Court Opinion

ID: 9930250
Source: CourtListenerOpinion
Date Created: 2024-02-06 16:11:06.124556+00
Date Added: 2024-06-11T11:11:54.037386
License: Public Domain

IN THE NEBRASKA COURT OF APPEALS

               MEMORANDUM OPINION AND JUDGMENT ON APPEAL
                        (Memorandum Web Opinion)

                          TUNINK V. CONTINENTAL FIRE SPRINKLER CO.

  NOTICE: THIS OPINION IS NOT DESIGNATED FOR PERMANENT PUBLICATION
 AND MAY NOT BE CITED EXCEPT AS PROVIDED BY NEB. CT. R. APP. P. § 2-102(E).

       IN RE ESTATE OF GREG TUNINK, DECEASED, BY AND THROUGH ITS PERSONAL
                    REPRESENTATIVE, KATELYN TUNINK, APPELLEE,
                                        V.
CONTINENTAL FIRE SPRINKLER CO., DOING BUSINESS AS CONTINENTAL ALARM & DETECTION,
    EMPLOYER, AND SELF-INSURED C/O SEDGWICK, INSURANCE CARRIER, APPELLANTS.

                             Filed February 6, 2024.    No. A-23-457.

         Appeal from the Workers’ Compensation Court: J. MICHAEL FITZGERALD, Judge. Affirmed
in part, and in part reversed and remanded with directions.
       Jennifer S. Caswell, of Caswell, Panko & Westerhold, L.L.C., for appellants.
       Laura L. Pattermann and Thomp. J. Pattermann, of Gallner & Pattermann, P.C., for
appellee.

       RIEDMANN, ARTERBURN, and WELCH, Judges.
       ARTERBURN, Judge.
                                        INTRODUCTION
        Continental Fire Sprinkler Company (“Continental Fire”) appeals from an award entered
by the Nebraska Workers’ Compensation Court finding that Greg Tunink had suffered a
work-related injury to his right foot and was entitled to disability benefits. On appeal, Continental
Fire argues that the compensation court erred in finding that Tunink’s work-related accident caused
permanent impairment to his right foot and, thus, was compensable. Continental Fire also argues
that the compensation court erred in ordering it to pay for Tunink’s medication for depression and
anxiety without specifically finding such conditions were caused or exacerbated by the
work-related accident. Finally, Continental Fire challenges the compensation court’s finding that
Tunink is entitled to vocational rehabilitation services.

                                                -1-
        Upon our review, we cannot say that the compensation court’s award of disability benefits
to Tunink for the injury sustained to his right foot was clearly wrong. As such, we affirm that
portion of the court’s award. However, because of ambiguity in the compensation court’s award
as to the cause of Tunink’s depression and anxiety, we vacate that portion of the order awarding
Tunink payment for depression and anxiety medication, and remand the cause with directions to
enter an order in compliance with Workers’ Comp. Ct. R. of Proc. 11 (2021) (Rule 11). We also
conclude that Continental Fire’s allegations regarding the award of vocational rehabilitation
services are moot, because Tunink died prior to receiving such services.
                                         BACKGROUND
         On May 21, 2019, Tunink was employed by Continental Fire as a fire alarm technician.
On that day, Tunink was assigned to test all of the fire alarms at a local nursing college campus.
When he was walking into one of the buildings on the campus, he pushed open a heavy glass door
to walk through. However, the door began to slam shut before he was all the way through it, hitting
the top and side of his right foot. Tunink’s right foot immediately began to swell and he telephoned
his supervisor to determine what he should do.
        When his boss arrived at the campus, he informed Tunink that he should finish out his work
day, but restrict the amount of walking he did. Tunink continued to work in the days immediately
after the accident, using pain medication and icing his foot at the end of each day. Approximately
one week after the accident, Tunink informed his supervisor that he needed to see a doctor about
his right foot. On May 29, 2019, Tunink and his supervisor attended an appointment with a doctor
at WorkFit. At the appointment, Tunink rated his pain as a two out of ten. An x-ray was performed
and revealed that there were no broken bones in the foot. Tunink was diagnosed as suffering from
a sprain of his right ankle and his foot. He was told he could continue working without restrictions.
        Tunink returned to WorkFit for a followup appointment on June 5, 2019. At this
appointment, Tunink rated his pain a one out of ten. According to medical records, Tunink
informed the doctor that while there was still some swelling and pain in his right foot, he felt it
was improving. In the records, the treating doctor noted that Tunink’s right foot was “not 100%,
but getting close.” The doctor indicated that Tunink should feel much better in one to two more
weeks. Tunink was informed he could continue working without restrictions.
        On July 15, 2019, almost 2 months after the work-related accident, Tunink attended an
appointment with his primary care physician, Dr. Heather Obregon. At this appointment, Tunink
reported that he had been having pain in his left great toe for approximately 1 week. He did not
mention the injury to his right foot at this appointment. Obregon referred Tunink to Dr. Shane
Schutt, a foot and ankle surgeon, for further evaluation of the left foot.
        Tunink saw Schutt on July 17, 2019, regarding the pain in his left foot which, according to
Tunink, “came on spontaneously” a week prior to the appointment. Notably, prior to the
appointment with Schutt, Tunink filled out paperwork in which he indicated that his complaints
were not related to a workers’ compensation case. Tunink did inform Schutt about his May 21,
2019, work-related accident, but indicated that his injury from that accident had “gotten better”
and that his current pain “feel[s] a little bit different.” Ultimately, Schutt was unable to provide a
diagnosis for Tunink’s left foot pain. Schutt indicated that Tunink was prediabetic and suffering

