MICHAEL T. BAUMGART, Employee, v. MONARCH WOOD PRODS. and WEST BEND MUT. INS. CO., Employer-Insurer/Appellants, and HEALTHPARTNERS, INC., Intervenor.
WORKERS’ COMPENSATION COURT OF APPEALS
JUNE 22, 2011
EVIDENCE - EXPERT MEDICAL OPINION. Based on the hypothetical questions asked of him by the employee’s attorney, the employee’s treating orthopedist had adequate foundation for his opinion that the employee’s work activities substantially contributed to the employee’s shoulder condition and resulting need for surgery.
Determined by: Wilson, J., Johnson, J., and Milun, C.J.
Compensation Judge: Bradley J. Behr
Attorneys: Michel Steven Krug, Krug & Zupke, St. Paul, MN, for the Respondent. James C. Searls, Searls and Assocs., Edina, MN, for the Appellants.
DEBRA A. WILSON, Judge
The employer and insurer appeal from the compensation judge’s decision that the employee sustained a Gillette injury to his shoulder as a result of his work for the employer as a cabinet maker and machinist. We affirm.
The employee began working for Monarch Wood Products [the employer] as a cabinet maker and machinist in 2000. Beginning in about 2005, the employee’s job involved fabricating cabinets made of either melamine, particle board, or MDF. Sheets of these materials often weighed 75 to 80 lbs. and sometimes as much as 100 lbs. To perform his job, the employee was periodically required to lift or drag and sometimes carry sheets of this material, at times above shoulder height. The employee testified he was the worker who performed most of the lifting required for this job.
In early 2008, the employer began manufacturing display cabinets for Best Buy, which, according to the employee, resembled large rectangular boxes when completed. The employee testified that he noticed more fatigue and aches and pains than usual after working on Best Buy projects.
In late October 2008, the employee sought treatment for right shoulder pain. No specific injury was reported. However, the employee testified that, also in October 2008, he experienced severe right shoulder pain while reaching from the driver’s seat to unlock the passenger door in his compact car. He later explained that this incident caused him to realize just “how painful [his] shoulder was.”
Treatment for the employee’s right shoulder symptoms included two injections for what was at one point diagnosed as bursitis. In January of 2009, Dr. Steven Adorn indicated that the employee should “ice his shoulder at night after work or otherwise” and that he “need[ed] to not work above shoulder level.”
The employee ultimately consulted an orthopedist, Dr. Robert Knowlan, who ordered an MRI scan. That scan, performed on March 26, 2009, revealed a “[f]ull thickness tear of the supraspinatus tendon” and also evidence of a “moderate subacromial bursitis.”
The employee subsequently sought a second opinion from Dr. Jonathan Braman, at Tria Orthopaedic Center. Dr. Braham ultimately recommended surgery, and, in response to questions from the employee’s attorney, he indicated that the employee’s shoulder condition was related to his work activities for the employer. Dr. Mark Engasser, the employer and insurer’s independent examiner, concluded otherwise, reporting that the employee had not sustained “any work injury” to his right shoulder while employed by the employer.
The employee claimed entitlement to the surgery recommended by Dr. Braman, and the matter came on for hearing before a compensation judge. In a decision issued on February 2, 2011, the judge concluded that the employee had sustained a work-related Gillette injury to his right shoulder on or about May 1, 2009, when he obtained a definitive diagnosis of rotator cuff tear. The employer and insurer appeal.
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 (2010). 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).
The nature of the employee’s shoulder condition, and the reasonableness of the proposed surgery, are not disputed. The sole issue is whether substantial evidence supports the compensation judge’s decision that the employee’s work activities substantially contributed to his need for the proposed surgery. In findings relevant to that issue, the compensation judge expressly found the employee to be a credible witness, and the judge also expressly accepted the opinion of Dr. Braman over that of Dr. Engasser.
On appeal, the employer and insurer contend that the “assumptions underlying Dr. Braman’s opinion are unsupported.” Specifically, the employer and insurer argue that Dr. Braman based his opinion on the assumption that the employee “had the onset of pain while working . . . without any other etiology for this,” in contradiction to the employee’s testimony that his first instance of right shoulder pain “was not at work, but while unlocking the passenger side door to let his daughter in the car.” We are not persuaded.
