HELEN M. ZILKA, Employee/Appellant, v. WAL-MART STORES, INC., and AMERICAN INT=L GROUP/CLAIMS MANAGEMENT, INC., Employer-Insurer, and HEALTHPARTNERS, INC., Intervenor.
WORKERS= COMPENSATION COURT OF APPEALS
APRIL 19, 2002
MEDICAL TREATMENT & EXPENSE - CHIROPRACTIC TREATMENT; MEDICAL TREATMENT & EXPENSE - REASONABLE & NECESSARY. Where it was evident from her decision that, in addition to the pre-scheduling of the treatment at issue, the judge carefully considered the medical evidence presented by the parties, together with the employee=s testimony as to the effectiveness and other aspects of the chiropractor=s treatment, the judge=s conclusion that the final six of thirty-four chiropractic treatments were not reasonable and necessary was not clearly erroneous and unsupported by substantial evidence.
Determined by Pederson, J., Rykken, J., and Wilson, J.
Compensation Judge: Jeanne E. Knight.
WILLIAM R. PEDERSON, Judge
The employee appeals from the compensation judge=s finding that chiropractic treatment provided after April 19, 2000, was not reasonable and necessary to cure and relieve the employee from the effects of her work injury of July 13, 1999. We affirm.
The facts in this case are essentially undisputed. On July 13, 1999, Helen Zilka [the employee] sustained a Gillette-type injury to her neck and back while working as a stocker for Wal-Mart Stores, Inc. [the employer]. The employee=s job required her to move pallets of merchandise from the back room to the sales floor using a pallet jack. She would then unload the pallet, fill shelves left empty by customer shopping, and then clear the aisle of empty boxes and product overstock. The employee would also take on additional duties when her department manager was on vacation or away from the store on other assignments.
During June and July of 1999, the employee performed her usual department duties but also worked in a second department, performing manager=s duties in both departments. During this period, the employee worked an average of five hours of overtime each week and began to experience headaches and soreness in her neck, in her shoulders, and in the middle of her back. By July 13, 1999, the employee was experiencing her headache and sore neck symptoms daily. Two days later she reported these symptoms to her employer as an injury.
On July 16, 1999, the employee began treating with chiropractor Dr. Robert Roloff, who restricted her from lifting more than ten pounds, from reaching overhead, and from pulling heavy pallets. Dr. Roloff=s treatment included manipulations and moist heat three times a week for the first three weeks and gradually less frequently thereafter. The employee=s appointments were pre-scheduled from July 16, 1999, through June 9, 2000, and after that were on an as-needed basis. The treatment modalities administered by Dr. Roloff have essentially remained the same since the employee=s initial visit.
On May 8, 2000, the employee filed a claim petition seeking payment for Dr. Roloff=s treatment related to her July 13, 1999, injury. The employer and its workers= compensation insurer responded by denying primary liability.
Orthopedic surgeon Dr. Tilok Ghose examined the employee on behalf of the employer and insurer on August 11, 2000. In a report issued August 30, 2000, Dr. Ghose concluded that the employee had suffered a temporary aggravation of a pre-existing condition, which he diagnosed as a myofascial strain to the cervical spine. The doctor opined that chiropractic treatment was reasonable and necessary up to the end of September 1999 and that the employee would have reached maximum medical improvement by that time. He found the employee=s physical examination to be normal and consequently placed no restrictions on her activities and assessed no permanent partial disability.
