JOSEPH R. GABOURY, Employee, v. EBENEZER LUTHER HALL and RTW, INC., Employer-Insurer/Appellants, and MEDICA HEALTH PLANS, SUBURBAN RADIOLOGIC CONSULTANTS, and UNIVERSITY OF MINN. MED. CTR./FAIRVIEW HEALTH SERVS., Intervenors.
WORKERS’ COMPENSATION COURT OF APPEALS
MAY 27, 2010
CAUSATION - MEDICAL TREATMENT. Substantial evidence, including well-founded medical expert opinion, supports the compensation judge’s determination that the employee’s August 2004 work-related injury was a substantial contributing cause of the employee’s need for medical treatment to the lumbar spine in 2008 and 2009.
Determined by: Johnson, C.J., Stofferahn, J., and Wilson, J.
Compensation Judge: Cheryl LeClair-Sommer
Attorneys: David R. Vail, Soderberg & Vail, Minneapolis, MN, for the Respondent. David J. Klaiman, Aafedt, Forde, Gray, Monson & Hager, Minneapolis, MN, for the Appellants.
THOMAS L. JOHNSON, Judge
The employer and insurer appeal the compensation judge’s finding that the employee’s need for medical care was caused by his personal injury.
On August 31, 2004, Joseph R. Gaboury, the employee, sustained a personal injury while working for Ebenezer Luther Hall, the employer, as a licensed practical nurse (LPN). The employee slipped on liquid on the floor and fell, landing on his back and was unable to rise from the floor. The employer and insurer admitted the employee injured his low back and sustained a recurrence of a ventral incisional hernia as a result of his personal injury and paid wage loss and medical benefits.
The employee testified he experienced occasional low back pain for forty years prior to his personal injury. He stated that his duties as a LPN over the last twenty years caused periodic low back pain because of the physical nature of the job. In 1993, the employee fell down stairs and was seen at the Fairview Riverside emergency center complaining of severe low back pain. The diagnosis was a right lower back contusion. The employee was provided with pain medications and instructed to follow up with his primary care provider. The employee testified that following this incident he returned to his regular employment as an LPN without restrictions and stated he was able to perform all his job duties.
Following his August 2004 work injury, the employee was taken by ambulance to the Fairview Southdale Hospital emergency room. The diagnosis was a recurrence of a hernia repaired several months prior to the injury, a lumbar strain, and a contusion. The next day the employee saw Dr. Michael Schaal at the Bloomington Lake Clinic who diagnosed a partial recurrence of a ventral hernia. The doctor scheduled surgery for September 13, 2004. The employee saw Dr. Kenneth Haycraft on September 7, 2004. He gave a history of prior mild back pain from lifting and complained of neck and back pain. The doctor diagnosed a recurrent hernia, an acute cervical strain, lumbar spasms, and a contusion and mechanical low back discomfort. A CT scan of the lumbar spine on September 14, 2004, showed bulging discs from L2 through L5 without stenosis or herniation, a chronic-appearing disc protrusion at L2-3 on the left, and mild bilateral foraminal narrowing from the bulging discs. Dr. Haycraft reviewed the CT scan, diagnosed mechanical back pain with discogenic disc disease, and prescribed physical therapy.
By September 29, 2004, Dr. Haycraft noted the employee’s neck pain was resolved but he continued to experience mechanical low back pain. In October 2004, Dr. Haycraft reported the employee’s range of motion was much improved and he had no radicular symptoms. The doctor allowed the employee to return to work as a LPN without restrictions. By report dated November 11, 2004, Dr. Haycraft opined the employee would reach maximum medical improvement (MMI) on December 10, 2004, with no permanent disability. The employee returned to see Dr. Haycraft on January 5, 2005, with continuing complaints of intermittent muscle spasms in the low back about three times a week. The doctor diagnosed mechanical low back pain and discomfort and recommended a home exercise program. The doctor noted he could not say that the employee had yet maximally improved.
The employee testified on or about October 20, 2005, he was at home preparing to go to work when he sneezed, felt a pop in his back, fell to his knees and was unable to stand. Dr. Haycraft saw the employee on October 27, 2005, and recorded a history of a spontaneous onset of marked back pain following a sneeze approximately four days previously. The doctor diagnosed an acute back injury, took the employee off work, and prescribed medication and physical therapy. In his November 25, 2005, office note, Dr. Haycraft stated the employee had been in his usual state of good health until October 20, 2005, when he developed an acute back spasm. The doctor opined this incident was a recurrence of the October 2004 personal injury, and noted the signs and symptoms the employee was experiencing exactly duplicated his previous symptoms. The diagnosis remained mechanical low back injury related to the August 2004 injury. Dr. Haycraft ordered physical therapy. The employee returned to see Dr. Haycraft in February 2008 in follow up for treatment of pneumonia. The employee also reported intermittent back pain which had improved.
