LORI B. HUMPHREYS, Employee/Appellant, v. GRANDMAS, INC., and STATE FUND MUT. INS. CO., Employer-Insurer.
WORKERS= COMPENSATION COURT OF APPEALS
NOVEMBER 3, 2004
CAUSATION - SUBSTANTIAL CONTRIBUTING CAUSE. Substantial evidence supports the compensation judge=s finding that the employee=s work injury of July 2, 2002, was no longer a substantial contributing cause of the employee=s left upper extremity condition after March 27, 2003.
Determined by Rykken, J., Stofferahn, J., and Pederson, J.
Compensation Judge: Gregory A. Bonovetz
Attorneys: Russell J. LaCourse, Duluth, MN, for the Appellant. Steven T. Scharfenberg, Lynn, Scharfenberg & Assocs., Minneapolis, MN, for the Respondents.
MIRIAM P. RYKKEN, Judge
The employee appeals from the compensation judge=s finding that her injury was temporary in nature and his corresponding denial of temporary partial disability benefits as of August 3, 2003, as well as from the compensation judge=s denial of approval for a referral to Mark Bookhout for medical treatment. We affirm.
The employee, Lori Humphreys, sustained an admitted injury to her left hand on July 6, 2002, while employed by Grandma=s, Inc., the employer. At the time of the injury, as she had for a number of years, the employee held employment at two different restaurants, working approximately 10 to 15 hours per week with Grandma=s, Inc., and approximately 30 to 32 hours with another restaurant. She worked as a waitress or server for both employers.
During the years before her injury on July 6, 2002, the employee had received medical treatment for both upper extremities. In 1993, she sustained a left wrist sprain, in April 1996 she underwent physical therapy for a diagnosed overuse syndrome of the left shoulder with trapezius strain and multiple trigger points, in December 1996 she received treatment for left shoulder pain diagnosed as a subacromial bursitis, and in March 2002 she injured her left upper arm when she slipped on water and fell into a door jamb. In July 2000, she was diagnosed with right lateral epicondylitis or tennis elbow, for which she received physical therapy and a cortisone injection, and last treated for her right elbow in February 2001. There are no further medical reports in the record until June 6, 2002, when the employee consulted the Duluth Clinic for complaints of left hand pain radiating up her left arm, with tenderness in her third finger. X-rays taken of the employee=s left hand and wrist on that date were interpreted as being unremarkable, and the employee was diagnosed as having a probable sprain/strain and was provided with a left wrist splint. The employee next sought medical treatment on July 6, 2002, the date of her work-related injury.
On July 6, 2002, the employee attempted to dislodge ice jammed in an ice-making machine by using her left hand to push up the metal door of the machine. The ice dislodged and pushed the metal door down, causing the employee=s left hand and fingers to bend backward. As a result of pain and discomfort in the back of her left hand and fingers, the employee sought treatment at the emergency room of Virginia Regional Medical Center. The notes from that treatment reflect mild pain and tenderness in the left hand. The employee was diagnosed with a left hand sprain, and was released from the emergency room with a directive to use Tylenol as needed and to make an appointment with her treating physician if her condition did not improve. Six days later, on July 12, 2002, the employee consulted a physician=s assistant (PA) complaining of left hand swelling and constant achiness. The PA diagnosed the employee as having a hyperextension sprain/strain. X-rays taken on that day were noted as being unremarkable and unchanged from the x-ray taken on June 6, 2002.
On July 15, 2002, the employee consulted Dr. T. Scott Douglass, in the occupational medicine department of the Duluth Clinic. Dr. Douglass diagnosed a strain of the left hand or what seemed to be a hyperextension injury. Dr. Douglass advised the employee to Abuddy tape@ her index and middle finger of her left hand, provided her with an Ace wrap, and prescribed Ultram for pain relief. Dr. Douglass released the employee to return to work with restrictions of limited use of her left hand, as tolerated. Dr. Douglass later prescribed physical therapy and occupational therapy, and continued the employee=s work restriction of limited use of her left hand. Dr. Douglass later restricted the employee from work for three days in early September due to her continued symptoms.
