MARK TURNER, Employee/Respondent, v. SMDC MED. CTR. and BERKLEY RISK ADM’RS CO. LLC, Self-Insured Employer/Cross-Appellant, and MN DEP’T OF LABOR & INDUS./VRU, Appellant, and ST. LUKE’S CLINICS, Intervenor.

Intervenor Minnesota Department of Labor and Industry/Vocational Rehabilitation Unit (DOLI/VRU) appeals the compensation judge’s failure to address its claim for reimbursement of rehabilitation expenses. The self-insured employer cross-appeals from the compensation judge’s finding that the employee’s fear of returning to work after an injury resulted in a compensable claim. We reverse that finding and dismiss the intervenor’s appeal based on our determination of the employer’s cross-appeal.

Mark Turner, the employee, began working as a security guard for SMDC Medical Center, the employer, in 2010. His duties included entry control, monitoring security cameras, providing backup to other security guards, and helping with disruptive and violent patients. The employee testified that as his employment progressed, violent occurrences started to happen quite regularly. He told his family doctor, Dr. Timothy Kufahl, that in the ER zone where he worked, there was a physical altercation “just about weekly.”

On November 16, 2016, the employee was summoned to the behavioral health clinic to help subdue an aggressive patient. The employee and three other guards tried to control the patient and in the ensuing altercation, the patient grabbed the employee’s right little finger and bent it backwards until it touched the back of the employee’s hand. After the incident, the employee went to the hospital’s emergency room. He stated during his visit there that his finger had popped back into place when he made a fist. X-rays were taken and were read as showing no fracture or dislocation. The employee was treated there by having his little finger taped to another finger. The employee was told he should ice the affected area, use Tylenol and ibuprofen for pain relief, and follow-up with his primary care physician, if necessary. There is no record of the employee receiving any further care for his finger at any time after that appointment.

The employee continued to work as a security guard for the employer without restrictions and did not miss any time from work.^[1] The employee testified at the hearing that he became anxious about going into the behavioral health unit because of his fear of becoming involved in another altercation. On December 14, 2016, the employee requested that his job duties be modified. The employer could not accommodate the employee’s request and the employee did not return to work with the employer after that date. A first report of injury was prepared on that date and states that the employee “reports that due to repeated physical and emotional stress he is unable to work – emotional stress.”

On January 23, 2017, the employee saw Dr. Kufahl, at St. Luke’s Internal Medicine for a refill of medications for preexisting conditions not related to his employment. The employee told Dr. Kufahl that he was having a lot of anxiety and panic from physical and verbal altercations at work. The employee did not refer to any physical injury he might have sustained and did not mention the November incident. Dr. Kufahl assessed panic anxiety syndrome and stated that the employee needed to be off work until he could sort out his anxiety. No other treatment was recommended.

The employee returned to Dr. Kufahl on February 22, 2017. The employee reported no physical complaints and his examination was normal. In his report, Dr. Kufahl diagnosed anxiety as well as post-traumatic stress disorder (PTSD). Dr. Kufahl further stated that the employee could not perform his duties because being in parts of the hospital caused panic and anxiety. There was no indication that any physical injury was a factor in this assessment.

Dr. Kufahl referred the employee to mental health services where he saw Jake Pierce Walsh, LICSW, on February 28, 2017. He was diagnosed by LICSW Pierce Walsh as having adjustment disorder with mixed anxiety and depressed mood in addition to PTSD. No work restrictions were provided. Dr. Kufahl wrote a short note on March 15, 2017, stating that the employee was “ok to return to work with the continued restriction in ER zones.”

In April 2017, the employee retained an attorney to represent him in a workers’ compensation claim. The attorney referred the employee to Dr. Mark Gregerson for an orthopedic evaluation of the employee’s right little finger. The employee told Dr. Gregerson that he continued to have swelling of the right little finger, as well as limited active range of motion. The employee made no mention of any emotional problems following this incident. In his initial report, Dr. Gregerson requested the x-rays taken after the injury. In a subsequent report, after reviewing that information, Dr. Gregerson opined the employee had 0.5 percent permanent partial disability pursuant to Minn. R. 5223.0480, subp. 4.A(3)(a) and subp. 1.B(1)(e). Dr. Gregerson also stated, “the patient requires no further medical care in order to acquire any restrictions.” Dr. Gregerson did not provide any physical restrictions in his reports.

The employee filed a claim petition in September 2017, alleging a work injury on December 14, 2016, and claiming temporary total disability from December 14, 2016, to the present and continuing, permanent partial disability as rated by Dr. Gregerson, and medical expenses. Dr. Gregerson’s report of August 17, 2017, and LICSW Pierce Walsh’s report of February 28, 2017, were attached as the medical support for the claim.

Dr. Scott Yarosh, a psychiatrist, evaluated the employee at the employer’s request on February 23, 2018. After reviewing the employee’s records, Dr. Yarosh prepared a report dated March 8, 2018. He opined the employee failed to meet the criteria required for a diagnosis of PTSD and further stated that the employee’s diagnosis of PTSD had not been made by a licensed psychiatrist or psychologist as required by the statute. Dr. Yarosh diagnosed the employee with preexisting anxiety and depressive disorder. He concluded, “The act of being assaulted and suffering some physical injury, which he did, is disconcerting and would temporarily aggravate his preexisting mental condition.” Dr. Yarosh also stated, “the degree to which he claims injury and damages is far in excess of what is objectively elicitable on mental health examination and in review of the records provided. Therefore, the question of potential malingering cannot be ruled out.” In an addendum to his report, Dr. Yarosh stated the temporary aggravation lasted three months. At the time of his evaluation, the employee had no restrictions or limitations as it pertains to gainful employment.

