TIMOTHY RUSSELL, Employee/Appellant, v. OPPORTUNITY PARTNERS, INC., and BERKLEY RISK ADM=RS CO., Employer-Insurer, and MEDICA by HRI, THIRD PARTY SOLUTIONS, and MINNEAPOLIS CLINIC OF NEUROLOGY, Intervenors.
WORKERS= COMPENSATION COURT OF APPEALS
SEPTEMBER 18, 2006
CAUSATION - PSYCHOLOGICAL INJURY. Substantial evidence, including expert medical opinion and medical records, supports the compensation judge=s finding that the employee=s work-related injury to his upper extremities did not result in his current psychological condition.
Determined by Rykken, J., Wilson, J., and Stofferahn, J.
Compensation Judge: Danny P. Kelly
Attorneys: Thomas A. Klint and William J. Marshall, Babcock, Neilson, Mannella, Klint, Anoka, MN, for the Appellant. Timothy P. Jung, Rider Bennett, Minneapolis, MN, for the Respondents.
MIRIAM P. RYKKEN, Judge
The employee appeals from the compensation judge=s findings that his work-related injury represented a temporary condition that had resolved no later than December 2003 and that the employee did not sustain a psychological injury as a result of that injury, and appeals from the compensation judge=s denial of his claim for permanent total disability benefits, permanent partial disability benefits and medical expenses. We affirm.
On December 10, 1990, the employee, Timothy Russell, began his employment with Opportunity Partners, an organization that provides vocational and recreational services to disabled individuals. He initially worked as a line leader, for approximately eight years; his job responsibilities included helping workers who ran a packing machine. In 1998, he became an instructor; in that position, he was responsible for teaching independent living skills. He planned classes on topics such as arts and crafts skills, current events information, and cooking; he controlled the class content and structured classes around what he deemed appropriate for his particular students. The employee took his students on field trips and prepared class plans and reports. He typically prepared for his classes between 7:30 and 9:00 a.m., and, at the end of the day, he also wrote student evaluations for eight to ten students. His daily activities, outside of his direct teaching, required approximately one and a half hours of handwriting plus an additional one half hour of computer work.
In 2001, the employee began to notice symptoms in his hands, such as cramping in his wrist and palm of his right hand and intermittent pain. As a result of the ongoing pain in his right upper extremity, the employee began using his left hand, exclusively, for all tasks. On November 19, 2001, the employee noticed increased tightness and discoloration in his right hand while performing his writing responsibilities. He also noticed that same tightness after performing his computer work. The level of his pain depended on the type of activities he performed.
On December 5, 2001, the employee first consulted Dr. William Brombach at Midway Internal Medicine, reporting hand pain. He reported that he had injured his hand while throwing a ball a few weeks ago, that this injury had slowly resolved, and that over the past few days he had developed pain in his right hand, along with some tingling radiated up into his arm. Dr. Brombach diagnosed hand pain with a possible ruptured ligament with developing ganglion cyst, but no evidence of significant pathology. He prescribed anti-inflammatory medication. On December 12, 2001, the employee sought medical treatment at Park Nicollet, for right carpal tunnel symptoms. He was provided with a splint for his right wrist, but returned the next day reporting left wrist and hand symptoms related to overuse of his left hand.
Upon referral, the employee consulted Dr. Dave Klock, orthopedist, who diagnosed right hand pain and paresthesia, and prescribed hand therapy. His symptoms worsened, and he was seen by Dr. A. Nadine Maurer, physical medicine specialist. She reviewed the results of an EMG and a nerve conduction study performed on January 24, 2002, both of which had normal results. The employee received hand therapy between January and May 2002, including ultrasound, splinting and exercises. He continued to work at his same job, but noticed ongoing symptoms.
In March 2002, on referral from Dr. Klock, Dr. Scott McPherson, also an orthopedist, examined the employee and diagnosed bilateral hand and distal forearm symptoms. At a reexamination in May 2002, Dr. McPherson diagnosed chronic forearm/hand pain and dysfunction. He took cervical spine x-rays to rule out symptoms related to the employee=s neck, and also referred the employee for a rheumatological consultation and for treatment with physicians in the physical medicine and rehabilitation departments. He restricted the employee to no typing, no prolonged writing, limited driving at work, limited pushing of wheelchairs, and no lifting over 10 pounds. He also restricted the employee from performing CPR. Dr. McPherson recommended pool therapy, which the employee did attend.
