SHARON A. DARNICK, Employee, v. SWETT & CRAWFORD and AON GROUP, CAMBRIDGE INTEGRATED SERVS., Employer-Insurer/Appellants.

 

WORKERS= COMPENSATION COURT OF APPEALS

OCTOBER 29, 2002

 

HEADNOTES

 

CAUSATION - SUBSTANTIAL EVIDENCE; EVIDENCE - EXPERT MEDICAL OPINION.  Substantial evidence, including the adequately founded opinion of the employee=s treating physician and the testimony of the employee, supports the compensation judge=s deter­mination that the em­ployee=s admitted July 18, 2000 personal injury was a substantial contributing cause of the need for medical treatment for scaphotrapeziotrapezoid (STT) joint arthritis in the employee=s right hand

 

Affirmed.

 

Determined by Johnson, C.J., Wilson, J., and Stofferahn, J.

Compensation Judge: Carol A. Eckersen                

 

OPINION

 

THOMAS L. JOHNSON, Judge

 

The employer and insurer appeal the compensation judge=s finding that the employee=s July 18, 2000 personal injury was a substantial contributing factor to the scaphotrapeziotrapezoid (STT) joint arthritis in the employee=s right hand.  We affirm.

 

BACKGROUND

 

Sharon A. Darnick, the employee, began working in the mail room at Swett & Crawford, an insurance brokerage company, in January 1994.  Her job duties included opening, sorting and de­livering mail and filing, pulling and purging files.  The employee estimated she sometimes pulled and filed five hun­dred to a thousand files in a week.

 

On March 15, 2000, the employee was lifting a box from a shelf in her daughter=s room at home, when it fell and struck her right wrist.  She was seen in Urgent Care by Dr. Ali Ahmad Hamidi at the Park Nicollet Clinic, St. Louis Park, on March 16, 2000.  The employee complained of dif­ficulty moving the wrist and wrist pain.  The doctor noted tenderness over the right wrist in the radius area, and diag­nosed a soft tissue contusion.  Dr. Hamidi prescribed  icing and Tylenol for pain.

 

The employee was next seen by her family physician, Dr. Edwin Clonts, at the Park Nicollet Clinic on May 18, 2000, reporting continuing pain in her wrist, particularly when mov­ing her thumb.  Dr. Clonts diagnosed de Quervain=s tenosynovitis of the right wrist, and prescribed a thumb and wrist splint along with use of ice and ibuprofen.  By June 8, 2000, the employee de­scribed a decrease in swelling and pain, stating she was reasonably comfortable so long as she wore the splint.  Dr. Clonts injected the short extensor tendon with cortisone, producing immediate relief of the pain.  He advised the employee to wear the splint for another day or two, and as needed there­after, cautiously increasing the use of her thumb and wrist.

 

On July 18, 2000, the employee testified she was requested to obtain a file that had been packed in a box to be sent to an off-site location.  There were two full boxes with files on top of the box she needed.  The employee lifted the first box and moved it over to the side, then lifted the second box.  As she lifted the second box, the employee stated she felt a very sharp pain in the right wrist, Awhere it bends and there=s a little hollow in there.@  (T. 38.)

 

The employee saw Dr. Clonts on August 3, 2000, stating she had developed pain in her right wrist while lifting a heavy box that was too heavy at work two weeks previously.  (Pet. Ex. C.)  Dr. Clonts diag­nosed a work-related exacerbation of de Quervain=s tenosyno­vitis, pro­vided work restrictions, and referred the employee to the Park Nicollet Hand Clinic.  The employee reported the injury to the employer after seeing Dr. Clonts.  The employer and insurer admitted liability for the July 18, 2000 right wrist injury and paid various workers= com­pensation benefits.

 

The employee began treating with Dr. Benjamin Levine, an orthopedic hand specialist at the Park Nicollet Clinic, St. Louis Park, on September 1, 2000.  The employee described persistent sharp pain in the right wrist and stated she had injured the wrist at work.  Dr. Levine initially con­curred with Dr. Clonts= diagnosis of de Quervain=s syndrome, treating the employee with a cortisone injection into the first dorsal compartment, thumb-spica splints and physical therapy.  In a follow-up appointment on February 19, 2001,^[1] Dr. Levine noted tenderness in the right wrist snuff box area and a mildly positive Finkelstein=s test.  Dr. Levine=s notes indicate an x-ray taken on that date showed STT arthritis in the right wrist.  The doctor injected the STT joint, continued physical therapy, and imposed work restrictions.