We note initially that the employee’s testimony as to the start of his symptoms is not unequivocal. When asked about that at hearing, the employee repeatedly attempted to indicate that the incident in the car was the first time that he experienced pain that severe. In any event, in his September 13, 2010, report, Dr. Braman recorded both the question asked of him by the employee’s counsel, and his answer, as follows:
Did Mr. Baumgart’s work as a carpenter for Monarch Wood Products, lifting, turning, and manipulating ¾ inch thick compressed particle boards weighing an approximately 75-150 pounds, as well as lifting completed cabinetry manufactured for Best Buy in the autumn of 2008 constitute repetitive lifting activity (a Gillette injury) that caused and/or substantially contributed to the development of a right shoulder full thickness tear of the supraspinatus tendon involving roughly the anterior one-half of the tendon culminating in disablement recorded as 12/30/08 and 05/01/09, when you diagnosed the need for arthroscopic repair? Please explain how this mechanism of injury caused a rotator cuff tear.
The actual cause of rotator cuff tears is unknown. There are numerous theories as to what causes the tendon of the rotator cuff muscle to tear off of the bone. One theory involves the repetitive use of the shoulder. The theory is that repetitive stress involving heavy lifting, pushing, pulling, and carrying, especially but not exclusively in the above shoulder position, causes fraying at the attachment of the tendon to the bone. Consequently, Mr. Baumgart’s heavy lifting of 70-150 lbs compressed particle board weights, coupled with his above-shoulder level activities involving these heavy objects, is a causative factor to a reasonable degree of medical certainty. He had the onset of pain while working in this facility without any other etiology for this.
It is important to understand that some rotator cuff tears are caused by acute injuries such as falling off of a ladder. In young, active, healthy males such as Mr. Baumgart, rotator cuff tears are extremely uncommon, and such an acute injury would be likely to require a significant amount of force, such as a fall off a ladder or a sudden violent activity.
In the absence of such an acute event, a repetitive injury is more likely. Consequently, I believe that his vocation was a substantial contributing factor to his disablement.
By saying that the employee “had the onset of pain while working in this facility without any other etiology for this,” Br. Braman may very well have meant merely that the employee’s symptoms were contemporaneous with the term of his employment by the employer. At any rate, with regard to the question of the employer and insurer’s claimed “other etiology,” Br. Braman was asked and answered as follows:
Please indicate whether the act of reaching across from the driver’s side seat to a passenger door itself is the likely cause of Mr. Baumgart’s right shoulder pathology, or, in the alternative, is a symptomatic reaction to the pathology substantially contributed to by Mr. Baumgart’s work activities for Monarch.
As I mentioned above, in young otherwise healthy patients, it is likely that a simple event such as reaching across one’s body would not be likely to cause a full thickness tear of the rotator cuff. This particular motion is called “cross body adduction” and is a frequent finding of pain. As patients get more disabled by their shoulder dysfunction and disability, they lose increasing amounts of motion. This motion loss is what frequently causes pain with this cross body adduction or reaching across the body. Consequently, I believe this is more likely to be a symptomatic reaction to his shoulder problem that an actual cause of his rotator cuff tear.
We would also note, in this regard, that Dr. Engasser, the employer and insurer’s examiner, made no mention of the reaching incident in discussing the cause of the employee’s condition. And, finally, Dr. Braman adequately explained why he attributed the employee’s condition to his work. Contrary to the employer and insurer’s argument, Dr. Braman did not find the work causative merely because he could find no other cause.
As a rule, a judge’s choice between conflicting expert opinions is generally upheld unless the facts assumed by the expert are unsupported by the record. See Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985). Finding no good reason to overturn the judge’s reliance on Dr. Braman, we affirm the judge’s decision in its entirety.
 See Gillette v. Harold, Inc., 257 Minn. 313, 101 N.W.2d 200, 21 W.C.D. 105 (1960).
 However, Dr. Engasser agreed that the employee’s treatment, including the proposed rotator cuff tear repair, was appropriate to address the employee’s right shoulder condition.
 The employer and insurer also do not dispute the injury date chosen by the judge, only causation.