Following the employee=s injury, he continued working with the employer in a modified capacity until the summer of 2002. He found that certain activities worsened his symptoms, including turning pages in a book, writing, driving, putting his clothes on, and other activities of daily living. Between July 2002 and January 20, 2003, the employee took a leave of absence from work for approximately six months as a result of his symptoms. During that time, however, he continued to note symptoms and continued to treat for his condition. His hand, wrist and arm symptoms persisted, and he experienced difficulty with many activities such as eating, brushing his teeth, cooking and cleaning. The employee eventually moved to his parents= home in order to obtain assistance with his activities of daily living, such as cooking, laundry, house cleaning and driving.
Since 2001, the employee has consulted various physicians in an attempt to obtain a diagnosis of his condition. His records reflect that his physicians often have been unable to delineate any specific diagnosis or explanation for his symptoms. On August 20, 2002, the employee was seen again by Dr. Maurer, who then diagnosed him with bilateral upper extremity limb, forearm, wrist and hand pain, secondary to repetitive trauma. She scheduled him for a bone scan to rule out reflex sympathetic dystrophy; a scan conducted on September 3, 2002, was negative.
On November 15, 2002, on referral from Dr. Maurer, the employee consulted Dr. Felix Zwiebel, Minneapolis Clinic of Neurology. Dr. Zwiebel found no evidence of any neurologic abnormality, even though the employee=s pain persisted. He stated that
I cannot find evidence of any neurologic abnormality in this gentleman. His discomfort/pain symptoms are a bit unusual for their persistence and vague nature. It is hard to believe that he has had an inflammatory tenosynovitis that has not resolved in a year. He does not have evidence of neuropathy, motor neuron disease (which is generally completely non-painful), or other neurologic disorders.
Dr. Zwiebel commented that, from a neurologic standpoint, he would not personally pursue additional neurodiagnostic testing.
By January 2003, the employee attempted a return to work as a teacher assistant. He worked in that position for five to six weeks, but eventually was unable to continue working for the employer due to his physical restrictions. He has not returned to work since then. The employee testified that he is not actively engaged in any job search other than his contacts with Minnesota Work Force Center. He claims he is physically unable to drive, and he has been approved in the past to receive rides from Metro Mobility, and his father provides him with rides. He also has consulted with the Courage Center to obtain some adaptive driving equipment. The employee has not applied for any jobs in the 12 month period before the hearing, but he did apply for and secure entitlement to Social Security disability income effective as of January 2003.
Following the employee=s injury, the employer and insurer paid temporary total disability benefits during most weeks commencing in July 2002, and paid temporary partial disability benefits for the month-long period in early 2003 when the employee returned to work for the employer. An evidentiary hearing was held in 2003 to address the issue of the employee=s entitlement to ongoing temporary total disability benefits. A petition to discontinue benefits, filed by the self-insured employer, was addressed at a hearing on November 19, 2003, before Compensation Judge William R. Johnson. At that hearing, the employer contended that 90 days had passed since the employee had reached maximum medical improvement (MMI) from his injury, and also contended that the employee had no physical restrictions causally related to his work injury. The compensation judge concluded that the employee had not yet reached MMI, and that the employee would benefit from a chronic pain program to address the psychological component of his disability. The employer and insurer reinstated payment of temporary total disability benefits.
