CARMEN YVONNE, Employee, v. SUPER ONE FOODS, and QUADRANGLE GROUP/BERKLEY RISK ADM'RS CO., Employer-Insurer/Appellants.
WORKERS= COMPENSATION COURT OF APPEALS
JUNE 20, 2006
REHABILITATION - RETRAINING. Where the employee initially returned to work with the employer and later was precluded from performing positions available with the employer due to her physical work restrictions, where the employee had conducted an adequate job search with no success in obtaining replacement employment, and where the record contains a labor market survey, vocational reports and testimony that reflect that a job in the field of social work eventually could provide the employee with an economic status as close as possible to her pre-injury status, substantial evidence supports the compensation judge=s findings that the Poole factors had been met and the related award of a retraining program.
Determined by: Rykken, J., Johnson, C.J., and Stofferahn, J.
Compensation Judge: Gregory A. Bonovetz
Attorneys: Thomas R. Longfellow, Longfellow Law Office, St. Paul, MN, for the Respondent. Joseph J. Mihalek, Fryberger, Buchanan, Smith & Frederick, Duluth, MN, for the Appellants.
MIRIAM P. RYKKEN, Judge
The employer and insurer appeal from the compensation judge=s award of the proposed retraining plan. We affirm.
In 1996, Ms. Carmen Yvonne, the employee, began working in the bakery at the Hibbing Super One Grocery Store. She transferred two years later to the meat department, where she worked full-time as a meat wrapper. On May 3, 2002, the employee sustained an admitted low back injury while loading packages of meat. On that date, the employer was insured by Quadrangle Group, with Berkley Risk Administrators serving as its insurance administrator. At the time of her injury, the employee was 45 years old, and earned a weekly wage of $637.60.
The employee=s meat wrapper job duties included taking packages of cut and portioned meat off a conveyor belt, placing them on a roller to be wrapped, removing them from a wrapping machine, and filling trays situated on a cart. The employee wheeled carts to the store=s meat case, and placed the packages of meat in the self-serve meat display case for retail sale. The employee was also responsible for stocking the meat case with pre-packaged chicken, which she removed from a walk-in cooler and transferred to the display case. The employee=s injury occurred when she was working in the cooler, attempting to remove a box of chicken down from the top of a stack of boxes. She pulled the top box, let it fall to a lower level, and then picked it up to place it in a shopping cart. As she bent over to pick up the box of chicken, she experienced pain in her low back.
The employee initially sought chiropractic treatment from Dr. Gary Wheelock; she had treated with Dr. Wheelock periodically in 2001 and early 2002 for pain in her lower back, upper back, neck and legs which she attributed at least in part to some of her work duties. On May 6, 2002, the employee reported to Dr. Wheelock that she had low back pain radiating into her buttocks. At his recommendation, she underwent an MRI scan on May 22, 2002, which showed a bulging disc at the L4-5 level and possibly some nerve root compression. Dr. Wheelock restricted the employee from work until June 20, 2002, and then released her to return for three work shifts per week, within certain work restrictions, including no more than four hours standing and walking, no more than four hours sitting, no bending, no lifting in excess of 20 pounds, and a recommendation for a break every two hours.
The employer then assigned the employee to assist with wrapping, which was a lighter duty position than her original meat wrapping job. The employee was again removed from work on July 1, 2002, however, and remained off work until July 22, 2002, when she returned to work within restrictions, including a limit of no more than three four-hour shifts per week. Because her physical limitations prevented her from performing all duties of an assistant meat wrapper, the employee was transferred to the deli department, to work as a deli cutter/slicer, a job classified as light-duty, where she worked until January 2003. She was unable to continue working at that position because her back was aggravated by standing on the hard surface and leaning into the counter.
