GERI L. WIENEN, Employee/Appellant, v. CARLTON COUNTY, SELF-INSURED/MINNESOTA COUNTIES INS. TRUST, Employer-Insurer, and ORTHOPAEDIC ASSOCS. OF DULUTH, LAKEWALK SURGERY CTR., CLOQUET CMTY. MEM. HOSP., and BC/BS OF MINN. & BLUE PLUS, Intervenors.
WORKERS= COMPENSATION COURT OF APPEALS
MAY 7, 2008
CAUSATION - GILLETTE INJURY. Substantial evidence supports the compensation judge=s decision that the employee failed to establish that her work activity was a substantial contributing factor in the development of bilateral trigger thumb, right middle and ring trigger finger, and bilateral thumb basilar joint arthrosis.
Determined by: Stofferahn, J., Wilson, J., and Pederson, J.
Compensation Judge: Gregory A. Bonovetz
Attorneys: Russell J. LaCourse, LaCourse Law Office, Duluth, MN, for the Appellant. Adam D. Rosenfield, Lind, Jensen, Sullivan & Peterson, Minneapolis, MN, for the Respondents.
DAVID A. STOFFERAHN, Judge
The employee claimed wage loss benefits and medical expenses related to a number of physical conditions affecting her upper extremities that she alleged were the result of a Gillette injury culminating on February 5, 2004. The compensation judge denied the employee=s claims and the employee appeals. We affirm.
The employee, Geri L. Wienen, began working for Carlton County in 1986. Initially, she worked in office support, primarily transcribing case notes. Thereafter she worked as a case worker and as a switchboard operator. In August 2000, she began working again as a case worker.
As a case worker, her primary responsibility was to assist people with applications for benefits. She would interview applicants, verify information, and then enter the application information into the computer. The employee worked four 10-hour days and estimated that she spent about seven-and-a-half hours a day entering information into the computer. The other part of her job was to maintain her own caseload of about 250 cases. She took calls from clients and added updated information into the computer. This part of her job required her to pull the paper files from the filing cabinet. The employee described a pinching motion which she did with her hand to pull the files. She testified that she would pull between 25 and 40 files each day.
The employee testified that she began experiencing upper extremity symptoms and saw Dr. David McKee for those symptoms on February 1, 2004. Dr. McKee=s chart note for that date indicates that the employee was seen in follow-up for carpal tunnel syndrome and neck discomfort. The employee reported getting good relief for her neck pain from Flexeril. Dr. McKee stated the MRI showed some degenerative changes but nothing that implied nerve root or spinal cord compromise. The chart note also indicates that the employee was Astarting on a new house very soon@ and was concerned about down time from carpal tunnel surgery.
The employee saw Dr. McKee again on February 5, 2004, for an EMG. The history she provided to Dr. McKee on that date was,
She=s had problems with pain in the neck and both shoulders for about two months. For a longer period of time, she=s had recurrent paresthesia in the hand and forearms. She has a vague perception of weakness in the upper extremities. She says she gets an electric-like radiated sensation at times through the wrists.
The EMG showed moderate right carpal tunnel syndrome and mild left carpal tunnel syndrome.
The employee saw Dr. Peter Goldschmidt at Orthopaedic Associates of Duluth on April 13, 2004, and he recommended carpal tunnel release surgery. Carpal tunnel release surgery was done on the right wrist on May 11, 2004. On follow up on May 18, the employee reported that she was pleased with the results of the surgery and noted improvement in her numbness. In December 2004, when she returned to schedule her left carpal tunnel surgery, she also reported a new symptom of right thumb discomfort. Dr. Goldschmidt assessed right trigger thumb.
Dr. Goldschmidt did surgery for the left carpal tunnel on January 14, 2005. The employee returned for follow up on March 29 and also discussed with Dr. Goldschmidt right trigger thumb release surgery. That procedure was done by Dr. Goldschmidt on August 5, 2005. When the employee returned to Dr. Goldschmidt on August 15 she inquired about a left trigger thumb release. That surgery was done on September 14, 2005.
The employee saw her family doctor, Dr. Darla Van Heerde, on September 7, 2006. She told the doctor that,
Her only real concern is that her hands have been swollen, they hurt. The fourth finger on the right hand has been locking. The right hand hurts more than the left. She has been doing a lot of physical work this summer with finishing up building her house, moving dirt, sawing timber and so forth.
The employee returned to Dr. Goldschmidt on September 19 and he assessed bilateral thumb basilar joint arthrosis and right long and ring finger trigger digits. Dr. Goldschmidt recommended either injection or surgical release for the trigger finger condition. The employee opted for surgery and that procedure was done on February 14, 2007.
Throughout this period of time, the employee continued to perform her regular duties as a case worker except when she was off work immediately after surgeries. The employer and insurer initially admitted liability for a February 5, 2004, work injury and paid medical expenses and temporary total disability benefits for limited periods after the various surgeries. In October 2006, the employer and insurer advised the employee that they would not accept further liability for upper extremity problems because of the reference in the medical records to the employee working on her house. The employee filed a medical request. As of the date of hearing, September 19, 2007, the employee continued to be employed as a case worker for Carlton County.
