JEAN PERSON, Employee, v. GLACIAL RIDGE HOSP. and MHA INS. CO., Employer-Insurer/Appellants, and BLUECROSS BLUESHIELD OF MINN., Intervenor.
WORKERS’ COMPENSATION COURT OF APPEALS
AUGUST 9, 2011
EVIDENCE - EXPERT MEDICAL OPINION. The compensation judge did not err in basing his causation decision on the opinion of the employee’s treating physician where that physician’s opinion was not based on any assumptions clearly not supported by the record.
Determined by: Wilson, J., Milun, C.J., and Pederson, J.
Compensation Judge: Danny P. Kelly
Attorneys: DeAnna M. McCashin, Schoep & McCashin, Alexandria, MN, for the Respondent. Whitney L. Teel, Cousineau McGuire, Minneapolis, MN, for the Appellants.
DEBRA A. WILSON, Judge
The employer and insurer appeal from the compensation judge’s conclusion that the employee sustained a left foot injury as a consequence of her work-related left knee injury. We affirm.
The employee is a licensed practical nurse [LPN] and has been employed by Glacial Ridge Hospital [the employer] since 1970. She works primarily for Drs. Roderick Brown and Jeffrey Schlueter. On October 23, 2009, the employee fell from a step stool at work, landing on her left knee and left side. She experienced immediate left knee pain, reported the incident, and was directed to see Dr. Brown.
The employee remained on the job, but her left knee symptoms continued. In early November 2009, Dr. Brown recommended an MRI, which showed joint effusion and an anterior collateral ligament tear. Dr. Brown subsequently referred the employee to Dr. Patrick Hurley, an orthopedist, who saw the employee on December 1, 2009. Dr. Hurley concluded that the employee had sustained an ACL tear, with pes bursitis. He administered a steroid injection and recommended physical therapy.
The employee began physical therapy in mid December of 2009. According to physical therapy records, she experienced significant improvement in her left knee symptoms over the next few weeks.
On December 29, 2009, the employee was seen again by Dr. Brown, complaining of pain in her left foot. Dr. Brown’s record of that date indicates that the employee had experienced left foot pain “for the past several days,” with no precipitating trauma or activities, and Dr. Brown observed that the employee “walk[ed] with somewhat of a limp favoring the left foot.” Dr. Brown administered a steroid injection and advised the employee to apply heat to her foot over the next week.
The employee discontinued physical therapy for her left knee condition in January of 2010. On March 1, 2010, she was seen by Dr. Schlueter for what was described as “an insidious onset and gradual increasing pain in her left foot.” The pain was located behind the medial malleolus and occurred when the employee walked, particularly during stair climbing. Dr. Schlueter diagnosed tibialis posterior syndrome and wrote as follows with respect to the employee’s treatment plan:
This is certainly past early stages and there is some associated weakness. Described this to her as a tendinopathy with microvascular and degenerative changes. This is certainly a risk of fraying and rupture of that tendon. It is interesting that her mom had what sounded like the same thing where she had chronic ankle pain and then her arch collapsed. She has not responded to over-the-counter and nonsteroidals and injection. I would recommend a period of immobilization along with some gentle stretching exercises. She should start on Celebrex 200 mg daily. Would reassess in three weeks. If she is not showing improvement at that time would consider an MRI to define if the tendon is intact.
A few weeks later, in an addendum dated March 22, 2010, Dr. Schlueter observed,
In reviewing the consideration for etiologies of her foot problem, there is no history of any specific injury to her foot. She has not done anything unusual in terms of activity. She, however, did suffer a knee injury this fall and was diagnosed with an ACL tear. This resulted in a chronic antalgic gait and I believe may have contributed to the stress and development of her foot problem. Her original injury was 10/23/2009 she fell off of a stool at work and suffered knee pain. She was seen by Dr. Brown and had a knee injection and this was followed by an MRI on 11/19/2009 confirming an ACL tear. She did have ortho consultation and then physical therapy. Her initial foot pain developed around the end of December and Dr. Brown then did an injection and she continued to have problems until I saw her in March.
