The Minnesota Workers’ Compensation Court of Appeals (WCCA) recently decided the case of Nash v. Diocese of Duluth/St. Joseph’s Church and addressed two important issues: reasonableness and medical necessity of a dorsal root ganglion (DRG) implant trial and the continuation of vocational rehabilitation services for an injured employee who had returned to work, arguably in suitable gainful employment. The WCCA’s September 23, 2025 decision affirmed the compensation judge’s award of the DRG implant trial and allowed for continued rehabilitation services. While this case may yet be appealed to the Minnesota Supreme Court, the decision provides valuable context for claims handlers and defense counsel navigating medical necessity and rehabilitation disputes.
Factual Background
Karen Nash, a physical education teacher, sustained a right ankle injury on February 1, 2018, during a school ice-skating field trip. Initial treatment revealed a posterior malleolar distal tibia fracture. Nash’s recovery was complicated by improper gait mechanics and a non-union fracture. A missed syndesmosis injury further exacerbated her condition, leading to multiple surgeries, culminating in an ankle fusion in December 2022.
Throughout her treatment, Nash reported persistent pain, limited mobility, and psychological distress. Diagnoses included chronic regional pain syndrome (CRPS), chronic pain syndrome, major depressive disorder, generalized anxiety disorder, and ADHD. She underwent cortisone injections, lumbar sympathetic blocks, psychotherapy, and physical therapy with limited success.
By 2023, her treating physicians recommended a DRG stimulator trial to address CRPS. Nash underwent psychological evaluations to assess her candidacy for the procedure. Dr. Peg Maude-Griffin and Dr. Kerry Brockberg supported the trial, citing treatable psychological conditions and improved mental health. The employer and insurer’s Independent Psychological Examiner (IPE) Dr. Scott Yarosh, opined she was not a candidate, citing unresolved psychological conditions despite prolonged treatment and unrealistic expectations.
Nash also participated in vocational rehabilitation, securing part-time employment working 15 hours per week. Despite inconsistent job search reporting, she remained engaged in rehabilitation services. Ultimately, Ms. Nash found a second job working up to 29 hours per week in that position. Between the two jobs, the employee had the ability to work more than 40 hours per week.
Nash filed a Claim Petition seeking approval for the DRG implant trial. The employer and insurer filed a request for assistance to terminate vocational rehabilitation services. The compensation judge granted the implant trial and denied the termination of rehabilitation. The employer and insurer appealed. On appeal, the WCCA affirmed holding that the compensation judge’s findings were supported by substantial evidence and deferring to the judge’s adoption treating recommendations over independent medical opinions.
- DRG Implant Trial Approval
The court upheld the compensation judge’s approval of the DRG implant trial under Minn. R. 5221.6305, subp. 3.B. The rule requires:
- Intractable pain;
- No viable alternative surgical therapy;
- No untreatable psychological comorbidity preventing benefit from the procedure;
- A second opinion confirming candidacy;
- At least 50% pain improvement during a trial screening.
The employer and insurer argued Nash’s psychological conditions were untreatable and disqualified her from the trial. The WCCA rejected this interpretation, emphasizing that “untreatable” does not equate to “not cured.” It found that Nash’s mental health had improved with treatment and that her psychological conditions were not severe enough to preclude benefit from the DRG trial.
The court adopted the opinions of treating physicians, who affirmed Nash’s candidacy and noted her realistic expectations. It dismissed the employer’s reliance on Dr. Yarosh’s narrower psychological assessment, declining to disturb the compensation judge’s reliance on treating physician opinions.
- Rehabilitation Plan Continuation
The court also affirmed the denial of the employer’s request to terminate Nash’s rehabilitation plan. The WCCA found that under Minn. R. 5220.0100, subp. 22, the employee remained a qualified employee due to ongoing medical management and work restrictions. Despite inconsistent reporting to her qualified rehabilitation consultant (QRC), Nash had secured employment and continued to pursue vocational goals.
The court found that Nash’s participation in rehabilitation services, combined with her physical limitations and continued treatment, justified the continuation of the plan. The compensation judge did not err in concluding that Nash remained eligible for rehabilitation support.
