JEFFREY T. DIBBLE, Employee/Appellant, v. NORTHERN STATES POWER d/b/a XCEL ENERGY, SELF-INSURED/CCMSI, Employer-Insurer, and HEALTHEAST ST. JOHN’S HOSP., Intervenor.
WORKERS’ COMPENSATION COURT OF APPEALS
APRIL 13, 2012
CAUSATION - SUBSTANTIAL EVIDENCE. Substantial evidence, including expert medical opinion, supports the compensation judge’s finding that the employee’s 1992 personal injury was not a substantial contributing cause of his urethral meatal stenosis.
Determined by: Johnson, J., Wilson, J., and Stofferahn, J.
Compensation Judge: Bradley J. Behr
Attorneys: Lorrie L. Bescheinen, Borkon, Ramstead, Mariani, Fishman & Carp, Minneapolis, MN, for the Appellant. Mary Dienhart, Northern States Power d/b/a Xcel Energy, Minneapolis, MN, for the Respondent.
THOMAS L. JOHNSON, Judge
The employee appeals the compensation judge’s finding that the employee’s personal injury on October 21, 1992, was not a substantial contributing cause of his urethral meatal stenosis. We affirm.
Jeffrey T. Dibble, the employee, sustained a personal injury to his penis on October 21, 1992, arising out of his employment with Northern States Power, the employer. The self-insured employer admitted liability for the employee’s personal injury.
The employee did not miss time from work and received no medical care following his personal injury. In September 1996, the employee saw Dr. James Beall at Allina Clinic. The doctor’s records reflect the employee complained of soreness and burning with urination over the past 12 years with excessive urination at night. The doctor prescribed an antibiotic. The employee returned to see Dr. Beall in November 1996 and stated the antibiotics helped minimally but he continued to have urinary urgency and difficulty emptying his bladder. Dr. Beall referred the employee to a urologist from whom the employee received treatment, including surgery to dilate his urethra, in November 1996. The parties were unable to locate the treatment records for this period of time.
In May 2004, the employee saw Dr. J.R. Beahrs, a urologist, complaining of problems with urination. The doctor advised the employee he needed a meatal dilation. In August 2004, Dr. Todd Brandt performed a meatotomy, cystoscopy and a urethral dilation. The doctor noted the employee had a significant problem with balanitis xerotica obliterans [BXO] and urethral strictures. In January 2007, Dr. Brandt performed a second cystoscopy and urethral dilation for a meatal stricture.
By report dated February 10, 2010, Dr. Brandt stated, “It is my understanding that Jeffrey Dibble had a direct trauma to the penis in 1992, which began a process of scaring along the meatus and the urethra that resulted in this patient’s current status with the medical care that he receives in my office and continues to need that care on an ongoing basis. As the information has been related to me, this was the traumatic event that began the process and certainly his current medical findings would be explained by this and I believe have played a substantial contributing factor in his current need for medical care.” (Pet. Ex. D.)
Dr. James J. Meyer, a urologist, examined the employee in May 2011 at the request of the employer. The doctor concluded he had a meatal stenosis typical of BXO. Dr. Meyer stated BXO was a well-established and well known condition in urology and is a chronic skin condition not associated with trauma. Dr. Meyer opined the employee’s personal injury was unrelated to his current condition. The doctor stated he had “some difficulty in believing that Mr. Dibble, who has morbid obesity, would have been able to hit himself in the penis from an autonomic standpoint based on his obesity.” The doctor further stated that had the employee sustained a significant injury on October 1992 causing significant scarring and deformity, he could have not have waited four years before seeking medical attention. Accordingly, Dr. Meyer concluded the employee’s work injury had nothing to do with his current diagnosis of BXO.
The employee filed a claim petition seeking wage loss benefits, permanent partial disability benefits, and payment of medical expenses. In a Findings and Order served and filed November 23, 2011, the compensation judge found the employee failed to prove by a preponderance of the evidence that his October 21, 1992, personal injury substantially contributed to his development of urethral meatal stenosis. The employee appeals.
The employee contends the compensation judge’s finding that the employee failed to prove that his personal injury substantially contributed to the development of urethral meatal stenosis is unsupported by substantial evidence. The employee acknowledges the September 1996 chart note of Dr. Beall reflects a history of urinary problems over the past twelve years. He, however, denies giving that history and states that he told the doctor he had problems with sleep apnea for twelve years. The employee testified that prior to his 1992 personal injury he had no difficulty with urination. The compensation judge noted in his memorandum that the employee was generally a credible witness and acknowledged that Dr. Beall may not have accurately recorded the employee’s complaints in 1996.
The employee also acknowledges Dr. Meyer’s opinion that his meatal stenosis was secondary to BXO which the doctor opined was unrelated to the employee’s work injury. The employee argues, however, the opinions of Dr. Meyer are without foundation because those opinions were clearly based on the doctor’s belief that the employee could not have sustained an injury to his penis due to his morbid obesity. Further, the appellant contends Dr. Meyer’s causation opinion is based on the erroneous history that the employee had urinary problems prior to his personal injury. For these reasons, the employee contends the compensation judge’s decision is erroneous and must be reversed. We are not persuaded.
At the hearing, both parties offered medical articles about BXO (Pet. Exs. F, G; Resp. Ex. 5). The articles report that BXO is a chronic, progressive, inflammatory dermatosis of unclear etiology and state that the condition can be an independent cause of urethral meatal stenosis. As the compensation judge noted, the exhibits support Dr. Meyer’s causation opinion that BXO was the cause of the employee’s condition not his personal injury. The competency of a medical expert to provide an expert opinion depends upon both the extent of the scientific knowledge of the expert and the expert’s practical experience with the matter that is the subject of the expert opinion. Drews v. Kohl’s, 55 W.C.D. 33 (W.C.C.A. 1996) (citing Reinhardt v. Colton, 337 N.W.2d 88, 93 (Minn.1983). Dr. Meyer obtained a history from the employee, reviewed his medical records, and performed a physical examination. This level of knowledge is sufficient to afford foundation for the opinions of a medical expert. See, e.g., Caizzo v. McDonald’s, 65 W.C.D. 378 (W.C.C.A. 2005). Dr. Meyer did question whether the employee could have sustained the injury as reported due to his morbid obesity. That concern does not, however, affect the foundation for Dr. Meyer’s opinions since he found the employee’s condition unrelated to the personal injury.
Ultimately, the resolution of this case depends on a choice between conflicting medical opinions. Dr. Brandt opined the employee’s personal injury was the cause of the employee’s urethral meatal stenosis while Dr. Meyer opined it was not. It is the responsibility of the compensation judge 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). As the compensation judge noted, both medical opinions are plausible but the judge ultimately adopted the opinion of Dr. Meyer. On appeal, this court must determine whether the findings of fact 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). 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 the 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). We conclude the findings and order of the compensation judge are supported by substantial evidence and they are affirmed.
 BXO is also called lichen sclerosus which is a “chronic atrophic skin disease characterized by flat white indurated papules with erythematous halos and black follicular kerototic plugs . . . . In males it affects the prepuce and glans penis and may result in stricture of the urethal meatus.” Dorland’s Illustrated Medical Dictionary 988-89 ( 29th Ed. 2000).