TERRY MELSNESS, Employee/Appellant, v. OVERHEAD DOOR CO. OF SIOUX FALLS and CINCINNATI INS. CO., Employer-Insurer.
WORKERS' COMPENSATION COURT OF APPEALS
MARCH 10, 2000
CAUSATION - SUBSTANTIAL EVIDENCE. Substantial evidence, including medical records, lay testimony, and expert medical opinion, supported the compensation judge=s finding that the employee=s 1997 work injury was not a substantial contributing cause of the employee=s low back problems.
Determined by Pederson, J., Rykken, J., and Wheeler, C.J.
Compensation Judge: Bonnie A. Peterson
STEVEN D. WHEELER, Judge
The employee appeals from the finding that the employee=s August 18, 1997 work injury was not a substantial contributing cause of the employee=s L5-6 disc herniation. We affirm.
The employee, Terry Melsness, sustained an admitted work-related injury to the right ankle on August 18, 1997 when he fell about ten feet from a ladder, landing on his feet. The employee was driven by a co-employee to a hospital in Adrian, Minnesota, from which he was transferred by ambulance to the Sioux Valley Hospital in Sioux Falls, South Dakota. When seen at the Sioux Valley Hospital by Dr. Brian C. Aamlid, the employee=s right ankle was noted to be deformed and swollen. The employee denied any back pain or back injury. He was diagnosed with an extensively comminuted fracture of the metadiaphyseal junction of the distal right tibia extending down into the tibial plafond. His right tibial plafond fracture was treated surgically with open reduction and internal fixation on August 19, 1997. The employee was discharged to his home with pain medications and a return appointment with Dr. Aamlid was scheduled for August 29, 1997. (Exh. H; T. 23-28.)
In November 1997, the employee began a regimen of physical therapy treatments for his left lower extremity three times per week at the Luverne Community Hospital. At the intake assessment on November 3, 1997, the employee mentioned by way of history that he had cracked a vertebra in 1984 and that he had experienced low back pain intermittently once every one to two years. (Exh. C: 11/3/97 PT assessment.)
The employee was off work due to his ankle condition until January 15, 1998 when he was released to return to light duty work four hours per day. During the period that the employee was wholly off work he had found his leg and ankle pain so troublesome that he depended heavily on pain medications and spent much of his time sleeping. After returning to light duty work the employee continued to have pain in his foot and he limped, but did not initially have any trouble with his back. He stopped taking pain medications during the workday but continued to take them at night. (T. 28-32, 47; Exh. G: 1/15/98.)
At some point after returning to light duty work, the employee began assisting in loading and unloading semi trucks at work. The employee continued to experience constant pain in his right foot and also began to experience some back pain during heavier parts of this work. The employee did not report any back symptoms to the employer or to his QRC. He attributed the low back pain to being out of shape after the prolonged period off work. On February 12, 1998 the employee mentioned to his physical therapist that his low back had started bothering him. He was provided with a booklet about back strengthening and instructed to perform low back exercises at home, but he did not perform the exercises because they worsened the pain in his foot. (T. 33-37, 49-51.)
On March 3, 1998 the employee was seen by a neurologist, Dr. Jerome W. Freeman, on referral from Dr. Aamlid for his continuing right leg dysfunction. The examination and recommendations focused on the employee=s right lower extremity. The employee, however, did mention to Dr. Freeman that he Ahas had some occasional left lumbar discomfort.@ The doctor also noted that the employee=s history included several fractured vertebrae in 1983 when Aa car fell on his back.@ Dr. Freeman did not make any diagnosis or treatment recommendations regarding the employee=s back. Other than this note, none of the physical therapy notes or medical records between February 13, 1998 and June 10, 1998 mention any complaints of back pain and the employee received no treatment for his back during this period. (Exh. E; T. 52.)
On June 7, 1998, a Sunday, the employee bent over at home to pick up a cardboard box and experienced the onset of intense, sharp pain in his low back at about the beltline. The employee was scarcely able to straighten up. Soon afterwards, the employee also had radiating pain in the left leg. The employee testified that his low back and leg pain was unlike any he had previously experienced. (T. 38-40, 52-53.)
The employee sought treatment from Dr. Gutnick on June 11, 1998. He reported that he had been lifting a box and since had back pain and persistent spasms. A CT scan on June 16, 1998 revealed a focal posterior central disc herniation at a presumed L5-6 level. Dr. Gutnick referred the employee to Dr. Walter O. Carlson, an orthopedic surgeon, who has recommended that the employee undergo surgical treatment for his low back condition. Dr. Gutnick has opined that the employee=s 1997 work injury Alikely . . . led to the start of his back problems and led to the weakening of an area in his back that went on with his leg problems to cause back and leg pain and then the need now for this surgery.@ Dr. Gutnick also opined that the employee=s altered gait following the right ankle injury is an aggravating factor to the employee=s back and leg problem. (Exh. I: 6/11/98, 6/16/98 CT scan; Exh. A [generally and] at 12.)
