GARY COUET, Employee, v. NATIONWIDE HOUSING, and CREDIT GENERAL/MIGA, Employer-Insurer/Appellants, and IDENTI-GRAPHICS, and INDIANA INS. COS., Employer-Insurer, and BLUE CROSS & BLUE SHIELD OF MINN., PARK NICOLLET MEDICAL CTR. and METHODIST HOSP., Intervenors.

WORKERS= COMPENSATION COURT OF APPEALS

MAY 21, 2003

CAUSATION - GILLETTE INJURY.  Substantial evidence supports the determination of the compensation judge that the employee sustained a Gillette injury in the nature of carpal tunnel syndrome. 

Affirmed.

Determined by Stofferahn, J., Pederson, J., and Rykken, J.

Compensation Judge: William R. Johnson

OPINION

DAVID A. STOFFERAHN, Judge

Employer, Nationwide Housing, and its insurer, Credit General, appeal from the compensation judge=s finding that the employee sustained a Gillette^[1] injury to his right hand and wrist on or about February 15, 2000.  We affirm.

BACKGROUND

On July 10, 1995, Gary Couet, the employee, was working for Identi-Graphics having started there about three years previously.  Initially, the employee refurbished vending machines and later in his employment, he installed signs and decals at convenience stores.  On July 10, 1995, the employee and a co-worker were loading large boxes into the back of a truck at Identi-Graphics.  The employee was standing on top of one of the boxes which he had already loaded when his foot went through the top of the box and he fell off.  When he fell he reached out with his left arm to break his fall and he landed on his out stretched left hand.  The employee injured his left wrist but indicated that there was no injury to his right hand and wrist in this incident. 

The employee=s treatment for his 1995 left wrist injury has been at Park Nicollet Medical Center.  The injury was initially diagnosed as a left wrist strain and the employee was provided with a wrist splint and pain medication.  He was also placed on work restrictions which precluded the use of his left arm and hand.  There were some initial signs of improvement but when his symptoms did not resolve he was referred to Dr. Scott McPherson, an orthopedist at Park Nicollet, who saw the employee for the first time on October 17, 1995.  After diagnostic tests, the first of the employee=s left wrist surgeries was performed on November 8, 1995.

The employee went off work because of his injury on July 22, 1995.  He was released to return to work in December 1995 with restrictions of no use of his left arm and wrist.  Identi-Graphics had no work for him and the employee remained off work, receiving temporary total disability benefits from Identi-Graphics and its insurer until February 1996 when the employee went to work for a new employer, Stevens Community Apartments.

Stevens managed 23 buildings with approximately 760 apartments and the employee was hired to work in the maintenance department of the company.  The employee repaired appliances and took care of plumbing and electrical problems.  The employee continued to have restrictions on the use of his left hand and testified that he followed his restrictions during his employment with Stevens.

Additional surgery on the left wrist was done on May 15, 1996 by Dr. McPherson.  The employee was taken off work for a time and then returned to his maintenance job at Stevens with continuing restrictions of avoiding repetitive use of his left hand.  The employee continued to work at the maintenance department at Stevens until laid off due to management changes at the end of 1997.  The employee testified that he was able to do most of his work at Stevens with his right hand alone and that if two hands were needed for a job he was able to find someone to help him. 

The employee went to work for Nationwide Housing on December 15, 1997.  Nationwide was a management company for apartment buildings and the employee was hired to perform maintenance at Phillips Tower, one of the buildings.  The employee=s duties included appliance repair, maintenance and repair of the plumbing, electrical and heating systems, and tasks such as installing mini-blinds in all of the apartments.  The employee testified that he did most of this work with his right hand.  He avoided using his left hand at all but would use his left forearm to balance and hold items in place.  Twice a week the employee had to move garbage dumpsters and the employee testified that rather than use both hands to push and pull the dumpsters, he would use his right hand alone. 

The employee had additional surgery to his left wrist on October 28, 1998.  He was off work for about five weeks.  He had fusion surgery to his left wrist on October 26, 1999, and was off work through December 24, 1999.  Identi-Graphics and its insurer accepted responsibility for the surgeries and resultant lost time.  After each surgery, the employee returned to his regular job at Nationwide with restrictions to minimize the use of his left hand. 

The employee first noticed symptoms to his right hand in the middle of February 2000, when he felt as though his thumb and two fingers were asleep.  He went to Park Nicollet for his symptoms on February 17, 2000.  The chart note for that date provides a history of the onset of right upper arm pain two days after shoveling snow.  The note also states Athe patient contends that his right arm injury is caused by his left wrist injury.  His rationale is that if he had full use of the left arm, he would not have to put so much pressure on his right arm.@  The only treatment recommendation was to put ice on the upper right arm.

The employee returned to Park Nicollet on March 2, 2000, with complaints of paresthesias in the right hand.  Nerve conduction studies confirmed a diagnosis of right carpal tunnel syndrome and the employee began treatment for this condition at Park Nicollet.  Restrictions were also placed on the employee=s use of his right arm with no lifting greater than 20 pounds and only light grasping or occasional wrist motion allowed.  The employee has continued to have right hand and wrist symptoms and carpal tunnel surgery was recommended by Dr. Thomas Walsh at Park Nicollet in a visit on June 6, 2000.

