LAURA M. POWERS, Employee/Appellant, v. ALLINA HEALTH SYS. d/b/a UNITED HOSP., SELF-INSURED, Employer-Insurer, and INJURED WORKERS’ PHARMACY, Intervenor.
WORKERS’ COMPENSATION COURT OF APPEALS
MARCH 5, 2012
CAUSATION - PSYCHOLOGICAL CONDITION. Substantial evidence, including expert opinion, supported the compensation judge’s decision that the employee’s psychological condition and need for treatment were not causally related to her work injury.
Determined by: Wilson, J., Stofferahn, J., and Milun, C.J.
Compensation Judge: Paul D. Vallant
Attorneys: Charles M. Cochrane, Cochrane Law Office, Roseville, MN, for the Appellant. Douglas J. Brown and Elizabeth Chambers-Brown, Brown & Carlson, Minneapolis, MN, for the Respondent.
DEBRA A. WILSON, Judge
The employee appeals from the judge’s finding that the employee did not develop a psychological disorder as a consequence of her 2004 work injury. We affirm.
The employee sustained a work-related injury to her neck on October 11, 2004, while employed by United Hospital [the employer] as a licensed practical nurse. The self-insured employer admitted liability for the injury and paid various workers’ compensation benefits, including medical expenses for two surgeries: a left C5-6 hemilaminectomy, microdiscectomy, and foraminotomy performed on May 18, 2005, and an anterior cervical discectomy and fusion at C5-6 performed on January 22, 2008. The employee was also paid more than 104 weeks of temporary total disability benefits and permanent partial disability benefits for an 11% whole body disability.
After the 2008 fusion surgery, the employee initially reported that her neck and left arm pain were improved, but she continued to complain of numbness in her left hand. She was subsequently treated with physical therapy, cervical injections, and medications for pain in her neck, left arm, and hand. A cervical spine MRI scan performed in April of 2008 showed no evidence of nerve root compression. An MRI scan performed in March of 2009 was read as showing multi-level degenerative disc disease, most pronounced at C6-7.
The employee has an extensive history of treatment for certain psychological/psychiatric conditions and was hospitalized for these conditions in August and November of 1985. She has taken anti-depressant medications since at least 1995, with varying results.
In March of 2000, the employee underwent a psychological evaluation by John Hung, PhD., as part of a fitness-for-duty evaluation. According to Dr. Hung, testing documented that the employee had Attention Deficit/Hyperactivity Disorder (ADHD) and impaired executive and memory functioning, which made her unable to perform the essential job functions of a clinical nurse.
From May through December of 2004, the employee underwent psychotherapy with therapist Jack Kasl to discuss her feelings of stress and being overwhelmed by personal and parent-child issues. The employee was seeing Dr. Kasl and taking anti-depressants at the time of her work injury.
Medical records from Dr. Steven Voss, the employee’s primary care doctor, reflect that when the employee was seen by him on February 21, 2006, it was not a “work comp related visit.” Dr. Voss went on to describe the employee’s “stressors” and diagnosed the employee as having adjustment disorder with mixed anxious and depressed mood.
The employee received psychotherapy from Nystrom and Associates from March 22, 2006, through February 27, 2007. Records document that the employee was experiencing various psychosocial problems. During therapy in May of 2006, the employee noted that she felt that “workers’ comp” was out to get her. The majority of her sessions revolved around family relationship issues.
In December of 2006, the employee was evaluated by psychologist Robert Clift at the request of the employer. As part of his evaluation, he had the employee complete a Minnesota Multiphasic Personality Inventory (MMPI-2). He concluded that the employee suffered from “somatoform pain disorder (chronic pain syndrome) with hypochondrical features;” major depressive disorder, partially in remission; chronic generalized anxiety disorder with obsessive-compulsive features; situational depression, anxiety, and anger; and a borderline personality. He recommended that the employee participate in long-term individual psychotherapy to work on self-defeating behaviors, “principally necessitated by her chronic, pre-existing mental condition.” While he agreed that the employee might require physical restrictions due to her work injury, he recommended that those restrictions be based on objective medical findings as “her self-described limitations are apt to be grossly contaminated by the complex psychological factors” noted in his report.
