LOREE RUDNITSKI, Employee/Appellant, v. SPX VALVES & CONTROLS, and CONSTITUTION STATE SERV. CO., Employer-Insurer, and ST. CLOUD ORTHOPEDICS, Intervenor.
WORKERS= COMPENSATION COURT OF APPEALS
JULY 2, 2008
CAUSATION - MEDICAL TREATMENT. Substantial evidence supports the compensation judge=s finding that the employee=s need for medical treatment in 2007 was not causally related to the employee=s 2002 work injury.
Determined by: Rykken, J., Pederson, J., and Johnson, C.J.
Compensation Judge: Jane Gordon Ertl
Attorneys: DeAnna M. McCashin, Schoep & McCashin, Alexandria, MN, for the Appellant. Richard L. Plagens, Lommen, Abdo, Cole, King, Stageberg, Minneapolis, MN, for the Respondents.
MIRIAM P. RYKKEN, Judge
The employee appeals the compensation judge=s finding that the employee=s current need for medical treatment for her neck and shoulder is not causally related to her work injury. We affirm.
On November 29, 2002, Loree Rudnitski, the employee, sustained a work-related injury to her left shoulder and neck while working as an assembler for SPX Valves & Controls, the employer. The employer and its workers= compensation insurer, Constitution State Service Company, initially denied liability.
On December 9, 2002, the employee treated with Dr. Philip Bachman, who diagnosed a left posterior shoulder strain with a left brachioradialis strain, forearm pain, and low back pain. Dr. Bachman assigned the employee work restrictions, including a 25 pound lifting restriction and no overhead work. The employee=s pre-injury position required frequent lifting of up to 45 pounds and occasional lifting more than that amount. On December 23, 2002, Dr. Bachman referred the employee for physical therapy, which the employee attended through February 2003. On February 6, 2003, the employee returned to Dr. Bachman, who found positive impingement signs on examination and referred the employee to Dr. Matthew Hwang, an orthopedic specialist. The employee was examined by Dr. Hwang on February 13, 2003. At that time the employee was working outside of her restrictions, which she found to be aggravating her symptoms. Dr. Hwang recommended restrictions of no lifting over 25 pounds, avoiding overhead reaching, and avoiding repetitive left arm motion. He also referred the employee for additional physical therapy and prescribed anti-inflammatory medication.
The employee continued to work for the employer until March 4, 2003, when she was placed on medical leave. The employee=s symptoms decreased after being off work. The employee returned to Dr. Hwang on April 7, 2003, after six weeks of therapy. Dr. Hwang noted that the employee=s impingement signs were negative, and recommended that the employee discontinue physical therapy and start a home exercise program. He also recommended ongoing restrictions of no lifting over 30 pounds and no repetitive overhead use of her arms.
The employee also received chiropractic care for her low back, mid back, neck, and left arm with Dr. Michael Milbauer from March 20, 2003 through July 7, 2003. During this period of time, the employee returned to work, on May 12, 2003; she found that her work activity increased her symptoms. The employee also received physical therapy from April 3, 2003, through July 7, 2003. The employee continued to have ongoing symptoms in her left shoulder, neck, and low back, and would have increased symptoms based on work activities.
On August 4, 2003, Dr. Milbauer indicated that the employee had a permanent shoulder injury and a decrease in range of motion with persistent pain and spasm. He recommended permanent restrictions of no lifting over 30 pounds and limited repetitive use of her left arm or use at or above shoulder height, and rated the employee=s cervical spine injury at 10% permanent partial disability. In early 2004, the employee was laid off; she returned to work for three shifts in April 2004. The employer then advised the employee that she could not return to work unless she was released to work without restrictions.
On March 17, 2004, the employee began working with QRC Mary Merchlewicz. The QRC attended the employee=s appointments with Dr. Hwang.
On May 24, 2004, the employee was evaluated by Dr. Robert Wengler, an orthopedic specialist. Dr. Wengler opined that the employee had sustained a rotator cuff injury and ordered an MRI of the cervical spine, which indicated a left-sided C6-7 herniated disk and multi-level degenerative changes and C7 nerve impingement. An MRI of the left shoulder indicated rotator cuff irritation, moderate AC joint arthrosis with moderate inferior hypertrophic changes, and Type II anterior acromial process. Dr. Wengler rated the employee at 12% permanent partial disability for her neck and 8% permanent partial disability for her left shoulder.
In October 2004, the employee began working full time at Dubow Textile, at a position involving steaming clothes. On December 16, 2004, the employee sought treatment for her left shoulder again, reporting left shoulder and neck pain and numbness. Dr. Hwang diagnosed recurrent scapular thoracic pain and recommended physical therapy, electrical stimulation, a TENS unit and prescription medication. The employee returned to Dr. Hwang in February 2005; by that time she had been laid off from her job at Dubow Textile. The employee reported that her symptoms had improved and Dr. Hwang noted that her impingement signs were negative. Dr. Hwang recommended long-term use of a TENS unit and permanent work restrictions of no lifting over 30 pounds, no working with her arms outstretched, and no repetitive over-the-shoulder work. Dr. Hwang stated in a chart note: AI will be happy to see [the employee] back at any time in the future if she has any problems. Otherwise, we will let her follow up P.R.N.@
In November 2004, the parties negotiated a stipulation for settlement in which the employer and insurer admitted primary liability. The parties agreed that the employee had reached maximum medical improvement from her 2002 injury as of October 9, 2003. The stipulation closed out permanency to the extent of 20% permanent partial disability of the body as a whole, as well as chiropractic care, chronic pain programs, and health club memberships. The employer and insurer agreed to pay ongoing medical treatment and rehabilitation services. The employee=s claim for wage loss benefits through June 14, 2004, was also closed out. An award on stipulation was served and filed on November 4, 2004.
