JOYCE CAGLE, Employee/Appellant, v. ST. BENEDICT’S CHURCH and CATHOLIC MUT. GRP., Employer-Insurer/Respondents.

This matter was remanded for a determination of issues related to collateral estoppel, causation, and reasonableness and necessity of medical treatment that were raised at hearing but not adequately addressed in a prior findings and order.  From the findings and order on remand, the employee appeals the compensation judge’s finding that the employer and insurer are not barred by collateral estoppel from raising a causation defense.  The employee also appeals the finding that proposed surgery is not reasonable or necessary.  We affirm, in part, and reverse, in part, affirming the denial of medical treatment.

Joyce Cagle, the employee, sustained low back and hip injuries lifting a couch while working for St. Benedict’s Church, the employer, on February 3, 2012.  The employer and its insurer admitted liability and paid benefits.  The employee underwent both low back and right hip surgeries with good results.

Over time her left hip became painful and the employee first sought treatment for the left hip a year after the injury.  Diagnostic tests of the left hip were ordered.  An August 2013 MRI scan revealed a probable left hip labral tear and a December 2013 CT scan showed femoral neck impingement in both hips.  In 2017, the employee was examined by Mark Gregerson, M.D.  In his August 9, 2017, report, Dr. Gregerson noted pain and loss of range of motion in both the right and left hips during the physical examination.  He further observed femoral neck impingement on the right hip and similar findings on the left hip in a CT scan of both hips on December 23, 2013.  He diagnosed right hip femoral neck impingement and a labral tear secondary to the February 3, 2012, work injury, and also noted that the MRI scan of August 23, 2013, showed a probable anterior labral tear of the left hip. 

In June 2018, the parties entered into a settlement agreement, closing out benefits except for future medical expenses related to the low back, right hip, and left hip.  Two months after the award on stipulation was filed, the employee sought left hip treatment with Christopher Larson, M.D., the orthopedic surgeon who previously performed surgery on her right hip.  The diagnosis on August 8, 2018, was again femoral neck impingement and labral tear.  Dr. Larson recommended an anesthetic injection of the left hip to determine whether left hip surgery would be appropriate.  The injection was described as diagnostic rather than therapeutic and was reported as performed on August 17, 2018.  The employer and insurer sought the opinion of Bradley Helms, M.D., who opined that the treatment for both of the employee’s hips was not related to the work injury.

The employer and insurer denied payment of the August 2018 treatments, and the employee filed a claim petition on March 26, 2019.  In the employer and insurer’s answer of April 3, 2019, the employer admitted that it has been “judicially determined that Employee sustained work-related injuries to her low back, right hip, and left hip on February 3, 2012.”  The matter went to hearing in March 2020.  In an unappealed Findings and Order of May 4, 2020, the compensation judge dismissed the opinion of Dr. Helms and adopted the opinion of Dr. Gregerson in finding that the left hip treatment in August 2018 was causally related to the employee’s work injury of February 3, 2012.^[1]

On July 27, 2020, the employee returned to Dr. Larson who noted an “improved status post right hip arthroscopy with increasing pain on the left side, Workers’ Compensation.”  To address the increasing left hip pain, Dr. Larson recommended an injection and possible arthroscopic femoral resection osteoplasty and labral repair.  On September 3, 2020, the employee filed a medical request for the recommended surgery.

The employer and insurer sought the medical expert opinion of Loren Vorlicky, M.D., who reviewed medical records, took a medical history from the employee, examined the employee, and drafted a narrative report of December 16, 2020.  He reported that the employee gave a medical history statement that the left hip injection given by Dr. Larson was not helpful.  On examination, Dr. Vorlicky noted full range of motion of both hips with no pain or weakness.  Radiographic evidence of the left hip, he reported, showed femoral acetabular impingement and a small labral tear.  Noting that the employee had no left hip symptoms immediately after the work injury, he opined that the findings of “femoral acetabular impingement are longstanding and unrelated to the event of February 3, 2012.”  Dr. Vorlicky gave no opinion regarding the causal relationship between the work injury and the labral tear of the left hip for which surgery was recommended.  He concluded that the employee would have a poor surgical result.

