KATHY L. MARICLE, Employee/Appellant, v. FARMSTEAD FOODS, SELF-INSURED, Employer, and EMPI, INC., MN DEP=T OF HUMAN SERVS., MAYO FOUND., BLUE CROSS/BLUE SHIELD OF GA./HEALTHCARE RECOVERIES, INC., and UCARE MINN., Intervenors, and SPECIAL COMPENSATION FUND.
WORKERS= COMPENSATION COURT OF APPEALS
JUNE 14, 2007
CAUSATION - SUBSTANTIAL EVIDENCE; EVIDENCE - EXPERT MEDICAL OPINION. Substantial evidence, including the employee=s testimony, medical records, and expert medical opinion, supported the finding that the employee=s claimed disability and medical care were not causally related to the employee=s work activities for the employer, Farmstead Foods, or to her September 29, 1989, work injury with the employer.
Determined by: Stofferahn, J., Pederson, J., and Rykken, J.
Compensation Judge: Danny P. Kelly
Attorneys: Robert M. Maus, Baudler, Baudler, Maus & Blahnik, Austin, MN, for the Appellant. Thaddeus V. Jude, St. Paul, MN, for the Respondent Employer and Special Compensation Fund.
DAVID A. STOFFERAHN, Judge
The employee appeals from the compensation judge=s determination that the disability and medical care claimed by the employee were not causally related to her work activities for the employer, Farmstead Foods, or to her September 29, 1989, work injury. We affirm.
The employee, Kathy L. Maricle, started working for the employer, Farmstead Foods, in 1985. She initially worked as a floater performing various jobs in the Albert Lea plant. In 1987 she was given a permanent job assignment as a full-time puller in the casing department, a job that involved pulling hog intestines away from the ruffle fat. Over time changes were made to the production line which resulted in an increased work pace for the employee=s job.
On September 25, 1989, the employee sustained a work injury while working on this production line. A First Report of Injury was filed identifying neck and shoulder strain, related to working with the neck in an extended position. The employer admitted that the employee sustained a right shoulder impingement syndrome and a mild cervical strain. The employee alleges that this injury, and the cumulative effects of her work for the employer generally, were the cause of several further conditions which are the subject of the appeal before this court.
The day following the work injury, the employee sought chiropractic treatment for her symptoms with Dr. M.P. Christian, who diagnosed a thoracic sprain or strain. A cervical x-ray on October 24, 1989, was negative. After chiropractic care failed to provide relief, the employee went to the Albert Lea Clinic on October 26, 1989, where she was seen by Dr. Edward Shaman. She told Dr. Shaman that she had been having pain in the neck and right shoulder, extending down into the right hand, for about a week. The doctor diagnosed her with myalgia, and recommended an EMG to rule out cervical radiculopathy. The EMG was negative.
The employee=s symptoms continued to persist and on November 30, 1989, she was seen for a neurological consultation with Dr. James R. Allen at the Albert Lea Medical Center. Dr. Allen's diagnosis was tendinitis of multiple levels in the right upper extremity secondary to her work activity, neuritis at C6‑7 on the right, and arthritis of the interphalangeal joints secondary to repetitious work. Dr. Allen initially recommended that the employee remain off work and undergo physical therapy.
On December 28, 1989, the employee returned to Dr. Allen following completion of physical therapy. He noted that the employee now had full range of motion of her cervical spine and the muscles were supple in her neck. Swelling was decreased throughout the right arm, wrist, and mid finger. The employee=s grip was still somewhat diminished on the right, and she had slightly diminished sensation in the right thumb and adjacent two fingers. Dr. Allen advised the employee to return to work on a part time basis in January but recommended she reduce repetitive activity involving the right arm.
The employee was also seen the next day, by Dr. Barry J. Larson at Albert Lea Clinic for chronic neck and shoulder pain. Dr. Larson found what appeared to be a fibrositic nodule in the superior aspect of the right scapula, which dissipated with massage and manipulation. There was point tenderness in a classic trigger point area. He diagnosed probable fibrositis.
