BRENDA L. HAHN, Employee/Appellant, v. PERHAM MEMORIAL HOSP. AND HOME and AMERICAN COMPENSATION INS. CO./RTW, INC., Employer-Insurer.
WORKERS= COMPENSATION COURT OF APPEALS
DECEMBER 31, 2002
CAUSATION - SUBSTANTIAL EVIDENCE. Substantial evidence, including the adequately founded opinion of the independent medical examiner, supports the compensation judge=s determination that the employee failed to prove she suffered a new, or an aggravation of a pre-existing, psychological injury as a consequence of her admitted July 21, 2000 work injury.
Determined by Johnson, C.J., Wilson, J. and Stofferahn, J.
Compensation Judge: Catherine A. Dallner
THOMAS L. JOHNSON, Judge
The employee appeals from the compensation judge=s finding that the employee did not sustain a psychological injury as a consequence of her admitted July 21, 2000 work injury. We affirm.
Brenda Hahn, the employee, sustained a personal injury while working for Perham Memorial Hospital and Home, the employer, on July 21, 2000. The employer and its insurer admitted liability for the employee=s injury and paid various workers= compensation benefits.
On July 21, 2000, the employee was a passenger in a vehicle which was struck by another vehicle causing it to roll over. The employee was unconscious for a period of time following the accident. She was transported by ambulance to Perham Hospital and was later transferred to MeritCare Medical Center in Fargo, North Dakota. The employee was diagnosed with a laceration of the right ear and a fractured dislocation of C5-6 with bilateral C5 radiculitis. Initially, the employee was placed in halo traction and later fitted with a halo vest. On August 6, 2000, Dr. Maria Li performed an open reduction and internal fixation of the C5-6 fracture with wiring and bone graphs of the posterior processes of C4-C6. Despite the surgery, there was poor alignment at the fracture site and Dr. Li and Dr. Harry Weiser again operated on the employee on August 10, 2000, removing bone fragments and placing Allograft and stabilization plates from C4-C6. Following the second surgery, the employee underwent physical therapy.
During her hospitalization, the employee was examined by Dr. Patrick J. Konewko, a neuropsychologist, for a questionable traumatic brain injury because the employee and the hospital staff reported symptoms of anxiety, inattention and memory. The employee reported long-standing problems falling asleep and anxiety for many years. She had been placed on medication for this condition the previous summer. Dr. Konewko believed the employee was experiencing anxiety due, in part, to her car accident and, in part, to long-standing personality traits and problems. He recommended the employee continue with her medication but found no evidence of any post-traumatic stress disorder. The doctor noted, however, the employee was an individual who was at risk for developing more psychological disability as a result of her car accident.
Upon her discharge from the hospital, the employee followed with Dr. Li. On April 24, 2001, Dr. Li diagnosed a whiplash injury with neck pain, status post fusion, and subjective neurological complaints without objective signs of instability. The doctor noted the employee had some legitimate complaints due to her personal injury, but noted she had Aperhaps fostered in her [the employee] a tendency to expect less of herself.@ (Pet. Ex. C.) Dr. Li recommended the employee return to work four hours a day. On May 24, 2001, the employee told Dr. Li she felt she was unable to work more than three hours, three times a week and stated she was unable to drive because of a severe driving phobia. Dr. Li found no Apsychological reason why this patient can=t drive or can=t work, but I understand that this patient also has chronic renal failure and I suspect that this may be a concomitant cause of her fatigue.@ The doctor noted the employee also had a very severe driving phobia. (Pet. Ex. C.) On June 26, 2001, Dr. Li stated she thought that all of the employee=s issues were psychological and psychosocial and she was going to leave those issues to the employee=s family physician. Dr. Li last saw the employee on February 15, 2002, at which point she stated the employee was mechanically and neurologically stable and recommended she return in one year.
The employee saw Dr. Steven D. Berndt on July 13, 2001, on referral from Dr. Li. Dr. Berndt diagnosed a cervical postlaminectomy syndrome, development of a chronic pain syndrome and obesity. The doctor prescribed an analgesic, muscle relaxant and TENS unit and referred the employee to Dr. Larry Bauste, a clinical psychologist, whom she saw on August 14, 2001. Dr. Bauste obtained a history from the employee, conducted a medical status examination and concluded the employee was psychologically intact, but experiencing anxiety and depression in response to her motor vehicle accident with subsequent chronic pain. The doctor recommended individual therapy to develop a systematic desensitization procedure for driving and a pain coping therapy group. The employee followed with Dr. Bauste thereafter. By report dated January 22, 2002, Dr. Bauste stated he suspected the employee had problems with anxiety before the accident, but opined the anxiety was exacerbated by her injury. The doctor stated the employee had attained maximum medical improvement (MMI) with respect to her psychological functioning.
