CRUZ M. HERNANDEZ, Employee/Appellant, v. RYT-WAY INDUS., INC., and SFM MUT. INS. CO., Employer-Insurer/Cross-Appellants, and ALLINA MED. CLINIC, BLUE CROSS & BLUE SHIELD OF MINN., CENTER FOR DIAGNOSTIC IMAGING, CONSULTING RADIOLOGISTS, INJURED WORKERS’ PHARMACY, MAYO CLINIC, MEDICA HEALTH PLANS/INGENIX, MN DEP’T OF EMPLOYMENT & ECON. DEV., MN DEP’T OF LABOR & INDUS./VRU, MINNESOTA SPINE REHAB, and SUMMIT ORTHOPEDICS, Intervenors.
WORKERS’ COMPENSATION COURT OF APPEALS
OCTOBER 21, 2008
TEMPORARY TOTAL DISABILITY - WORK RESTRICTIONS. Substantial evidence supports the compensation judge’s determination that the employee failed to prove she has had work restrictions as a result of her work-related injury to the left hip/gluteal area.
CAUSATION - TEMPORARY INJURY. Substantial evidence supports the compensation judge’s finding that the employee’s injury to the lumbar spine was a temporary low back strain that resolved by August 2004.
CAUSATION - MEDICAL TREATMENT. Substantial evidence supports the compensation judge’s determination that the employee’s personal injury resulted in a chronic left gluteus medius muscle strain and hip pain and the judge’s award of medical expenses for treatment of that condition.
Determined by: Johnson, C. J., Rykken, J., and Pederson, J.
Compensation Judge: Cheryl LeClair-Sommer
Attorneys: Charles M. Cochrane, Cochrane Law Office, Roseville, MN, for the Appellant. Eric S. Westphal and Elizabeth Chambers-Brown, Heacox, Hartman, Koshmrl, Cosgriff & Johnson, St. Paul, MN, for the Cross-Appellants.
THOMAS L. JOHNSON, Judge
The employee appeals the compensation judge’s finding that she has no work restrictions as a result of her work-related left hip/gluteal injury and the finding that her low back strain was a temporary injury. The employer and insurer cross-appeal the compensation judge’s finding that the employee’s personal injury resulted in an ongoing injury to the left hip and the judge’s award of medical care for the left hip condition. We affirm.
Cruz M. Hernandez, the employee, sustained a personal injury on October 16, 2003, when she was struck by an L-shaped piece of metal on the left hip while working for Ryt-Way Industries, Inc., the employer. The employer and its insurer admitted liability for the employee’s personal injury.
The employee was seen at the Apple Valley Medical Center on October 16, 2003, and reported she was hit in the left hip by a chipper machine. The employee complained of left hip pain radiating across her pelvis to the right hip with numbness in her right leg. The examining physician prescribed pain medication and released the employee to return to work, with restrictions. The employee returned on October 18, 2003, complaining of increased pain in her hips and tenderness in the lumbosacral spine. On October 27, 2003, the employee again complained of left hip and low back pain and physical therapy was ordered. The employee followed with the Apple Valley Clinic periodically until her last visit on November 18, 2003. The employee complained at that time of continuing and increasing left hip pain. The examining physician recommended a consultation with an orthopedic surgeon.
The employee saw Dr. David Boxall, an orthopedic surgeon, on December 5, 2003. On examination, the doctor noted some touch-me-not tenderness in the left hip with diminished pinprick sensation in the right foot. Dr. Boxall diagnosed a contusion of the left hip and low back, prescribed Vioxx, continued physical therapy, and assigned light-duty work restrictions. On January 22, 2004, Dr. Boxall’s diagnosis was a resolving low back strain and left hip contusion. On April 26, 2004, the doctor diagnosed a cervical and lumbar strain. Dr. Boxall last saw the employee on April 29, 2004. She then complained of left shoulder and groin pain, swelling in the left trapezius area and buttock pain. Dr. Boxall diagnosed cervical and low back strain and stated the employee’s symptoms were out of proportion to his findings on examination, suggestive of functional overlay.
The employee saw Dr. William Laney at the Orthopedic & Fracture Clinic on May 27, 2004. The employee complained of persistent back, left hip, and neck pain. Dr. Laney diagnosed chronic back pain which he related by history to the employee’s personal injury. The doctor recommended an exercise program and released the employee to work with lifting restrictions. Dr. Laney ordered an MRI scan which he stated was normal and noted he found no evidence of any significant musculoskeletal problem associated with the employee’s chronic pain complaints. Dr. Laney further stated he had no good explanation why the employee continued to complain of so much pain so long after her injury.
