RITA BRYANT, Employee, v. HONEYWELL, INC., SELF-INSURED, adm'd by SEDGWICK CLAIMS MGMT. SERVS., Employer/Appellant.
WORKERS= COMPENSATION COURT OF APPEALS
APRIL 25, 2003
CAUSATION - SUBSTANTIAL EVIDENCE. Substantial evidence, including records of the employee=s treating physicians and the employee=s testimony, supports the compensation judge=s finding that the employee sustained a cervical spine injury on January 4, 1979, and that the treatment received to the cervical area at Medical Advanced Pain Specialists and the Minneapolis Clinic of Neurology was causally related to her 1979 work injury.
MEDICAL TREATMENT & EXPENSE - TREATMENT PARAMETERS. The treatment parameters may not be applied to deny payment for treatment rendered after the employer denied liability asserting the injury had resolved.
MEDICAL TREATMENT & EXPENSE - REASONABLE & NECESSARY. Substantial evidence, including the adequately founded opinion of Dr. Dowdle, supports the compensation judge=s determination that treatment for the low back on January 17 and 30, 2002 was reasonable and necessary to cure and relieve from the effects of the employee=s 1995 personal injury to the low back.
Determined by Johnson, C.J., Wilson, J., and Stofferahn, J.
Compensation Judge: Nancy Olson
THOMAS L. JOHNSON, Judge
The self-insured employer appeals the compensation judge=s findings that the employee sustained an injury to her cervical spine on January 4, 1979, and that the employee=s treatment at Medical Advanced Pain Specialists (MAPS) and the Minneapolis Clinic of Neurology was causally related to her 1979 personal injury. The employer further appeals the compensation judge=s finding that the treatment provided to the employee by Dr. Dowdle was reasonable and necessary to cure and relieve the effects of the 1995 low back injury. We affirm.
Rita Bryant, the employee, began working for Honeywell, Inc., the employer, on September 14, 1977, and worked there continually through the date of the hearing. On January 4, 1979, the employee was pulling on a large crate when she felt pain over the top of her right shoulder. The employer, then self-insured for workers= compensation liability, with claims administered by Sedgwick Claim Management Services, admitted liability for the employee=s personal injury.
The employee saw Dr. Bruce Tennebaum at the Noran Clinic on April 16, 1979, on referral from Dr. Donald Miller. The employee reported an aching pain in her right neck and shoulder radiating into her right arm following her injury of January 4, 1979. The doctor diagnosed a myofascial strain syndrome, prescribed physical therapy and restricted the employee from heavier strenuous lifting. An x-ray of the right shoulder and cervical spine and an EMG of the right arm were normal. In August 1979, the employee was hospitalized at Abbott-Northwestern Hospital by Dr. Tennebaum for treatment of a cervical strain syndrome. She was discharged on August 31, 1979, with a diagnosis of myofascial strain syndrome and chronic trigonitis.
The employee continued to treat with Dr. Tennebaum. On May 8, 1980, his diagnosis was mild chronic myofascial strain syndrome for which he rated a five percent permanent partial disability and recommended a Neuroprobe stimulator for pain relief. In November 1980, Dr. Tennebaum restricted the employee to 15 to 20 pounds of lifting, with no repetitive reaching or shoulder motion. On April 6, 1981, Dr. Tennebaum stated the employee could return to work subject to his prior restrictions. The employee returned to the doctor in June 1981 complaining of a recurrence of pain in the medial scapular area on the right. The employee saw Dr. Tennebaum periodically thereafter with continued complaints of right supra and medial scapular pain of varying intensity. Dr. Tennebaum=s diagnosis remained chronic myofascial strain. In June 1990, Dr. Tennebaum stated the employee could work 40 hours a week subject to a 15-pound lifting restriction and no overhead reaching. The employee was seen by Dr. Tennebaum in May 1992, February 1993 and January 1994 with continued complaints of right trapezius pain.
