KIRK A. BORDEAU, Employee/Appellant, v. GREEN TOUCH INDUS. and ZURICH COMMERCIAL, Employer-Insurer, and WAUSAU SPINE & NEUROSCIENCES, LLC, and ALLIED HEALTH CHIROPRACTIC CTRS., Intervenors.
WORKERS= COMPENSATION COURT OF APPEALS
AUGUST 31, 2006
File No. WC06-131
MEDICAL TREATMENT & EXPENSE - CHIROPRACTIC TREATMENT; MEDICAL TREATMENT & EXPENSE - REASONABLE & NECESSARY. Where it was clear from the judge=s specific findings that he was familiar with the legal standards established in case law, where it was not unreasonable for the judge to find, based on his findings pursuant to those standards, that the expenses at issue were not reasonable, necessary, and causally related to the work injury, and where the judge=s decision was also reasonably supported by expert medical records and opinion, the compensation judge=s denial of payment of the chiropractic expenses at issue was not clearly erroneous and unsupported by substantial evidence, notwithstanding the fact that the judge did not specifically cite the case law containing the legal standards that he applied.
PRACTICE & PROCEDURE - ADEQUACY OF FINDINGS; CAUSATION - MEDICAL TREATMENT. Where medical as well as chiropractic bills were clearly at issue at the hearing but the judge addressed specifically only the chiropractic treatment, the judge=s reference in his findings to his Aconclusion that the employee=s current low back problems are not substantially related to the 1987 work injury@ was read to be a reference not just to the employee=s need for chiropractic care but also to his need for medical care, and the judge=s ultimate denial of all Aclaims of the employee,@ medical as well as chiropractic, was not clearly erroneous and unsupported by substantial evidence and did not require remand for further findings and reconsideration.
Determined by Pederson, J., Johnson, C. J., and Wilson, J.
Compensation Judge: Gary P. Mesna
Attorneys: Patrick E. Mahoney, Mahoney, Dougherty & Mahoney, Minneapolis, MN, for the Appellant. Mark A. Kleinschmidt, Cousineau McGuire Chartered, Minneapolis, MN, for the Respondents.
WILLIAM R. PEDERSON, Judge
The employee appeals from the compensation judge's denial of payment of medical and chiropractic expenses on grounds of reasonableness and necessity and causation. We affirm.
On October 28, 1987, Kirk Bordeau sustained an injury to his low back while lifting a large lawnmower in the course of his employment doing lawn care work with Green Touch Industries. Mr. Bordeau [the employee] was twenty-nine years old on that date and was earning a weekly wage of $240.00. On December 1, 1987, Green Touch Industries [the employer] and its insurer denied liability for the injury, and on January 6, 1988, the employee underwent a CT scan that was read to reveal some mild bulging at L4-5 on the left. On January 14, 1988, the employee filed a claim petition, alleging entitlement to various benefits consequent to a Aruptured@ lumbar disc. Although the CT scan had revealed no evidence of any nerve root compression, in February of 1988 the employee underwent a laminectomy at level L4-5 of his lumbar spine. Subsequent to that surgery, the employee developed some puffiness around his incision, which was surgically drained, and he returned to work with restrictions shortly after the surgery. By findings and order filed May 25, 1988, the employee was determined to be entitled to benefits, and the employer and insurer commenced payment of benefits. Within six months after his surgery, the employee was released to work again without restrictions, and the employer and insurer paid permanent partial disability benefits for a 9% whole-body impairment, apparently based on an excellent surgical result. Among the jobs at which the employee subsequently worked was first a job as a car salesman, which kept him on his feet most of the day, and then a job as a bouncer at a nightclub, in the course of which work he was evidently injured occasionally in altercations.
