SCOTT ROUX, Employee/Appellant, v. R.J. REYNOLDS TOBACCO and ACE USA/ESIS, Employer-Insurer/Cross-Appellants and IMPACT PHYSICAL MED., ALLINA MED. CLINIC, UNITED HOSP., MED. HEALTH PLANS, and ABBOTT NW. HOSP., Intervenors.

The compensation judge awarded some, and denied other, claims for medical treatment and mileage. The employee appeals and the employer and insurer cross-appeal.

On June 20, 2011, while working for the employer R.J. Reynolds, Scott Roux was injured in a motor vehicle accident. The employer and its insurer admitted liability and paid medical benefits, including right ankle surgery, vocational rehabilitation benefits, and wage loss benefits. The parties entered into a Stipulation for Settlement in June 2013 in which the employee settled his claims on a full, final and complete basis. The stipulation closed out all medical expenses of any type or nature related to the employee’s claimed injuries to the left eye, neck, back, head/brain, traumatic brain injury, and mental health treatment. Only medical expenses related to the injured right ankle remained open.

Following the 2013 settlement, the employee’s condition required ongoing treatment which was extensive and resulted in piecemeal litigation. As such, the medical and procedural background in this matter is complicated.

In January 2014, the employee sought treatment with Dr. John N. Dunne of Park Nicollet who recommended that the employee continue to treat with MAPS for pain management, continue pool therapy, and continue medications including Lyrica, Vicodin, and trazadone. In December 2014, the employee filed a medical request seeking approval of pool therapy at Courage Center, a referral to MAPS, a referral to Dr. Chris Coetzee, and approval of prescription medications hydrocodone and trazadone. These issues were ultimately heard at a formal hearing, and in an unappealed Findings and Order of April 15, 2015, the compensation judge awarded treatment with Dr. Dunne, some treatment at MAPS, and prescription medications hydrocodone and trazadone, concluding these treatments were reasonable, necessary, and causally related to the employee’s right ankle injury. The judge denied the pool therapy and the referral to Dr. Coetzee.

The employee continued to experience burning right ankle pain throughout 2015 and 2016. He was ultimately diagnosed with chronic regional pain syndrome (CRPS) by several doctors, including Dr. Barbara Seizert, Dr. Raghavendra Nayak, and Dr. Orlando Charry all with Courage Kenny, as well as by Dr. Todd Hess and Dr. Coetzee. (Exs. C, D, and 8.) Both Dr. Charry and Dr. Hess recommended treatment plans to include topical ointments, injections, and acupuncture. The employer and insurer retained Dr. Nolan Segal who conducted independent medical examinations of the employee. He opined that there was no evidence of CRPS and the employee’s current complaints of pain were unrelated to the work injury. The issue of whether Dr. Charry’s treatment and expenses were reasonable, necessary and causally related to the employee’s work injury was heard at a formal hearing. In an unappealed Findings and Order dated August 11, 2016, the compensation judge awarded payment for Dr. Charry’s treatment.

Between August 2016 and December 2017, the employee treated with multiple providers. Dr. Charry continued to recommend treatment including physical therapy, acupuncture, pool therapy, and prescription medications Cymbalta, Topamax, and opioids. The employee also sought continued care with Dr. Dunne who managed the employee’s prescriptions, pool therapy, and acupuncture, and who referred the employee to Terri Allen, N.P., with Allina. Ms. Allen diagnosed the employee with CRPS and ordered pain psychological evaluations and refills of the employee’s prescription medication. The employee treated with three psychologists. Dr. John Mullen of Allina saw the employee seven times between November 14, 2016, and March 3, 2017, and provided pain behavior counseling. Dr. David Lund of Allina treated the employee eight times between October 16, 2016, and September 7, 2017, for cognitive behavior therapy in connection with the employee’s chronic pain. Dr. Murray McAllister of Allina saw the employee four times between April 7 and July 12, 2017. Consequently, the employee was receiving concurrent psychological treatment by two psychologists between November 2016 and July 2017.

The employee saw Dr. Hess at United Pain Clinic on November 10, 2017, who recommended pool therapy, acupuncture and a TENS unit. The employee also treated at Abbott Northwestern Hospital for physical and occupational therapy.

The employer and insurer retained medical expert Dr. Randal Wojciehoski to offer an opinion on the employee’s diagnosis and the reasonableness of the medical treatment between September 2016 and December 2017. Dr. Wojciehoski opined that there was no evidence of CRPS, nor physical findings to substantiate the employee’s subjective complaints of pain. He concluded that the employee received excessive amounts of treatment and physical therapy, and opined that there was no need for acupuncture, sympathetic blocks, a spinal cord stimulator, physical therapy, occupational therapy, pool therapy, medications, biofeedback, or topical pain medication. With an essentially normal examination and evidence of psychological overlay, Dr. Wojciehoski explained that the employee required no further treatment. He also questioned the employee traveling 250 miles round trip to obtain treatment when there was adequate treatment closer to his home.