                                                -2-
from neuropathy in the foot, which caused diminished sensation, and Schutt was unable to identify
exactly where Tunink was hurting.
        In August 2019, Tunink returned to Obregon for a well adult examination. At this time,
Tunink reported he still had some pain and swelling in his left foot. Obregon spoke with Tunink
about his “morbid obesity” playing a role in regard to his foot pain and his other medical issues.
She counseled him regarding losing weight. Obregon also renewed Tunink’s prescription for
medication associated with his mild depression.
        A few weeks later, on September 12, 2019, Tunink emailed Obregon and indicated that the
swelling and pain in his left foot was not improving. Obregon referred Tunink to Dr. Kent DiNucci,
a podiatrist. Tunink saw DiNucci for the first time on September 19. At the appointment, Tunink
complained of pain in his left foot and numbness in the toes on both feet. He denied suffering any
specific traumatic injury which would explain his symptoms and did not mention the May 2019
work-related accident. In fact, DiNucci noted in his records, “The right foot was not an issue and
no pain.” DiNucci ultimately diagnosed Tunink as suffering from multiple stress fractures in the
left foot and a possible tear of one of his tendons. DiNucci explained:
        Basically, the bones are inflamed and his foot is swollen because they can’t heal as fast as
        they are being broken down by the activity and weight of the patient. Therefore, we need
        to off-load the foot by using a camwalker and an arch support to allow the bones to have
        less stress and heal appropriately.

DiNucci also ordered an MRI and counseled Tunink on losing weight.
         On October 1, 2019, Tunink sent DiNucci a message asking him to provide certain
information to the human resources department at Continental Fire. First, Tunink asked if DiNucci
could provide an opinion that the injury to his left foot was “possibly related to putting extra stress
on left foot when right foot was injured.” He also asked if DiNucci could approve of him returning
to work in some capacity so that he could generate some income. DiNucci authored an “Excuse
Slip” which directed that Tunink “is improving and can work full-time as long as he has camwalker
on his left foot/leg for next 4 wks.” DiNucci did not provide any opinion about the cause of the
injury to Tunink’s left foot.
         Tunink messaged Obregon on November 5, 2019, asking for medication for his anxiety:
“Can you call me in something for my high anxiety. I really need to stop using alcohol for my
anxiety. I think my alcohol use is partly adding to my problems with my feet.”
         Tunink visited an urgent care facility on November 9, 2019, again complaining of left great
toe pain. He was diagnosed as suffering from a diabetic foot ulcer. The treating physician opined
that the neuropathy in Tunink’s foot was likely contributing to the development of such sores.
Tunink followed up with Obregon on November 14. He reported that his whole left leg was now
swollen and red and felt hot to the touch. Obregon referred Tunink to Dr. Amir Sasan Gholami, an
infectious disease specialist.
         Tunink saw Gholami on November 18, 2019. At that time, he complained of “left great toe
ulcer, left foot swelling, edema and erythema.” He told Gholami that the issue had been present
since June. Gholami diagnosed him as suffering from cellulitis of the left foot, left great toe, and
left leg and from a diabetic ulcer of the left foot. Tunink was counseled to take prescribed
antibiotics, keep pressure off of his foot, and work on losing weight. When Tunink returned to see

