BONITA ASK, Employee/Appellant, v. WINONA HEALTH, SELF-INSURED/BERKLEY RISK ADMR’S CO., Employer.
WORKERS’ COMPENSATION COURT OF APPEALS
OCTOBER 29, 2008
CAUSATION - TEMPORARY AGGRAVATION. Where the medical record subsequent to February 18, 2004, was essentially bare of reference to low back injury and focused instead on the employee’s preexisting chronic myofascial pain and fibromyalgia syndromes, and where the judge’s conclusions were supported by expert medical opinion, the compensation judge’s findings that the employee reached MMI with regard to her 2002 low back work injuries by February 18, 2004, and that those injuries were fully resolved by October 1, 2004, were not clearly erroneous and unsupported by substantial evidence, notwithstanding the employee’s own testimony to the contrary.
TEMPORARY TOTAL DISABILITY - SUBSTANTIAL EVIDENCE. Where there had been no reference to any physical difficulty in the employee’s notice of resignation from the employer, where the employee had not been subject to any doctor’s restrictions at the time of her resignation, where the only evidence that she was disabled at the time she resigned was the employee’s own uncorroborated testimony, where the employee offered no evidence other than her own testimony of any job search either before or after restrictions were eventually issued, and where the employee offered no expert vocational opinion or other evidence other than her own testimony that a diligent job search would have been futile, the compensation judge’s denial of wage loss benefits during the periods of the employee’s claim was not clearly erroneous and unsupported by substantial evidence.
MEDICAL TREATMENT & EXPENSE - CHIROPRACTIC TREATMENT; MEDICAL TREATMENT & EXPENSE - MEDICAL MILEAGE; MEDICAL TREATMENT & EXPENSE - REASONABLE & NECESSARY. Where it was difficult to tell from records of the chiropractic treatment at issue exactly what area of the body was being treated, where the judge’s denial of the employee’s claim for payment for that treatment and for certain prescription medications was supported by expert medical opinion, and where there were no records supporting the employee’s contention that claimed mileage expenses were for obtaining compensable treatment prior to resolution of the employee’s work injuries, the compensation judge’s denial of the employee’s claims for payment of treatment and related expenses was not clearly erroneous and unsupported by substantial evidence.
PERMANENT PARTIAL DISABILITY - SUBSTANTIAL EVIDENCE. Where it was supported by the expert opinion of an independent medical examiner, the compensation judge’s rating of the employee’s permanent partial disability at 0% was not clearly erroneous and unsupported by substantial evidence; a compensation judge is not required to afford greater weight to the opinion of a treating physician than to that of an independent examiner, and the issue on appeal is not whether the appellant’s position is supported by substantial evidence but whether there is substantial evidence to support the conclusion of the compensation judge.
Determined by: Pederson, J., Johnson, C. J., and Rykken, J.
Compensation Judge: Jane Gordon Ertl
Attorneys: Katherine A. Brown Holmen, Dudley and Smith, St. Paul, MN, for the Appellant. Brad R. Kolling, Felhaber, Larson, Fenlon & Vogt, St. Paul, MN, for the Respondent.
WILLIAM R. PEDERSON, Judge
The employee appeals from the compensation judge's findings of maximum medical improvement, from the judge’s finding as to the duration of the employee’s work injury, from the judge’s denials of temporary total disability and medical benefits, and from the judge’s finding of 0% permanent partial disability. We affirm.