Dr. Allen referred the employee to Dr. A. Douglas Lilly, an orthopedic surgeon, for treatment of her shoulder and right upper extremity. Dr. Lilly first saw the employee on January 15, 1990. She presented with right shoulder pain and pain down the right forearm and into the right hand. Dr. Lilly diagnosed a flare up of tendinitis involving the right shoulder. Injection of the employee=s right shoulder with cortisone failed to provide relief, so Dr. Lilly recommended right shoulder surgery. On January 28, 1990, Dr. Lilly performed an exploration and debridement of the employee's right shoulder, including the removal of the coracoacromial ligament and subdeltoid bursa. The employee subsequently had therapy at St. Olaf Hospital.
An EMG was performed on March 30, 1990, to rule out carpal tunnel syndrome in the employee=s right hand. The EMG showed normal motor and sensory nerve conduction and no evidence of cervical brachial plexus, generalized peripheral nerve or primary muscle involvement. It was concluded that there was no evidence of peripheral nerve entrapment.
All of the employer=s workers lost their jobs as of March 3, 1990, when Farmstead Foods closed due to bankruptcy. Since losing her job with the employer, the employee has worked only sporadically at a number of unskilled, entry-level jobs of short duration. Her most recent employment was delivering newspapers one day per week, a job she discontinued early in 2000.
The employee continued to complain of pain in her neck at the base on the right side. Dr. Lilly suspected a pressure problem involving the greater occipital nerve, and referred her to Dr. V.R. Zarling, a neurologist, who saw her on April 30, 1990. A cervical X-ray showed normal alignment with vertebral bodies, disc spaces, and neural foramina essentially normal. There was a suggestion of mild facet region sclerosis at C7-T1. Dr. Zarling=s diagnosis was occipital neuralgia secondary to a healed sprain, strain, or contusion of the cervical spine. He suggested a nerve block, which the employee had in May 1990.
On June 21, 1990, Dr. Lilly concluded that the employee had reached maximum medical improvement as of June 15, 1990. Dr. Lilly stated that the employee=s complaints of neck pain were not related to her occupation but were more likely related to stress.
In a letter dated September 10, 1990, Dr. Zarling noted that none of the employee=s doctors= examinations had revealed any restriction of motion. However, since she did exhibit chronic muscle spasm and subjective pain complaints, he rated her as having 3.5 percent permanent partial disability for a healed sprain, strain or contusion of the cervical spine.
By report dated September 20, 1990, Dr. Lilly noted that the employee=s right shoulder had done very well and he did not recommend any work limitations for the right shoulder. He stated that the employee had reached MMI and had a three percent permanent disability to her right shoulder from the January surgery. He deferred an opinion about the employee=s neck condition to her neurologist.
The employee began treating with Dr. Lawrence Farber at the Noran Neurological Clinic on November 15, 1990. Dr. Farber found moderately limited range of neck motion with extension. Flexion caused some pain in the right posterolateral neck and shoulders. There was a decreased C7 dermatomal sensation on the right side. Tinel's sign was positive on the right side but not the left. A median nerve distal latency study discounted the possibility of a right carpal tunnel syndrome. Dr. Farber concluded that the employee=s problems were primarily cervical, possibly consisting of a brachioplexis. He recommended a CT scan.
The CT scan showed a minimal disc bulge at the C5‑6 level without evidence of acute disc herniation or spinal stenosis. An EMG on November 29, 1990, was normal. Dr. Farber concluded that the employee's problem was ligamental laxity or weakness with nerve root irritation. He recommended a muscle tone building program and restricted the employee from lifting over 15 to 20 pounds, frequent lifting, twisting, turning or bending and motions of the neck, working over her head, or remaining in static positions for long periods of time.
In a letter dated December 30, 1990, Dr. Farber stated that, in his view, the employee had sustained a work-related Gillette injury to her right hand, arm, shoulder and neck, culminating with acute symptoms on September 25, 1989. He rated her with a permanent partial disability of seven percent for a healed cervical sprain associated with rigidity at a single vertebral level. In his opinion, the employee had reached maximum medical improvement.