Analysis and Takeaways
This case offers several key insights for legal practitioners and claims professionals:
Interpreting “Untreatable” Psychological Comorbidities
The court’s interpretation of Minn. R. 5221.6305, subp. 3.B(1)(c) clarifies that psychological conditions need not be cured to satisfy the rule. Instead, the focus is on whether comorbidities are treatable and whether they are severe enough to prevent benefit from the trial. This is an important distinction in cases involving chronic pain/CRPS and mental health diagnoses, where improvement and not complete cure or resolution is the standard.
Claims professionals should ensure that IPEs address both the severity and treatability of comorbid conditions in the context of DRG implant trials and similar implants. When obtaining an IPE / IME, claims professionals should specifically request that the examiners provide a detailed treatment history, address whether psychological co-morbidities are treatable, determine whether there is symptom improvement, and identify the employee’s understanding of procedural risks and benefits.
Resolving Conflicting Expert Opinions
The court reaffirmed the compensation judge’s role in resolving medical opinion conflicts. When multiple experts offer divergent views, the judge’s choice of which opinion to credit will be upheld if supported by substantial evidence. This underscores the importance of presenting comprehensive, well-supported expert opinions that align with the statutory and rule-based criteria.
If faced with an expert opinion that is weak or lacking foundation, it is important for claims handlers to work with IME vendors to request that retained experts bolster and substantiate opinions to increase the likelihood of the compensation judge adopting that opinion over the opinions of treating practitioners.
Rehabilitation Eligibility and Participation
The decision also highlights that rehabilitation eligibility under Minn. R. 5220.0100, subp. 22 hinges on continued medical management and functional limitations—not perfect compliance with job search reporting. Even when an employee’s participation is imperfect, demonstrated engagement in vocational efforts and ongoing treatment may justify continuation of rehabilitation.
Employers seeking to terminate rehabilitation must show that the employee is no longer eligible for rehabilitation services under Minn. Stat. 176.102, Subd. 8, and can bolster that argument by showing the employee no longer meets the definition of a qualified employee. Evidence of disengagement is likely to be weighed against the employee’s medical status and vocational progress.
It is interesting to note that the opinion does not outline any argument from the employer and insurer that the rehabilitation plan should have been terminated due to the employee having suitable gainful employment under Minn. R. 5220.0510, Subp. 7A. That rule requires a QRC to close their rehabilitation plan within 30 days of becoming aware that an employee has been working in suitable gainful employment for 30 days or more. As it appears Nash had returned to what was arguably suitable gainful employment for more than 30 days, those arguments may have proven more successful than the argument that the employee was no longer qualified for rehabilitation services.
There may also have been an argument that the employee was no longer entitled to medical management services as she had returned to work and no longer met the definition per Minn. R. 5220.0100, Subp. 20. That definition states, “[m]edical management refers only to those rehabilitation services necessary to facilitate the employee’s return to work.” Given Nash’s return to work for two employers, arguing that she no longer met Minn. R. 5220.0100, Subp. 20 may have proven persuasive, especially if argued in addition to the other factors supporting plan termination.
Finally, it does not appear that an argument was raised to modify the rehabilitation plan rather than terminate the plan entirely. There may have been an option to seek plan modification under Minn. R. 5220.0510, Subp. 1 and/or Minn. Stat. 176.102, Subd. 8. Both statutes allow for a party to seek modification of aspects of a rehabilitation plan rather than seek plan termination. Seeking plan modification rather than termination may have been more successful in limiting costs and exposures associated with rehabilitation.
Conclusion
Nash v. Diocese of Duluth illustrates the complex interplay between chronic pain, psychological conditions, and vocational rehabilitation in workers’ compensation claims. The WCCA’s decision signals they prefer a flexible, evidence-based approach to determining medical necessity and rehabilitation eligibility. For employers and insurers, the case underscores the importance of comprehensive medical documentation, obtaining well-founded expert opinions, and taking a creative and multifaceted statutory approach when seeking rehabilitation plan termination or modification.
If you have any questions or would like to discuss how to best approach a claim with complex medical and/or rehabilitation issues, please contact myself or any of the attorneys at Brown & Carlson. We would love to hear from you.