Bonita Ask [the employee] has a history of back-related complaints dating back to at least 1977, when she began treating off and on with Dr. Mike Rusak at the Barge Chiropractic Clinic, primarily for soreness in her neck. About nine years later, on February 4, 1986, she was seen at the Gundersen Clinic, Ltd., regarding injuries sustained in a motor vehicle accident on December 24, 1985. Treatment notes on that date indicate that the employee was having “fairly constant aching in her C spine, T spine and lumbar spine paraspinal musculature with some radiation of the pain out both shoulders.” On April 15, 1986, she was seen again at that clinic, by physiatrist Dr. Susan Halter, “for evaluation of persistent pain that seems to involve her entire back,” which the employee traced to her December 1985 motor vehicle accident. Dr. Halter diagnosed probable myofascial pain related to the motor vehicle accident and referred the employee for treatment and instruction the following month at the Gundersen Clinic’s myofascial pain clinic, from which treatment the employee evidently “benefitted a great deal.” The employee last treated with Dr. Rusak at the Barge Chiropractic Clinic on January 16, 1987, for symptoms that had come to include shoulder and low back pain in addition to neck pain. On February 10, 1987, still consequent to her 1985 motor vehicle accident, the employee began treating with Dr. Steven Schams at LaCrescent Chiropractic Center, who diagnosed moderate but chronic myofascial pain syndrome, primarily involving the trapezius, together with mild C5-6 disc degeneration. Upon examining the employee again on June 24, 1987, Dr. Halter reported that the employee “continues to have chronic intermittent back pain,” which the doctor concluded the employee would probably continue to have. The employee also treated about five years later, in 1992, with Dr. James Krenzke at the Houston Chiropractic Clinic, primarily for neck pain, and in November of 1994 she commenced another series of treatments with Dr. Schams at the LaCrescent Chiropractic Center for lower back and upper neck pain, which she had begun experiencing after falling backward off a four-foot step stool. She was treated at the LaCrescent Center again in the summer of 1995 for generalized spinal pain, in January of 1996 for generalized low back and scapular pain, and in April of 1999 for bilateral shoulder pain. The employee subsequently continued to treat regularly for many years with Dr. Krenzke at the Houston clinic for symptoms at all levels of her spine.
On December 14, 2001, the employee became employed as a file room coordinator in the radiology department at Winona Health [the employer], where she was responsible for handling patient files, “pulling” them for x-rays and preparing them for pick-up upon referral to other facilities. The employee’s job sometimes required her to bend over a cabinet-like counter to assemble films and envelopes and sometimes to lift from thirty to fifty pounds of film and to carry it to other locations, work that evidently resulted in her lifting at least five hundred pounds a day. On January 14, 2002, the employee was examined by her family practitioner, Dr. Mary Michener at the Winona Clinic, regarding various issues including what the doctor diagnosed as “[c]hronic back pain, well controlled on Diclofenac and Amitriptyline.” A few months later, on April 12 and again on August 28, 2002, the employee aggravated her low back condition and experienced symptoms in her legs and hip in the course of her job at the employer. The employee was forty-six years old on the first of these dates and forty-seven years old on the second, and she was earning a weekly wage of $342.08.
Subsequent to her injuries, the employee continued to work for the employer until February of 2003. On February 4, 2003, she resigned from her job, stating as her reason only that she was “[t]ired of disrespectful behavior from co-workers, no benefits, no permanent hours.” She continued to work for the employer thereafter until February 25, 2003. At the time of her resignation, the employee was not subject to any physical restriction from working, nor had she been advised by any physician to terminate her employment. Eventually, after apparently denying liability initially, the employer, which was self-insured against workers’ compensation liability at the time, evidently acknowledged liability and paid wage replacement benefits up to February 26, 2003, together with the costs of continued treatments with Dr. Krenzke at the Houston Chiropractic Clinic through April 22, 2003.
On March 4, 2003, about a week after last working for the employer, the employee saw Dr. Michener again with regard to symptoms in her left hip that radiated down from her low back and continued into her lower leg, which symptoms the employee “related to her duties in filing at CMH Radiology Department.” Dr. Michener noted in her history that the employee had “said [that] on February 26th, the first day she was home, she had aches all over her entire body, even into her arms, doing simple things like working on the computer.” X-rays on that date revealed degenerative changes of the L5 facets bilaterally and narrowing of the lumbosacral interspace. Reporting those films to reveal “some mild degenerative changes but no wedging or bony lesions,” Dr. Michener assessed “[c]oncern for lumbar back strain and diffuse muscle aches also possibly consistent with reactive fibromyalgia.” The doctor increased the employee’s amitriptyline to help control the employee’s pain, and she anticipated obtaining a lumbar MRI or CT scan. An MRI was approved and conducted on March 21, 2003, and was read to be normal except for bulging discs at L2-3 and L5-S1. Upon follow-up examination of the employee on March 25, 2003, Dr. Michener noted that the employee reported continuing to “hurt all over,” notably in “her forearms, her upper arms, her shoulders, her mid back, her thighs, low back, buttocks.” Dr. Michener diagnosed lumbar disc disease at L2-3 and L5-S1 and reactive fibromyalgia syndrome, continued the employee’s medication, prescribed a course of prednisone treatments, and referred the employee for physical therapy. With conservative treatment proving generally ineffective in reducing the employee’s complaints of pain, on April 8, 2003, Dr. Michener recommended referral for consultation with a neurosurgeon, but the referral was denied by the employer. On June 2, 2003, Dr. Michener indicated on an Attending Physician’s Statement of Disability that the employee was released to do only light, sedentary work.