On May 2, 1991, the employee underwent an independent medical examination performed by Dr. Mark Engasser. The employee told him that her shoulder condition had improved with surgery but was now worsening. The employee had full range of motion in the right shoulder and the cervical spine, although abduction and rotation of the right shoulder caused discomfort. Dr. Engasser opined that employee had sustained a local injury to the right shoulder in the form of an impingement syndrome as a result of her repetitive work at Farmstead Foods, for which surgical treatment had been Amoderately successful.@ He recommended restrictions on the use of the right upper extremity at or above shoulder level, with a 40 pound lifting restriction on the right. He believed the employee had reached MMI, and rated her with a three percent permanent partial disability for the right shoulder. In his view, the employee had sustained only a temporary strain to her cervical spine.
On or about March 28, 1990 Farmstead Foods filed for bankruptcy. In July, 1991, the employee settled her workers' compensation claim with the Minnesota Self‑Insurers Security Fund (SISF) on a full, final and complete basis, leaving open only reasonable and necessary medical care, exclusive of ongoing and future treatment to her neck.
Medical records in evidence indicate the employee did not treat for her neck or right upper extremity between December 1990 and October 1992 when she saw Dr. Farber again. She did not seek any care for her neck or shoulder from then until she saw her chiropractor in 1996. In the interim, the employee treated for other medical conditions but there is no mention in those records of her neck and shoulder problems.
In December 1996, the employee saw her chiropractor, Dr. Christian, reporting an insidious onset over the previous two weeks of upper back and neck pain with intermittent tingling into the right arm and hand. Dr. Christian noted right paraspinal tenderness at T3-5 and C4 with possible right subluxation and right scapular fibrositic nodules. Dr. Christian suggested she see her medical physician for anti-inflammatory medication.
On December 23, 1996, the employee saw Dr. Waldron at the Albert Lea Clinic. He noted point tenderness throughout the employee=s shoulder and diagnosed tendinitis. The employee followed up once more with Dr. Waldron in January 1997, reporting chronic neck and back discomfort. She continued to see her chiropractor occasionally for treatment for upper back and neck pain between 1997 and 2001.
On January 25, 2002, the employee was seen at the Naeve Hospital complaining of pain in the shoulder and the right hand. She was tender to palpation over the entire shoulder and had "trigger points" along the trapezius muscles. The doctor diagnosed possible rotator cuff and biceps tendinitis, with neurological symptoms stemming either from her neck or a carpal tunnel condition. An MRI of the right shoulder on February 1, 2002, showed impingement and a partial tear of the rotator cuff supraspinatus tendon.
The employee was next seen at the Albert Lea Clinic on February 8, 2002 for follow-up of her right shoulder impingement. A subacromial injection was performed and it was recommended that the employee participate in physical therapy and undergo an EMG of the right upper extremity. The EMG was normal.
On March 26, 2002, the employee returned to the Naeve Hospital for follow-up on her right hand symptoms. The doctor noted that the employee=s history did not suggest carpal tunnel syndrome, that there was little in the way of specific sensory complaints, and that the employee=s EMG had been normal. A cervical MRI was performed on March 29, 2002, which showed degenerative disc disease, and disc herniations at the C5‑6 and C6‑7 levels.
In late 2003, the employee returned to the Austin Medical Center complaining of pain in the middle of the back of her neck and down the right side of her arm into the wrist. She also had some paresthesias extending into the three middle fingers on the right hand. Dr. Larson referred the employee to Dr. Keith A. Bengtson for an evaluation at the Mayo Clinic=s spine center.
The employee saw Dr. Bengtson on February 17, 2004. She complained of constant mid and upper cervical spine pain with pain radiating down both arms and numbness in the second through fourth digits. Dr. Bengtson ordered a repeat MRI of the cervical spine. The MRI, done on March 2, 2004, showed moderate interval progression of the employee=s degenerative disc disease from C3 through C7. There was increased stenosis at C5-6, and the herniation at C6-7 had also increased in size. Dr. Bengtson diagnosed back pain and paresthesias of uncertain etiology and recommended EMG studies of the upper left and upper right extremities. Both studies were read as normal.