On December 11, 1989, chronic pain specialist Dr. Warren Bilkey, who had evidently first examined the employee in August of 1989, issued a report to the employee=s attorney. In his report, Dr. Bilkey opined that the employee was subject to a 15% whole-body disability related to his repaired herniated disc, pursuant to Minnesota Rules 5223.0070, subpart 1B(2)(d), which provides for compensation for multiple operations on a single low back disc with poor results. Dr. Bilkey opined also that Ait can be argued@ that an additional 10.5% rating was Areasonable@ under the Minnesota Rules 5223.0070, subpart 1A(3)(b), which provides for compensation for objectively substantiated pain associated with rigidity or muscle spasm at multiple vertebral levels. Subsequently, on December 28, 1989, the employee filed a claim petition, alleging in part entitlement to permanent partial disability compensation for a 25.5% whole-body impairment, less the 9% already paid, based on the opinion of Dr. Bilkey. In January of 1990, subsequent to the employee=s claim petition, Dr. Bilkey evidently diagnosed chronic pain syndrome with significant depression and recommended a chronic pain program.
On March 20, 1990, the employee underwent a neurological evaluation for the employer and insurer by orthopedic surgeon Dr. David Johnson. Dr. Johnson opined that the employee had sustained only a 13% whole-body impairment consequent to his October 1987 work injury, pursuant to Minnesota Rules 5223.0070, subpart 1B(2)(c), which provides for compensation for a single herniated disc surgery with poor results, Dr. Johnson being of the opinion that the employee=s incision-drainage surgery did not constitute a second disc surgery. Dr. Johnson noted also that, although the employee was frustrated with his post-injury situation and continued to complain of a lot of intermittent and variable low back pain, the employee had not taken any medications post-surgically and was not currently taking any. Dr. Johnson recommended a chronic pain program but did not consider the employee to be a surgical candidate, noting also that the employee was Aan unusually well-built, muscular young man,@ who Alooks like a terrific physical specimen,@ easily capable of lifting twenty-five to thirty-five pounds on occasion.
The employee commenced participation in a chronic pain program in early May of 1990, but he discontinued participation after only a few days. On June 25, 1990, the parties filed a stipulation for full, final, and complete settlement of all of the employee=s claims related to his 1987 work injury, with the exception of medical benefits, compromising in part the employee=s claim to permanent partial disability compensation. At some point in 1992, about two years after his settlement, the employee was involved in a motorcycle accident in which he broke his collarbone, following which he was evidently comatose for ten days and required two hundred stitches in his head. Several years later, evidently in the late 1990s, the employee moved to Colorado, where he continued to work at various rather heavy jobs, including construction and roofing. While performing such work in Colorado, the employee fell twenty to twenty-five feet from a ladder and subsequently commenced treatment with a chiropractor. Several months later, in the summer of 2000, he moved from Colorado back to Wausau, Wisconsin, where he worked for about six months as a roofer with Badger Roofing and has since worked manufacturing windows with Kolbe & Kolbe.
Once back in Wisconsin, the employee continued to experience back pain, and on July 20, 2000, he began treating with chiropractor Dr. H. Dale Poland, in Wausau, Wisconsin. Dr. Poland diagnosed primarily a Avertebral subluxation complex and its components@ and commenced treatment of all levels of the employee=s spine, using various treatment modalities. On April 16, 2001, the employee reported to Dr. Poland that the pain in his Aneck, mid back area, chest and lower back area@ had spiked to a level ten out of ten, was getting worse, and seemed to be aggravated by his job with Kolbe and Kolbe. Dr. Poland increased the frequency of his treatments under a revised treatment plan through July 2001, after which he did not see the employee for over half a year.
