DANIEL A. IHRIG, Employee/Appellant, v. SPECIAL SCH. DIST. #1, SELF-INSURED/SEDGWICK CMS, INC., Employer, and PRIMARY BEHAVIORAL HEALTH CLINIC, and NORAN NEUROLOGICAL CLINIC, Intervenors.
WORKERS’ COMPENSATION COURT OF APPEALS
JANUARY 26, 2010
CAUSATION - PSYCHOLOGICAL CONDITION. Substantial evidence, including expert opinion, supported the compensation judge’s decision that the employee’s depression was not causally related to his work injury.
Determined by: Wilson, J., Rykken, J., and Johnson, C.J.
Compensation Judge: Jennifer Patterson
Attorneys: David H. Bailly, St. Louis Park, MN, for the Appellant. Timothy P. Jung, Lind, Jensen, Sullivan & Peterson, Minneapolis, MN, for the Respondents.
DEBRA A. WILSON, Judge
The employee appeals from the judge’s decision that his work injury is not a substantial contributing cause of his depression and chronic pain syndrome. We affirm.
The employee was working as a journeyman plumber for Special School District #1 [the employer] on November 6, 1984, when he sustained a work-related injury to his low back in the nature of an L5-S1 disc herniation. He was subsequently unable to return to his job as a plumber.
Over the years following his injury, the employee received various kinds of conservative treatment, including chiropractic treatments, physical therapy, a back brace, and epidural steroid injections. Gaps in treatment for low back symptoms occurred between September 4, 1985, and February 6, 1999, and again between February 9, 1999, and August 29, 2006.
In the interim, on March 29, 1985, the employee presented to Group Health requesting a tranquilizer, explaining that he was having trouble dealing with low back pain, had become irritable, and was having interpersonal difficulties with his wife and children. About three years later, on May 5, 1988, Dr. Robert B. Clift performed a vocational-psychological evaluation. Based on the employee’s MMPI results, Dr. Cliff concluded that the employee’s current status was “probably characterized by mild depression and extreme preoccupation with physical complaints.”
In March of 1996, the employee entered into a full, final, and complete settlement of his workers’ compensation claims, except for claims for medical treatment.
On August 29, 2006, the employee was examined by Dr. Thomas Schriefer, at the Noran Neurological Clinic, for evaluation of low back pain. The employee gave a history of back pain dating back to 1984, with a worsening of that pain “since August 10th.” At that time, the employee also told Dr. Schriefer that his life had spiraled downhill to an “unmanageable point,” and he requested medication for depression, noting that in the last five years or so he had been feeling increasingly “worthless and low.” Dr. Schriefer noted a history of depression, indicating that the employee “does appear clinically depressed, and I have started him on Wellbutrin XL.” Dr. Schriefer also referred the employee to Dr. Gregory Lamberty, Ph.D., for a neuropsychological evaluation.
An MRI scan performed on September 1, 2006, was interpreted as showing disc involvement at L4-5 and L5-S1. An epidural steroid injection was performed on September 13, 2006.
On November 6, 2006, the employee filed a medical request seeking approval for a mental health evaluation and payment for treatment with Noran Clinic. The employer and insurer denied that the employee had sustained a consequential injury in the nature of a mental health injury or depression. The matter proceeded to an administrative conference, after which the employer and insurer filed a request for formal hearing, although they eventually paid the bills for medical treatment with the Noran Clinic.
The employee was evaluated by Dr. Lamberty on February 1, 2007. In his office note of that date, the doctor recorded that the employee had felt depressed “for the past 10 years.” Dr. Lamberty recommended a psychiatric consultation to determine the potential benefit of medication and psychotherapy/counseling.
The employee was seen by orthopedic surgeon Dr. Thomas Comfort for an independent medical evaluation on March 21, 2007. Dr. Comfort’s report indicates that the employee had experienced intermittent low back pain since the work injury, with the pain being “almost unbearable” since August 10, 2006. In Dr. Comfort’s opinion, the employee had suffered an exacerbation of his work-related L5-S1 disc herniation, for which he had undergone epidural steroid injections, “with substantial resolution of his symptoms.”