Dr. Bengtson then recommended cervical facet injections. The employee, however, insisted on a surgical referral. Dr. Bengtson referred her to Dr. David W. Beck, an orthopedic surgeon. On June 14, 2004, the employee was seen by Dr. Beck. He suspected that her neck and arm pain was due to her cervical disc herniations and recommended surgery. On June 18, 2004, Dr. Beck performed a C5‑6, C6‑7 anterior discectomy and fusion.
Following the surgery, the employee reported resolution of her neck pain, though she continued to have upper extremity pain. Based on the employee=s history of ongoing neck and arm pain since the work injury in 1989, Dr. Beck offered the opinion that the employee=s work for the employer was a substantial contributing factor in her cervical disc herniations and the onset of her neck pain.
On September 20, 2004, the employee returned to see Dr. Bengtson at the Mayo Clinic. Her main complaint was now mid‑thoracic through mid‑lumbar pain which she claimed had been present for the last 15 years but had not received much attention since her neck complaints, which were now resolved, had been a more significant problem. The employee underwent an MRI of the thoracic spine on October 12, 2004, which showed multilevel disc degeneration from T7 through T12, small right protrusions at several levels without nerve root or spinal cord compression, and an old compression fracture at T11.
The employee then initiated treatment with Dr. Matthew J. Kirsch of the Austin Medical Center. She gave a history of right shoulder pain since 1989 and left shoulder pain since 2002. Dr. Kirsch noted that the employee=s pain complaints were out of proportion to the examination findings. He diagnosed bilateral rotator cuff tendinitis and injected her shoulders with Kenalog and prescribed physical therapy. Subsequent MRI studies showed the left shoulder to be essentially normal, while the right shoulder showed mild impingement on the supraspinatus tendon and mild tendinosis of the supraspinatus with no evidence of a tear.
The employee returned to Dr. Kirsch on November 2, 2004, stating that her shoulder pain had gone away for a day following the injections and then returned. Dr. Kirsch noted that the employee had difficulty localizing her pain and exhibited a Phalen=s test which was only questionably positive. He also thought she significantly exaggerated her clinical presentation. However, the employee was Avery intent on surgery.@ On November 12, 2004, Dr. Kirsch performed a right shoulder arthroscopic subacromial decompression with right shoulder limited glenohumeral debridement. Dr. Kirsch's post‑operative diagnosis was a right shoulder partial thickness supraspinatus tear and subacromial impingement.
On February 15, 2005, the employee returned to see Dr. Kirsch. Her right shoulder pain was better overall after surgery, but she still had pain. Dr. Kirsch noted scapular trigger points in the employee=s shoulders and diagnosed fibromyalgia.
The employee subsequently treated with Dr. Larson for fibromyalgia. Dr. Larson found marked "trigger point tenderness" and pain behavior at the medial trapezius and the suprascapular levels. His diagnosis was fibromyalgia syndrome involving the shoulders, right much greater than left. On May 23, 2005, Dr. Larson issued a Health Care Provider Report in which he offered the opinion that the employee=s fibromyalgia was caused, aggravated or accelerated by the employee's work activity for the employer through September 25, 1989, thereafter building after multiple surgeries. He further opined that MMI had not been reached for the fibromyalgia.
In a report dated May 31, 2005, Dr. Kirsch stated that the employee=s right shoulder bursa and tendon disorder was caused, aggravated or accelerated by her employment activity on September 25, 1989.
On September 16, 2005, the employee returned to Dr. Kirsch complaining of severe pain in the right hand, as well as numbness and tingling in the fingers. Dr. Kirsch found decreased sensation in a median nerve distribution of the right hand. The employee had a positive Phalen=s test. Dr. Kirsch diagnosed a right carpal tunnel syndrome.
