JOANN COLLINS, Employee, v. COMMUNITY LIVING OPTIONS and MINNESOTA ARP/WAUSAU INS., Employer-Insurer/Appellants.
WORKERS= COMPENSATION COURT OF APPEALS
SEPTEMBER 28, 2006
MAXIMUM MEDICAL IMPROVEMENT; TEMPORARY TOTAL DISABILITY. Where the parties had stipulated to service of separate MMI reports in 1997, 2003, and 2006, where there was no way to read the compensation judge=s memorandum except to conclude that the judge=s own reasoning required dating of MMI at the 1997 service, where the latter two reports had also both essentially dated MMI at the time of the 1997 report, where the judge offered no explanation or contrary evidence to support her nominal finding of MMI in 2003, and where, on review, the court found no substantial evidence conflicting with its legal conclusion or supporting the nominal but unexplained finding of the judge, the compensation judge=s nominal finding of MMI in 2003 was reversed and the 1997 date substituted in its place, the judge=s award of temporary total disability benefits more than 90 days after the 1997 service was reversed, and a related finding was vacated as irrelevant.
TEMPORARY PARTIAL DISABILITY - SUBSTANTIAL EVIDENCE; REHABILITATION - CONSULTATION. Where it was reasonably supported by expert medical opinion and the testimony of the employee, and where the judge expressly credited the employee=s testimony, the compensation judge=s award of temporary partial disability benefits based on a finding that the employee remained subject to a chronic condition consequent to her work injury was not clearly erroneous and unsupported by substantial evidence, and the judge=s conclusion that the employee was entitled to a rehabilitation consultation was also affirmed.
CAUSATION - MEDICAL TREATMENT. Where the employee=s work injury was clearly to her low back, where much of the treatment awarded by the judge appeared to be to parts of her body arguably unrelated to her low back, where the parties had stipulated to the reasonableness and necessity of all treatment at issue but not to its causal relationship to the work injury, and where the employee=s entitlement to temporary partial disability benefits was affirmed, the compensation judge=s general award of payment of all claimed medical expenses, without any citation of the evidence on which she was relating nonlow-back treatment to the low back work injury, was remanded to the compensation judge for reconsideration and more reviewably specific findings.
Reversed in part, vacated in part, affirmed as modified in part, and remanded in part.
Determined by Pederson, J., Johnson, C. J., and Rykken, J.
Compensation Judge: Peggy A. Brenden
Attorneys: David R. Vail, Soderberg & Vail, Minneapolis, MN, for the Respondent. Joseph G. Twomey, Hansen, Dordell, Bradt, Odlaug & Bradt, St. Paul, MN, for the Appellant.
WILLIAM R. PEDERSON, Judge
The employer and insurer appeal from the compensation judge's conclusion as to the date of maximum medical improvement and from her awards of wage replacement and medical benefits and a rehabilitation consultation. We reverse the judge=s dating of MMI and her award of temporary total disability benefits, we vacate a related finding as irrelevant, we affirm the judge=s finding of entitlement to a rehabilitation consultation and, with modification, her award of temporary partial disability benefits, and we remand for reconsideration and further findings the judge=s award of medical benefits.
On September 18, 1996, Joann Collins sustained a work-related injury to her low back when a resident in the group home in which Ms. Collins worked struck her low back with his fists in the course of her employment as a personal care assistant with Community Living Options. At the time of the injury, Ms. Collins [the employee] was fifty-seven years old and was earning a weekly wage of $109.25. The employee, who had never before had any symptoms or restrictions associated with her low back, experienced an immediate onset of pain in her low back, just above her waist line at the center of her back. She was seen the following day by Dr. Pam Doorenbus at Chisago Health Services, who diagnosed A[l]umbar back strain,@ prescribed an anti-inflammatory, stretching exercises, and heat therapy, and restricted the employee from working for a week. Community Living Options [the employer] received proper notice of the injury, and benefits were commenced.
Since her work injury, the employee=s medical history has been long and complex and has included treatment or examination by at least a dozen different medical doctors and chiropractors. On September 25, 1996, a week after the injury, apparently on the referral of a Dr. Overgaard at the Chisago Clinic, she commenced a program of physical therapy, evidently remaining off work through October 28, 1996. On November 11, 1996, apparently upon completion of her physical therapy program, she began about a six-week regimen of chiropractic treatment with Dr. Todd Elert at Luck Chiropractic, whose records suggest that he treated symptoms at all levels of the employee=s back - - cervical, thoracic, and lumbar - - together with pain into her right leg.