In January 2003, the employee attended an independent medical examination with Dr. Tilok Ghose, orthopedic surgeon, at the request of the employer and insurer. The employee reported significant symptoms, including bilateral upper extremity pain and neck pain. Dr. Ghose diagnosed a chronic repetitive motion injury, in the nature of tendinitis tenosynovitis. Dr. Ghose stated, however, that the employee did not have any neurological findings nor limited range of motion, and that he agreed with the observation of the employee=s treating physicians that the employee had Asignificant subjective symptoms without any objective findings to substantiate his symptoms.@ In Dr. Ghose=s opinion, the employee=s use of his arms for activities of teaching and work caused his repetitive motion injury. Dr. Ghose stated that Ain anticipating [the employee=s] return to work, I think he needs to be seen by a qualified hand rehabilitation specialist and/or a therapist,@ and recommended that he undergo a functional capacity evaluation to determine his physical capabilities. He also recommended volumetric testing, which could objectively determine whether the employee=s physical tasks cause an increase in volume of the upper extremity. He commented that if none resulted, the implication would be that the employee had Asignificant functional overlay symptomatology.@ Dr. Ghose also concluded that the employee had sustained no permanent partial disability as a result of his work-related injury, and recommended no continued physical therapy, no assessment by a neurologist nor a pain program.
In April 2003, the employee underwent a functional capacities evaluation. The therapist noted signs of general deconditioning and the employee=s limited ability to complete the majority of tasks due to his reports of increased pain. She concluded that the employee=s physical capacities fell below the sedentary work level. The therapist recommended that the employee undergo a chronic pain evaluation Ato encourage reactivation and learn alternate pain coping strategies.@ She also felt that the employee would benefit from postural education and instruction in a general conditioning and exercise program. The therapist commented that A[b]ased on the client=s limited test performance, [she questioned] the client=s feasibility to be competitively employed@ and that if he were to pursue job opportunities, she recommended specific work restrictions.
Dr. Ghose reviewed the employee=s functional capacity evaluation and also his volumetric testing which showed minimal increase in volume. In a supplemental report dated June 3, 2003, he concluded that the examination was negative for any neurological deficit. Based on the results of the testing, Dr. Ghose found no objective evidence to support a contention that physical work restrictions were warranted for the employee=s upper extremity condition. He concluded that the employee did not have reflex sympathetic dystrophy nor any neurological problem, and no peripheral neuropathy. As a result, he concluded that the employee was capable of working on a full-time basis without restrictions, and that the employee had reached MMI as of April 16, 2003. In his supplemental report of December 17, 2003, Dr. Ghose concluded as follows:
The employee=s current symptoms and diagnosis of limb pain are not related to the work-related tendinitis injury. That has now resolved. The rationale for that is that there is no clinical examination showing any evidence of significant swelling. Mr. Russell=s condition of tendinitis is resolved. The diagnosis of limb pain is not related to the tendinitis, which has resolved.
In February 2004, Dr. Matthew Monsein, at the Sister Kenny Institute, performed a chronic pain evaluation on the employee. He diagnosed bilateral arm pain of unknown etiology, chronic pain syndrome and mild atrophy of the arms, most likely due to disuse of his arms. He referred the employee for a follow-up neurological evaluation by Dr. Zweibel and for an evaluation with Dr. Douglas Drake, hand surgeon, for further assessment before beginning a pain rehabilitation program. Dr. Drake examined the employee in March 2004, and concluded that the employee showed no evidence of rheumatological abnormalities. He recommended additional diagnostic testing, including a repeat EMG study, to rule any other condition, but stated his opinion that AI think there is a large element of functionality in this patient and that he would be best served by a chronic pain program.@ An EMG conducted in March had normal results. Dr. Zweibel examined the employee in March as well; he concluded that all of his lab studies were entirely normal, and that he could not determine any specific underlying muscle or nerve disorder. Dr. Zweibel did not recommend any diagnostic testing from a neurological standpoint, and encouraged the employee to attend a chronic pain program.
The employee attended the Sister Kenny Pain Clinic Program in May and June 2004. Dr. Monsein examined the employee following that program, and stated, in his report of June 18, 2004, that he saw no significant change in the employee=s symptoms, although he detected a change in the employee=s attitude towards his pain and his willingness to follow recommendations for exercise and conditioning. Dr. Monsein found the greatest improvement to be psychological, in that the employee appeared less depressed, had an improved affect, and seemed to benefit from interactions with other patients in the program. Dr. Monsein recommended a work hardening program if the employee was to return to work. He stated he was Acautiously optimistic that with ongoing physical re-conditioning and desensitization on [the employee=s] part, while he may never get back to >normal use of his hands,= that we will see slow but progressive improvement.@
The program nurse recommended that the employee return for treatment at the Sister Kenny Institute for aftercare, on the basis of one day per month for six months, and he followed through with that aftercare.