The employee was seen by Dr. Mark E. Friedland on October 18, 2005, for an independent medical examination. Dr. Friedland noted that she exhibited exaggerated pain behaviors, diffuse non‑physiologic tenderness of the spine of a regional and non‑anatomic nature with very light touch palpation, positive distraction testing, discrepancy between sitting and supine straight leg raising, as well as non-physiologic distribution of sensory and motor findings of the right upper extremity. He diagnosed marked functional overlay and/or malingering. He felt the employee=s symptoms were far in excess of her objective findings.
Based on his examination and review of the employee=s medical history, Dr. Friedland concluded that the employee=s 1989 work injury had resulted in a right shoulder impingement syndrome without rotator cuff tear and a mild cervical strain/sprain. He believed that MMI from these conditions had been reached by at least December 30, 1990, consistent with Dr. Farber=s report of that date, and that the employee was then fully capable of unrestricted work. He found no evidence to indicate that the employee=s 1989 work injury was a substantial contributing cause of any alleged temporary total disability after December 30, 1990. He further stated that none of the medical care and treatment received by the employee after December 30, 1990, was causally related to the 1989 work injury. Specifically, he stated that the employee=s cervical disc herniations and degenerative disc disease were not a consequence of her work injury but were instead due to normal aging of the cervical spine over the ensuing 13 years after the injury. Similarly, noting that the conditions treated in the most recent shoulder surgery had not been found present at the time of her prior shoulder surgery in 1990, Dr. Friedland attributed these conditions to normal aging and denied any causal relationship with the 1989 work injury. He diagnosed the employee=s thoracic spine condition as being mild age-appropriate multilevel disc disease.
On November 1, 2005, the employee returned to see Dr. Kirsch for a repeat cortisone injection in the right carpal tunnel and the first dorsal extensor compartment. Dr. Kirsch noted that, as the employee=s EMG studies had been normal, he was hesitant to do carpal tunnel surgery. On December 19, 2005, the employee returned to see Dr. Kirsch and requested surgical treatment. Dr. Kirsch found a positive Phalen's test and diagnosed right de Quervain's tenosynovitis. He agreed to perform a surgical release of the first dorsal extensor compartment. The employee underwent this procedure on January 19, 2006. The employee continued to have pain in her right hand, and Dr. Kirsch decided to proceed with a right carpal tunnel release, performed on March 2, 2006. On March 17, 2006, the employee returned to see Dr. Kirsch stating she had no numbness or tingling or pain in her fingers and hand.
In a report dated March 16, 2006, Dr. Kirsch agreed that some of the changes in the employee=s right shoulder were the result of a normal aging process. However, noting that the employee insisted that her current de Quervain's symptoms and carpal tunnel symptoms were consistent with the symptoms she had in 1990, he offered the opinion that a work-related Gillette injury had been a substantial contributing factor to the employee=s current right shoulder, wrist and hand injuries and disabilities.
Following review of Dr. Friedland=s IME report, Dr.Beck issued a report dated March 22, 2006, in which he agreed with Dr. Friedland that the employee's cervical disc herniations were more likely due to the aging process rather than the work injury at Farmstead Foods in 1989. However, in a subsequent report dated March 30, 2006, he maintained that the 1989 work injury substantially contributed to the disc herniations by making the employee's cervical spine more susceptible to degenerative arthritis.
Dr. Friedland performed another independent medical examination on April 5, 2006. In his report of the same date, he indicated that the employee=s thoracic, lumbar and right hand and wrist symptoms did not result either from her work activities or the specific work injury of September 29, 1989. He also offered the opinion that the de Quervain=s and carpal tunnel release surgeries on the right hand were not reasonable or necessary in the absence of any positive EMG findings. Dr. Friedland also noted that the employee=s examination did not reveal trigger point findings of the type that he considered to be diagnostic of true fibromyalgia.
