ANITA K. MOORMAN, Employee/Appellant,
v.
ST. ANTHONY HEALTH CTR. and AMERICAN COMPENSATION INS./RTW, INC., Employer-Insurer, and MEDICA CHOICE/HRI, Intervenor.
Minnesota Workers Compensation
Workers' Compensation Court of Appeals
February 17, 1999
HEADNOTES
PRACTICE
& PROCEDURE - REMAND; MAXIMUM MEDICAL
IMPROVEMENT. As this court is unable to determine the
factual basis for the compensation judge's determination
that the employee reached MMI as of July 8, 1994, and the
compensation judge failed to address the employee's
alternative claim that she was medically unable to continue
working after August 6, 1997, the appealed findings and
conclusions of law are vacated and the matter remanded for
redetermination.
PRACTICE
& PROCEDURE - REMAND; MEDICAL TREATMENT &
EXPENSE. Where the compensation judge failed to explain
her determination that the treatment provided by Dr. Holmes
was not causally related to the August 14, 1993, injury, and
failed to make the findings required by Minn. R. 5221.6050,
subp. 7.D., of the permanent treatment parameters, the matter
is remanded for a redetermination of the medical causation
for, and reasonableness and necessity of, the treatment in
dispute.
Vacated
and remanded.
Determined by Johnson, J., Wilson, J., and Hefte, J.
Compensation Judge: Carol A. Eckersen
OPINION
THOMAS
L. JOHNSON, Judge
The
employee appeals from the compensation judge's finding
the employee reached maximum medical improvement (MMI) from
her August 14, 1993 injury effective July 8, 1994, and was
not entitled to temporary total disability benefits from
August 6, 1997 through the date of hearing. The employee
also appeals from the judge's determination that medical
treatment provided by Dr. Holmes from and after May 15, 1997
was not causally related to the work injury, exceeded the
treatment parameters and was not reasonable or
necessary. We vacate and remand for redetermination.
BACKGROUND
The
employee sustained an admitted, work-related injury to her
left hip and left leg on August 14, 1993, while working,
part-time, as a nursing assistant for the employer, St.
Anthony Health Care.1 The employee was treated by Dr.
James Keane following the injury. He diagnosed a left
hip strain and took the employee off work. In follow-up
on August 16, 1993, Dr. Keane noted the employee's left
hip pain had intensified and she was unable to stand on her
left leg alone. A course of physical therapy was
prescribed. On August 20, 1993, Dr. Keane noted the
employee had been given crutches by the physical
therapist. A lumbar CT scan, an MRI scan of the hip
area, x-rays of the left hip and lumbar spine, and a bone
scan were negative.
The
employee experienced some improvement in her left hip pain
and range of motion with physical therapy, and on September
27, 1993, Dr. Keane released the employee to return to
work with the employer, two hours a day, seated work
only in a reclining position, with no carrying, pulling or
pushing, or lifting. The employee continued to receive
physical therapy on a daily basis. On October 25, 1993,
the employee reported coldness and numbness in the left leg
when doing physical therapy exercises. Concerned that
the employee might be developing early reflex sympathetic
dystrophy (RSD), Dr. Keane referred the employee to an
orthopedist, Dr. Orrin Mann, for further evaluation.
Dr.
Mann first saw the employee on October 29, 1993. She
reported constant stabbing pain in the left hip area, as well
some pain in the left buttocks and quadriceps areas and in
the low back. She was unable to bear weight on the left
leg and was using crutches and occasionally a wheel
chair. Dr. Mann was uncertain whether the employee's
left leg weakness was the result of a mechanical or
musculo-neurologic dysfunction or whether it was secondary to
functional overlay, and referred the employee for additional
testing.
An
independent medical examination (IME) was completed by Dr.
John Sherman, an orthopedic surgeon, on November 10,
1993. Dr. Sherman thought the most likely explanation
for the employee's symptoms was RSD or possibly a
conversion reaction. He recommended an aggressive
mobilization and reactivation physical therapy
program. Dr. Dorn, a neurologist, examined the employee
on November 18, 1993. He concluded the problem was
primarily in the hip and ruled out a lumbar spine
radiculopathy. He believed the problem might be RSD or
some sort of vascular compromise, and recommended against
more aggressive therapy until a complete evaluation was
done. Subsequent vascular studies were
negative. The employee completed an MMPI on November 29,
1993. Psychologist James Gilbertson interpreted the
results as showing a "[s]trong suggestion of a
conversion profile." (Ex. I.)
Dr.
Mann restarted physical therapy in mid-November 1993 which
continued through December 1993. On January 6, 1994, Dr.
Loran Pilling evaluated the employee, diagnosing a conversion
hysteria. The employee completed Dr. Pilling's
four-week pain clinic program, followed by additional
physical therapy through April 1994. On June 6, 1994, an
independent medical examination was performed by Dr. Bruce
Van Dyne. Dr. Van Dyne observed the employee had made
progress with the recent...
