EVERETT BRYANT, Employee, v. WAL-MART STORES, INC., and AMERICAN HOME ASSURANCE CORP./AIG/CLAIMS MGMT., INC., Employer-Insurer/Appellants, and INSTITUTE FOR LOW BACK AND NECK CARE, ST. CLOUD HOSP. and PRIMEWEST HEALTH, Intervenors.
WORKERS’ COMPENSATION COURT OF APPEALS
JULY 3, 2012
CAUSATION - SUBSTANTIAL EVIDENCE. Substantial evidence, including expert opinion, supported the compensation judge’s decision that the employee had injured his cervical spine in an accident at work, notwithstanding the fact the early treatment records reference only left upper extremity complaints, not head or neck symptoms.
Determined by: Wilson, J., Johnson, J., and Milun, J.
Compensation Judge: John Ellefson
Attorneys: Martin T. Montilino, The Law Office of Martin T. Montilino, Minneapolis, MN, for the Respondent. Christopher E. Sandquist, Gislason & Hunter, Mankato, MN, for the Appellants.
DEBRA A. WILSON, Judge
The employer and insurer appeal from the compensation judge’s decision that the employee injured his cervical spine in an accident at work. We affirm.
The employee began working for Wal-Mart [the employer] as an automobile service technician in May of 2007. On the morning of September 7, 2009, he sustained injuries at work when a tire exploded, throwing him about ten feet across the room. The employee testified that he must have struck his head because he had two “goose eggs,” but he could not recall whether he lost consciousness. He subsequently sought treatment in the emergency department of Hutchinson Health Center.
According to records from the emergency department evaluation, the employee “complain[ed] of left hand and wrist discomfort and no other injury.” X-rays showed fractures of two metacarpal bones and a hairline fracture of the distal radius on the left. A short cast was applied, and the employee was advised to follow up for further treatment.
The employee saw Paul Coleman, a physician assistant with Orthopedic & Fracture Clinic, the next day. Mr. Coleman later referred the employee for surgery because the fractures were not healing satisfactorily. The employee testified that he told Mr. Coleman, on his first day of treatment, that he was experiencing headaches, and that he told all subsequent medical providers about having headaches and neck pain following the September 7, 2009, incident. Treatment records, however, contain no references to such symptoms for several months.
In November of 2009, the employee told Mr. Coleman that his left hand and little finger were numb. The following month, at the end of December, the employee began chiropractic treatment for back and neck pain and headaches that had purportedly begun in November. In January 2010, numbness was again noted in Mr. Coleman’s records, and the employee also reported experiencing headaches and weakness in his grip. Then, in February, the employee reported that he had left arm pain from his neck into his hand. Mr. Coleman referred him for an MRI, and that scan, performed in March, disclosed a large herniation at C6-7, resulting in severe left foraminal narrowing and canal narrowing with cord compression, and moderate to severe right C5-6 foraminal narrowing and central foraminal narrowing with mild contact and compression of the cord.
On April 6, 2010, the employee underwent decompression and fusion surgery at C5-6 and C6-7, performed by Dr. David Strothman.
In June of 2010, Dr. Thomas Nelson reviewed the employee’s medical records and issued a report addressing the question of causation of the employee’s neck condition and need for treatment. In that report, Dr. Nelson indicated that the employee’s neck condition was not related to the September 7, 2009, tire explosion, explaining as follows:
Based on my review of the records, it is my opinion that Mr. Bryant’s cervical symptoms are not related to the accident of September 7, 2009. The reason for this is the amount of time that has elapsed between the initial injury of September 7 and his initial presentation of symptoms in February of 2010, more than five months later. Mr. Bryant was seen by numerous medical providers including a doctor in the emergency room, Mr. Coleman, the P.A., Dr. Fisher, and the primary care physician (Dr. Lea Schrupp) who completed his pre-surgical history and physical. He did not have any complaints of neck pain or even hand numbness until the cast came off and he began using the hand more and the pins were removed in November of 2009. He had no complaints of neck or arm pain until February of 2010. In addition, the EMG that was completed in March of 2010 did confirm median nerve compression at the wrist.
In contrast, Dr. Strothman, the treating surgeon, connected the employee’s neck condition and need for treatment to the September 2009 incident at work.
