VICKI L. KOECHER, Employee/Appellant, v. GREAT FRAME UP OF EDINA and CASUALTY RECIPROCAL EXCH./MEADOWBROOK, Employer-Insurer.
WORKERS= COMPENSATION COURT OF APPEALS
DECEMBER 30, 2003
HEADNOTES
CAUSATION - SUBSTANTIAL EVIDENCE; EVIDENCE - EXPERT MEDICAL OPINION. Where it was supported by properly founded expert medical opinion, the compensation judge=s conclusion that the employee=s low back condition was not proven to be causally related to her work activities was not clearly erroneous and unsupported by substantial evidence.
Affirmed.
Determined by Pederson, J., Wilson, J., and Johnson, C.J.
Compensation Judge: Jane Gordon Ertl
Attorneys: Kathryn Hipp Carlson, Miller & Carlson, Minneapolis, MN, for Appellant. Gerald M. Linnihan, Jardine, Logan & O=Brien, Lake Elmo, MN, for Respondents.
OPINION
WILLIAM R. PEDERSON, Judge
The employee appeals from the compensation judge=s determination that the employee failed to prove a causal relationship between her medical condition and her employment. We affirm.
BACKGROUND
In May of 2000, Vicki Koecher [the employee] began working for a custom frame shop known as The Great Frame Up of Edina [the employer]. Ms. Koecher=s duties involved all aspects of custom framing, including working with customers to select frames and matting, measuring and cutting the mats and frames, and putting each frame, mat, and glass together into a finished product. The vast majority of the employee=s work was performed while standing on hard surfaces.
In about October of 2001, the employee began to experience tingling in the lateral aspect of her lower right leg between the knee and the ankle. She evidently saw a doctor at East Metro Family Practice for this symptom, and the doctor apparently recommended several stretching exercises for her to do before and after her work shift.[1] The employee found that this stretching helped, but her symptoms nevertheless gradually worsened.
According to her trial testimony, by the summer of 2002, the employee=s began to experience symptoms in her left as well as right lower extremity, and these symptoms eventually came to include calf and ankle pain. Her problems evidently came on gradually, leaving her generally feeling well when she awoke in the morning but experiencing symptoms within a couple of hours of starting her shift at the employer.
By August of 2002, the employee noted significant ankle pain, tingling along the sides of her legs, and calf pain. On August 14, 2002, the employee saw Dr. Denise Lewis at East Metro. The employee advised Dr. Lewis that early on in her work day she experienced pain just above the lateral malleolus, especially on the left ankle. By the end of her work day, however, the employee evidently stated that she had symptoms of numbness and tingling extending over a confined patch on the lateral aspect of her left calf, with a similar problem to some extent evident also on her right side. Dr. Lewis noted that there had been no specific injury and that the employee stands for eight hours at a time on a concrete floor, the doctor going on to diagnose Aprobable lateral compartment syndrome, secondary to the prolonged standing@ and recommending some time off work.
On September 10, 2002, the employee was seen in consultation by orthopedist Dr. Rajan Jhanjee. Dr. Jhanjee obtained a history from the employee of pain in the ankles and calves and numbness and tinging from the knee down. The employee advised him that her pain was worse after prolonged walking. Dr. Jhanjee diagnosed bilateral peroneal tendinitis and recommended physical therapy and an EMG. Dr. Jhanjee offered no opinion as to whether the employee=s condition was causally related to her employment. The employee did not return for follow-up visits with Dr. Jhanjee.
The employee returned to see Dr. Lewis on October 9, 2002, and advised the doctor that physical therapy was not helping her symptoms. Dr. Lewis noted that the physical therapist had suggested a trial of a TENS unit and that Dr. Jhanjee had recommended an EMG. About two weeks later, on October 22, 2002, Dr. Lewis noted that the employee=s EMG was within normal limits and that the TENS unit was not of much help.
On December 10, 2002, the employee was seen at the United Pain Center by Dr. Edrie Kioski. Dr. Kioski reported that the employee had advised her that Athis work-related injury first started bothering her in October 2001.@ She stated that it was Adeemed to be a workers= compensation case because it began after 5 years of prolonged standing on a cement floor.@ Dr. Kioski=s diagnosis was Abilateral leg pain of uncertain etiology,@ evidently concluding that the employee=s examination findings were not consistent with compartment syndrome. She stated, AI would think a compartment syndrome would have more evidence of swelling and tightness in her calf muscles, and compartments on the lateral side are all soft.@ She noted that some of the employee=s symptoms would imply a neuropathic origin but that her EMG was normal. She also concluded that the employee=s pain might originate from the bone, and she thought that obtaining a bone scan might be prudent. Dr. Kioski recommended ten visits with an acupuncturist and STS (sympathetic therapy system) treatments. Dr. Kioski offered no opinion on the relationship of the employee=s condition to her employment.
On January 8, 2003, the employee was examined by orthopedist Dr. Diane Palkert. The employee told Dr. Palkert that her pain was present on a daily basis, both at rest and while standing and walking. She stated that she had the worst pain while standing and that rest did not provide much relief of her symptoms. Dr. Palkert diagnosed bilateral lower extremity pain of unclear etiology, concluding that the employee probably did not have compartment syndrome, as her symptoms did not improve with rest as one would expect with that diagnosis. Dr. Palkert also noted that the employee may have some problems with nerve compression, although she had a normal EMG. Dr. Palkert recommended an MRI of both lower extremities to rule out any type of mass, but she offered no opinion as to whether the employee=s condition was causally related to her employment.
