LEONARD CERSINE, Employee, v. LTV STEEL MINING CO., and AMERICAN INT=L GROUP (AIG), adm=d by SEDGWICK CLAIMS MANAGEMENT SERVS., Employer-Insurer/Appellants.
WORKERS= COMPENSATION COURT OF APPEALS
OCTOBER 16, 2002
CAUSATION - SUBSTANTIAL EVIDENCE. Substantial evidence, including the employee=s testimony and the opinions of his treating doctors, supports the compensation judge=s finding that the employee=s July 1, 1992 personal injury to both knees was a substantial contributing cause of his need for bilateral knee replacement surgery.
Determined by Johnson, C.J., Wilson, J. and Stofferahn, J.
Compensation Judge: Gregory A. Bonovetz
THOMAS L. JOHNSON, Judge
The employer and insurer appeal from the compensation judge=s finding that the employee=s July 1, 1992 personal injury was a substantial contributing cause of his need for bilateral knee replacement surgery. We affirm.
Leonard Cersine, the employee, sustained a personal injury to both knees on July 1, 1992 while working for LTV Steel Mining Company, the employer, then insured by American International Group (AIG). On that date, the employee tripped and fell landing on his knees. A First Report of Injury filed on July 26, 2001 indicates the employer was first notified of the July 1, 1992 injury on August 20, 1992. The employee apparently missed no time from work as a result of the injury and continued to perform his regular job, without any formal restrictions, until the plant closed on January 5, 2001.
On July 20, 1992, the employee saw Dr. Steven Park complaining of bilateral knee pain over the past three weeks. The doctor noted the employee was Anot sure of any specific aggravating incident that he can identify.@ (Resp. Ex. 3.) Dr. Park noted the employee was morbidly obese, diagnosed bilateral chondromalacia and advised weight reduction. The employee then saw Dr. J. J. Davis in August 1992 on referral from Dr. Park. The employee gave Dr. Davis a history of falling at work and twisting his knees. X-rays suggested early degenerative joint disease but were otherwise negative. Dr. Davis diagnosed chondromalacia of the patellas and recommended a leg strengthening program.
Dr. Park next referred the employee to Dr. Mark Carlson, an orthopedic surgeon. By letter dated December 7, 1992, Dr. Park wrote to Dr. Carlson, stating the employee=s knee pain Aseems to be precipitated by falling and banging both knees impacting them on a hard surface, while at work when he slipped.@ (Resp. Ex. 3c.) The employee was examined by Dr. Carlson in December 1992, and reported an onset of bilateral knee pain when he fell at work on July 1, 1992 with increasing pain and discomfort. X-rays of the employee=s knees showed a complete loss of joint space medially at the femoral tibial joints with marked joint space narrowing of the left knee. The doctor diagnosed severe degenerative arthritis and noted the employee weighed 342 pounds. Dr. Carlson opined the employee=s weight was exacerbating his problems significantly. Dr. Carlson opined the employee would, at some point, need an upper tibial osteotomy on the right and possibly on the left but he stated he would not recommend total knee arthroplasty at that time. Before any surgery, however, the doctor stated the employee should lose at least 100 pounds. The employee returned to see Dr. Carlson on March 9, 1993. His diagnosis remained degenerative disease of the medial compartment of both knees. The doctor again noted the employee would likely eventually need consideration of an upper tibial osteotomy.
The employee received no further treatment for his knees until he returned to see Dr. Park on September 25, 1997. The doctor again noted the employee was morbidly obese and complained of persistent knee pain. Dr. Park diagnosed degenerative joint disease and prescribed Naprosyn. X-rays taken on January 5, 2000, showed bilateral degenerative changes of the knees, left more than right, which, the radiologist concluded, had progressed remarkably since 1992.
On April 30, 2001, the employee saw Dr. Robin Hendricks for his bilateral knee pain. The doctor diagnosed severe bilateral knee arthrosis and recommended total knee arthroplasty. By letter dated May 3, 2001, Dr. Hendricks advised the insurer the employee had bilateral knee arthrosis secondary to a work related injury in December 1992 and stated total knee arthroplasty was the employee=s only option. On June 25, 2001, the doctor stated he and the employee Areviewed a letter from workers= compensation that denied his claim that his severe knee arthrosis is secondary to his job despite significant documentation in his medical records over the years. His work is certainly directly related to his severe knee arthrosis and he will be seeking guidance from the union as well as legal assistance to rectify this situation.@ (Pet. Ex. A-1.) The doctor again recommended total knee replacement surgery.
The employee has been significantly overweight all of his adult life. On September 15, 1969, the employee saw Dr. Grahek at the Duluth Clinic in Ely stating he wanted to go on a diet. The employee then weighed 253 pounds. Dr. Grahek was concerned the employee might not follow through with the prescribed diet. On July 3, 1970, Dr. Grahek reported the employee refused to abide by the diet plan but still wanted to lose weight. In 1985, the employee again sought medical advice for his weight problem. The employee then weighed 293 pounds. Dr. Park diagnosed morbid obesity and prescribed dietary measures. In May 1990, the employee returned to see Dr. Park. He reported his weight to be 350 and again wanted to go on a diet to lose weight. In October 1991, Dr. Park referred the employee to the Duluth Clinic for family counseling for eating disorders. In the summer of 1993, the employee entered a rigid weight loss program. On May 5, 1994, Dr. Park noted the employee had lost approximately 59 pounds over the prior six weeks on this diet monitored by Miller Dwan Hospital. At some point, the employee reduced his weight to approximately 195 pounds. However, by October 1996, Dr. Park noted the employee had regained weight and then weighed in excess of 300 pounds.