On August 11, 1995, the employee sustained a low back injury for which the self-insured employer admitted liability. Initially, the employee treated with Kent J. Erickson, D.C., whom she saw on August 21, 1995. Dr. Erickson diagnosed a lumbar strain and commenced chiropractic care. The doctor released the employee to work eight hours a day subject to a ten-pound lifting restriction, with no repetitive bending or twisting. The employee continued to receive chiropractic care through May 1996.
On September 11, 1995, the employee returned to see Dr. Tennebaum. The employee stated that a recent job change at Honeywell caused her to do more reaching and triggered an onset of pain in the right trapezius area. The doctor again restricted the employee to no overhead work and imposed a 20-pound lifting restriction. The employee next saw Dr. Richard Koller at the Noran Clinic in September 1996, asking to have the work restrictions removed because she wanted to take a new job in light assembly at Honeywell. Dr. Koller opined that the employee had reached maximum medical improvement from the effects of her 1979 work injury and released her with no restrictions. The employee returned to see Dr. Tennebaum on February 4, 1997, complaining of problems at work when using a power driver. The doctor restricted the employee from using the power driver and again rated a five percent permanent partial disability secondary to her 1979 injury.
On August 12, 1997, the employee saw Dr. Jack Bert at Summit/Landmark Orthopedics complaining of shoulder pain since 1979. On examination, Dr. Bert noted dramatic tenderness in the mid-trapezial muscle group on the right over the top of the shoulder and in the insertion in the scapula superomedially. Dr. Bert diagnosed chronic right trapezial insertionitis and recommended the employee see Dr. Lon Lutz for trigger point injections. The employee was seen by Dr. Lutz at the Landmark Surgery Center on September 4, 1997. She gave a history of right-sided neck and shoulder pain since 1979. On examination, Dr. Lutz found full range of motion of the right arm without evidence of impingement or rotator cuff pathology, but found tenderness along the mid and upper portion of the trapezius and elevator scapula muscle on the right. Dr. Lutz recommended physical therapy. The employee saw Karen Guba, a registered physical therapist, on September 25, 1997 at the Minneapolis Clinic of Neurology. Ms. Guba commenced a series of ultrasound, myofascial release and trigger point therapies, together with strengthening exercises and heat. The employee returned to see Dr. Lutz on October 2 and October 23, 1997, and the doctor recommended continued conservative therapy.
On June 24, 1998, the employee saw Dr. John A. Dowdle at Summit/Landmark Orthopedics complaining of continued low back pain since August 1995. The doctor diagnosed degenerative disc disease and recommended conservative treatment. An MRI scan on October 6, 1998 reflected moderate degenerative disc disease at L5-S1, with a moderate-sized disc herniation causing mild to moderate compression on the left S1 nerve. Dr. Dowdle performed a lumbar epidural steroid injection at L5-S1 on November 9, 1998. On November 24, 1998, the employee reported a good response to the epidural injection. Dr. Dowdle recommended no further care and released the employee to return as needed.
Dr. Joseph Tambornino examined the employee on December 29, 1998, at the request of the employer. The doctor opined the medical treatment the employee received had been reasonable and necessary to relieve her from the symptoms and effects of the 1979 and 1995 work injuries. Dr. Tambornino, however, found no objective abnormalities to substantiate the need for any further medical care and concluded the employee had returned to her pre-injury status. The doctor opined the employee had reached maximum medical improvement and required no restrictions for either injury.
On November 14, 2001, the employee returned to see Dr. Lutz, then with Medical Advanced Pain Specialists (MAPS). The employee complained of continued neck and periscapular pain secondary to her 1979 work injury. Dr. Lutz injected a local anesthetic into the cervical epidural space and prescribed additional physical therapy. The employee returned to the Minneapolis Clinic of Neurology on January 8, 2002, on referral from Dr. Lutz, receiving eight physical therapy treatments consisting of therapeutic exercise, ultrasound and manual therapy.
