MIKE SMITH, Employee/Appellant, v. QUEBECOR PRINTING, INC., and KEMPER NATIONAL INS. COS., Employer-Insurer, and MINNEAPOLIS ORTHOPEDIC AND ARTHRITIS INSTITUTE, BLUE CROSS/BLUE SHIELD, MIDAS RECOVERY (STANDARD INS.), MINN. DEP=T OF LABOR & INDUS./VRU, MINN. DEP=T OF HUMAN SERVS., and ABBOTT-NORTHWESTERN HOSP., Intervenors.

 

WORKERS= COMPENSATION COURT OF APPEALS

MARCH 19, 2003

 

HEADNOTES

 

CAUSATION - SUBSTANTIAL EVIDENCE.  Substantial evidence supports the decision of the compensation judge that the employee did not sustain an injury to his hip as a part of his admitted knee injury. 

 

Affirmed.

 

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

Compensation Judge: Jennifer Patterson

 

OPINION

 

DAVID A. STOFFERAHN, Judge

 

The employee appeals from the determination of the compensation judge that he did not sustain an injury to his left hip as part of his admitted knee injury on January 3, 1998.  We affirm.

 

BACKGROUND

 

Michael Smith was born on December 14, 1957.  When he was twelve or thirteen years old, he fell while playing football and had pain in his left hip.  When treated, he was diagnosed with slipped capital femoral epiphysis, a developmental condition which weakens the growth plate just below the hip joint.  The condition was treated by pinning the femur into the ball of the hip joint.  A year or so after this procedure, the right hip was done as well.^[1]  The employee testified that he had no pain or problems with his hips from that time until January 3, 1998. 

 

Mr. Smith began working for Quebecor, a printing company, in 1994.  On January 3, 1998, the employee ran a feeder, putting rolls of paper into the press.  The paper rolls weighed between two thousand and four thousand pounds.  The rolls would be guided down an incline on to a dolly and then pushed to the press.  When the employee was performing this process on January 3, 1998, one end of a paper roll came off the dolly and struck him in the left knee, pinning it against the wall.  The employee testified that he twisted and pulled his leg to get it out, taking about ten seconds to do so.  

 

The employee sought medical care on the date of his injury at the emergency room of United Hospital, St. Paul.  Those records indicated the employee complained of left knee pain and an x-ray was taken of his left knee.  A diagnosis of MCL strain was made and the employee was placed in a knee immobilizer and given pain medication.  The employee returned to United the next day, after having returned to work, and complained of increased swelling and pain in his left knee.  He was taken off work for four days.

 

On January 8, 1998, the employee was seen for treatment at the Airport Clinic.  He noted difficulty with his left knee with full weight bearing and with activities such as putting on his shoes, getting in his car, or using stairs.  He was diagnosed with left knee strain, given pain medication, encouraged to continue with his use of the immobilizer along with elevation and ice.  He was also given work restrictions.  He returned to the Airport Clinic on January 14 and because  of his continued knee symptoms, was referred to Dr. Jack Bert at Summit Orthopedics.

 

The employee saw Dr. Bert on January 27, 1998.  According to the chart notes for that visit, Dr. Bert treated only the left knee.  Dr. Bert diagnosed soft tissue injuries to the left knee, recommended Aaggressive@ physical therapy and placed work restrictions. 

 

Sometime after the January 27^th visit, the question arose as to whether the employee had discussed hip problems with Dr. Bert at that time.  There is no reference to hip complaints in the January 27^th chart notes.  The employee testified at hearing that he spoke to Dr. Bert about his hip either at this first appointment or at the second appointment on February 10, 1998.  The employee was accompanied on his visits to Dr. Bert by Jane Skarie, a nurse and disability case manager for the insurer.  Her initial report of February 16, 1998, makes no mention of hip complaints.

 

The employee=s follow-up care for his knee was uneventful.  Dr. Bert saw the employee again on February 24, 1998 and recommended continuing with anti-inflammatories and physical therapy.  On April 7, Dr. Bert indicated the employee would be able to return to work without restrictions on June 1, 1998.  There is no record of treatment for the left knee after that date in evidence.  The employee returned to his pre-injury job with the employer in April 1998.

 

The first reference to hip complaints in Dr. Bert=s records is with the visit of April 7, 1998.  Dr. Bert noted the history of an old slipped capital femoral epiphysis, had x-rays done of both hips which showed pinning and advised the employee that a total hip arthroplasty on the left would eventually be needed.  There was no reference to the employee=s work injury in this chart note.  On May 21, 1998, Dr. Bert wrote a report to the disability case manager in which he stated AHis hip complaints are congenital.  They are not related to his knee injury.  He will eventually need total hip replacement.  I would agree that his knee condition is totally unrelated to his hips.@  After receipt of this report the disability case manager indicated in her June 13, 1998 report that she would close her file since the employee was treating for a non-work related condition.

