FRANKLIN CARTAGENA QUIJADA, Employee/Appellant, v. HEIKES FARM, INC., and GENERAL CASUALTY COS., Employer-Insurer, and IUOE LOCAL #49 HEALTH & WELFARE FUND, HENNEPIN CO. MED. CTR., and INJURED WORKERS’ PHARMACY, Intervenors.
WORKERS’ COMPENSATION COURT OF APPEALS
MAY 4, 2011
CAUSATION - PSYCHOLOGICAL CONDITION. Substantial evidence, including adequately-founded expert opinion, supports the compensation judge’s determination that the employee’s depression was a result of psychosocial stresses, including unemployment and related financial stresses, separate from any physical stresses resulting from the personal injury and that the employee did not suffer a psychological injury as a consequence of his work-related injury.
TEMPORARY BENEFITS - WORK RESTRICTIONS; TEMPORARY BENEFITS - FULLY RECOVERED. Substantial evidence, including the opinions of three adequately founded medical experts supports the compensation judge’s finding that the employee had no restrictions secondary to his work injury. Since the employee has no disability or restrictions caused by his work injury, he has no entitlement to workers’ compensation benefits.
Determined by: Johnson, J., Stofferahn, J., and Wilson, J.
Compensation Judge: Catherine A. Dallner
Attorneys: Sharifa Elaraj and Christine Wojdyla, Elaraj & Assocs., Minneapolis, MN, for the Appellant. Richard W. Schmidt, Cousineau McGuire, Minneapolis, MN, for the Respondents.
THOMAS L. JOHNSON, Judge
The employee appeals the compensation judge’s findings that the employee’s psychological condition is unrelated to his personal injury and the judge’s finding that the employee has no restrictions secondary to his personal injury. We affirm.
Franklin Cartagena Quijada, the employee, sustained a personal injury on June 3, 2008, while working for Heikes Farms, Inc., the employer, then insured by General Casualty Companies. On that date, the employee was driving a truck when he was struck by another vehicle. The employee testified he struck his head in the accident and testified he recalled little between the time of the impact and the arrival of the emergency personnel. The employee called his supervisor who came to the scene of the accident. The employee drove the truck back to the employer’s shop followed by his supervisor and then drove himself home.
On June 6, 2008, the employee went to the emergency room at Regions Hospital complaining of headaches and a foggy feeling. The employee stated he did not lose consciousness and denied any head trauma, focal motor deficits, or weakness. He denied neck pain but complained of aching muscles on the right side of the neck. A neurological examination was normal with no evidence of acute focal deficits or external signs of trauma. The diagnosis was postconcussive syndrome. The employee was discharged and instructed to follow up with a primary care physician.
The employee commenced chiropractic treatment on June 9, 2008, and received adjustments, electrical muscle stimulation, and instruction in a home exercise program. On June 17, 2008, the employee saw Dr. George Adam, a neurologist. The doctor ordered a brain MRI scan which was normal. A cervical MRI scan showed small disc herniations at C5-6 and C6-7 that flattened the spinal cord with mild stenosis at each level and a bulging disc at C3-4. In August 2008, the employee underwent cervical nerve blacks and cervical facet injections in September 2008. Thereafter, the employee attended physical therapy.
Dr. Matthew Monsein examined the employee on January 9, 2009. The employee complained of headaches and neck pain and the doctor diagnosed myofascial pain syndrome, musculoligamentous strain, and soft tissue injury with muscle contraction headaches. Dr. Monsein stated no further diagnostic evaluations were necessary and recommended a pain management program.
The employee went to the Regions Hospital emergency room in January 2009 complaining of headaches, dizziness, and nausea with some light sensitivity. A CT scan of the head was normal with no findings to explain the employee’s headache.
In February 2009, the employee was examined by PAC Chad Swearingen at the Institute for Low Back and Neck Care who stated the employee was not a surgical candidate at that time. Dr. David Spight at the Institute recommended medial branch blocks that were administered in March and April 2009. The blocks did not result in any pain improvement and Dr. Spight explained that he had nothing further to offer the employee from an interventional standpoint. Thereafter, the employee saw Dr. Francis Denis at the Twin Cities Spine Center who ordered selective C-5 nerve root blocks that helped only mildly. Dr. Jeffrey Pinto at the Institute ordered a CT myelogram in September 2009 that showed some mild right-sided spurring at C3-4 without nerve root compression and a moderate right-sided stenosis at C4-5. Dr. Pinto discussed with the employee a discectomy and fusion which he stated might reduce the employee’s pain level.
