DIANE BIRKHOLZ, Employee, v. WAGNER SPRAY TECH, and SAFECO INS. CO., Employer-Insurer/Appellants.
WORKERS= COMPENSATION COURT OF APPEALS
JUNE 5, 2006
CAUSATION - SUBSTANTIAL EVIDENCE. Substantial evidence, including the employee=s testimony and the medical opinions of her treating doctors, support the compensation judge=s finding that the employee=s June 16, 1999, work injury was a substantial contributing cause of her carpal tunnel syndrome.
MEDICAL TREATMENT & EXPENSE - SURGERY. Substantial evidence, including the opinion of the employee=s treating orthopedic surgeon, supports the compensation judge=s finding that proposed carpal tunnel release surgery is reasonable and necessary.
PRACTICE & PROCEDURE - CONTINUANCE. The compensation judge did not abuse her discretion by denying a continuance for the purpose of joining an additional insurer where the employer and insurer may assert a contribution claim at a later date and were not prejudiced by the judge=s ruling.
Determined by Johnson, C.J., Rykken, J., and Pederson, J.
Compensation Judge: Kathleen Behounek
Attorneys: Frederick E. Kaiser and Jason Schmickle, Hansen, Dordell, Bradt, Odlaug & Bradt, St. Paul, MN, for the Respondent. Aaron P. Frederickson, Arthur, Chapman, Kettering, Smetak & Pikala, Minneapolis, MN, for the Appellants.
THOMAS L. JOHNSON, Judge
The employer and insurer appeal from the compensation judge=s approval of carpal tunnel release surgery and her award of medical treatment expenses. We affirm.
On June 16, 1999, Diane Birkholz, the employee, sustained a personal injury while working for Wagner Spray Tech, the employer, then insured by Safeco Insurance Company. On that date, the employee was struck from behind by two falling pallets. The employer and insurer admitted liability for the employee=s personal injury.
The employee was rendered unconscious by her injury and was transported by ambulance to the North Memorial Hospital emergency room where she was treated for a fractured jaw and a laceration on her lip. The employee next sought medical care on July 7, 1999, with Dr. Karen Kane at NorthWorks Occupational Health Services. Dr. Kane noted the employee=s fractured mandible remained banded, and the employee complained of a gradual onset of thoracic pain and arm and leg symptoms. The employee reported she had returned to work the day before. Dr. Kane opined the employee=s problems were related to her injury and released her to return to work subject to restrictions. Following an examination on July 14, Dr. Kane diagnosed a cervical and thoracic strain and prescribed physical therapy. On August 5, 1999, the employee complained of tingling and paresthesia in her right arm in addition to the cervical pain. The doctor prescribed Flexeril and additional physical therapy. In October, the employee reported she was slowly improving.
The employee was seen by Dr. Irfan Altafullah, a neurologist, on October 27, 1999, on referral from Dr. Kane. The employee complained of cognitive concerns, particularly with short term memory. The doctor diagnosed a closed head injury with significant craniofacial trauma, jaw fracture and lip laceration secondary to the work injury. Dr. Altafullah related the employee=s impaired concentration and attention to a post-concussion syndrome and prescribed Amitriptyline and occupational therapy. The doctor ordered a brain scan which was normal. By report dated December 6, 1999, Dr. Altafullah concluded the employee=s head injury was very mild and felt no further treatment was necessary.
The employee returned to see Dr. Kane in January 2000, complaining of continued discomfort in her neck and upper back. The diagnosis remained cervical strain, right upper thoracic pain, and post-concussion syndrome. Dr. Kane prescribed additional physical therapy.
On April 11, 2000, the employee went to Buffie Chiropractic complaining of neck, upper back and shoulder pain with pins and needle sensations in her arms, numbness in her fingers, and fatigue. Chiropractic treatment was initiated. In November 2000, the employee complained of numbness in her right hand. In December 2000, Dr. Buffie diagnosed right elbow tendinitis which the doctor attributed to a repetitive-stress injury at work. In January 2001, the employee stated she felt better and had little discomfort in her arms, upper back, and neck.
The employee returned to see Dr. Kane on April 26, 2001, and continued to treat with the doctor for thoracic and arm pain. The employee last saw Dr. Kane in September 2001, with persistent complaints of right upper thoracic pain. On examination, the doctor noted full range of motion with some tenderness to palpation in the rhomboid area. Dr. Kane=s diagnosis remained chronic thoracic pain.
