SANDRA K. NYSTROM, Employee, v. KANABEC HOSP., SELF-INSURED/MINN. COUNTIES INS. TRUST/RSKCO., Insurer-Appellant.

 

WORKERS= COMPENSATION COURT OF APPEALS

JANUARY 6, 2003

 

HEADNOTES

 

CAUSATION.  Substantial evidence supports the compensation judge=s decision that proposed medical treatment was causally related to the employee=s work injury.

 

Affirmed.

 

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

Compensation Judge: Jane Gordon Ertl.

 

OPINION

 

DAVID A. STOFFERAHN, Judge

 

The employer has appealed the determination of the compensation judge which found recommended right knee arthroscopic surgery and cervical foraminal nerve root injections to be causally related to the employee=s work injury.  We affirm.

 

BACKGROUND

 

Sandra Nystrom, the employee, sustained a work injury on December 13, 2000.  The employee, who had worked as a registered nurse at Kanabec Hospital since October 1995, slipped and fell on snow on the hospital sidewalk as she was entering the hospital to begin her shift.  The employee testified that she fell hard on her right shoulder and right hip, striking the right side of her head and the outer side of her right knee.

 

The employee had right shoulder problems before her work injury which had necessitated surgery.  On December 3, 1999, the employee had a right shoulder acromioplasty and distal resection performed by Dr. Curtis Leonard.  The employee testified that she made a good recovery from this surgery and was doing well until the fall in December 2000 aggravated her symptoms.  After the work injury, the employee received treatment to the shoulder in the form of physical therapy and medication.  On July 16, 2001, the employee had additional surgery to her shoulder.  Dr. Alan Markman performed a right shoulder arthroscopy with resection of a bucket handle tear of the labrum. 

 

In addition to her right shoulder, the employee had treated for other medical conditions before her work injury.  The records reflect that the employee received chiropractic care for cervical complaints in 1995 and physical therapy for cervicobrachial pain in 1996.  An MRI of the cervical spine done in October 1997 showed posterior disc bulging and mild left foraminal stenosis at the C5-6 and C6-7 levels.  The employee noted cervical pain after her December 2000 work injury and she was treated with chiropractic care, pain medication, and physical therapy.  An MRI done in May 2001 indicated mild cervical kyphosis, advanced degenerative disease at C6-7, and mild degenerative disease at C5-6.

 

After her work injury, the employee consulted Johnson Family Chiropractic for treatment.  An office note of December 26, 2000, identified right knee symptoms, in addition to cervical strain/sprain, right shoulder and other symptoms which followed the December 2000 fall.  In a January 15, 2001 letter to the claims administrator, the employee=s chiropractor stated that the right knee subluxation had resolved. 

 

In March 2001, however, the employee complained to her treating orthopedist, Dr. Leonard, that she had knee pain ever since the fall which was not being treated.  At Dr. Leonard=s request, an MRI of the employee=s right knee was done in April 2001, and Dr. Leonard thereafter diagnosed mild right knee degenerative joint disease with osteochondrial defect involving the patellofemoral compartment in the trochlear groove.  Dr. Leonard presented the employee with different treatment options for the knee, including a diagnostic right knee arthroscopy which might include debridement of the cartilage at the sight of the osteochondrial defect.  Dr. Leonard also suggested a second opinion.

 

Dr. Leonard had also suggested a second opinion on the right shoulder which resulted in a referral to Dr. Markman and surgery to the shoulder in July 2001.  The employee testified she was not happy with Dr. Markman=s care and went to see Dr. Peter Daly, an orthopedist who had treated her husband.

 

The employee first saw Dr. Daly on October 24, 2001, for her shoulder, knee, and cervical complaints.  Dr. Daly recommended a referral to Dr. Lon Lutz for consideration of a foraminal nerve root injection to assist with the cervical pain.  He also scheduled a series of Synvisc injections and strengthening exercises for the knee.  No significant improvement from the injections was noted, and, in an office visit on February 12, 2002, Dr. Daly recommended arthroscopic debridement and chondroplasty of the patellofemoral joint.  He also continued to recommend foraminal nerve root injections by Dr. Lutz.