The employee received vocational rehabilitation assistance from DOLI/VRU. A rehabilitation plan was filed in March 2018 which called for placement services. DOLI/VRU intervened in the pending litigation for related rehabilitation expenses.

A hearing on the employee’s claims was held before a compensation judge on October 2, 2018. The compensation judge issued his Findings and Order on November 14, 2018. The compensation judge determined that “while the employee does not suffer from post-traumatic stress syndrome as a result of his injury, his fear of returning to work as a security guard was an impediment to his returning to the work force and represented a limitation on his ability to secure employment.” (Finding 8.) The employee was awarded temporary total disability benefits from March 20, 2018, when he began working with DOLI/VRU, through September 15, 2018, when he returned to work with a different employer. The compensation judge did not address the employee’s claim for permanent partial disability or DOLI/VRU’s intervention claim.

DOLI/VRU has appealed the compensation judge’s failure to address its intervention claim. The employer has cross-appealed the compensation judge’s finding of a work injury and the award of benefits.

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 compensation judge determined that the employee did not suffer from PTSD as he alleged in his claim petition. Nevertheless, the compensation judge found that the employee’s “fear” of returning to work as a security guard was an “impediment” in returning to employment and awarded workers’ compensation benefits to the employee. The employer has appealed and contends that the compensation judge erred as a matter of law. We reverse the compensation judge’s finding and vacate the award.

The general rule in Minnesota is that mental injury or disability resulting from work-related stress is not compensable under the Minnesota Workers’ Compensation Act. Lockwood v. Ind. Sch. Dist. No. 877, 312 N.W.2d 924, 34 W.C.D. 305 (Minn. 1981); see also Schuette v. City of Hutchinson, 843 N.W.2d 233, 74 W.C.D. 169 (Minn. 2014). An exception is made for PTSD so long as certain criteria are met. See Minn. Stat. § 176.011, subd. 15 and subd. 16. The employee made his claim for benefits on this basis, but that claim was properly denied by the compensation judge because the statutory criteria had not been met.

The rationale for the compensation judge’s award is not set out in his decision. The decision refers to the employee’s fear of returning to work as a security guard as the basis for an award. However, there is no medical record or report in which the employee’s psychological diagnosis is fear. Indeed, that word is nowhere to be found in the records. Instead, the diagnosis used by the employee’s providers is anxiety. We need not consider whether that diagnosis in this case rises to the level of a mental “injury or disability” because we conclude that the employee’s claim is barred by Lockwood and its progeny.

Mental injury or disability which is the result of a physical injury may be compensable. See Hartman v. Cold Spring Granite Co., 243 Minn. 264, 271, 67 N.W.2d 656, 660, 18 W.C.D. 206, 212 (1954); Dotolo v. FMC Corp., 375 N.W.2d 25, 38 W.C.D. 205 (Minn. 1985). The employee argues in his response to the employer’s cross-appeal that his anxiety and depression were consequences of the physical injury to his little finger and resulted in a compensable injury on that basis. In his brief, the employee cites to no medical evidence which makes a connection between the little finger injury and the employee’s claimed emotional problems. The employee instead claims that the physical injury was a “limiting injury” which justified the compensation judge’s award. (Employee’s Brief, pp. 4-5.)

The employee did not mention the November incident or complain of any physical symptoms when he saw Dr. Kufahl in January and February 2017. LICSW Pierce Walsh wrote a four-page, single-spaced report of his evaluation of the employee on February 28, 2017. There was a detailed history of the stress the employee felt on the job but no specific mention of the November 2016 incident and no reference to any physical injury. Not until the employee saw Dr. Gregerson at the referral of his attorney in August 2017 is there any specific mention of the November incident in the records.

Similarly, Dr. Yarosh’s opinion does not establish a causal relationship between the physical injury to the employee’s little finger and his alleged mental injury. In concluding that the physical injury had temporarily aggravated the employee’s preexisting mental problems, Dr. Yarosh assumed the physical injury was of sufficient significance to result in emotional distress. The evidence clearly shows this was not the case.

This evidence is not sufficient to support the award. “Where healed injuries have not impaired an employee's ability to work and other possible causes of the mental injury are present, medical opinion that establishes a causal connection between the physical injury and the mental injury or disability is required before the mental injury can be found compensable ….” Bell v. Ind. Sch. Dist. 625, 65 W.C.D. 465, 469 (W.C.C.A. 2005) (emphasis added); Rindahl v. Brighton Wood Farm, 382 N.W.2d 855, 38 W.C.D. 473 (Minn. 1986); Greer v. Minn. Vikings Football Club, No. WC14-5693 (W.C.C.A. Sept. 30, 2014); Phan v. Radisson Hotel, 70 W.C.D. 358 (W.C.C.A. 2009), summarily aff’d (Minn. Aug. 26, 2009).^[2]

In summary, the employee presented no medical evidence of a causal relationship between his little finger injury on November 16, 2016, and his alleged anxiety. The compensation judge erred as a matter of law in finding the employee sustained a compensable mental injury through his fear of returning to work. The compensation judge’s decision is therefore reversed.

DOLI/VRU appealed the compensation judge’s failure to address its intervention claim for reimbursement of rehabilitation services and disbursements. Our decision that the employee failed to establish a compensable claim as a matter of law resolves the appellant’s intervention claim as well. Accordingly, we need not address the issues raised in the appellant’s brief of the intervenor.