In April of 2010, Dr. Schlueter wrote that the employee’s left foot condition was related to “the change in her gait and change in mechanical stresses,” given the fact that there was no history of trauma.
On May 20, 2010, the employee was evaluated by Dr. Tilok Ghose, an orthopedic surgeon, on behalf of the employer and insurer. Dr. Ghose agreed that the employee was suffering from posterior tibial tendonitis but concluded that that condition was not caused by her October 2009 fall off the step stool, explaining that the employee would have experienced immediate left foot pain had she injured her foot in the fall. In a subsequent report dated September 22, 2010, Dr. Ghose wrote that the employee’s left foot condition was also unrelated to her left knee condition, explaining that someone with a painful left knee would favor that leg and put more weight on the right. As he put it, “Clearly, this is not a patient who would be putting more pressure on the left lower extremity when the left lower extremity would be hurting. This is beyond any common sense.” According to Dr. Ghose, the employee’s posterior tibialis syndrome was related to another foot condition, that is, pes planus deformity, or flat feet.
On November 26, 2010, in response to a letter from the employee’s attorney, Dr. Schlueter wrote,
I am writing a summary report on my medical interactions with Jean Person. Jean’s original injury was a knee injury that she suffered and was confirmed as an ACL tear. Her original injury was 10/23/2009 and at that point had no associated initial foot pain. She developed foot pain in an insidious fashion and clinically this was diagnosed as a posterior tibialis syndrome. The pain and findings were consistent with that. For a considerable period of time, Jean suffered a limp to protect the pain resulting from her knee injury. Jean does suffer from chronic endogenous obesity and it is my opinion that this combination of factors caused her foot problem to develop because of the excessive stress due to the change in her gait. Therefore, I feel that this [is] a substantial contributing cause to her foot problem.
On January 13, 2011, the matter came on for hearing before a compensation judge for resolution of the employee’s claim that her left foot condition was a compensable consequence of her work-related left knee injury. The compensation judge decided the issue in the employee’s favor and awarded related medical expenses. 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).
In granting the employee’s claim for medical expenses for treatment of the employee’s left foot condition, the compensation judge expressly accepted the causation opinion of Dr. Schlueter over the contrary opinion of Dr. Ghose. On appeal, the employer and insurer contend that substantial evidence does not support the compensation judge’s decision. More specifically, the employer and insurer contend that the judge erred in relying on the opinion of Dr. Schlueter, in that Dr. Schlueter is merely a family practice doctor and not an orthopedist; Dr. Schlueter did not explain how, precisely, the employee’s gait had been altered due to her left knee condition; medical records prior to December 29, 2009, make no reference to the employee exhibiting a limp; and the employee was unable to recall or describe with specificity just how she limped. For all of these reasons, the employer and insurer contend, Dr. Schlueter’s opinion lacked foundation. We are not persuaded.
Dr. Schlueter is a medical doctor who treated the employee for the condition at issue in these proceedings. His opinion was based in part on the assumption that the employee limped in response to her left knee pain, an assumption supported by the employee’s testimony. As Dr. Schlueter saw it, the employee’s left knee condition caused the employee to alter her gait, which altered the mechanical stresses on the employee’s left foot. We find no basis to conclude that Dr. Schlueter was required to give a more detailed explanation for his opinion, and the fact that he is a family practitioner rather than an orthopedist was a factor for the compensation judge to weigh. Similarly, the fact that Dr. Ghose, an orthopedist, vehemently disagreed with Dr. Schlueter is not determinative.
Contrary to the assertion of the employer and insurer, this is a relatively straightforward case involving a compensation judge’s choice of one expert opinion over another. The opinion chosen by the judge had adequate foundation and was not based on any assumptions clearly unsupported by the record. Under these circumstances, we find no basis to reverse the judge’s decision on causation of the employee’s left foot condition. See Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985); Drews v. Kohl’s, 53 W.C.D. 33 (W.C.C.A. 1996).