On February 2, 2002, the employee was seen in the walk-in department of a Wisconsin medical clinic by Dr. Douglas Olmanson, complaining of Alow back pain which happened about a week ago when his snowmobile got stuck, he attempted to lift it out and could not lift it out . . . and then injured the back while he was trying t[o] jerk the snowmobile out of the snow.@ The doctor noted that the employee Adid have a discectomy on his back two years ago@ with A[n]o real complications as the result of surgery but occasionally he will strain . . . the back and it usually goes away but this has been going on for about a week now and is not going away.@ After physical examination, Dr. Olmanson diagnosed low back strain and prescribed medication. The employee was seen at the same clinic on March 7, 2002, by Dr. John Webb, who diagnosed chronic and recurrent low back pain and renewed the employee=s Vicodin prescription without authorization for a refill. The employee was seen with similar complaints at the same clinic again about ten months later, on January 30, 2003, by Dr. Thomas McCool, who diagnosed back pain flare up and declined to prescribe more narcotics from the walk-in department. On April 7, 2003, the employee was seen by Dr. Thomas Hupy at the same clinic, complaining of chronic back pain, an inability to work, and depletion of his Vicodin. Dr. Hupy diagnosed low back pain, prescribed Ultracet, and released the employee to return to work the following day, noting Dr. McCool=s instruction that the employee not come to the walk-in clinic for the purpose of obtaining narcotics.
The employer and insurer continued to pay the employee=s chiropractic and medical bills until December of 2003, when they apparently began denying liability. Over the course of December 2003 and January 2004, the employee=s complaints increased, and on January 28, 2004, Dr. Poland restricted him from all work. On February 2, 2004, Dr. Poland issued a treatment plan, on which he referenced only cervical/thoracic examinations, reporting progress toward achievement of goals on orthopedic tests but none in the symptom areas of pain, tenderness, edema, spasm, or range of motion. The treatment plan identified improvement in those and several other symptom areas as short-term goals and correction of subluxations as the single long-term goal. The lone identified modality of planned home treatment was anti-inflammatory/protective measures, and the lone identified modality of planned in-office treatment was chiropractic adjustment and mobilization. Anticipated frequency of treatment was of A[s]upportive care,@ defined as one time per month, or more often with flare-ups, with re-evaluation anticipated on the fifteenth visit. The employee apparently remained restricted from working until March 8, 2004, when Dr. Poland released him to return to work Awith no limitations.@ Ten months later, on December 1, 2004, Dr. Poland reiterated to the employee=s attorney that, as of his most recent full evaluation of the employee, the previous February, the employee=s Aprimary complaints w[ere of] achiness and burning pain in the cervical/thoracic spine radiating across both shoulders.@
On December 30, 2004, the employee filed a medical request, seeking payment of outstanding bills for chiropractic treatment with Dr. Poland in the amount of $960.00. On January 27, 2005, the employer and insurer filed a medical response, renewing its denial of payment for the treatment, on grounds that the treatment exceeded the workers= compensation treatment parameters and was not causally related to the October 28, 1987, work injury. On April 13, 2005, Dr. Poland wrote to the employee=s attorney Ato explain the progress of the [employee=s] case and the degree of impairment he now experiences.@ In his letter, Dr. Poland opined expressly that Athe trauma sustained in the May 5, [sic] 1987 work injury and the following surgical procedure of the laminectomy of the lower back has caused the accelerated degenerated changes that are occurring throughout the spine but primarily in the lower back area that has caused the patient to have a permanent impairment and worsening subjective picture.@ Without citation of Minnesota Rules, Dr. Poland rated the employee=s permanent impairment at 23% of the whole body, and he recommended that the employee continue to receive chiropractic treatments on a supportive care basis of one to four times a month over the course of the next five years, at a projected cost of about $1,270.00.
On April 20, 2005, the employee was examined by neurologist Dr. Barry Passini, on referral from Dr. Poland. Dr. Passini diagnosed chronic low back pain, history of lumbar laminectomy at L4/5, and worsening low back pain for the past year Awithout significant response to chiropractic therapy,@ and he recommended a trial of Naproxen, a lumbar MRI scan, and EMGs and nerve conduction studies of the right lower extremity. The MRI, conducted on April 25, 2005, was read to reveal multilevel disc bulging, a very small left-side foraminal disc protrusion/herniation at L4-5, multilevel facet degenerative change, and post-surgical changes at L4-5 on the left. The EMG/nerve conduction studies, conducted on May 5, 2005, were read to be normal. Dr. Passini subsequently referred the employee to physical medicine and rehabilitation specialist Dr. Margaret Anderson, noting in his referral letter of May 6, 2005, that he did not find any evidence of radiculopathy based on the MRI or EMG/nerve conduction studies and that the employee=s only and very small actual disc herniation was on the left, whereas his complaints of pain were on the right. Upon examination of the employee on June 23, 2005, Dr. Anderson diagnosed mechanical back pain with multilevel degenerative disc disease and chronic pain syndrome, concluding that the employee was not a surgical candidate. She recommended trial use of a TENS unit, trial of Zanaflex for complaints of muscle spasm, and physical therapy for formal instruction in a home program. She also explained to the employee that his was not a problem that would cause neurological deficit.
