CAUSATION – SUBSTANTIAL EVIDENCE. A medical opinion is not necessarily unopposed, even though there is no competing medical opinion, when the record contains other evidence contradictory to that opinion.
Compensation Judge: Grant Hartman
Attorneys: Lucas V. Cragg, Teplinsky Law Group, Ltd., Minneapolis, Minnesota, for the Respondent. David O. Nirenstein and Kelly B. Nyquist, Fitch, Johnson, Larson & Held, P.A., Roseville, Minnesota, for the Appellants.
Affirmed.
GARY M. HALL, Judge
The employer and insurer appeal the compensation judge’s finding that the employee’s bilateral hernia condition was causally related to his work injury. We affirm.
On September 26, 2018, Dick Wilkins, the employee, was injured while working as a forklift operator for United States Distilled Products, the employer, which was insured for workers’ compensation liability by Great American Insurance. The employee was picking up a case weighing about 30 pounds when his right foot was caught under a pallet. He lost his balance and twisted his back while still holding the case, experiencing a burning sensation in his left groin. He reported the injury to his supervisor on that date and completed an incident report, describing the injury as a left groin pull and abdominal strain. He did not seek medical attention initially and continued his regular duty work. The employee testified that he continued to experience some discomfort in his left groin, that he curtailed his hobbies and household chores, and that he experienced increased pain over time.
The employee first treated for left groin pain on March 8, 2019, with Dr. Kevin Stiles, who diagnosed the employee with a hernia, gave him light duty restrictions, and referred the employee to a general surgeon. On a fitness-for-duty form completed on March 11, 2019, Dr. Stiles listed the date the employee’s condition began as September 26, 2018. A first report of injury completed on March 12, 2019, listed the employee’s hernia diagnosis from Dr. Stiles.
The employee was evaluated by Dr. Damon Campbell at CentraCare Health on March 15, 2019. Dr. Campbell noted that the employee reported he had experienced pain in his left groin in September while lifting at work and that the pain had come and gone, but had increased over the previous few weeks. The employee did not report any right-sided symptoms. Dr. Campbell conducted a physical examination of the employee, observing noticeable left-sided swelling and detecting a small hernia on the right side. Based on these findings, Dr. Campbell diagnosed the employee with bilateral inguinal hernias and recommended laparoscopic surgical repair. Dr. Stiles took the employee off work on March 20, 2019. A note in the employee’s CentraCare Health records dated March 21, 2019, indicated that paperwork was needed regarding authorization of surgery under workers’ compensation. Another note dated April 17, 2019, indicated that the employee’s health insurance would instead be used.
On April 25, 2019, the employee underwent laparoscopic bilateral inguinal hernia repair surgery performed by Dr. Campbell. The preoperative diagnosis was listed as “Bilateral inguinal hernias, left attributed to injury at work.” (Ex. E.) The employee returned to his regular work without restrictions on June 2, 2019. In January 2020, the employee experienced pain and swelling in his left groin for several days. A CT scan showed a recurrent large left inguinal hernia and the employee underwent another hernia repair surgery on January 2, 2020, performed by Dr. Andrea Kales. The employee was released to return to his regular work as of March 2, 2020.
On February 6, 2020, the employee was evaluated by Dr. Michael England at the employer and insurer’s request. Dr. England opined that the employee’s bilateral hernias were not caused by the September 2018 work incident based on the gap in treatment and on his conclusion that the mechanism of the injury as described by the employee was inconsistent with the employee’s condition.
The employee claimed temporary total disability benefits and medical expenses. The employer and insurer denied liability, arguing that the employee’s bilateral hernia condition was not causally related to the September 2018 work injury because he was able to work without any modifications, he did not report any additional issues at work until March 2019, and there was no medical causation opinion supporting the employee’s claim. After a hearing on March 5, 2020, the compensation judge found that the employee’s bilateral hernia condition was causally related to his work injury and awarded the employee’s claims. The employer and insurer appeal.