The matter was heard before the same compensation judge on May 5, 2021.  The employee argued that the causation issue was previously litigated and decided in the 2020 findings and order.  As such, she argued, the doctrine of collateral estoppel prevented the employer and insurer from relitigating the causal relationship between the work injury and the employee’s left hip condition and treatment.  The compensation judge did not address the employee’s argument and found that the left hip condition was not related to the 2012 work injury.  The judge made no finding that the employer and insurer were barred from relitigating the causation issue and made no specific finding that the proposed left hip surgery was reasonable or necessary.   The employee appealed and this court vacated the denial of the surgery and remanded the matter for specific findings related to the issues that were raised by the parties but not addressed by the compensation judge.  Cagle v. St. Benedict’s Church, No. WC21-6425 (W.C.C.A. Feb. 18, 2022).

On remand, no additional testimony or evidence was presented.  By Findings and Order on Remand served and filed May 24, 2022, the compensation judge made specific findings on the issues.  The judge found under the doctrine of collateral estoppel that the employer and insurer were not estopped from litigating the causation issue, stating that Dr. Gregerson’s opinion submitted into evidence at the 2020 hearing did not address the left hip condition.  The judge also found that the proposed left hip surgery was not reasonable and necessary.  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 remand, the compensation judge concluded that the 2020 findings and order did not prevent the employer and insurer from litigating the issue of the nature and extent of the February 3, 2012, injury.  The judge found that the previous finding was solely related to the two dates of service which were diagnostic in nature and did not address the relationship between the employee’s ongoing left hip condition and the work injury.  The compensation judge also found that the left hip surgery was not reasonable and necessary.  He based this finding on several factors including that the surgery was not recommended for two years following the 2018 procedures, that Dr. Vorlicky opined that the employee would have a poor surgical result, and that there was conflicting evidence regarding the relief from the injection given.  The employee appeals both issues.

We first address the employee’s appeal of the finding that collateral estoppel did not bar the employer and insurer from relitigating the causation issue.  The employee relies on the judge’s prior 2020 finding to assert that the left hip condition was found to be causally related to the work injury and that the compensation judge’s attempt to limit the scope of that finding is erroneous.  She argues that on remand, “without taking additional evidence, [the compensation judge] essentially stated, in conclusory terms, that he did not mean to say what his finding said.”  (Appellant’s brief at 7.)  Instead, she contends that the 2020 finding should have the full legal effect given at the time it was made that the left hip condition was causally related to the work injury.  The employee’s point appears well taken.

Collateral estoppel, also called “issue preclusion,” applies to specific issues that have previously been adjudicated.  Mach v. Wells Concrete Prods. Co., 866 N.W.2d 921, 927, 75 W.C.D. 279, 286 (Minn. 2015).  Under this doctrine, once a court has decided an issue of fact or law necessary to its judgment, that decision may preclude relitigating the issue on the same or a different cause of action involving a party to the first case.  The doctrine applies when the issue was identical to one in a prior adjudication, there was a final judgment on the merits, the estopped party was a party or in privity with a party to the prior adjudication, and the estopped party was given a full and fair opportunity to be heard on the adjudicated issue.  Nelson v. Am. Family Ins. Grp., 651 N.W.2d 499, 511 (Minn. 2002) (quoting Willems v. Comm’r of Pub. Safety, 333 N.W.2d 619, 621 (Minn. 1983)).  The party asserting collateral estoppel has the burden to prove that the issue was presented and necessarily determined in the earlier action.  See Lange v. City of Byron, 255 N.W.2d 226, 228 (Minn. 1977).

In this case, the application of collateral estoppel is a mixed question of law and fact which we will consider de novo.  See Hauschildt v. Beckingham, 686 N.W.2d 829, 837 (Minn. 2004); Care Inst., Inc.-Roseville v. Cnty. of Ramsey, 612 N.W. 2d 443, 446 (Minn. 2000).  Here, there is no dispute that the prior adjudication on the employee’s claim in 2020 was a final judgment, involved the same parties, and there was a full and fair opportunity to be heard.  The only question is whether the issues are identical.

