THOMAS WOLNER, Employee/Appellant, v. SPX VALVES & CONTROLS, and ACE USA, Employer-Insurer, and NORTH STAR THERAPY, LTD., GRANITE FALLS MUN. HOSP., ST. CLOUD MED. GROUP, MN DEP=T OF LABOR & INDUS./VRU., ST. CLOUD ORTHOPEDIC ASSOCS., ST. CLOUD HOSP./CENTRA CARE HEALTH SYS., ANESTHESIA ASSOCS. OF ST. CLOUD, MN DEP=T OF EMPLOYMENT & ECON. DEV., and NEUROLOGY CLINIC OF ST. CLOUD, Intervenors.
WORKERS= COMPENSATION COURT OF APPEALS
JUNE 16, 2005
EVIDENCE - EXPERT MEDICAL OPINION. The medical experts possessed sufficient information about the employee=s job duties to establish foundation for an opinion as to whether the employee sustained a Gillette injury.
Vacated and remanded.
Determined by: Stofferahn, J., Johnson, C.J., and Pederson, J.
Compensation Judge: Catherine A. Dallner
Attorneys: Mark R. Black, Black Law Office, St. Cloud, MN, for the Appellant. Richard L. Plagens, Lommen, Nelson, Cole & Stageberg, Minneapolis, MN, for the Respondents.
DAVID A. STOFFERAHN, Judge
The employee appeals from the compensation judge=s determination that the opinions of his medical experts were without foundation and from the resultant denial of his claim. We vacate and remand.
Thomas Wolner, the employee, alleged he sustained a Gillette injury in the form of bilateral carpal tunnel as the result of his work as a machinist for the employer, SPX Valves & Controls. The employee began working for SPX in June 2000. SPX manufactured sewer and water valves and the employee operated a variety of machines in his employment. According to the employee=s testimony some of his tasks involved minimal physical activity, but other tasks were more physical. The employee identified deburring parts as an activity which was quite physical because he had to grip the part firmly while he held it against a grinder and rotated his wrists. There was some conflict in the testimony as to the extent of deburring required by the job; the employee=s supervisor testified that it was one of a number of tasks the employee performed while the employee testified that, for a time in the summer of 2000, he did nothing but deburring.
The first indication in the medical records of the employee having hand and wrist symptoms is from chart notes of Affiliated Community Medical Center on February 8, 2002. The employee saw Dr. Darrell Carter with a number of complaints which included AHe gets some numbness in his hands when he drives his motorcycle.@ There were no findings on examination related to this complaint and no treatment was provided for this condition.
The employee testified that his hand and wrist symptoms worsened in the summer of 2002, and he advised his employer that he attributed this situation to his deburring work. The employee continued to do his usual work but was referred to Midwest Occupational Medicine. His first visit there was on September 17, 2002. The employee complained that Afor the past few weeks he has noticed that his hands are falling asleep and his wrists have been hurting.@ The employee did not recall any specific injury but stated that he had noted increased discomfort after doing Aquite a bit of grinding a few weeks ago.@ The assessment was of regional neck, bilateral epicondylitis, and bilateral carpal tunnel. Physical therapy was recommended and the employee was given Vioxx. No work restrictions were provided.
The employee began physical therapy on September 18, 2002. The records indicate that the employee received therapy for cervical dysfunction as well as for pain and numbness in his hands. In those records, the employee identified his symptoms as having occurred as the result of deburring parts with power hand tools.
The employee returned to Occupational Medical Group for follow-up on September 24, 2002. He reported that the Vioxx was helpful but he did not feel that the physical therapy was helping much. The employee was encouraged to continue with therapy and to continue his use of Vioxx. No work restrictions were provided. His last visit to Occupational Medical Group was on October 16, 2002, when he saw Dr. Basil LeBlanc for the second time. The employee stated his symptoms had improved but he had problems with numbness and tingling both at work and at night time. No work restrictions were given and no further treatment was to be provided because workers= compensation had denied the employee=s claim. Dr. LeBlanc stated AI also explained to him that I am of the opinion that the activities that he is involved with certainly could cause or exacerbate carpal tunnel syndrome.@ Dr. LeBlanc recommended that the employee consult with his own physician.
