THOMAS H. JESBERG, Employee, v. WALDOCH CRAFTS, INC., and STATE FUND MUT. INS. CO., Employer-Insurer/Appellants, and PAINTERS & TRADES DIST. COUNCIL 82, FAIRVIEW HEALTH SERVS., UNIVERSITY OF MINN. PHYSICIANS, and TWIN CITIES ANESTHESIA, Intervenors.
WORKERS= COMPENSATION COURT OF APPEALS
APRIL 3, 2006
CAUSATION - SUBSTANTIAL EVIDENCE. Substantial evidence, including expert opinion, supported the judge=s decision that the employee=s work-related injury was a substantial contributing cause of the employee=s ankle condition and resulting need for surgery.
Determined by: Wilson, J., Rykken, J., and Pederson, J.
Compensation Judge: Carol E. Eckersen
Attorneys: Timothy J. McCoy, McCoy, Peterson & Jorstad, Minneapolis, MN, for the Respondent. Beth Giebel Mandel, Lynn, Scharfenberg & Associates, Minneapolis, MN, for the Appellants.
DEBRA A. WILSON, Judge
The employer and insurer appeal from the compensation judge=s decision that the employee=s left ankle condition and need for surgery were causally related to the employee=s March 5, 1997, work injury. We affirm.
The employee began working for Waldoch Crafts, Inc. [the employer], a van manufacturer, in 1996. On March 5, 1997, the employee=s left foot slipped on a protective cloth covering a bumper as he was climbing into a van, and he hit the ground, with his full weight, landing on the side of his left foot. The employee testified that he experienced immediate severe pain from his foot almost up to his knee, and he sought treatment that same day from Dr. Paul Nerothin at Forest Lake Doctors= Clinic. When x-rays showed a Athrough and through nondisplaced fracture to the base of the fifth metatarsal,@ the employee was advised to use ice, to elevate his foot, and to return later to the clinic for casting.
The employee=s foot was in a cast for several weeks. The employee testified that, by the time the cast was removed, his symptoms were better, but he continued to experience pain, intermittently, running the length of his foot. The employer and its insurer admitted liability for the March 5, 1997, injury and paid related medical expenses.
In May of 1997, the employee started a job as a painter, for a different employer. He had apparently worked as a painter in the past.
In December of 1997, the employee sought medical care again, from Dr. Charles Beck, complaining of continuing pain in his left foot. The exam notes from that visit indicate that the employee had been doing well until he went hunting in November and had Aquite a bit of discomfort.@ X-rays indicated that the employee=s metatarsal fracture was not yet completely healed, and the employee was advised not to overstress his foot or to walk on it if he had any pain.
In November of 1998, the employee experienced an aching in his left ankle while walking several blocks from his car to the site of a painting job on the University of Minnesota campus. As time went on, the discomfort became Aa little worse,@ and the employee began using a magnetic ankle wrap and ibuprofen. While the symptoms never completely disappeared, the employee sought no formal medical care for ankle pain until several years later, in about January of 2003, when he experienced a very sharp pain in his left ankle while walking on a sidewalk by a church he was painting. As the employee described it, the pain occurred Ajust in the normal course of walking.@ The employee testified that he knew at that time that something had changed, and he sought an evaluation at Orthopaedic Partners.
X-rays taken on January 30, 2003, disclosed severe degenerative changes in the employee=s left ankle. Cortisone injections provided only temporary relief, and physicians recommended ankle fusion surgery. The employee resisted the idea of fusion, because of concerns about mobility, and he eventually consulted Dr. J. Chris Coetzee, at the University of Minnesota, to determine whether there were any alternative treatment options.
The employee first saw Dr. Coetzee in July of 2003. In the report from the initial consultation, Dr. Coetzee recorded that the employee had developed increasing left ankle pain and instability over time and Arecall[ed] a foot fracture many years ago.@ Treatment options presented to the employee included medication, additional cortisone injections, and either fusion or ankle replacement surgery.
In a record from a December 2003 follow-up examination, Dr. Coetzee wrote that,
[The employee] relates his ankle problem started in 1997 when he sustained an inversion injury to the ankle. He slipped on a cloth that was draped over a bumper and apparently landed on the outside of his foot. There are apparently clinical records that confirm the injury. Since that time, his ankle never recovered completely.
The employee testified that he had also told the doctors at Orthopaedic Partners of the inversion injury, but there is no reference to the injury in those doctors= records. In any event, the employee underwent left ankle replacement surgery in February of 2004.
On April 1, 2004, Dr. Coetzee wrote a letter, addressed to ATo Whom it May Concern,@ regarding the nature and cause of the employee=s left ankle condition. In that letter, Dr. Coetzee indicated that the employee had asked him to try to determine whether his left ankle arthritis could be related to the March 1997 work injury, writing that,
Looking back at his records, he sustained inversion injury that resulted in a fifth metatarsal fracture. I believe this happened at work. There is a thorough account of the incident and treatment in his clinical records.