The employee has undergone additional diagnostic testing, including an MRI of the cervical, thoracic and lumbar spine in August 2004, to rule out any potential issue of spine abnormality causing neck and arm pain; those tests were interpreted as showing some mild degenerative disk changes. He also underwent a rheumatologic evaluation in 2004, which had negative results. By August 2004, Dr. Robert Tierney, rheumatologist, re-examined the employee and diagnosed tenosynovitis of the hands.
On August 30, 2004, the employee attended an independent medical examination with Dr. William Call, an orthopedic surgeon who specializes in the treatment of the hand. Dr. Call stated that he could not Aidentify any pathological condition objectively supported with respect to the upper extremities that can be attributed to [the employee=s] work activity with Opportunity Partners.@ He found no objective evidence of any work injury of November 19, 2001, and instead stated that the employee demonstrated Aa history, physical examination and record review consistent with subjective discomforts and reported subjective weakness about the upper extremity with no objective findings.@ Dr. Call found no evidence of tenosynovitis, reflex sympathetic dystrophy nor orthopedic pathology. He advised that he did not believe the employee required any physical restrictions due to any injury in 2001, and found that there was no reason the employee could not return to work on a full-time sustained basis, without restrictions.
Following the employee=s attendance at a chronic pain program in 2004, the self-insured employer sought to discontinue the employee=s temporary total disability benefits 90 days after June 30, 2004, the date on which the employee had been served with notice of MMI. The employee objected to a discontinuance of benefits, and a hearing was held before Compensation Judge Danny Kelly on December 30, 2004, to address the employee=s objection. In his findings and order issued on January 27, 2005, the judge found that the employee had reached MMI upon the completion of the Sister Kenny pain program on June 18, 2004, and granted the request to discontinue benefits by September 17, 2004.
The employee continued to treat with Dr. Maurer, who prescribed anti-inflammatory medication. In February 2005, Dr. Tierney noted some swelling over the right flexor tendon mechanism at the wrist, and diagnosed tenosynovitis and probable right carpal tunnel syndrome. He referred the employee for an additional EMG study. On March 10, 2005, the employee consulted Dr. Jeffrey Husband, who diagnosed him with Adiffuse, nonspecific upper extremity pain,@ and concluded that the employee=s symptoms did not have an organic basis and that he did not feel that Ait would be fruitful to pursue any additional medical treatment@ and that there was no need for surgery or injections.
The employee=s extensive medical records thoroughly outline the consultations and treatment he has undergone for his symptoms of anxiety, depression, fatigue and nervousness since his 2001 injury, and also outline medical treatment he underwent before that injury, including treatment for gastroesophageal conditions and a related surgery with a six-month period of recovery and disability from work for his surgical recovery. The employee testified that his physical symptoms resulting from his work injury have significantly affected him from an emotional perspective and have restricted his ability to work. He also testified that his participation in the chronic pain program had been beneficial; although the level of his pain had not changed, he had been encouraged to try increasing the level of his functioning.
In 2004, an additional dispute arose over the employee=s ongoing entitlement to benefits and the nature of his injury. On October 18, 2004, the employee filed a claim petition, seeking payment of permanent total disability benefits since September 17, 2004, and payment of medical expenses. The employee later amended his claim, alleging that he sustained a psychological injury as a consequence of his work injury, and seeking benefits based on a rating of 25% permanent partial disability of the body as a whole based upon his psychiatric condition. In its answer to the employee=s claim petition, the self-insured employer admitted the employee=s injury to his upper extremities, but contended that the injury had resolved, that the employee=s current complaints were not causally related to the work injury, and that the employee was not permanently and totally disabled as a result of that injury.