The employer and insurer arranged for the employee to be examined by orthopedist Dr. Gary Wyard on January 15, 2003. Dr. Wyard obtained a history from the employee, reviewed her medical records, and performed a physical examination. Dr. Wyard reported that the employee had no objective findings to support her subjective complaints. He stated that A[h]er subjective complaints are not consistent with any particular diagnosis that I am aware of.@ In his opinion, there was nothing to suggest that the employee has compartment syndrome, nor anything in her work activities that would have caused any specific ongoing problem or complaints. He was unable to relate the employee=s subjective complaints to her work activities with the employer. He concluded the employee is capable of working full time, Awith or without restrictions.@
In a letter to the employee=s attorney dated February 27, 2003, Dr. Lewis stated that the employee=s working diagnosis is lateral compartment syndrome in the lower legs. She opined, AI feel that her work activities contributed to her condition.@ She continued to restrict the employee from work, and she recommended continued evaluation and treatment by Dr. Palkert.
On February 20, 2003, the employer and insurer filed a rehabilitation request, seeking to terminate rehabilitation benefits on grounds that the employee did not sustain an injury arising out of and in the course of her employment. On February 21, 2003, the employee filed a medical request for the recommended acupuncture treatments, STS treatments, and an MRI. The employer and insurer ultimately filed a petition to discontinue benefits on March 28, 2003, and the employee filed a claim petition on April 7, 2003. The issues raised by the rehabilitation and medical requests and the petition to discontinue and the claim petition were consolidated and came on for a hearing before a compensation judge on May 15, 2003. In a Findings and Order issued June 18, 2003, the compensation judge concluded that the preponderance of the evidence did not support a finding that the employee had sustained a work-related injury. Accordingly, she granted the employer and insurer=s request to discontinue temporary total disability benefits and to terminate rehabilitation services. The employee=s request for payment of medical treatment was denied. The employee appeals.
STANDARD OF REVIEW
In reviewing cases on appeal, the Workers= Compensation Court of Appeals must determine whether Athe 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 (1992). Substantial evidence supports the findings if, in the context of the entire record, Athey 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, A[f]actfindings are clearly erroneous only if the reviewing court on the entire evidence is left with a definite and firm conviction that a mistake has been committed.@ Northern States Power Co. v. Lyon Food Prods., Inc., 304 Minn. 196, 201, 229 N.W.2d 521, 524 (1975). Findings of fact should not be disturbed, even though the reviewing court might disagree with them, Aunless 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.@ Id.
DECISION
In a memorandum accompanying her Findings and Order, the compensation judge explained that, while she accepted the medical information and the employee=s testimony that she had pain in her lower legs, none of the specialists support the diagnosis of compartment syndrome, nor do they opine that the employee=s lower extremity problems are related to standing on hard floors. While the judge concluded that the employee had not reached maximum medical improvement [MMI], because her doctors have recommended additional studies to assess treatment options, at Finding 10 the judge specifically accepted the opinion of Dr. Wyard regarding the lack of causal relationship between the employee=s condition and her work activities.
On appeal, the employee contends that the compensation judge=s finding that the employee did not sustain a work-related injury is clearly erroneous and unsupported by substantial evidence. Specifically, the employee argues that the judge=s acceptance of Dr. Wyard=s opinion regarding causation is inconsistent with her findings that the employee has an injury to her lower extremities, that she is in need for further medical treatment, and that she has not reached MMI. Because Dr. Wyard did not acknowledge any injury at all, she contends, it was inconsistent and erroneous for the judge to acknowledge that the employee has an injury and yet accept Dr. Wyard=s opinion regarding causation. We are not persuaded.
We have carefully reviewed the judge=s findings and memorandum and do not agree that the judge found that the employee has an injury to her lower extremities. The judge accepted the medical information and the employee=s testimony that the employee has pain in her lower legs, but she did not accept Dr. Lewis=s opinion that the employee=s work activities contributed to her current Acondition.@ Drs. Jhanjee, Kioski, and Palkert offered no opinions on causation of the employee=s condition, nor did they apparently agree with the compartment syndrome diagnosis offered by Dr. Lewis. Dr. Wyard, on the other hand, expressly opined that there is nothing in the employee=s work activities that would have caused any specific ongoing problem or complaints. While it is true that the judge concluded that the employee had not reached MMI, and that additional studies were necessary to assess treatment, it was not inconsistent for the judge to also conclude that the employee had not sustained a work-related injury. While the employee testified that her symptoms gradually occurred while she was working, and that they were made worse by standing, the judge was not required to conclude that the employee=s condition was for that reason causally related to her employment. The compensation judge chose to accept the opinion of Dr. Wyard over that of Dr. Lewis. In accepting Dr. Wyard=s opinion, the judge was not obligated to accept all of Dr. Wyard=s opinions in their entirety. See Johnson v. L.S. Black Constr. Co., slip op. (W.C.C.A. Aug. 18, 1994) (a compensation judge is free to accept a portion of an expert=s opinion yet reject other portions of that expert=s opinions), citing City of Minnetonka v. Carlson, 298 N.W.2d 763, 767 (Minn. 1980) (a factfinder generally Amay accept all or only a part of any witness= testimony@). To the extent that the judge based her decision that the employee did not sustain a work-related injury on the opinion of Dr. Wyard, and to the extent that that opinion was not based on any false premises, the compensation judge was entitled to rely on Dr. Wyard=s opinion and to have this court=s deference in doing so. See Nord v. City of Cook, 360 N.W.2d 337, 342-43, 37 W.C.D. 364, 372-73 (Minn. 1985) (Athe trier of fact=s choice between experts whose testimony conflicts is usually upheld [unless] the facts assumed by the expert in rendering his opinion are not supported by the evidence@). Therefore, the decision of the compensation judge is affirmed. Hengemuhle, 358 N.W.2d at 59, 37 W.C.D. 239.