SARA WILLY, Employee/Appellant, v. NW. AIRLINES CORP. and LIBERTY MUT. INS. CO., Employer-Insurer/Respondents.

The compensation judge determined that the employee does not suffer from reflex sympathetic dystrophy (RSD) or complex regional pain syndrome (CRPS) as the result of her work injuries and denied the employee’s claim for medical treatment recommended for that diagnosis. The employee has appealed. We affirm.

The employee, Sara Willy, was employed by the employer, Northwest Airlines, as an airplane cleaner beginning in 1995. She suffered three work-related injuries to her left knee over the course of her employment, on April 22, 1997, December 1, 1998, and January 24, 1999. Subsequent to these injuries, the employee underwent extensive medical care, including eight surgical procedures and intensive mental health treatment. While all three injuries were admitted, claims for various benefits resulted in protracted litigation.^[1]

At issue in Ms. Willy’s current appeal before this court is whether she suffers from CRPS/RSD and the compensability of treatment recommended by her treating physician. With respect as to how this claim has developed procedurally, in Findings and Order dated July 25, 2003, it was determined that the employee had CRPS/RSD of the left leg. In Findings and Order dated February 23, 2010, it was determined that the employee no longer had CRPS/RSD. This later determination was not appealed.^[2]

Following the 2010 hearing, the employee continued to seek medical treatment, primarily with an orthopedic specialist, Dr. Corey Welchlin, and a pain specialist, Dr. Matthew Monsein. In 2012, Ms. Willy treated for continued symptoms in the area of the peroneal nerve of the left leg. An updated EMG did not show compression of the peroneal nerve. On July 27, 2012, Dr. Welchlin diagnosed peroneal nerve irritability secondary to RSD. He recommended that the employee undergo what would be her eighth surgical procedure after a recent cortisone injection did not reduce Ms. Willy’s left knee pain.

On August 7, 2012, Ms. Willy underwent an arthroscopic partial medial meniscectomy and chondroplasty to the femoral condyle. This surgery was followed by a physical therapy regimen. In the months that followed, the employee reported continued discomfort and even worsening pain in the left knee.

In November 2013, Ms. Willy began treating with Dr. Todd Hess of United Pain Center upon referral from Dr. Monsein. In his initial consultation note, Dr. Hess outlined the employee’s reported history of work injuries and treatment to the left leg, as well as an incident in which she noticed symptoms of CRPS/RSD in her right upper extremity and a crossover of symptoms to the right lower extremity. She further reported that both lower extremities were shiny, alternated between hot and cold, were purplish and red in color, with nail changes, allodynia and decreased range of motion, and that her right upper extremity was discolored, swollen, and would change in temperature. Upon visual observation and temperature measurement of Ms. Willy’s extremities, Dr. Hess assessed stage 3 CRPS/RSD. He recommended pool therapy to encourage range of motion, ordered injection therapy, and adjusted her medications.

At the recommendation of Dr. Hess, Ms. Willy underwent lumbar sympathetic blocks in July and August 2014. She reported that the first injections were helpful, but the second were not. While Ms. Willy testified at hearing that the injections were helpful, the September 2014 records reflect that at the time, she was reporting that her pain had exacerbated and that even morphine was not working. In late 2014, she complained of CRPS/RSD symptoms in her left upper extremity, as well.

Ms. Willy returned to see Dr. Hess in May 2015 with complaints of increased pain. Dr. Hess recommended ongoing medications, occupational and physical therapy, pool therapy, stress management, and psychologic support for severe right upper extremity and severe bilateral lower extremity CRPS/RSD. He later also recommended Calmare treatment and a mobility assessment. By November 2015, Ms. Willy was also reporting symptoms of CRPS/RSD in her face.

On March 3, 2016, Ms. Willy was seen for an independent medical examination with Dr. Kristen Zeller. Dr. Zeller questioned whether the employee ever had CRPS/RSD, citing a lack of physical examination findings fitting the criteria for such a diagnosis, as well as the employee’s lack of response to lumbar sympathetic blocks. Dr. Zeller emphasized Ms. Willy’s mental conditions, somatization disorder, and lack of insight into her condition. It was Dr. Zeller’s opinion that the treatment recommendations made by Dr. Hess were not reasonable, necessary, or causally related to the work injuries, and that nothing from a medical standpoint would ease Ms. Willy’s pain. Rather, it was Dr. Zeller’s opinion that the best approach for Ms. Willy would be to address her ongoing mental health issues, which would also likely improve her functionality.

This matter came on for hearing on March 29, 2016, for consideration of whether the employee suffered from CRPS/RSD and which body parts might be affected, whether her work injury is a substantial contributing factor to such a condition, and whether the treatment recommendations of Dr. Hess are reasonable and necessary. The compensation judge adopted the opinions of Dr. Zeller in finding that the employee does not suffer from CRPS/RSD and denied the employee’s claim for the treatment recommendations set forth by Dr. Hess. The employee appeals.

The compensation judge was presented with three issues for determination: whether the employee established by preponderance of the evidence that she suffers from CRPS/RSD of the lower extremities, upper extremities, and face; if so, whether the CRPS/RSD is the result in substantial part of her work injuries; and, if so, whether the treatment program recommended by Dr. Hess is reasonable, necessary and related to the work injuries.

