DONALD W. RADKE, Employee/Appellant, v. PARK CONSTR. CO. and TRAVELERS PROPERTY & CASUALTY, Employer-Insurer, and BLUE CROSS/BLUE SHIELD/BLUE PLUS and ALLINA MEDICAL CTR. (HASTINGS), Intervenors.
WORKERS= COMPENSATION COURT OF APPEALS
JANUARY 28, 2002
CAUSATION - SUBSTANTIAL EVIDENCE. Substantial evidence, primarily expert opinion, adequately supported the compensation judge=s decision that the employee=s work injury was merely temporary.
Determined by: Wilson, J., Rykken, J., and Johnson, J.
Compensation Judge: Ronald E. Erickson
DEBRA A. WILSON, Judge
The employee appeals from the compensation judge=s finding that the employee=s work injury had resolved by June 19, 2000. We affirm.
On September 23, 1999, the employee fell while walking and landed on his left knee. He had pain in the front of his knee when he walked and was seen at the River Valley Clinic later that day. On examination by a physician=s assistant, the employee had no pain to palpation, no swelling, and no lateral or medial instability. He was advised to take ibuprofen for a few days and to follow-up as needed.
The employee began work for Park Construction [the employer] in October of 1999. Five days later, on November 3, 1999, he slipped while on the job site and fell and struck his left knee on a steel beam. The employee finished his day of work and then went to the River Valley Clinic for treatment that night. At that time, he was complaining of tightness in the posterior knee. On examination, it was noted that the employee=s knee was normal color, that there was no obvious effusion, and that the medial and lateral ligaments were nontender and appeared intact. The doctor diagnosed a contusion of the knee and prescribed Relafen, elevation, and ice packs. Restrictions were placed on the employee=s work activities, and he was advised to return to the clinic in one week. On November 4, 1999, the employee was told that he had been laid off from his job with the employer.
When the employee returned to the River Valley Clinic on November 10, 1999, he was observed to be in no apparent distress. However, the employee complained of pain in the knee and lower leg, and examination revealed some swelling over the patella and pretibial area, with those areas being tender to palpation. Dr. Anthony Walsh also diagnosed a knee contusion and continued the employee=s work restrictions, including no kneeling directly on the knee, no climbing ladders or squatting, and a 25-pound weight restriction. On November 18, 1999, Dr. Walsh reported that the employee=s knee was normal appearing, without obvious swelling, deformity, or discoloration, although the employee did have some tenderness over the medial portion of the knee. The employee reported that his knee was much improved, and Dr. Walsh advised him to gradually increase his activity as tolerated. The only written restriction at that time was no squatting or kneeling.
On December 14, 1999, the employee again saw Dr. Walsh, reporting that his knee continued to bother him over the medial surface. Dr. Walsh referred him for an orthopedic examination and continued the employee=s restrictions, adding a 25-pound weight limit and no climbing ladders or squatting.
Dr. Jack Drogt conducted an orthopedic examination on January 14, 2000, and made two diagnoses: a contusion of the knee, which the doctor felt was still symptomatic, and pre-existing degenerative joint disease, which the doctor believed had been aggravated by the work injury. Dr. Drogt prescribed physical therapy and anti-inflammatory medication but released the employee to work without restrictions. On February 11, 2000, Dr. Drogt opined that the employee had sustained a significant contusion and Amay have sustained a medial meniscal tear,@ and he reinstated restrictions on the employee=s work activities.
The employee returned to Dr. Drogt on March 17, 2000, indicating that Ahe is reasonably comfortable.@ Dr. Drogt allowed the employee to increase his activities as tolerated and to return to work Afull-time, full-duty,@ and he instructed the employee to return to see him again in two months. The employee returned to the doctor again on March 24, 2000, indicating that he had Anot been able to return to work in a normal capacity because of the nature of his work.@ Dr. Drogt recommended an MRI and again placed restrictions on the employee=s work activities through April 7, 2000, preparing a report of work ability that advised the employee to return to the clinic by April 7.
The employee was seen by Dr. Paul Cederberg for an independent medical examination on June 19, 2000. In his report of that date, Dr. Cederberg noted 1+ effusion of the left knee and some discrepancies on examination. It was his opinion that the employee had sustained a contusion of the left knee as a result of the work injury, which had since resolved. Dr. Cederberg was also of the opinion that the employee had Aa significant pre-existing condition of degenerative arthritis of the left knee with narrowing of the medial compartment.@ He opined in his report that the employee=s ongoing symptoms were not related in any manner to the September 1999 work injury.
The employee did not return to the River Valley Clinic until October 4, 2000, at which time he was seen by Dr. Walsh. Dr. Walsh noted that the employee=s left knee appeared normal, without obvious swelling or deformity, and that the employee had tenderness over the medial joint line, with minimal tenderness on the lateral joint line surface. Dr. Walsh agreed that the employee needed an MRI and restricted the employee from climbing, squatting, or kneeling. The employee was continued on work restrictions and Naprosyn thereafter. It was eventually determined that the employee could not undergo an MRI because of metal in his eye, but an arthrogram done on May 22, 2001, was interpreted as normal, with no meniscal tear. The employee eventually returned to work for a different employer.