The employee first saw licensed psychologist Dr. John Cronin, of Primary Behavioral Health Clinics, Inc., on March 21, 2007. He was subsequently seen on April 19, 2007, May 15, 2007, May 21, 2007, June 27, 2007, and August 7, 2007, “for the purpose of a chronic pain evaluation.” The employee related that he had been “experiencing emotional distress since his injury and failed attempts to reduce his pain levels.” Dr. Cronin noted that the employee had been attempting to cope with chronic pain since the 1984 work injury and that, “since then, in addition to the daily pain he has also developed a significant depression.” Dr. Cronin went on to opine that the employee was “exhibiting an emotional reaction to the injury in the form of depression” and that the employee’s condition met the criteria for chronic pain syndrome. The employee subsequently received psychotherapy from Dr. Cronin. The employee has also been prescribed antidepressants by psychiatrist Dr. John Currant, of the Behavioral Mental Health Clinic.
On March 13, 2008, the employee underwent an independent psychiatric evaluation with Dr. John Rauenhorst. In his report of that same date, Dr. Rauenhorst noted,
[i]n the review of systems, he indicated he had been having depression for many years. He could not be sure when this began, but thought it probably began sometime in the mid-to-late 1980’s. He did not directly attribute this to the back injury, but, in discussing this, he appeared to believe that the back pain was causing the depression.
Dr. Rauenhorst’s Axis I diagnosis was depressive disorder NOS (not otherwise specified), and the doctor opined that the employee’s depressive disorder was not due to the injury in 1984, because, in part, “there is not a clear chronological relationship between the symptoms of the depressive disorder and the symptoms of Mr. Ihrig’s back pain.” It was also Dr. Rauenhorst’s opinion that the employee had experienced other significant stressors over the years that “appear to outweigh the direct effects of the back injury.”
The employer and insurer’s request for formal hearing came on for hearing on June 10, 2009. The issue before the compensation judge was whether the employee had developed an emotional injury, in the nature of depression, arising out of his admitted 1984 work injury. In findings and order filed on July 9, 2009, the compensation judge accepted the opinions of Dr. Rauenhorst and found that the 1984 work injury was not a substantial contributing cause of the employee’s depression and chronic pain syndrome. The employee appeals.
STANDARD OF REVIEW
On appeal, the Workers’ Compensation Court of Appeals must determine whether “the findings of fact and order [are] clearly erroneous and unsupported by substantial evidence in view of the entire record as submitted.” Minn. Stat. § 176.421, subd. 1 (2008). Substantial evidence supports the findings if, in the context of the entire record, “they are supported by evidence that a reasonable mind might accept as adequate.” Hengemuhle v. Long Prairie Jaycees, 358 N.W.2d 54, 59, 37 W.C.D. 235, 239 (Minn. 1984). Where evidence conflicts or more than one inference may reasonably be drawn from the evidence, the findings are to be affirmed. Id. at 60, 37 W.C.D. at 240. Similarly, findings of fact should not be disturbed, even though the reviewing court might disagree with them, “unless they are clearly erroneous in the sense that they are manifestly contrary to the weight of evidence or not reasonably supported by the evidence as a whole.” Northern States Power Co. v. Lyon Food Prods., Inc., 304 Minn. 196, 201, 229 N.W.2d 521, 524 (1975).
On appeal, the employee challenges the judge’s decision to accept the opinions of Dr. Rauenhorst, over those of Dr. Cronin, as to causation of the employee’s depression, contending that the judge’s choice between experts is clearly erroneous and unsupported by substantial evidence in the record. We are not persuaded.