Dr. Joel Gedan examined the employee in May 2009 at the request of the employer and insurer. The doctor opined the employee’s symptoms were grossly exaggerated with regard to any identifiable injury that occurred, physical findings on examination, or radiographic studies. The doctor opined the employee sustained a mild, temporary injury on June 3, 2008, which likely resolved within a few days or weeks. Dr. Gedan stated the employee required no physical restrictions and was able to work on a full-time basis without the need for further medical care or treatment.
Dr. Mark Larkins, a neurosurgeon, examined the employee in October 2009 at the request of the employer and insurer. The doctor opined the employee sustained a cervical strain as a result of his June 2008 motor vehicle accident. The doctor noted the employee’s complaints and examination findings were inconsistent over time and the multiple diagnostic studies were unremarkable. Dr. Larkins noted the imaging studies showed mild degenerative changes with no evidence for cervical radiculopathy. The doctor opined the employee did not need the proposed C3-5 decompression and fusion, opined a chronic pain program was not reasonable or necessary, and concluded the employee had no restrictions on his work activities as a result of the personal injury.
By report dated March 17, 2010, Dr. Monsein opined the employee’s personal injury caused a legitimate physical problem, a cervical strain superimposed on two levels, degenerative disc disease, and a chronic pain syndrome. The doctor stated the employee was not a good surgical candidate due to his “very exaggerated pain responses and the fact that the independent medical evaluations did note that he has what appears to be a significant functional component to his pain.” (Pet. Ex. C.) Dr. Larkins stated the employee’s condition prevented him from resuming his normal activities. The doctor recommended a pain management and rehabilitation program for the employee focused on functional restoration.
The employee attended Phoenix Center Pain Services at the Courage Center in June 2010. By report dated June 17, 2010, Dr. Monsein stated the employee suffered from myofascial pain, musculoligamentous strain, soft tissue injury, and muscle contraction headaches. Dr. Monsein further noted the employee was very depressed and anxious due to his ongoing pain and its effects on his life. The doctor stated the employee participated well and fully in the pain management program. At discharge, the employee no longer required narcotic medication for pain and was encouraged to participate in a fitness regime. A Nada-chair was recommended for low back and posture support along with a three-month gym membership. Dr. Monsein prepared a Functional Capacities Evaluation form establishing significant restrictions and limitations on the employee’s activities. Following a driving assessment, an evaluator concluded the employee failed the assessment and driving was not recommended.
Dr. Thomas Gratzer, a psychiatrist, examined the employee in August 2010 at the request of the employer and insurer. The doctor diagnosed a major depressive episode, moderate, and pain disorder associated with psychological factors and a general medical condition. The doctor noted the employee sustained relatively mild injuries in the motor vehicle accident and opined it would be atypical for an individual to develop a fairly significant major depressive episode from relatively mild physical stresses. Dr. Gratzer found significant the fact that Dr. Adams noted the employee was having significant symptoms of major depression two weeks after the motor vehicle accident. Dr. Gratzer explained it would be atypical for an individual to become so depressed two weeks after an injury. The doctor opined the employee’s major depression likely developed in the context of family stresses, relationship difficulties, and acculturation issues separate from the physical stresses of the June 3, 2008, injury and likely began prior thereto.
The employer and insurer filed a petition to discontinue the employee’s temporary total disability benefits contending the employee no longer had restrictions on his work activities and/or that the employee had reached maximum medical improvement [MMI] from his June 3, 2008, personal injury. The employer and insurer also sought to terminate the employee’s rehabilitation plan because he was no longer a qualified employee. The employee contended he suffered a psychological injury in the nature of depression as a consequence of his June 3, 2008, personal injury. The employee also sought payment for certain medical expenses, the Nada-chair, an electrical muscle stimulation unit, and the health club membership as recommended by Dr. Monsein.
Following a hearing, the compensation judge found the employee did not suffer a psychological injury as a consequence of his work-related injury. The judge found the employee had no restrictions resulting from his personal injury and that the employee reached MMI by July 9, 2010. The compensation judge further found the Nada-chair, the electrical stimulation unit, and the gym membership recommended by Dr. Monsein were not reasonable or necessary to cure or relieve the employee from the effects of his personal injury. Accordingly, the compensation judge granted the employer and insurer’s request to discontinue temporary total disability benefits and the employee’s rehabilitation plan. The judge denied the claims of the intervenors for medical expenses and denied the employee’s claims for medical expenses. The employee appeals.
