MICHAEL J. MINIER, Employee/Appellant, v. ERNEST FOREST PRODS. and LUMBERMEN=S UNDERWRITING ALLIANCE, Employer-Insurer, and ST. MARY=S MEDICAL CTR., POLINSKY MEDICAL REHAB. CTR. and DULUTH CLINIC, LTD., Intervenors.
WORKERS= COMPENSATION COURT OF APPEALS
FEBRUARY 14, 2003
CAUSATION - SUBSTANTIAL EVIDENCE; CAUSATION - INTERVENING CAUSE. Substantial evidence, including the well-founded opinion of the independent medical examiner, supports the compensation judge=s finding that the employee=s work-related injury of September 30, 1999, in the nature of a medial collateral ligament (MCL) strain, had resolved by December 1999, and was not a cause of the employee=s need for right knee surgery in July 2001. The compensation judge=s characterization of the March 2001 incident at home as a superseding, intervening cause, although incorrect, was harmless error where it was clear that the judge, in fact, concluded that the September 30, 1999 work injury had resolved, and that the injury in March 2001 was a new and wholly separate cause of the employee=s subsequent need for surgery.
Determined by Johnson, C.J., Wilson, J., and Stofferahn, J.
Compensation Judge: Gregory A. Bonovetz
THOMAS L. JOHNSON, Judge
The employee appeals from the compensation judge=s findings that by December 1999, the employee had recovered from the effects of his admitted, personal injury to the right knee on September 30, 1999; that the employee sustained a superseding, intervening injury to his right knee in early March 2001 which was the substantial cause of his need for surgery; and that the employee=s September 30, 1999 personal injury was not a substantial contributing cause of the employee=s right knee condition in the spring of 2001 or his need for surgery in July 2001. We affirm.
Michael J. Minier, the employee, sustained a personal injury on September 30, 1999, while working as a logger for Ernest Forest Products, the employer, then insured by Lumbermen=s Underwriting Alliance. On that date, the employee was struck on the head by a falling tree, sustaining an injury to his head and right knee. The employer and its insurer accepted liability for the employee=s personal injury.
The employee was taken to the Cook County North Shore Hospital immediately following his injury. He was diagnosed as having suffered a probable medial collateral ligament (MCL) strain with a possible meniscal injury, and a knee immobilizer was applied to the employee=s right knee. On October 7, 1999, the employee saw Dr. Janus Butcher, an orthopedic surgeon with the Duluth Clinic. Dr. Butcher ordered an MRI scan which showed bone bruising of the proximal tibia and a partial tear of the MCL, without meniscal tears. The lateral collateral, anterior cruciate and posterior cruciate ligaments were intact and normal. Dr. Butcher diagnosed a Grade III MCL strain. By December 2, 1999, Dr. Butcher stated the employee=s symptoms had fully resolved and he released the employee to return to work at full duty.
The employee returned to his regular employment with the employer in December 1999. He testified he did not thereafter complain to any of his coworkers about knee pain and did not limp at work. However, the employee stated his knee was always a little sore and would occasionally lock up when he performed certain duties at work. In July 2000, the employee was terminated by the employer. From August through November 2000, the employee worked for Viking Pulpers and then started his own logging business. The employee testified this job was similar to the other logging businesses he had worked for. The employee worked in the woods felling and removing limbs from trees and hauling them out of the woods with a log skidder. The employee testified he was able to perform all of the duties of this job without missing any time from work due to his knee condition.
In March 2001, the employee got up from a couch in his home to answer the telephone and his knee buckled. The employee testified his knee had buckled in the past but the March 2001 incident was much more severe. The employee returned to see Dr. Butcher on March 9, 2001. He gave a history of recurrent instability following his September 1999 injury with a buckling incident in early March causing significant pain and swelling. Dr. Butcher diagnosed recurrent instability in the setting of a complete MCL disruption and a partial anterior cruciate ligament (ACL) tear. Dr. Butcher opined the employee=s condition was related to his initial workers= compensation injury.
Dr. Butcher referred the employee to Dr. Thomas Kaiser whom he saw on April 17, 2001. On examination, the doctor noted posterolateral instability, a positive McMurray=s sign and positive shift maneuver. An anterior drawer test demonstrated no anterior laxity. The doctor reported the employee=s MCL injury appeared well healed. Dr. Kaiser recommended arthroscopic surgery, which he performed on July 17, 2001. During surgery, the doctor found the employee=s ACL was avulsed off the femur and the lateral meniscus was torn. The doctor=s post operative diagnosis was anterior cruciate insufficiency of the right knee, with grossly positive pivot shift and a torn lateral meniscus posterior horn, treated by reconstructive surgery. The employee followed with Dr. Kaiser after his surgery. By September 10, 2001, the doctor noted the employee walked well without a limp and released the employee to return to medium-level work. By March 19, 2002, Dr. Kaiser concluded the employee had a very stable knee. He recommended the employee continue to use his knee brace for protection while working. On November 21, 2001, Dr. Kaiser=s physical examination of the employee=s right knee was unchanged. The doctor concluded the employee had good medial and lateral stability, and x-rays demonstrated the knee joint was in good alignment. By report dated December 22, 2001, Dr. Kaiser concluded the employee was not yet at maximum medical improvement (MMI). The doctor further opined the employee=s September 30, 1999 injury was the initiating incident that caused his subsequent knee problems.
