MINH-PHUONG T. PHAN, Employee/Appellant, v. RADISSON HOTEL and AMERICAN COMP. INS./RTW, INC., Employer-Insurer.
WORKERS’ COMPENSATION COURT OF APPEALS
MARCH 17, 2009
CAUSATION - PSYCHOLOGICAL CONDITION. Where no medical expert opinion was submitted establishing a causal connection between the employee’s work-related thoracic contusion and thoracic strain/sprain in May 1997 and her ongoing chronic pain, depression and somatoform disorder, the compensation judge properly found the employee failed to establish a compensable permanent and total disability.
Determined by: Johnson, C.J., Rykken, J., and Stofferahn, J.
Compensation Judge: Particia J. Milun
Attorneys: Minh-Phuong T. Phan, pro se Appellant. Kristen L. Ohlsen, Aafedt, Forde, Gray, Monson & Hager, Minneapolis, MN, for the Respondents.
THOMAS L. JOHNSON, Judge
The pro se employee appeals from the compensation judge’s determination that the employee’s current medical/psychological condition is not causally related to the employee’s May 7, 1997, work injury, and the judge’s denial of benefits for permanent total disability. We affirm.
Minh-Phuong T. Phan, the employee, was born in Vietnam on April 19, 1958. At the age of thirty-eight, she immigrated to the United States with her husband and children, arriving on March 13, 1997. She began working as a housekeeper on April 14, 1997, for the employer, Radisson Hotel. On May 7, 1997, the employee was standing in a basement hallway waiting for an elevator. A service door opened suddenly into the hallway and the door handle struck the employee in the mid-back.
The employee reported the injury, and she was sent by the employer to United Health Services where she was treated for a mid-thoracic contusion. The employee was released to return to work the next day. The employee was experiencing considerable pain and did not believe she was able to work. The employee has not returned to competitive employment since then.
The employee received additional chiropractic and medical treatment for upper, mid, and low back pain in May, June, and July 1997. At the end of July 1997, the employee’s treating chiropractor referred the employee to Regions Hospital International Clinic for further evaluation, expressing concern that the employee was not improving, and that her vague, overall symptoms, including weakness and fatigue, might reflect other health problems. The employee has continued to treat with various medical providers at the Regions hospital and clinics since that time.
An evaluation was performed by Michael Richardson, a licensed psychologist, on December 8, 1997. Mr. Richardson noted the employee’s physical complaints included pain in her head, neck pain, shoulder pain, shortness of breath, pain radiating throughout her back into both legs, and sleep disturbance. The employee stated her medical problems were getting worse. Mr. Richardson observed there was “no documented organic etiology to her systemic pain symptoms and progressively worsened condition” and he concluded the employee was experiencing a psychological disorder that was “influencing, in a direct way, her perception of and her reporting of pain symptoms. The events of the accident in question do not seem to justify the variety, magnitude, and persistence of her self-reported medical problems.” (Pet. Ex. G.)
On September 29, 1997, the employee filed a claim petition seeking temporary total disability benefits from and after August 14, 1997, along with rehabilitation benefits. The employer and insurer denied liability for further benefits. In a Findings and Order filed September 14, 1999, a compensation judge found the employee sustained an injury to her mid-back on May 7, 1997, resulting in a thoracic contusion and thoracic strain/sprain. The judge denied the employee’s claim, finding the employee failed to prove her disability from August 14, 1997, through June 14, 1999, was caused, aggravated or accelerated by the May 7, 1997, work injury. The employee attempted to appeal this decision, but failed to properly serve the notice of appeal on the employer and insurer.
On December 28, 2004, the employee filed a second claim petition seeking permanent total disability from May 7, 1997, rehabilitation benefits, and payment of medical expenses. On April 21, 2005, a compensation judge dismissed the employee’s claim petition concluding it was barred by the doctrine of res judicata. The employee appealed, and in a decision issued December 6, 2005, this court held that the employee’s claim for wage loss benefits for periods subsequent to the July 27, 1999, hearing remained open, and vacated and remanded the case for a hearing on the merits.
A hearing was held on the second claim petition on April 16, 2008. The employee submitted eight exhibits at the hearing, including a report and treatment records from Dr. Karen Ta, a psychiatrist at Regions Hospital. The employee was first seen by Dr. Ta on December 29, 1997. The doctor has continued to treat the employee for major depression and somatoform disorder since then. In a report dated June 14, 2002, and a letter dated August 16, 2002, Dr. Ta stated the employee continued to have chronic back pain and multiple somatic complaints, including pain all over her body, numbness and so on, that had not improved at all over the past five years. The doctor stated the employee’s significant stressors included loss of her job, along with significant resentment and anger toward her former employer for unjustifiably laying her off, the stress of moving from Vietnam to the United States with language and cultural barriers, and marital conflict. In Dr. Ta’s opinion, the employee’s
work injury could have been a trigger point for her depression, but I cannot say that the work injury, itself, was a substantial contributory factor to the depression she continues having. I would say that her subsequent conflict with her former employer after the work injury is the main underlying factor for her depression, not the physical injury itself.
(Pet. Ex. E.)