On January 24, 1997, the employee saw Minnesota orthopedist Dr. Glenn Buttermann at the Midwest Spine Institute, Afor consultation of upper, mid and low back pain.@ Lumbar x-rays ordered by Dr. Buttermann were read to reveal no underlying bony abnormality of the thoracic or lumbar spine and no fractures or demonstrable destructive lesions, although the L5-S1 disc was seen to be mildly narrowed, consistent with mild early degenerative disc disease. Dr. Buttermann diagnosed A[p]robable lumbar strain,@Aconsistent with the inflammation of the lumbar dorsal fascia or tendonitis,@ noting also that the employee=s symptoms also sounded somewhat consistent with degenerative disc disease at L5-S1, Agiven the pain that she has with sitting and bending.@ Dr. Buttermann prescribed physical therapy and restricted the employee from lifting over ten pounds and from working more than four hours a day. By April 4, 1997, the employee was reporting improvement as a result of her physical therapy, and Dr. Buttermann relaxed her lifting and carrying restriction from ten pounds to twenty pounds.
On May 2, 1997, on referral from Dr. Buttermann, the employee was seen at the Physicians Neck & Back Clinic by family practitioner Dr. Alison Coulter, who diagnosed cervical strain, mechanical low back pain, and deconditioning syndrome. Concluding that the employee was not yet at maximum medical improvement [MMI], Dr. Coulter prescribed a short-term active rehabilitation program, with a goal Ato specifically restore the [employee] to optimal functioning.@
On May 9, 1997, the employee was examined for the employer and insurer by orthopedist Dr. Richard Edwards, to whom the employee complained of
[e]ntire spine pain with occasional pain into my right upper extremity and numbness occasionally in my right hand when I have been sleeping. Occasionally I get numbness and tingling in the left arm and hand also. Also, some burning sensation in my left calf. The pain hurts into my whole spine almost down to the end of the base of my spine. However, the symptoms change everyday.
After reviewing the employee=s x-rays, which he found to reveal Adegenerative changes of the lumbosacral spine, which are obviously old and are in no way related to the [employee=s work] injury,@ Dr. Edwards diagnosed A[t]horacolumbar strain by history with no evidence of any residuals on this examination.@ He indicated that he had found Ano objective evidence to support [the employee=s] subjective complaints,@ concluding that the employee=s current medical status was stable and that she Acould return to her preinjury work status without any restrictions.@ On those conclusions, Dr. Edwards opined that the employee had not sustained any permanent partial disability as a result of her September 1996 work injury and that she had reached MMI six weeks after that injury. Dr. Edwards= report to this effect was served on the employee on May 29, 1997.
On July 9, 1997, Dr. Coulter discharged the employee from her prescribed rehabilitation program essentially for noncompliance, and, unaware of any other treatment regimen that would benefit the employee, she indicated that her Asuggestion would be to establish MMI and stop further medical intervention.@ In that same report, Dr. Coulter indicated also that she did Anot believe there is a contraindication in the absence of a neurological deficit to [the employee=s] resuming her pre-injury work situation.@ Dr. Coulter stated in follow-up, AObviously my recommendations should be reviewed by Dr. Butterman[n] for final approval.@ On July 18, 1997, Dr. Buttermann indicated that the employee=s work-hours-per-day restriction had been relaxed from four to six hours and that her lifting restriction had been relaxed from twenty pounds to thirty pounds, and he recommended a rehabilitation program closer to home for work hardening. Two months later, on September 19, 1997, although the employee was reportedly Ano better,@ Dr. Buttermann authorized the employee to increase her hours to eight per day and ordered a lumbar MRI scan, intending to see the employee again in four weeks. The employee evidently did not undergo the MRI, and she did not see Dr. Buttermann again for nearly two years.
Between May and December of 1997, the employee found and worked at about four different jobs, and on about September 9, 1997, the employer and insurer filed a petition to discontinue the employee=s temporary total and temporary partial disability benefits. Stated grounds for the petition were that more that ninety days had passed since service of Dr. Edwards= MMI report, that the employee had been released to return to her pre-injury job by her treating physician, Dr. Coulter, and that she had failed to conduct a reasonable and diligent job search. A hearing was scheduled, but the matter was subsequently stricken from the calendar, subject to reinstatement, upon the employee=s assertion that she could not attend.