Dr. Richard Strand examined the employee on May 11, 2001, at the request of the employer and insurer. The doctor obtained a history of the 1999 work injury and the incident at home in March 2001. On examination, Dr. Strand found a full range of motion of the right knee, no effusion and a negative pivot shift. He noted the employee had moderate instability of the MCL. The doctor stated his examination of both knees was essentially normal. The doctor concluded the employee sustained a strained medical collateral ligament in the right knee on September 30, 1999. Dr. Strand opined this injury fully resolved within twelve weeks and stated the employee needed no further care relative to that injury. Finally, Dr. Strand opined the employee had reached MMI from the effects of his September 30, 1999 injury and sustained no permanent partial disability.
The employee filed a claim petition seeking temporary total disability benefits from and after March 9, 2001, together with medical expenses incurred for the right knee surgery. The case was heard by a compensation judge at the Office of Administrative Hearings on May 30, 2002. In a Findings and Order filed September 9, 2002, the judge found the employee sustained a strain of his medial collateral ligament on September 30, 1999, but recovered from the effects of that injury by December 1999. The compensation judge further found the employee sustained a superseding, intervening injury to his right knee in early March 2001 which was the substantial cause for the surgery. Finally, the judge found the September 30, 1999 personal injury was not a substantial contributing cause to the employee=s right knee condition in the spring of 2001 or to his need for surgery in July 2001. Accordingly, the judge denied the employee=s claims for benefits. The employee appeals.
The employee first argues the opinions of Dr. Strand lack foundation. He contends Dr. Strand=s findings on examination in May 2001 differ so dramatically from those of Dr. Kaiser in April 2001 that they must be either wrong or fabricated. Accordingly, the employee contends the compensation judge improperly relied upon the opinions of Dr. Strand and the judge=s denial of benefits must be reversed. We disagree.
Dr. Strand obtained a history from the employee, reviewed his medical records and conducted a physical examination. As a general rule, this combination of medical expertise and practical experience is sufficient to establish competency to provide an expert medical opinion. See Grunst v. Immanuel-St. Joseph Hosp., 424 N.W.2d 66, 40 W.C.D. 1130 (Minn. 1988). As a part of his examination, Dr. Strand reviewed Dr. Kaiser=s April 17, 2001 report. In addition, the doctor reviewed the MRI scan of the employee=s right knee obtained on October 21, 1999, showing a partial tear of the MCL; the anterior cruciate ligament was normal. The doctor=s physical examination was essentially normal. Dr. Strand concluded the employee sustained a strain of his MCL on September 30, 1999, that had healed within six to twelve weeks. This is not an unreasonable conclusion based upon the MRI study. This conclusion is also consistent with Dr. Kaiser=s opinion on April 17, 2001 that the employee=s MCL injury had healed. The compensation judge properly relied upon Dr. Strand=s opinions, and we affirm.
The employee next argues the compensation judge erred in finding the employee=s March 2001 injury at home was a superseding, intervening injury to his right knee. The employee argues his activity at home was not unreasonable, negligent or dangerous conduct, thus the home incident cannot constitute a superseding, intervening cause of the injury. See Nelson v. American Lutheran Church, 420 N.W.2d 588, 40 W.C.D. 845 (Minn. 1988). Accordingly, the employee asks the compensation judge=s denial of his claim be reversed. We decline to do so.
AA superseding, intervening cause is one which severs the causal link between the original personal injury and the resultant disability such that the original personal injury is no longer a substantial and contributing cause of the resultant disability.@ Buford v. Ford Motor Co., 52 W.C.D. 723, 728 (W.C.C.A. 1995), summarily aff=d (Minn. June 30, 1995). Thus, the doctrine of superseding, intervening cause is applicable only in those cases in which the effects of the original personal injury continue until the occurrence of some new nonwork-related incident or event which breaks the causal connection between the original injury and the resultant disability. Here, however, the compensation judge found the effects of the personal injury ended by December 1999 and was not a cause of the employee=s need for surgery in July 2001. Although the compensation judge labeled the March 2001 incident a Asuperseding, intervening injury,@ we conclude such characterization was an inadvertent and harmless error. Clearly, the compensation judge=s actual conclusion was that the March 2001 incident was a new and wholly separate cause of the employee=s subsequent disability and need for surgery. This conclusion is supported by the evidence in the case and must, therefore, be affirmed.