Dr. Bengtson saw the employee on April 7, 2006. In a letter of that date, he noted that she continued to have mechanical neck and lower thoracic pain. Dr. Bengtson also opined that her symptoms were directly related to her 1989 work injury in that her injury Aled to her surgery which eventually led to her current mechanical situation.@
Dr. Kirsch responded to Dr. Friedland's latest IME report on May 11, 2006. He noted that his diagnosis of de Quervain's tenosynovitis was based not only on subjective patient complaints but also on clinical exam findings. He defended his diagnosis of and surgery for carpal tunnel syndrome by pointing out that the employee's subjective complaints were consistent with carpal tunnel syndrome, clinical test characteristics for carpal tunnel were positive, and a cortisone injection into the carpal tunnel temporarily relieved her symptoms. He described the employee=s situation as "EMG negative carpal tunnel syndrome."
Dr. Friedland wrote a supplemental report on July 5, 2006, in which he reaffirmed his earlier opinions and disagreed with Dr. Beck's opinion that the employee's work injury made her more susceptible to degenerative arthritis and cervical disc herniations, noting that there had been no evidence of any objective disc injury at the time of the 1989 work injury. He also discounted work causation for a right carpal tunnel syndrome or de Quervain's tendinitis due to the absence of any documentation of such conditions in the contemporaneous medical records and to consistent negative EMG testing following the work injury.
On October 12, 2004, the employee petitioned the Workers' Compensation Court of Appeals to set aside set the 1991 Award on Stipulation on the grounds that there had been an unanticipated substantial change in her medical condition. This court granted the petition. The employee filed a claim petition for further benefits. Following the hearing on August 18, 2006, the compensation judge found that the personal injury of September 25, 1989, resulted in a right shoulder injury and a cervical sprain/strain. The judge found that the cervical spine injury had resolved no later than January 30, 1990, and that the employee had failed to prove that the right shoulder injury remained a substantial contributing factor to the employee=s medical expenses or wage loss after December 30, 1990. The judge further determined that the employee had failed to establish a causal connection between the 1989 injury and fibromyalgia or any injury to the right hand, right wrist, thoracic spine, or lumbar spine. The employee appeals.
The issues addressed by the compensation judge in this matter were questions of causation. Causation is an issue of fact which falls within the province of the compensation judge. Felton v. Anton Chevrolet, 513 N.W.2d 457, 50 W.C.D. 181 (Minn. 1994). Where, as here, the compensation judge is presented with conflicting medical opinions on the issue of causation, this court will generally affirm a compensation judge=s choice of medical opinion unless the opinion relied upon lacks adequate foundation. Nord v City of Cook, 360 N.W.2d 337, 37 W.C.D. 64 (Minn. 1985); Voshage v. State (MNSCU), Winona State Univ., 65 W.C.D. 167 (W.C.C.A. 2004).
The compensation judge adopted the medical opinions of Dr. Friedland and Dr. Engasser, finding that the employee=s cervical spine injury had resolved no later than January 30, 1990, and that the employee had failed to prove that her right shoulder injury remained a substantial contributing factor to medical expenses or wage loss after December 30, 1990. The judge further determined that the employee had failed to establish a causal connection between the 1989 injury and fibromyalgia or any injury to the right hand, right wrist, thoracic spine, or lumbar spine.
The employee first argues on appeal that the compensation judge=s findings indicate that he misunderstood the nature of her job duties at the time of her injury. Specifically, she cites portions of Finding 3 in which the compensation judge found that the employee worked Ain a variety of positions,@ and that the employee Awas required to quickly and repetitively throw the hog intestines over her shoulder.@ The employee points out that she was permanently assigned to one job position for some time prior to the date of injury. She further notes that her job duties in that position did not require throwing intestines over her shoulder, but instead variously over a four-foot wall behind her or into a chute at head level. Accordingly, she suggests, the compensation judge=s causation findings were based on an invalid foundation.
First, the compensation judge=s statement that the employee worked in a variety of positions expressly relates to the entire period of her employment and is not inaccurate. And, while the evidence does not indicate that she was required to throw the intestines over her shoulder, she was required to throw them over a four-foot wall located behind her. We do not find that the compensation judge=s statement in Finding 3 is at variance with the evidence. Second, the issues in this case did not turn on a disagreement among the medical experts over the mechanism of injury or whether the employee sustained a Gillette injury. The question, rather, was whether or not the injury continued to be a substantial contributing factor in the employee=s claimed disability. The precise physical activity of the employee on the job is not determinative on this question.