The employee continued to work for both employers, favoring her left hand. The employee met with Dr. Dean Weber on September 10, 2002, for a surgical consultation. Dr. Weber concluded that the employee=s left hand problem did not appear to be related to any underlying tendon injury, but that the employee may have strained her volar ligaments with her hyperextension-type injury. Dr. Weber also determined the employee was not a surgical candidate, and referred the employee for a rheumatoid factor test to verify that her symptoms were not early signs of underlying rheumatic arthritis. Blood tests showed no arthritis. Dr. Weber referred the employee to Dr. John E. (Jed) Downs, occupational medicine specialist, for possibly adjustment of the employee=s work environment so that she did not require the hypertension in her fingers that caused her discomfort.
On September 23, 2002, the employee consulted Dr. Downs, and continued treating with him through at least late 2003. Dr. Downs diagnosed a wrist and elbow sprain with a component of mechanical dysfunction and mild flexor tendinitis of the second and third fingers secondary to the employee=s hyperflexion injury. Dr. Downs injected the employee=s finger tendons with corticosteroid, and prescribed physical therapy or occupational therapy for soft tissue work. The employee underwent eight physical therapy treatments but advised her therapist that although her pain had decreased, working and using her hand at home continued to cause pain. By October 14, 2002, the employee reported that she no longer experience shooting pain into her arm. The consulted Dr. Downs on November 11, 2002, reporting a flare-up of symptoms in her forearms afer carrying gallons of syrup up stairs at work.
At that point, the employee advised that she was working 8-13 hours per day, six days per week. Dr. Downs released the employee to return to work while wearing a left hand/wrist splint. By mid-November 2002, however, Dr. Downs again restricted the employee from work for two weeks as she was unable to perform her work duties while wearing a splint. By December 3, 2002, the employee again consulted Dr. Downs and reported that she had received no relief from her time off work. Dr. Downs released the employee to return to work with the recognition that she was unable to wear a brace or splint while working. The employee continued to consult Dr. Downs; he continued to restrict the employee to light-duty work. A CT scan taken in January 2003 was interpreted as normal. By January 14, 2003, Dr. Downs concluded the employee had reached maximum medical improvement from her 2002 injury, and determined the employee had no ratable permanent partial disability.
In a letter dated March 31, 2003, apparently in response to an inquiry from the employee=s QRC, Dr. Downs stated that he did not feel that an on-site job analysis was necessary concerning the employee=s job description. Dr. Downs stated that the employee=s Ainjury, though seemingly minor, is certainly disabling for someone in her line of work,@ that if the employee was Adecompensating in the workplace, I really feel that I should be reevaluating her from a clinical standpoint to make any specific recommendations,@ and that if the employee=s QRC had any other suggested career tracks for the employee, he would be willing to consider those. The employee=s symptoms persisted, and in April 2003, Dr. Downs prescribed additional physical therapy. There is no indication in the record whether other job descriptions were reviewed by Dr. Downs.
On August 14, 2003, the employee again consulted Dr. Downs, reporting bilateral upper extremity pain, low back and pelvic pain related to injuries occurring while waitressing. Dr. Downs stated in this chart note that AI feel that I am getting to the end of my expertise in terms of being able to help Ms. Humphreys. She has responded partially to physical therapy and interventions with [the physical therapist] over time but had plateaued.@ Dr. Downs therefore advised that he would follow-up with the employee in three months, and recommended that she obtain treatment from Mark Bookhout of Physical Therapy Orthopaedic Specialists, Inc. In the interim, Dr. Downs prescribed continued light work restrictions including avoiding reaching at arms= length and reaching behind her. Dr. Downs wrote to Mr. Bookhout, expressing his hope that Mr. Bookhout could identify the course of the employee=s ongoing dural tension, to better treat her symptoms.
