JANET FREEDLUND, Employee/Appellant, v. HILLCREST HEALTHCARE CTR., and AMERICAN HOME ASSURANCE CO., adm=d by CONSTITUTION STATE SERVS. CO., Employer-Insurer, and MINNESOTA ORTHOPAEDIC SPECIALISTS, INC., Intervenor.
WORKERS= COMPENSATION COURT OF APPEALS
DECEMBER 21, 2006
CAUSATION - SUBSTANTIAL EVIDENCE. Substantial evidence supports the compensation judge=s determination that the employee=s cervical condition was not causally related to her August 2004, work injury.
Determined by Stofferahn, J., Wilson, J., and Pederson, J.
Compensation Judge: Gary M. Hall
Attorneys: James A. Reichert, Attorney at Law, Minneapolis, MN, for the Appellant. Christine L. Tuft, Arthur, Chapman, Kettering, Smetak & Pikala, Minneapolis, MN, for the Respondents.
DAVID A. STOFFERAHN, Judge
The employee appeals from the compensation judge=s determination that the work injury she sustained on August 7, 2004, was not a substantial contributing factor in her cervical condition. We affirm.
The employee sustained an admitted injury to her right shoulder on August 7, 2004, while employed as an LPN for Hillcrest Healthcare Center. The employee claims she injured her cervical spine at that time as well. The employer and insurer denied this assertion.
Janet Freedlund began working as an LPN for Hillcrest Healthcare in 1999. There is no record or history of the employee having any cervical or right shoulder problems before August 7, 2004. On that date, one of the residents was upset and the employee tried to help him sit in his wheelchair. As she was doing so, the resident grabbed and hung onto her right arm. The episode lasted for at least 20 minutes. The employee testified that she had no immediate symptoms but felt soreness in her right shoulder area the next day.
The employee first sought medical care for this injury on August 10, 2004, when she saw Dr. Michael Thompson at Fairview Lakes Regional Health Care. Her complaint at that time was of right shoulder pain at a 6-7 level on a scale of zero to 10. She was given medication and work restrictions. The diagnosis was right shoulder strain. The employee continued to treat thereafter with Dr. Thompson who prescribed physical therapy and medication. Throughout this time, the employee noted pain in her anterior right shoulder when doing over-shoulder activity with her arm. On October 26, 2004, she was released to return to work without restrictions by Dr. Thompson.
On November 18, 2004, the employee returned to the clinic, saw Dr. Julie VanEck, and advised the doctor that she thought her condition had regressed. Dr. VanEck recommended an MRI of the right shoulder. The MRI, done on December 3, 2004, was read as showing a full-thickness tear of the anterior lateral supraspinatus tendon as well as degenerative changes at the acromioclavicular joint.
Dr. VanEck referred the employee to Dr. Edward Kelly at Minnesota Orthopaedic Specialists. Dr. Kelly saw the employee on December 27, 2004, and did a full examination, including an examination of the cervical spine. The cervical spine examination was normal with no tenderness or reduction in range of motion. Dr. Kelly diagnosed the employee=s condition as a full-thickness rotator cuff tear and he recommended surgery.
Surgery was done on February 1, 2005. After the surgery, Dr. Kelly diagnosed a full-thickness rotator cuff tear of the right shoulder along the supraspinatus tendon. He performed an arthroscopic subacromial decompression and an open rotator cuff repair of a moderate-sized full thickness, supraspinatus tendon tear.
The employee testified that after the surgery she had burning pain from her shoulder down her right arm. On February 10, Dr. Kelly assessed her situation as doing fair and on follow up on March 10, the employee reported her pain was at a level of three on a ten-point scale. Dr. Kelly began the employee on range of motion exercises. She also saw Dr. VanEck during this time and was treated for depression in addition to her shoulder surgery.
On April 11, 2004, the employee saw Dr. VanEck and complained of a Apurple hand@ on the right. The employee also noted a sharp pain in the anterior part of her shoulder that radiated to the supra clavicular region. Dr. VanEck found tenderness on examination in the anterior shoulder and referred the employee for an orthopedic review.
The employee saw Dr. Aaron Butler at Minnesota Orthopaedic Specialists on April 27, 2005. The employee=s primary symptoms were of Asearing, burning-type pain in the anterior shoulder with some radiation of the neck and paresthesias into the right side of the face in addition to paresthesias and numbness almost constantly in the fourth and fifth fingers of the hand that worsen with increasing activity.@ Dr. Butler=s assessment was of possible cervical radiculopathy and/or ulnar neuropathy. He recommended a cervical MRI.
The cervical MRI was done on May 5, 2005, and was read as showing a straightening of the normal cervical lordosis, minimal right posterolateral bulging at C4-5 without impingement on neural structures, degenerative disc disease at C5-6 with small central disc protrusion and early degenerative disc disease 6-7.
After the MRI, the employee was referred by Dr. Butler to Dr. Thomas Rieser at Midwest Spine and Orthopedics. In his chart note from his July 29, 2005, appointment with the employee, Dr. Rieser noted the employee=s symptoms as being neck pain, right shoulder pain, and right arm pain. The history the employee gave Dr. Rieser of the August 2004 injury was that she had been Atossed around like a rag doll.@ Dr. Rieser diagnosed degenerative disc disease primarily at C5-6 with radiculitis and tardy ulnar nerve palsy on the right.
