 233 S.W.3d at 17
    .
    Although Nichols’s claim is pursuant to a federal statute, the trial court
    must follow state procedure in determining the reliability of expert testimony.
    
    Id. at 18;
    see Mar. Overseas Corp. v. Ellis, 
    971 S.W.2d 402
    , 406 (Tex.), cert.
    denied, 
    525 U.S. 1017
    (1998).       To be admissible into evidence, an expert
    witness’s testimony must, among other things, be reliable.       E.I. du Pont de
    Nemours & Co. v. Robinson, 
    923 S.W.2d 549
    , 565 (Tex. 1995). The expert must
    be qualified, and the testimony must be relevant and be based on a reliable
    foundation. 
    Id. at 556.
    Expert testimony is unreliable if (1) it is not grounded in
    the methods and procedures of science and is thus no more than subjective
    belief or unsupported speculation, or (2) there is too great an analytical gap
    between the data upon which the expert relies and the opinion he offers. Cooper
    Tire & Rubber Co. v. Mendez, 
    204 S.W.3d 797
    , 800 (Tex. 2006). The purpose of
    the reliability determination is not to decide whether the expert’s conclusions are
    correct, but only whether the analysis used to reach them is reliable. Exxon
    Pipeline Co. v. Zwahr, 
    88 S.W.3d 623
    , 629 (Tex. 2002).
    Evidence
    Nichols
    During Nichols’s testimony, his attorney played a video that showed
    railroad workers engaged in GOOME that was filmed for Burlington Northern
    (also a predecessor of BNSF) in 1992. Nichols testified that he did the same
    5
    thing that the person in the video did. According to Nichols, the step down from
    the cars to the ballast (the gravel on which the track sits) was “a good” two feet
    off the ground. Nichols stated that stepping onto ballast was not like stepping
    onto flat ground and that “[y]ou could twist one way or another like stepping off
    on a golf ball.” Nichols said that he had never been hurt doing so, however.
    Nichols said that after stepping down, he had to take a few steps, depending on
    how fast the cars had been moving.
    Nichols also testified from a 1992 report admitted into evidence; the report
    is from an ergonomics manager at Burlington Northern, Bill Barbre.         For the
    report, Barbre analyzed video recordings of workers engaged in GOOME and
    attempted to estimate the total body forces that would occur during GOOME at
    different speeds. Nichols testified that he had stepped off moving cars at as
    much as ten miles per hour, which is higher than the eight miles per hour
    maximum that Barbre used for his calculations.5 Nichols testified from a chart
    attached to the report that total forces on a body from getting off a moving car at
    four miles per hour were 8.8 times a person’s body weight, at six miles per hour
    were 11.2 times a person’s body weight, and at eight miles per hour were fifteen
    times a person’s body weight.6 Barbre characterized the total body forces of
    5
    The maximum speed at the Temple yard where Nichols worked was ten
    miles per hour, so Nichols did not GOOME at speeds higher than ten miles per
    hour.
    6
    The chart also shows that total body forces from getting off stopped
    equipment was 5.2 times a person’s body weight.
    6
    fifteen times a person’s body weight at eight miles per hour as “extreme.” For a
    two hundred pound man, this would amount to three thousand pounds of total
    body force.
    Although the Santa Fe stopped GOOME in 1993, Nichols testified that the
    practice did not cease in the Temple yard where he worked until 1995.
    According to Nichols, production slowed when the practice was stopped in 1995;
    he did not believe the practice was allowed so long for the convenience of the
    workers but to speed up production. Nichols testified that although the Santa Fe
    Middle Division issued a safety circular in 1988 stating that “[g]etting on or off
    moving equipment should be avoided whenever possible,” the Temple yard was
    not included in that division, and the Temple yard did not prohibit or discourage
    GOOME until 1995.7
    Lawrence Fleischer
    Lawrence    Fleischer,   the   BNSF   corporate   representative   and   an
    ergonomist, testified that the only company document he could find regarding
    why GOOME was stopped was a notice to employees from the Chairman,
    President, and CEO Jerry Grinstein and the Executive Vice President of
    Operations Jack Chain that the company (Burlington Northern at the time) was
    7
    BNSF admitted into evidence a 1993 rules pamphlet from the Santa Fe
    indicating that GOOME was prohibited except as allowed by Operating Circular
    or in cases of emergency. According to Nichols, an Operating Circular either
    was or may have been issued for the Temple yard extending the practice of
    GOOME there until 1995.