At Dr. Wheelock=s referral, the employee consulted a neurosurgeon, Dr. Richard Freeman, in July 2002. Dr. Freeman diagnosed an L4-5 disc herniation with radiculopathy, and, after reviewing the employee=s MRI scan, recommended that the employee undergo discectomy surgery. At the insurer=s request that additional conservative treatment be provided before surgery, the employee underwent an epidural steroid injection on November 11, 2002, but later reported to Dr. Freeman that the injection provided no relief of her back discomfort. In December 2002, Dr. Freeman recommended an updated MRI study, and imposed the same restrictions as those assigned by Dr. Wheelock, including a limit of working every other day for four hours per day. A second MRI scan performed on December 19, 2002, confirmed a significant central disc herniation at the L4-5 level with secondary stenosis. Dr. Freeman again recommended a transforaminal discectomy on the left at the L4-5 level, and recommended that the employee remain off work after January 6, 2003, in anticipation of surgery, and that she remain off work until she had sufficiently recovered from surgery. On February 14, 2003, Dr. Freeman performed surgery in the nature of a transforaminal discectomy.
The employee underwent physical therapy post-surgery, but her pain persisted, and a repeat MRI performed on April 21, 2003, showed severe central stenosis at the L4-5 level. The employee sought further medical treatment from Dr. James Callahan, at the Duluth Clinic, after Dr. Freeman=s retirement from his practice. Dr. Callahan recommended an L4-5 laminectomy with a left L4-5 discectomy, with the hope of significantly eliminating or alleviating her low back and radicular pain. Dr. Callahan conducted that surgery on July 10, 2003.
By late August, the employee reported an improvement in her symptoms following the surgery, but still noted back pain after a long period of sitting or standing, as well as some numbness and pain in her left leg. She continued physical therapy, but in late September, she felt a flare-up of symptoms after sneezing quite hard. A repeat MRI scan of the employee=s lumbar spine showed some disc space collapse at the L4-5 level, which Dr. Callahan feared might cause some ongoing long-term back pain. He referred the employee to Dr. Thomas Silvestrini, occupational medicine physician, for strengthening exercises. By October 28, 2003, Dr. Callahan released the employee to return half-time sedentary work. At that point, however, the employer had no work available within the employee=s restrictions.
The employer and insurer have paid temporary total and temporary partial disability benefits to the employee since her injury, eventually paying her temporary total disability benefits through November 12, 2004, when her statutory entitlement to 104 weeks of temporary total disability benefits expired. In addition, they have paid benefits based upon a rating of 16% permanent partial disability of the whole body.
The employee continued to work with her qualified rehabilitation consultant (QRC), Kim Eisenhuth, performing a job search in an attempt to locate other employment. The employer and insurer have provided extensive rehabilitation assistance to the employee, since at least November 2002. As documented by the voluminous rehabilitation records in evidence, those services have included medical management, coordination of return to work with the employer, counseling and guidance, vocational medical management, vocational testing, job seeking skills training, job placement services, transferrable skills analysis, preparation of a labor market survey, and preparation of a retraining proposal.
The employee first consulted Dr. Silvestrini on March 3, 2004. He initially restricted the employee to sedentary work at four hours per day, and anticipated she eventually could work light duty on a full-time basis. He also recommended physical therapy for the employee and advised that it might take six to twelve months for the employee to be able to return to full-time light-duty work.
On July 6, 2004, Dr. Paul Cederberg examined the employee at the request of the employer and insurer. At that exam, the employee reported persistent low back pain radiating into her left leg, and noted some weakness in her left leg. She also reported that her symptoms made it difficult for her to sit for any length of time. Dr. Cederberg concluded that the employee=s work injury of May 3, 2002, permanently aggravated her underlying degenerative condition, that she had reached maximum medical improvement (MMI) from that injury, and that she had sustained permanent partial disability to the extent of 16% whole body impairment. Dr. Cederberg concluded that the employee required no further treatment other than a self-directed home exercise program as directed by Dr. Silvestrini. Although Dr. Cederberg advised that the employee could work full-time, he imposed restrictions of no lifting over 20 pounds, and no repetitive lifting or bending of the low back.