The employee returned to see Dr. Dowdle on January 17, 2002, with complaints of low back pain since 1995. The doctor diagnosed left sacroiliac joint inflammation and prescribed anti-inflammatory medication. The employee followed up with Dr. Dowdle on January 30, 2002. His diagnosis was mechanical low back pain and degenerative disc disease at L5-S1. On March 28, 2002, Dr. Dowdle=s diagnosis was unchanged.
Dr. Tambornino re-examined the employee on June 18, 2002. The doctor obtained a history from the employee, reviewed her medical records and performed a physical examination. Dr. Tambornino diagnosed a mild cervical and upper scapular strain which he concluded had healed. The doctor found no objective abnormal findings to indicate an ongoing serious problem. With respect to the low back, the doctor diagnosed mild degenerative disc space narrowing without objective findings. Dr. Tambornino concluded the employee=s recent medical care was unrelated to her 1979 or 1995 injuries because the employee had previously healed from the mild strains of her neck and back. The doctor opined the employee needed no limitations on her work activities as a result of her personal injuries and was in need of no further medical care or treatment.
In a medical report dated September 25, 2002, Dr. Dowdle stated the employee=s diagnosis remained mechanical low back pain with a degenerative disc at L5-S1 which he attributed to the 1995 personal injury. Dr. Dowdle rated a seven percent whole body disability for the degenerative disc and opined the employee=s care and treatment was reasonable and necessary to cure and relieve her from the effects of her work injury. Finally, Dr. Dowdle recommended a diskogram to determine whether a fusion would be beneficial for the employee.
The employee filed a medical request seeking payment of expenses at Summit Orthopedics, the Minneapolis Clinic of Neurology and Medical Advanced Pain Specialists. The case was heard by a compensation judge on September 26, 2002. In a Findings and Order filed October 22, 2002, the compensation judge found the employee=s January 4, 1979 injury involved her cervical spine and right scapular area. The judge further found the care and treatment at Summit Orthopedics, the Minneapolis Clinic of Neurology and MAPS was reasonable and necessary to cure and relieve the employee from the effects of her 1979 and 1995 injuries. The self-insured employer appeals.
1. Cervical Treatment
The self-insured employer appeals the compensation judge=s finding that the employee sustained an injury to her cervical spine on January 4, 1979, and the judge=s finding that the employee=s treatment at MAPS and the Minneapolis Clinic of Neurology was causally related to her 1979 work injury. The employer argues these findings are unsupported by the medical records or the employee=s testimony at trial. The appellant contends the treatment has been ineffective, temporary and redundant. Further, the employer contends, the employee offered no expert testimony causally relating the treatment at issue to the 1979 injury. Accordingly, the appellant asks this court to reverse the award of benefits. We are not persuaded.
Minn. Stat. ' 176.135 requires the employer to provide such medical care Aas may reasonably be required at the time of the injury and any time thereafter to cure and relieve from the effects of the injury.@ Included under the statute is palliative care to prevent pain and discomfort even though the treatment cannot effect a cure. Castle v. City of Stillwater, 235 Minn. 502, 51 N.W.2d 370, 17 W.C.D. 103 (1952). The reasonableness and necessity of medical treatment under Minn. Stat. ' 176.135 is a question of fact for the compensation judge. See Hopp v. Grist Mill, 499 N.W.2d 812, 48 W.C.D. 450 (Minn. 1993).