The employee saw Dr. Joel Sagedahl at Northwest Family Physicians on October 22, 2003, complaining of right shoulder pain, arm pain, and numbness. On examination, the employee=s right elbow had full function and range of motion with negative Tinel=s and Phalen=s signs. The doctor diagnosed right shoulder paresthesias and prescribed physical therapy. In November 2003, the employee complained her right arm was going to sleep, especially at night and complained of pain in the right shoulder blade. An MRI scan of the right shoulder showed a small partial thickness tear in the anterior, distal supraspinatus tendon, and an abnormal signal consistent with extensive tendonopathy/partial thickness tear.
In March 2004, the employee was examined by Dr. Thomas N. Conner, an orthopedic surgeon, on referral from Dr. Sagedahl. The employee complained of shoulder and arm pain with a tingling sensation down her right arm. The doctor reviewed the MRI scan which he read as showing tendinosis changes in the right shoulder without a rotator cuff tear. Dr. Conner diagnosed right shoulder and upper arm pain and recommended an EMG to rule out cervical radiculopathy or nerve entrapment.
The employee was examined by Dr. Stephen Barron in April 2004, at the request of the employer and insurer. The doctor diagnosed subjective complaints of numbness in the right arm and a scapular strain. Dr. Barron noted the employee was complaining of severe numbness in her right arm which he concluded was a new symptom unrelated to the June 1999 personal injury, but related to an aggravation at work in 2003. Dr. Barron opined the employee had reached maximum medical improvement (MMI) and concluded the employee required no permanent restrictions since she had no objective findings on examination.
The employee had an EMG in January 2005, which showed a right carpal tunnel syndrome of moderate severity. The employee returned to see Dr. Conner who diagnosed right carpal tunnel syndrome and recommended a carpal tunnel release. By report dated September 12, 2005, Dr. Conner opined the employee=s right upper extremity symptoms and carpal tunnel syndrome were substantially caused or contributed to by the June 1999 personal injury. He based his opinion on his review of the medical records which documented complaints of right upper extremity symptoms, including tingling and paresthesias into the arm and hand, following the accident.
By report dated May 4, 2005, Dr. Sagedahl diagnosed a mandibular fracture, closed-head injury with right leg strain, cervical strain, thoracic strain, shoulder strain, partial tears of the supraspinatus and infraspinatus tendons and median nerve entrapment consistent with carpal tunnel disease. The doctor related all of these diagnoses to the June 1999 personal injury. Dr. Sagedahl stated the January 2005 EMG demonstrated a carpal tunnel problem which he related directly to the employee=s personal injury. The doctor recommended a carpal tunnel release.
Dr. Barron re-examined the employee in May 2005. The doctor concluded the employee sustained a work-related sprain to her right shoulder and scapula on June 16, 1999, but concluded this injury resolved within six months. Dr. Barron noted the 2005 EMG showed a sensory motor carpal tunnel syndrome of moderate severity. The doctor concluded, however, the employee=s personal injury did not cause the carpal tunnel syndrome. Further, Dr. Barron opined there were insufficient findings on physical examination to warrant a carpal tunnel release.
The employee filed a Medical Request seeking approval for a carpal tunnel release and reimbursement of treatment expenses. Following a hearing, the compensation judge approved the surgical request and ordered the insurer to pay the treatment expenses for the treatment of the employee=s right arm complaints. The employer and insurer appeal.
1. Carpal Tunnel Syndrome
The appellants assert the employee=s treatment records between 1999 and 2005 do not reflect findings consistent with carpal tunnel syndrome following the June 16, 1999, personal injury. Rather, the appellants argue, these medical records reference only right shoulder and back complaints. The first confirmed finding of a carpal tunnel syndrome, the appellants assert, was not until January 2005. Prior thereto, the doctors noted numerous negative Tinel=s and Phalen=s tests. The appellants argue there is insufficient support for the compensation judge=s conclusion that the personal injury was a substantial contributing cause of the carpal tunnel syndrome.