The employee was examined by Dr. Donald Starzinski on September 13, 2001, at the request of the employer and insurer. The doctor obtained a history from the employee, reviewed her medical records and conducted a neurological examination. Dr. Starzinski diagnosed cervical spine pain following a fracture and dislocation at the C5-6 level with Asubstantial psychiatric symptom metrology@ with features of Aboth anxiety and depression.@ The anxiety symptoms, the doctor opined, related to a pre-existing anxiety disorder rather than any specific problem resulting from the injury of July 21, 2000. Dr. Starzinski also opined the employee had reached MMI from the effects of her July 21, 2000 personal injury. Dr. Starzinski subsequently reviewed additional medical records, including those from MeritCare Health System with notes from its neurosurgery, psychiatric and coordinated treatment departments. By report dated April 5, 2002, the doctor stated review of those records did not change any of his opinions from his prior examination. Dr. Starzinski further stated the employee certainly might have some ongoing chronic pain issues secondary to her work injury, but the doctor again concluded the employee had reached MMI with regard to those symptoms. The doctor again repeated the employee=s ongoing psychological and psychiatric symptoms were a result of pre-existing problems with an anxiety disorder and not specifically related to the work injury.
The employer and insurer filed a NOID to which the employee filed an objection. The case was ultimately heard by a compensation judge on April 9, 2001. In a Findings and Order filed May 2, 2002, the judge documented the parties= stipulation that the employee had reached MMI from the physical aspects of her personal injury by September 24, 2001. The compensation judge then found the employee failed to prove she suffered a consequential psychological injury as a result of her physical injury of July 21, 2000, and allowed the employer and insurer to discontinue benefits. The employee appeals.
The employee contends the compensation judge=s determination that the employee did not sustain a psychological injury is clearly erroneous and unsupported by substantial evidence. The employee concedes she had symptoms of anxiety and depression prior to July 21, 2000, but points out she was not under treatment or taking any medication for those conditions until after her personal injury. Further, the employee contends her driving phobia did not pre-exist her personal injury so must be due to the personal injury. Citing Pickart v. Multi-Resource Center, slip op. (W.C.C.A. Nov. 30, 1987) the appellant contends the compensation judge=s decision is clearly erroneous and unsupported by substantial evidence.
In the Pickart case, the compensation judge found the employee=s automobile accident was a substantial and contributing cause of a driving phobia. On appeal, the employer and insurer argued the compensation judge=s decision was unsupported by substantial evidence because the employee had a history of pre-existing psychological problems. In affirming the compensation judge, this court stated the fact that the Aemployee has a history of psychological problems is not in and of itself a basis upon which to find a lack of causation between the employee=s driving accident and her phobia. It would be an unfounded and unfair presumption to assume that because of past problems, the employee would have sooner or later developed a driving phobia without an intervening cause. Though the employee may have had a pre-existing psychological condition which made her more inclined to develop a phobia, it took the automobile accident to trigger the development of that phobia.@ Id. at 4.
We disagree the Pickart case is controlling here. This court=s affirmance, on a substantial evidence basis, of a compensation judge=s finding is of limited precedential value. See e.g., Regan v. VOA Nat=l Housing, 61 W.C.D. 142 (2000). The issue in Pickart, as it is in this case, is whether substantial evidence supports the compensation judge=s decision. The compensation judge here relied upon the opinions of Dr. Starzinski, which she found more persuasive than those of the employee=s treating physicians. The resolution of a conflict in expert medical testimony is the function of the compensation judge. See Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985).
The employee further argues the opinions of Dr. Starzinski lack adequate foundation and should not have been relied upon by the compensation judge. We are not persuaded. Dr. Starzinski has a bachelors degree in psychology, a doctorate degree in psychopharmacology and is a medical doctor, board certified in neurology and psychology. Dr. Starzinski reviewed the employee=s medical records and conducted a physical examination. As a general rule, this level of medical expertise and practical experience establishes competency to provide an expert medical opinion. See Reinhardt v. Colton, 337 N.W.2d 88 (Minn. 1983). Dr. Starzinski was aware the employee claimed a driving phobia resulting from her personal injury and reviewed Dr. Bauste=s treatment records. Dr. Starzinski, however, concluded the claimed driving phobia Ain my opinion, simply represents symptoms of Ms. Hahn=s long-standing anxiety disorder.@ (Resp. Ex. C.) This opinion is adequately founded. The compensation judge could, therefore, rely upon the opinions of Dr. Starzinski. The decision of the compensation judge must, therefore, be affirmed.
 Notice of Intention to Discontinue Workers= Compensation Benefits.