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Gholami on November 25, Gholami noted that the antibiotics appeared to be helping to improve
the condition of Tunink’s left foot. Gholami discussed with Tunink the importance of keeping
pressure off of his left foot, controlling his diabetes, and losing weight.
         Also on November 25, 2019, Tunink saw Dr. John Harris, his new primary care physician.
At this appointment, Tunink continued to complain of problems with his left foot. Harris referred
Tunink to Dr. Scott Nelson, a foot and ankle specialist. In Harris’ notes from the November 25
appointment, he indicated that Tunink’s “[d]epression screen is negative and [Tunink’s depression
is] currently treated with medication and/or therapy.”
         Tunink saw Nelson for the first time on December 9, 2019. At that time, Tunink described
the issues with his left foot. However, he did mention the May 2019 work-related accident and
inquired whether the injury to his right foot from that accident caused the injuries and issues with
his left foot. Nelson diagnosed Tunink as suffering from Charcot’s joint of the left foot and from
a left foot ulcer. Nelson indicated that such conditions were secondary to neuropathy and diabetes.
Shortly after this appointment with Nelson, Tunink returned to Harris to inquire about obtaining
medication for his diabetic condition. At this appointment, Tunink denied struggling with his
depression or anxiety.
         In 2020, Tunink continued to seek treatment with Nelson. On March 7, he presented with
an ulcer on his left great toe and a bunion on his right foot. An x-ray of Tunink’s right foot indicated
“hallux valgus deformity with digital contracture noted to the great toe as well as the lesser digits
midfoot showed no evidence of a general changes or soft tissue swelling and no evidence of
collapse noted to the midfoot.” When Tunink returned to Nelson in May, he only complained of
pain in his left foot. However, when he returned in June, he complained of an ulcer located on the
bunion on his right foot. At this appointment, Nelson also diagnosed Tunink as suffering from
cellulitis of his right lower extremity. Nelson opined that Tunink’s “shoes are the source of
irritation to the bunion site.” He prescribed a postoperative shoe for his right foot and indicated
that Tunink required work restrictions, as he was still working at Continental Fire and on his feet
a great deal. After this appointment, Tunink took a leave of absence from his employment with
Continental Fire.
         Tunink returned to see Nelson in July 2020. At this appointment, Tunink reported that the
bunion on his right foot was getting worse. Tunink informed Nelson that he believed that the
deformity to his right foot was related to his May 2019 work accident. Tunink explained that
several months after the injury, he started developing bunion deformity and “has had progression
of deformity since then and this has been progressive since his original injury despite multiple
conservative efforts.” Upon his examination, Nelson found that on the right foot, “there has been
a propagation of injury and initiation of charcot arthropathy.” On August 12, 2020, Nelson further
explained his diagnosis as “Charcot foot right forefoot due to diabetes mellitus.” In September,
Nelson recommended that Tunink have the toes on his right foot amputated due to his persistent
and worsening deformity. Nelson indicated that Tunink should obtain a second opinion.
         Tunink sought such a second opinion from Dr. Scott McMullen. Tunink’s first appointment
with McMullen was on September 10, 2020. At this appointment, Tunink described the problems
with both his left and his right foot. Tunink attributed the problems with both feet to his May 2019
work-related accident. McMullen ultimately diagnosed Tunink as suffering from deformities to
both feet. He did not believe that amputation of the right toes was necessary. Instead, McMullen

                                                 -4-
recommended reconstructive surgery of the right foot, subject to Tunink’s ability to quit smoking
prior to any surgery taking place. McMullen advised Tunink that he could return to work in a light
duty or sedentary position with minimal standing or walking requirements. McMullen opined that
Tunink’s “current findings are related to his previous history of trauma as reported.”
        McMullen performed reconstructive surgery on Tunink’s right foot on December 9, 2020.
Two months after the surgery, in February 2021, McMullen indicated that Tunink could return to
work, but with only minimal standing and walking. Shortly thereafter, Continental Fire sent
Tunink notice that they were terminating his employment because he had been unable to return to
his duties after his medical leave of absence. On March 29, McMullen opined that Tunink was
best situated for a sedentary job with no standing or walking required.
        On March 8, 2021, Tunink filed a petition in the compensation court alleging that he was
injured on May 21, 2019, in the course and scope of his employment with Continental Fire and
that, as a result, he was entitled to compensation. Specifically, Tunink alleged that as a result of
the work-related accident, he suffered injuries to his right foot and toes, left foot and toes, and
nerves in his right lower extremity. Tunink also alleged that the accident worsened his anxiety and
depression. Tunink asked that he be awarded indemnity benefits, ongoing medical benefits, future
medical benefits, compensation for his loss of earning capacity, and vocational rehabilitation
benefits. In Continental Fire’s answer, it admitted that Tunink had a work-related accident in May
2019, but denied that he suffered from any lingering disability as a result of the accident.
Continental Fire asserted that any disability that Tunink currently suffered from was not the result
of the work accident.
        Trial was held on Tunink’s petition on August 11, 2022. Prior to any testimony being heard,
the parties offered a joint stipulation to the compensation court to narrow the issues being
presented. As is relevant to this appeal, the parties stipulated:
        [Tunink] had an accident arising out of and in the course of his employment with
        [Continental Fire] on May 21, 2019 and sustained an injury to his right foot. However, the
        parties dispute whether the injury to [Tunink]’s right foot is permanent, whether [Tunink]
        sustained an injury to his left foot and whether [Tunink] sustained a mental injury as a
        result of said accident.