In March 2005, the employee consulted Dr. John Patrick Cronin, Primary Behavioral Health Clinics, for an independent psychological evaluation. The employee reported to Dr. Cronin that his daily physical activities were extremely limited, that he continued to rely heavily on his parents for help, and that his level of pain often left him feeling fatigued and run down. The employee also reported that he often felt depressed and blue, and had noticed an increase in his irritability and tension due to his physical limitations, since he formerly was very active and self-sufficient. He also reported to Dr. Cronin that his inability to work and his financial situation exacerbated his depression and that his stress caused additional flare-ups in his pain.
Dr. Cronin concluded that the employee=s work-related injury had triggered his current psychiatric condition, and that the employee exhibited an emotional reaction to the injury in the form of depression and anxiety. Dr. Cronin diagnosed chronic pain syndrome. He concluded that the employee Aneeds to continue receiving ongoing treatment to deal with both chronic pain issues as well as his psychological and psychiatric dysfunction. This would include individual psychotherapy, clinical biofeedback and psychotropic medication.@ He concluded that the employee was not capable of engaging in any continued and sustained work activity, and that he would not reach MMI until comprehensive treatment had been exhausted. Dr. Cronin assigned a permanent partial disability rating of 25% whole body impairment, using a Weber rating based on the employee=s condition.
On May 10, 2005, the employee consulted Dr. Maurer again. The employee reported hand, upper arm and neck pain. He described his ongoing symptoms as including worsening aching, burning and cramping. He reported that his symptoms were aggravated with housework, jarring, lifting, reaching, sitting, sneezing, stress, tension, and walking, and that he had difficulty writing and feeding himself. Dr. Maurer diagnosed chronic limb, hand and neck pain, advised the employee to continue with his independent exercise program, asked him to follow-up in six months, and later outlined physical work restrictions.
On June 29, 2005, the employee underwent an independent psychiatric evaluation with Dr. Thomas Gratzer. Dr. Gratzer reviewed the employee=s medical records, including the report and testing recently conducted by Dr. Cronin. He reported to Dr. Gratzer that he had enjoyed his employment and that his physical limitations following his 2001 injury had caused stress, low self-worth and low self-esteem. He also reported some anxiety about his condition and prognosis, and that he was currently prescribed Wellbutrin, an anti-depressant medication, by his treating physician. The employee reported to Dr. Gratzer that he currently was not receiving mental health treatment, and that he understood his current problems to be physical and not psychiatric in nature.
Dr. Gratzer diagnosed the employee with pain disorder associated with psychological factors and adjustment disorder with depressed mood, and also with a dependent personality disorder. He concluded that the employee=s testing was consistent with a pain disorder associated with psychological factors. Dr. Gratzer stated that A[i]n this disorder, psychological factors are judged to play the principal role in the onset, severity, exacerbation, or maintenance of the pain.@ He further concluded that the employee=s Apain disorder associated with psychological factors is related to pre-existing psychodynamics and secondary gain factors,@ and that the pain disorder Awas initially precipitated by unresolved emotional issues and inability to manage these without somatization.@ Dr. Gratzer felt that the employee=s pain disorder was separate from his physical stresses associated with the 2001 injury. He concluded that the employee had no permanent partial disability relative to his work injury, since he found no causal relationship between the work injury and the employee=s psychological condition. In terms of recommendations for the employee, Dr. Gratzer stated the following:
The treatment for pain disorder associated with psychological factors is social and vocational reintegration. The more [the employee] is able to reintegrate socially and vocationally, the less reliant he will be on his functional pain complaints to meet his emotional needs. In that regard, in my opinion, [the employee] does not require any work restriction relative to his psychiatric condition. [The employee] does not have any major disturbance of mood, thought, or anxiety that would affect his vocational functioning.