In June of 2007, the employee began mental health treatment with Dr. John Curran. His first office note indicates that the employee was referred to him by Dr. Voss for pain management. Dr. Curran recorded the employee’s physical symptoms but also that the employee spoke of deaths in her family, family issues, and her perception that “nothing has gone right since ’02.” Dr. Curran saw the employee thirty-four times through August 16, 2010. He issued a report on October 22, 2008, in which he diagnosed the employee as having a pain disorder associated with psychological factors and a general medical condition “obviously work-related.” He stated, in part, that, “prior to the work-related injury of October 11, 2004, Ms. Powers demonstrated an outstanding work history, and was regularly employed, while enjoying excellent physical and mental health, all of which evaporated due to the work-related injury.”
The employee filed a claim petition on November 26, 2008, contending that she had developed a psychological disorder as a result of the 2004 injury to her neck, and she sought payment of medical expenses for her treatment by Dr. Curran and medication expenses incurred with Injured Workers’ Pharmacy [IWP], which subsequently intervened in this matter.
Dr. Thomas Gratzer performed an independent psychiatric evaluation of the employee in December of 2009, at the employer’s request. He had the employee undergo an MMPI-2 administered by his staff and asked psychologist Marvin Logel, Ph.D., to interpret the results. Dr. Gratzer diagnosed the employee as having a depressive disorder, anxiety disorder, undifferentiated somatoform disorder, and a personality disorder n.o.s. with histrionic and borderline features. He opined that the personality disorder had formed in late adolescence or early adulthood and reflected enduring maladaptive patterns of perceiving and relating to the environment. In his report of December 24, 2009, Dr. Gratzer opined that the employee “did not develop psychiatric sequelae attributable to the physical stresses of the October 11, 2004, injury.”
The employee was also examined by a physical medicine and rehabilitation doctor, Dr. Paul Biewen, on behalf of the employer, in December of 2009. Dr. Biewen performed a physical examination and reviewed the employee’s medical records. In his report of January 15, 2010, Dr. Biewen diagnosed the employee as having chronic neck pain with a subjective report of left upper extremity weakness and paresthesias, status post two surgeries, chronic pain syndrome, and somatoform pain disorder. It was Dr. Biewen’s opinion that the employee had reached maximum medical improvement [MMI] from her work injury as of July 31, 2008. He further concluded that the employee’s current cervical spine symptoms were primarily a result of her mental health condition.
The deposition of Dr. Gratzer was taken on September 24, 2010, by which time he had reviewed the report of Dr. Biewen. According to Dr. Gratzer, the employee had reported to him that she had been able to manage the stress of her pain and that she had become depressed in 2006 because she felt rejected by her employer and workers’ compensation. Dr. Gratzer relied on the multiple psychosocial stressors that were present between 2004 and 2006, unrelated to the employee’s work injury, the MMPI, the employee’s medical records, and his interview of the employee to support his 2009 diagnoses and his opinion that the employee’s mental health conditions were not caused, aggravated, or accelerated by physical stresses related to the work injury.
When the employee’s claim petition proceeded to hearing, the employee testified that “the biggest thing that has me down” was that she was not a contributing member of society. Dr. Curran testified that the focus of his treatment was to help the employee live with her pain, and he also explained that the employee’s current psychological stress and discomfort were related to the employee’s inability to provide for herself financially, her inability to distract herself with productive work, and her despair at being forced to abandon her profession. He agreed that the employee had a depressive disorder and an anxiety disorder but testified that both were in remission as of August 16, 2010. He also testified that he did no psychological testing and did not review the employee’s MMPI-2 results because he does not recognize that test as a diagnostic tool.