        During the trial, both Tunink and his wife testified. In addition to testifying about the recent
medical treatment he had received for his right and left feet, Tunink also testified about his work
history and his current condition. At the time of the trial, Tunink was 49 years old. He was a high
school graduate who possessed an associate’s degree in tool and die manufacturing and who had
attended trade school to become a licensed journeyman electrician. His work history included
relatively physically demanding jobs and almost no experience with sedentary work. Most
recently, he was employed as an electrician servicing fire alarm systems. Such work required a lot
of walking, kneeling, crawling, climbing, and standing. Tunink indicated he was currently unable
to perform the tasks required of him as an electrician.
        When Tunink was hired at Continental Fire as a fire alarm technician, he was 6 feet, 6
inches tall and weighed 450 pounds. He remained approximately that size at the time of trial.
Tunink testified that at the time of being hired, he had never had any health problems due to his

                                                 -5-
size. However, just prior to his work-related accident in 2019, he was diagnosed as prediabetic.
By that time, he was also beginning to suffer from neuropathy in the tips of his toes on both feet.
         Tunink testified that as a result of the work-related accident and resulting injuries he was
suffering from extreme anxiety and depression at the time of the trial. He admitted that he was
diagnosed with depression as a sophomore in high school and that he had been prescribed a
low-dose of anti-depressant medication ever since. He explained that prior to the accident, his
depression had been controlled by this medication. Tunink denied ever suffering from anxiety prior
to the accident. Tunink testified that after the accident, his depression increased and he developed
anxiety. He described himself as constantly stressed and irritable and discussed how he was
worried about his future. Prior to the accident, Tunink had planned on working as an electrician
until he retired. He felt secure in his employment prospects. After the accident, he felt worthless
and helpless, being unable to perform basic tasks without assistance. On August 8, 2022, just three
days prior to the trial, Tunink returned to Harris with complaints of increased depression symptoms
and panic attacks.
         Tunink’s wife of just over a year, Julie, testified that she has been his primary caregiver for
his foot injuries. She described how Tunink has been consistently in pain since the May 2019
work-related accident: first with his right foot, then with his left foot, and now with the deformities
in his right foot. Tunink has been unable to help around the house, including being unable to mow
the yard, go to the grocery store, or transport himself. Julie testified that Tunink was extremely
interested in vocational rehabilitation programming because he truly wanted to work again. She
explained that she and Tunink separated for a few months leading up to the trial as a result of
Tunink’s deteriorating mental health.
         As a part of his evidence, Tunink offered medical opinions regarding the cause of his foot
problems from McMullen, Dr. Thomas Atteberry, who provided a medical evaluation of Tunink
in February 2022, and Dr. Rashmi Joshi, who performed an independent records review. Tunink
also offered evidence regarding his current mental health status.
         In a letter authored by McMullen on March 15, 2021, he opined: “The structural changes
to [Tunink’s] right foot, I believe, are secondary to that work related injury which occurred in May
of 2019. . . . This statement is based upon a reasonable degree of medical certainty.” In a followup
letter dated September 7, 2021, McMullen reiterated his opinion that the cause of Tunink’s right
foot problems was the work-related accident. He went on to provide the following prognosis for
that foot:
         I believe that Mr. Tunink’s prognosis is fair to good. With proper care of his right foot
         including utilizing specialty shoes and custom inlays, I would anticipate that he will
         continue to have a stable foot. Utilizing the 5th Edition and the American Association
         Guides to the Evaluation of Partial Permanent Impairment, taking into consideration the
         collapse and posture of his right midfoot as well as his forefoot deformity which occurred
         . . . his partial permanent impairment rating of the right foot is 21%.

