LAPRINCA WILLIAMSON, Employee/Appellant, v. COMCAST CORP., SELF-INSURED/HELMSMAN MGMT. SERVS., Employer-Insurer, and ABBOTT N.W. HOSP. and TWIN CITIES ORTHOPEDICS, P.A., Intervenors.
WORKERS’ COMPENSATION COURT OF APPEALS
AUGUST 31, 2011
CAUSATION - SUBSTANTIAL EVIDENCE. Substantial evidence, including expert medical opinion, supported the compensation judge’s decision that the employee’s work activities did not substantially contribute to the employee’s wrist and arm condition and, the employee’s arguments notwithstanding, the case was simply one involving the compensation judge’s choice between conflicting expert opinions.
Determined by: Johnson, J., Stofferahn, J., and Milun, C.J.
Compensation Judge: Harold W. Schultz, II
Attorneys: Roger D. Poehls, Jr. and Aaron W. Ferguson, Robert Wilson & Assocs., Minneapolis, MN, for the Appellant. Susan K. H. Conley and Noelle L. Schubert, Arthur, Chapman, Kettering, Smetak & Pikala, Minneapolis, MN, for the Respondent.
THOMAS L. JOHNSON, Judge
The employee appeals the compensation judge’s determination that the employee did not sustain a personal injury arising out of her employment. We affirm.
LaPrinca Williamson, the employee, began working for Comcast Corporation, the employer, in October of 2000 as a customer service representative. In 2010, the employee was promoted to a position as a Senior Specialist, but her primary job duties remained unchanged. The employee worked in a cubicle, entering information on a computer keyboard while taking customer service telephone calls. The computer was positioned in front of the employee, and the telephone was to her right. The employee wore a headset so she did not have to turn her body to use the keyboard.
At the start of each day, the employee would first log into her computer and then take calls from customers. She responded to customer complaints, billing questions, sales questions, and some technical questions. Between 8:00 a.m. and noon, the employee typically experienced a heavy volume of calls. In responding to these calls, the employee navigated in six to seven different computer screens and typed notes and emails regarding customer complaints or service order information. On a busy day, she handled up to ninety calls, on a slow day, forty to fifty calls. The employee spent approximately 80% of her work day typing notes into the computer or using the computer mouse.
On January 24, 2009, the employee claimed that she had sustained a work injury, stating that she had experienced sharp pains in her right elbow while typing at her computer. After reporting these symptoms, the employee was taken off the telephone.
The employee sought treatment at Twin Cities Orthopedics on January 26, 2009, complaining of right foot and bilateral knee pain. She made no mention of a work injury or any symptoms in her right elbow at that time. The employee returned on February 2, 2009, for an injection into her right knee and again made no complaints of right elbow pain or problems.
On February 27, 2009, the employee underwent an EMG at the Noran Neurological Clinic for investigation of symptoms of tingling, numbness, and pain in both hands. The EMG showed moderate bilateral median neuropathy across the wrists and a mild left ulnar neuropathy at the elbow. In April 2009, the employee saw Dr. Chad Evans at that same clinic. His diagnosis was bilateral carpal tunnel syndrome, and he recommended surgery. Dr. Elmer Salovich performed a right carpal tunnel release on May 14, 2009, a right cubital tunnel release on June 19, 2009, and a left carpal tunnel release on July 23, 2009. The employee was off work from May 7, 2009, until September 6, 2009, when she returned to a job with the employer on a part-time basis, with restrictions. In January 2010, Dr. Salovich advised the employee to avoid repetitive and strenuous use of her right and left arms.
Dr. William Call examined the employee on July 15, 2009, at the request of the employer. Dr. Call took a history from the employee, reviewed her medical records, and conducted a physical examination. His diagnosis was mild bilateral carpal tunnel syndrome with evidence of mild left ulnar neuropathy at the elbow. He opined that the employee’s carpal tunnel syndrome was not related to her data entry work because the hand position demonstrated to him by the employee would not cause or irritate a carpal tunnel syndrome. The doctor also stated that the January 24, 2009, incident was a mere manifestation or appearance of symptoms of a developmental carpal tunnel syndrome. Dr. Call further opined that the employee’s left ulnar neuropathy was similarly developmental and not work-related.
Dr. Salovich re-examined the employee in August 2009 and stated:
Ms. Williamson gives a history of having to place pressure on her right elbow at work due to the type of work she does. She also states that she has significant use of both her right and left hands and wrists in her employment. It is my opinion based on the history she gives, that the right cubital tunnel syndrome was precipitated by her work activities. It is possible that her obesity may contribute to the bilateral carpal tunnel syndrome and that her work activities precipitate or substantially aggravate the bilateral carpal tunnel syndrome.