1. Psychological Injury
The compensation judge found persuasive and adopted Dr. Gratzer’s opinion that the employee’s psychological condition was unrelated to his personal injury. The doctor attributed the employee’s major depression to psychosocial stresses, including family stresses, relationship difficulties, and acculturation issues, which he maintained were unrelated to the work injury. The employee contends Dr. Gratzer lacked foundation for his opinions. The employee further argues that he had no psychological impairment prior to his personal injury and, since it developed after the injury, causation must exist. Accordingly, the employee asserts the compensation judge erroneously relied on the opinions of Dr. Gratzer in denying the claim.
The competency of a witness to provide expert medical testimony depends upon both the degree of the witness’s scientific knowledge and the extent of the witness’s practical experience with the matter which is the subject of the offered testimony. Reinhardt v. Colton, 337 N.W.2d 88, 93 (Minn. 1983). Dr. Gratzer, a psychiatrist, reviewed the employee’s medical records and conducted a psychiatric examination of the employee. We have stated on many occasions that this level of knowledge about the subject matter provides ample foundation for an expert opinion. Drews v. Kohl’s, 55 W.C.D. 33 (W.C.C.A. 1996).
A mental injury which is caused, aggravated, or precipitated by a work-related physical injury is compensable. Hartman v. Cold Spring Granite Co., 243 Minn. 264, 67 N.W.2d 656, 18 W.C.D. 206 (1954). The employee has the burden of proving that he sustained a compensable injury. Minn. Stat. § 176.021, subd. 1. In cases involving physical injury, evidence that a condition did not pre-exist the work injury but came on immediately thereafter may support a finding of causation. Laurent v. Sterling, Inc., slip op. (W.C.C.A. Mar. 9, 1994). In cases involving mental injury, however, the fact that there exists a temporal relationship between the injury and the onset of a mental condition, standing alone, is insufficient to establish causation. “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.” Rather, some medical opinion causally relating the mental condition to the physical injury is required before the depression can be found compensable. Rindahl v. Brighton Wood Farms, Inc., 382 N.W.2d 855, 856, 38 W.C.D. 473, 475 (Minn. 1986). Dr. Monsein supplied the necessary medical opinion causally relating the employee’s mental condition to his personal injury. Dr. Gratzer, however, came to the opposite opinion. The compensation judge adopted the opinions of Dr. Gratzer. It is the compensation judge’s responsibility, as the trier of fact, to resolve conflicts in expert testimony. See Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985). The compensation judge did not err in accepting the opinion of Dr. Gratzer.
The compensation judge concluded the employee’s depression was a result of psychosocial stresses separate from any physical stresses resulting from the personal injury. The employee concedes he has had difficulty in maintaining his romantic relationship with his long-time partner, has had difficulty caring for their child, and is frustrated by his inability to work, to provide for his family, and the severe financial hardship caused by the work injury. The employee, however, asserts that each of these stressors resulted directly from the personal injury so the personal injury is a substantial contributing cause of the depression. Accordingly, the employee contends the compensation judge erred in denying his claim for a psychological injury. We disagree.
In Gerhardt v. Welch, 267 Minn. 206, 125 N.W.2d 721, 23 W.C.D. 108 (1964) the supreme court, in reviewing the range of compensable consequences of a personal injury, adopted the “direct and natural consequence rule” set forth at 1. A. Larson, Workers’ Compensation Law, § 13.00, which stated as follows:
When the primary injury is shown to have arisen out of and in the course of employment, every natural consequence that flows from the injury likewise arises out of the employment, unless it is a result of an independent intervening cause attributable to the claimant’s own negligence or misconduct.
The question of what constitutes a natural consequence flowing from a personal injury involves issues of medical and/or legal causation. In Jackson v. Red Owl Stores, Inc., 375 N.W.2d 13, 17, 18, 38 W.C.D. 170, 177 (Minn. 1985), the supreme court noted medical causation is a “distinct legal concept that concerns the connection between the primary injury and a later condition . . . how far the range of compensable consequences is carried, once the primary injury is causally connected with the employment.”
