CHRIS N. ERICKSON, Employee/Appellant, v. QWEST CORP. and SEDGWICK CLAIMS MGMT SERVS., Employer-Insurer/Respondents, and INJURED WORKERS PHARMACY, Intervenor.

The employee appeals the compensation judge’s findings related to the nature and extent, cause, and compensability of medical treatment related to his alleged complex regional pain syndrome.  As substantial evidence supports the compensation judge’s findings, we affirm.

Before Chris Erickson, the employee, began working at Qwest Corporation (Qwest), the employer,  he had a history of low back and left leg pain following a car accident in the 1980s.  He treated with David Pautz, M.D., conservatively with Tylenol until July 1999 when Vicodin, an opioid medication, was prescribed for his continued low back pain.  (Ex. 13.)

In August 2000, Qwest hired the employee to work as a maintenance technician.  From 2000 to 2004, the employee worked primarily outdoors as a span technician.  He traveled to various locations to repair and install wiring.  The job required climbing ladders and telephone poles as well as working with underground cables.  He would stand, sit, kneel and crouch when working with underground cables.  The span technician job was seasonal with winter layoffs.  In September 2003, the employee saw Dr. Pautz and reported pain in both feet, left greater than right.  Dr. Pautz diagnosed the condition as metatarsalgia.  In December 2003, Dr. Pautz directed the employee to increase his activity in order to lose weight.  The employee indicated that he began climbing stairs each day when at work and walking a total of five to six miles daily.  Dr. Pautz referred the employee to a podiatrist, Steven Kiester D.P.M., who examined the employee in January 2004.  Dr. Kiester diagnosed the employee with a left foot neuroma and metatarsalgia.

In 2004,^[1] the employee began working as a Central Office Technician which was an indoor job and required him to install and repair phones and high capacity data lines.  In this position, the employee climbed stairs, walked, crouched, and kneeled.

On December 29, 2004, the employee treated with Arthur V. Anderson, M.D,. for left foot, leg and back pain.  Dr. Anderson noted that the left foot pain worsened as the employee was climbing steps more frequently.  Dr. Anderson diagnosed a probable neuroma and prescribed time-release Oxycodone, an opioid medication.

On January 31, 2005, Dr. Kiester surgically removed the neuroma from the employee’s left foot.  On March 9, 2005, Dr. Kiester recorded that the employee was doing well and “having absolutely no problems.”  (Ex. J.)  The employee returned to work.  Two months later, the employee saw Dr. Kiester with complaints of ongoing pain in the left foot and leg.  Dr. Kiester suspected reflex sympathetic dystrophy (RSD) and ordered a bone scan which was positive.  On examination, there were no findings of edema or skin temperature changes.

The employee continued treating with Dr. Anderson for pain from 2004 until 2014 when he began treating with Adam Locketz, M.D.  Dr. Anderson gradually increased the employee’s dose and types of opioid medication with follow up medication checks.  Between 1999, when the employee was prescribed Vicodin for his back pain, and 2018, the employee’s opioid dose increased significantly.  Dr. Matthew Monsein, who examined the employee as a neutral physician under an order pursuant to Minn. Stat. § 176.155, subd. 2,  described the 2018 dosage as eight times the recommended dose of opioid medication according to federal government guidelines and six times the dose recommended by the Minnesota Workers’ Compensation rules.  (Ex. 4.)

The employee filed a claim petition alleging a Gillette-type injury which resulted in chronic pain and complex regional pain syndrome (CRPS).  He also claimed ongoing medical treatment.  Injured Workers Pharmacy (IWP) intervened seeking reimbursement for prescriptions for oxycodone, Oxycontin, and Lorazepam between February 8, 2016, and December 26, 2018, in excess of $86,000.00.  (Ex. N.)

The employee treated with several physicians, many of whom wrote narrative reports.  Dr. Anderson opined that the employee’s RSD/CRPS was due to his work activity and injury.  Dr. Lockertz also opined that the RSD/CRPS was a result of the employee’s work injury with possible complications due to a high dose opioid regimen.  Dr. Kiester, diagnosed RSD and secondary chronic pain syndrome.  He noted the employee recovered from the foot surgery, and then developed ongoing problems with his left foot.