The employee next saw Dr. Walid Mikhail at the Allina Medical Clinic on August 19, 2004. The employee reported a history of intermittent severe left back pain radiating into her left leg and left neck pain radiating into her upper arm subsequent to her work injury. On August 31, the employee saw Dr. Peter Badroos at the Allina Clinic and he continued as her treating physician thereafter. Dr. Badroos referred the employee to the Minnesota Spine Rehab Medex program. The employee was discharged from the program on November 8, 2004, with a recommendation for a work hardening program and a home-based exercise program. The employee returned to see Dr. Badroos on November 1, 2004, and his diagnosis was regional low back pain. On November 17, 2004, Dr. Badroos diagnosed arthral trochantric bursitis and a paresthesia of the left hand/wrist. In December 2004, the doctor told the employee she could return to her full eight-hour shift at work in two weeks with no restrictions or limitations. A lumbar MRI scan in June 2005 showed multi-level disc bulging from L2-S1 without disc herniation, stenosis or neural impingement at any level. In November 2005, Dr. Badroos diagnosed persistent left hip pain and lumbosacral muscle strain and referred the employee for an orthopedic evaluation.
Dr. Daniel Hoeffel at Summit Orthopedics examined the employee in November 2005. The doctor diagnosed left hip pain possibly due to a calcified labrum posteriorly. Dr. Hoeffel ordered a steroid injection into the employee’s hip and recommended the employee be seen at the Mayo Clinic.
The employee was evaluated at the Mayo Clinic from April 24 through May 12, 2006, under the direction of Dr. Robert Trousdale. Cervical, thoracic and lumbar MRI scans were all normal as was an EMG of the left lower extremity. An MRI scan of the left hip on April 26, 2006, showed the articular surface of the left hip and the acetabular labrum were normal, but there was an increased signal in the distal gluteus medius muscle and tendon at its insertion on the trochanter of the femur. The report stated this was likely due to a gluteus medius muscle strain. Dr. Trousdale’s diagnosis was left hip pain, of uncertain etiology, and he stated he could not explain all of the employee’s pain from a structural problem in her hip joint. The doctor recommended time, anti-inflammatory medication, and gentle physical therapy. Dr. Shelly Cross examined the employee on May 12, 2006, and concluded the employee may have bruising, swelling, and irritation of the left hip with muscle pain and nerve irritation.
Robert Roloff, D.C., saw the employee on June 2, 2006. The employee presented with multiple complaints following a work injury including low back, left hip, leg, neck and mid-thoracic pain. Following an examination, Dr. Roloff diagnosed chronic lumbar, thoracic, and cervical sprain/strain, lumbar radiculitis and muscle spasms, and left hip sprain/strain. The doctor instituted physical therapy and chiropractic manipulation, but opined there was a poor prognosis for the employee’s recovery from her personal injury. The employee continued to treat with Dr. Roloff through September 14, 2007.
By report dated July 19, 2007, Dr. Roloff diagnosed a chronic left gluteus medius muscle strain, chronic lumbar sprain/strain, multi-level disc bulging of the lumbar spine, cervical and thoracic subluxations, and pelvic dysfunction. The doctor related these diagnoses to the employee’s personal injury. Dr. Roloff rated a 10% permanent disability to the lumbar spine and a 4% permanent disability relative to the left hip and imposed permanent restrictions on the employee’s work activities.
Dr. Robert Wengler examined the employee on November 16, 2007, at the request of her attorney. On examination, the doctor noted a depression of the left ankle reflex and a positive straight leg raising test on the left. Dr. Wengler diagnosed possible discogenic back pain with pathology at L5-S1 and recommended a repeat MRI scan to evaluate the disc. The doctor noted he had no explanation for the employee’s cervical spine complaints. Dr. Wengler rated a 10% whole body disability for multiple-level degenerative disc disease and imposed work restrictions.
Dr. Paul Wicklund, an orthopedic surgeon, examined the employee on January 22, 2007, at the request of the employer and insurer. Dr. Wicklund prepared a medical report and his deposition was obtained in December 2007. Based upon the history he obtained, his examination of the employee, and his review of the medical records, Dr. Wicklund opined the employee’s injury caused a contusion to the posterolateral aspect of her left hip. Dr. Wicklund testified the employee did not sustain any injury to her low back or mid-back on October 16, 2003, and stated he could find no connection between the employee’s neck and thoracic complaints and her left hip injury. The doctor testified the nature of the injury was a blunt trauma to the area of the greater trochanter which did not cause any fracture, nerve damage or disc injury. The doctor opined this injury was temporary and healed within six weeks. Thereafter, the doctor opined the employee would have been able to function normally without work restrictions. Dr. Wicklund testified the employee needed no further medical treatment and sustained no permanent partial disability as a result of her personal injury.