In a letter to the employee=s attorney dated April 4, 2001, Dr. Roloff diagnosed the employee=s condition as a chronic musculoligamentous sprain/strain of the cervical and thoracic spine. He reported that the employee had ongoing muscle spasm from time to time and degenerative disc changes in the cervical spine. The employee was being treated on a PRN basis at the time, and the doctor indicated that Athe frequency of treatment is dependent on the amount of repetitive work she does while at work.@
The employee=s claim for payment of her chiropractic treatment expenses came on for hearing before a compensation judge on June 19, 2001. Evidence at trial included the employee=s testimony and her medical records. The employee testified to gradual improvement in her condition with Dr. Roloff=s treatment and with limiting of her activities at work. She testified that by March or April of 2000, Dr. Roloff wanted to see her every three months on a preventative basis. She indicated also that, in early 2001, she was transferred to the employer=s pharmacy department, where the work is lighter and does not aggravate her condition. She testified also that her use of over-the-counter medication has been substantially reduced, that she rarely has headaches, and that her neck and back hurt only when she Ahappen[s] to do something to pull it wrong or if there isn=t somebody there to help.@ She indicated that she has lost no time from work due to her injury. In a decision issued August 20, 2001, the compensation judge found the employee=s chiropractic treatment through April 19, 2000, to be reasonable and necessary and causally related to the work injury. She concluded that treatment after that date was not reasonable and necessary. 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.
At issue before the compensation judge was the reasonableness, necessity, and causal relationship of the thirty-four treatments incurred by the employee with Dr. Roloff between July 16, 1999, and March 26, 2001. The judge awarded the first twenty-eight of the treatments, concluding that they were not excessive and that they had allowed the employee to continue working with no loss of time. The judge denied those treatments after April 19, 2000, concluding that the employee had not proved that they were reasonable and necessary.
An employee has the burden of proving that his or her claimed medical expenses were reasonable, necessary, and causally related to his or her work injury. See, e.g., Adkins v. University Health Care Ctr., 405 N.W.2d 233, 39 W.C.D. 898 (Minn. 1987). The determination of whether particular services rendered by a chiropractor were reasonably required to cure and relieve the employee from the effects of the injury at issue is a factual one to be made by the compensation judge. Pursuant to well established case law, a number of factors may be considered in analyzing the reasonableness and necessity of chiropractic treatment. See Field-Seifert v. Goodhue County, slip op. (W.C.C.A. Mar. 5, 1990); Horst v. Perkins Restaurant, 45 W.C.D. 9 (W.C.C.A. 1991), summarily aff=d (Minn. July 10, 1991). AThe appropriate factors will vary from case to case, depending upon the unique circumstances of each situation.@ Fuller v. Naegele/Shivers Trading, slip op. (W.C.C.A. Apr. 14, 1993).
In the present case, the employee contends that the compensation judge applied an incorrect legal standard in determining that the treatment provided by Dr. Roloff after April 19, 2000, was not reasonable and necessary. The judge concluded in Finding 6 that the employee=s Aappointments were pre-scheduled from July 16, 1999 through June 9, 2000, at which time he released her prn@ and A[h]e now wants to see the employee every three months for preventative care.@ The employee contends that the only factor considered by the judge was whether or not the treatment was preventative or maintenance in nature, to the exclusion of the several other factors identified by case law. We disagree.
There is no question that the compensation judge=s determination in this case was affected by the employee=s testimony that about April 2000 Dr. Roloff had indicated that he wanted to see the employee every three months on a preventative basis. This testimony was also consistent with the employee=s testimony that she was feeling Apretty good@ on the date of the hearing, even though she was scheduled for treatment with Dr. Roloff the following week. We do not agree, however, that these were the judge=s only considerations.
In support of her denial, the judge noted, in addition to her finding that appointments were pre-scheduled beginning July 16, 1999, that the employee=s current job in the pharmacy department is lighter in nature than her previous job and does not aggravate her condition. The judge noted also that, although Dr. Roloff=s treatment plan in July 1999, to provide care during the acute phase of the injury, was altered in January 2000 to provide rehabilitative and supportive care, the treatment provided under each plan remained the same. She noted further that the employee essentially testified to currently having minimal symptoms. It is evident from these conclusions that the compensation judge carefully considered the medical evidence presented by the parties and the employee=s testimony as to her response to Dr. Roloff=s treatment. Substantial evidence in the record supports the judge=s determination that the treatment provided after April 19, 2000, was not reasonable and necessary. Accordingly, we affirm the judge=s decision. Hengemuhle v. Long Prairie Jaycees, 358 N.W.2d 54, 37 W.C.D. 235 (Minn. 1984).
 See Gillette v. Harold, Inc., 257 Minn. 313, 101 N.W.2d 200, 21 W.C.D. 105 (1960).