On November 13, 2002, the employee saw Dr. Dennis Weslander at St. Cloud Medical Group. The employee reported to Dr. Weslander that he had pain in both hands and forearms which had Abeen going on for several years. This has been worse the last few months.@ The employee attributed his symptoms to his work as a machinist, doing Adeburring, grinding, and a lot of wrenching.@ The physical examination showed no weakness of grip strength, no obvious swelling or limitation in range of motion, and normal reflexes. Dr. Weslander recommended EMGs and nerve conduction velocities for the upper extremities. Based on the results, which were read as being consistent with a distal median neuropathy at the wrist, Dr. Weslander recommended that the employee see an orthopedist.
As part of a general layoff, the employee was separated from his employment at SPX as of November 29, 2002. To that date, the employee had not missed any time from work and had not been given work restrictions for his wrist complaints.
On January 16, 2003, the employee saw Dr. Christopher Widstrom at St. Cloud Orthopedic Associates. Dr. Widstrom recorded a history from the employee that he had been laid off in November and that his hands had gotten better since he was not working so much. Dr. Widstrom diagnosed bilateral carpal tunnel syndrome, greater on the left than the right. Dr. Widstrom referred the employee for occupational therapy and recommended the use of wrist splints at night. Dr. Widstrom also noted Awe did discuss that if he is planning to return to the same work, it is likely his symptoms will return.@
The employee began therapy on January 23, 2003, but when he returned to see Dr. Widstrom on February 13, he reported that he had gotten no better and was perhaps slightly worse, apparently due in part to having done some shoveling of snow. Dr. Widstrom discussed treatment options with the employee and it was decided to proceed with surgery.
The employee had a right carpal tunnel release on February 25, 2003, and a left carpal tunnel release on March 27. On May 5, 2003, Dr. Widstrom=s records indicated that the employee had no numbness and tingling and that his scars were only modestly tender. The employee was released to return without restrictions, and Dr. Widstrom advised the employee to return on an as-needed basis. The employee returned with complaints of pain on May 8, and Dr. Widstrom precluded the employee from doing overtime work. On June 25, 2003, Dr. Widstrom again released the employee to work without restrictions.
Dr. William Call generated a report on behalf of the employer and insurer on June 10, 2003. Dr. Call did not physically examine the employee. Dr. Call reviewed the employee=s medical records and viewed a video tape of machinist activities at SPX. Based upon this information, Dr. Call concluded that the employee had bilateral carpal tunnel syndrome but that the employee=s work activities would not be Acausal, irritative, or exacerbatory.@
At the request of the employee=s attorney, Dr. Widstrom generated a report of April 5, 2004. On the subject of causation, Dr. Widstrom stated AI think the more difficult question here is whether or not his work activities substantially contributed to the development of his carpal tunnel. Certainly, Dr. LeBlanc=s notes would indicate that his symptoms got worse while at work and he indicated to me that his symptoms lessened when he was laid off, both indicating that at least his symptom was work aggravated. I think that given the fact that his symptoms did not completely resolve while he was off work would indicate that they were not solely caused by work.@
The employee=s attorney also sent a request for a report to Dr. LeBlanc and included a number of pages from the employee=s deposition. In response, Dr. LeBlanc authored a report dated June 3, 2004. That report, in its entirety, stated AMr. Wolner first presented to Midwest Occupational Medicine on 09/17/02 with a several week history of bilateral hand numbness, tingling, and pain. He had a history and physical findings consistent with bilateral carpal tunnel and regional neck syndrome. I believe it is reasonable to assume that this machinist activities at Dezurik=s, although perhaps not the specific cause certainly could have exacerbated his symptoms. I note that he did go on to have an EMG and subsequent successful surgery.@
The employee=s claim petition, which alleged a Gillette injury to his hands and wrists on August 22, 2002, and which was filed December 4, 2002, was heard by Compensation Judge Catherine Dallner on May 20 and July 8, 2004. In her Findings and Order, filed October 5, 2004, the compensation judge concluded that none of the doctors who provided opinions on causation in this matter had adequate foundation for their opinions. The compensation judge determined that the employee had failed to meet his burden of proof in establishing a Gillette injury and the employee=s claims were denied. The employee appeals.