In the prior 2020 litigation, the employee claimed that the treatment to her left hip was not only reasonable and necessary, but also causally related to the work injury.  Relying on Dr. Gregerson’s report, the judge found that the treatment for the left hip was causally related to her work injury.  The employer and insurer chose not to appeal this decision and this court lacks jurisdiction to consider the merits of the 2020 decision.  See Publicover v. Voltelcon, 64 W.C.D. 231 (W.C.C.A. 2004), summarily aff’d (Minn. June 29, 2004).  In 2021, the employee made a claim for more treatment for the left hip, this time for surgery.  The employee relied on the prior finding that a causal connection had already been established and argued that the employer and insurer were estopped from raising a defense to the causation issue.   On remand, in what appears to be an inconsistent result, the judge disagreed and found that the medical expert opinion of Dr. Gregerson, adopted in the prior hearing to establish a causal connection, could not be relied upon for the surgical issue because that expert did not actually offer an opinion regarding the left hip condition.   The judge also stated that in his 2020 decision there were no findings related to the nature and extent of the 2012 injury, and that the issue was only for treatment related to dates of service that were “diagnostic in nature and in no way address the ongoing relationship between the employee’s ongoing left hip condition and the February 3, 2012, work injury.”  (Finding 3.)  We note that the judge did not indicate in his 2020 finding that the 2018 treatment was causally related to the work injury because it was diagnostic in nature.  Further, while Dr. Larson’s August 8, 2018, medical record describes the anesthetic injection as diagnostic rather than therapeutic, the injection was recommended in order to determine whether the proposed surgery was appropriate, not to determine the employee’s diagnosis or the cause of her diagnosis.

Inherent in the Workers’ Compensation Act is the ongoing nature of an employer’s liability for medical treatment.  Mach, 866 N.W.2d at 927, 75 W.C.D. at 287.   Liability continues until the effects of an injury are cured or symptoms are relieved.  Id.; see also Minn. Stat. § 176.135, subd. 1a.  Absent a change of condition or new facts, an employee should not be forced to undertake the expense of relitigating the matter.  Mach, 866 N.W.2d at 928, 75 W.C.D. at 288.  Collateral estoppel does not apply when an employee’s medical condition has changed.  Id. The 2020 findings and order is replete with references to the employee’s bilateral hip pain and specifically left hip pain. In addition, the stipulation for settlement left open medical treatment for the left hip and the judge rejected Dr. Helm’s opinion that treatment for the bilateral hips was not related to the work injury.  The judge plainly found that the evidence provided at the 2020 hearing showed the employee’s treatment with Dr. Larson on August 8, 2018, and August 17, 2018, was “causally related to her work injury of February 3, 2012.”  (Finding 18.)  At the second hearing, there were no new facts to sever the previous causation finding.  There were no new injuries or change of condition.  The 2021 medical issue was to the same body part and carried the same diagnosis as the 2020 medical issue. The issue of whether reasonable and necessary medical treatment for the employee’s left hip was causally related to the work injury was the same at both hearings.  Based on the doctrine of collateral estoppel, we reverse the judge’s finding that the treatment for the left hip was not causally related to the work injury.

As to the issue of whether the proposed left hip surgery was reasonable and necessary, the compensation judge determined that the employee did not meet her burden of proof.  The judge found that the surgeon, Dr. Larson, indicated an injection on the left hip could be considered to assess the reasonableness of left hip surgery and that the employee’s testimony regarding the efficacy of the injection was inconsistent.  Furthermore, Dr. Vorlicky took a medical history from the employee and reported that the employee’s injection did not work and that the employee would have a poor surgical result.  Based on substantial evidence, the compensation judge reasonably concluded that the proposed left hip surgery was not reasonable and necessary, and we therefore affirm the denial of the employee’s left hip surgery.