 

On July 28, 1998, the employee underwent left total hip arthroplasty.  Initially, the surgery appeared successful but in November he went to an emergency room and also saw Dr. Bert with pain in his left hip area.  Dr. Bert suspected infection and referred him to Dr. Douglas Becker at Minneapolis Orthopedic and Arthritis Institute.  Dr. Becker saw the employee for the first time on November 23, 1998. 

 

During the period of the employee=s treatment for his left hip, beginning in the summer of 1998, the question of whether this condition was related to his work injury continued.  The disability case manager re-opened her file for the purpose of trying to answer that question.  She indicated in her report of August 8, 1998, AMr. Smith has stated on several occasions that he thinks his current hip problems are related to his knee injury of 1/3/98.  He contends that he did not have the discomfort in his hips prior to the injury that he does at present.  On 1/27/98 when Dr. Bert initially examined Mr. Smith he asked if Dr. Bert would be able to also treat him for his congenital hip problems as he had been having recurrent pain.  Dr. Bert informed Mr. Smith at that time that after his knee injury was resolved, claimant could make a separate appointment regarding his chronic hip problems.@

 

Dr. Bert generated two more reports, one on September 23, 1998 and the other on October 23, 1998.  In the first he stated that the employee=s hip condition could have been aggravated by the altered gait caused by his knee injury.  In the second report, he said that this aggravation will be only temporary and Aany restrictions right now for his hips are because of his congenital Perthes disease and subsequent total hip replacement.  His hip condition, obviously, is congenital and pre-existent and unrelated to his January 3, 1998 condition.  As stated, he had temporary aggravation of his knee condition because of his total hips, but certainly no permanent condition is relative to the January 3, 1998 accident.@

 

When the employee saw Dr. Becker on November 23, 1998, he related a history of the work injury on January 3, 1998.  He reported that he had persistent hip and knee pain since that incident and that initially the knee was more symptomatic than the hip.  After review of medical records and examination of the employee, Dr. Becker concluded that the arthroplasty was infected and recommended component removal.  This procedure was done by Dr. Becker on December 17, 1998.  Revision surgery in the form of a new arthroplasty for the left hip was done on February 4, 1999. 

 

The employee filed a claim petition on May 3, 1999, alleging that he had injured his left hip on January 3, 1998.  The employer and insurer denied the employee=s claim.  The employee=s claim petition proceeded to hearing on August 21, 2002, before Compensation Judge Jennifer Patterson.  At the hearing, the parties agreed that if primary liability for the left hip were established, the employee was entitled to 104 weeks of temporary total disability and ten percent permanent partial disability.  The issues for the compensation judge=s consideration were whether the employee sustained an injury to his left hip on January 3, 1998, and whether the employee was entitled to temporary partial disability for the period January 1, 2001 to August 21, 2001. 

 

The employee presented a medical report from Dr. Bert dated October 24, 1999, in which Dr. Bert opined that, while the employee=s hip condition was congenital and pre-existing, the employee had a Aacceleration@ of his condition as a result of the work accident which required the hip replacement.  There was no further discussion of this issue in the report.

 

The employee also introduced a report from Dr. Becker of March 8, 1999 and Dr. Becker=s deposition testimony.  In his report, Dr. Becker stated:

 

Ahe appears to have suffered a permanent aggravation injury from his work-related job injury and exposure on or about January 3, 1998.  Although there is history of pre-existing disease, the incident on January 3, 1998, appears to have led to persistent symptoms of the knee and hip.  Hip pain often presents as knee discomfort initially.  Mr. Smith=s symptoms did not subside.  His work also entailed prolonged standing and walking activities which appear to have aggravated his hip condition.  His total hip arthropasty surgery would, therefore, be a result of his occupational exposure and work injury.@

 

Dr. Becker affirmed his report in his deposition testimony.  Dr. Becker=s opinion was that the injury on January 3, 1998, strained not just the employee=s knee but his entire leg and hip, leading to inflammation in the left hip.  The inflammation was the cause of symptoms which led to the need for treatment.  In Dr. Becker=s opinion, the fact that the employee=s initial pain was in his knee did not contradict this conclusion and Dr. Becker identified the knee pain as referred pain.

 

The employee was seen for an independent medical examination on July 22, 1999 by Dr. Mark Friedland who prepared a report of that date.  In his report, Dr. Friedland indicated that the employee stated he had immediate pain from the knee to the hip at the time of the work injury.  Based in part on the lack of reference to hip problems in the medical records before April 7, 1998, Dr. Friedland concluded that the employee=s work injury was not a causative factor in the employee=s hip condition.  Dr. Friedland also stated that slipping of the epiphysis which would require pinning would also result in significant degenerative arthritis which was consistent with the findings on x-rays.  Dr. Friedland opined that the hip surgery was due to this pre-existing condition and the January 3, 1998 injury did not involve the left hip. 

