BONNIE L. BRANDIA, Employee/Respondent, v. KEYSTONE AUTOMOTIVE and CCMSI, Employer-Insurer/Respondents, and MINNEAPOLIS PAIN CTRS. and MAPS, Intervenor/Appellant, and BLUE CROSS BLUE SHIELD, Intervenor.

Intervenor MAPS appeals from the compensation judge’s denial of payment for procedures involving the implantation of a spinal cord stimulator.  We vacate in part and remand to the compensation judge for reconsideration.

Bonnie Brandia, the employee, sustained an admitted work injury to her right upper extremity while working for Keystone Automotive, the employer, in September 2013.  The employee began treating at MAPS, the intervenor and appellant, in December 2015.  To treat what had been diagnosed as chronic regional pain syndrome (CRPS) of the employee’s right upper extremity, medical providers at MAPS implanted a trial spinal cord stimulator (SCS) in the employee in December 2016, and implanted a permanent SCS in April 2017.

The employer and its insurer denied payment for the procedures, claiming that they were not reasonable or necessary medical treatment.  The employee filed a medical request seeking payment for medical expenses and MAPS intervened.  A hearing was held before a compensation judge on January 8, 2019.  In a decision issued February 15, 2019, the judge denied the request for payment of the procedures.  MAPS appealed.

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).

The issue at the hearing, as identified by the compensation judge and the parties, was whether the SCS procedures were reasonable, necessary, and causally related to the employee’s work injury.  The compensation judge found the employee did not have CRPS and denied the request for payment of the SCS procedures on that basis.

This case was tried and decided before the Minnesota Supreme Court issued its decision addressing the applicability of medical treatment parameters^[1] in Johnson v. Darchuks Fabrication, Inc., 926 N.W.2d 414, 79 W.C.D. 291 (Minn. 2019), and thus the compensation judge understandably did not consider the application of the treatment parameters.  In Johnson, the supreme court reversed the general rule that treatment parameters do not apply in cases in which an employer and insurer admit primary liability but deny payment of medical treatment.  Id. at 420-21, 79 W.C.D. at 301-02.  The supreme court determined that the treatment parameters will generally apply to a given injury once primary liability is established.  Id. at 422, 79 W.C.D. at 304-05.

Medical treatment must be reasonable and necessary to be reimbursable pursuant to the Workers’ Compensation Act.  Minn. Stat. § 176.135, subd. 1(a); Minn. R. 5221.6050, subp. 1.A.; Minn. R. 5221.6040, subp. 10 (medically necessary treatment is defined as “health services for a compensable injury that are reasonable and necessary for the diagnosis and cure or significant relief of a condition consistent with any applicable treatment parameter in parts 5221.6050 to 5221.6600”).  Where the treatment parameters do not govern, the medical treatment must be reasonable and necessary.  Minn. R. 5221.6040, subp. 10.

At the time the SCS procedures were performed, the basis for the implants was to treat the employee’s CRPS condition.  At the hearing, the intervenor submitted evidence indicating the SCS procedures were reasonable and necessary treatment whether her diagnosis was CRPS or another pain disorder.  The judge did not make any findings regarding the conflicting evidence in the record regarding whether the SCS procedures could be reasonable and necessary for a non-CRPS diagnosis.  Instead, the judge found that because the employee did not have CRPS, the SCS procedures were not reasonable and necessary medical treatment.

Because we cannot effectively review the denial of the SCS procedures due to the lack of findings on these issues, we vacate findings 43 and 44, as well as the part of finding 46 that is limited by finding 43.^[2]  We remand this matter to the compensation judge for further findings and analysis consistent with this opinion, including consideration of whether the SCS procedures are consistent with treatment parameters, and whether the SCS procedures are reasonable and necessary treatment in light of the employee’s diagnosis.

I concur with the result reached by the majority in this matter.  I do however respectfully disagree with the limited approach taken by the majority in its review.  Further, I would note that although there were no findings regarding the treatment parameters, the trial transcript does indicate that they were at least discussed.  Nonetheless, I agree with the result reached by the majority to vacate some of the compensation judge’s findings and remand for reconsideration.