 

At the request of the employer, the employee was seen for an independent medical examination [IME] on January 31, 2002, by Dr. Scott O=Connor.  It was Dr. O=Connor=s conclusion that the employee=s pain complaints were out of proportion to the findings on examination, that the employee had likely sustained a contusion to her right shoulder and right knee as a result of the December 13, 2000 fall but that these were temporary injuries.  His opinion was that patellofemoral contusion significant enough to cause an osteochondrial fracture would result in immediate and excruciating pain.  Since that was not the employee=s history, Dr. O=Connor concluded that the December 2000 fall was not a causative factor in the employee=s ongoing knee complaints.  Dr. O=Connor also stated that the employee was capable of working without restrictions.

 

The employee had been seen for an IME by Dr. Jeffrey Husband with regard to a claimed 1999 work injury to the right shoulder.  Dr. Husband reviewed the medical records and prepared a report with his conclusions on April 24, 2002.  His opinion was that the employee had sustained an injury to the right shoulder of a bucket handle tear of the posterior labrum.  He concluded, however, that the injury had resolved.  He also concluded that the employee had sustained an injury to her right knee based upon her history but did not discuss the extent of injury.  Dr. Husband believed the employee was at maximum medical improvement and did not need any work restrictions.

 

Based upon the reports of Drs. O=Connor and Husband, the employer denied the procedures recommended by Dr. Daly and sought to discontinue the employee=s workers= compensation benefits.  The employee filed a medical request on April 8, 2002, and an objection to discontinuance on May 16, 2002.

 

The deposition of Dr. Daly was taken on June 11, 2002.  Dr. Daly was provided with a 26-page hypothetical which set forth the employee=s medical history.  Based upon his review of the medical records, the hypothetical, and his treatment of the employee, Dr. Daly diagnosed cervical disc disease with an aggravation from the work injury on December 13, 2000.  He diagnosed right shoulder myofascial pain and opined that the bucket handle tear of the labrum was due to the fall in December 2000.  His conclusion was that the employee had right knee chondromalacia.  In Dr. Daly=s opinion, the trauma to the right knee from the fall produced a muscle contraction which inflamed the employee=s underlying condition.  Dr. Daly stated that the proposed arthroscopic surgery to the right knee and the proposed foraminal nerve root injection to the neck were related to the employee=s work injury.  He restricted the employee from work until these procedures were done, and indicated that, in his opinion, she was not at maximum medical improvement.

 

The employee=s medical request and objection to discontinuance were heard by Compensation Judge Jane Gordon Ertl on June 14, 2002.  In her Findings and Order served and filed July 10, 2002, the compensation judge found that the knee surgery and the nerve root injections were related to the work injury.  She further determined that the employee continued to be temporarily totally disabled and had not reached maximum medical improvement from the injury.  The employer appeals.

 

 

 

 

 

 

 

 

DECISION

 

The employer appeals, arguing that the compensation judge erred in failing to make specific findings on the nature and extent of the employee=s injuries and in finding that the proposed medical treatments were causally related to the work injury.^[1]

 

At hearing, the compensation judge identified as an issue the nature and extent of the employee=s work injury.  The employer argues that the judge failed to make specific findings on that issue, citing the decision in Mendez-Merino v. Farmstead Foods, slip op. (W.C.C.A. Aug. 7, 2001).

 

In Mendez-Merino this court vacated a compensation judge=s findings and remanded the case for further determination because it was unclear on review whether the judge had followed the correct legal standard in considering an aggravation of a pre-existing medical condition and because the judge had not identified the medical basis for his decision.  Contrary to the employer=s argument, however, Mendez-Merino does not impose a requirement that in every case the compensation judge must provide a specific diagnosis of an employee=s injury.  Here, the compensation judge specifically adopted the opinions of Dr. Daly who provided diagnoses of the employee=s injuries.  We conclude the compensation judge determined the issues as presented by the parties.

 

The employer also appeals the determination of the judge that the proposed right knee arthroscopic procedure and the proposed foraminal nerve root injections were causally related.  The employer argues that substantial evidence does not support the compensation judge=s decision. 

 

The decision of the compensation judge is based upon the opinion of Dr. Daly.  As might be expected, the employer disputes Dr. Daly=s interpretation of the medical records and his conclusions.  There is no question, however, that Dr. Daly, through his treatment of the employee, his review of the medical records, and his consideration of the hypothetical presented to him, had adequate foundation to render an opinion in this matter.  Grunst v. Immanuel-St. Joseph=s Hosp., 424 N.W.2d 66, 68, 40 W.C.D. 1130, 1132 (Minn. 1988).  It is the compensation judge=s role to choose between conflicting medical opinion.  Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985).  A compensation judge=s factual determination based on adequately founded medical opinion will not be reversed on appeal.  The compensation judge=s decision is affirmed.