 

Dr. Friedland=s deposition was taken for the hearing.  In his testimony, Dr. Friedland indicated that any significant slipping of the epiphysis always causes arthritis at a very early age.  He reiterated his opinion that the work injury of January 3, 1998 did not involve the left hip because there were no medical records of complaints relating to the hip before April 7, 1998.  According to Dr. Friedland, the left leg pain referenced by the employee was not referred pain from the hip.

 

In her Findings and Order, served and filed on October 11, 2002, the compensation judge found that the employee did not injure his hip on January 3, 1998, and denied the employee=s claim.  The employee appeals.

 

DECISION

 

The employee argues that the compensation judge erred in her determination that he did not sustain a hip injury on January 3, 1998.  Specifically, the employee contends that the opinion of Dr. Friedland lacked foundation, that substantial evidence does not support the rejection of Dr. Becker=s opinion and that the compensation judge erred in commenting that there were significant discrepancies in the employee=s testimony. 

 

With regard to Dr. Friedland=s opinion, the employee claims that foundation for the opinion was lacking because Dr. Friedland assumed there were no complaints of left hip pain before April 7, 1998, when, in fact, the employee testified that his hip and upper leg pain began with the work injury.

 

The employee misreads Dr. Friedland=s opinion.  Neither in his report nor in his deposition testimony did Dr. Friedland state the employee had no symptoms before April 7, 1998.  Dr. Friedland=s report contains the employee=s history of the onset of hip pain on January 3, 1998.  Rather than lack of symptoms, Dr. Friedland referred to the lack of medical records relating to the left hip before April 7, 1998.  Dr. Friedland=s reference to a lack of medical records was correct.  There are no medical records before April 7, 1998 which refer to hip symptoms for the employee.  Adequate foundation for a medical opinion may be established, as it was here, by a review of the medical records and a hypothetical question propounded to the doctor.  Scott v. Southview Chevrolet Co., 267 N.W.2d 185, 188, 30 W.C.D. 426, 430 (Minn. 1978).  We conclude Dr. Friedland=s opinion had adequate foundation and the compensation judge did not err in considering that opinion in reaching her decision.

 

With regard to Dr. Becker=s opinion, the employee alleges that the compensation judge should be reversed because she refused to give any weight to the treating doctor=s opinion or she misread his testimony.  We find no basis in the record for these contentions.  Dr. Becker=s opinion was that the trauma of the work injury caused an inflammation in the left hip and that the inflammation was a gradual process.  The pain from the inflammation might take several weeks to localize in the hip and the knee pain would mask the hip pain.  In her memorandum, the compensation judge explained her rationale for disregarding Dr. Becker=s opinion.  Her primary reasons were that the employee complained to Dr. Bert of hip pain on January 27, 1998, just three weeks after the injury and not the longer period of time contemplated by Dr. Becker and that on that date the employee=s knee symptoms had not subsided so as to unmask the hip pain.  We find no misunderstanding by the compensation judge of Dr. Becker=s testimony. 

 

Clearly, the compensation judge considered the opinion of Dr. Becker in arriving at her decision.  Considering an opinion does not mean that the compensation judge must accept that opinion.  It is the function of the compensation judge to consider competing expert opinions and the compensation judge=s decision in that regard will not be reversed so long as the accepted opinion has adequate foundation.  Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985).  We note also that the compensation judge=s determination is supported by the records of Dr. Bert.  It is obvious that as of April 7, 1998, Dr. Bert did not believe that the employee=s hip problems were work related and there is no indication that the employee related those problems as being work related.  Further, Dr. Bert provided a number of medical reports in which he set forth his conclusion that the employee=s need for surgery was the result of his pre-existing condition. 

 

Finally, the employee argues that the compensation judge erred in stating that there were significant discrepancies in the employee=s testimony and various records regarding the onset of symptoms.  The language of which the employee complains is not in the compensation judge=s findings but rather in her memorandum.  The question for our review is not the language of the memorandum but whether the findings of the compensation judge are supported by substantial evidence.  Turek v. Northfield Freezings, 652 N.W.2d 265 (Minn. 2002).  We see no reason to review this issue further.  Even if we were to disagree with the choice of words used by the compensation judge, it is not clear from the employee=s argument how that would change the result in this case.

 

The issue in this case was medical causation.  The compensation judge accepted the opinion of Dr. Friedland and denied the employee=s claim.  Since we have found Dr. Friedland=s opinion to have adequate foundation, we do not reverse the compensation judge=s findings.  The decision of the compensation judge is affirmed.^[2]