 

The employee was seen again, by Dr. Levine, on June 4, 2001, reporting no significant im­provement.  On examination, the doctor noted STT tender­ness in the distal scaphoid, distal snuff box tenderness, and pain with grasping and motion of her thumb.  Dr. Levine diagnosed work-related STT arthritis and recommended surgery, noting the employee had tried conservative therapy but continued to have pain.  A bone scan of the right wrist on July 19, 2001, showed moderate increased uptake at the junction of the greater multangular (trapezium) and navicular (scaphoid) bones in the wrist.  An x-ray taken that same day was interpreted as showing small calcifi­cations laterally at the junction of the great­er multangular and navicular bones, reflecting degener­ative change.  By letter reports dated November 12, 2001 and February 20, 2002, Dr. Levine stated that, in his opinion, the em­ployee had x-ray, bone scan and physical evidence of STT arthritis in the right wrist.  He observed that any trauma, such as a fall, sudden impact or repetitive motion, could permanently flare up an underlying arthritic condition, and opined the July 18, 2000 work injury was a contributing factor to the employee=s need for treatment, including the proposed surgery.

 

The employee was examined by Dr. William Call, a hand surgeon, at the request of the employer and insurer on May 15, 2001.  By letter reports dated May 31, 2001 and July 2, 2001, Dr. Call concluded that, based on his review of the records and his examination of the employee, in­cluding x-rays on the date of examination, the employee did not have any significant STT arthritis in the right wrist.  He further maintained that if STT arthritis was present, it was idiopathic and not the result of any trauma.  Dr. Call explained that lifting a box would not exacerbate STT arthritis as it would lead to a distraction force, not a com­pression force to the STT joint.  Dr. Call, accordingly, opined the July 18, 2000 work injury did not cause any STT arthritis nor a temporary aggravation of any underlying STT arthritis.  Dr. Call subse­quently reviewed the July 19, 2001 bone scan and, by report dated February 5, 2002, agreed  the scan was consistent with STT arthritis.  He continued to maintain, however, the employee=s examinations and tests showed only minimal, early arthritic STT changes and did not reveal any significant degeneration.  Dr. Call further stated that his opinion with respect to the July 18, 2000 incident had not changed, and he did not believe the changes shown in the bone scan were the result of anything that occurred that day.

 

The employee filed a Medical Request on November 23, 2001, seeking approval of the right wrist surgery proposed by Dr. Levine.  The employer and insurer denied primary liability, as­sert­ing the proposed surgery was neither reasonable or necessary nor causally related to any work-related condi­tion.  In a Findings and Order, issued March 27, 2002, a compensation judge found  the employee=s work activities on July 18, 2000 aggravated the em­ployee=s underlying STT joint arthritis and substantially contributed to her need for medical treat­ment.  The judge con­cluded, however, the proposed surgery was premature, but ap­proved fluoroscopically guided steroid in­jection, indica­ting the employee could renew her request for STT joint surgery if indicated by the injection results.  The em­ployer and insurer appeal.

    

DECISION

 

The employer and insurer assert the compensation judge=s finding that the employee=s July 18, 2000 work injury was a substantial contributing factor to her STT arthritis is clearly erro­neous and not supported by substantial evidence in the record as a whole.  The appellants first argue that Dr. Levine=s opinion is legally insufficient to establish causation because the doctor failed to describe or explain the mechanism of injury.   We disagree.

