PAUL VOLNESS, Employee/Appellant, v. CEMSTONE and RISK ENTER. MGMT., LTD., Employer-Insurer/Appellants, and CENTER FOR DIAGNOSTIC IMAGING and TWIN CITIES ORTHOPAEDICS, P.A., Intervenors.
WORKERS= COMPENSATION COURT OF APPEALS
JANUARY 10, 2007
CAUSATION - MEDICAL TREATMENT. The compensation judge=s finding that the employee=s second surgery was unrelated to the 2004 work injury was supported by her choice of well-founded medical opinion, as well as by her reasonable interpretation of the opinions of the treating physician and by the employee=s testimony and medical records.
PRACTICE & PROCEDURE ‑ ADEQUACY OF FINDINGS. The compensation judge's findings and orders adequately disclose the factual and legal basis for his decision and are sufficient under Minn. Stat. ' 176.371. The absence of a detailed explanation of the rejection of certain evidence is not, accordingly, here a basis for remand or reversal.
Determined by: Stofferahn, J., Wilson, J., and Pederson, J.
Compensation Judge: Jennifer Patterson
Attorneys: Thomas A. Klint, Babcock Neilson Mannella Klint, Anoka, MN, for the Appellant. Jeremy D. Rosenberg, Johnson & Condon, Minneapolis, MN, for the Respondents.
DAVID A. STOFFERAHN, Judge
The employee appeals from the compensation judge=s finding that the employee=s 2004 work injury was not a substantial contributing factor in the employee=s need for cervical surgery on April 18, 2006. We affirm.
The employee, Paul Volness, sustained an admitted injury while working for the employer, Cemstone, when he was lifting 80-pound sacks of cement on June 29, 2004. He began to experience a burning sensation in his neck and not long afterwards began to have neck pain. Subsequently, he began to experience pain and numbness in his right arm radiating down to his little finger.
The employee sought chiropractic treatment on July 6, 2004, and then began treating for neck and right arm pain with his family medical practitioner, Dr. R. Bruce Hoggarth, who diagnosed cervical radiculopathy into the right shoulder and upper arm area. Physical therapy, medications and cervical traction did not relieve his symptoms, and on August 20, 2004, an MRI scan of the cervical spine was performed at the Ridgeview Medical Center. The MRI showed moderate diffuse disc bulging at C5-6 producing foraminal narrowing with probable right C6 nerve root impingement, diffuse disc bulging at C6-7 with bilateral foraminal stenosis and possible bilateral C7 nerve root impingement, and central stenosis at several levels, moderately severe at C6-7 and mild to moderate at C4-5 and C5-6. There was mild flattening of the ventral spinal cord at the C5-6 and C6-7 levels. Dr. Hoggarth concluded that the employee=s neck pain and radicular symptoms were secondary to the bulging discs.
Epidural steroid injections failed to change the employee=s symptoms and Dr. Hoggarth referred the employee to Dr. Jeffrey C. Dick, an orthopedic surgeon. Dr. Dick saw the employee on November 12, 2004. At that time, the employee=s symptoms consisted of neck pain, right shoulder pain, and right arm pain. The neck pain was constant but the shoulder and arm symptoms were intermittent. The doctor diagnosed C5-6 and C6-7 degenerative disc disease and foraminal stenosis, and recommended nerve root injections to localize the employee=s symptoms. An epidural injection in the form of a right C6 nerve root blockade on November 24, 2004, gave the employee a 90 percent decrease in his pain symptoms. Dr. Dick recommended that the employee undergo surgery at the C5-6 level, where he considered the employee=s symptoms to be well-localized. In light of the severe degenerative changes and central stenosis at C6-7, he recommended that this spinal level also be fused.
On January 11, 2005, the employee underwent a C7 corpectomy with foraminal decompressions on the right at C5-6 and C6-7 and C5-7 spinal fusion. One month after the surgery the employee was reporting an 80-90 percent improvement of his neck symptoms, and Dr. Dick returned him to work under a 35-pound lifting restriction on April 25, 2005. As of July 13, 2005, the employee reported his neck pain was 95 percent better and consisted principally of an occasional neck kink which generally resolved when he changed positions. His right arm symptoms were completely resolved. Dr. Dick concluded that the employee had reached maximum medical improvement. He continued the employee=s lifting restrictions as permanent.
In mid-October, 2005, the employee returned to Dr. Dick for symptoms of increasing neck pain and stiffness with some numbness throughout the left arm. A high-resolution cervical CT scan was performed on October 19, 2005, to rule out pseudoarthrosis. The scan showed that the bone graft was well incorporated without evidence of pseudoarthrosis. There was marginal osteophyte formation resulting in mild central stenosis at C4-5 and C5-6 and mild to moderate central stenosis at C6-7. Dr. Dick felt that the residual central stenosis, particularly at the C6-7 level, might be causing the employee=s left-sided symptoms, which showed a C8 nerve distribution. He recommended a cervical laminoplasty with foraminal decompressions on the left at C7 and C8, and further suggested the same procedure be performed at the C5 level due to an increased risk of C5 radiculopathy.
The employer and insurer, which had paid for the initial surgery, did not agree to pay for the surgery recommended by Dr. Dick, and sought a further opinion as to the proposed surgery from Dr. William T. Simonet, M.D. Dr. Simonet saw the employee on January 24, 2006. In his report, Dr. Simonet offered the opinion that the employee=s work injury had caused an aggravation of pre-existing degenerative disc disease at C5-6 and C6-7 which had been effectively treated by the first surgery, after which the employee=s symptoms from the work injury resolved. He viewed the employee=s current condition for which the proposed surgery had been offered as unrelated to the work incident and due solely to the preexisting degenerative disc disease.