The employee continued to work at his maintenance job at Nationwide, following restrictions on the use of both his left arm and hand and right arm and hand.  The employee voluntarily left his job at Nationwide in November 2000 so he could return to Stevens, where he did his previous maintenance work and also trained other employees.  The employee has been able to physically tolerate this employment.

The employee had an additional surgery to his left wrist on November 16, 2001.  As of the date of hearing the employee had not returned to any employment because of the surgery. 

The employee filed a claim petition in January 2001, alleging that his right hand and wrist problems were the result of the July 10, 1995 injury at Identi-Graphics or of a February 15, 2000 injury at Nationwide.  The employee also sought approval of the carpal tunnel surgery recommended by Dr. Walsh. 

The employee was evaluated by Dr. William Call on behalf of Nationwide and its insurer on April 3, 2001.  In his report of April 27, 2001, Dr. Call diagnosed a mild carpal tunnel syndrome on the right side.  He also concluded that Athere is a causal connection between the employee=s current right arm and wrist complaints and his injury of 7-10-95.  He has had five surgeries on the left side and significantly decreased ability to use his left arm requiring him to use his right arm.  As a result his right carpal tunnel injury is a consequential result of his left wrist injury which has required heretofore five surgeries.@  Dr. Call recommended a steroid injection to treat the carpal tunnel condition and stated that an open carpal tunnel release would be appropriate if no relief was obtained from the injection. 

At the request of Indenti-Graphics and its insurer, the employee was seen by Dr. Mark Fischer on May 31, 2001.  As he stated in his report of that date, it was Dr. Fischer=s opinion that the employee had a Gillette injury to the right wrist as a result of his work activities at Nationwide which culminated on February 15, 2000.  Dr. Fischer disagreed with Dr. Call=s causation conclusion that the carpal tunnel injury was a consequence of overuse by the employee of his right hand because of his left wrist problems.  Dr. Fischer agreed with the recommendation for carpal tunnel release surgery. 

This matter was heard by Compensation Judge William Johnson on August 21, 2002.  As presented to the compensation judge, the issues were whether the employee=s right carpal tunnel syndrome was an overuse injury as a consequence of the left wrist injury or was instead the result of a Gillette injury.  In his Findings and Order, the compensation judge determined that the employee had sustained a Gillette injury to his right hand and wrist on February 15-17, 2000 from his employment at Nationwide.  The compensation judge also found that the proposed carpal tunnel surgery to be reasonable and necessary and to be causally related to the February 2000 Gillette injury.  Nationwide appeals.

DECISION

Nationwide argues that the finding by the compensation judge that the employee sustained a Gillette injury to his right hand and wrist is not supported by substantial evidence.  Specifically it is alleged that the compensation judge=s reliance on the opinion of Dr. Fischer was inappropriate since foundation for Dr. Fischer=s opinion was lacking.  Nationwide further claims that Dr. Call=s opinion on causation should have been adopted since it was the opinion which most closely agreed with the employee=s opinion regarding causation.  We are not persuaded.

The compensation judge specifically adopted the opinion of Dr. Fischer who concluded that the employee=s carpal tunnel syndrome was the result of his work activities at Nationwide.  Dr. Fischer rejected the opinion that the carpal tunnel syndrome represented a consequence of the employee=s 1995 left wrist injury.  In doing so, Dr. Fischer referred to the fine motor activity of the right hand required by the employee=s duties at Nationwide and noted that there was little indication that this activity was affected by the employee=s left hand disability.

Nationwide contends that Dr. Fischer was not aware of the employee=s complete medical history.  In his report Dr. Fischer said that the employee had not had any injuries to his left wrist when the records show a left radial fracture in 1983.  Further, Dr. Fischer raised a question as to whether a certain radiographic study had been done when the records had disclosed that the study was completed.  Nationwide speculates that Dr. Fischer may have been unaware of other medical history and that his opinion, therefore, lacks foundation.

Nationwide does not attempt to show what, if anything, these two points have to do with the critical issue of causation in this case.  Neither Dr. Call nor Dr. Fischer refer to these items as being significant in reaching their conclusions.  We are not willing to engage in speculation that perceived errors on two minor points indicate a general lack of knowledge of the employee=s medical history.  We find no foundational lack in Dr. Fischer=s opinion which would render the compensation judge=s reliance on that opinion to be error.

Nationwide also argues that Dr. Call=s opinion should have been accepted because it follows the opinion of the employee who believed that his carpal tunnel was due to overuse of his arm brought on by the 1995 left arm injury.  It is understandable that the employee would focus on a condition which has resulted in seven surgeries and which has been a disabling injury for over seven years.  However, the question of whether a Gillette injury has occurred is primarily a question of medical evidence.  Marose v. Maislin Transport, 413 N.W.2d 507, 40 W.C.D. 175 (Minn. 1987).

It is the province of the compensation judge to consider competing medical opinions and to adopt an opinion as the basis for the decision.  Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985).  The decision of the compensation judge is supported by substantial evidence and is affirmed.

Nationwide also appeals from the compensation judge=s decision that the proposed carpal tunnel surgery is reasonable and necessary and is causally related to the Gillette injury.  In its brief, Nationwide limits its argument to the issue of causation.  This question having been considered, the decision of the compensation judge on this issue is affirmed as well.