The employee apparently continued to work for the employer, subject to restrictions, through July 18, 2006. On July 19, the employer terminated the employee because they could no longer accommodate her restrictions. The employee received rehabilitation services from a qualified rehabilitation consultant and a job placement specialist from the Department of Labor and Industry/VRU.
The employee’s claim for benefits was heard by a compensation judge at the Office of Administrative Hearings. In a Findings and Order served and filed March 13, 2008, the compensation judge found the nature of the employee’s October 16, 2003, work injury was an ongoing injury to the left hip/gluteal area where the muscle attaches to the side of the greater trochanter. The judge further found the October 16, 2003, injury resulted in a temporary low back strain that resolved by August 14, 2004. The compensation judge found the evidence failed to prove the employee’s personal injury was a cause of her total disability after July 20, 2006. Finally, the compensation judge found the employee sustained no permanent partial disability and had no work restrictions as a result of her personal injury. The employee appeals the compensation judge’s finding that she has no restrictions as a result of her personal injury and the finding that her low back strain was a temporary injury. The employer and insurer cross-appeal the compensation judge’s finding that the personal injury resulted in an ongoing injury to the employee’s left hip and the judge’s award of medical care for the left hip condition.
The compensation judge found the employee sustained an ongoing injury to her left hip/gluteal area, but found she had no restrictions resulting from her personal injury. The employee contends the compensation judge’s finding that the employee has had no restrictions as a result of her personal injury is unsupported by substantial evidence. She argues that all of her treating physicians placed physical restrictions on her work activities. The employee contends it is inconsistent to find she sustained a continuing injury and also find she had no restrictions resulting from that condition. Accordingly, the employee contends the compensation judge’s finding must be reversed. We are not persuaded.
It is true, as the employee argues, that the medical records from the employee’s treating physicians document consistent subjective complaints of left hip and low back pain as well as examination findings of muscle tenderness and decreased range of motion since October 16, 2003. There is, therefore, evidence of record to support the employee’s claim that she had continuing restrictions caused by her personal injury. Under our standard of review, however, the issue is not whether the evidence will support alternative findings, but whether substantial evidence supports the judge’s findings. Where evidence conflicts or more than one inference can be drawn from the evidence, the judge’s findings must be affirmed. Hengemuhle v. Long Prairie Jaycees, 358 N.W.2d 54, 59, 37 W.C.D. 235, 239 (Minn. 1984).
In this case, there is substantial evidence of record which supports the compensation judge’s decision. In April 2004, Dr. Boxall’s examination was essentially normal and he stated the employee’s symptoms were out of proportion to any examination findings, suggestive of functional overlay. A lumbar MRI scan in August 2004 was normal, and Dr. Laney stated he had no good explanation why the employee continued to complain of so much pain so long after her injury. Dr. Trousdale diagnosed left hip pain of uncertain etiology and stated he could not explain the employee’s pain from a structural problem in her hip joint. Dr. Wicklund examined the employee in January 2007 and noted full range of motion of the left and right hip and an essentially normal examination of the lumbar spine. Dr. Wicklund testified restrictions would have been appropriate for 6 to 10 weeks following the personal injury, but not thereafter. Given this evidence, the compensation judge could reasonably conclude that while the employee had an ongoing left hip problem, it was not then resulting in any physical restrictions. Accordingly, the compensation judge’s finding is affirmed.
The compensation judge found the employee’s October 16, 2003, injury resulted in a temporary low back strain, as documented by the medical records of Dr. Laney, that resolved by August 14, 2004. The employee contends this finding is unsupported by substantial evidence contending Dr. Laney did not opine the employee fully recovered from her low back injury, although he did find she sustained no permanent disability. Rather, the employee contends Dr. Laney acknowledged the employee had chronic low back complaints and suggested she see an occupational medicine specialist. While Dr. Wicklund did opine the employee’s work injuries resolved within six weeks, the employee asserts Dr. Wicklund had no compelling explanation to support his opinion. Accordingly, the employee asserts the compensation judge’s finding must be reversed. We do not agree.