Notably, McMullen did not provide any opinion regarding the cause of the injuries to Tunink’s
left foot.
        Atteberry, an orthopedic specialist, provided a medical examination of Tunink at the
request of his attorneys on February 25, 2022. After this examination, Atteberry opined that

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Tunink’s “injury to his right foot and subsequent need for surgery on his right foot is a direct result
of his work injury on 05/21/2019.” Atteberry went on to opine,
        I think [Tunink]’s left foot pain and current great toe issues are also related to his work
        injury of 05/21/2019. In that his antalgic gait and attempts to protect his right foot led to
        him being placed into a Cam boot on his left foot, which eventually led to the ulcer
        formation on his left great toe.

Atteberry rated Tunink’s permanent partial impairment at 20 percent of the right foot and 3 percent
of the left foot. Atteberry recommended that Tunink return to work in a job that would allow him
to be sedentary.
        Joshi, a board certified internal medicine specialist, performed a review of Tunink’s
medical records for purposes of Tunink’s application for Social Security disability benefits.
Contrary to Atteberry’s opinion, Joshi opined that the Charcot foot and recurrent right foot
ulcerations were the result of diabetic neuropathy, and not the May 2019 work accident. Joshi did
not change this opinion, even after speaking with McMullen about Tunink’s condition:
        Per Dr. McMullen, he first saw [Tunink] in September 2020. [Tunink] told him that he had
        a foot injury at work in May 2019. However, Dr. McMullen has not seen any records
        related to the injuries by any other provider and does not know what, if any, treatment
        [Tunink] had after the reported work injury in 2019. Therefore the additional information
        does not change the determination.

       On May 25, 2022, Tunink was given a psychological evaluation as part of his application
to receive social security disability benefits. A report authored by a licensed psychologist,
Elizabeth Morell, PhD, concluded:
       Prognosis is guarded for [Tunink] from a mental health point of view. He experiences
       depression and anxiety. He continues to take medication and participate in therapy. He
       appears to struggle with ongoing medical concerns, and this exacerbates the underlying
       mental health. His medical concerns would be better evaluated by a medical doctor.

Notably, Morell’s opinion appears to have depended exclusively on Tunink’s self-report. Harris
did, however, concur with Morell’s opinion that Tunink’s current depression is triggered by the
fact that he is physically incapable of performing the duties of a fire alarm technician.
         As a part of Continental Fire’s evidence, it offered a report from Dr. Dean Wampler, who
performed a medical examination of Tunink in September 2020. Wampler opined that Tunink’s
problems with his feet were not caused by the May 2019 work-related accident:
                 The WorkFit notes identify an injury not nearly as severe as reported by Mr. Tunink
        during my interview. His pains were 1 to 2 out of 10, and most of his swelling and
        discomfort was over the lateral malleoli of his ankle, rather than any significant damage to
        his forefoot that is now so deteriorated.
                 For these reasons I can only establish that Mr. Tunink had a hindfoot contusion or
        mild crush injury as a result of the 05/21/2019 accident. All new pathology and treatment
        beginning in July or August of 2019 is progression of right pathology due to neuropathy or
        neuropathic ulceration of his left foot.

                                                 -7-
               Charcot arthropathy is caused by loss of sensation and accumulation of
       microtrauma from activities of daily living. Because there is lack of joint sensation, the
       patient is unaware that damage is occurring and the condition progresses unnoticed.
       Charcot joint is a condition only related to peripheral neuropathy established in Mr.
       Tunink’s case by untreated mild diabetes. Mr. Tunink’s bunion deformity in his right foot
       is also a part of his Charcot deformity.
               Mr. Tunink’s left foot problems are classic diabetic ulceration and callus
       overloading. His left ankle MRI scan demonstrated stress in his bones, which means he
       will soon develop Charcot deformities in his left foot.