On July 31, 2008, the employee complained of back and left leg pain and Dr. Haycraft referred the employee to an orthopedic surgeon. The employee saw Dr. Sara Lehnert at Midwest Orthopedic Specialists on August 19, 2008, complaining of increasing low back pain radiating into his left leg. An MRI scan showed an abdominal aortic aneurysm at L4-5, a left lateral disc bulge causing moderate left neural foraminal stenosis, and multi-level degenerative changes. On September 19, 2008, the employee returned to Dr. Haycraft complaining of low back and leg pain after helping lift a 385 pound patient off the floor. The doctor’s diagnosis was lumbar disc disorder with myelopathy. The employee underwent surgery to repair the aneurysm after which he returned to see Dr. Lehnert in November 2008. The diagnosis was left-sided foraminal stenosis secondary to a disc bulge and degenerative disc disease. Dr. Lehnert stated physical therapy was on hold until the employee healed from his surgery. The employee also saw Dr. Haycraft in November 2008 with complaints of continuing low back pain with radiculopathy into the left leg. In March 2009, the employee received a lumbar epidural steroid injection and then saw Dr. Theresa Gurin on referral from Dr. Lehnert for treatment of chronic pain. Dr. Gurin ordered physical therapy. On July 31, 2009, the employee saw Dr. Haycraft with continuing complaints of low back and left leg pain of moderate severity.
By report dated October 27, 2009, Dr. Haycraft stated the employee was a reliable observer of his pain and stated the pattern of the employee’s pain was confirmed by the September 2008 MRI scan. The doctor opined the original injury involved considerable force which never resolved and stated the employee would have been prone to relapses thereafter. Dr. Haycraft concluded the employee’s symptoms and need for treatment in 2008 and 2009 were substantially related to the original injury on August 31, 2004.
By report dated November 30, 2009, Dr. Gurin opined the employee’s symptoms from his August 31, 2004, personal injury never resolved and substantially contributed to subsequent intermittent low back exacerbations. These exacerbations required medical care in 2008 and 2009. Dr. Gurin stated she agreed with Dr. Haycraft’s opinions as expressed in his October 27, 2009, report stating the employee’s initial injury made him subject to intermittent exacerbations.
Dr. Terry Hood, a neurosurgeon, examined the employee in November 2009 at the request of the appellants. Dr. Hood obtained a history from the employee, reviewed the employee’s medical records, and performed a physical examination. Dr. Hood diagnosed degenerative disc disease of the lumbar spine that predated the August 2004 work injury. Dr. Hood opined the August 2004 work injury was a temporary aggravation of this preexisting low back condition and had resolved by January 6, 2005. Dr. Hood opined the employee developed a new pain syndrome on October 27, 2005, which for the first time included radicular leg symptoms that did not exist for the five months following the personal injury. Dr. Hood concluded the treatment received by the employee after January 6, 2005, was unrelated to his personal injury.
The employee brought a claim for medical expenses incurred in 2008 and 2009. Following a hearing, the compensation judge adopted the opinions of Dr. Gurin and Dr. Haycraft and found the August 31, 2004, personal injury was a substantial contributing cause of the employee’s need for the claimed medical treatment. The self-insured employer appeals.
The appellants contend the opinions of Dr. Gurin and Dr. Haycraft lack foundation for several reasons: the doctors failed to consider the employee’s longstanding history of low back pain; the medical opinions do not address the employee’s 1993 injury sustained after falling down stairs at home; the doctors failed to consider and give substantial weight to the employee’s injury of October 27, 2005; neither Dr. Gurin nor Dr. Haycraft considered the incident of September 19, 2008, in which the employee complained of severe low back pain after attempting to lift a patient; and the doctor’s reports ignore the fact that the employee did not complain of radicular symptoms until nearly three years after the August 2004 personal injury. For these reasons, the appellants assert the judge erred in adopting the medical opinions of Dr. Haycraft and Dr. Gurin, and contend the judge’s decision should be reversed.
The employee testified he was involved in a motor vehicle accident in 1993 but denied that he injured his back at that time. He also testified he injured his back when he fell down the stairs in 1993 but denied any continuing problems or restrictions on his activities thereafter. The employee described his job as an LPN with the employer as very physical and he testified he was able to perform the job. The employee acknowledged periodic low back pain and complaints over forty years but stated they did not prevent him from doing his job or require him to seek medical care.
The employee began treating at the Bloomington Lake Clinic in April 2000 and the records reflect numerous visits to the clinic. The first recorded complaint of low back pain was on September 7, 2004, when the employee saw Dr. Haycraft following his personal injury. The records thereafter are replete with complaints of low back pain and treatment. The September 2004 CT scan reflected multilevel disc bulging and degenerative disc disease of the lumbar spine. As Dr. Hood correctly notes, this condition predated the employee’s personal injury. There is, however, no evidence that the employee’s low back condition required medical treatment or limited the employee’s activities or ability to work prior to his personal injury. We cannot, therefore, conclude that any lack of knowledge by Dr. Haycraft or Dr. Gurin of the employee’s 1993 injury or his condition prior to the personal injury renders their opinions without foundation.
