VERN W. HELING, Employee/Respondent, v. BLACK HORSE CARRIERS, INC., and GREAT WEST CAS. CO., Employer-Insurer/Appellants.

The employer and insurer have appealed the compensation judge’s determination that the employee’s work injury of January 30, 2015, is a substantial contributing factor in the employee’s need for shoulder replacement surgery.  We affirm.

Vern Heling was employed as a truck driver by Black Horse Carriers, delivering products to Aldi Foods.  The products were transported on pallets in the truck and the employee loaded and unloaded the pallets using a pallet jack.  The employee testified that the load would shift in the truck at times and he would need to rearrange the pallets so the load would not fall over and result in breakage.  He straightened the pallets by pushing against the load with his left shoulder. As he did this on January 30, 2015, he felt popping and immediate pain in his left shoulder.  The employer and insurer admitted liability for the work injury.

In June 2011, when Mr. Heling started working for the employer, he had no prior history of left shoulder problems.  He had sustained an earlier work injury to his left shoulder in January 2013.  He was treated with physical therapy until July 2013 and continued to do his regular job.  He had no ongoing symptoms of left shoulder pain after that time.

Following the 2015 injury, the employee treated with Dr. Clinton Muench, an orthopedic surgeon at Orthopedic and Fracture Clinic.  The employee’s complaints when he started treating with Dr. Muench included pain, decreased strength, and limited range of motion.  An MRI scan done on February 18, 2015, was read as showing a likely full-thickness tear of the supraspinatus tendon, degenerative changes of the glenohumeral joint, and subdeltoid bursitis.

The employee initially treated conservatively with steroid injections and physical therapy.  He continued to have shoulder pain and restricted range of motion despite the therapy.  The employer provided light-duty office work.  However, the employee testified he did not care for office work and instead found work as a truck driver with another employer where he did not have to load or unload the truck.

In January 2016, Dr. Muench recommended a total shoulder arthroplasty and rotator cuff repair. At the request of the employer and insurer, the employee was evaluated by Dr. Scott McPherson, an orthopedist, on February 13, 2016.  In his report, dated March 7, 2016, Dr. McPherson opined that the rotator cuff tear was related to the work injury and the surgery for that condition was reasonable treatment. He concluded that the additional diagnosis of osteoarthritis was a “personal developmental-type age-related problem not related to the work injury.”  It was also his opinion that arthroplasty would not be appropriate in any event since the employee wanted to continue working as a truck driver, an occupation Dr. McPherson described as “fairly stressful labor.”

The employer and insurer denied the arthroplasty and rotator cuff surgery recommended by Dr. Muench.  The employee decided to proceed with the rotator cuff surgery as approved by Dr. McPherson, which Dr. Muench performed in July 2016 and was paid for by the employer and insurer.  Following that surgery, the employee continued to experience left shoulder pain, diminished strength, and restricted motion.  Dr. Muench continued to recommend left shoulder arthroplasty surgery. The employee requested approval for that surgery, which the employer and insurer denied.

The employee’s claim for arthroplasty surgery approval was heard by a compensation judge on October 9, 2018.  The employee’s medical records relating to his left shoulder, the opinion of Dr. McPherson, and the deposition testimony of Dr. Muench were presented to the compensation judge.  The employee also testified.

In the Findings and Order issued on November 8, 2019, the compensation judge determined that the January 30, 2015, work injury substantially aggravated the employee’s pre-existing asymptomatic condition and that the work injury was a substantial contributing factor in the need for the left shoulder arthroplasty proposed by Dr. Muench.

The employer and insurer have 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 compensation judge determined that the employee’s left shoulder injury of January 30, 2015, is a substantial contributing factor and is causally related to employee’s need for left shoulder arthroplasty as recommended by Dr. Muench.  The issue for this court is whether the decision of the compensation judge is supported by substantial evidence when considering the entire record.  Bender v. Dongo Tool Co., 509 N.W.2d 366, 49 W.C.D. 511 (Minn. 1993).

The parties presented two competing medical opinions for consideration.  The opinions were in agreement that the surgery was necessary in substantial part because of osteoarthritis in the shoulder.  The employee’s treating doctor, Dr. Muench, testified that, in his opinion, the employee’s pre-existing, asymptomatic osteoarthritis was aggravated by the traumatic work injury of January 30, 2015, and that the work injury was a substantial contributing factor in the need for the shoulder arthroplasty he was recommending.  The independent medical examiner, Dr. McPherson, stated in a supplemental report dated October 7, 2019, that in his opinion, the shoulder surgery was reasonable and necessary to treat the employee’s condition, but that the surgery was not related to the work injury.

This court has held that the choice between two well-founded medical opinions is a question for the compensation judge which this court will generally affirm.  Smith v. Quebecor Printing, 63 W.C.D. 566 (W.C.C.A. 2003), summarily aff’d (Minn. Aug. 15, 2003).  The employer and insurer argue that this rule does not apply in the present case because Dr. Muench’s opinion lacked adequate foundation.  Specifically, the appellants contend that Dr. Muench was not aware of the employee’s left shoulder complaints and treatment in 2013.  On cross-examination in his deposition, Dr. Muench admitted having limited knowledge of the employee’s shoulder problems in 2013.  On redirect examination, however, he was provided with additional information concerning the earlier work injury and he stated that this additional information did not change his opinions.  We also note in this regard that Dr. McPherson did not find the 2013 injury to be relevant to the employee’s current condition.

The compensation judge found that Dr. Muench had relied on the employee’s reported history that he had no significant issues with his left shoulder before 2015.  The compensation judge noted in his memorandum that the employee’s reported history was consistent with his testimony that he had no ongoing symptoms, restrictions, or treatment for his left shoulder for about three years prior to the work injury.

We agree with the compensation judge that Dr. Muench had adequate foundation for his opinions.  The compensation judge found those opinions to be persuasive.  We conclude the decision of the compensation judge is supported by substantial evidence and the decision is affirmed.