The employee has also treated with Dr. Richard Timming, a physical medicine and rehabilitation specialist at Regions Hospital, since August 9, 2001. Dr. Timming noted the employee has been seen by multiple specialists, including neurologists, orthopedic specialists, and a rheumatologist, had cervical, thoracic, lumbar spine, pelvic, feet and chest x-rays, a CT scan of the cervical spine, and MRI scans of the head and cervical and thoracic spines, EMG and nerve conduction studies, a bone scan, and various diagnostic lab tests. All of the workups, he stated, were essentially normal and did not explain the employee’s pain. The doctor could not provide a medical diagnosis for what was causing her pain. In a note dated December 15, 2005, Dr. Timmings stated,
It is my medical opinion that your back pain was related to the work injury of May 7, 1997. . . . However, I do not know why you are still having pain now years later; I do not have a medical explanation for that.
I also know you have been followed by multiple physicians because of depression and almost total body pain. That may be related to the work injury of May 7, 1997, but I am not able medically to prove that. I based that on your telling me.
(Pet. Exs. C, G.)
The employee was also seen by Dr. Fozia Abrar in Occupational Medicine at Regions Hospital. On July 31, 2006, Dr. Abrar diagnosed chronic pain syndrome with psychological factors affecting physical condition. Dr. Abrar observed the employee had multiple workups and had seen multiple specialists and no organic conditions were noted. Dr. Abrar stated,
[I]t’s unlikely that the work injury in 1997 could contribute to her chronic pain syndrome. Within medical certainty I cannot, I’m not convinced that the work injury in 1997 contributes to her chronic pain syndrome, depression and her lower extremity weakness.
(Pet. Ex. B.) Dr. Abrar completed a report of work ability that same day in which he provided a diagnosis of chronic pain syndrome, not work related, and stated the employee was permanently unable to return to work and unable to sustain gainful employment. (Pet. Ex. F.)
The compensation judge found the employee suffers severe, chronic debilitating body pain that renders her incapable of sustained, gainful employment. The judge further found, however, that the employee failed to establish that her May 7, 1997, work injury was a substantial contributing factor to her severe chronic pain syndrome and psychological conditions, and denied the employee’s permanent and total disability claim. The employee appeals.
The employer and insurer do not dispute the employee suffers from a significant and disabling psychological condition. The sole dispute is whether the employee’s admitted, work-related physical injury is a substantial contributing cause of her psychological condition and/or ongoing total disability.
In Minnesota, a psychological injury or condition is compensable if the psychological condition was caused, aggravated, or accelerated by a work-related physical injury. See, e.g., Childers v. Honeywell, Inc., 505 N.W.2d 611, 49 W.C.D. 230 (Minn. 1993); Hartman v. Cold Spring Granite Co., 243 Minn. 264, 67 N.W.2d 656, 18 W.C.D. 206 (1954). The employee asserts her mid-back injury on May 7, 1997, was serious, that it quickly evolved into depression and chronic pain, and that there is a logical connection between her pain symptoms and the work injury. There is no doubt the employee experiences incapacitating pain, and she clearly attributes her pain and medical problems to the work injury. Where a psychological condition is involved, however, something more is needed. In Rindahl v. Brighton Wood Farms, Inc., 382 N.W.2d 855, 856, 38 W.C.D. 473, 475 (Minn. 1986), the Supreme Court stated,
We do not think causation in this complex and subtle area of emotional distress is entirely a matter of logic, for it does not necessarily follow that because the depression came after the injury that the injury caused the depression.
The court accordingly held that where other possible casues of a psychological condition are present, some medical opinion causally relating the employee’s psychological injury to his or her physical injuries is required before the psychological condition can be found compensable Id. at 856-57, 38 W.C.D. at 476.
In this case, there is simply no medical evidence the employee’s physical injury caused or contributed to her ongoing disability. It is apparent the employee is convinced her pain, depression, and other symptoms are a result of her mid-back injury on May 7, 1997. The employee’s doctors have ordered multiple evaluations and workups. The diagnostic tests have been essentially normal and no organic basis for her pain has been found. No doctor has provided a medical opinion that the employee’s ongoing pain complaints are causally related to her thoracic contusion and sprain/strain. Dr. Timming was unable or unwilling to state the employee’s ongoing back pain, total body pain, or depression were related to the work injury. Dr. Abrar did not believe the employee’s 1997 work injury contributed to her chronic pain syndrome, depression or lower extremity weakness and stated her chronic pain syndrome was not work related. Dr. Ta opined the employee’s depression and somatoform disorder were the result of non-work-related psychosocial stressors, including the employee’s anger and resentment toward the employer for the loss of her job, the stress of immigrating from Vietnam and the language and cultural barriers she faces in the United States, and marital conflicts. Dr. Ta clearly opined the work injury, itself, was not a substantial contributing factor to the employee’s ongoing depression and somatoform disorder.
Based on the evidence presented, the compensation judge properly found the employee failed to prove a compensable permanent and total disability. We affirm.
 “Somatoform” denotes physical symptoms that can not be attributed to organic disease and appear to be of psychic origin. “Somatization,” in psychiatry, refers to the conversion of mental experiences or states into bodily symptoms. Dorland’s Illustrated Medical Dictionary 1663 (29th ed. 2000).