The matter came on for hearing before a compensation judge on December 6, 2011, for resolution of the employee’s claim for medical and chiropractic treatment expenses related to his neck condition. The employer and insurer admitted that the employee had injured his left hand and wrist in the September 7, 2009, work accident but denied that the employee had injured his cervical spine at that time. Evidence included the employee’s testimony, his medical records, and the report of Dr. Nelson, the employer and insurer’s independent examiner.
In a decision issued on January 11, 2012, the compensation judge resolved the causation issue in the employee’s favor and ordered the employer and insurer to pay for the claimed cervical spine treatment. 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 a narrative report dated August 31, 2011, Dr. Strothman wrote, in part, as follows about the employee’s history and the cause of his neck condition:
Our care for Mr. Bryant can be summarized as follows: Mr. Bryant was initially seen March 23, 2010. He presented reporting a significant work injury as outlined above with questionable loss of consciousness and severe left hand and left arm pain following this. He underwent excellent care by Mr. Coleman and Dr. Fisher with regards to his left metacarpal fracture. During Mr. Bryant’s time with these health care providers, there was no mention of any cervical injury. However, Mr. Bryant very clearly described to us at his initial visit in March that he initially had both neck and left arm pain. He also described that over the last month (so, beginning in February of 2010) he was having increasing and progressive neck pain as well as left arm pain that seemed to replicate mostly a left C7 nerve root distribution. This was increasingly causing him to drop things and cause the weakness in his upper extremities. He also described a wobbly type feeling when walking down hallways, almost as if he were drunk when he was not, a clearer sign of gait instability.
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Certainly, this type of trauma could result in a cervical spine injury including fracture and/or disc herniation and nerve impingement. From the review of medical records, it is unclear exactly when Mr. Bryant’s cervical problem originated. However, he has been very specific with me and with others that his headaches and arm pain began immediately following this accident, but the injury to his wrist overshadowed this and those symptoms were ignored. I have no data to support this other than Mr. Bryant’s words. As his treating physician, my number one rule is to believe my patients’ history as it is taken. Consequently, I believe that Mr. Bryant’s cervical problems began with the tire explosion accident. He has not reported to me at any time that he had any of these symptoms prior to this.
The compensation judge expressly accepted the opinion of Dr. Strothman over the contrary opinion of Dr. Nelson, the employer and insurer’s medical expert. On appeal, the employer and insurer argue that the compensation judge erred in this regard, in that Dr. Strothman’s opinion was premised on his acceptance of the employee’s account of the onset of his symptoms. And, according to the employer and insurer, the employee’s version of events is so “full of contradictions, inconsistencies, and ‘explanations’ [that] no rational trier of fact could find [it] credible or persuasive.”
We acknowledge that none of the employee’s medical providers, beginning in the emergency department on the date of injury, made any reference to complaints of headache or neck pain until at least late December of 2009. We are also aware that, once those complaints began appearing in the employee’s medical records, the duration of the symptoms was generally noted to be several weeks, rather than the several months that had passed since the work incident. The employee, however, offered some explanation for these discrepancies. He testified, for example, that he had sometimes misunderstood the nature of the forms he completed and was confused about what he was being asked. In any event, contrary to the argument of the employer and insurer, the lack of head or neck symptoms noted in the employee’s early treatment records does not constitute a “physical fact,” or “truth,” that the compensation judge was obligated to base his decision on.
The employee was 36 years old on the date of the injury. The tire explosion threw him ten feet, and he landed with enough force to break several bones in his hand. There is no evidence that he had any history of neck symptoms or treatment prior to the incident in September 2009. He testified that he began experiencing headaches immediately after the accident and that he did not understand why the treating providers failed to document his complaints. The employer and insurer’s arguments notwithstanding, the compensation judge was entitled to accept the employee’s testimony to this effect. See, e.g., Even v. Kraft, Inc., 443 N.W. 2d 831, 42 W.C.D. 220 (Minn. 1989). In addition to this evidence, Dr. Strothman reported that the tire explosion had caused the employee’s neck condition and need for treatment and, again, the compensation judge was entitled to accept this opinion as well. See Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985). Based on the record as a whole, we find no grounds adequate to overturn the judge’s decision on causation. His award of cervical treatment expenses is therefore affirmed.
 The surgery was performed on September 22, 2009.