In his report, Dr. Rauenhorst indicated that, “were there to be a causative relationship, one would expect a closer relationship chronologically,” and, in his deposition, he testified that the time frame for the diagnosis and treatment “didn’t fit.” The employee contends, initially, that Dr. Rauenhorst’s opinions are flawed because he relied on the employee’s statement to him about his depression starting in the mid to late 1990’s, when the employee testified at hearing that he has since recognized signs of depression in his behavior dating back to shortly after his work injury. We note, however, that the employee had also told Dr. Lamberty, in February of 2007, that he had been feeling depressed for the past ten years, the employee had no treatment for mental health conditions from March 29, 1985, to August 29, 2006, and the employee was not prescribed anti-depressants until 2006. Clearly, the facts assumed by Dr. Rauenhorst were supported by the record.
While the judge did not make a specific finding as to the credibility of the employee’s testimony about the timing of his depressive symptoms, it is apparent that she put greater weight on the history the employee gave to two doctors and the lack of reference in the employee’s medical records to depression prior to 2006. We find no error by the judge in this regard. See Even v. Kraft, Inc., 445 N.W.2d 831, 42 W.C.D. 220 (Minn. 1989) (credibility assessments are for the compensation judge). And, contrary to the employee’s argument on appeal, the Group Health chart note in 1984 did not “clearly substantiate that [the employee] had depression soon after his injury.” Even Dr. Cronin testified that the Group Health chart note did not indicate that the employee was depressed.
The employee also contends that Dr. Rauenhorst incorrectly based his opinion on the presence of other stressors in the employee’s life that would make his depression understandable, even if the employee had never had a work injury. It is the employee’s contention that his restrictions and chronic pain have “contributed, at least in part, to the other stressors in his life.”
Dr. Rauenhorst pointed to the employee’s divorce, his loss of contact with his children, his failure to develop outside relationships, and his financial difficulties as stressors that “appear to outweigh the direct effects of the back injury.” While the employee contends, on appeal, that his chronic pain contributed to those stressors, he offered no specific examples or expert opinion, at hearing, in that regard. In fact, the employee testified at hearing that he was “not really sure” to what he attributed his divorce, and Dr. Cronin testified that he had insufficient information to conclude why the employee’s marriage and subsequent relationships had ended. The employee also testified he became estranged from his children several years after his divorce and that he had not seen either one of them for about 10 years, but neither the employee nor Dr. Cronin offered testimony connecting this breakdown in relationships to the work injury. Finally, Dr. Rauenhorst also offered a third explanation for why the employee’s depressive disorder was not causally related to his work injury. That is, according to Dr. Rauenhorst, the employee’s condition does not meet the criteria for the types of depression that were likely to be related to physical injury. The employee did not address this rationale in his brief on appeal.
A judge’s choice between expert opinions is generally upheld unless the facts assumed by the expert are not supported by the record. Nord v. City of Cook, 360 N.W. 2d 337, 37 W.C.D. 364 (Minn. 1985). In the instant case, the facts assumed by Dr. Rauenhorst are adequately supported by the evidence, and the judge’s findings are therefore affirmed in their entirety.
 Per Dr. Cronin’s report of September 5, 2007.
 Dr. Cronin’s Axis I diagnoses were pain disorder associated with both psychological factors and a general medical condition (chronic pain syndrome with some sort of an emotional component, per his testimony) and dysthymic disorder (long-term, low grade depression).
 Dr. Rauenhorst’s report indicates that the employee’s depression began in the mid to late 1980s; however, in his deposition, Dr. Rauenhorst testified that the history he took was that the employee’s depression began in the mid to late 1990s. The employee admitted in his appellate brief that he told Dr. Rauenhorst that his depression began in the mid to late 1990s.
 Dr. Cronin also testified that Dr. Cliff’s 1988 evaluation did not contain a diagnosis and was not helpful in connecting the employee’s current depression with his work injury.
 Specifically, post-traumatic stress disorder, acute stress disorder, adjustment disorder, or specific phobia.