As noted above, Dr. Boxall’s April 2004 examination was essentially normal as was a lumbar MRI scan in August 2004. Dr. Laney examined the employee on August 12, 2004, after his review of the MRI scan. The doctor told the employee he found no evidence of any significant musculoskeletal problems associated with her chronic pain complaints and had no good explanation for why she continued to complain of so much pain so long after her injury. The doctor noted his clinical examination was normal as well as the x-rays and the lumbar MRI scan. Dr. Laney concluded the employee could return to work with no restrictions and stated, “I can find no significant abnormality in association with her complaints.” While the doctor did suggest it might be good for the employee to be evaluated by an occupational medicine specialist, he clearly found no objective evidence of any continuing lumbar injury.
There was conflicting evidence at the hearing concerning the nature and extent of the employee’s personal injury. Where evidence is conflicting or more than one inference may be reasonably be drawn from the evidence, the findings of the compensation judge are to be upheld. Redgate v. Sroga’s Standard Service, 421 N.W.2d 729, 40 W.C.D. 948 (Minn. 1988). The records of Dr. Laney support a conclusion that the employee’s low back condition was temporary. Accordingly, the compensation judge’s decision must be affirmed.
The compensation judge found the employee reached maximum medical improvement (MMI) on April 8, 2005, based upon service on that date of Dr. Laney’s office note of August 12, 2004. The employee contends Dr. Laney’s opinion is flawed and the doctor did not state in his report that no further significant recovery from or significant lasting improvement to the personal injury could reasonably be anticipated. Accordingly, the employee asked this court to reverse the compensation judge’s MMI finding.
Dr. Laney’s August 12, 2004, examination has been extensively discussed in this decision. In summary, the doctor concluded the effects of the employee’s personal injury had resolved and he released her to return to work without restrictions. By report dated April 5, 2005, Dr. Badroos also opined the employee had reached maximum medical improvement. This report was served on the employee on April 7, 2005. These two reports provide sufficient evidence to support the compensation judge’s finding of maximum medical improvement. That finding is, therefore, affirmed.
The employer and insurer appeal the compensation judge’s finding that the October 16, 2003, work injury caused a chronic left gluteus muscle strain. In her memorandum, the compensation judge stated she reached the conclusion based upon “the records and opinions of the physicians at the Mayo Clinic, the employee’s testimony of ongoing subjective left hip symptoms, the opinion of Dr. Wengler, and the diagnostic studies taken April 26, 2006, with signal changes signifying muscular abnormality in the same area of the original contusion.” (Mem. at p.7.) The cross-appellants argue the Mayo Clinic records do not support the judge’s finding of an ongoing hip injury because neither Dr. Trousdale nor Dr. Cross found any significant abnormality in the employee’s hip; the employee’s testimony regarding her hip symptoms were vague and insubstantial; Dr. Wengler did not comment on the nature and extent of any left hip injury; and the April 26, 2006, tests at the Mayo Clinic were obtained two years prior to the hearing and do not support a finding of a current and ongoing left hip condition. The cross-appellants contend the compensation judge relied on outdated and inconclusive medical evidence to conclude the employee has an ongoing hip injury. Considering all of the medical evidence, the cross-appellants contend the employee failed to prove an ongoing left hip injury. We are not persuaded.
In November 2005, Dr. Hoeffel obtained a history from the employee of consistent and ongoing left hip pain. The doctor diagnosed left hip pain possibly due to a calcified labrum and prescribed steroid injections to the employee’s left hip. In December 2005, the doctor’s diagnosis remained persistent left hip pain. The April 26, 2006, MRI scan of the left hip at the Mayo Clinic showed an increased signal in the gluteus medius muscle and tendon. The employee gave Dr. Tousdale a history of consistent left hip pain since October 2003. Dr. Cross noted the employee might have some bruising, swelling, and irritation with muscle pain and nerve irritation in the left hip. At the hearing, the employee testified to continuing and ongoing left hip symptoms, and the medical records are replete with the employee’s complaints of left hip pain since her personal injury. In November 2007, the employee gave Dr. Wengler the history of ongoing left hip pain since October 2003. An x-ray of the employee’s left hip showed questionable narrowing of the articular surface of the joint space with a small fleck of calcification in the capsule over the lateral margin of the acetabulum. Clearly, Dr. Wengler was aware of the employee’s left hip difficulties and considered those in his report. Finally, in his July 19, 2007, report Dr. Roloff diagnosed chronic left gluteus medius muscle strain.
The above summarized evidence provides ample evidentiary support for the compensation judge’s finding that the employee’s personal injury caused a chronic left gluteus medius muscle strain. Based upon this finding, the compensation judge properly ordered the cross-appellant to pay for the medical expenses necessary to treat that condition. The compensation judge’s decision is affirmed.