The employee filed a claim petition on August 8, 1998 alleging, among other things, entitlement to various benefits associated with his low back condition. The employer and insurer answered by denying that the employee=s low back condition and need for low back surgery are causally related to the 1997 ankle injury. (Judgment Roll.)
On December 4, 1998, Dr. John Dowdle examined the employee on behalf of the employer and insurer. Dr. Dowdle offered the opinion that the employee=s back problems are the result of a non-work injury at home in June 1998 and are unrelated to the August 1997 work injury. (Exh. 2.)
A hearing was held before a compensation judge at the Office of Administrative Hearings on July 20, 1999. Following the hearing, the judge found that the employee failed to show that his low back problems, specifically his herniated disc and need for surgery, were either directly related to the work injury of August 18, 1997 or consequentially related as a result of the employee=s altered gait following the work-related ankle injury. The employee appeals.
STANDARD OF REVIEW
On appeal, this court must determine whether the compensation judge's findings and order are "clearly erroneous and unsupported by substantial evidence in view of the entire record as submitted." Minn. Stat. ' 176.421, subd. 1(3) (1992). Substantial evidence supports the findings if, in the context of the record as a whole, they "are supported by evidence that a reasonable mind might accept as adequate." Hengemuhle v. Long Prairie Jaycees, 358 N.W.2d 54, 59, 37 W.C.D. 235, 239 (Minn. 1984). Where the evidence conflicts or more than one inference may reasonably be drawn from the evidence, the findings must be affirmed. Id. at 60, 37 W.C.D. at 240. Similarly, "[f]actfindings are clearly erroneous only if the reviewing court on the entire evidence is left with a definite and firm conviction that a mistake has been committed." Northern States Power Co. v. Lyon Food Prods., Inc., 304 Minn. 196, 201, 229 N.W.2d 521, 524 (1975). Factfindings may not be disturbed, even though this court might disagree with them, "unless they are clearly erroneous in the sense that they are manifestly contrary to the weight of the evidence or not reasonably supported by the evidence as a whole." Id.
The employee asserts that he introduced evidence sufficient to support either a finding that he sustained direct injury not only to the right lower extremity but also to the low back during his 1997 work injury, or a finding that the altered gait resulting from the ankle injury was a substantial contributing cause of a consequential low back injury in June 1998. In his brief, he sets forth the various lay and medical evidence he offered and discusses how this evidence was legally adequate to support such findings. The employee argues that, as the compensation judge held that the employee had failed to meet his burden of proof, the compensation judge must have applied an erroneous standard, such as requiring that the employee prove a work-related injury beyond a reasonable doubt. In attempting to support this argument, the employee points out, for example, that the compensation judge=s findings note that Dr. Gutnick Adoes not explain how the employee could have developed a herniated disc nearly a year after the actual fall or how an altered gait would herniate a disc.@ (Finding 13.) The employee asserts that this demonstrates that the judge applied an improper standard, noting that an expert medical opinion is not inadmissible or insufficient for want of detailed explanation.
The employee=s arguments confuse the issue of the standard of proof with that of the weight of the evidence. An employee may meet his or her burden of proof even without expert medical evidence, and an expert=s failure to fully explain an opinion does not disqualify that opinion as part of the evidence towards a claimant=s claim. However, a compensation judge may legitimately consider the extent to which an expert has explained an opinion in determining the weight afforded that opinion in relation to opposing evidence, particularly opposing expert opinion.
Our review of the compensation judge=s findings and memorandum convinces us that the compensation judge=s determination was not based on the application of an improper standard of proof. We see no indication that the judge required a greater showing than proof by a preponderance of the evidence, and the judge=s reasoning as set forth in her memorandum makes clear that the judge properly arrived at her decision by weighing the evidence submitted by the employee against that submitted by the employer and insurer.
The employee=s evidence, standing alone, could have supported contrary findings. However, the compensation judge found the evidence offered by the employer and insurer in this case to be more convincing, and afforded it greater weight. The relative weight of the conflicting evidence is a matter primarily entrusted to the compensation judge. The compensation judge=s decision is supported by substantial evidence, and we must affirm. Even v. Kraft, Inc., 445 N.W.2d 831, 42 W.C.D. 220 (Minn. 1989); Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985).