The employee=s claim petition was addressed at a hearing on October 6 and 21, 2005, again before Compensation Judge Danny Kelly. In his findings and order issued on December 20, 2005, the compensation judge found that the employee=s 2001 injury was in the nature of a temporary aggravation, diagnosed as tendinitis, that resolved no later than December 17, 2003, and that the injury did not substantially contribute to the employee=s ongoing disability. The judge also found that the evidence did not establish that the employee sustained a psychological injury as a consequence of his work injury, nor that the employee was entitled to permanent total disability benefits as a result of that injury. The judge ordered payment of outstanding medical expenses related to treatment of the employee=s bilateral upper extremity tendinitis before December 17, 2003, but denied payment for expenses incurred after that date. The employee appeals from those findings and the related denial of his claims.
The employee argues that he is permanently and totally disabled as a result of a psychological injury sustained as a result of his November 2001 work injury, and appeals the compensation judge=s finding that the employee did not sustain a psychological injury as a result of that injury.
Workers' compensation claims involving psychological or mental problems are divided into three categories: (1) cases in which mental stimulus produces physical injury, (2) cases in which physical stimulus produces mental injury, and (3) cases in which mental stimulus produces mental injury. Under Minnesota law, claims for compensation based on the first two categories are recognized, but claims for compensation where a mental stimulus results in mental injury are denied. Johnson v. Paul's Auto & Truck Sales, Inc.. 409 N.W.2d 506, 40 W.C.D. 137 (Minn. 1987); Lockwood v. Indep. Sch. Dist. No. 877, 312 N.W.2d 924, 34 W.C.D. 305 (Minn. 1981). In this case, the employee claims that the physical stimulus of his work injury led to his current disabling psychological condition, and that his psychological condition therefore is compensable. See, e.g., Childers v. Honeywell, Inc., 505 N.W.2d 611, 49 W.C.D. 230 (Minn. 1993) (depression caused by low back injury); Hartman v. Cold Spring Granite Co., 243 Minn. 264, 67 N.W.2d 656, 18 W.C.D. 206 (1955) (psychological problems caused by back injury); see also Dotolo v. FMC Corp., 375 N.W.2d 25, 38 W.C.D. 205 (Minn. 1985) (depression caused or aggravated by tinnitus).
The compensation judge found that the employee=s psychological condition was not related to the employee=s work injury, and relied upon Dr. Gratzer=s opinion in support of that finding. The employee relies on Dr. Cronin=s opinion that the employee=s psychological condition is causally related to the employee=s work injury, and contends that Dr. Gratzer acknowledged that the employee developed a physical injury that developed into a psychiatric condition and that Dr. Gratzer did not indicate that the employee=s psychological condition was not triggered by the work injury. However, Dr. Gratzer diagnosed the employee as having a psychogenic pain disorder, also termed a pain disorder associated with psychological factors, which he explained was not related to physical stressors but instead was related to emotional issues and an underlying personality disorder.
The employee argues that the compensation judge erred in accepting one medical expert opinion while ignoring the other opinions in evidence, since the judge provided no explanation or basis for ignoring the substantial evidence supporting the employee=s disability Awhile adopting the one opinion that did not support disability.@ (Ee=s Brief, p. 4.) The employee argues that the compensation judge=s decision did not comply with the requirements of Minn. Stat. ' 176.371, and that his minimal memorandum provided no explanation of how the judge reached his decision or why the opinion of Dr. Gratzer should be considered to be more persuasive than that of Dr. Cronin concerning the causation of the employee=s psychological condition. We concur that the compensation judge did not specifically state why he accepted certain medical opinions over others. Minn. Stat. ' 176.371, however, provides that a Acompensation judge=s decision shall include a memorandum only if necessary to delineate the reasons for the decision or to discuss the credibility of witnesses.@ In his findings and order, the compensation judge outlined the employee=s medical history and the various medical opinions concerning his medical conditions, and, while more explanation as to the judge=s rationale for relying on particular opinions might have been useful, his decision as a whole provides a sufficient basis for review of the disputed issues. In addition, this court has previously stated that a judge is not required to discuss every piece of evidence submitted at hearing, see, e.g., Smith v. The Press, slip op. (W.C.C.A. Apr. 27, 1995), and we find no error in the compensation judge=s reliance on particular medical opinions.