On August 31, 1998, the employee commenced about a three-year course of undefined treatment with Missouri osteopath Dr. Peter Christiansen, for pain in her low back and right hip and between her shoulder blades. While in Missouri, the employee treated also with chiropractor Dr. Roger Whaley, whose records indicated that, beginning January 3, 1999, he treated the employee for another injury to her right hip and back that she had sustained on December 31, 1998, when she got a severe pain in her back and fell to the floor while walking at home in her dining room. Dr. Whaley=s records report that the employee=s symptoms had first appeared on December 31, 1998, that she had not Aever had [the] same or [a] similar condition@ before, and that she was not at that time subject to Aany other disease or infirmity affecting [her] present condition.@ As a result of the injury, the employee was apparently disabled from working for about three weeks, after which she apparently returned to work with restrictions to light duty.
On June 25, 1999, the employee returned to see Dr. Buttermann again, who reported advanced degeneration at L5-S1 and the possibility of a central disc herniation, confirmation of which was being complicated, he suggested, by the insurer=s denial of diagnostic evaluation. Noting that she was already taking medications, was already using a TENS unit, and was already undergoing some chiropractic and massage therapy, Dr. Buttermann indicated that the only further treatment option that he could offer the employee was epidural steroid injections, which the employee had declined to undergo. The employee has been referred to no orthopedic specialist or neurologist since seeing Dr. Buttermann for the last time in June of 1999.
On June 26, 2000, the employee saw Dr. Whaley again, regarding an injury to her low back that she had sustained two days earlier while attempting to corral some escaped goats in an open pasture on her farm. Dr. Whaley recommended ice therapy and no driving, lifting, or bending for the rest of the day, and he restricted her from all work through June 28, 2000. On July 7, 2000, on referral from Dr. Whaley, the employee underwent x-rays of her lumbar spine, which were read to reveal no apparent signs of bone pathology, very mild lumbar spondylosis with disc thinning at L3-4 and possible facet degeneration at L5-S1, retrolisthesis of L5 upon S1, multiple biomechanical changes suggesting significant muscle spasms, and a slightly anomalous coccyx. On August 21, 2000, treating her now for neck pain in addition to back pain, Dr. Whaley restricted the employee to working only five-hour days three days a week. For about two weeks beginning September 27, 2000, the employee also received seven treatments from chiropractor Dr. Brad Kothlow, in Balsam Lake, Wisconsin, regarding complaints of symptoms in her neck, ribs, entire back, area between the shoulder blades, lower back, pelvis, tail bone area, and right hip. She indicated to him that she could not bend, that flexion and extension and rotation were all very painful, that she couldn=t lie down or sit down or stand for long, that her stomach was very tender, and that she had Ahad [right] hip much more pain off & on since injury 9/18/96 at work@ (sic).
On October 26, 2000, the employee commenced treatment with chiropractor Dr. Lisa Turek-Shay, for what she described as weakness and numbness and constant severe pain of all types at all levels of her back and hips, which she had experienced for four years. Dr. Turek-Shay apparently treated the employee intermittently over the course of about a year, using various nonmanipulative modalities.
On June 26, 2002, the employee filed a claim petition, alleging entitlement to temporary total disability benefits continuing from June 2, 1997, to temporary partial disability benefits from May 5, 1997, to June 1, 1997, to penalties pursuant to Minnesota Statutes section 176.225, to over $3,000 in medical benefits, and to QRC services. That petition was subsequently consolidated with the employer and insurer=s September 1997 petition to discontinue benefits, and a hearing was scheduled.
On December 13, 2002, the employee commenced treatment with osteopath Dr. Vicki Skarda, for Apain in her neck all the way down to her low back area.@ Dr. Skarda recommended physical therapy and ordered an MRI scan of the employee=s low back. The scan, conducted on December 27, 2002, was read to reveal a slight disc protrusion at L3-4 and a small disc extrusion mildly effacing the thecal sac at L5-S1, but no findings at L4-5 and no disc pathology or encroachment upon any neural tissues in the upper lumbar spine or lower thoracic spine to correlate with the employee=s L1-related symptoms.
