BARBARA J. BROERS, Employee/Appellant,
v.
E.F. JOHNSON and SENTRY INS. GROUP, Employer-Insurer.
Minnesota Workers Compensation
Workers' Compensation Court of Appeals
February 27, 2002
HEADNOTES
EVIDENCE
- CREDIBILITY; NOTICE OF INJURY; CAUSATION - SUBSTANTIAL
EVIDENCE. Where the judge identified the employee's
credibility as an issue, and where the employee had not
alleged a separate, subsequent, work-related injury or
aggravation prior to her testimony at hearing, the
compensation judge's conclusion that the employee did not
sustain a separate work-related injury or aggravation one
month after her admitted work injury was not clearly
erroneous and unsupported by substantial evidence, and the
issue of notice of such an injury was moot.
MEDICAL
TREATMENT & EXPENSE - REASONABLE &
NECESSARY. Where the employee's original symptoms
had been confined to her wrist and now ranged all the way up
her arm and into her shoulder and neck and face and ear,
where the injury at issue was originally diagnosed as a wrist
tendonitis while the medical treatment at issue was
recommended as a diagnostic and therapeutic measure to
address a possible thoracic outlet syndrome, where medical
records indicated that thoracic outlet syndrome had at least
twice been ruled out previously, where the employee had now
seen over twenty different physicians in connection with her
broadly varying complaints, none of them able ultimately,
even upon evidence of completed surgery, to conclusively
diagnose her problems beyond her early diagnosis of
tendonitis, and where, in the opinion of the independent
medical examiner, the employee's broadly ranging symptoms
were not even indicative of thoracic outlet syndrome to begin
with, the compensation judge's denial of the diagnostic
measures and medical treatment at issue was not clearly
erroneous and unsupported by substantial evidence.
Affirmed.
Determined by: Pederson, J., Johnson, J. and Rykken, J.
Compensation Judge: Bernard Dinner.
OPINION
WILLIAM R. PEDERSON, Judge
The
employee appeals from the compensation judge's conclusion
as to the nature of the employee's work injury and from
the judge's denial of the employee's request for
certain medical treatment. We affirm.
BACKGROUND
Barbara
Broers' medical history since July of 1996 is long and
complex. On July 3, 1996, Ms. Broers [the employee]
sustained a work-related injury symptomatic as soreness in
her right wrist while employed as an electronic assembler
with E. F. Johnson. The job at which Ms. Broers was
working at the time, at which she had been employed for about
twenty-three years, entailed the use of various small to
medium-sized hand-held tools, in the production of ceramic
circuit boards for two-way radio products. The employee
did not seek medical attention for her injury until July 22,
1996, when she saw family practitioner Dr. Mark
Gray. Noting no history of any numbness or tingling into
the employee's fingers, little tenderness or swelling
over the base of the thumb, no discoloration, normal x-rays
and sensation into the hand, and good grasp and movement of
the thumb without pain, Dr. Gray diagnosed tendonitis and
prescribed anti-inflammatories and a wrist splint. The
employee was forty-nine years old on the date of her injury
and was earning a weekly wage of evidently about
$532.20. E. F. Johnson [the employer] admitted liability
for the injury and commenced payment of benefits. The
employee apparently took a few days off work, but on August
8, 1996, she returned to see Dr. Gray with renewed
discomfort. Dr. Gray noted that the employee had
reported improvement in her condition until recently but
"thinks her right hand looks puffy and darker in color
sometimes." He also indicated, however, that
"[b]oth hands are pink and equal in temperature
now" and "I don't notice any significant
swelling." On a diagnosis of "pain in right
wrist, probably tendonitis," Dr. Gray prescribed
medication and recommended that the employee perform no
repetitive wrist movement for at least two weeks.
The
employee's symptoms apparently did not improve, and on
August 28, 1996, she saw orthopedist Dr. Gordon
Welke. Dr. Welke diagnosed possible carpal tunnel
syndrome and prescribed a different splint and medication,
eventually ordering an EMG and referring the employee to
orthopedist Dr. Michael Kearney, who saw the employee on
October 3, 1996. In his report on October 7, 1996, Dr.
Kearney noted in his history that "[w]hen [the employee]
was working she also had a blue discoloration of the
fingertips one day." Upon examination, he found
that the fingers on the employee's right hand
"developed a somewhat deeper pink discoloration than the
fingers on the left" when she stood with her arms at her
sides. Dr. Kearney diagnosed overuse symptoms and carpal
tunnel syndrome on the right, recommending conservative
treatment rather than surgery.
On
October 22, 1996, the employee saw hand surgeon Dr. Melissa
Barton, who recommended thoracic outlet stress testing, a
second opinion regarding the myofascial arm pain, and
injection treatment for the hand problems. The thoracic
outlet stress testing proved negative, and Dr. Barton treated
the employee with carpal tunnel injections, "the only
option I would have further at this point," and referred
the employee to orthopedist Dr. Peter Daly. Dr. Daly saw
the employee on November 25, 1996, when he diagnosed right
shoulder, elbow, wrist, and hand myofascial pain and
recommended three weeks of physical therapy. He
indicated that he did not detect any cervical abnormalities
that would contribute to the employee's pain, and he
hoped that the physical therapy would "build up her
endurance for her work activities." The physical
therapist's report on December 26, 1996, indicated that
the employee's therapy resulted in "little if any
change in her symptoms," and Dr. Daly ordered a bone
scan to better diagnose the employee's complaints and
assess the possibility of reflex sympathetic dystrophy
[RSD]. The bone scan, conducted on January 7, 1997,
proved normal, and Dr. Daly referred the employee to the Mayo
Clinic to rule out either RSD or thoracic outlet
syndrome. The employee was evaluated at the Mayo Clinic
on various bases between February 18, 1997, and March 25,
1997. In a report to Dr. Daly on the latter date, Dr.
Dietlind Roedler indicated that focuses of the employee's
evaluation had included, in addition to her right hand
problems, the possibility of cardiovascular discase, vascular
problems, and rheumatological disease. He indicated that
two different Mayo physicians had recommended psychiatric
evaluation for the employee, that physical therapy,
exercises, "reassurance," and chronic pain therapy
had also been recommended, and that Mayo physicians'
final diagnoses were of chronic pain in the right upper
extremity and mild left carpal tunnel syndrome. Upon
receipt of this report, Dr. Daly referred the employee to the
United Pain Center, noting on April 16, 1997, that he did
"not have anything further to offer her from an
orthopedic standpoint."
The
employee was evaluated at the United Pain Center on April 16,
1997, by Dr. Todd Hess. Finding the employee to be
"in no acute distress," Dr. Hess diagnosed (1)
chronic right hand and arm pain, probably due to mild carpal
tunnel syndrome, (2) degenerative shoulder changes, possibly
the cause of the employee's shoulder and neck symptoms,
and (3) lower cervical pain, probably myofascial. The
employee received...