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 found that the employee’s bilateral hernia condition was causally related to the work injury. The judge noted that the employee’s primary complaint was left-sided pain and that the asymptomatic right-sided hernia was smaller, and determined that it was plausible that both hernias occurred on the date of injury. The employer and insurer argue that substantial evidence does not support the compensation judge’s finding that the employee’s bilateral hernia condition was caused by his September 2018 work injury. They assert that the employee’s hernia condition is only identified as work-related where self-reported by the employee, that the employee did not specify that his condition started at work when he first sought treatment, and that the only expert opinion in the record is that of Dr. England, who opined that the employee’s hernias were not causally related to his work injury. The employer and insurer further assert that substantial evidence does not support the compensation judge’s finding of causation for the right-sided hernia, arguing that the employee did not report right-sided symptoms at the time of his injury and that there is no medical support indicating that the mechanism of the injury was related to the development of a right-sided hernia.
Causation is a question of fact for the compensation judge to determine. Felton v. Anton Chevrolet, 513 N.W.2d 457, 459, 50 W.C.D. 181, 184 (Minn. 1994). The issue for this court is whether the decision of the compensation judge is supported by substantial evidence when considering the entire record. See Bender v. Dongo Tool Co., 509 N.W.2d 366, 49 W.C.D. 511 (Minn. 1993). While a medical opinion as to causation is desirable in making a case to a compensation judge, it is not always required. In addition to medical opinions, a judge may base his or her conclusions on other reliable evidence in the record. See Reimer v. Minnit Tool/M.I.T. Tool Corp., 520 N.W.2d 397, 398, 51 W.C.D. 153, 154 (Minn. 1994) (a medical opinion connecting an employee’s return of carpal tunnel syndrome symptoms to post-injury employment was not essential for a finding of causation).
The employer and insurer argue that the compensation judge is not free to disregard unopposed medical testimony, referring to Dr. England’s opinion regarding causation. See Olson v. Midwest Printing Co., 347 N.W.2d 43, 46, 36 W.C.D. 623, 627 (Minn. 1984) (citing DeHaan v. Farmers Union Mktg. & Processing Ass’n, 302 Minn. 552, 225 N.W.2d 21, 27 W.C.D. 682 (1975)). A compensation judge may not ignore or “disregard” uncontroverted medical opinion. See Flansburg v. Giza, 284 Minn. 199, 201-02, 169 N.W.2d 744, 746, 25 W.C.D. 3, 6 (1969). There is a difference, however, between disregarding an unopposed medical opinion and rejecting that opinion based on other evidence. See Ruether v. State, 455 N.W.2d 475, 478, 42 W.C.D. 1118, 1123 (Minn. 1990) (expert medical opinion is not necessarily unopposed where other medical evidence exists to the contrary); Clark v. Archer Daniels Midland, 50 W.C.D. 363 (W.C.C.A. 1994), summarily aff’d (Minn. May 23, 1994). This court has recognized that even though unopposed expert medical testimony cannot be disregarded, such testimony is not necessarily conclusive upon a trier of fact. Palmer v. ELO Eng’g, slip op. (W.C.C.A. June 28, 2005) (citing Tuomela v. Reserve Mining Co., 299 Minn. 203, 204, 216 N.W.2d 638, 639, 27 W.C.D. 312, 313 (1974) (per curiam)); see also Sutherland v. Metro. Council Transit Operations, slip op. (W.C.C.A. Oct. 14, 1997).
Although the medical record in this case does not contain an express causation opinion supporting the employee’s claim, there are references in the medical records that the employee’s symptoms had started at work and the employee had testified that he had ongoing symptoms that worsened before he sought treatment. The judge’s decision was also based on the credibility of the employee’s testimony as to the nature of his symptoms over time. An employee is most familiar with the severity of his or her symptoms, and the judge did not err by relying on that testimony. See Brening v. Roto-Press, Inc., 306 Minn. 562, 237 N.W.2d 383, 28 W.C.D. 225 (1975). In determining that it was plausible that both of the employee’s hernias occurred on the date of injury, the compensation judge was clearly aware that the employee’s primary complaint was left-sided pain, but the judge also considered that Dr. Campbell had indicated that the right-sided hernia was smaller and was not apparent until the March 15, 2019, examination.
The compensation judge found that the employee’s testimony regarding the nature and mechanism of his injury was credible and was supported by the initial incident report and the medical records, and went on to conclude that the employee’s bilateral hernia condition was caused by his work injury. Substantial evidence supports the compensation judge’s decision, and we affirm.