    7
    ceasing the practice of GOOME for safety reasons.          The notice says that
    Burlington Northern is ceasing the practice of GOOME because it is an inherently
    dangerous work practice. But Fleischer testified that GOOME is not inherently
    dangerous. Fleischer was familiar with an Association of American Railroads8
    study showing that during 1979–86, getting on and off equipment was the main
    cause of lost-time injuries to railway workers. However, Fleischer clarified that
    the report does not specify whether the injuries were acute or cumulative trauma
    injuries. Moreover, Fleischer said that it is hard to tell whether a chart in the
    report showing injuries occurring from mounting and dismounting equipment
    applies to moving or stopped equipment, or both.
    According to Fleischer, the Barbre study was initiated to convince the
    railyard workers of the wisdom of discontinuing GOOME. Fleischer said that his
    problem with the Barbre study was that Barbre did not take into account that the
    men getting on and off moving railcars were still hanging onto the cars by their
    arms so that the total body force would not be distributed solely on the lower
    body.9 Fleischer testified that he spoke with Barbre, and all of the injuries that
    were discussed in the report were acute, not cumulative trauma, injuries. The
    report states that Burlington Northern had a fifty to sixty percent reduction in
    8
    Fleischer agreed that Burlington Northern and the Santa Fe were both
    members of the AAR, and BNSF is still a member.
    9
    Later, however, Fleischer testified that he was not sure whether the study
    took this fact into account.
    8
    accidents from getting on or off equipment within a year after stopping GOOME,
    which Fleischer says also supports his discussion with Barbre that the events
    referred to in the report are acute trauma events. Fleischer also agreed that the
    report showed that forty-three accidents still occurred from GOOME even after
    equipment was required to be stopped.
    Fleischer testified that as a trained ergonomist, when looking for
    cumulative trauma risk, he would look for an action that would happen repetitively
    every thirty seconds or so, like the actions performed by a machinist or factory
    worker. According to Fleischer, GOOME is not the type of high force activity that
    would cause cumulative trauma. However, he admitted that the cut-off level for
    just how much force or repetition can cause injury is not known. Fleischer also
    admitted that as an ergonomist, not a doctor, he could not opine as to what
    caused Nichols’s injuries.
    Fleischer testified that he had never seen a study concluding that GOOME
    causes degenerative disc disease and that the Barbre report is the only study
    that has tried to calculate the forces involved in GOOME.
    Dr. Dan Eidman
    Dr. Dan Eidman, an orthopedic surgeon who treated Nichols, testified by
    video deposition. Dr. Eidman performed a cervical fusion on Nichols’s neck in
    November 2007, a lumbar fusion on his low back in June 2008, and surgery to
    repair Nichols’s left rotator cuff in June 2009.   In Dr. Eidman’s opinion, the
    injuries necessitating the surgeries were due to repetitive usage.      Nichols’s
    9
    counsel read a definition of cumulative trauma injuries from a 1989 article,
    Cumulative Trauma Disorders, which Dr. Eidman agreed with: “a collective term
    for syndromes characterized by discomfort and impairment, disability or
    persistent pain in joints, muscles, tendons and other soft tissues, with or without
    physical manifestations.” According to Dr. Eidman, this definition means that a
    patient could have symptoms in more than one joint or area of the spine without
    any “obvious physical findings” on examination. He also stated that a person
    with the syndrome may have an injury due to repetitive trauma that has yet to
    manifest itself. Dr. Eidman testified that cumulative trauma disorders have been
    recognized “for many, many years” and that he had treated them since the
    beginning of his practice.10 Dr. Eidman said that cumulative trauma injuries are
    recognized by the United States government, specifically NIOSH,11 the National
    Institute for Occupational Safety and Health.
    Nichols’s attorney questioned Dr. Eidman about a NIOSH article that
    describes how to diagnose repetitive trauma injury. Dr. Eidman answered that
    [t]he article indicates that part of the diagnosis would involve
    evaluating the patient for objective findings on physical examination,
    subjective symptoms, as well, would be important, and then it goes
    on to say examples of positive physical findings, include positive
    10
    At the time of his deposition, Dr. Eidman had been an orthopedic
    surgeon for thirty years.
