EVIDENCE – EXPERT MEDICAL OPINION. The compensation judge did not err in relying upon an adequately founded medical expert opinion in determining that the employee did not sustain a work-related injury on July 31, 2020.
PRACTICE & PROCEDURE – ADEQUACY OF THE FINDINGS. The compensation judge did not err in not discussing portions of the employee’s testimony at hearing as she is not required to refer to or discuss each portion of evidence introduced at hearing.
Compensation Judge: Stacy P. Bouman
Attorneys: C. Jeremy Lagasse, Aaron Ferguson Law, St. Paul, Minnesota, for the Appellant. Jay T. Hartman, Heacox, Hartman, Koshmrl, Cosgriff, Johnson, Lane & Feenstra, P.A., City, St. Paul, for the Respondent.
THOMAS J. CHRISTENSON, Judge
The employee appeals from the compensation judge’s finding that the employee did not sustain a work-related injury in July 2020. We affirm.
Dana Handeland, the employee, presented claims for permanent partial disability, medical expenses, and rehabilitation benefits for asserted work-related injuries to the low back sustained on March 27, 2015, and July 31, 2020, while working for the self-insured employer, Target Corporation.
From 2009 until just prior to the 2015 injury, the employee had undergone regular chiropractic care and physical therapy for mid and lower back and left buttock pain. In the early months of 2015, he had also treated with a medical doctor and was diagnosed with left buttock pain and sciatica from performing leg exercises at the gym. A March 13, 2015, lumbar MRI showed sacralization of L5 on the right, diffuse disc bulging at L1-2 and L2-3 with mild narrowing of the spinal canal, an L4-5 posterior disc bulge with superimposed disc protrusion and caudal migration, annular fissure along the left subarticular zone, and impingement of the left L5 nerve root.
On March 27, 2015, the employee injured his low back while lifting a case of apples at work. Later that same day, the employee was seen by his chiropractor, Dr.Gary Kiekhoefer, for complaints of pain in the mid and lower lumbar spine. The employee characterized the pain as constant, sharp, and stabbing, and also reported that his back condition “deteriorated and the pain increased yesterday without cause.” (Ex. 2.)
On April 4, 2015, the employee was seen in the emergency department at Woodwinds Hospital for back pain. He reported that the pain was related to “lifting something heavy and had acute back pain about 4 weeks ago” and “about 8 days ago, he was lifting something at work once again and the pain flared up.” (Ex. 5.) Pain was noted in the left buttock radiating down the left leg and there was decreased range of motion and positive straight leg raising on the left. He was prescribed Percocet, diclofenac, Robaxin, and oral steroids and was to follow up with his primary clinic. The employee returned the next day reporting no relief from the medications. Examination findings were consistent with musculoskeletal peripheral back pain and he was diagnosed with lumbosacral disc herniation versus sciatica. The employee underwent a left L4-5 epidural steroid injection on April8, 2015, which reduced his pain by 60 percent.
On April 13, 2015, the employee was seen at Oasis Chiropractic for “acute tightness/stiffness, shooting and numbness discomfort of insidious onset left leg located in the lumbar, left sacroiliac, left buttock, left posterior knee, and left ankle region(s) aggravated even worse after working out using leg press.” (Ex. 7.) Previous episodes of the condition were denied by the employee. The employee was diagnosed with sciatica, lumbar IVD disorder with myelopathy, thoracic segmental dysfunction, cervical segmental dysfunction, and lower extremity segmental dysfunction. Recommended care included a spinal examination, surface EMG, x-rays, and continued chiropractic care.
On April 17, 2015, the employee was seen by Dr. David Olson at Allina Health Clinic for ongoing left leg and lower back pain. The employee was assessed with an exacerbation of a pre-existing disc problem at work. Percocet and gabapentin were prescribed and an MRI scan was ordered. On April 20, 2015, the employee was seen for a sports consultation at Allina Health Clinic and complained of pain from the left hip into the toes. On examination, straight leg raising was positive on the left. He was diagnosed with lumbar radiculopathy.
The employee underwent a second MRI scan on April 24, 2015, which revealed transitional thoracolumbar and lumbosacral junctions with sacralization of L5, left parasagittal disc herniation at L4-5 with caudal extension of extruded portion, and impingement on the shoulder of the traversing L5 nerve root. Dr. Olson noted that there was no change from the employee’s pre-injury March 13, 2015, MRI scan. The employee was then released to work with restrictions.
On May 5, 2015, the employee underwent another steroid injection which provided 25percent relief of his symptoms. The employee was seen again on May 12, 2015, and on examination, positive straight leg raising on the left and constant numbness was noted. Dr.Olson prescribed Lyrica and a Lidoderm patch. By July 29, 2015, he was discharged from physical therapy. On August 5, 2015, Dr. Olson deemed the employee to have reached maximum medical improvement (MMI) with no rated permanency.
From 2015 through 2020, the employee continued receiving chiropractic care from Dr.Kiekhoefer for symptoms resulting from various non-work-related activities. The employee treated at Allina Health on a few occasions in 2017 and 2018 for low back complaints, and was referred to physical therapy. In 2019, while playing softball, the employee tore his left hamstring. This injury impacted his left exterior buttock down to the Achilles tendon.