The compensation judge denied the employee=s claim based on her conclusion that the medical opinions relied upon by the employee, those of Drs. Widstrom and LeBlanc, lacked adequate foundation for consideration. According to the compensation judge, neither Dr. Widstrom nor Dr. LeBlanc had sufficient information about the Anature or extent of the employee=s work activities as a machinist.@
It is the obligation of the employee to establish by preponderance of the evidence that there is a causal connection between Aordinary work and ensuing disability.@ That causal connection is to be provided by adequately founded medical opinion. Steffen v. Target Stores, 517 N.W.2d 579, 582, 50 W.C.D. 464, 467 (Minn. 1994). Steffen reversed the Reese standard which required proof of specific work activity causing specific symptoms. Reese v. North Star Concrete, 38 W.C.D. 63 (W.C.C.A. 1985). The question here then is whether Dr. Widstrom and Dr. LeBlanc had foundation to render an opinion on the causal relationship between the employee=s ordinary work as a machinist and his carpal tunnel syndrome.
Foundation goes to the competency of a witness to provide expert opinion. Competency of a medical expert depends both on the extent of the scientific knowledge of the witness and Athe witness=s practical experience with the matter which is the subject of the offered testimony.@ Reinhardt v. Colton, 337 N.W.2d 88, 93 (Minn. 1983). Sufficient knowledge of the subject matter can be obtained through personal knowledge, a hypothetical question, or testimony at the hearing. Scott v. Southview Chevrolet Co., 267 N.W.2d 185, 188, 30 W.C.D. 426, 430 (Minn. 1978).
In the present case, the history obtained by Dr. LeBlanc from the employee was of discomfort and numbness in his hands and forearms which had worsened since doing Aquite a bit of grinding.@ The employee said that his symptoms worsened over the work week and lessened over the weekend when he was not working. The employee also saw a physical therapist at the referral of Dr. LeBlanc and advised the therapist that his symptoms occurred as a result of Adeburring parts with power hand tools.@ Dr. Widstrom had available the records of Dr. LeBlanc and the chart notes of Dr. Weslander which noted the employee worked as a machinist and did deburring, grinding and a lot of wrenching.
We conclude that this evidence provided sufficient information to Dr. LeBlanc and Dr. Widstrom to provide foundation for their opinion and that the compensation judge erred in refusing to consider those opinions in making her decision. We also conclude Dr. Call=s opinion did not lack foundation because he did not examine the employee. His review of the employee=s medical records and the video tape of the employee=s job provided sufficient information to provide foundation for his opinion.
The alleged lack of information of work activity goes to the weight to be accorded to the medical opinion rather than its foundation. Karakash v. Superior Rock Bit Co., slip op. (W.C.C.A. May 3, 2001). See also Heitz v. Par 30 Restaurant & Lounge, Inc. 60 W.C.D. 98 (W.C.C.A. 2000); Drews v. Kohl=s, 55 W.C.D. 33 (W.C.C.A. 1996); and Stuhr v. Northwestern Travel Serv., Inc., 57 W.C.D. 352 (W.C.C.A. 1997).
The employer argues in its response that the opinions of Drs. Widstrom and LeBlanc were not expressed with sufficient certainty to be relied upon by the compensation judge, citing Holmlund v. Standard Constr. Co., 307 Minn. 383, 240 N.W.2d 521, 28 W.C.D. 317 (1976). The question of whether a medical opinion has been rendered with a reasonable degree of medical certainty or with some lesser standard goes to the persuasiveness of the opinion and not to the foundation for that opinion. The issue raised by Holmlund was not reviewed by the compensation judge in her decision and may be considered on remand.
The findings and order of the compensation judge are vacated and this matter is remanded to the compensation judge for further consideration.
 Gillette v. Harold, Inc. 257 Minn. 313, 101 N.W.2d 200, 21 W.C.D. 105 (1960).
 SPX and Dezurik are the same entity.
 The employee also contends that foundation for Dr. LeBlanc=s opinion was provided by the portions of the employee discovery deposition which were sent to Dr. LeBlanc. We agree with the compensation judge that this information did not provide foundation since the deposition was not in evidence and not a part of the record.