Nash v. Diocese of Duluth, et al., No. WC25-6599 (WCCA Sept. 23, 2025)
Karen Nash sustained an admitted right ankle injury when she fell during an ice-skating field trip with her students while working as a physical education teacher for the employer, St. Joseph’s School/Diocese of Duluth, on February 1, 2018. X-rays showed a posterior malleolar distal tibia fracture. She was casted and given crutches to walk.
She then had an extensive series of medical treatment. A CT scan showed that the fracture never completely healed.
On November 21, 2018, the Employee underwent an arthroscopic debridement and an open reduction fixation of a posterior malleolar tibia facture.
In 2019, a CT scan showed a nonunion of the distal tibia fracture. An injury to the syndesmosis was also diagnosed at this time.
A revision open reduction internal fixation of the distal tibia fracture with bone graft taken from the right proximal tibia and a reduction fixation of the syndesmosis on June 13, 2019.
The Employee’s symptoms continued to persist after this procedure, and the Employee was also diagnosed with several mental health conditions around this time as well.
In 2020, CT and MRI scans showed that the fracture had healed, but the chronic syndesmosis injury remained a problem.
The employee’s ankle condition continued to deteriorate through 2021.
On October 4, 2022, Dr. Coetzee issued a report on October 4, 2022, recommending an ankle fusion. This surgery was performed on December 6, 2022.
She underwent post-surgery physical therapy, but her symptoms did not improve. She was diagnosed with CRPS.
A functional capacity evaluation (FCE) was performed on August 27 and 28, 2024 which limited the Employee to sedentary work.
On October 31, 2024, Dr. Coetzee issued a report after re-examining the employee. Dr. Coetzee diagnosed the employee with a well-healed right ankle fusion with ongoing right calf atrophy and muscle weakness. He opined that the treatment the employee had received to treat her ankle had been reasonable and necessary but that no further orthopedic treatment was necessary to cure or relieve her condition, deferring any necessary mental health care to experts in that field. He further opined that the employee required restrictions, including light or sedentary activities, and avoiding uneven terrain.
The employee underwent a DRG implant trial on November 26, 2024.
The employee had secured a job at L & S Consulting in March 2022, working within her work restrictions averaging 10-15 hours of work per week. A job search plan was made, however, the employee did not regularly report to her QRC on her job search efforts, nor did she follow up on job search leads that were provided to her. Nevertheless, the employee found a second job on her own with another employer with the opportunity to work up to 29 hours per week.
The employee filed a claim petition seeking approval of a DRG implant trial. The employer and insurer filed a medical request seeking to discontinue vocational rehabilitation services. The matters were consolidated and came on for hearing before a compensation judge on January 10, 2025.
On February 10, 2025, the compensation judge granted the employee’s request for a DRG implant trial and denied the employer and insurer’s request to discontinue rehabilitation services. The employer and insurer appeal.
Issue on Appeal: The Employer and Insurer appeal the implant trial and the denial of their request to terminate the Employee’s rehab plan.
- DRG Implant Trial
- The Employer and Insurer argued that the DRG implant was not reasonably required to cure and relieve the effects of the employee’s work injury, that under Minn. R. 5221.6305, subp. 3.B(1)(c) the employee has an untreatable major psychological or psychiatric comorbidity that would prevent the employee from benefitting from the procedure, and that the employee had unrealistic expectations of the procedure.
- The court found substantial evidence supporting the judge’s decision that Nash was an appropriate candidate, and that her psychiatric comorbidities did not rise to the level of “untreatable” or preclusive under the rule.
- The court rejected the employer/insurer’s argument that failure of prior surgeries and therapies barred further modalities.
- The court also found Nash’s expectations were realistic ( i.e. not looking for the stimulator to relieve her psychological stress, but rather to reduce her chronic pain and reduction of pain increasing her physical functioning).
- Rehabilitation Plan Termination
- Employer and Insurer argued that the employee did not cooperate or participate effectively in the rehabilitation plan, that she is not likely to benefit from further rehabilitation services, and that the employee has been steadily working at suitable gainful employment for 30 days or more.
- Although Nash had some lapses in cooperation with the QRC, the court held the record supported that she still derived benefit from medical management services (which the QRC provided), and that she remained a qualified employee eligible for services.
- The court found termination of the rehabilitation plan would be premature, and affirmed the compensation judge’s refusal to terminate it.
Takeaway: That medical treatment may be reasonable and necessary if the reason for getting it is to improve physical functioning. Further, that an employee may still qualify for Rehab if the Employee derives some benefit from medical management.