The employee received follow-up care from Dr. Silvestrini. By October 2004, he advised her that although he hoped she eventually could return to work in a medium-strength classification, he doubted she would ever be able to stand in one place for a long period of time due to potential back fatigue.
Despite an ongoing job search, the employee was unsuccessful in obtaining a job within her restrictions until December 2004. By April 2004, the employee=s QRC began investigating whether retraining would be a viable option for the employee; the QRC outlined her investigation in her rehabilitation reports and plan amendments filed between May and December 2004. In December 2004, the employee=s QRC filed a rehabilitation request, seeking approval of a retraining plan for a four-year college degree program, to attain a Bachelor of Science Degree in Applied Psychology, with a goal of working in the field of social work. The employee earlier had attended a junior college for two years; the proposed retraining plan included course work at Hibbing Community College, Arrowhead University Consortium in Hibbing, and Bemidji State University. The QRC estimated that the retraining plan would cost approximately $35,252.00 for tuition, supplies, fees and mileage, in addition to indemnity benefits payable up to a maximum of 156 weeks allowed for retraining under Minn. Stat. ' 176.102, subd. 11. The QRC conducted a labor market survey to investigate employment opportunities for the employee upon completion of a degree, primarily in the areas of social worker and case worker. The survey showed that employment of social workers is expected to grow faster than the average for all occupations through 2012, due to the rapidly growing elderly population and the aging Ababy boom@ generation. The survey showed salary ranges between $10.50 - $22.00 per hour for entry-level positions and $23.89 - $26.24 per hour for the top salary level in that field.
The employer and insurer filed a rehabilitation response, disputing the appropriateness of that retraining plan and contending that it was premature. The employer and insurer argued that since the employee was not yet at MMI and had temporary work restrictions, any consideration of retraining should be delayed until after the employee had reached MMI and had been released for full-time work within permanent restrictions.
In December 2004, the employee located a part-time job north of Nashwauk, Minnesota, approximately 11-12 miles from her home. She began working as a personal companion assistant for Life=s Companion, assisting an 86-year-old woman with spine and head injuries by performing various light housekeeping chores, including dishwashing, grocery shopping, laundry, and telephoning. She worked ten hours each week at that job, earning $9.00 per hour. The employee later began a second job, working twenty hours each week for the Star of the North Animal Humane Shelter in Coleraine, approximately 22-24 miles from home. She worked as a kennel assistant, and earning $5.40 per hour; her job duties include cleaning kennels, sweeping and washing floors, performing laundry and maintaining the animals= kennels, food and water. At the time of the hearing, the employee earned a total of $198.00 weekly, from the wages earned at both jobs.
On March 11, 2005, the employee was examined by Dr. Richard C. Strand, orthopedic surgeon, at the request of the employer and insurer. Dr. Strand diagnosed pre-existing degenerative disc disease of the lumbar spine, with failed laminectomy syndrome. He noted that the employee=s symptoms, including radiculitis, were similar to those she had experienced before her May 3, 2002, injury. On that basis, Dr. Strand concluded that the employee had sustained Aa temporary aggravation of her underlying degenerative condition as the result of the injury on May 3, 2002,@ and stated that, in his opinion, the work injury of May 3, 2002, was not a substantial contributing factor in the employee=s permanent partial disability. Dr. Strand recommended no further medical care, chiropractic treatment or acupuncture; he also recommended that the employee discontinue taking narcotic medication. He concluded that the employee had reached maximum medical improvement, and released her to return to work on a full-time basis, with permanent work restrictions on lifting and bending. Dr. Strand placed no restrictions on the employee=s standing, sitting or walking, but recommended limited ladder climbing and limited stair climbing. Evidently in response to an inquiry about the employee=s capacity to participate in a retraining program or college classes, he stated that there were no restrictions that he would place on the employee Athat would affect her ability to go back to school or be trained in another vocation.@
On February 15, 2005, the employee underwent an independent vocational evaluation with Ms. Kandise Garrison, QRC, CDMS. Following that exam and interview, and her review of medical and rehabilitation records, Ms. Garrison concluded that retraining was Anot the most effective way to return Ms. Yvonne to her pre-injury economic status.@ In Ms. Garrison=s opinion, if Dr. Silvestrini=s temporary work restrictions for sedentary half-time work were to be used as a basis for evaluating the employee=s job potential, retraining would be premature because permanent restrictions have not yet been imposed. She also concluded that if, on the other hand, Dr. Strand=s opinion were to be adopted, retraining would not be appropriate because the employee has not yet sought full-time work either from her pre-injury employer or a new employer, using the light-duty work restrictions recommended by Dr. Strand. Ms. Garrison also concluded that the employee=s vocational testing did not support a four-year academic program.