On September 21, 2001, the employee was examined by Dr. Jack Drogt, an orthopedic surgeon, at the request of the employer and insurer. The doctor obtained a history from the employee, reviewed his medical records and performed a physical examination. Dr. Drogt diagnosed severe degenerative joint disease in both knees. Dr. Drogt acknowledged the employee sustained a work injury in July 1992 but noted that x-rays at that time revealed significant degenerative joint disease which, the doctor opined, clearly pre-existed the work injury. The doctor opined the 1992 injury was a temporary aggravation of the employee=s pre-existing degenerative joint disease and was not a substantial contributing cause to his ongoing knee condition. Rather, the doctor opined the employee=s current knee condition was caused by his long history of morbid obesity.
The employee filed a Medical Request seeking approval for the knee surgery. The employer and insurer denied the July 1992 injury was the cause of the employee=s need for surgery. The case was heard by Compensation Judge Bonovetz on April 26, 2002. In a Findings and Order filed April 30, 2002, the compensation judge found the employee=s injury of July 1, 1992 was a significant contributing cause to the employee=s need for knee replacement surgery. The compensation judge then ordered the employer and insurer to pay the reasonable costs and expenses of the proposed surgeries. The employer and insurer appeal.
The appellants contend the judge=s finding that the work injury was a significant contributing cause of the need for knee replacement surgery is unsupported by substantial evidence in view of the entire record. They acknowledge Dr. Park causally related the employee=s knee pain to his work injury by letter dated December 7, 1992 to Dr. Carlson. They argue, however, Dr. Park=s office notes consistently state the employee=s degenerative knee problems were the result of his long term obesity. The employee missed no time from work as a result of his work injury and continued at his job as a millwright without restrictions until the plant closed on January 5, 2001. The medical records reflect the employee sought no medical attention for his knees between April 1993 and September 1997 and then not again until January of 2000. The employee has a long history of morbid obesity which Dr. Drogt opined was the cause of the employee=s need for surgery. These facts, the employer and insurer argue, compel a reversal of the compensation judge=s decision. We disagree.
Based upon the facts in this case, we acknowledge the compensation judge could have reached a different conclusion. On appeal, however, the question is not whether the facts might support a different result, but whether the findings of fact and order are clearly erroneous and unsupported by substantial evidence. Minn. Stat. ' 176.421, subd. 1 (1992). Factual findings Aare 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, 229 N.W.2d 521 (1975). In this case, we cannot conclude the findings of the compensation judge are clearly erroneous.
In his letter of December 7, 1992, Dr. Park stated the employee=s knee pain Aseems to be precipitated by falling and banging both knees impacting them upon a hard surface while at work.@ On February 1, 1994, the doctor wrote, AThere is no question that his recent knee pain was exacerbated by a fall that occurred at work, however, his obesity is a component of this as well...@ Finally, on January 24, 2000, Dr. Park noted, ADiscussed again with him [the employee] the etiology of all of this [knee pain] and it goes back to 1992 when he kneeled on an impeller at work.@ (Resp. Ex. 3c.) Dr. Hendricks and Dr. Carlson also opined the employee=s bilateral knee pain was substantially aggravated by his work injury. The employee testified his knee condition worsened after his fall on July 1, 1992 which caused him to reduce his activity levels both at work and at home. He further testified that before his injury, he used no pain medication for any knee complaints but used medication extensively after the injury because of increasing knee pain.
In his memorandum, the compensation judge acknowledged the employee=s excessive weight was a substantial contributing cause of his degenerative joint disease. The judge also observed that Dr. Drogt made a valid case that the employee=s excess weight substantially contributed to his knee problems. The judge noted, however, the employee=s testimony that he had no knee pain until July, 1992, and used pain medications extensively thereafter. The judge also accepted the opinions of Drs. Park and Carlson that the employee=s personal injury was a substantial contributing cause of the need for surgery. It is the compensation judge's responsibility, as trier of fact, to resolve conflicts in expert testimony. See Nord v. City of Cook, 360 N.W.2d 337, 342, 37 W.C.D. 364, 372 (Minn. 1985). The compensation judge=s decision is supported by substantial evidence, and must be affirmed.
 On July 7, 1993, Dr. Park stated the employee was Abeginning to suffer the sequelae of all the adverse effects of long term weight including his knees.@ On May 2, 2000, the doctor stated the employee had Asevere arthritis in his knees from his rather marked obesity.@ On February 5, 2001, the doctor opined the employee had Ahorrible degenerative arthritis involving his knees, all obesity related.@ (Resp. Ex. 3c). In an office note dated April 2, 2001, the doctor stated the employee=s Aknees are still causing him significant problems basically due to degenerative arthritis related to his weight.@