The employee testified that within weeks of her injury she began to experience severe pain in her right shoulder extending into her arm and testified that her arm had been Afalling asleep@ since 1999. (T. 26-27, 29, 32.) She further testified she experienced numbness and tingling in her right arm since her injury. (T. 42.) Both Dr. Sagedahl and Dr. Conner opined that a causal relationship exists between the employee=s personal injury and her carpal tunnel syndrome. Both doctors took histories from the employee, reviewed her medical records and performed physical examinations. As a general rule, this level of expertise qualifies a doctor to render an expert opinion. While Dr. Barron disagreed with Dr. Sagedahl and Dr. Conner, it is the compensation judge=s responsibility as a trier of fact to resolve conflicts in expert testimony. See Nord v. City of Cook, 360 N.W.2d 337, 342, 37 W.C.D. 364, 371 (Minn. 1985).
We acknowledge the employee was not diagnosed with carpal tunnel syndrome until January 2005. That fact alone, however, does not mandate a conclusion that the condition is unrelated to her personal injury. Rather, it is only one fact which the compensation judge could consider in resolving the issue of causation. The issue on appeal, is whether the factual findings are Aclearly erroneous and unsupported by substantial evidence in view of entire record as submitted.@ Minn. Stat. ' 176.421, subd. 1. The testimony of the employee together with the medical opinions of Drs. Sagedahl and Conner provide substantial support for the compensation judge=s decision. Accordingly, that decision must be affirmed. Hengemuhle v. Long Prairie Jaycees, 358 N.W.2d 54, 59, 37 W.C.D. 235, 239 (Minn. 1984).
2. Carpal Tunnel Surgery
The compensation judge concluded the recommended carpal tunnel release surgery was reasonable and necessary to cure and relieve the employee from the effects of the June 16, 1999, work injury. The employer and insurer appeal this finding contending it is unsupported by substantial evidence. We are not persuaded.
Dr. Barron agreed the employee had right carpal tunnel syndrome, but opined it was an idiopathic condition, unrelated to her 1999 personal injury. The doctor further opined there were insufficient findings on physical examination to warrant a carpal tunnel release and concluded the proposed surgery was not reasonable or necessary. Dr. Conner concluded, based upon the employee=s EMG results, that she would benefit from a carpal tunnel release procedure. There is conflicting expert medical opinion which is the responsibility of the compensation judge to resolve. See Nord at 342, 37 W.C.D. at 371. The compensation judge adopted the opinion of Dr. Conner. The judge=s decision is, therefore, supported by substantial evidence and must be affirmed.
In their medical response, Wagner Spray Tech and Safeco Insurance Company denied liability for the carpal tunnel release surgery sought by the employee. On August 29, 2005, the appellants filed a motion seeking the joinder of Fireman=s Fund Insurance Company as a party to the proceeding, alleging the employee=s work activities with the employer during the coverage of Fireman=s Fund was the substantial contributing cause of the employee=s need for carpal tunnel release surgery. At the hearing, the appellants sought a ruling on their motion. The employee had no objection to the joinder of Fireman=s Fund but objected to the case being continued. The compensation judge viewed the joinder motion as a request for a continuance which the judge denied. The employer and insurer appeal the denial of a continuance.
The employer and insurer argue they established good cause for a continuance under Minn. Stat. ' 176.341, subd. 4. They contend they promptly filed their joinder motion after receipt of the independent medical examination report of Dr. Barron. Furthermore, the appellants assert that by granting a continuance and joinder, all issues could have been fully litigated at a later date which would have promoted judicial economy. By failing to grant a continuance, the appellants assert the compensation judge abused her discretion. We disagree.
Minn. Stat. ' 176.341, subd. 4 provides:
A continuance of a hearing will be granted only upon a showing of good cause. Good cause is established when the underlying eventuality is unforeseen, is not due to lack of preparation, is relevant, is brought to the chief administrative law judge=s attention in a timely matter and does not prejudice the adversary.
The issue before the compensation judge was whether the employee=s proposed surgery was reasonable, necessary and causally related to her June 16, 1999, personal injury. The appellants contend a second insurer is liable, in whole or in part, for the medical expenses sought by the employee. We acknowledge it may have been more efficient to try all issues at one hearing. But the fact that a continuance might promote efficiency and judicial economy does not automatically establish good cause for a continuance. The employee was not obligated to assert a claim against anyone other than the employer and Safeco Insurance Companies. The employee needed only to prove the 1999 personal injury was a substantial contributing cause of her need for the claimed medical treatment. The employee sought approval for a surgery and is entitled to an expedient resolution of her claim. The appellants may assert a contribution claim in a subsequent proceeding so were not prejudiced by the compensation judge=s ruling. We conclude the employer and insurer did not establish good cause and the compensation judge properly denied a continuance.