In considering the question of whether the employee has CRPS/RSD, the compensation judge was presented with two competing medical opinions. Dr. Hess diagnosed the employee as having CRPS/RSD. Dr. Zeller stated the employee did not have CRPS/RSD. The compensation judge found “[t]he opinions of Dr. Zeller are more persuasive than the opinions of Dr. Hess that the employee does not exhibit objective symptoms to support the diagnosis of RSD/CRPS and that the employee’s pain complaints are better explained on the basis of her chronic pain syndrome and somatization disorder. Dr. Hess does not fully appreciate or take into consideration the psychological condition and somatization disorder in his conclusions.” (Finding 6.)

Citing to Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985), we have consistently held that when a compensation judge’s decision is based on a medical opinion with adequate foundation, we will generally affirm the compensation judge. Smith v. Quebecor Printing, Co., 63 W.C.D. 566 (W.C.C.A. 2003); Kranz v. Coca-Cola Entrs., Inc., 73 W.C.D. 631 (W.C.C.A. 2013). The employee does not challenge that general rule but argues it does not apply here because Dr. Zeller lacked competency to provide an opinion on CRPS/RSD and because her opinion lacked foundation.

Competency of a witness to provide an expert opinion “depends upon both the degree of the witness’ scientific knowledge and the extent of the witness’ practical experience with the matter which is the subject of the offered testimony.” Reinhardt v. Colton, 337 N.W.2d 88, 93 (Minn. 1983). However, “[t]he qualifications of an expert do not usually go to the admissibility of the expert’s opinion but merely to its weight.” Ruether v. State, Mankato State Univ., 455 N.W.2d 475, 477, 42 W.C.D. 1118, 1121 (Minn. 1990).

In her report, Dr. Zeller identifies her areas of practice as “Chronic Pain Management/Anesthesiology.” Her report also states that she is “a board-certified physician in the area of pain management.” There is no reference to any particular expertise in CRPS/RSD. However, the reports of Dr. Hess, in which he provided his opinions, identify him as “Medical Director, United Pain Center.” No particular expertise in CRPS/RSD is referenced. It would appear that Dr. Zeller has the same competency to discuss CRPS/RSD as does the doctor whose opinion is provided by the employee to support her claim.^[3]

The employee also challenges the foundation for Dr. Zeller’s report. Dr. Zeller examined the employee, took a history from her, and, in a thirteen-page recitation, reviewed Ms. Willy’s medical records in detail. This information provides a sufficient basis to establish foundation for an expert opinion. Scott v. Southview Chevrolet Co., 267 N.W.2d 185, 188, 30 W.C.D. 426, 430 (Minn. 1978); Marchesani v. Buffalo Dry Cleaners, No. WC13-5621 (W.C.C.A. Mar. 24, 2014).

The employee alleges in her brief that Dr. Zeller’s report fails to adequately consider what she believes to be indicators of CRPS/RSD. This argument appears to be merely an expression of opinion of counsel and is not reflected in the evidence in the record. The employee also testified that Dr. Zeller did not do a complete examination, and never looked at her arms to determine if there was swelling or discoloration. That testimony is contradicted by Dr. Zeller’s account of her examination of the employee. Given the acceptance of Dr. Zeller’s opinion by the compensation judge, it is apparent that to the extent there was a conflict in the evidence on this point, the compensation judge gave more weight to Dr. Zeller’s report. It is the function of a compensation judge to weigh conflicting evidence and we see no reason here to reverse the compensation judge on this basis.

Finally, if a party believes that an expert is not competent to render an opinion on the subject matter, or that the expert lacks foundation to provide an opinion, the party must object to the admission of the expert’s testimony or report at the time it is introduced. Weis v. Clinton Elec. Co., slip op. (W.C.C.A. Oct. 10, 1997). Upon admission into evidence, the testimony or report becomes part of the record and may be considered by the compensation judge. The employee here raised no objection to the introduction of Dr. Zeller’s report. (T. 10-11.) Because the employee did not object to the introduction of Dr. Zeller’s report, its admissibility is not at issue and our review is limited to whether the compensation judge properly weighed the evidence. We conclude that the opinions of Dr. Zeller were competent and well-founded, and that the compensation judge’s decision is amply supported by substantial evidence in the record.

The employee also contends that the compensation judge erred in “citing and relying” on the IME report prepared by Dr. Joel Gedan in 2009. The employee argues that the 2010 determination that the employee did not have CRPS/RSD is not relevant to the question as to whether the employee had CRPS/RSD in 2016. We agree. However, the employee introduced hundreds of pages of medical records detailing treatment between 1996 and 2016, upon which we assume the employee wanted the compensation judge to rely. It is reasonable that the compensation judge would review and rely upon the report of Dr. Gedan in addition to other medical evidence.

In a footnote of her brief, the employee questions whether the compensation judge considered all of the evidence in this case because of time limits placed on compensation judges in considering and determining disputes. The employee suggests that it “appears” the compensation judge’s consideration of the evidence was limited to review of Dr. Zeller’s report. We find no basis for this criticism.