    11
    NIOSH is the federal agency responsible for conducting research and
    making recommendations for the prevention of work-related injury and illness
    and is part of the Centers for Disease Control and Prevention. Kuiper v.
    Givaudan, Inc., 
    602 F. Supp. 2d 1036
    , 1047 n.4 (N.D. Iowa 2009).
    10
    maneuvers that are used quite often in our exams in orthopedic
    examination surgery, as well as any localized physical findings, such
    as redness or joint deformity or loss of motion.
    Nichols’s counsel also questioned Dr. Eidman about a 1997 article from the U.S.
    Department of Health and Human Services, entitled Musculoskeletal Disorders
    and Workplace Factors, a Critical Review of Evidence for Work-Related
    Musculoskeletal Disorders of the Neck, Upper Extremity and Lower Back.12
    Dr. Eidman     agreed    with    the   following   statement     from    the   article:
    “Musculoskeletal Disorders and Workplace Factors found that there is evidence
    for a causal . . . relationship between highly-repetitive work and . . . neck and
    shoulder musculoskeletal disorders.” He also agreed with a second statement
    from the article:     “There is strong evidence that low-back disorders are
    associated with work-related lifting and forceful movements.”
    Dr. Eidman testified to treating football players with cumulative trauma
    injuries. He said he makes his diagnosis in these cases when the person has a
    history of playing high school or college football, shows up five or ten years later
    with complaints of neck, back, or shoulder pain, and an MRI shows a tear in the
    cartilage, meniscus, or ligament.      According to Dr. Eidman, “most of those
    patients do fairly well for several years after their initial injuries, until such time
    that they’ve had enough activity to increase the symptoms and aggravate those
    12
    Although the trial court pre-admitted this article as an exhibit, it is not
    included in the reporter’s record. A note in the index states, “Defendant’s Exhibit
    33-D was not tendered to the Court Reporter at the time of trial, therefore, was
    not considered during jury deliberation . . . .”
    11
    areas.” He believed the cause of their injuries was the direct contact and the
    “running and cutting” they do when playing. Dr. Eidman said such injuries are
    common in his practice.
    Dr. Eidman testified that he had also treated joggers with knee problems
    that he attributed to constant vibration from running. He had also treated people
    with tennis elbow due to repetitive use of the elbow combined with wrong
    technique. Dr. Eidman testified that it is common for people who do heavy lifting
    and manual labor to sustain back or neck injuries due to the repetitive nature of
    their work and that he treats quite a few people like that. Dr. Eidman agreed that
    these people’s injuries do not manifest right away but may take quite a while.
    Dr. Eidman testified that in his practice, he had treated about one hundred
    railroad workers with cumulative trauma injuries to their neck or back or shoulder,
    which he believed were a result of GOOME. Dr. Eidman relied on the 1992
    Barbre report in formulating his opinion on causation. According to Dr. Eidman,
    GOOME at the speeds shown in the video would cause force to a person’s
    lumbar and cervical spine region. Dr. Eidman believed that if a person performed
    GOOME as shown in the video twenty times a day, over time he would suffer an
    injury in his lumbar and cervical spine.     Dr. Eidman testified that getting on
    equipment could also cause a rotator cuff injury because the person would have
    to pull his whole body weight to get on the train. According to Barbre’s report,
    GOOME at eight miles per hour could put more force on a person’s body than
    gymnastic vaulting.   In Dr. Eidman’s opinion, Nichols’s specific activity as a
    12
    switchman for BNSF––including engaging in GOOME twenty to thirty-five times
    per day over an approximately fourteen-year period––“would contribute to his
    symptoms and conditions in the neck and back and shoulder.”            Dr. Eidman
    agreed that his opinion would be consistent with the articles referenced in the
    deposition, which he said he relied on in forming his opinion.