After the employee was laid off from her position with Dubow Textile in February 2005, she then worked for few months for the City of Foley through Midwest Staffing. That job ended due to lack of work. In May 2005, the employee began working for Greenview on a part-time basis, cleaning rest areas. In June 2006, the employee attempted a position with Midwest Canvas sewing canvas pieces. The employee=s symptoms increased in the six weeks to two month period that she worked for Midwest Canvas; after leaving this job her symptoms returned to the same level they were before that position. The employee testified that she had sustained no additional injuries to her neck, left shoulder, mid back or low back since the work injury in November 2002, but that her neck and left shoulder symptoms never resolved and have continued to worsen.
On February 26, 2007, the employee returned to Dr. Hwang, reporting worsened left shoulder symptoms over the last three months. Dr. Hwang ordered an X-ray of the employee=s left shoulder which indicated the Type II acromial process that had been detected on an MRI scan in 2004, and noted that the employee had crepitus in the left shoulder range of motion and impingement signs. He recommended that the employee return to her home exercise program and the use of her TENS unit, and also recommended physical therapy and an updated MRI of her neck and left shoulder. The bill for this visit was sent to the workers= compensation insurer, which denied payment.
On May 7, 2007, the employee filed a medical request for payment of the bill for the employee=s evaluation by Dr. Hwang on February 26, 2007, and for approval of the diagnostic and treatment recommendations he had made. The employer and insurer denied the request, claiming that there was no causal relationship between the employee=s work injury and the claimed medical treatment. A hearing was held on November 1, 2007. In her findings and order served and filed November 13, 2007, the compensation judge found that the claimed medical treatment was not causally related to the employee=s work injury. The employee appeals.
The compensation judge based her decision on several factors, noting that the employee had significant improvement in her symptoms after treatment for the work injury and that the employee had been discharged from treatment by Dr. Hwang in 2005. The employee did not have any other treatment until she returned to Dr. Hwang in February 2007, reporting increased pain for three months. The compensation judge also noted that Dr. Hwang=s recommendation that the employee have updated MRIs taken was made at the employee=s request and that the employee now exhibited impingement signs that she did not have in 2005. The judge also emphasized that there was no medical opinion from Dr. Hwang stating that the employee=s treatment in 2007 was causally related to the employee=s work injury.
The employee claims that the compensation judge erred by stating that the employee had new findings on examination, arguing that the employee had left shoulder impingement findings on examination many times in 2003 and 2004. The compensation judge, however, did not state that the employee had never had impingement symptoms, but noted that the employee no longer had impingement findings when she stopped seeing Dr. Hwang in 2005. The employee also argues that it appears the compensation judge is requiring that an employee must either provide a formal report that specifically states that each treatment is causally related to the work injury or must present a formal deposition of a medical doctor stating that there is medical causation. The compensation judge does not indicate that a formal opinion is required, but simply states that Dr. Hwang=s notes did not directly draw a causal relationship between the employee=s 2002 work injury and her need for treatment in 2007.
The employee also notes that Dr. Hwang did not release the employee from care, but only released her from ongoing regularly scheduled appointments. The employee argues that a Agap in treatment when there is ongoing active medical treatment consisting of a home exercise program and the use of a TENS unit does not equate to a finding that [the employee] had no ongoing medical treatment between 2005 and 2007.@ We disagree. There is no dispute that the employee had not seen Dr. Hwang or any other medical provider from February 21, 2005, through February 26, 2007, which the compensation judge considered as a factor in determining that the employee=s treatment in 2007 was not causally related to the employee=s 2002 work injury.
The employee also argues that the employee=s lack of treatment is due to her successful self-care and that without a finding of a superseding, intervening injury, the compensation judge=s finding that the treatment is not causally related to the employee=s injury cannot be supported by substantial evidence. We disagree. The compensation judge considered all of the evidence and found that the employee=s treatment in 2007 was not causally related to the employee=s 2002 work injury. It is not the role of this court to choose different inferences from the evidence than the compensation judge. Krotzer v. Browning-Ferris/Woodlake Sanitation Serv., 459 N.W.2d 509, 513, 43 W.C.D. 254, 260-61 (Minn. 1990). The question for this court is whether substantial evidence exists to support the decision of the compensation judge. Hengemuhle v. Long Prairie Jaycees, 358 N.W.2d 54, 37 W.C.D. 235 (Minn. 1984). Substantial evidence supports the compensation judge=s findings, and we affirm.
 After the appeal was filed, the parties indicated through correspondence with this court that the employer and insurer had agreed to pay for the employee=s examination with Dr. Hwang on February 26, 2007, and that they had paid that expense. Therefore, we vacate Finding No. 8 and Order No. 1 regarding this expense, and we will not address whether this examination was causally related to the employee=s work injury.