On January 21, 2003, the employee was examined for the employer and insurer by orthopedic osteopath Dr. Richard Reut. In his report on that date, Dr. Reut indicated that, upon physical examination, he found the employee=s cervical spine to be normal and, although the employee had complained of Avague right lower extremity radiating symptoms to the knee, without reports of numbness or tingling,@ he found no evidence of lumbar radiculopathy by clinical examination. He indicated that the employee=s Asubjective complaints are out of proportion to her clinical presentation today, which does not demonstrate any organic pathology other than age-appropriate tissue texture changes.@ Dr. Reut went on to conclude that the employee=s Atreatment to date has not been reasonable and necessary. In fact, it has been excessive@ and that her Acomplaints regarding her hip, back, and leg are not related to the September 18, 1996 accident.@ He considered further medical treatment, chiropractic treatment, or physical therapy unnecessary relative to that injury, concluding that the employee was not a surgical candidate, Aas she does not have any organic pathology from a clinical standpoint.@ He found no evidence of any pathology that would prevent the employee from working, and he indicated that he would place no formal restrictions on her. It was his opinion that the employee had reached MMI by the date of Dr. Edwards= May 9, 1997, examination and that her permanent partial disability rating was 0%, pursuant to Minnesota Rules 5223.0390, subpart 3. Dr. Reut=s report in these regards was served on the employee on February 11, 2003.
In May of 2003, the matter was stricken again from the calendar, upon the employee=s failure to appear, again subject to reinstatement. Eventually, in September of 2005, the employee=s claim petition was reinstated, and on January 9, 2006, the employee amended that petition, alleging, consequent to a low back injury on September 18, 1996, entitlement to the following: temporary total disability benefits from December 31, 1998, to January 22, 1999, and continuing from August 25, 2000; temporary partial disability benefits from July 31, 1997, to December 31, 1998, and from January 22, 1999, to August 25, 2000; over $4,400.00 in medical expenses; and QRC services.
The employee continued to treat with Dr. Skarda into December of 2005, for chronic pain syndrome Aall over her body@ but primarily in her torso and lower back and hips. Treatment modes included physical therapy, medication, and osteopathic manipulation, but records suggest that the employee experienced only little and temporary relief from her symptoms. On May 5, 2005, Dr. Skarda noted a significant weight loss in the employee over the past half year and discussed with the employee the possibility of occult cancer. She noted also, on that same date, that she considered the employee=s chronic low back pain to be mechanical rather than due to any disc pathology, although a week later, on May 13, 2005, she noted that the employee had Adisc disease and herniation at L3 and L4 on the left,@ and on May 20, 2005, she referenced evidence on the employee=s December 27, 2002, MRI scan revealing left-side herniated discs at both L3-4 and L5-S1, noting that some of the employee=s pain complaints correlated with her MRI an some did not. In a report to the employee=s attorney dated November 22, 2005, Dr. Skarda diagnosed Achronic pain syndrome of both myofascial pain syndrome as well as a left-sided radiculopathy.@ It was Dr. Skarda=s opinion that Arealistically [the employee] would be unable to perform any reasonable work duties.@
On December 5, 2005, Dr. Whaley had also written to the employee=s attorney. In his letter, while acknowledging that he had not seen the employee in some time, Dr. Whaley indicated that he believed that the employee=s September 1996 work injury was Athe major contributing factor of her ongoing pain and chronic complaints, resulting in >Chronic Pain Syndrome=.@ He recalled her not being able to lie either supine or prone or in a neutral side lying position for good proper adjustment or manipulation on the treatment table during his treatment of her. He indicated that he had been and remained unable to foresee her ever improving to a point where she was able to perform any kind of employment. It was Dr. Whaley=s opinion in the end that Athere is a possibility that [the employee] may have had an abnormal disc involvement that just did not heal; or due to extended time a result of major scar tissue in the area of the spinal canal which may produce symptoms that do not resolve.@
On December 8, 2005, chiropractor Mark McCarthy, who had evidently been treating the employee for the past six months, wrote to the employee=s attorney to report his impressions regarding her physical condition. Dr. McCarthy opined that, A[a]ccording to the history [the employee] has provided regarding the nature and extent of the injury, her report that no other incidents occurred prior to or after the assault at the group home in 1996,@ together with objective findings on examination and therapeutic sessions over the past six months, Aobjective findings certainly support [the employee=s] subjective report of the initiation of her condition being the injuries sustained in an assault from behind by a resident of the group home in 1996.@
On December 23, 2005, in a follow-up letter to her report of November 22, 2005, Dr. Skarda opined further that Athe injury on September 18, 1996 is a major contributing factor to [the employee=s] current chronic pain syndrome and symptomatology.@