On July 22, 2005, the employee was examined for the employer and insurer by orthopedic surgeon Dr. Paul Cederberg. Upon completion of his exam and review of the employee=s medical records, in a report issued July 25, 2005, Dr. Cederberg diagnosed a history of an L4-5 laminectomy and recurrent lumbar strains, concluding that the employee=s October 28, 1987, work injury was not a significant or substantial contributing factor in any of the employee=s current symptoms. He concluded further that ongoing chiropractic care was not reasonable or necessary or curative of the employee=s low back condition, that it might even be exacerbating the employee=s chronic spondylosis at L4-5, and that any current treatment was unrelated to the employee=s 1987 work injury. In a follow-up report issued August 4, 2005, after reviewing recent records of Dr. Poland and records from the Wausau walk-in clinic, Dr. Cederberg reiterated his opinion that the employee=s October 1987 work injury was not a significant contributing factor in his current condition.
On September 1, 2005, the employee filed a claim petition, alleging entitlement to medical care and treatment expenses consequent to his work injury on October 28, 1987, and on October 27, 2005, that claim petition and the employee=s December 30, 2004, medical request were consolidated for hearing. In a letter to counsel for the employer and insurer on November 7, 2005, Dr. Cederberg reiterated his concern that the employee=s chiropractic care might actually be counterproductive, noting that Dr. Poland himself had agreed with him that the employee=s condition was not curable and that his chiropractic care was not curative. The employee=s last treatment of record by Dr. Poland was November 8, 2005.
The employee=s consolidated medical request and claim petition came on for hearing on January 26, 2006. Specific issues addressed at hearing included (1) A[p]ayment of medical and chiropractic bills@ in the amount of $8,663.40, for treatment from Drs. Poland, Anderson, and Passini and for the employee=s MRI scan on April 25, 2005, (2) A[w]hether the treatment was causally related to the 1987 work injury,@ and (3) A[w]hether the chiropractic treatment was reasonable and necessary.@
At the hearing, the employee testified in part that he had sought no chiropractic treatment prior to his move to Colorado in about 2000 but had nevertheless experienced very severe and increasing burning and numbness and other problems with his low back during that time. He testified, AI couldn=t put my shoes on, I had to lay on the ground to put my shoes on. I couldn=t sit on the toilet at times. Just terrible, terrible.@ He testified also that he subsequently received chiropractic treatments in Colorado Athe entire time I was there,@A[c]lose to eight years,@ but that each treatment Aseemed like it did work for three or four, five hours, but the pain came back immediately.@ With regard to his later treatment with Dr. Poland in Wisconsin, he testified that his therapies would seem to work A[f]or a little while,@ would helped to get him back to work, and would A[s]ometimes@ help him to be able to carry out the normal functions of his life. Later in his testimony, however, he indicated that Dr. Poland=s treatment seemed to help Avery much@ and that he Acan=t function unless I see [Dr. Poland]. I absolutely can=t do anything.@ The employee testified further that he limited himself to fifty pounds lifting in his current job, acknowledging that he was not, however, subject to any written restrictions from a doctor. He indicated that he had lost A[v]ery much@ time from work due to his low back condition and that Dr. Poland had put him on Aa chronic pain thing, so if I have to leave work because of my back goes out, work doesn=t hold it against me.@ He said that the frequency of his flare-ups had increased since 1987 and that the intensity of them was A[o]ff the chart.@ He testified that, in the past week to ten days, he had been having A[t]errible@ pain on both sides of his low back and pain, numbness, and tingling in both of his legs. He testified that his pain was of all sorts - - A[e]xcruciating, dull, burning@ - - and that at its worst, on a scale of one to ten, AIt=s about ten. It gets to the point sometimes it=s so bad it makes me cry almost.@ Finally, he testified also that none of the several injuries that he sustained subsequent to his 1987 work injury - - including those that he sustained in the altercations while working as a bouncer, in the 1992 motorcycle accident, and in the twenty-foot fall off the ladder in Colorado, just before returning to Wisconsin - - had affected the ongoing condition of his low back.