The employee underwent multiple independent medical examinations.  Dr. Paul Biewen reviewed medical records, examined the employee and issued his medical opinion.  He diagnosed chronic low back pain, chronic opioid dependence, chemical dependency, chronic calf, ankle and foot pain of unknown etiology, thigh pain, and chronic pain syndrome.  He opined that the employee’s foot pain occurred gradually without significant causation from his work activity.  He concluded that the employee developed foot pain in an attempt to become more physically active to lose weight, which coupled with his obesity, was the cause of the employee’s ongoing foot pain.

Dr. Bruce Van Dyne also reviewed medical records, conducted an examination, and issued a narrative report.  He found no edema, discoloration or allodynia.  He assessed the employee’s reported symptoms as “distinctly atypical” for a diagnosis of RSD or CRPS.  He noted that the employee’s report of chronic pain and occasional numbness in his feet began prior to the employee working for the employer.  He concluded that the employee suffered no permanent disability and required no ongoing medical treatment due to his work activities with the employer.

Dr. Wanda Blaylark also reviewed medical records, conducted an examination, and drafted a narrative report.  She diagnosed a resolved left foot neuroma and chronic pain syndrome of both lower extremities not related to a work injury.  She rejected a diagnosis of chronic pain syndrome as the employee did not meet the clinical requirement.  A psychiatrist, Dr. John Rauenhorst, offered a diagnosis of recurrent depression and alcohol abuse.

Dr. Monsein, the court-ordered neutral physician, diagnosed the employee with chronic pain syndrome with high dose opiate dependency and tolerance.  He indicated that the employee may have had the condition of RSD/CRPS at one time, but he did not have it currently as the employee did not meet the diagnostic criteria for the condition.  Dr. Monsein recommended a taper from the employee’s medications and an EMG to rule out other reasons for the employee’s pain perceptions.  Despite the diagnosis of CRPS, Dr. Monsein noted that there had not been an effort towards physical rehabilitation which is a mainstay treatment recommendation for that condition.

On January 14, 2019, the matter was heard by a compensation judge.  The issues presented were whether the employee suffered a work-related Gillette injury to his left foot on January 31, 2005, whether the employee developed CRPS as a result of the injury and whether he continued to suffer from it, whether the employee developed chronic pain syndrome due to the January 31, 2005, injury, and whether the medical treatment and intervention by IWP for reimbursement were reasonable, necessary, and causally related to January 31, 2005, injury.  The compensation judge found the preponderance of the evidence showed the employee developed a neuroma to the left lower extremity which resolved as of the office visit with Dr. Kiester on March 9, 2005.  The judge also found the preponderance of the evidence failed to show that the employee developed CRPS or chronic pain as a result of the January 31, 2005, injury.  The judge denied IWP’s intervention claim for reimbursement in its entirety.  The employee appeals.

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 committed an error of law by relying on the opinion of Dr. Monsein, and, to a lesser extent, the opinions of Drs. Biewen, Blaylark, and Van Dyne in denying the employee’s claim.  The employee argues that the medical opinion on which the judge relied did not have adequate foundation.  He also argues that the judge ignored the claim that the employee developed chronic pain as a result of the work injury.  We disagree.

The employee maintains that the medical opinions relied on by the judge lack foundation.  At the hearing, the employee did not object on the basis of foundation to any of the multiple medical opinions offered by the employer and insurer and admitted into evidence.  To assert lack of foundation on appeal, an objection must be made at hearing.  Gianotti v. Indep. Sch. Dist. 152, 889 N.W.2d 796, 77 W.C.D. 117 (Minn. 2017).  The employee waived that objection and there is no basis for reviving it here.^[2]

Here, the judge relied upon multiple medical opinions in denying the employee’s claims.  The judge’s assessment of the weight to be given the conflicting opinions is upheld on appeal, absent an abuse of discretion.  Mattick v. Hy-Vee Foods Stores, 898 N.W.2d 616, 77 W.C.D. 617 (Minn. 2017).  The judge made express findings on both CRPS and chronic pain.  He explained that the inconsistencies in the employee’s testimony, his reports to his doctors, and his history regarding his injury were not credible.  Both the inconsistencies in the file and employee’s past history of chronic pain and substantial opioid use, persuaded the judge to find that there was no tie between the employee’s current complaints and his work injury of January 31, 2005.  This court does not substitute its judgment for that of the compensation judge where the inferences taken are reasonable and based on substantial evidence in the record.  Redgate v. Sroga’s Standard Serv., 421 N.W.2d 729, 734, 40 W.C.D. 948, 957 (Minn. 1988).  Because it was reasonable for the judge to conclude that the injury was unrelated to the employee’s current complaints, we affirm.