RICK L. ANDERSON, Employee/Appellant, v. BORG & CO. DECORATING, and WESTERN NAT=L MUT. INS. CO., Employer-Insurer.
WORKERS= COMPENSATION COURT OF APPEALS
JUNE 30, 2005
PERMANENT PARTIAL DISABILITY - SUBSTANTIAL EVIDENCE. Substantial evidence supports the determination of the compensation judge that the employee=s work-related carpal tunnel syndrome was not a substantial contributing factor in the employee=s symptoms which would entitle him to an award of permanent partial disability.
Determined by: Stofferahn, J., Rykken, J., and Pederson, J.
Compensation Judge: William R. Johnson
Attorneys: Lawrence C. Miller, Miller & Carlson, Minneapolis, MN, for the Appellant. Ronald M. Stark, Jr., Minneapolis, MN, for the Respondents.
The employee appeals from the compensation judge=s denial of his claim for permanent partial disability from his work-related carpal tunnel syndrome. We affirm.
Rick Anderson began working as a painter in 1976 when he was nineteen years old. In about 1980, he started working as a painter for Borg and Company Decorating. He painted residential new construction, using brushes, rollers or spray guns; he also did sanding and puttying. About five years before seeking medical attention, Anderson began noticing numbness and tingling in his hands. He finally consulted Dr. Robin Crandall for this condition on May 12, 2000.
On examination, Dr. Crandall found diffuse weakness in the employee=s hands that did not definitely follow the median nerve distribution, although there was a positive Tinel=s sign. Dr. Crandall recommended an EMG to rule out bilateral carpal tunnel syndrome versus other peripheral neuropathy.
The EMG was done on May 19, 2000, and the findings were read as being consistent with moderately advanced bilateral carpal tunnel syndrome. Radiculopathy and neuropathy were looked for but not found. On return to Dr. Crandall after the EMG, the employee=s condition was diagnosed as work-related carpal tunnel syndrome. Eventually surgery was recommended and Dr. Crandall performed a right carpal tunnel decompression on July 28, 2000.
The employee did not have improvement in his symptoms after his surgery. On September 22, 2000, he reported to Dr. Crandall that he had not improved at all and was actually somewhat worse. Dr. Crandall suspected the employee had developed reflex sympathetic dystrophy and recommended a repeat EMG. The EMG was done on October 19, 2000, and was interpreted as showing evidence of a very mild right carpal tunnel syndrome. Dr. Crandall concluded from this test that the employee=s condition was improving despite the employee=s complaint and he recommended range of motion exercises to return the employee back to work.
When the employee returned to Dr. Crandall on November 15, 2000, however, he complained not only of continued pain and numbness in his hands but also of similar complaints in both feet. Dr. Crandall recommended a neurological consultation and on January 10, 2001, the employee saw Dr. Debra Peven at Noran Neurological Clinic.
Dr. Peven referred to the EMG studies as showing mild bilateral carpal tunnel syndrome but she also diagnosed Raynaud=s Syndrome as a reason for his hand complaints. Dr. Peven also stated Ait is conceivable that cervical spine disease could give referred symptoms to the hands and an MRI study of the cervical spine may be useful in assessing this.@ Dr. Peven placed the employee on medication and referred him back to Dr. Crandall for work restrictions.
The MRI was ultimately done on July 25, 2001, and was discussed by Dr. Peven in her August 22, 2001, chart notes. Dr. Peven stated the MRI showed Amultiple areas of demyelination which are non enhancing. This is the most likely etiology for his intractable bilateral arm pain, dyesthetic sensation and his inability to improve after a right carpal tunnel release@. Dr. Peven concluded Ahe does have mild to moderate carpal tunnel syndrome due to repetitive use, though the disproportion (sic) findings in the hands and upper extremities is related to the cervical spine changes@.
The employer and insurer had accepted liability for a work-related carpal tunnel syndrome and paid for the carpal tunnel surgery and related wage loss. On December 12, 2001, the employee was evaluated on behalf of the employer and insurer by Dr. Bruce Mack, a neurologist. Dr. Mack concluded that the employee did not have symptomatic carpal tunnel syndrome and that the employee=s ongoing upper extremity symptoms were due to cervical lesions which Dr. Mack stated were not due to the employee=s work activity. Based on Dr. Mack=s report, the employer and insurer denied any additional liability for the employee=s condition.
The employee returned to see Dr. Peven on May 29, 2002, with complaints of increasing pain and numbness in his upper extremities. Dr. Peven provided a number of medications for the employee and recommended that the employee consult with a general practice physician for treatment of his medical problems which were identified as transverse myelitis, cervical and thoracic; bilateral carpal tunnel syndrome; Raynaud=s syndrome, bilateral arm pain; hypertension; and depression.
The employee was evaluated by Dr. Crandall on January 2, 2004, for the numbness in his hands. Dr. Crandall concluded Athe question is whether or not his work related carpal tunnel is causing a lot of the numbness or if the demyelinating issue is. There is, however, no doubt that his EMG=s have shown bilateral carpal tunnel syndrome and I do think part of the numbness is carpal tunnel.@ Dr. Crandall rated the employee for permanent partial disability under Minn. R. 5223.0470, subp. 2. B.(3) for a total of 6% of the whole body.
The employee filed a claim petition for the permanent partial disability rated by Dr. Crandall. The employee=s claim was heard by Compensation Judge William R. Johnson on November 16, 2004. In his Findings and Order, issued on January 12, 2005, the compensation judge found that the employee had bilateral carpal tunnel as a result of his employment but denied the employee=s claims for permanent partial disability. The employee appeals.
The employee argues that the compensation judge erred in denying his claim. The applicable rule allows permanent partial disability for Apain and paresthesia persisting despite treatment@. According to the employee, Dr. Crandall=s finding that Apart of the numbness@ is due to his carpal tunnel syndrome satisfies the requirements of the rule. We disagree.
We cannot agree that some numbness is the functional equivalent of pain and paresthesia when one considers the totality of the medical evidence in this case. Dr. Mack concluded that the carpal tunnel syndrome was not symptomatic and that the employee=s pain was due to the cervical spine lesions found in the MRI. Dr. Pleven was of the opinion that the cervical spine condition was the Amost likely etiology for his intractable, bilateral arm pain.@ Even Dr. Crandall, the employee=s support for his claim, states that the employee=s arm pain Aprobably is cervical and radicular in character@. The employee argues that these opinions all leave open the possibility that some of the symptoms were due to the carpal tunnel syndrome. We find no language in the medical records which would require this conclusion.
This matter is essentially one in which the compensation judge had to choose between competing medical opinions. The compensation judge chose to accept the opinions of Drs. Mack and Peven from which he concluded that the work injury is not a substantial contributing factor in the employee=s symptoms. Based on the record before us, we conclude that substantial evidence exists to support the compensation judge=s denial of the permanent partial disability claim. The compensation judge=s decision is affirmed. Hengemuhle v. Long Prairie Jaycees, 358 N.W.2d 54, 37 W.C.D. 235, (Minn. 1984).