On July31, 2020, while pulling a pallet of juice boxes at work, the employee experienced left lower extremity pain. He attributed the pain to his hamstring condition and not to his work activities. (T. 80.) On August 4, 2020, the employee underwent a left lower extremity ultrasound which was unremarkable. The employee had notified his supervisor of the medical visit via text message, however, there is no indication that the employee stated that the visit was related to any work injury.
On August 8, 2020, the employee presented at the emergency department of Woodwinds Health Campus with complaints of increased pain in the left buttock over the prior ten days. An MRI scan revealed moderate right and mild-to-moderate left foraminal stenosis at L4-5, along with severe left and moderate right lateral stenosis at L4-5. A broad-based posterior disc bulge was noted at L4-5. The assessment was lumbar radiculopathy.
The employee was then evaluated at MHealth Spine Center Maplewood for low back and left lower extremity pain on August 14, 2020. He explained that he was attempting to re-open his April 2015 workers’ compensation claim. The examination revealed normal strength and reflexes in the lower extremities and his pain was noted to be related to lumbar radiculopathy. Gabapentin and naproxen were prescribed and physical therapy was ordered.
The employee presented again at the emergency department for low back pain. He was administered Dilaudid for pain management. On August 25, 2020, he underwent a left L4-5 steroid injection which provided a 60 percent reduction in pain. An L5-S1 injection was administered on October 7, 2020, which reduced his pain by 10 percent.
On October 7, 2020, the employee was seen by Dr. Daniel Hanson of the Minnesota Spine Institute for low back, bilateral legs, and right foot pain after pulling a pallet of juice on July31, 2020. Dr. Hanson diagnosed bilateral lumbar radiculopathy in an S1 pattern caused by repetitive heavy lifting at work and recommended a hemilaminectomy surgery.
A first report of injury was prepared for the July 31, 2020, injury on October15, 2020, which indicated that the employee suffered an injury to his low back, bilateral leg, and right foot following repetitive lifting. (Ex. D.)
The employee underwent bilateral L5 hemilaminectomies, medial facetectomies and foraminotomies performed by Dr. Hanson at the Center for Restorative Surgery on November12, 2020. (Ex. 8.) The employee was seen for post-surgery follow up visits with Dr.Hanson on February 5 and May3, 2021. Based upon ongoing symptoms, an MRI scan was ordered which revealed transitional S1-2 segment, previous left L5 hemilaminectomy, and multilevel disc dehydration with no evidence of severe neurologic compression.
On April 5, 2021, the employee was seen again by Dr.Hanson and was assessed with spondylosis. In the absence of neurological symptoms, the employee was not considered to be a surgical candidate and conservative management was recommended.
On January 29, 2021, Dr. Wahlquist performed an independent medical examination of the employee on behalf of the employer. In his March 2, 2021, report, Dr.Wahlquist opined that the employee suffered from degenerative disc disease. He noted that the employee had transitional anatomy at L5-S1 and had undergone an L5-S1 hemilaminectomy and lateral recess decompression which, given the transitional level, was equivalent to a bilateral L4-5 procedure. It was Dr.Wahlquist’s opinion that the employee had a disc herniation prior to the March 27, 2015, date of injury that was related to the employee’s gym activities based upon the MRI scans. He opined that neither the March27, 2015, or the July 31, 2020, incident were substantial contributing causes of the employee’s current low back condition. Instead, the pre-existing, non-work-related disc herniation had naturally progressed and was the substantial contributing cause of the employee’s disability and need for medical care and ongoing restrictions. He also opined that the employee’s treatment for the disc herniation was reasonable and necessary but not causally related to the employee’s claimed work injuries. Finally, he indicated that MMI was reached on February 4, 2021, that any permanent partial disability (PPD) was unrelated to any claimed work injury, and that no restrictions were required.
Dr. Hanson prepared a narrative report dated July 6, 2022. Dr. Hanson opined that the employee had a history of low back pain with left leg radicular symptoms prior to the dates of injury. He also opined that the March 27, 2015, injury was an acute strain/sprain injury which resolved without the need for ongoing treatment and was not a substantial contributing factor to the employee’s current condition and need for treatment. Finally, he opined that as a result of the March27, 2015, injury, the employee did not require any restrictions, suffered no PPD, and reached MMI on April 3, 2015. According to Dr. Hanson, the employee’s July 31, 2020, injury caused severe low back pain with lumbar radiculopathy, the previous left L4-5 disc herniation had resorbed, and on July 31, 2020, the employee developed a broad-based L4-5 disc herniation (at the transitional L5-S1 level) in the setting of pre-existing bilateral L4-5 lateral recess stenosis, which later caused severe compression of the nerve roots due to the protuberant disc herniation. Dr.Hanson opined that this injury was a substantial contributing cause of his need for treatment, including conservative care and surgery to decompress the nerves at the L4-5 (transitional L5-S1) level. Dr.Hanson further opined that the employee would need future medical treatment and was permanently restricted to light-duty work, limiting lifting, pushing, and pulling to 20 pounds and changing position as needed. Finally, he opined that the employee had reached MMI and had a PPD rating of 27 percent.