On January 14, 2006, the employee was examined for the employer and insurer by orthopedic surgeon Dr. Randall Norgard. In his report on January 18, 2006, upon review of the employee=s medical records and interview and physical examination of the employee, Dr. Norgard diagnosed degenerative disc disease at L3-4 and L5-S1, degenerative joint disease at L5-S1, and chronic pain syndrome based on complaints at all three sections of the spineBcervical, thoracic, and lumbar. It was Dr. Norgard=s opinion in part that the employee had sustained temporary sprain/strains to all three sections of her spine consequent to her employment on September 18, 1996, that the employee=s treatment up until September 19, 1997, had been reasonable and necessary and causally related to her work injury, but that her treatment subsequent to September 19, 1997, had been no longer related to that injury but related instead to her pre-existing lumbar degenerative disc and degenerative joint diseases. He opined that the employee was not a candidate for further medical care, chiropractic care, or physical or massage therapy in relation to her September 1996 work injury, any need for further treatment being related instead to her pre-existing lumbar degenerative disc and degenerative joint diseases. It was Dr. Norgard=s opinion that the employee had been unable to work from September 18, 1996, until January 24, 1997, when she was re-evaluated by Dr. Buttermann and that doctor placed her on work restrictions, but that subsequent to September 19, 1997, she could have worked without restrictions related to her September 1996 work injury. Dr. Norgard found no objective physical findings to substantiate the employee=s subjective complaints. It was Dr. Norgard=s further opinion that the employee had reached MMI with regard to her work injury on September 19, 1997, with 0% permanent partial disability, when she was evaluated by Dr. Buttermann, and Dr. Norgard=s report to that effect was served on the employee on the date it was issued, January 18, 2006.
The matter came on for hearing on January 25, 2006, by which date the employee had been paid a total of 39.4 weeks of temporary total disability benefits. At hearing, the parties stipulated in part that all of the $3,606.33 in treatment expenses at issue were reasonable and necessary and that the employee had been properly served with reports of MMI dated May 9, 1997, January 21, 2003, and January 18, 2006, and the employee conceded that she reached MMI with the report served on the last of those dates. Among issues presented at the hearing for determination by the compensation judge were the following: (1) whether the employee had been temporarily totally disabled from December 31, 1998, through January 22, 1999, and from August 25, 2000, through the present and continuing; (2) whether the employee had been temporarily partially disabled from July 31, 1997, through December 31, 1998, and from January 22, 1999, through August 25, 2000; (3) whether the employee=s September 18, 1996, work injury had been a substantial contributing factor in any proven temporary disability; (4) whether the employee had conducted a reasonably diligent search for work during any or all of the periods for which wage replacement benefits were being sought; (5) whether the employee had reached MMI on any date earlier than January 18, 2006; (6) whether the $3,606.33 in medical and chiropractic expenses being claimed by the employee in Exhibit A, for treatment with Dr. Kothlow, Dr. Turek-Shay, Dr. Whaley, Dr. Christiansen, Dr. Buttermann, and Dr. Skarda and for certain out-of pocket medical expenses, were causally related to the employee=s September 1996 work injury; and (7) whether the employee was entitled to a rehabilitation consultation.
By findings and order filed February 3, 2006, and amended findings and order filed February 28, 2006, the compensation judge concluded in part that the employee had developed Achronic low back pain@ as a result of her September 19, 1996, work injury and had ultimately reached MMI with regard to that injury on February 11, 2003, with service of Dr. Reut=s report of January 21, 2003. The judge concluded further, however, that the employee had failed to prove either that she was physically unable to work or that she had conducted a reasonably diligent job search during the period December 31, 1998, through January 22, 1999, for which entitlement to temporary total disability benefits had been alleged. The judge found still further, however, that from July 31, 1997, through August 25, 2000, the employee had been intermittently temporarily partially disabled due substantially to her September 18, 1996, work injury and that from August 25, 2000, through November 21, 2001, she had been physically unable to work due substantially to that work injury. Based on these findings, and although the judge had found also that employee had not conducted a reasonably diligent job search during the period of her inability to work between August 25, 2000, and November 21, 2001, the judge ordered payment of temporary total disability benefits from August 25, 2000, though November 21, 2001, payment of temporary partial disability benefits in the sum of $543.06 for intermittent periods of her temporary partial disability in 1997 and 1999, payment or reimbursement of all treatment expenses claimed in Exhibit A, and a rehabilitation consultation. In her memorandum, and without further explanation, the compensation judge supported her finding that MMI was reached with service of Dr. Reut=s report on February 11, 2003, by detailing evidence to the effect that A[t]here is no evidence in the record of significant improvement after Dr. Edwards= independent medical examination in May 1997.@ The employer and insurer appeal from the judge=s finding of MMI on February 11, 2003, and from the judge=s awards of wage replacement and medical benefits and a rehabilitation consultation.