By findings and order filed February 6, 2006, the compensation judge denied the employee=s claims in their entirety, finding specifically at Finding 6 that A[t]he chiropractic treatment by Dr. Poland had not been reasonable and necessary,@ at Finding 8 that A[t]he chiropractic treatment is not causally related to the work injury of October 28, 1987,@ and at that same finding that Athe employee=s current low back problems are not substantially related to the 1987 work injury.@ The judge indicated further, at Finding 9, that A[t]he court did not find the employee=s testimony to be particularly credible@ and, at Finding 10, that A[t]he treatment parameters are not applicable in this case.@ The judge did not specifically reference in his findings the medical bills at issue, and he did not attach a memorandum. The employee appeals.
STANDARD OF REVIEW
In reviewing cases on appeal, the Workers= Compensation Court of Appeals must determine whether Athe findings of fact and order [are] clearly erroneous and unsupported by substantial evidence in view of the entire record as submitted.@ Minn. Stat. ' 176.421, subd. 1 (1992). Substantial evidence supports the findings if, in the context of the entire record, Athey are supported by evidence that a reasonable mind might accept as adequate.@ Hengemuhle v. Long Prairie Jaycees, 358 N.W.2d 54, 59, 37 W.C.D. 235, 239 (Minn. 1984). Where evidence conflicts or more than one inference may reasonably be drawn from the evidence, the findings are to be affirmed. Id. at 60, 37 W.C.D. at 240. Similarly, A[f]actfindings are clearly erroneous only if the reviewing court on the entire evidence is left with a definite and firm conviction that a mistake has been committed.@ Northern States Power Co. v. Lyon Food Prods., Inc., 304 Minn. 196, 201, 229 N.W.2d 521, 524 (1975). Findings of fact should not be disturbed, even though the reviewing court might disagree with them, Aunless they are clearly erroneous in the sense that they are manifestly contrary to the weight of the evidence or not reasonably supported by the evidence as a whole.@ Id.
The compensation judge found that the chiropractic treatment at issue by Dr. Poland was neither reasonable and necessary nor causally related to the employee=s work injury, noting expressly his Aconclusion that the employee=s current low back problems are not substantially related to the 1987 work injury.@ The judge did not specifically reference the medical bills that were at issue. On appeal, the employee contends that the judge=s denial of payment of Dr. Poland=s chiropractic bills is unsupported by substantial evidence and that the judge=s failure even to address the medical bills at issue mandates at least a remand if not an outright reversal.
1. Chiropractic Treatment
With regard to the reasonableness, necessity, and causal relationship of the chiropractic care, the employee asserts initially that the compensation judge not only failed to provide an explanatory memorandum with his decision but failed even to identify the legal standards or the rationale upon which his decision was based. He argues that, absent such explanatory support, the employee is prejudiced in his ability to argue his position and that A[s]uch slipshod writing@ mandates reversal. Further, the employee argues that the judge premised his decision on incorrect facts, in particular a finding that the employee was ultimately released to work without restrictions. He argues that A[t]he Employee has had left low back problems since 1987" and that Athe benefit of the chiropractic treatment was such that it had allowed the Employee to return to work, engage in sustained gainful employment, have relief from his symptoms, and to carry out his normal daily activities.@ He argues further that, contrary to specific implications of the judge=s findings, (1) A[t]here was a treatment plan,@ (2) A[t]here was documentation of the details of treatment,@ (3) A[t]here was a degree and duration of relief that was appropriate@ in that it (4) Aallowed [the employee] to carry out the normal duties involved [in his job],@ and (5) A[t]he [treatment=s] potential for aggravating the underlying condition is speculative.@ We are not persuaded.