Dr. Wahlquist reviewed the report of Dr. Hanson and issued an addendum report on August 12, 2022. He maintained his opinion that the employee’s low back symptoms on July31, 2020, were a continuation and normal progression of the employee’s pre-existing, non-work-related disc herniation. Support for this opinion included the employee’s episodic back pain prior to July 31, 2020, which indicated that the degeneration was continuous. He modified the employee’s PPD rating, but maintained that the PPD was unrelated to the employee’s claimed work injuries.
A hearing was held before the compensation judge and a findings and order was issued on October 3, 2022. The compensation judge found that the employee had a significant prior history of low back pain prior to March 27, 2015, and that the preponderance of the evidence supports a finding that the March 27, 2015, injury was a temporary aggravation of the employee’s pre-existing personal degenerative condition which resolved no later than July 16, 2015. The compensation judge further determined that the evidence did not support the employee’s recollection that his employment caused his symptoms on July 31, 2020, and found that the employee did not report the July 2020 injury immediately, but instead only communicated complaints of symptoms to the employer. The judge therefore denied the employee’s claims.
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, 37W.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 employee argues that the compensation judge’s decision is not supported by substantial evidence because the judge failed to properly analyze the medical records, ignored evidence favorable to the employee, erroneously rejected the employee’s testimony as unreliable, and erred in accepting Dr.Wahlquist’s expert medical opinion. We are not persuaded.
The employee asserts that the testimony regarding the reporting of the July31, 2020, date of injury was not fairly discussed or referenced by the compensation judge in her findings or memorandum, and that his testimony was not considered. We reject this assertion. The evidence, which the employee claims was not considered, was entered into the record through testimony before the compensation judge, was contained in the medical record exhibits introduced at hearing, and was referenced in the findings and order and in the judge’s memorandum. The absence of a reference to evidence does not mean that the evidence was not considered. We note that “[a] compensation judge is not required to refer to or discuss every piece of evidence introduced at the hearing.” Regan v. VOA Nat’l Hous., 61 W.C.D. 142, 149 (W.C.C.A. 2000),summarily aff’d(Minn. Apr. 6, 2001);see alsoRuby v. Casey’s Gen. Store, 71W.C.D. 535 (W.C.C.A. 2011),summarily aff’d(Minn. Sept. 28, 2011);Lowell v. Lee Stamping, 63W.C.D. 304 (W.C.C.A. 2003),summarily aff’d(Minn. Apr. 29, 2003). The judge’s decision is sufficient when the findings decide all questions of law and fact submitted and substantial evidence in the record supports the compensation judge’s conclusion. Cochran v. Target Stores, No.WC16-6013 (W.C.C.A. June5, 2017).
Further, the employee proposes a different set of inferences from the evidence and does not show that the compensation judge made any mistake of fact or law. Where evidence is conflicting or more than one inference may reasonably be drawn from the evidence, the findings of the compensation judge are to be upheld. Redgate v. Sroga’s Standard Serv., 421 N.W.2d 729, 734, 40 W.C.D. 948, 957 (Minn. 1988).
The employee also contends that Dr. Wahlquist’s medical opinions are incorrect and that the compensation judge’s reliance on those opinions warrants reversal. There was no foundational objection to Dr.Wahlquist’s reports made at the time of hearing. It is apparent from the compensation judge’s findings that she considered not only the medical evidence, which included various medical records and physician reports provided by both parties, but also contemplated the testimony of the employee and his supervisor in reaching her decision. The compensation judge relied on Dr.Wahlquist’s opinion that the 2020 exacerbation of the employee’s symptoms resulted, not from a new work injury or continuation of the 2015 work injury, but from deterioration of his underlying degenerative disc disease. A decision based on the compensation judge’s choice between competing medical opinions will generally be affirmed when the opinions relied upon have adequate foundation. Nord v. City of Cook, 360 N.W.2d 337, 37W.C.D. 364 (Minn. 1985);Smith v. Quebecor Printing, Inc., 63 W.C.D. 566 (W.C.C.A. 2003),summarily aff’d(Minn. Aug. 15, 2003). There is no reason to depart from the general rule in this case.
The employee bears the burden of proof to show that the claimed injury on July31, 2020, arose out of employment and substantial evidence supports the compensation judge’s determination that he failed to do so. While we acknowledge the employee’s testimony regarding his symptoms, the compensation judge was not required to fully accept that testimony when contrary conclusions could reasonably be drawn from the medical evidence. The compensation judge’s decision included evaluating the employee’s reliability and credibility as a witness. This court must give deference to the compensation judge with respect to the assessment of witnesses’ credibility.Tolzmann v. McCombs Knutson Assocs., 447 N.W.2d 196, 42 W.C.D. 421 (Minn. 1989). Substantial evidence supports the compensation judge’s decision that the employee did not suffer a work-related injury on July31, 2020. Accordingly, we affirm.