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.
1. MMI; Temporary Total Disability Benefits
At Finding 8, the compensation judge found that the employee reached MMI on February 11, 2003, with service of Dr. Reut=s January 21, 2003, report. The judge explained her finding in her memorandum as follows:
The employee had tried a wide range of treatments for her low back condition by May 1997. None of the treatments offered anything more than temporary relief. The medical records indicate that the employee considered her symptoms to have reached a plateau by January 1997. (Employee Exhibit E: 1/24/97 note) There is no evidence in the record of significant improvement after Dr. Edward[s=] independent medical examination in May 1997. There is no indication in the evidence that there were or are other treatments available that are likely to significantly improve the employee=s condition. These facts, coupled with the opinions of Dr. Edwards, Dr. Reut, Dr. Norgard and Dr. Coulter form the basis for my conclusion [that] maximum medical improvement has been reached. (Employer Exhibits 1, 2, 5 and 10.)
No other explanation is provided. At Finding 12, the judge concluded further that, consequent to her work injury, the employee had been physically unable to work from August 25, 2000, through November 21, 2001, on which date, the judge concluded at Finding 13, the employee=s right to temporary total disability benefits ended, with expiration of her statutory maximum entitlement to one hundred four weeks of benefits. On those findings, the judge awarded, at Order 1, payment of temporary total disability benefits for the period of August 25, 2000, through November 21, 2001.
The employer and insurer contend that the judge=s finding of MMI must be reversed, not only because it is unsupported by substantial evidence in the medical record but also because all of the evidence cited by the judge herself in support of her finding appears clearly mustered to support instead a finding that MMI was reached in May of 1997 with service of Dr. Edwards= May 9, 1997, report, rather than nearly six years later with service of Dr. Reut=s report. If MMI is properly dated in May of 1997, they contend, the employee is not entitled to temporary total disability benefits after August of 1997, ninety days thereafter, pursuant to Minnesota Statutes section 176.101, subdivision 1(j). Therefore, they contend, the judge=s award, at Order 1, of temporary total disability benefits for the period of August 25, 2000, through November 21, 2001, must also be reversed. In support of their substantial evidence-based position, they argue that Dr. Reut himself, in January of 2003, dated MMI at the time of Dr. Edwards= examination in May 1997 and that Dr. Norgard, in January of 2006, and even treating physician Dr. Coulter, in July of 1997, also both effectively place MMI in 1997. That the two formal MMI opinions subsequent to Dr. Edwards= opinion - - Dr. Reut=s opinion and Dr. Norgard=s opinion - - may have been served later than Dr. Edwards= report, they suggest, does not negate the statutory effect of service of Dr. Edwards= report in May of 1997, those other reports only serving to underscore the credibility of Dr. Edwards= opinion. In support of that argument, they quote Minnesota Statutes section 176.011, subdivision 25, to the effect that,
once the date of maximum medical improvement has been determined, no further determinations of other dates of maximum medical improvement for that personal injury is permitted. A determination that an employee has reached maximum medical improvement shall not be rendered ineffective by the worsening of the employee=s medical condition and recovery therefrom.
Minn. Stat. ' 176.011, subd. 25. We agree with the appellant and reverse the judge=s finding of MMI on February 11, 2003, at Finding 8, substituting a finding of MMI on May 29, 1997. Accordingly, we reverse also the judge=s implicit finding of entitlement to benefits at Finding 13 and her award of benefits at Order 1, and we vacate Finding 12 as irrelevant.