In her report, Ms. Garrison also addressed, generally, the questions of whether the proposed retraining program would result in employment and whether it was likely that a job in social work would produce an economic status as close as possible to that which the employee would have enjoyed without the disability. Although Ms. Garrison believed that it was premature to consider a retraining program for the employee, she concluded that employment opportunities in social work in Northeast Minnesota would increase during the next decade, and that, based on estimated pay ranges, employment in the field of social work would restore Ms. Yvonne=s economic status.
A hearing was scheduled to address the employee=s retraining request on March 29, 2005. Immediately before the hearing, the employer offered the employee a position of Aprice verification,@ which was a part-time position paying $14.61 per hour. The hearing was continued to August 11, 2005, to allow the employee to consider that light-duty job offer. The employee=s QRC met with Dr. Silvestrini on March 30, to discuss the employer=s job offer. Although he released the employee to work six hours per day on a light-duty basis, Dr. Silvestrini concluded that the proposed price verification position at Super One was not appropriate for the employee, because it required her to stand in one place for extended periods of time, or to walk or move slowly within a very small area. The QRC communicated Dr. Silvestrini=s conclusions to the employer and insurer.
Between the March and August hearing dates, the employee remained restricted to six hours of work per day, and continued to work at her two separate jobs on a part-time basis while conducting a part-time job search. The employer and insurer continued to pay temporary partial disability benefits and provided ongoing rehabilitation assistance; they submitted no alternative retraining program for consideration, either formally or informally. On August 10, 2005, the employer and insurer presented another job offer for a part-time position at the supermarket in a service counter/scanning job. This second job offer was discussed extensively at the second day of hearing held on August 11, 2005. With the employee=s retraining proposal at issue at the hearing, the employer presented its bases for disputing the proposed retraining plan, objecting on the grounds summarized below:
1. The plan was premature because the employee had not reached MMI and her permanent work restrictions were still unknown.
2. The employee had not engaged in an adequate job search for full-time light to medium-duty jobs that Dr. Strand concluded the employee could handle.
3. The employee and QRC failed to contact the employer to determine whether it had light duty work available for six hours per day as allowed by Dr. Silvestrini.
4. The employee lacked the vocational abilities to successfully complete the retraining plan as proposed. The program, and required remedial training in the areas of reading, spelling, math and computer skills, could not be completed within the statutory 156-week time limit allowed for the plan.
Testimony was presented at the hearing by the employee, her QRC, vocational expert Kandise Garrison, and the employee=s former supervisor at Super One Foods. Extensive exhibits were submitted into evidence, including medical and rehabilitation records.