In findings and order filed on June 3, 2011, the compensation judge found that the employee’s psychological disorder was not a consequence of the work injury and that the employer was not liable for payment of the outstanding bills of Dr. Curran or the intervenor, Injured Workers’ Pharmacy. The employee appeals.
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).
The employee argues in her brief on appeal that Dr. Gratzer’s opinions are lacking in foundation. At oral argument, however, it became clear that what the employee is actually arguing is that Dr. Gratzer’s opinions should have been given little or no weight by the compensation judge. We are not persuaded.
The employee contends that Dr. Gratzer’s opinions should be rejected because Dr. Gratzer was a “professional expert witness” who saw the employee only once. However, when this same argument was made in Nielson v. Wheel Service Brake & Equip., No. WC11-5293 (W.C.C.A. Jan. 20, 2012), we held, “[n]othing in the statutes or case law prohibits a doctor from rendering an opinion simply because he is an expert witness. . . . The fact that a physician is rendering an opinion solicited by one of the parties to a claim is for the compensation judge to weigh.” We find no basis to rule otherwise here. While a finder of fact may choose to afford greater weight to the opinion of a treating doctor, he or she is not required to do so. Caven v. Ag-Chem Equip. Co. Inc., slip op. (W.C.C.A. Sept. 14, 1993).
The employee also argues that Dr. Gratzer’s opinions should not be given much weight because the doctor did not conduct a physical examination of the employee and “did not administer any psychological tests himself.” Dr. Gratzer, however, was seeing the employee for the purposes of a psychiatric evaluation, and even Dr. Curran did not perform a physical examination of the employee, testifying that such an exam is generally not part of a psychiatric evaluation. Dr. Gratzer did review the employee’s medical records. And, while Dr. Gratzer did not administer any psychological testing himself, he did have his staff administer the MMPI, and he then had the test interpreted by a psychologist, Dr. Logel, who had additional training in MMPIs.
The employee’s final argument regarding Dr. Gratzer appears to be that the doctor’s opinions are lacking in credibility. Credibility determinations, however, are within the providence of the compensation judge. Even v. Kraft, Inc., 445 N.W.2d 831, 42 W.C.D. 220 (Minn. 1989).
This case rests on a compensation judge’s choice between expert opinions. Dr. Gratzer had adequate foundation for his opinions, and the employee has not pointed to any facts assumed by Dr. Gratzer that were not supported by the evidence. See Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985). The judge’s choice of expert opinions is therefore affirmed, and, on that basis, we affirm the judge’s denial of the employee’s claim.
 At the time of hearing, the employee testified that she experienced constant pain in the left side of her neck, left shoulder, left upper back, and left arm, as well as constant weakness and numbness in her left hand.
 In addition, Dr. Scott Callaghan of Neurological Associates of St. Paul completed an electrodiagnostic study of the left upper extremity in April of 2008, which was normal.
 The employer paid some of Dr. Curran’s charges in 2007 but has not paid anything since December 3, 2007.
 Dr. Gratzer defined this as one or more physical complaints that cannot be fully explained on the basis of a general medical condition.
 Dr. Biewen noted that “this diagnosis results from Ms. Powers’ presentation with symptom magnification, as well as her reported degree of functional limitation with minimal objective findings.”
 We would also note that Dr. Curran did not review all of the employee’s medical records but rather relied on Dr. Gratzer’s summary of his review of those records.
 In contrast, Dr. Curran did not have any psychological testing performed, testifying that he does not recognize the validity of the MMPI test as a diagnostic tool.
 In her brief, the employee cited to specific deposition testimony by Dr. Gratzer, but we find no such testimony in the transcript of that deposition.
 We note that Dr. Curran assumed that the employee had enjoyed good mental health prior to her work injury, when in fact she was taking anti-depressants and receiving psychotherapy at that time.