The employee was evaluated on behalf of employer and insurer by Dr. William Call on May 15, 2007. In his report, Dr. Call identified the employee as having done the same job as a eligibility specialist for about 20 years. He restated the medical history and, in his examination, had the employee demonstrate the type of work activities that she believed had led to her hand and wrist problems. It was Dr. Call=s conclusion that none of the employee=s hand and wrist conditions were related to her work. With regard to the carpal tunnel syndrome, Dr. Call found that the employee=s work activities had the wrist in a neutral or non-stressed position. Further, Dr. Call stated that the employee was perimenopausal in 2001 and that Acarpal tunnel syndrome and trigger fingers are part of the perimenopausal process as a result of progressive soft tissue thickening as a result of the loss of estrogen.@ Dr. Call also stated that the described work activity would not have led to trigger finger or trigger thumb. The bilateral basilar joint arthrosis was genetic in Dr. Call=s opinion. He stated that this bilateral condition was due to the employee=s ethnic background and also stated that the fact that the employee=s dominant hand was not worse than the non dominant hand indicated that use of her hands was not a causal factor. Dr. Call also noted that the employee=s symptoms increased when she was working on her house in the summer of 2006.
The employee=s attorney sent the employee=s deposition to Dr. Van Heerde. The employee=s deposition testimony was consistent with the information presented by the employee at the hearing. Dr. Van Heerde responded with a letter of September 13, 2007, in which she stated,
It is my medical opinion that Ms. Wienen=s work activity has contributed in a substantial way to the development of bilateral upper extremity condition since 2004, including bilateral carpal tunnel syndrome, right third and fourth trigger fingers, and bilateral basilar thumb arthrosis. She was compliant with therapy and required surgical interventions to address her work-related conditions.
The employee=s claims were heard by Compensation Judge Gregory Bonovetz on September 19, 2007. In his Findings and Order of September 25, 2007, the compensation judge denied the employee=s claims, finding that
Although the court finds the employee to be a most credible witness and although the employee has during the previous seven years been involved in hand intensive work duties, the court finds that a preponderance of the evidence does not establish that her performance of work duties was a substantial contributing cause to the development of the right trigger thumb, the left trigger thumb, the bilateral thumb basilar joint arthrosis or the right long and ring finger trigger digits.
In his memorandum, the compensation judge referenced the lack of opinion by Dr. Goldschmidt on the question of causation other then checking yes on a health care provider report. The compensation judge also stated that Dr. Van Heerde provided no explanation as to how she came to the causation opinion in her September 2007 letter. The compensation judge contrasted those opinions with the detailed report of Dr. Call and concluded, on balance, that the employee had failed to meet her burden of proof. The employee appeals.
The issue at hearing was whether the employee=s work activity was a substantial contributing factor in the medical expense and wage loss resulting from the treatment of bilateral trigger thumb, right long and ring trigger finger, and bilateral thumb basilar joint arthrosis. The compensation judge concluded that the employee had failed to establish that a causal relationship existed. In doing so, the compensation judge found the opinion of Dr. Call to be more persuasive than that of Dr. Van Heerde. As the compensation judge correctly noted, determination of a Gillette injury primarily depends on medical evidence. Steffen v. Target Stores, 517 N.W.2d 579, 50 W.C.D. 464, (Minn. 1994).
On appeal, the employee argues that the compensation judge erred as a matter of law in reaching his decision. The employee contends that Dr. Call lacked adequate foundation for his opinion and that the compensation judge failed to give adequate weight to Dr. Van Heerde=s opinion. We disagree.
We conclude Dr. Call=s opinion had adequate foundation. He conducted a thorough physical examination, reviewed past medical records, and discussed the employee=s work with her. As part of his examination, Dr. Call had the employee demonstrate the manner in which she did a number of her job duties. This information provided foundation for Dr. Call=s opinion. Harding v. Leigh Corp., No. WC07-211 (W.C.C.A. Feb. 12, 2008).
In her brief, the employee lists a number of details that were not mentioned by Dr. Call. While these details, such as the weight of files, were not mentioned by Dr. Call, there is nothing in the record to indicate he was unaware of that information. In his report, Dr. Call, after reviewing the employee=s job tasks stated, Ashe denies any other tasks and denies any other information would be of help to me.@ The employee also argues that Dr. Call misunderstood the length of time the employee worked as a case worker noting that Dr. Call=s report refers to the employee having done this task for 20 years. While that is inconsistent with the evidence of record, we do not believe it results in a lack of foundation for Dr. Call=s opinion. We find no basis for concluding that the compensation judge should have rejected Dr. Call=s opinion as a matter of law.
In addition, as the compensation judge noted, the employee has an obligation to prove her claim by a preponderance of the evidence. In this case, the employee attempted to establish a causal relationship between her work and her physical conditions through the opinion of Dr. Van Heerde, her family physician. Dr. Van Heerde=s letter setting forth her causation opinion was quoted in its entirety previously. Based on the record, her opinion appeared to be based completely on the employee=s deposition testimony. There is no mention at all in the employee=s medical records of her work activity.
Dr. Van Heerde did not explain why she concluded that the employee=s work activity was a substantial factor or what role, if any, was played by the employee=s house building activity in 2006 noted in her chart notes, or what her response was to Dr. Call=s opinion. The employee in her brief notes that the compensation judge found her to be a credible witness but the issue here was one of medical causation not employee credibility. An unadorned opinion of causation by a treating doctor may be legally sufficient to initiate a claim but it may not have the persuasiveness needed to establish a claim in a contested hearing. As the compensation judge noted in his memorandum,
The fact that the person makes extensive use of her hands while at work does not in and by itself establish that the performance of those hand intensive duties is a substantial cause of any hand or finger conditions.
We find substantial evidence in the record which supports the compensation judge=s findings. The decision of the compensation judge is affirmed.