In his Findings and Order, served and filed on November 3, 2005, the compensation judge concluded that the proposed retraining plan leading to a Bachelor of Science Degree in Applied Psychology was reasonable and appropriate, and that with the completion of the proposed retraining plan, the employee would obtain an economic status as close as possible to that which she would have enjoyed but for her work injury. The compensation judge found that the employee is permanently precluded from returning to her job as a wrapper in the meat department, the position she held on the date of injury, and that the other positions offered by the employer and insurer in 2005 were neither physically nor economically suitable for the employee. The compensation judge concluded that the employee was capable of completing the requirements of the proposed retraining program, from both a physical and intellectual standpoint, and that in all likelihood there would be suitable jobs available for her upon completion of her training, based upon the increasing need for social service workers in rural areas. In his memorandum, the judge summarized his findings as follows:
A preponderance of the evidence establishes the proposed retraining plan fits squarely within the factors delineated in Poole vs. Farmstead Foods, [cite omitted]. As indicated in the Findings, in spite of a most diligent search for employment the employee has been unable to find any employment which even approaches her date-of-injury economic status. Even by cobbling together part-time jobs the employee still is experiencing a substantial wage loss as witnessed by the ongoing payment of temporary partial disability benefits. Even the employer=s last minute job offers, if physically appropriate which they are not, were accepted these part-time temporary positions with none of the benefits available to full time employees in the meat department would not return the employee to her pre-injury economic status. Thus, retraining is the only viable option.
(Memo., p. 6.) Based upon his findings, the compensation judge awarded the employee retraining costs, including weekly compensation benefits, pursuant to the statute. The employer and insurer appeal.
The employer and insurer do not contest the employee=s entitlement to rehabilitation assistance but they appeal from the award of retraining benefits. The employee=s rehabilitation services began November 11, 2002, with the goal of returning the employee to work with Super One Foods. The employee=s QRC also provided counseling and guidance, vocational medical management, vocational testing, job seeking skills training, and job placement services. After the employee had attempted to return to work for the employer, after the employee=s physician had indicated that she could not tolerate employment that primarily involves standing throughout the day, such as various grocery positions, and after the employee had conducted a job search, her QRC recommended retraining. The compensation judge awarded the employee=s proposed retraining plan for a bachelor=s degree in social work.
Retraining an injured worker in another occupation may be appropriate if the retraining Awill materially assist the employee in restoring his impaired capacity to earn a livelihood.@ Norby v. Arctic Enters., Inc., 305 Minn. 519, 521, 232 N.W.2d 773, 775, 28 W.C.D. 48, 50 (1975). ARetraining is to be given equal consideration with other rehabilitation services, and proposed for approval if other considered services are not likely to lead to suitable gainful employment.@ Minn. R. 5220.0750, subp. 1. Pursuant to Minn. Stat. ' 176.102, subd. 1(b),
Rehabilitation is intended to restore the injured employee so the employee may return to a job related to the employee=s former employment or to a job in another work area which produces an economic status as close as possible to that the employee would have enjoyed without disability. Rehabilitation to a job with a higher economic status than would have occurred without disability is permitted if it can be demonstrated that this rehabilitation is necessary to increase the likelihood of reemployment. Economic status is to be measured not only by opportunity for immediate income but also by opportunity for future income.
AThe purpose of retraining is to return the employee to suitable gainful employment through a formal course of study.@ Minn. R. 5220.0750, subp. 1. ASuitable gainful employment@ is employment that is reasonably attainable and Aoffers an opportunity to restore the injured employee as soon as possible and as nearly as possible to employment which produces an economic status as close as possible to that which the employee would have enjoyed without disability.@ Minn. R. 5220.0100, subp. 34. An employee=s Aage, education, previous work history, interests, and skills@ are relevant in determining whether employment qualifies as suitable gainful employment. Id. When retraining is proposed, relevant considerations include:
(1) the reasonableness of retraining as compared to returning to work with employer or other job placement activities, (2) the likelihood that employee has the ability and interest to succeed in a formal course of study in a school, (3) whether retraining is likely to result in reasonably attainable employment, and (4) whether retraining is likely to produce an economic status as close as possible to that which the employee would have enjoyed without disability.
Poole v. Farmstead Foods, 42 W.C.D. 970, 978 (W.C.C.A. 1989). Generally, the propriety of a proposed retraining plan is a fact issue for the compensation judge, and this court must affirm the compensation judge=s determination where the judge=s application of the Poole factors is supported by substantial evidence. Anderson v. Metropolitan Mech. Contractors, slip op. (W.C.C.A. Oct. 19, 1999).