Wampler went on to opine that after Tunink was discharged from WorkFit in June 2019, no further
treatment for the injury he suffered on May 21, 2019, was necessary.
         After the close of trial, on May 25, 2023, the compensation court issued its findings in a
written order. The court found that Tunink “injured his right foot at work on May 21, 2019, which
got worse due to microtrauma from walking which ultimately required surgery by Dr. McMullen.”
The court agreed with McMullen’s opinion that Tunink has a 21 percent loss of use of his right
foot. It awarded Tunink temporary benefits of $855 per week from June 17, 2020, to September 7,
2021, which the court found was the date on which Tunink reached maximum medical
improvement with regard to his right foot. The court awarded Tunink permanent benefits for 31.5
weeks at a rate of $855 per week.
         The compensation court found that the injuries to Tunink’s left foot were not related to the
May 2019 work accident. However, the court did note that Tunink “has depression and anxiety
which will improve once he finds work after vocational rehabilitation which will be either training
or job placement, but most likely formal retraining due to his high average weekly wage.” The
court ordered Continental Fire to pay for all of Tunink’s past and future medical expenses related
to his right foot injury and resulting surgery in addition to “medication for depression and anxiety.”
The court found that Tunink is entitled to vocational rehabilitation services.
         Continental Fire filed their notice of appeal on June 15, 2023. A few weeks later, on August
2, 2023, Tunink died by suicide. The personal representative of his estate filed a motion to revive
the action and to substitute the estate as the appellee in this matter. We granted such motions.
However, we denied the estate’s motion to remand the matter back to the compensation court to
determine whether, in addition to the benefits already awarded, the estate is entitled to any death
benefits from Continental Fire. In this appeal, we review only the issues raised in connection with
the compensation court’s May 2023 order.
                                   ASSIGNMENTS OF ERROR
       On appeal, Continental Fire assigns four errors, which we consolidate and renumber for
our review. First, Continental Fire argues that the compensation court erred in finding that
Tunink’s work-related accident caused permanent impairment to his right foot and, thus, was
compensable. Second, it argues that the court’s decision to award Tunink with payment for his
depression and anxiety medication was not well reasoned pursuant to Rule 11 and was not
supported by sufficient evidence. Finally, Continental Fire challenges the court’s finding that
Tunink was entitled to vocational rehabilitation services.

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                                   STANDARD OF REVIEW
        Under Neb. Rev. Stat. § 48-185 (Reissue 2021), a judgment, order, or award of the
compensation court may be modified, reversed, or set aside only upon the grounds that (1) the
compensation court acted without or in excess of its powers; (2) the judgment, order, or award was
procured by fraud; (3) there is not sufficient competent evidence in the record to warrant the
making of the order, judgment, or award; or (4) the findings of fact by the compensation court do
not support the order or award. See Lewis v. MBC Constr. Co., 309 Neb. 726, 962 N.W.2d 359
(2021).
        On appellate review, the factual findings made by the trial judge of the compensation court
have the effect of a jury verdict and will not be disturbed unless clearly wrong. Id.
                                           ANALYSIS
Injury to Right Foot.
         On appeal, Continental Fire asserts that the compensation court erred in finding that
Tunink’s May 21, 2019, work-related accident caused permanent impairment to his right foot,
necessitating a disability award. Essentially, Continental Fire asserts that the evidence presented
at trial revealed that Tunink hurt his foot in the work-related accident, it healed, and he later
developed a separate and distinct condition in his right foot. Upon our review, we find sufficient
evidence in the record to support the compensation court’s finding that Tunink’s May 21, 2019,
work-related accident caused permanent impairment to his right foot.
         The record contains conflicting medical evidence regarding the cause of Tunink’s
deformity in his right foot which necessitated him to have reconstructive surgery and which caused
a permanent impairment to his right foot. McMullen, Tunink’s treating surgeon, opined to a
reasonable degree of medical certainty that Tunink’s deformity in his right foot was “secondary to
that work related injury which occurred in May of 2019.” Atteberry, who performed a medical
examination of Tunink at the request of his attorneys concurred with McMullen’s opinion of
causation: “[The] injury to his right foot and subsequent need for surgery on his right foot is a
direct result of his work injury on 05/21/2019.” Contrary to these opinions, Wampler, who
performed a medical examination of Tunink at the request of Continental Fire’s attorneys, and
Joshi, who performed a review of Tunink’s medical records, both opined to a reasonable degree
of medical certainty that Tunink’s right foot deformity and resulting surgery were unrelated to his
May 2019 work accident. Wampler believed that Tunink had fully recovered from any injury
suffered in the accident by June and that the right foot deformity which began months after the
accident, was related to his diabetic neuropathy. Joshi also believed that Tunink’s right foot
deformity was caused by diabetic neuropathy, rather than any lingering injury from the work
accident.
         In its award, the compensation court implicitly found that the opinions of McMullen and
Atteberry were more credible than the opinions of Wampler and Joshi. The court stated, “The court
finds [Tunink] injured his right foot at work on May 21, 2019, which got worse due to microtrauma
from walking which ultimately required surgery by Dr. McMullen. [Tunink] has a 21 percent loss
of use of his right foot.”