    On cross-examination, Dr. Eidman admitted that he had not done any
    research or studies on cumulative trauma injuries or on GOOME. Dr. Eidman
    had not read any of Barbre’s testimony on the 1992 study, nor had he heard or
    read anything Lonn Hutcheson––the contractor who actually performed the
    study––has said about the study. Dr. Eidman did not know whether the Barbre
    study had been peer reviewed, and he did not know of any peer-reviewed study
    concluding that GOOME causes cumulative trauma injury. But Dr. Eidman said
    that it was his understanding that GOOME is generally accepted as causing
    cumulative trauma because the railroads changed their policies allowing their
    employees to do it. Dr. Eidman had no opinion or basis for saying how much a
    person must GOOME before doing so will cause cumulative injury to the neck or
    shoulders. Dr. Eidman did not know the extent to which the theory that GOOME
    can cause cumulative trauma injury had been tested, and he agreed that other
    factors play a part in degenerative disc disease, such as genetics, age, weight,
    and general physical condition.      Dr. Eidman agreed that no studies show
    degenerative disc disease can result from running and that, in fact, it is generally
    recognized that exercise such a jogging has a preventative component for
    13
    diseases such as degenerative disc disease. Dr. Eidman also agreed that he
    would have expected Nichols’s symptoms to manifest themselves before thirteen
    years had passed.13
    Dr. Eidman agreed that Nichols had a Type 2 curvature of his acromion, 14
    which could have predisposed him to the shoulder problem. He also testified that
    at least eighty-five percent of people thirty-five or forty and older have
    degenerative disc disease. He also agreed that there are a lot of unknowns
    surrounding degenerative disc disease and that the relationship between
    physical force and degenerative disc disease is unknown. He agreed that there
    is “zero literature” connecting GOOME to musculoskeletal disorders in general,
    and degenerative disc disease specifically.      Dr. Eidman made no effort to
    quantify the force to which Nichols was exposed and did not know just how much
    force would be required to cause his injuries.
    Dr. Eidman testified on redirect that he saw probably a couple hundred
    people who had worked at the railroad and who he thought had problems due to
    GOOME.      When asked whether he knew of evidence that Nichols had any
    genetic history of degenerative disc disease, he answered, “I don’t believe so.”
    13
    Contrary to these calculations, Nichols testified that he ceased work as a
    switchman in 1995, and he first experienced neck pain in 2005.
    14
    The acromion is “[t]he lateral extension of the spine of the scapula
    [shoulder blade] that projects as a broad flattened process overhanging the
    glenoid fossa [cavity in the scapula].” Stedman’s Medical Dictionary 19, 764,
    1725 (28th ed. 2006).
    14
    According to Dr. Eidman, he would not expect a fifty-year old man to have the
    type of advanced changes he saw in Nichols’s back; Dr. Eidman thinks GOOME
    accelerated the changes. Dr. Eidman did not think Nichols’s weight was a factor
    in his injury, nor did he have any evidence that Nichols was a runner and could
    have injured himself that way.
    Dr. Eidman testified that Nichols told him his symptoms were worse at
    work. Nichols had gone to work for the railroad as a young man and never had
    another job. In Dr. Eidman’s opinion, based on his experience as an orthopedic
    surgeon and on the articles mentioned above, the forces to which Nichols was
    subjected during GOOME are the cause of his injuries to his back, neck, and
    shoulders.   He explained that the cause of cumulative trauma injury is the
    amount of force plus the time the force is exerted. Taking those two factors into
    account with Nichols’s testimony, he was likely exposed to about thirty seconds
    of GOOME per day.
    After Nichols’s counsel rested, BNSF moved for a directed verdict on no-
    evidence of causation. The gist of BNSF’s argument is that no study supported
    Dr. Eidman’s testimony, Dr. Eidman did not rule out other causes of Nichols’s
    injuries, and Dr. Eidman’s opinion is merely based on his ipse dixit testimony.
    The trial court denied the motion.
    Analysis
    To uphold the jury’s verdict on causation, there must be some probative
    evidence that work such as Nichols performed would play at least a small part in
    15
    bringing about his injuries. See Huffman v. Union Pac. R.R., 
    675 F.3d 412
    , 425
    (5th Cir. 2012). Thus, we look for probative evidence that Nichols’s degenerative
    disc disease is the kind of injury than can occur from the railroad’s negligently
    allowing him to GOOME in the course of his work as a switchman. 