The mere service of a doctor=s report of MMI, in and of itself, does not, of course, definitively establish that MMI was actually reached on the date certified by the doctor, only that the employee was given statutory notice that there is medical evidence to that effect. In this case, however, we can conceive of no way to read the compensation judge=s memorandum except to conclude that the judge=s own reasoning requires dating of MMI at service of Dr. Edwards= report in May of 1997 rather than at service of Dr. Reut=s report in February of 2003. The parties stipulated to service of MMI on each of those two dates, in addition to a third service, of Dr. Norgard=s report on January 18, 2006, the evidence cited by the judge in support of her finding leads only and inevitably to the May 1997 date, and the judge offers no explanation or contrary evidence whatsoever to support a different conclusion. Nor, on review, do we find any substantial evidence conflicting with this legal conclusion or supporting the nominal but unexplained finding of the judge. The judge=s finding of MMI on February 11, 2003, in Finding 8 is reversed, and a finding of MMI on May 29, 1997, is substituted in its place. Accordingly, the judge=s award of temporary total disability benefits from August 25, 2000, through November 21, 2002, is also reversed, in that this period post-dates ninety days after MMI, when any potential entitlement to temporary total disability benefits expires for the employee, pursuant to Minnesota Statutes section 176.101, subdivision 1(j). Finding 12, that the employee was physically unable to work during the claimed period, is vacated as legally irrelevant to this result.
2. Extent of the Injury; Temporary Partial Disability and Rehabilitation Benefits
The compensation judge found at Finding 7 that the employee=s September 1996 low back work injury had subsequently developed into a chronic low back condition, and at Finding 14 and Order 2 she awarded temporary partial disability benefits for two periods during which the employee worked at a wage loss between October 15, 1997, and July 29, 1999, having concluded at Finding 17 also that the employee was entitled to a rehabilitation consultation. The employer and insurer contend that, pursuant to the independent medical opinions of Drs. Edwards, Reut, and Norgard, together with treating physician Dr. Coulter=s conclusion in July 1997 that she did Anot believe there is a contraindication in the absence of a neurological deficit to [the employee=s] resuming her pre-injury work situation,@ the employee=s injury had fully resolved no later than September 1997, and she was not thereafter subject to any restrictions. They argue further that, even were we to affirm a finding of ongoing work-related disability, as implied in Finding 7, the employee is still not entitled to wage replacement benefits during the period of her claim because she did not conduct a reasonably diligent job search during that period. We are not persuaded.
Dr. Coulter=s recommendations in her report of July 9, 1997, including her belief that there was no reason why the employee could not return to her preinjury employment, were made A[o]bviously@ pending the approval of Dr. Buttermann, who in turn retained both work-hours and lifting restrictions, albeit relaxed ones, and recommended another rehabilitation program for work hardening. Later records of treatment with various other doctors, including Dr. Christiansen, Dr. Whaley, Dr. Kothlow, Dr. Turek-Shay, Dr. Skarda, and Dr. McCarthy, reflect medical crediting of a continuing restrictive symptomology and an essentially deteriorating condition. Moreover, in Section C of her memorandum, the compensation judge indicated expressly that she found the employee=s testimony as to the increasing severity of her low back pain credible and consistent with the histories taken by her doctors, several of whom - - Drs. Whaley, Skarda, and McCarthy in particular - - opined expressly that the employee=s condition was causally related to her September 1996 work injury. This court has frequently reiterated its deference to the perspective of compensation judges in matters of credibility, 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), and in the choice of medical opinion on which to rely, see 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).
Concluding that they were not unreasonable, we affirm the compensation judge=s conclusion in Finding 7 that the employee developed chronic low back pain consequent to her work injury and her conclusion in Finding 14 that the employee was consequently temporarily partially disabled for intermittent periods in 1997 and 1999. See Hengemuhle, 358 N.W.2d at 59, 37 W.C.D. at 239. Moreover, pursuant to Minnesota Statutes ' 176.102, subd. 4(a), an injured employee is entitled to a rehabilitation consultation upon request as a matter of law, see Brown v. Boxers Grill & Party Pub, slip op. (W.C.C.A. Mar. 31, 1998), absent the defense of complete recovery identified in Judnick v. Shalom Home West, slip op. (W.C.C.A. Aug. 4, 1995), see Ortega v. Medallion Kitchens of Minnesota, slip op. (W.C.C.A. Apr. 3, 2000) (where the court had affirmed the compensation judge=s termination of the employee=s wage replacement benefits based on an implied conclusion that the employee was without any residual disability related to his work injury, the judge=s award of a rehabilitation consultation was reversed). Therefore, concluding that the medical evidence substantially supports the judge=s implicit finding that the employee remained physically disabled by her work injury at the time of the hearing, we affirm also the compensation judge=s conclusion in Finding 17 that the employee is entitled to a rehabilitation consultation. Noting, however, that the judge=s award at Order 2 of $543.06 in temporary partial disability benefits does not conform with the result of $542.06 in the judge=s memorandum, presumably by typographical error, we modify Order 2 to reflect an award of the one-dollar-smaller result in the memorandum.