                                               -9-
        The compensation court is the sole judge of the credibility and weight to be given medical
opinions, even when the health care providers do not give live testimony. Yost v. Davita, Inc., 23
Neb. App. 482, 873 N.W.2d 435 (2015). When the record presents nothing more than conflicting
medical testimony, an appellate court will not substitute its judgment for that of the compensation
court. Id. The compensation court chose to find the opinions of McMullen and Atteberry credible,
and we do not reweigh that decision on appeal.
        Continental Fire asserts that even if the compensation court properly considered the
opinions of McMullen and Atteberry in finding that Tunink’s May 21, 2019, work-related accident
caused permanent impairment to his right foot, the court erred in determining that walking had
exacerbated Tunink’s condition. Continental Fire contends, “injuries due to walking are not
compensable under the [Workers’ Compensation] Act.” Brief for appellant at 21. We find
Continental Fire’s contention to be without merit. This is not a situation where Tunink injured his
right foot while merely walking at work, as in Maradiaga v. Specialty Finishing, 24 Neb. App.
199, 884 N.W.2d 153 (2016), the case cited by Continental Fire in support of its contention. In
Maradiaga, this court found that an employee’s injury did not arise out of her employment when
the employee fractured her ankle while getting out of her car in her employer’s parking lot.
Therein, we explained that “nonstrenuous walking is the ‘epitome of a nonemployment risk.’” Id.
at 212, 884 N.W.2d at 162. We went on to find that no evidence was adduced in the case indicating
“that the everyday activity of exiting a car, while carrying nothing heavier than a small lunchbox”
was a risk associated with her employment. Id.
        In this case, the evidence presented at trial indicated that Tunink injured his right foot in
the course and scope of his employment with Continental Fire when he was actively engaged in
testing a fire alarm system, all of which was admitted in Continental Fire’s answer. According to
expert medical testimony offered at the trial by Tunink, the injury suffered by Tunink in his
work-related accident was worsened by him continuing to work and to walk extensively. Such
evidence does not indicate that Tunink’s injury to his right foot resulted from an “everyday
activity” or from any “nonemployment risk.” See id. Rather, such evidence supports Tunink’s
contention that he suffered from an initial work-related injury which was exacerbated by the
requirements of his subsequent work.
        Taking into account the evidence presented at the trial and our standard of review, we
cannot say the compensation court was clearly wrong in determining that Tunink’s May 21, 2019,
work-related accident caused permanent impairment to his right foot.
Depression and Anxiety.
       At the close of the presentation of evidence at trial, the compensation court questioned in
open court whether there was any medical testimony that tied Tunink’s depression and anxiety to
the work-related accident. The court explained, “Common sense tells me that he’s probably
depressed and anxious because he can’t do what he used to do, but I usually have a doc say that.”
The court indicated its belief that Tunink did not present sufficient, competent evidence to support
an award for his mental health problems: “I got nothing to hang my hat on.” However, in the
compensation court’s award entered in May 2023, the court made a finding that Tunink “has
depression and anxiety which will improve once he finds work after vocational rehabilitation
which will be either training or job placement, but most likely formal retraining due to his high

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average weekly wage.” The court then awarded Tunink payment for his medication for his
depression and anxiety.
        On appeal, Continental Fire challenges the compensation court’s determination that Tunink
be awarded payment for “medication for depression and anxiety” without first explicitly finding
that Tunink’s depression and anxiety were caused by the May 21, 2019, work-related accident.
Continental Fire argues both that the compensation court’s decision violates Rule 11 of the
Nebraska Compensation Court’s rules of procedure and that it is not supported by sufficient
evidence. For the reasons set forth herein, we agree with Continental Fire that the compensation
court did not provide a reasoned decision containing facts and conclusions of law pursuant to Rule
11. Accordingly, we reverse and remand this issue for further decision by the compensation court.
        Rule 11 provides, in relevant part, that “[d]ecisions of the court shall provide the basis for
a meaningful appellate review.” Rule 11 ensures that compensation court orders are sufficiently
clear in addressing the parties’ requested relief so that an appellate court can review the evidence
relied upon by the trial judge in support of his or her findings. It requires “explicit findings of fact
and conclusions of law so that all interested parties and a reviewing court can determine the legal
and factual basis upon which a decision is made.” Torres v. Aulick Leasing, 258 Neb. 859, 863,
606 N.W.2d 98, 102 (2000). It also requires a record that elucidates the factors contributing to the
lower court’s decision. Hynes v. Good Samaritan Hosp., 285 Neb. 985, 830 N.W.2d 499 (2013).
        Here, in its order, the compensation court indicated its belief that Tunink’s depression and
anxiety will improve once he can work again. The court then ordered Continental Fire to pay for
Tunink’s depression and anxiety medication. However, the compensation court never made an
explicit finding that Tunink’s depression and anxiety were caused, or at least exacerbated, by the
May 2019 work-related accident. Nor does the compensation court indicate what evidence it may
have relied on for any causation finding. In fact, in its comments immediately after the trial, the
compensation court indicated its belief that Tunink had failed to prove a causal link between the
work-related accident and his depression and anxiety.
        The Nebraska Supreme Court has previously reversed orders and remanded causes under
Rule 11 when the order of the compensation court was unclear. See, e.g., Rogers v. Jack’s Supper
Club, 304 Neb. 605, 935 N.W.2d 754 (2019); Owen v. American Hydraulics, 254 Neb. 685, 578
N.W.2d 57 (1998); Hale v. Standard Meat Co., 251 Neb. 37, 554 N.W.2d 424 (1996). In a case
where the order was ambiguous and contradictory, the Supreme Court said that “[n]either party
should prevail on the basis of an ambiguity.” Owen v. American Hydraulics, 254 Neb. at 695, 578
N.W.2d at 64.
        The award before us is similarly unclear. First, it is not at all clear that the compensation
court found, based on the evidence presented, that Tunink’s depression and anxiety was caused by
the work-related accident. As such, it is not clear that Continental Fire should be responsible for
Tunink’s depression and anxiety medication. In addition, even if we could glean causation from
the court’s decision, the parameters of the compensation court’s decision are not clear, including
whether Continental Fire is required to pay for Tunink’s past use of such medicine, his future use,
or both. Finally, the award does not address whether Continental Fire will have to pay any other
medical expenses associated with Tunink’s depression and anxiety.
        Ultimately, we conclude that the compensation court’s award as to Tunink’s depression
and anxiety is confusing and unclear. As such, we vacate that portion of the award and remand the