While the applicable factors will vary from case to case depending on the particular facts and circumstances involved, it is well established - - and this court has frequently reiterated - - that certain factors should be considered by a judge in assessing the reasonableness and necessity of an injured employee=s claim to payment of chiropractic expenses. These general factors have come to overlap substantially and to include generally the following six: (1) documentation of the treatment itself and of the details of a reasonable treatment plan; (2) whether the frequency and duration of the treatment is warranted, in light of the potential for psychological dependency; (3) the degree and duration of the relief itself that is obtained from the treatment; (4) the relationship of the treatment to the goal of returning the employee to suitable employment and nonwork activities; (5) appropriate referral to medical providers in the event of continuing problems, in light of the possibility that the chiropractic treatment itself may be causing the problem; and (6) the cost of the treatment in light of the relief provided and the results obtained. See Selander v. Healey Ramme Co., Inc., slip op. (W.C.C.A. Jul. 14, 1993), citing Field-Seifert v. Goodhue County, slip op. (W.C.C.A. Mar. 5, 1990), Horst v. Perkins Restaurant, 45 W.C.D. 9 (W.C.C.A. 1991), and Fuller v. Naegele/Shivers Trading, slip op. (W.C.C.A. Apr. 14, 1993). Causation considerations are little different from those applying to nonchiropractic care. Although the judge may have declined to issue a memorandum in explanation of his decision, and although he may not have cited specific case-law guidance in reaching that decision, the bases for the compensation judge=s denial of payment for the chiropractic treatments here at issue are, contrary to the suggestion of the employee, clearly articulated in the judge=s very specific findings, and those findings are in turn clearly allusive to the case law cited above.
At Finding 5 the compensation judge notes in part that, instead of showing improvement as a result of the chiropractic care at issue, the condition of the employee=s low back actually appears to be getting worse, perhaps due to a natural degenerative process or even to repetition of the chiropractic adjustments themselves. At Findings 6 and 7, the judge goes on to conclude the following: (1) that A[t]here is not a reasonable treatment plan@; (2) that A[the employee] is not getting a great deal of relief from the treatments@; (3) that Athe duration of relief is not long@; (4) that A[t]here is a significant risk of aggravating the employee=s condition with the adjustments, considering the multi-level degenerative disc disease@; (5) that A[t]he court is not persuaded that the chiropractic treatment is playing a significant role in keeping the employee working@; (6) that A[t]here has been little effort to wean the employee from chiropractic care@; (7) that Athere is a likelihood of psychological dependence on the treatment@; and (8) that A[t]he benefits obtained from the care do not justify the cost.@ We conclude that this detailed list of specific factual conclusions in Findings 5 through 7 constitutes an implicit reliance on the legal standard for assessing the reasonableness and necessity of chiropractic care that is established in case law proceeding primarily from Field-Seifert v. Goodhue County, Horst v. Perkins Restaurant, and Fuller v. Naegele/Shivers Trading, as summarized above from Selander v. Healey Ramme Company, Inc..