3. Nature of the Injury; Treatment Expenses
At Finding 16 and Order 3, respectively, the compensation judge found entitlement to, and awarded payment of, $3,606.33 in medical and chiropractic expenses incurred by the employee in the course of her treatment with Dr. Kothlow, Dr. Turek-Shay, Dr. Whaley, Dr. Christiansen, Dr. Buttermann, and Dr. Skarda and in certain out-of pocket medical purchases. The employer and insurer contend that, even should this court affirm the employee=s award of wage replacement benefits subsequent to September 1997, the employer and insurer should be held responsible for only those medical bills subsequent to that date that pertain to treatment of the employee=s low back, not for bills pertaining to treatment to other body parts. We agree.
The compensation judge concluded at unappealed Finding 4 that the employee=s injury resulted from blows to her low back and that the employee=s immediate symptoms were of pain in the center of her back Ajust above her waist line.@ The employee=s diagnosis immediately after her work injury was of a A[l]umbar back strain,@ and at Finding 7 the compensation judge herself concluded that, as a result of her work injury, Athe employee sustained a lumbar strain and has subsequently developed chronic low back pain@ (underscorings added). Moreover, the employee=s attorney himself, in his opening statement, asserted that Ait=s a low back injury.@ Much of the treatment for which payment was ordered generally by the judge appears, however, to have pertained to parts of the employee=s body far removed from her low back, addressing as it does pain in her mid back, the area between her shoulder blades, her neckBin one case even Aall over her body.@ The parties stipulated to the reasonableness and necessity of all treatment at issue, but not to its causal relationship to the work injury. In Finding 16, the compensation judge concludes generally that A[t]he medical expenses itemized in Employee Exhibit A are causally related to the employee=s September 18, 1996 work injury,@ but nowhere in her memorandum or elsewhere in her decision does she identify the evidence on which she is awarding payment for treatment to areas of the employee=s body arguably separate from her low back. We grant that at least some of the treatment at issue appears reasonably to pertain to the low back work injury that we have affirmed to be continuing through the period of the employee=s temporary partial disability claim, but we conclude also that at least some of that treatment appears less than definitively associated with that low back injury, by expert opinion or otherwise.
On these conclusions, we remand Finding 16 and Order 3 back to the compensation judge for reconsideration and more reviewably specific findings. The judge is instructed to award payment of only those expenses clearly related to the employee=s low back injury and to identify clearly, for our review, the evidence on which her award is based.
 At that time Dr. Skarda=s last name was Kubesh.
 Exhibits in evidence reflect no treatment of the employee by Dr. Whaley after August of 2000.
 Aside from Dr. McCarthy=s letter, no treatment records are in evidence.
 At Stipulation 3 in her findings and order, the judge indicated that the parties had stipulated that A[t]he employee was properly served with a report of maximum medical improvement (MMI) on May 9, 1997, January 21, 2003 and January 18, 2006." This suggestion that these reports were actually served on these dates, rather than merely dated on these dates, conflicts with the affidavits of record in the case and with the judge=s own summary of the case on page 7 in the hearing transcript, with which the parties agreed on page 8 of the transcript, and we correct Stipulation 3 accordingly.
 The judge found that the employee will have received 104 weeks of temporary total disability benefits on this date, the maximum available pursuant to Minn. Stat. ' 176.101, subd. 1(k).
 The judge=s order was based on a recalculation of the employee=s claim, based on a different weekly wage.
 We note also that the calculation itself is inaccurately illustrated in the memorandum at the 7/29/99 date. The final figure in that line should be $68.53, not $102.79. Our modification takes both typographical errors into account.