    Id. In Huffman,
    the plaintiff contended that his osteoarthritis in the knees was
    caused by his work as a trainman, which included GOOME. 
    Id. The Fifth
    Circuit
    panel stated that “[a]t best, there was evidence that the kind of work trainmen
    did, if not performed properly, could increase the chances of musculoskeletal
    disorders.” 
    Id. The fatal
    flaw in that case was that there was no evidence listing
    osteoarthritis in the knees as a musculoskeletal disorder that could occur from
    performing the type of work he did as a trainman.15 
    Id. Here, as
    in Huffman, there was probative evidence of the type of work
    Nichols did and the type of injuries he has. According to BNSF, Nichols was
    required to also provide evidence of (1) epidemiological studies showing that
    mounting and dismounting moving railway cars can cause degenerative disc
    disease and (2) the amount of force Nichols himself experienced when getting on
    and off moving railcars.
    “Cumulative trauma disorder refers not to one specific injury, but to
    numerous disorders caused by the performance of repetitive work over a long
    15
    Judge Dennis dissented from the majority opinion, concluding that the
    doctors’ testimony including broad definitions of musculoskeletal disorders was
    sufficient to support the jury’s verdict on causation grounds. 
    Huffman, 675 F.3d at 431
    (Dennis, J., dissenting).
    16
    period of time.” Myers v. Ill. Cent. R.R., 
    629 F.3d 639
    , 643 (7th Cir. 2010);
    Gutierrez v. Excel Corp., 
    106 F.3d 683
    , 686 (5th Cir. 1997). These types of
    disorders result from wear and tear on the body, and they can be the product of
    many factors. 
    Myers, 629 F.3d at 643
    ; 
    Gutierrez, 106 F.3d at 686
    .
    In determining causation of an injury through differential etiology,16 the
    doctor rules in all the potential causes of a patient’s ailment and then by
    systematically ruling out causes that would not apply to the patient, the physician
    arrives at what is the likely cause of the ailment. 
    Myers, 629 F.3d at 644
    . There
    is nothing controversial about that methodology. Id.; Tamraz v. Lincoln Elec. Co.,
    
    620 F.3d 665
    , 673–74 (6th Cir. 2010), cert. denied, 
    131 S. Ct. 2454
    (2011). The
    question of whether it is reliable under Daubert is made on a case-by-case basis,
    focused on which potential causes should be “ruled in” and which should be
    “ruled out.” 
    Myers, 629 F.3d at 644
    . Calling something a “differential diagnosis”
    or “differential etiology” does not by itself answer the reliability question but
    prompts three more: (1) Did the expert make an accurate diagnosis of the nature
    of the disease? (2) Did the expert reliably rule in the possible causes of it? and
    (3) Did the expert reliably rule out the rejected causes? If the court answers “no”
    to any of these questions, the court must exclude the ultimate conclusion
    reached. 
    Tamraz, 620 F.3d at 674
    .
    16
    This term is often also referred to as differential diagnosis. 
    Myers, 629 F.3d at 644
    .
    17
    In a FELA case involving lateral epicondylitis (an elbow injury), the First
    Circuit held that the testimony of an orthopedic surgeon specializing in repetitive
    stress injuries was reliable when the surgeon had treated the plaintiff, used
    differential diagnosis to determine causation, had regularly diagnosed repetitive
    stress injuries, and had treated about 100–150 cases of lateral epicondylitis per
    year. Granfield v. CSX Transp., Inc., 
    597 F.3d 474
    , 485–87 (1st Cir. 2010). The
    court also held that the expert’s causation testimony was sufficient to support the
    jury’s verdict for the plaintiff. 
    Id. at 487.
    Similar to this case, the expert had
    testified that it is well known that repetitive motion causes lateral epicondylitis
    and that the amount of force and repetition required before injury occurs is
    unknown. 
    Id. at 485.
    In addition, the expert in that case did not rely on peer-
    reviewed studies, which the court concluded was not conclusive under Daubert.
    
    Id. at 486
    (“The mere fact of publication, or lack thereof, in a peer-reviewed
    journal is not a determinative factor in assessing the scientific validity of a
    technique or methodology on which an opinion is premised.”); see also Daubert
    v. Merrell Dow Pharm., Inc., 
    509 U.S. 579
    , 593, 
    113 S. Ct. 2786
    , 2797 (1993)
    (“Publication (which is but one element of peer review) is not a sine qua non of
    admissibility. . . .”).