Addressing the initial factor articulated in Poole, the compensation judge concluded that retraining is a reasonable option compared to returning to work with employer or other job placement activities, specifically stating that Aretraining is the only viable option.@ (Memo. at 6.) The employer and insurer argue that the compensation judge erred by awarding retraining since the extent of the employee=s permanent disability was not known and the employee had not reached MMI. While the employee=s treating physician, Dr. Silvestrini, opined that he expected the employee to continue to improve, Dr. Strand and Dr. Cederberg had opined that the employee had reached MMI. The compensation judge did not make a finding regarding MMI, but stated that the employee=s recovery had Aplateaued,@ concluding that A[w]hen reviewed in its entirely the evidence clearly establishes that the employee=s condition has plateaued, that any improvement will be marginal and, unfortunately, will not remove the limitations on standing.@ The compensation judge also found that the employee had permanent restrictions of,
lifting not in excess of 20-25 pounds, no repetitive bending, twisting, lifting, pushing or pulling and work hours of six hours per day, five days per week. In addition, a substantial, permanent restriction applying to the employee is that she must avoid standing for more than short periods of time, including slow walking in a limited space.
The employer and insurer argue that the medical evidence does not support the finding on restrictions since some of the restrictions were current rather than permanent, as indicated by the doctors= opinions. As the compensation judge explained in his memorandum, however, A[w]hen reviewed in its entirety the evidence clearly establishes that the employee=s condition has plateaued, that any improvement will be marginal and, unfortunately, will not remove the limitations on standing.@ (Memo., p. 6.) In view of the length of time that the employee=s restrictions had been in effect, and given the compensation judge=s conclusion that the employee=s recovery was not improving, the compensation judge could reasonably conclude that Athe employee=s present limitations are likely to continue into the indefinite future.@
The compensation judge concluded that the employee is permanently precluded from returning to the job she held at the time of her injury, and from performing any type of work which requires her to be on her feet for any periods of time. He also found the positions offered by the employer, both before and during the hearing, are not physically suitable for the employee. The employer and insurer appeal that finding, arguing that the employee is not permanently precluded from returning to work with the employer. The employer agrees that initially there was no work available for the employee within her initial restrictions, but argues that once her restrictions were lessened, there were positions available for her. The employer claims that the QRC should have consulted with the store manager each time the employee=s work restrictions changed since the primary goal of the rehabilitation plan was a return to work with Super One Foods. The employee argues that none of the positions available with the employer are within the restrictions imposed by Dr. Silvestrini, especially that of no prolonged standing or walking in small areas.
The employee did consider the position of price verification first offered to her in March 2005, before the first day of the retraining hearing. Dr. Silvestrini reviewed that job description, however, and concluded that the employee would not be able to perform the job because of the prolonged standing involved. Dr. Callahan also had earlier concluded that the employee would be restricted to sedentary work and, most likely, a light-duty position; as early as October 2003, Dr. Callahan advised that the employee would Amost likely need to be retrained into a sedentary position that will allow her frequent changes in position, as well as avoid overhead lifting and excessive twisting and bending.@ Based on the medical evidence in the record, the compensation judge could reasonably conclude that the employee was precluded from performing the positions offered by the employer.
The employer and insurer argue that the employee did not conduct a diligent job search. In December 2003, the employee=s rehabilitation plan was modified to include finding suitable employment through a job search, because by that time the employer had advised that it had no work available within the employee=s then-current restrictions. The employer and insurer did not object to this modification. The employee and the QRC made numerous job contacts as documented in the rehabilitation records and the employee=s rehabilitation plan was extended several times through May 2005 to continue her job search, with no objection from the employer.