The appellants further argue, based upon the opinion of Dr. Hood, that the effects of the August 2004 injury only temporarily aggravated the employee’s preexisting degenerative condition. The appellants assert this temporary aggravation resolved by January 6, 2005, when Dr. Haycraft stated the employee could continue working on a full-time basis. The employee did not return to see Dr. Haycraft until October 27, 2005, when he reported the sneezing episode at home which caused a marked increase in low back pain. The appellants assert Dr. Haycraft failed to acknowledge this new injury in October 2005 or acknowledge the fact that it was not until after this injury that the employee developed radicular symptoms. Since only Dr. Hood fully considered the employee’s entire medical history, the appellants argue the compensation judge erred in rejecting the opinions of Dr. Hood and accepting those of Drs. Haycraft and Gurin. We disagree.
Dr. Hood opined the effects of the August 31, 2004, personal injury ended by January 6, 2005. In his office note of January 6, 2005, Dr. Haycraft stated the employee was then having continuing problems with his low back, including intermittent muscle spasms about three times per week. The doctor’s diagnosis remained mechanical low back pain and discomfort and Dr. Haycraft opined the employee had not yet reached maximum medical improvement from the effects of his personal injury. The employee testified he continued to experience low back pain and muscle spasms in 2005 but stated he only sought medical attention when the pain became severe. Drs. Haycraft and Gurin both opined the employee’s personal injury would periodically worsen and require medical care. Based upon this evidence, the compensation judge could reasonably conclude the effects of the employee’s injury had not resolved by January 2005.
The appellants next argue the October 5, 2005, sneezing incident at home constituted a new injury. It was this injury, the employer and insurer contend, that was responsible for the employee’s disability and medical care thereafter. The appellants cite Dr. Hood’s opinion that the August 2004 injury resolved by January 2005 and the October 20, 2005, incident caused a new pain syndrome which for the first time included radicular leg symptoms. The opinions of Drs. Haycraft and Gurin, the appellants assert, fail to consider the effect of this injury. Accordingly, the appellants argue the compensation judge’s reliance on their opinions is unjustified. We disagree.
We have affirmed the compensation judge’s finding that the employee’s personal injury was not temporary and had not resolved by January 2005. Since the injury was not temporary, its effects were continuing on October 20, 2005. In his November 25, 2005, office note, Dr. Haycraft stated the employee’s symptoms after the October 20, 2005, sneezing episode were “a reoccurrence of any injury that took place on August 31, 2004.” (Pet. Ex. A.) The doctor opined the signs and symptoms the employee was then experiencing exactly duplicated the symptoms the employee experienced following his personal injury. The doctor’s opinions provide substantial evidential support for the judge’s conclusion that the sneezing incident was not a new injury but was an exacerbation of the August 2004 personal injury. The judge’s conclusion is affirmed.
Finally, the appellants contend that it was not until June 13, 2007, that the employee began to complain of pain extending into his right leg. On July 31, 2008, this complaint changed and the employee began to experience left leg pain. It cannot, the appellants contend, be reasonably concluded that the development of radicular symptoms nearly three years after the work injury were caused by the work injury. Accordingly, the appellants argue the need for medical treatment in 2007 and 2008 was not caused by the original personal injury and the compensation judge erred in reaching that conclusion.
In his October 27, 2009, report, Dr. Haycraft opined the employee’s current symptoms and need for treatment in 2008 and 2009 were substantially related to the original August 2004 work injury. Dr. Gurin opined the employee’s back pain never resolved following his initial injury and substantially contributed to subsequent intermittent exacerbations of that pain. These exacerbations, Dr. Gurin opined, required medical care in 2008 and 2009 which treatment the doctor concluded, was substantially contributed to by the August 2004 work injury. Both doctors had a history of the employee’s August 2004 work injury and subsequent treatment and both doctors examined and treated the employee. As we have stated on numerous occasions, this level of knowledge affords adequate foundation for an expert medical opinion. See Drews v. Kohls, 55 W.C.D. 33 (W.C.C.A. 1996). Since Drs. Haycraft and Gurin had adequate foundation for their opinions, the compensation judge could reasonably adopt and rely upon them. See Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985). The decision of the compensation judge is, therefore, affirmed.
 The appellants do not argue the October 20, 2005, incident was a superseding, intervening cause of the employee’s disability thereafter. See Nelson v. American Lutheran Church, 420 N.W.2d 588, 590, 40 W.C.D. 849, 851 (Minn. 1988); Rohr v. Knutson Constr. Co., 305 Minn. 26, 29, 232 N.W.2d 233, 235, 28 W.C.D. 23, 26 (1975).