The employee filed a medical request seeking payment of various medical and related expenses. Following a request for formal hearing, the matter was heard on February 27, 2018. Having provided much of the treatment, Allina, United Hospital, and Abbott Northwestern Hospital intervened. The employee’s health insurance carrier, Medica, also intervened, having paid Dr. Lund, Dr. Charry, Ms. Allen, and Dr. Hess. By Findings and Order, the compensation judge awarded medical benefits including payments to Allina (Drs. Charry, Lund, Mullen, McAllister, and Ms. Allen); to Medica (Drs. Lund, Hess, Charry, Ms. Allen, and United Hospital); and to Abbott Northwestern Hospital. The judge ordered treatment as prescribed by Dr. Charry and Ms. Allen for acupuncture and physical therapy, and found the employer’s request that the future treatment be undertaken in Rice Lake, Wisconsin, closer to the employee’s home was reasonable. He also awarded related medical mileage and approved a prescription for opioids.

However, the judge denied claimed medical benefits and medical mileage for Dr. Hess’ treatment rendered on November 10, 2017, pool therapy, acupuncture treatment by Dr. Magee, and occupational therapy at Abbott Northwestern, on the basis it was not reasonable, necessary, or causally related to the work injury. He denied claimed medical mileage for physical therapy and pool therapy received at Impact Physical Medicine. He also denied prescription medication for Topamax, Cymbalta, and trazadone, concluding this was treatment for headaches and/or depression which was closed out pursuant to the 2013 Stipulation for Settlement.

The employee appeals the judge’s findings denying treatment and medical mileage with Dr. Hess, pool therapy, prescription medications Topamax, Cymbalta, and trazadone, and the denial of the employee’s choice of provider.

The employer and insurer cross-appeal the judge’s findings awarding treatment by Dr. Hess, psychological treatment by Drs. Lund, Mullen, and McAllister, recommended acupuncture treatment, treatment by Drs. Dunne and Charry, physical therapy at Abbott Northwestern, related medical mileage, and an opioid prescription.

On appeal, the Workers’ Compensation Court of Appeals must determine whether “the 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(3). Substantial evidence supports the findings if, in the context of the entire record, “they 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, findings of fact should not be disturbed, even though the reviewing court might disagree with them, “unless they are clearly erroneous in the sense that they are manifestly contrary to the weight of evidence or not reasonably supported by the evidence as a whole.” Northern States Power Co. v. Lyon Food Prods., Inc., 304 Minn. 196, 201, 229 N.W.2d 521, 524 (1975).

A decision which rests upon the application of a statute or rule to essentially undisputed facts generally involves a question of law which the Workers’ Compensation Court of Appeals may consider de novo. Krovchuk v. Koch Oil Refinery, 48 W.C.D. 607, 608 (W.C.C.A. 1993), summarily aff’d (Minn. June 3, 1993).

On appeal, the employee argues that the judge erred in finding that the 2013 Stipulation for Settlement precluded prescriptions for Topamax and Cymbalta. The employee argues that these medications were prescribed by Ms. Allen for the right ankle CRPS nerve pain and were confirmed by Dr. Hess as effective for nerve pain. Because these medications were prescribed for the employee’s right ankle CRPS, the employee argues that they are not foreclosed by the stipulation.

The employee also argues that the judge erred in denying pool therapy at Courage Kenny in Stillwater and at Impact Physical Medicine in St. Paul. Pool therapy, he argues, was prescribed by multiple providers and alleviated his CRPS symptoms. The employee personally paid for this treatment but requested payment for the related medical mileage. The employee maintained that he traveled from his home in Rice Lake, Wisconsin, to Stillwater or to St. Paul because the pool was heated above 90 degrees and the pools near his home were cooler.

The employee argues that the judge erred in denying his claimed medical mileage, which compelled him to seek treatment in Rice Lake, and denied him choice of treating providers. Citing Maronde v. Robert Carr Constr. Co., 306 Minn. 529, 235 N.W.2d 207, 28 W.C.D. 129 (1975) and Hollar v. Ford Motor Co., slip op. (W.C.C.A. Jun. 14, 2002), the employee argues that while the insurer’s request that the employee treat closer to home may be reasonable, he cannot be compelled to forego his choice of treating providers.