The employer also argues that the employee limited her job search to sedentary jobs instead of light-duty jobs which she could perform under Dr. Strand=s restrictions or could perform in the future if her condition improved. The compensation judge, however, did not adopt the restrictions imposed by Dr. Strand. Although the judge did not specifically refer to the restrictions articulated by the employee=s treating occupational medicine physician, Dr. Silvestrini, in his findings and memorandum, the judge outlined restrictions consistent with those imposed by Dr. Silvestrini. The compensation judge could reasonably conclude that the employee=s job search was adequate given her restrictions. The employee attempted to return to work for the employer and later conducted a job search which was unsuccessful. The compensation judge concluded that retraining was a reasonable option compared to returning to work with employer or other job placement activities. The record as a whole adequately supports that conclusion.
In reference to the second factor outlined in the Poole decision, the employer and insurer also argue that the employee lacks the ability, skills and true vocational interest to successfully complete the retraining program. The employee underwent academic testing which indicated strong reading, spelling and visual skills, average verbal skills, lower math skills, and lack of training in computers. The proposed program, however, is designed for non-traditional students and computer assistance is available. The employee=s QRC testified that the employee was highly motivated. Substantial evidence supports the compensation judge=s finding that the employee has the ability to succeed in the retraining program.
Each retraining case is analyzed on its own facts to determine the plan that will most realistically result in a return to suitable gainful employment, a third factor listed in Poole. See Anderson v. Ford Motor Co., 46 W.C.D. 24, 30 (W.C.C.A. 1991); Stone v. General Office Prods., slip op. (W.C.C.A. Aug. 13, 1998); McCann v. Sysco/Continental, slip op. (W.C.C.A. Dec. 2, 1993); Kostreba v. Stay Clean Janitorial, slip op. (W.C.C.A. July 31, 1990). The labor market survey and QRC=s testimony reflect the increasing opportunities for employment in the social work field, in rural Minnesota and specifically in the employee=s geographical area. The compensation judge could reasonably conclude that the employee could realistically anticipate suitable gainful employment in the social work field upon her completion of her degree.
The compensation judge also addressed the issue of whether the proposed retraining plan was likely to produce an economic status as close as possible to that which the employee would have enjoyed without disability, the fourth consideration set out in the Poole decision. The record contains a labor market survey as well as reports and testimony from the QRC and the independent vocational expert on this issue, all of which reflect that a job in the field of social work eventually could provide the employee with an economic status as close as possible to her pre-injury status. Testimony was also presented at the hearing about positions with the employer that were potentially available to the employee. These jobs were part-time, and paid wages ranging between $11 to $13 per hour, a wage which exceeds the starting salary for a social worker. The employer and insurer argue that it is unreasonable to award a retraining plan that would qualify the employee for a starting wage that is likely to be lower than the wage rate of jobs available with the employer. The employee benefits provided with those part-time jobs, however, were less than those the employee had received at the time of her injury, when she was working full-time. The compensation judge found that these positions, as well as the positions offered by the employer, were not economically Asuitable,@ because they were temporary, part-time jobs that provided none of the same employee benefits available to the employee at the time she was injured or currently available to employees in the meat department. Based on that conclusion, the judge determined that none of those jobs would return the employee to her pre-injury economic status. He concluded that a job in the field of social work represented economically suitable employment opportunity, and found that A[w]ith completion of the proposed retraining program, the employee will obtain an economic status as close as possible to that which she would have enjoyed but for the work injury,@ a conclusion that is amply supported by the evidence in the record.
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. Substantial evidence supports the findings if, in the context of the entire record, they 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. In view of the substantial evidence in the record that supports the compensation judge=s award of the retraining program, including the employee=s testimony, expert vocational opinions, rehabilitation records and medical records, we affirm the compensation judge=s approval of the proposed retraining plan. See Hengemuhle, 358 N.W.2d at 59, 37 W.C.D. at 239.
 The QRC periodically submitted rehabilitation plan amendments for the insurer=s approval, and then filed those amendments with the Department of Labor and Industry, providing the employer and insurer with updates on the employee=s medical status, job search and rehabilitation goals.