Contrary to the assertions of the employee, the factual conclusions contained in Findings 5 through 7 are also not unsupported by substantial evidence. It is true that Dr. Poland did complete a form titled ATreatment Plan@ in February of 2004, but that document does not address the employee=s case in any very personal way, and, as the judge noted, the plan was no longer current at the time of the hearing, and it contained no indication of alternatives in the event that the checkmarked treatment goals are not accomplished. Given these weaknesses, it was not unreasonable for the judge to conclude that the employee was not subject to a Areasonable@ treatment Aplan.@ The employee argues further that A[t]here was documentation of the details of treatment,@ but this does not conflict with the judge own assertion, in Finding 7, that A[t]he details of [the employee=s] treatment are documented in his records.@ The employee=s argument that A[t]here was a degree and duration of relief that was appropriate@ is in effect contradicted by his own testimony that his pain continued to often be A[t]errible@ and Aoff the chart@ and that his treatment would seem to work only A[f]or a little while@ and would only Asometimes@ help him to carry out the normal functions of life. Indeed, as the judge noted in Finding 7, the employee is now actually working less than he used to, in spite of the treatment here at issue, and has an arrangement with his doctor that, without actually formally restricting him from certain physical activities, permits him to work at his job unrestricted but only whenever he wants to - - certainly an arrangement that encourages psychological dependence. With regard to the employee=s argument that the treatment=s potential for aggravating his underlying condition was only speculative, we note that it is reasonably supported by the expert medical testimony of Dr. Cederberg, which constitutes substantial evidence. Given the totality of the evidence, it was not unreasonable for the judge to conclude that the benefits obtained from Dr. Poland=s treatment did not justify the cost.
With regard to the causal relationship of the treatment to the work injury, the compensation judge notes accurately in the first part of Finding 5 that much of the chiropractic treatment at issue here has been to the employee=s neck and shoulders, rather than to his work-injured low back. Then, at Finding 8, the judge goes on to conclude that the causal connection is missing also in that,
following the 1988 surgery, the employee was released to return to work with no restrictions. Thereafter, he was able to work for a long period of time at rather strenuous jobs. He sustained a number of very significant incidents that did not affect his low back, which would indicate that his low back was pretty good at those times. Even after he started treatment with Dr. Poland, at many of the earlier visits, the low back was not a big problem. While the low back problems got worse at later visits, the worsening may have been due to the chiropractic adjustments, the work he was doing, or the natural progression of the degenerative disc disease.
Nor is the judge=s conclusion that the employee was released to work without restrictions unsupported, as the employee argues, by substantial evidence. The employee appears to have last been restricted from working on March 8, 2004, being released to return to work the following day Awith no limitations,@ and the employee testified at hearing that he was currently not subject to any written restrictions by a doctor. He argues in his brief, however, that he Ahas had left low back problems since 1987@ and that only by imposing certain lifting restrictions on himself at work and by availing himself of the chiropractic treatments of Dr. Poland has he been able to continue functioning satisfactorily on and off the job. The truth of this assertion, however, is importantly based in the employee=s own testimony and history of complaints - - evidence dependent on the employee=s own credibility. At Finding 9, the judge indicates that he Adid not find the employee=s testimony to be particularly credible,@ explaining that the employee Aappeared to exaggerate many of his complaints,@ that it was Ahard to believe that [the employee] could continue to perform such heavy work while in such extreme pain,@ that even ADr. Poland=s records do not support [the employee=s] claim of such severe low back pain,@ and that A[a]t many of the earlier visits, [the employee=s] low back was not much of a problem compared with his neck and shoulders.@ These conclusions as to the employee=s credibility are not unreasonable in light of the transcript of the hearing and particularly in light of the deference that this court has long shown to compensation judges with regard to credibility issues. See Brennan v. Joseph G. Brennan, M.D., 425 N.W.2d 837, 839-40, 41 W.C.D. 79, 82 (Minn. 1988) (assessment of a witness's credibility is the unique function of the trier of fact), citing Spillman v. Morey Fish Co., 270 N.W.2d 781, 31 W.C.D. 187 (Minn. 1978).
Concluding that it was not unreasonable for the judge to find, based on the evidence of record, that the expenses were not reasonable, necessary, and causally related to the 1987 work injury, and because the judge=s decision is also reasonably supported by the opinions and medical records of Drs. Cederberg, Anderson, and Passini, we affirm the compensation judge=s denial of payment of the chiropractic expenses at issue. See Hengemuhle, 358 N.W.2d at 59, 37 W.C.D. at 239; Nord v. City of Cook, 360 N.W.2d 337, 342-43, 37 W.C.D. 364, 372-73 (Minn. 1985) ("a trier of fact's choice between experts whose testimony conflicts is usually upheld [unless] the facts assumed by the expert in rendering his opinion are not supported by the evidence").