The compensation judge adopted Dr. Gratzer=s opinion that the employee=s pain disorder is separate from the physical stresses of the employee=s work injury. We note that it is the compensation judge's responsibility, as trier of fact, to resolve conflicts in expert testimony, and that a judge=s choice between expert opinions is generally upheld unless the facts assumed by the expert in rendering his opinion are unsupported in the record. Nord v. City of Cook, 360 N.W.2d 337, 342, 37 W.C.D. 364, 372 (Minn. 1985). Dr. Gratzer=s report outlines the information and records he reviewed in conjunction with his examination, and also outlines the history provided by the employee. We find no discrepancy between that information and the records submitted into evidence, and therefore cannot conclude that there is any foundational defect in Dr. Gratzer=s opinion. Substantial evidence, including expert medical opinion and the employee=s medical records, supports the compensation judge=s finding that the employee did not sustain a psychological injury as a consequence of his work-related injury, and we affirm that finding.
The compensation judge also determined that the employee=s physical injury to his upper extremities had resolved, based on the opinion of Dr. Ghose, who concluded that the employee=s work-related tendinitis injury had resolved and that his current symptoms and diagnosis of limb pain were not related to his work injury. Although the employee disputes the accuracy of the compensation judge=s interpretation of Dr. Ghose=s report and opinion, we conclude that the judge=s finding that the employee=s tendinitis injury had resolved is supported by substantial evidence in the record, including extensive medical records and medical expert opinion.
The employee argues that it is irrelevant whether the employee=s physical symptoms had resolved, as determined by the compensation judge, and also infers that the compensation judge required the employee=s physical injury to be substantial in order for that injury to have resulted in a psychological injury. The employee argues that there is no requirement that in order for psychological disability to be compensable, the underlying physical injury must be substantial. We agree. For a mental disability to be compensable, the psychological injury or symptoms must be a Aproximate result@ of the employee=s physical injuries and result in disability. Mitchell v. White Castle, 290 N.W.2d 753, 32 W.C.D. 288 (Minn. 1980). In certain instances, the psychological injury may be even more debilitating to the employee than the underlying physical injury. In this case, however, although the employee argues that there remains a causal connection between the employee=s original physical injury and his current psychological condition, we have affirmed the judge=s finding of no causal connection.
The employee also appeals the compensation judge=s denial of permanent total disability benefits and permanent partial disability benefits. He argues that he is entitled to benefits based on 25% permanent partial disability to the body as a whole, based upon an appropriate Weber rating assigned by Dr. Cronin, and to permanent total disability benefits. Since we have affirmed the compensation judge=s finding that the employee has not sustained a psychological injury as a consequence of his work-related injury, we need not address these issues.
 Weber v. City of Inver Grove Heights, 461 N.W.2d 918, 43 W.C.D. 471 (Minn. 1990).
 Dr. Cronin compared the employee=s condition to that which is described in Minn. R. 5223.0360, subp. 7(D), subsections 2 and 3. In his report dated March 29, 2005, Dr. Cronin stated that:
I arrive at this rating by considering those two categories which most represent his degree of psychological/psychiatric disturbance and utilizing the [Weber] decision which allows the examiner to rate between categories when an individual does not fit specifically into one category, I chose these two categories because his condition exceeds category 2, Amild emotional disturbance,@ but he does not meet the full criteria under category 3, Arequires some supervision on a daily basis.@ These two categories have a range from 20-40%, and, thus, utilizing the [Weber] decision, I am placing him between the categories at 25% permanent partial disability.
 Minn. Stat. ' 176.371 provides, in pertinent part, as follows:
The compensation judge to whom a petition has been assigned for hearing, shall hear all competent, relevant evidence produced at the hearing. All questions of fact and law submitted to a compensation judge at the hearing shall be disposed of and the judge=s decision shall be filed with the commissioner. . . . The compensation judge=s decision shall include a determination of all contested issues of fact and law and an award or disallowance of compensation or other order as the pleadings, evidence, this chapter and rule require. A compensation judge=s decision shall include a memorandum only if necessary to delineate the reasons for the decision or to discuss the credibility of witnesses. A memorandum shall not contain a recitation of the evidence presented at the hearing but shall be limited to the compensation judge=s basis for the decision.