Dr. Rieser did cervical surgery on the employee in March 2006. He performed a fusion at the C3-4 and C5-6 levels, skipping the C4-5 level with the thought that when that level needed intervention an artificial disc might be available. The employee testified that the cervical surgery improved her symptoms and that she no longer had numbness and tingling into her hand and that the stabbing pain in her shoulder was gone.
The employee was evaluated on behalf of the employer and insurer by Dr. Mark Friedland on October 10, 2005. In his report of that date, with respect to the employee=s cervical condition, Dr. Friedland diagnosed age appropriate, multilevel cervical degenerative disc disease and complaints of paresthesias of the right hand without objective corroborating findings on physical examination or EMG studies. As to causation, he concluded Ait is therefore my opinion that the incident of 8/7/04 was not a substantial contributing cause to the need for care and treatment, evaluation or diagnostic studies with respect to the patient=s cervical or right upper extremity ulnar neuropathic symptomatology. In fact, the patient=s cervical symptomatology is far in excess of objective findings on physical examination or radiographic studies and her paresthesias of the ring and little fingers are not consistent with physical examination or EMG findings.@ Dr. Friedland was of the opinion that the employee did not need any further diagnostic studies or care for her cervical complaints. In a supplemental report prepared after reviewing the 2005 cervical MRI, Dr. Friedland stated that there was Aabsolutely no evidence of cervical nerve root impingement, displacement or compression noted on the MRI scan images.@
The employee was also evaluated by Dr. Edward Szalapski on February 28, 2006, who prepared a report and provided a deposition shortly before the hearing. Dr. Szalapski=s opinion was that the employee=s cervical complaints were not related to the August 2004 work injury. Of particular importance to Dr. Szalapski was the gap of several months between the injury and the diagnosis of a cervical problem, a time when the employee was seen by a number of doctors. During that time, the employee had a normal cervical exam in December 2004 by Dr. Kelly. Finally, Dr. Szalapski stated that the MRI only demonstrated degenerative changes with no nerve root impingement and that the MRI findings were inconsistent with the severity of the employee=s complaints.
Dr. Butler prepared a report on the question of causation for the cervical condition. In that report, dated May 16, 2006, Dr. Butler stated that Awith a high degree of medical certainty that the work related injury on 08/07/04 contributes at least 50 to 60 percent to her present pain pathology and the subsequent surgery necessary for this.@ Dr. Butler referenced the employee=s Achart, medical records, x-rays, MRIs, and the like@ as leading him to his opinion but provided no further explanation for his conclusions.
This matter was heard by Compensation Judge Gary Hall on May 24, 2006. In his Findings and Order of June 26, 2006, the compensation judge determined that the employee had not established by preponderance of the evidence that the August 2004, work injury was a substantial contributing factor in her cervical condition. The employee=s claims for benefits were denied. The employee appeals.
The employee argues on appeal that the compensation judge erred in determining that the medical evidence did not support a conclusion of causation. She contends that her symptoms from the date of injury were consistent with a cervical injury on that date. She also points to her testimony that her symptoms did not abate until after her cervical surgery, and that Dr. Butler concluded her work injury was a substantial contributing factor to her cervical condition.
The question for this court, however, is not whether the evidence would support a contrary result but whether substantial evidence supports the decision of the compensation judge. Hengemuhle v. Long Prairie Jaycees, 358 N.W.2d 54, 37 W.C.D. 235, (Minn. 1984). We find there is substantial evidence to support the compensation judge=s decision and we affirm that decision.
While the employee argues that her symptoms after the work injury were evidence of a cervical condition, the employee saw three different doctors before Dr. Butler diagnosed his cervical condition in April 2005. None of those doctors diagnosed a cervical condition. Dr. Butler provided an opinion which found causation but gave no rationale for his opinion other than his review of the medical information.
In his report and deposition, Dr. Szalapski provided a detailed explanation for his opinion that the employee=s cervical condition was not work related. The employee attacks Dr. Szalapski=s opinion as being without foundation but he evaluated the employee and took a detailed history, actions which generally provide foundation for providing a medical opinion. Caizzo v. McDonald=s, 65 W.C.D. 378 (W.C.C.A. 2005). Dr. Szalapski=s conclusion that the employee=s cervical complaints were the result of a spontaneous exacerbation of an underlying degenerative process was challenged on cross-examination. It is clear that Dr. Szalapski=s opinion was also based in part on his conclusion that the employee=s complaints were out of proportion to the findings and that the diagnostic tests did not show a surgical condition. We also note that Dr. Freidland=s report, examination, and conclusions provide support for determination that the employee=s cervical condition was not related to the work injury.
We conclude the compensation judge did not err in accepting the opinion of Dr. Szalapski and of Dr. Friedland and in basing his decision on those opinions. This court will uphold a factual determination based on a compensation judge=s choice of expert opinion unless the opinion relied upon was without foundation. Smith v. Quebecor Printing, Inc., 63 W.C.D. 566 (W.C.C.A. 2003).