2. Medical Treatment
While expressly identifying A[p]ayment of medical and chiropractic bills@ (underscoring added) as one of three issues for decision before him, and while that issue was, indeed, identified at hearing, the compensation judge did not specifically address the medical bills at issue and did not explain any deliberate decision not to address them. The employee contends that this failure by the judge mandates reversal and remand. He notes that Dr. Cederberg, the independent examiner upon whom the judge relied, also neglects to address the employee=s medical treatment. The employee cites several facts in evidence, including his MRI scan, indicating that the medical care and treatment in and of itself was reasonable and necessary, and he argues that no evidence was presented that that care was not reasonable and necessary. Therefore, he argues, the case must be at least remanded, if not reversed outright, for findings on both the reasonableness and necessity of the care and its relationship to the work injury. We are not persuaded.
Following his conclusion at Finding 7 that Dr. Poland did not have a reasonable chiropractic treatment plan, the compensation judge went on to find at Finding 8 that that same chiropractic treatment also was not causally related to the employee=s October 1987 work injury. Later in that same finding, however, the judge went on to reference A[t]he conclusion that the employee=s current low back problems are not substantially related to the 1987 work injury@ (underscoring added). We read this reference to the employee=s Acurrent low back problems@ to be a reference not just to the employee=s need for chiropractic care but also to his need for medical care. Regardless of how reasonable and necessary might have been the employee=s medical treatment, whether diagnostic or otherwise, either in the context of the chiropractic care here held unrelated to the work injury or even in its own right, Finding 8 appears to us clearly to imply a conclusion that the employee=s medical care as well as his chiropractic care was unrelated to his work injury, that injury having essentially resolved long before the advent of the current condition and its need for treatment. That conclusion was not unreasonable in light of the evidence of record as a whole, particularly as it is expressly supported by the reports of Dr. Cederberg on July 25, 2005, and August 4, 2005. Therefore we will not either reverse or remand the judge=s denial of all Aclaims of the employee,@ medical as well as chiropractic. See Hengemuhle, 358 N.W.2d at 59, 37 W.C.D. at 239; Nord, 360 N.W.2d at 342-43, 37 W.C.D. at 372-73.
 The employee appealed also from the judge=s finding that the workers= compensation treatment parameters did not apply in this case both because Minnesota does not have jurisdiction over the intervening out-of-state provider and because the judge had already, in any event, denied the benefits on grounds of the more threshold issue of causation. The employee did not, however, address the parameters issue in his brief, and therefore we will not address it. See Minnesota Rules 9800.0900, subpart 1 (AIssues raised in the notice of appeal but not addressed in the brief shall be deemed waived and will not be decided by the court.@).
 This is according to the employee=s testimony at hearing. The date contradicts the employee=s statement taken in a telephone interview on May 29, 2003, regarding a flare-up in symptoms that the employee experienced on May 8, 2003, in the course of his employment with Kolbe & Kolbe, in which interview the employee indicated that the motorcycle accident with collar bone injury happened in 1987.
 Here again, the employee=s testimony is inconsistent. On page 23 of the transcript of hearing he testifies that he moved to Colorado AI think in the late >90s, around 2000, maybe,@ but on page 28 of the transcript he testifies that he lived in Colorado A[c]lose to eight years, I think@ before moving back to Wisconsin in the summer of 2000.
 Dr. Cederberg=s suggestion that the renewal of symptoms at work on April 16, 2001, was probably consequent to the employee=s attempting to lift his snowmobile about a week earlier, rather than to any work-related aggravation of the original work injury on that date, appears, however, to arise from a confusion of the April 16, 2001, examination by Dr. Poland with the February 2, 2002, examination by Dr. Olmanson.
 See Footnote 3.