    We believe this case is more similar to Granfield than Huffman.
    Dr. Eidman testified that as a thirty-year orthopedic surgeon, he treated many
    patients with degenerative disc disease, which is caused by repetitious and
    forceful movements. He ruled out weight, genetics, other activity, and Nichols’s
    18
    general condition; he also testified that age itself was not a factor in that he would
    not have expected to see the kind of injury he saw with Nichols from a fifty-year-
    old man. Thus, we conclude that Dr. Eidman’s experience in his practice and the
    methodology he used to determine causation were sufficient to render his expert
    opinion testimony reliable and also sufficient to sustain Nichols’s burden of
    proving causation under the standard applicable to FELA cases.17                 See
    
    Granfield, 597 F.3d at 485
    –87; Hardyman v. Norfolk & W. Ry., 
    243 F.3d 255
    ,
    261–67 (6th Cir. 2001); see also Synar v. Union Pac. R.R., No. 12-99-00428-CV,
    
    2001 WL 1263573
    , at *11 (Tex. App.––Tyler 2001, pet. denied) (not designated
    for publication) (determining that doctors’ testimony that ulnar neuropathy was
    caused by repetitive use of hands and arms in operating hand brakes and switch
    equipment was sufficient to prove causation). We therefore overrule BNSF’s first
    issue.
    Jury Charge
    BNSF contends in its second issue that the trial court erred by refusing to
    include the following instructions on general and specific causation in the jury
    charge:
    17
    In contrast to the doctors in Myers, Dr. Eidman was well aware of
    Nichols’s history and had reviewed materials, such as the Barbre report and the
    video showing GOOME, specifically related to the type of work Nichols
    
    performed. 629 F.3d at 645
    . Additionally, Dr. Eidman’s testimony is the type of
    testimony that was missing in Lewis v. CSX Transp. Inc., 
    778 F. Supp. 2d 821
    (S.D. Ohio 2011), in which the district court granted summary judgment because
    of a lack of scientific evidence, including studies, linking the plaintiff’s carpal
    tunnel syndrome and his work on a ballast regulator.
    19
    In order to establish that exposure to getting on and off
    moving equipment caused [Nichols’s] back, neck and/or shoulder
    conditions, Plaintiff must prove by reliable scientific evidence that
    such cumulative exposure generally causes these conditions and
    that his exposure specifically caused such conditions. . . .
    In order to prove specific causation to getting on and off
    moving equipment, Plaintiff must exclude, with reasonable certainty,
    other plausible causes of his conditions such as age, genetics, other
    activities, or no known cause. . . .
    Plaintiff must establish [Nichols’s] level of exposure using
    techniques subject to objective, independent validation in the
    scientific community. He must also prove that such exposure/dose
    was sufficient to cause his conditions. . . .
    The charge here was substantially similar to the charge recently reapproved by
    the United States Supreme Court, as BNSF acknowledges in its reply brief. See
    CSX 
    Transp., 131 S. Ct. at 2640
    –41. Thus, we overrule its second issue.
    Foreseeability
    In its third issue, BNSF argues that there was no or insufficient evidence
    that GOOME was a defective work practice or that it had a reasonable
    opportunity to correct it before it caused injury to Nichols. According to BNSF,
    Because there is no evidence to this day that GOOME can cause
    degenerative changes to the cervical or lumbar discs (or could cause
    a rotator cuff tear over a decade later), [the Santa Fe] could not have
    known of the possibility when Nichols worked as a switchman from
    1979-1995.
    Nichols’s testimony that he was required to engage in GOOME is evidence that
    the railroad was aware of the practice; thus, the disputed question is whether the
    railroad knew or should have known that GOOME created a likelihood that an
    employee could suffer injuries to the neck, back, and shoulder.
    20
    Reasonable foreseeability of harm is an essential ingredient of a
    negligence action under FELA. CSX 
    Transp., 131 S. Ct. at 2643
    . The jury in
    such a case must be asked whether the carrier failed to observe “that degree of
    care which people of ordinary prudence and sagacity would use under the same
    or similar circumstances.”   