 

In this case, the compensation judge found the causation opinion of Dr. Levine more per­suasive than the opinion of Dr. Call.  (Findings 4, 5.)  Dr. Levine examined and treated the em­ployee for her right wrist symptoms on a number of occasions, and had sufficient medical ex­pertise and practical experience to establish competency to provide an expert medical opinion.  See Reinhardt v. Colton, 337 N.W.2d 88 (Minn. 1983).  A failure to identify or explain the specific mechanism of injury does not render a causal relationship opinion legally insufficient.  Rather, the presence or absence of such testimony goes to the weight that may be afforded the opinion by the compensation judge.  All that is required is, under the facts of the case con­sidered as a whole, it appears a competent medical witness opined the injury causally contributed to the disabling condition.  See, e.g., Goss v. Ford Motor Co., 55 W.C.D. 316 (W.C.C.A. 1996); McBride v. Anderson Power & Equip., Inc., mem. op. (W.C.C.A. Feb. 21, 2002);    Here, Dr. Levine clearly expressed his opinion that the July 18, 2000 injury aggravated the employee=s un­derlying condition, stating the work injury of July 18th was Adefinitely a contributing factor@ to the employee=s STT joint arthritis and need for treatment to the right wrist.  (Pet. Ex. D, Nov. 12, 2001 letter report.)

 

The employer and insurer further contend Dr. Levine=s opinion lacks adequate foundation, because his opinion is inconsistent with the employee=s testimony regarding the occurrence of the injury.  The appellants point in particular to Dr. Levine=s letter report of February 20, 2002, and suggest Dr. Levine believed a box hitting the em­ployee=s wrist flared up the employee=s condition.  Accordingly, they argue, the only conclusion that can be drawn from Dr. Levine=s reports is that the injury of March 15, 2000 caused the disabling condition,  rather than the incident in July 2000.  A careful reading of Dr. Levine=s report, however, clearly indicates that he was re­spond­ing to the Asecond point in [Dr. Call=s] letter@ referring to the box that hit the employee, further noting he agreed with Dr. Call that this incident probably did not cause the employee=s STT arthritis.  (Pet. Ex. D.)

 

The employer and insurer further argue that Dr. Levine=s opinion lacks foundation be­cause, although he explained that an injury or trauma to the wrist could permanently aggravate pre-existing arthritis, he referred generally to occurrences such as falls, sudden impacts or repe­titive motion, but did not indicate that lifting a box, the mechanism of injury described by the employee, could causally affect or aggravate STT arthritis.  While it might have been helpful if Dr. Levine had specifically included in his report a description of the trauma or occurrence on July 18, 2000, the lack of such a description does not necessarily render an opinion without foundation.  Dr. Levine is the em­ployee=s treating physician.  His opinion is based on his personal knowledge about and involve­ment in the employee=s care and treatment.  The employee was referred to Dr. Levine by Dr. Clonts, the employee=s family physician, who worked at the same clinic.  Dr. Clonts= August 3, 2000 chart note specifically notes that A[t]wo weeks ago, on 7/18/00, [the employee] . . . lifted a box at work that was a little too heavy and developed more pain in her right wrist. . . . She states that her work involves a lot of filing and using of her hands.@  (Pet. Ex. C.)  The employee testified she told Dr. Levine, when she first saw him in September 2000, that she was lifting a box at work in July and that was when the sharp pain started in the right wrist.  (T. 44, 76-77.)   Dr. Levine further noted the em­ployee has had per­sistent symptoms in her right wrist since the July 18, 2000 incident.  Based on this record, we cannot conclude that Dr. Levine=s opinion lacks at least minimally ade­quately foundation, or that the compensation judge erroneously relied upon his opinion.

 

Finally, the employer and insurer contend the compensation judge failed to address the sig­nificance and role of the March 15, 2000 injury at home and the employee=s credi­bility.  Although acknowledging that, ordinarily, a compensation judge is not required to specifically dis­cuss or ex­plain every­thing in the record,^[2]  the appellants argue that in this case, these issues were crucial to a deter­mination of medical causation, and failure to specifically address them constitutes reversible error.

 

Contrary to the appellants= assertion, the compensation judge made a specific finding describing the March 15, 2000 incident and the employee=s medical treatment following the injury in some detail.  The compensation judge accepted the employee=s testimony that her symp­toms from the March 15th injury resolved prior to the July 18, 2000 incident, and explained in her memorandum, A[t]he em­ployee=s testimony was credible that the injury at home was to a different area of her hand and wrist.  Dr. Clonts= records are consistent with her testimony that her symptoms were improved before the work injury.@  (Finding 2; Mem. at 3.)   The com­pensation judge=s finding and mem­orandum adequately address her decision on this issue, and there is nothing which would require reversal on these facts.  We, accordingly, affirm.