In resolving this factual issue, the judge considered the treatment records of the Noran Clinic. These records reveal the employee saw Dr. Tennebaum on April 16, 1979, complaining of pain in her neck and right shoulder radiating into her right arm since her January 1979 work injury. In August 1979, Dr. Tennebaum hospitalized the employee for treatment of what he diagnosed as a cervical strain syndrome. The employee treated with Dr. Tennebaum periodically thereafter with complaints of pain in the cervical and shoulder areas. Based on this evidence, the judge concluded the employee required treatment of the cervical area as a result of her 1979 injury. The compensation judge also considered the employee=s testimony. The employee testified to continuing symptoms in an area the compensation judge described for the record as Athe right neck a little up and down and along the top of the shoulder.@ (T. 43.) The employee also testified the cervical epidural injections provided by Dr. Lutz and the physical therapy at the Minneapolis Clinic of Neurology improved her symptoms, alleviated pain and helped her to continue working. The employee further stated she sought medical care only when her pain flared up to the point that home treatment was unsuccessful. The judge found the employee=s testimony credible.
These are factors which the compensation judge may properly consider in reviewing the reasonableness and necessity of medical care. Horst v. Perkins Restaurant, 45 W.C.D. 9 (W.C.C.A. 1991). Substantial evidence supports the compensation judge=s decision and we must, therefore, affirm that decision. Hengemuhle v. Long Prairie Jaycees, 358 N.W.2d 54, 37 W.C.D. 235 (Minn. 1984).
The appellant further argues the physical therapy at issue is barred by the treatment parameters. See Minn. R. 5221.6010 et seq. We disagree. In his December 1998 report, Dr. Tambornino opined the effects of the employee=s 1979 and 1995 injuries had ended, she had returned to her pre-injury status and no further medical care was necessary. The employer denied liability, asserting the admitted injury had no continuing effects. In such circumstances, an employer Amay not reasonably rely on the parameters to deny payment for treatment rendered after the alleged resolution of the injury.@ Oldenburg v. Phillips & Temro Corp., 60 W.C.D. 8 (W.C.C.A. 1999). We, accordingly, affirm.
2. Lumbar Treatment
The employer appeals the compensation judge=s finding that the employee=s care with Dr. Dowdle was reasonable and necessary to cure and relieve the effects of the 1995 low back injury. The appellant argues Dr. Dowdle=s treatment has been ineffective, and has neither cured or relieved the employee=s symptoms despite four to five years of treatment. The appellant further argues Dr. Dowdle=s opinions lack foundation because there is no evidence he reviewed the employee=s prior medical records. Accordingly, the appellant contends the compensation judge=s findings are unsupported by substantial evidence and must be reversed.
The medical expenses at issue in this proceeding were charges from Dr. Dowdle for January 17 and January 30, 2002. In his examination on January 17, 2002, Dr. Dowdle found tenderness over the left sacroiliac joint and a positive hop test, drop test and Patrick test. By January 30, 2002, Dr. Dowdle again found low back tenderness but noted the employee had improved. The doctor opined the employee=s symptoms and his findings were consistent with an ongoing problem from her 1995 personal injury which caused mechanical low back pain consistent with a degenerative disc condition at L5-S1 causing pain in the left sacroiliac joint.
The competence of a witness to render expert medical testimony depends upon both the degree of the witness=s scientific knowledge and the extent of the witness=s practical experience with the matter at issue. Reinhardt v. Colton, 337 N.W.2d 88, 93 (Minn. 1983). Dr. Dowdle is an orthopedic surgeon and has treated the employee for low back pain since June 1988. At the time of his initial examination, Dr. Dowdle obtained a history from the employee, performed a physical examination and reviewed the results of a prior MRI scan. As a general rule, this level of knowledge establishes a doctor=s competence to render an expert opinion. See Grunst v. Immanuel-St. Joseph Hosp., 424 N.W.2d 66, 40 W.C.D. 1130 (Minn. 1998). That Dr. Dowdle may not have reviewed all of the employee=s prior medical records does not render his opinions without foundation. A medical expert=s failure to review certain medical records, to the extent those records are relevant, goes to the weight to be afforded the expert=s opinion not its admissibility. The compensation judge accepted Dr. Dowdle=s causation opinion. Although Dr. Tambornino reached a contrary conclusion, it is the compensation judge=s function to choose between conflicting medical evidence. Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985). The decision of the compensation judge is, therefore, affirmed.