On March 6, 2006, Dr. Dick wrote a letter discussing Dr. Simonet=s opinions. He agreed with the opinion that the employee=s work injury had been a permanent aggravation of pre-existing degenerative disc disease, spinal and foraminal stenosis. He further agreed that the employee=s current symptoms were likely the result of his central stenosis and not due to discs or facet joints, since the initial fusion was solid. However, he reasoned that, as the first surgery was considered work-related, the second surgery should be as well, on the basis that the initial surgery did not adequately relieve the employee=s stenosis and that the second surgery was simply intended to finish the decompression performed in the first surgery.
The employer and insurer continued to refuse the proposed surgery. On April 18, 2006, the employee underwent a C4-7 laminoplasty with decompression of the left side of the C5, C7 and C8 nerves. As of the date of the hearing below, about a month after surgery, the employee had not had any significant relief of his symptoms.
In deposition testimony, Dr. Dick further explained his view of the employee=s condition and treatment. He agreed that the employee=s congenitally small spinal canal and the development of central canal stenosis were conditions which pre-existed the work injury and which were not physically changed by that injury. In his view, however, the employee=s work activities in lifting a number of heavy bags of cement on the date of the work injury, in combination with the pre-existing stenosis, had caused a swelling and irritation of the employee=s spinal cord resulting in the inception of his symptoms. The symptoms were related to the central stenosis impinging on the nerve at the C5-6 level and causing radicular symptoms in the pattern of the C6 nerve distribution on the right. Following the decompression of the spinal canal during the first surgery, and removal of these spurs, the symptoms the employee had experienced following the work injury had fully abated. However, during the months following the first surgery, the employee=s central stenosis had recurred in that there was new bone growth and new spur formation from the bony mass at a level where bone had been taken out during the initial fusion. By the fall of 2005, this new bony growth had developed sufficiently to result in pressure on the spinal cord, with symptoms this time displaying a C8 nerve root distribution on the left. Although the bone spurs to which Dr. Dick attributed the impingement were at the C6-7 spinal level, he noted that the differentiation of the C8 nerve from the spinal cord began to occur at this level and that it was not unusual for a C8 distribution pattern to result from cord pressure at a higher level.
At a hearing before Compensation Judge Jennifer Patterson on May 23, 2006, the parties litigated the issues of whether the employee=s April 18, 2006, surgery was reasonable and necessary and causally related to the June 29, 2004, work injury. Following the hearing, the compensation judge determined that the surgery was reasonable and necessary but was not related to the work injury. The employee appeals.
The employee argues that the compensation judge overlooked crucial evidence supporting his case, in that the compensation judge=s findings and memorandum fail to fully discuss Dr. Dick=s deposition testimony and reasoning, particularly as regards the recurrence of bony spurs and central stenosis following the employee=s initial surgery. The employee further points to portions of the findings and memorandum in which the compensation judge indicates that the employee=s second surgery was performed principally to prevent permanent damage to the spinal cord from any continuation of bony growth and impingement, rather than to alleviate the employee=s current symptoms. The employee contends that this language suggests that the compensation judge erroneously based her denial of the employee=s claim on this factor, and failed to adequately consider the other evidence in the case. We disagree.
This court has frequently noted that a compensation judge is not required to relate or discuss every piece of evidence introduced at the hearing. See, e.g., Regan v. VOA Nat=l Housing, 61 W.C.D. 142 (W.C.C.A. 2000). Rather, the compensation judge=s findings and memorandum need only disclose the judge=s reasoning sufficiently to provide an adequate basis for this court to review the disputed issue. Cf., e.g., Lang v. H & W Motor Express, slip op. (W.C.C.A. June 11, 1991) (absence of detailed explanation for rejection of certain evidence not a basis for remand or reversal where the findings and order, read as a whole, sufficiently disclose the basis for the decision); Minn. Stat. ' 176.371 (1998) (providing that a memorandum attached to a compensation judge=s decision is not necessary unless "necessary to delineate the reasons for the decision or to discuss the credibility of witnesses").
In this case, a sufficient basis for the compensation judge's decision is evident in the compensation judge=s findings and order, read as a whole. The findings explicitly state that she accepted the opinion of Dr. Simonet and found that A. . . the second surgical procedure was done to treat congenital and developmental central stenosis . . . [but] the work injury on June 29, 2004 did not cause, aggravate or accelerate the central bony stenosis at the C4, C5, C6 and C7 levels of the employee=s cervical spine.@ While it appears that the compensation judge also based her decision in part on the view that the second surgery was performed more to prevent future problems than treat current symptoms, we need not consider whether the judge correctly apprehended or applied this factor, as her underlying finding of a lack of causal connection between the work injury and the condition being treated required denial of the employee=s claims arising from the second surgery.
The compensation judge=s findings were supported by her choice of well-founded medical opinion, as well as by her reasonable interpretation of the opinions of the treating physician and by the employee=s testimony and medical records. The judge=s choice between conflicting medical experts will not be reversed by this court so long as there is sufficient foundation for the expert=s opinion. Nord v. City of Cook, 360 N.W.2d 337, 342, 37 W.C.D. 364, 371 (Minn. 1985). We conclude that the compensation judge=s determination in this case is supported by substantial evidence, and that the result is not clearly erroneous. We therefore affirm.