The employee next addresses the judge=s finding that she failed to prove that the fibromyalgia first diagnosed in 2005 was caused by the 1989 work injury. In her brief, she restates the evidence she offered below, including the causation opinions of Dr. Larson and of her chiropractor, Dr. Christian. The employee objects to the contrary opinion of Dr. Friedland, which the judge adopted, on the basis that he did not mention medical records of other physicians referring to trigger points, and Amay have missed@ trigger points in the employee=s shoulder during his examination.
We do not find a foundational defect based on these objections. Dr. Friedland specifically based his views on his own examination findings, which showed Aglobal tenderness that is not localized to specific trigger points that would be required for a diagnosis of fibromyalgia.@ He did not state that the employee=s prior medical records failed to mention possible trigger points. Nor does his failure to discuss the details of examination findings by some of the prior physicians indicate that he was unaware of those findings. In his first IME report, Dr. Friedland noted that he had reviewed the employee=s outside medical records, that they were voluminous, and that Athey cannot be fully summarized in a report of this nature.@ The compensation judge was entitled to conclude that Dr. Friedland=s opinion, which was contrary to that of Dr. Larson and Dr. Christian, was based on a difference in medical viewpoint rather than an absence of critical information.
The employee=s arguments with respect to each of her other alleged conditions are similar. Regarding the cervical disc herniations, first noted in radiographic studies in 2002, but absent in prior studies, the employee relies on Dr. Beck=s opinion that the employee=s work for the employer was a substantial causative factor. The employee argues that Dr. Friedland=s opinion denying work causation for the disc herniations was without foundation. Specifically, the employee points out that Dr. Friedland summarized the employee=s records as indicating that she Adid not seek any further or ongoing care or treatment for her cervical . . . symptomology by physicians [from 1992] until 2002.@ She points out that there was occasional chiropractic treatment for chronic neck pain between 1996 and 2001, and further points to a medical visit with Dr. Waldron in 1997 during which he noted that she had chronic neck pain. We note, however, that Dr. Friedland=s report elsewhere discusses in detail the basis of his opinion regarding the employee=s cervical disc herniations, and does not rely on a gap in treatment, but rather on the absence of herniation findings in the employee=s 1990 cervical CT scan and on the progression of the employee=s degenerative disc disease as a normal aging process.
On the issue of the employee=s current right shoulder and thoracic spine conditions, she restates the supporting evidence for her position at the hearing as to why her current symptoms should be seen to have resulted from her work injury. She states that Dr. Friedland=s opinion was inadequate in that he failed to discuss certain factors she deems significant. We see no foundational defect. Dr. Friedland=s opinion did not need to discuss the specific contentions of the employee in rendering an expert medical opinion. Finally, the employee does not raise a foundational defect in Dr. Friedland=s opinion denying her alleged carpal tunnel condition because there were no positive EMG findings. She argues, instead, that the compensaation judge should have adopted Dr. Kirsch=s view that the employee might have an AEMG negative carpal tunnel syndrome.@ This was a matter of a conflict in medical opinion and the compensation judge did not err in choosing one opinion over the other.
Overall, we see no basis to reverse the compensation judge=s reliance on the expert medical opinions of Dr. Friedland and Dr. Engasser and we affirm.
The employee also appealed from the compensation judge=s denial of a request for a functional capacities evaluation. In light of our affirmance of the findings denying a relationship between the employee=s work injury and her current disability or need for medical treatment, that finding is affirmed. An appeal was also taken from the compensation judge=s order that the Special Compensation Fund was entitled to a credit for the amount paid to the employee under the 1991 settlement agreement. Since no benefits are payable to the employee, this issue is moot.
 Maricle v. Farmstead Foods, No. WC04-282 (W.C.C.A. Apr. 21, 2005).