I could not find any mention of ankle ligament disruption in his records at the time of his injury. Having said that, a significant inversion of [sic] injury of the ankle that resulted in fifth metatarsal fracture could have caused ligamentous injury to the ankle as well. His ankle degeneration is secondary to a chronic lateral ligament instability.
As mentioned, it is impossible to determine but is theoretically possible that the injury at that time played a role in his ankle degeneration.
Shortly thereafter, the employee notified the employer that he intended to claim workers= compensation benefits related to his left ankle condition. In June of 2004, Dr. Coetzee drafted a more detailed letter addressing the issue of causation.
The employee underwent a second left ankle surgery in February of 2005. This procedure was also performed by Dr. Coetzee.
The matter came on for hearing before a compensation judge on September 16, 2005, to resolve the employee=s claim for medical benefits related to his left ankle condition. The parties stipulated that the sole issue was causation. Evidence included the employee=s medical records, the reports of Dr. Coetzee, and causation opinions from Drs. Daniel Janiga and Lowell Lutter. Both Dr. Janiga and Dr. Lutter reported that the arthritis in the employee=s left ankle was not related to the admitted March 5, 1997, work injury.
In a decision issued on October 17, 2005, the compensation judge determined that the employee=s left ankle condition and resulting disability were causally related to the employee=s March 5, 1997, work injury. The employer and insurer appeal.
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 employer and insurer contend that substantial evidence does not support the judge=s decision that the employee=s left ankle condition is causally related to the admitted March 5, 1997, work injury. In support of their position, the employer and insurer point out that there is no contemporaneous medical evidence of left ankle symptoms on or immediately following the date of the injury, that the employee did not seek any formal medical treatment for ankle symptoms for almost six years after the injury, and that the employee himself acknowledged that he did not experience any left ankle symptoms until November of 1998, when he was walking to the site of a painting job on the university campus. The employer and insurer also contend that this Aincident@ at the university, as well as the Aincident@ of increased symptoms while the employee was walking by a church on another job, were in fact what led to the employee=s need for surgery in 2004 and 2005. Some of the evidence cited by the employer and insurer might support their theory of the case. However, in our view, this case rests on the judge=s choice between conflicting expert opinions.
Both Dr. Lutter and Dr. Janiga were of the opinion that the employee=s severe arthritis of the left ankle was not related to his March 5, 1997, injury, because there was no evidence of ligament disruption cited in medical records detailing the employee=s treatment immediately following that injury. However, while acknowledging that there was no mention of ligament disruption in contemporaneous treatment records, Dr. Coetzee nevertheless concluded that it was Aprobable@ that the degenerative changes in the employee=s left ankle were related to the employee=s March 5, 1997, work injury. More specifically, in his June 24, 2004, report, Dr. Coetzee wrote, in part, as follows:
Looking back at his records, he sustained a severe inversion injury on that date that resulted in fifth metatarsal fracture. There was a thorough account of the incident and treatment in his clinical records. I could not find any mention of an ankle ligament disruption in his records at the time of the injury. Having said that, a significant inversion injury of the ankle can result in any or all of the following. The most common is ankle ligament disruption. This followed by either fifth metatarsal fracture, peroneal tendon disruption, anterior process calcaneal fracture, or ankle fracture.
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Initial evaluation of his left ankle showed a severe hindfoot varus deformity secondary to longstanding ankle ligament instability. It is a well known fact that lateral ligament instability will result in ankle arthritis. With his history of a significant inversion injury, it is therefore conceivable and probable that his degenerative changes are the result of his injury that at the time presented with a fifth metatarsal fracture.
Dr. Coetzee also noted that the employee=s right ankle showed Aabsolutely no signs of degeneration.@
The compensation judge expressly accepted Dr. Coetzee=s causation opinion. Contrary to the employer and insurer=s contention, we cannot conclude that the judge erred in relying on that opinion, despite Dr. Coetzee=s failure to express his opinion in terms of Areasonable medical certainty.@ See McBride v. Anderson Power Equip., Inc., slip op. (W.C.C.A. Feb. 21, 2002) (a physician need not use any particular words in rendering a causation opinion); see also Kientz v. Allina Health Sys./Home Medical Equip., slip op. (W.C.C.A. Aug. 19, 2002).
This is a straight-forward case involving a judge=s reasonable choice between conflicting medical opinions. We affirm. See Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985).
 Dr. Lutter is the employer and insurer=s independent examiner. Dr. Janiga is the medical director of CompCost, Inc., a company associated with the insurer.
 In this regard, it is important to note that neither physician assigned any responsibility to the two so-called Aincidents@ when the employee experienced symptoms while walking to painting job sites. As such, there is no medical evidence whatsoever to support the employer and insurer=s assertion that these Aincidents@ contributed to the employee=s condition.