    Id. Reasonable foreseeability,
    then, depends on
    whether the carrier had a reasonable ground to anticipate that a particular
    condition would or might result in a mishap and injury.     Id.; Union 
    Pac., 85 S.W.3d at 166
    . The test is whether the railroad was or should have been aware
    of conditions which created a likelihood that the employee would suffer the type
    of injury he did. 
    Rogers, 352 U.S. at 503
    , 77 S. Ct. at 447; Union 
    Pac., 85 S.W.3d at 166
    , 169. However, once negligence is proven, the carrier is liable for
    damages, regardless of whether the full extent of the injury or the manner in
    which it occurred was probable or foreseeable. 
    Rogers, 352 U.S. at 503
    , 77 S.
    Ct. at 447; Union 
    Pac., 85 S.W.3d at 166
    , 169. In other words, “[t]he test of
    foreseeability does not require that the negligent person should have been able
    to foresee the injury in the precise form in which it in fact occurred.”    E.g.,
    Green v. River Terminal Ry., 
    763 F.2d 805
    , 808 (6th Cir. 1985). Under FELA, “a
    tortfeasor must compensate his victim for even the improbable or unexpectedly
    severe consequences of his wrongful act.” 
    Gallick, 372 U.S. at 120
    –21, 83 S. Ct.
    at 667.
    In evidence was a December 1987 AAR Research Report, which shows
    that AAR was researching how to reduce injuries in railroad workers. The report
    21
    states that trainmen and yardmen suffered the most injuries and that one of the
    major causes was “getting on an[d] off cars and locomotives.” The report further
    indicates that AAR was involved that year in providing ergonomic and safety
    programs for railroads. Specifically, one of the programs assisted in redesigning
    jobs to minimize the chance for overexertion injuries. This program was primarily
    aimed at lifting activities, but was “not restricted to lifting” and also applied to
    “lowering, pushing, and pulling tasks.” The report also states about railroad jobs
    in general that “[t]he chances for injuries from over[]exertion are high in such
    jobs.” The report also addresses force and compression in the lower back as
    concerns.
    Another AAR study was also in evidence, An Ergonomic Investigation of
    Railroad Yard Worker Tasks; it is undated, but it relies on 1986 and 1987 data. A
    chart attached to the report lists lower extremity injuries, upper extremity strains,
    and back sprains as typical injury types for mounting and dismounting cars. A
    contributing factor to such injuries was listed as “[s]peed of train.” That study
    followed a small group of workers in one railyard, who experienced less injuries
    from mounting and dismounting cars than had been reported nationwide. Even
    so, those workers reported “that they slipped and fell while mounting or
    dismounting, suffering strains and sprains of the torso and lower extremities as a
    result.”
    Although BNSF’s ergonomist testified that GOOME did not involve the kind
    of rapid repetitive activity that he looked for in considering the cause of
    cumulative trauma, the jury had evidence to rely on in determining that the
    railroad should have known that GOOME caused a significant risk of injury to
    railyard workers, specifically overexertion-type injuries. That there are no studies
    22
    specifically linking GOOME and degenerative disc disease does not diminish the
    evidence that the railroad industry was aware of the types of risks involved in
    railyard work (and GOOME), that it was working on changing work methods to
    minimize the occurrence of such injuries, and that those injuries were not limited
    to acute injuries but included injuries from overexertion. Cf. Allenbaugh v. BNSF
    Ry., No. CV-09-3086-LRS, 
    2011 WL 2182430
    , at *4 (E.D. Wash. June 6, 2011)
    (denying summary judgment motion because plaintiff produced evidence of
    foreseeability sufficient to create a fact issue); Cook v. CSX Transp., Inc., 557 F.
    Supp. 2d 1367, 1373–74 (M.D. Fl. 2008) (same). We overrule BNSF’s third
    issue.
    Conclusion
    Having overruled all three of BNSF’s issues, we affirm the trial court’s
    judgment.
    TERRIE LIVINGSTON
    CHIEF JUSTICE
    PANEL: LIVINGSTON, C.J.; DAUPHINOT and WALKER, JJ.
    DELIVERED: June 21, 2012
    23