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cause for further proceedings. On remand, the compensation court shall, inter alia, enter an order
based on the existing record, clarifying its finding regarding the causation of Tunink’s depression
and anxiety and, if necessary, clarifying Continental Fire’s economic obligations as a result of
Tunink’s psychological condition.
Vocational Rehabilitation Services.
        In its brief on appeal, Continental Fire asserts that the compensation court erred in
determining that Tunink was entitled to vocational rehabilitation benefits or, in the alternative,
erred in failing to define the parameters of those benefits. In the estate’s brief, it asserts that while
the award of vocational rehabilitation benefits by the compensation court was proper, such award
is now moot given that Tunink is deceased. And, in Continental Fire’s reply brief, it agrees with
the estate that this issue is now moot due to Tunink’s death.
        We agree with the parties that the issue of Tunink’s entitlement to vocational rehabilitation
benefits is moot given that Tunink is deceased. An action becomes moot when the issues initially
presented in the proceedings no longer exist or the parties lack a legally cognizable interest in the
outcome of the action. Nesbitt v. Frakes, 300 Neb. 1, 911 N.W.2d 598 (2018). A moot case is one
which seeks to determine a question that no longer rests upon existing facts or rights—i.e., a case
in which the issues presented are no longer alive. Id. Mootness refers to events occurring after the
filing of a suit which eradicate the requisite personal interest in the resolution of the dispute that
existed at the beginning of the litigation. Id.
        One of the primary purposes of the Nebraska Workers’ Compensation Act shall be the
restoration of an injured worker to gainful employment. See Neb. Rev. Stat. § 48-162.01(1)
(Reissue 2021). Typically, vocational rehabilitation benefits are awarded to workers who can no
longer perform work for which they have previous training, and who need assistance with
retraining and job placement to obtain suitable employment after an injury. See § 48-162.01(3).
Here, Tunink died soon after the compensation court entered its order. As such, he was unable to
participate in any vocational rehabilitation programming. The compensation court’s award of this
benefit was rendered moot by Tunink’s death.
                                           CONCLUSION
        Upon our review, we affirm that portion of the compensation court’s award which
determined that Tunink’s May 21, 2019, work-related accident caused permanent impairment to
his right foot. However, we reverse that portion of the court’s award which awarded Tunink with
payment for his depression and anxiety medication, as the court’s determination in this regard was
not a reasoned decision containing facts and conclusions of law pursuant to Rule 11. We remand
the cause with directions for the court to enter an order based on the existing record, clarifying its
finding regarding the causation of Tunink’s depression and anxiety and, if necessary, clarifying

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Continental Fire’s economic obligations as a result of Tunink’s psychological condition. Finally,
we agree with the parties that the issue of whether Tunink was entitled to vocational rehabilitation
benefits was rendered moot by Tunink’s recent death.
                                                      AFFIRMED IN PART, AND IN PART REVERSED
                                                      AND REMANDED WITH DIRECTIONS.

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