On July 28, 2003, the employee underwent an independent medical examination with Dr. William H. Call. Upon examination, Dr. Call found full range of motion of both wrists along with full extension of the index finger and concluded the employee had normal grip strength. Dr. Call diagnosed a sprain of the MP (metacarpal phalangeal) joint of the left index, long and right fingers. He concluded that the sprain had resolved and that the employee had reached maximum medical improvement from her work injury as of October 23, 2002. Dr. Call also determined that the employee had sustained no permanent partial disability and had no restrictions relative to that injury. In his findings, the compensation judge summarized Dr. Call=s conclusions as follows:
With a normal examination, a normal x-ray of July 12, 2002, a normal CT of January 3, 2003, no evidence of carpal tunnel subluxation, no orthopedic findings, no fractures and no evidence of RSD and with no ligamentous abnormalities Dr. Call diagnosed the employee as having suffered a sprain of the MP joints of the index, long and ring fingers of the left hand which sprain had resolved.
(Finding No. 14.)
By November 2003, the employee again reported chronic left upper extremity pain. Dr. Downs diagnosed Achronic mechanical myofascial pain involving the left upper extremity, component of vascular compromise felt to be likely but also going to dural tension.@ Dr. Downs advised that the employee remained restricted to light duty work.
The employer and its insurer, State Fund Mutual Insurance Company, accepted primary liability for the employee=s injury and paid her intermittent temporary total and temporary partial disability benefits. As of March 26, 2003, after the employee lost her employment with the second restaurant, the employer and insurer paid the employee temporary partial disability benefits based upon her reduced wages resulting from her loss of that job.
On August 20, 2003, the employer and insurer filed a notice of intention to discontinue benefits, advising that benefits were being discontinued based on Dr. Call=s medical opinion that the employee had recovered from the effects of her 2002 work injury and no longer was restricted as a result of that injury. The employer and insurer paid temporary partial disability benefits through August 3, 2003. Following an administrative conference, a compensation judge issued an order granting the employer and insurer=s request to discontinue benefits, and the employee filed an objection to that discontinuance.
In addition, on September 24, 2003, the employee filed a medical request, seeking approval for a referral to Mark Bookhout for physical therapy. The employer and insurer denied that request, relying upon Dr. Call=s assessment that the employee required no additional treatment for her work injury. Both the medical and discontinuance issues were consolidated for an expedited hearing, held on December 2, 2003.
In his findings and order served and filed on February 3, 2004, the compensation judge found that the employee had sustained a sprain/strain to her MP joints of her index, middle and ring fingers of her left hand on July 6, 2002. He found that this injury was temporary in nature and had resolved well before August 2003. The compensation judge found that any left upper extremity condition from which the employee may presently suffer was neither caused nor substantially aggravated by the employee=s injury on July 6, 2002, that the employee no longer was physically restricted as the result of that injury, and that the employee=s injury did not substantially contribute to any reduction in earning capacity or any loss of time from work after March 27, 2003, the date when the employee lost her job with her other employer. The judge also found that the employee needed no further medical care and treatment for her July 6, 2002, injury, and therefore denied approval for the referral to therapy with Mr. Bookhout which Dr. Downs had recommended. The employee appeals.
STANDARD OF REVIEW
On appeal, the Workers' Compensation Court of Appeals must determine whether "the 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 (2004). Substantial evidence supports the findings if, in the context of the entire record, "they 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, findings of fact should not be disturbed, even though the reviewing court might disagree with them, "unless 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.@ Northern States Power Co. v. Lyon Food Prods., Inc., 304 Minn. 196, 201, 229 N.W.2d 521, 524 (1975).
The employee appeals from the compensation judge=s determination that after March 27, 2003, the employee=s injury of July 6, 2002, no longer substantially contributed to the employee=s restrictions and ongoing medical condition. The compensation judge relied upon the opinion of Dr. Call when reaching that finding. The employee argues that Dr. Call=s opinion lacks foundation and that the compensation judge erroneously relied upon that opinion when evaluating the employee=s claims.
