Dahl v. Rice County and Minnesota Counties Intergov’t Trust, Inc.

Dahl v. Rice County and Minnesota Counties Intergov’t Trust, Inc., No. WC13-5572 (October 2, 2013)

The employee unsuccessfully appealed from a compensation judge’s denial of his claims for neuropsychological testing and psychotherapy treatment.

The employee worked as a deputy sheriff for the employer, Rice County, from 1992 until 2005 during which time he sustained four admitted work injuries:

  1. The first injury happened in 1996, when the employee twisted his back reaching in to his squad car to retrieve files.  Four months later, he underwent back surgery.
  1. The second injury occurred in 1999 when the employee was responding to an emergency call.  While traveling at a high rate of speed, the employee rolled his squad, hit his head and was temporarily knocked unconscious.  He was diagnosed with a head trauma and a mild concussion, but a CT scan did not show any abnormalities. The employee testified at the hearing that he had memory and concentration problems following this injury.
  1. The third work injury occurred in April 2002, when a flash-bang grenade detonated causing permanent hearing loss in his right ear.
  1. The fourth injury took place in August 2005 after his boss, the sheriff, struck him in the chest during an argument causing him to fall backwards.  The employee was diagnosed with an exacerbation of his back condition.

From August through January 2005, the employee was treated by a psychologist for symptoms of anxiety, depression, and post-traumatic stress disorder associated with the altercation with the sheriff.  He was given prescription medication. In March 2007, the employee was still in therapy sessions for his mental health symptoms, including concentration problems, which he related to the 1999 and 2005 work injuries.  The employee was diagnosed with ADHD and given medication.

The employee had back surgeries in 2006 and 2009, but his back symptoms continued to worsen.  His family doctor referred him to pain clinic where he saw Dr. Matthew Monsein.  The employee told Dr. Monsein he was being treated for depression, anxiety, ADHD, and had been diagnosed with a traumatic brain injury from the 1999 motor vehicle accident.  Dr. Monsein recommended a formal neuropsychological evaluation to determine whether the employee’s memory and concentration issues might be related to a traumatic brain injury.

Dr. Paul Arbisi, a psychologist, evaluated the employee in December 2011 and again March 2012 on behalf of the employer and insurer.  Dr. Arbisi concluded psychiatric treatment was unrelated to any of his work injuries and did not consider Dr. Monsein’s proposed neuropsychological evaluation reasonable or necessary.

From January through March 2012, the employee had six visits for chronic pain and neuropsychological evaluation with Dr. John Patrick Cronin.  He concluded the employee had a traumatic brain injury caused by at least one work injury, and that the work injuries were a substantial contributing cause of the employee’s psychiatric condition, including chronic pain, anxiety, depression and post-traumatic stress disorder. He recommended further psychotherapy treatment.

In January 2013, Dr. Monsein again examined the employee. Although he could not state within a reasonable degree of medical certainty whether the employee’s current mental health issues, (including concentration, memory, and depression) were due to a traumatic brain injury, he did believe these problems were related to the employee’s work injuries.  He recommended the employee be evaluated at the VA Hospital in Minneapolis.

A compensation judge determined the employee had sustained a psychological injury in the form of depression resulting from chronic pain syndrome associated with his four work injuries.  The judge found the treatment for depression was reasonable and necessary.

However, the judge denied reimbursement for the six visits with Dr. Cronin because the evidence failed to support a finding that the employee’s ADHD or memory problems were causally related to the work injuries. The judge further found that the evidence failed to support a finding that the employee had a traumatic brain injury and that the neurological evaluation with Dr. Cronin was not reasonable or necessary for treatment or diagnosis of the effects of the employee’s work injuries. The judge also denied the employee’s request for additional psychotherapy sessions for the same reason.

The employee argued that even if the purpose of medical testing was to assess a potential non-work-related condition, it was still compensable where it would have assisted the treating doctors in their treatment of the employee’s work injuries by ruling out an alternative explanation for some of the reported symptoms.  It is true that diagnostic testing to “rule out” other possible causes for the employee’s apparently work-related symptoms may be considered a reasonable medical expense to be covered by workers’ compensation.  Abdelrazig v. American Bottling Co., No. WC06-166 (W.C.C.A. Nov. 16, 2006).

But in this case, there was an incorrect assumption on the part of the medical provider (Dr. Monsein) making the recommendation for further testing because the employee had never been diagnosed with a traumatic brain injury.  Whether the purpose of diagnostic testing is to rule out other causes of work-related symptoms or, instead, is only to help diagnose a non-work condition is a question of fact for the compensation judge.  Stolp v. Cardinal Drywall, Inc., slip op., (W.C.C.A. July 19, 1994).  The W.C.C.A. did not disturb the compensation judge’s findings on these issues.