Where a personal injury causes or aggravates some independent medical condition such as depression, that condition may be compensable if medical causation exists. In the present case, the employee does not contend the personal injury was a medical cause of his depression. Rather, the employee asserts his personal injury caused him to be unemployed which, in turn, resulted in financial and family problems. Thus, there is in this case an intervening non-medical factor, unemployment, separating the personal injury from the claimed compensable consequence. In that aspect, this case is similar to Melartin v. Mavo Sys., Inc., 65 W.C.D. 405 (W.C.C.A. 2005) in which the employee contended his preexisting alcoholism was aggravated by his work injury. In that case, Mr. Melartin did not contend his personal injury was a medical cause of his worsened alcoholism. Rather, he asserted his personal injury caused him to be unemployed and the unemployment aggravated his alcoholism. In denying the employee’s claim, this court noted that the more remote the claimed consequence is from the personal injury, the less likely it is the claimed consequence is compensable. Similarly, in this case the coverage of the Workers’ Compensation Act does not extend to depression caused by unemployment and related financial stresses caused by the unemployment. The decision of the compensation judge that the employee’s psychological condition is unrelated to his personal injury is affirmed.
2. Newly Discovered Evidence of Psychological Injury
The employee asserts that following the hearing, physicians at the Hennepin County Medical Center diagnosed the employee with a traumatic brain injury. Thereafter, the employee underwent neuropsychological testing and was examined by Dr. John Cronin who has stated diagnoses and opinions regarding the causation of the employee’s psychological condition. This evidence, the employee contends, constitutes newly discovered evidence under Minn. Stat. § 176.461. The employee requests this court allow the introduction of new evidence on appeal. We decline to do so.
On appeal, this court may not consider matters not contained within the record before the compensation judge. Minn. Stat. § 176.421, subd. 6; Gollop v. Gollop, 389 N.W.2d 202, 38 W.C.D. 757 (Minn. 1986). The medical records and reports which the employee now seeks to introduce on appeal result from treatment provided to the employee after the hearing. This court will not consider that evidence on appeal. The employee has not petitioned this court to set aside the compensation judge’s decision under Minn. Stat. § 176.461. The employee’s request that this court consider evidence not introduced at the hearing before the compensation judge is denied.
3. Restrictions Due to Work Injury
The compensation judge found the employee no longer has restrictions on his work activities due to his personal injury. The employee contends this conclusion is unsupported by substantial evidence. We are not persuaded.
Dr. Gedan examined the employee in May 2009 and opined that his symptoms were “unexplainable on the basis of any injury that occurred, radiographic studies or findings on examination.” (Resp. Ex. 2.) Dr. Gedan opined the employee sustained only a mild temporary injury which resolved within a few days or weeks and stated the employee required no physical restrictions and was able to work on a fulltime basis. Dr. Larkins noted the employee’s complaints and examination findings were inconsistent over time and multiple diagnostic studies were unremarkable. The doctor concluded the employee had no restrictions on his work activities as a result of his personal injury. Dr. Gratzer stated the employee developed a functional component to his physical pain complaints in connection with his major depression. The doctor concluded the restrictions set forth in the Functional Capacities Evaluation performed at Courage Center in June 2010 may be causally related to the employee’s depression, but that depression is not causally related to the work injury.
Three medical experts, Dr. Gedan, Dr. Larkin, and Dr. Gratzer, all opined the employee had no restrictions caused by his June 2008 personal injury. All three doctors had foundation for their opinions and the compensation judge could reasonably rely upon them. The compensation judge’s finding that the employee has no restrictions secondary to his work injury is affirmed.
4. Maximum Medical Improvement
The compensation judge found the employee reached maximum medical improvement by July 9, 2010, the first day of the hearing. The employee contends the medical records, specifically those from the Phoenix Pain Center and Hennepin County Medical Center, demonstrate that the employee is still likely to significantly improve with additional treatment. Accordingly, the employee asserts the compensation judge’s finding is unsupported by substantial evidence.
Temporary total disability benefits cease if the employee has been released to return to work without any physical restrictions due to a work injury. Minn. Stat. § 176.101, subd. 1a. Since the employee has no disability or restrictions caused by his personal injury, he is not entitled to workers’ compensation benefits. Kautz v. Setterlin Co., 410 N.W.2d 483, 40 W.C.D. 206 (1987). Since the employee has no restrictions, the issue of maximum medical improvement is moot.
 In the current version of Larson, this rule is set forth at § 10.01 and is unchanged except the words “negligence or misconduct” are replaced by the words “intentional conduct.” 1 A. Larson & L. K. Larson, Workers’ Compensation Law, § 10.01 (2000).
 See, e.g., Dotolo v. FMC Corp., 375 N.W.2d 25, 38 W.C.D. 205 (Minn. 1985); Hartman v. Cold Spring Granite Co., 243 Minn. 264, 67 N.W.2d 656, 18 W.C.D. 206 (1954).