Finally, the employee argues that the judge erred in denying payment of Dr. Hess’ treatment. The employee was referred to Dr. Hess by Dr. Dunne for a consult of chronic pain of the right ankle, but due to Dr. Hess’ schedule, the employee sought care with Dr. Charry instead. The employee claims that he kept his appointment with Dr. Hess who confirmed that the employee had CRPS and suggested a care plan similar to the one prescribed by Dr. Charry. He argues that Dr. Hess’ treatment was not redundant, and was therefore reasonable and necessary.

On cross-appeal, the employer and insurer argue that substantial evidence does not support the judge’s award of future treatment as no treatment plan is in evidence. They argue that the judge erred in ordering reimbursement to the employee’s personal health insurer, Medica, for treatment with Dr. Hess in light of the finding that Dr. Hess’ treatment was not reasonable and necessary. Finally, they argue that the judge erred in ordering payment of psychological treatment by Drs. Lund, Mullen and McAllister, when psychological treatment had been foreclosed by the 2013 Stipulation for Settlement.

The employee bears the burden of proving that the claimed medical treatment was reasonable and necessary to cure or relieve the effects of the injury. Leuthard v. Craig’s Tree Serv., 76 W.C.D. 735 (W.C.C.A. 2016) (internal citations omitted). Whether medical treatment is reasonable and necessary is a fact question to be decided by the compensation judge. Hopp v. Grist Mill, 499 N.W.2d 812, 48 W.C.D. 450 (Minn. 1993). Medical treatment is reasonable and necessary if there is evidence of a reasonable treatment plan, documentation of the details of treatment, a degree and duration of relief resulting from the treatment, and the frequency of treatment is warranted. Field-Seifert v. Goodhue Cnty., slip op. (W.C.C.A. Mar. 5, 1990). Here, the compensation judge found some medical treatment to be reasonable and necessary and causally related to the employee’s right ankle injury. He found other medical treatment was not reasonable or necessary, or was foreclosed by the 2013 Stipulation for Settlement. Substantial evidence supports the judge’s findings.

The record supports the diagnosis of CRPS beginning in 2016 followed by significant and long-term treatment to address it. Multiple doctors diagnosed the condition and most treatment options were consistent in addressing it.

The record supports the judge’s denial of prescription medications. Topamax was prescribed for headaches, and Cymbalta and trazadone were prescribed for depression. It was reasonable for the compensation judge to conclude that these medications are precluded by the 2013 Stipulation for Settlement which closed out “any alleged TBI, and any alleged mental health injury involving depression,” and left open only treatment related to the right ankle. (Ex. 1.)

The record supports the judge’s finding that pool therapy was not reasonable and necessary to cure or relieve the effects of the injury. Pool therapy had previously been denied by a compensation judge as not reasonable and necessary, and this was not appealed. (Findings and Order, April 15, 2015.) Thereafter, the employee personally paid for pool therapy out of pocket or through personal health insurance. Here, the judge’s denial of pool therapy was reasonably based on the 2015 denial and the employee’s failure to prove by a preponderance of the evidence that there had since been any change in the nature or duration of relief.

Furthermore, the judge did not err in compelling the employee to seek future treatment in Rice Lake, Wisconsin, near his home. Minn. Stat. § 176.135 requires that medical treatment be not only necessary, but also reasonable. If similar treatment can be obtained in a location closer to the employee’s home, it was within the judge’s discretion to determine that it was the more reasonable choice.^[1] See, e.g., Dombai v. Gold ‘N Plump Poultry, Inc., 51 W.C.D. 506 (W.C.C.A. 1994).

The record supports the judge’s finding that Dr. Hess’ treatment was not reasonable and necessary. The judge explained that the treatment rendered by Dr. Hess was duplicative of the treatment rendered by Dr. Charry. We agree. Dr. Hess merely reiterated the diagnosis of CRPS and the treatment Dr. Charry at Courage Kenny had recommended. The employer and insurer further argued in its cross-appeal that the judge’s award of Medica’s intervention interest, which they alleged included the service date with Dr. Hess of November 10, 2017, was inconsistent with his denial of the same date of service because it was duplicative of Dr. Charry’s treatment. In reviewing Medica’s intervention claim, it appears that contested date of service was not paid by Medica, and therefore, there is no inconsistency within the judge’s finding.

Finally, the record supports the reasonable and necessary treatments with Drs. Lund, Mullen, and McAllister in addressing the employee’s chronic pain from CRPS. In the course of counseling sessions, the employee discussed the stresses of family life, however, those notes also reflect the employee’s need to gain control over the mental sequelae of chronic pain. While concurrent treatment with two psychologists appears duplicative, that issue was not properly raised on appeal. See Armstrong v. RJ Sport & Cycle, 73 W.C.D. 457 (W.C.C.A. 2013) (internal citations omitted). Because substantial evidence supports the judge’s findings, we affirm.