On February 29, 2000, the employee filed a claim petition seeking temporary total disability benefits from November 4, 1999, to December 20, 1999, and temporary partial disability benefits thereafter. An amended claim petition was filed on April 5, 2000, adding a claim for penalties. The matter proceeded to hearing on May 31, 2001. In findings and order filed on July 31, 2001, the compensation judge found, in part, that the employee=s left knee problems secondary to the contusion of November 1999 had resolved as of June 19, 2000, and that the employee=s wage loss after June 20, 2000, was not causally related to the work injury. The employee appeals.
STANDARD OF REVIEW
In reviewing cases on appeal, the Workers= Compensation Court of Appeals must determine whether Athe findings of fact and order [are] clearly erroneous and unsupported by substantial evidence in view of the entire record as submitted.@ Minn. Stat. ' 176.421, subd. 1 (1992). Substantial evidence supports the findings if, in the context of the entire record, Athey 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 evidence conflicts or more than one inference may reasonably be drawn from the evidence, the findings are to be affirmed. Id. at 60, 37 W.C.D. at 240. Similarly, A[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). Findings of fact should not be disturbed, even though the reviewing court might disagree with them, Aunless 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 contends that the compensation judge erroneously relied on the report of Dr. Cederberg in concluding that the employee had recovered from the effects of his work injury by June 19, 2000. The employee contends that the employee=s testimony and the medical records do not support the judge=s conclusion that the work injury had resolved by June 19, 2000. We agree that the employee=s testimony does not support the judge=s conclusion; however, the judge specifically accepted Dr. Cederberg=s opinion that the work injury resolved by June 19, 2000.
A compensation judge=s choice between experts whose testimony conflicts is usually upheld unless the facts assumed by the expert in rendering his opinion are not supported by the evidence. Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985). The employee has pointed to no fact or facts assumed by Dr. Cederberg that are not supported by the evidence. Dr. Cederberg relied on the x-ray taken by Dr. Drogt in January of 2000 in opining that the employee had pre-existing degenerative joint disease, the same diagnosis made by Dr. Drogt. Dr. Cederberg also relied on the fact that, according to the medical records, Dr. Drogt released the employee to return to work without restrictions on January 14, 2000. All of Dr. Cederberg=s medical record references are supported by evidence in the record. The employee contends that Dr. Cederberg=s opinions are lacking in foundation because he failed to mention the fact that, after a temporary period of no restrictions in January of 2000, Dr. Drogt reinstated restrictions that he had previously recommended. However, while Dr. Cederberg did not specifically mention the reinstatement of restrictions in his report, he did clearly indicate that he had reviewed the February 11, 2000, records of Dr. Drogt, and it is at that time that Dr. Drogt reinstated the employee=s restrictions.
In addition to the medical evidence mentioned in the compensation judge=s decision, we note that on March 17, 2000, Dr. Drogt again released the employee to return to work without restrictions, and, when he reinstated restrictions on March 24, 2000, those restrictions were only valid through April 7, 2000. The employee did not return to the River Valley Clinic between March 24, 2000, and October 4, 2000. As such, he was not subject to ongoing restrictions at the time he was evaluated by Dr. Cederberg. We also note that after March 17, 2000, there is no reference in either Dr. Drogt=s or Dr. Walsh=s records to ongoing problems with a left knee contusion or degenerative joint disease. Rather, from March 24, 2000, and forward, the employee was continually described as suffering from Aknee pain@or Apossible medial meniscal tear@ or Apossible ACL tear.@ In his narrative report dated April 25, 2001, Dr. Walsh stated, A[t]o this date the exact diagnosis of patient=s knee pain is not known since he has not had the MRI scan.@
The employee also contends that Dr. Cederberg failed to explain his opinion, thus rendering it speculative. It would have been helpful if Dr. Cederberg had explained why he did not believe the November 1999 work injury aggravated or accelerated the pre-existing degenerative joint disease. However, in a similar vein, Dr. Drogt failed to explain why he believed that the work injury did aggravate the pre-existing condition, and, in his report of April 25, 2001, Dr. Walsh could only say that the knee contusion Amay have aggravated pre-existing degenerative joint disease.@ Again, we rely on the compensation judge to choose between conflicting expert opinions.
The report of Dr. Cederberg provides adequate evidence to support the compensation judge=s conclusion that the employee=s work injury was temporary and had resolved as of June 19, 2000. That report is not based on evidence which is not in the record. While the record would also have supported a finding that the employee=s work injury continued to be a substantial contributing cause of his ongoing left knee complaints, where evidence conflicts or more than one inference may reasonably be drawn from the evidence, the judge=s findings are to be affirmed. Hengemuhle v. Long Prairie Jaycees, 358 N.W.2d 54, 60, 37 W.C.D. 235, 240 (Minn. 1984). We therefore need not reach the issue of whether the employee is entitled to benefits after June 19, 2000. The compensation judge=s decision is affirmed in its entirety.
 Dr. Cederberg also noted that on December 1, 1999, Dr. Walsh stated that he thought the employee was not yet at maximum medical improvement and that no permanency would result from the work injury. The employer and insurer make specific mention of this report in their brief. We could not find that report, but the employee does not specifically dispute the existence of such an opinion when questioning the foundation for Dr. Cederberg=s opinions.