Adequate foundation is necessary for a medical opinion to be afforded evidentiary value. Winkles v. Independent Sch. Dist. No. 625, 46 W.C.D. 44, 58 (W.C.C.A. 1991). To be of evidentiary value, a medical opinion must rest on a factual basis. Zappa v. Charles Mfg. Co., 260 Minn. 217, 224, 109 N.W.2d 420, 424, 21 W.C.D. 459, 467 (1961). Furthermore, the facts upon which the expert relies for his or her opinions must be supported by the evidence. McDonald v MTS Sys. Corp., 43 W.C.D. 83 (W.C.C.A. 1990), summarily aff'd (Minn. July 13, 1990).
Foundation for medical opinion is established by a physician=s knowledge of the employee=s case through treatment, review of records, or a hypothetical question. Scott v. Southview Chevrolet Co., 267 N.W.2d 185, 30 W.C.D. 462 (Minn. 1978). Dr. Call reviewed the employee=s medical records, obtained a medical history from her and performed a physical examination of the employee. The employee testified that she had demonstrated to Dr. Call how her injury occurred. As a general rule, this level of medical expertise and practical experience establishes competency to render an expert medical opinion. Reinhardt v. Colton, 337 N.W.2d 88 (Minn. 1983). We conclude the opinions of Dr. Call were adequately founded and the compensation judge could reasonably rely upon them.
It is evident from the compensation judge=s findings and order, and his memorandum, that he closely reviewed the employee=s medical records. In his memorandum, he refers to the treatment the employee received from Dr. Douglass and Dr. Downs, and to the diagnoses they rendered. The judge also outlined the opinions set forth by Dr. Call in his written report and deposition testimony and explained how that written opinion and testimony addressed the issue of causal relationship between the employee=s July 6, 2002, injury and her current medical condition and restrictions. The compensation judge explained in his memorandum, as follows:
Dr. William Call, examining on behalf of the employer and insurer, has clearly and cogently written in his report and testified at his deposition that the employee=s July 6, 2002 injury was in fact merely a temporary sprain/strain from which she has recovered. Dr. Call has straight forwardly described the mechanism of the injury and the effect that injury has on the muscles and tendons in the left fingers and hand. Further, and more enlightening, Dr. Call has testified as to the total non-relationship between the hyperextension injury of July 6, 2002 and the conditions and treatments that Dr. Downs has diagnosed and provided. In addition Dr. Call rather effectively calls into question the rational[e] of Dr. Downs= diagnosis and treatment as it applies to the July 6, 2002 hyperextension injury. In fact as Dr. Call has indicated at his deposition, the employee could not have sustained an injury to the extensor muscles of the left forearm since in fact those muscles would have been relaxed with this type of injury.
Further the Court notes that Dr. Call, in his examination of the employee, found the employee to have had normal range of motion of the wrist and normal grip strength. In addition although various tests elicited pain responses from the employee, as Dr. Downs indicates those pain responses were anatomically not possible from the tests which he performed. With both the long finger extension test and the palpation of the dorsal midline of the wrist the employee complained of left shoulder symptoms. However, as Dr. Call testified, there is no connection anatomically which would have resulted in any left shoulder complaints. This thus further calls into question the existence of any relationship between the employee=s current complaints and the injury of July 6, 2002.
As indicated earlier, the employee has the burden of establishing her claim. In the present case the employee has failed in that burden.
Given the circumstances of the employee=s injury, her medical history, and Dr. Call=s adequately founded medical opinion, substantial evidence supports the compensation judge=s finding that the employee=s work injury was no longer a substantial contributing cause of the employee=s left upper extremity condition after March 27, 2003, and that the medical treatment recommended by Dr. Downs was not reasonable and necessary to cure or relieve the effects of the employee=s work injury. We therefore affirm.