Melsness v. Overhead Door Co., No. WC15-5793 (July 17, 2015)
In this case, the employee sustained a comminuted fracture of the right ankle in August 1997 after falling off a sixteen foot ladder and falling eight feet. The employer and insurer accept liability for the injury. He underwent surgery, but his symptoms remained and in March 1998 he was diagnosed with RSD to the right leg and foot as result of the work injury.
In a 2003 settlement he was deemed permanently totally disabled. Since his injury the employee had been evaluated by more than eighteen doctors and received treatment including epidural nerve blocks, acupuncture and physical therapy with no significant relief. In 1998 he was prescribed Neurontin and amitriptyline with no success. He was then prescribed various medications until he began taking OxyContin and oxycodone in 2002. Later he began treatment with a psychiatrist and received more prescriptions.
A 2013 IME examination concluded that the employee no longer had RSD and was suffering from osteoarthritis in the right ankle. The employee was suggested to taper off of OxyContin and oxycodone and replace with Tylenol and Neurontin. The insurer then disputed the use of OxyContin and oxycodone as well as medication for the employee’s psychological condition.
A hearing was held in 2013 and the judge determined the employee continued to have RSD arising from the work injury. The judge also determined the employee’s accident was a substantial cause of his depression and anxiety and found that the medications were reasonable and necessary.
The employee was then recommended to begin using Viagra to address his pain from RSD. In deposition the prescribing doctor stated that Viagra would help increase blood circulation and reduce the feeling of coldness associated with RSD, as well as reduce pain. In November 2014 the doctor testified the employee’s condition and depression had improved since using Viagra.
The employee was reevaluated by the IME doctor in November 2014 who opined that Viagra was not warranted. The employer and insurer then disallowed the prescription expense for Viagra. In January 2015 the compensation judge found Viagra to be reasonable and necessary treatment for the employee’s condition.
In affirming the compensation judge’s ruling, the WCCA noted that the issue of if specific medical treatment was reasonable and necessary is a question of fact to be determined by the compensation judge. Hopp v. Grist Mill, 499 N.W.2d. 812 (Minn. 1993) The court stated that if the decision is supported by substantial evidence it is to be affirmed. Minn. Stat. § 176.421, subd. 1.
The employer and insurer argued that the judge erred in not requiring the employee to show that no cheaper alternative existed. The cited Peterson v. Kandi Kourts, 45 W.C.D. 528 (W.C.C.A. 1991) and Olson v. Control Data Corp., slip op. (W.C.C.A. Aug. 8, 1991) in which the court found that a Nordic Track and an expensive model of an exercise bike were not reasonable or necessary treatment. In addressing these cases the Court found that these were decided on very specific facts of each case and had no connection with the present case. Further, they stated that as to “the question of balancing costs and benefit in considering medical expenses, we consider that question to be inherent in the statute’s requirement that medical care be reasonable and necessary.”
The Court held that while Viagra is not typically prescribed to treat a work injury, the compensation judge applied the standards of reasonableness and necessity that apply to any medication claimed compensable and reached a conclusion which was supported by substantial evidence.