By report dated December 1, 2009, Dr. Evans stated the employee had suffered permanent injury to her bilateral median nerves, with ongoing paresthesia and sensory change in the distribution of the median nerve distal to the transcarpal ligament, with paresthesias in the fourth and fifth fingers of the right hand. Dr. Evans went on to state:
It is my opinion the work activities as data entry and customer service caused the carpal tunnel syndrome bilaterally as well as the ulnar nerve impingement at the elbow bilaterally. Her job was also a substantial contributing factor to the worsening of the nerve injuries leading up to the need for surgical and ongoing medical treatment. Based upon my review of the chart, the medical and surgical treatment was reasonable and necessary to the work-related injuries dated above.
Dr. Jeffrey Husband examined the employee in June 2010, at the request of the employer, and his deposition was obtained in January 2011. Dr. Husband diagnosed bilateral carpal tunnel syndrome and bilateral cubital tunnel syndrome but testified that the employee’s subjective symptoms were markedly out of proportion to her objective findings. He also opined the employee’s work activities with the employer were not a substantial contributing cause of the employee’s bilateral carpal tunnel syndrome or cubital tunnel syndrome and that the employee’s work activities did not cause any aggravation of these conditions. Rather, the doctor opined, these conditions were ideopathic in origin, with other substantial contributing factors including obesity, gender, and age. Dr. Husband stated the two conditions would likely have progressed regardless of the employee’s work activities. Finally, Dr. Husband testified that keyboard use has not been shown to be a significant contributing factor to the development of carpal tunnel syndrome or cubital tunnel syndrome. According to Dr. Husband, keyboarding may irritate the nerves within the carpal and cubital tunnels, but keyboarding does not cause nerve compression or worsen any existing compression.
The employee filed a claim petition seeking payment of workers’ compensation benefits by reason of a personal injury sustained on January 24, 2009. Following a hearing, the compensation judge found the employee’s work activities for Comcast Corporation were not a substantial contributing cause of the employee’s carpal tunnel syndrome or cubital tunnel syndrome. Accordingly, the judge denied the employee’s claim for benefits. The employee appeals.
In his memorandum, the compensation judge stated,
This compensation judge does not accept the opinions of Drs. Call and Husband that keyboarding or the use of a mouse can never be a substantial contributing factor to carpal tunnel syndrome. In this fact specific case, the compensation judge accepts the opinions of Dr. Husband in respect to the risk factors that the employee has in the development of carpal tunnel syndrome. They are thoroughly discussed in his deposition. Her age, weight and gender are all probably contributory to the condition. On the other hand, the work activities are not high impact. Also, these were done at normal speed. Overall, the opinions of Drs. Salovich and Evans are not convincing. They are not explained. It is unclear as to the factual basis for their opinions in respect to causation.
On appeal, the employee contends the language of the judge’s memorandum suggests that the judge refused to even consider the opinions of Drs. Salovich and Evans because they were not explained and the factual basis for the opinions was unclear. There is no dispute, the employee asserts, that the opinions of Dr. Salovich and Dr. Evans were adequately founded. Therefore, since the compensation judge arguably failed to consider those opinions, the employee contends that the case should be remanded to the judge for reconsideration.
We agree that the opinions of Drs. Salovich and Evans were properly founded. See, e.g., Drews v. Kohl’s, 55 W.C.D. 33 (W.C.C.A. 1996). Had the compensation judge rejected the opinions of Drs. Salovich and Evans on foundational grounds, remand for reconsideration would be required. However, we are not persuaded that the compensation judge’s decision was based on any concerns as to foundation. The judge rejected the opinions of Drs. Call and Husband that keyboarding activities do not cause carpal tunnel or cubital tunnel syndrome, but the judge accepted Dr. Husband’s opinion that the employee’s age, weight, and gender were contributory to these conditions. The judge further noted the employee’s keyboarding activities were not high impact and were performed at normal speed. This conclusion is consistent with the evidence in the case.
The compensation judge appears to have rejected the opinions of Drs. Salovich and Evans because neither doctor explained why normal typing activities performed at normal speed would cause the employee’s carpal tunnel and cubital tunnel syndromes. In other words, the judge simply found the opinions of Drs. Salovich and Evans to be unpersuasive. As such, the employee’s arguments notwithstanding, this case essentially involves a compensation judge’s choice between conflicting medical opinions. Dr. Husband testified the employee’s age, weight, and gender were the substantial contributing causes of her conditions rather than her work activities. The compensation judge was entitled to accept that opinion and deny the employee’s claims on that basis. The judge’s decision is supported by substantial evidence and is, therefore, affirmed.