On July 10, 2003, the employee was examined in the neurosurgery department at the Gundersen Clinic with regard to her low back and leg pain. No surgical intervention was recommended, and the employee, under a diagnosis of chronic pain that was “now extended to back and lower extremities,” was referred to physiatrist Dr. Evan Robert Nelson. The employee saw Dr. Nelson on July 28, 2003, on which date the doctor diagnosed a history of fibromyalgia, together with musculoligamentous back and leg pain that “would be thought to be work related based on the history [the employee] is giving me.” On August 26, 2003, Dr. Nelson released the employee to return to work at very light duty, where she would be able to alternate tasks and change positions as needed and only rarely bend. Eventually, when he saw the employee on October 1, 2003, Dr. Nelson diagnosed back and leg pain “secondary to work-related incident with date of record of April 12, 2002,” together with myofascial pain that “predated her injury of April 12, 2002,” noting that the employee was “currently doing much better.”
On January 2, 2004, the employee obtained a job doing computer keyboarding and receptionist work with H & R Block. The employee’s complaints of back pain subsequently increased, and on February 2, 2004, Dr. Nelson permanently restricted her to “light median physical capacity” work and rated her back and leg-related permanent partial disability at 3% of the whole body.
On February 18, 2004, the employee was examined for the employer by neurologist Dr. Daniel Randa. In his report on that date, Dr. Randa opined in part that the employee
may have sustained a lumbar musculoligamentous strain injury subsequent to work-related activity while employed at Winona Hospital as a file room aide/coordinator in the radiology department on April 12, 2002, and August 28, 2002. The lumbar strain injury simply reflects an aggravation of a long-standing preexisting condition. In my judgment, the lumbar strain syndrome would have reasonably persisted for 6 to 12 weeks following each event. Thereafter, [the employee’s] subjective pain complaints simply reflect a long-standing chronic pain syndrome well documented within the medical records. The incidents of April 12, 2002, and August 28, 2002, therefore simply represent temporary aggravation[s] of preexisting conditions in my judgment.
Dr. Randa went on to conclude also that medical and chiropractic treatment and/or physical therapy were reasonable therapies for the employee no longer than up to twelve weeks following the employee’s work injuries and that chiropractic care subsequent to November 28, 2002, simply reflected treatment for long-standing chronic psychogenic pain syndrome/fibromyalgia. He concluded that the employee no longer required any medical or related care for her work injuries and that she had obtained maximum medical improvement [MMI] with regard to those injuries by November 28, 2002, three months after the August 28, 2002, activity. He rated the employee’s permanent partial whole-body impairment at 0%, pursuant to Minnesota Rules 5223.0390, subpart 3A, which provides for compensation for pain and stiffness in the lumbar spine not substantiated by persistent objective clinical findings, regardless of radiologic findings, which criteria he found to precisely describe the employee’s clinical condition. It was Dr. Randa’s opinion that neither clinical nor radiological examination had revealed any work-injury-related abnormalities necessitating any physical restrictions, that, on the contrary, it was advisable for the employee to pursue a regular daily exercise program, to resume a full, unrestricted lifestyle, and to minimize her medication use to anti-inflammatory medications. Dr. Randa concluded that the employee’s history of subjective pain complaints was long-standing, that it preexisted the employee’s employment with the employer, that it reflected underlying stress and anxiety, and that it was unrelated to the employee’s work-activity in April and August of 2002. Dr. Randa’s report was served on the employee by letter dated March 19, 2004.
The employee apparently worked for H & R Block, with continuing back pain, until the job ended on April 15, 2004. When she saw the employee again on September 20, 2004, Dr. Michener noted that the employee “has pain all over if she does any sort of activity.” Dr. Michener did not mention any specific low back complaints or prescribe any medication for such, and her assessment did not reference any work-related injury or aggravation of the low back. In a September 27, 2004, letter replying to a query of the employee’s attorney, Dr. Michener stated,
It is my overall impression that [the employee] had long-standing pain syndrome prior to her employment at Community Memorial Hospital. I do think her employment did contribute in some way to an aggravation of this underlying problem, but I am not in a position to write the degree to which this employment contributed to her pain. Thus, I believe that her employment was a contributing factor to exacerbating her underlying condition but whether or not it was a “substantial” contributing factor, is unclear to me.
On September 29, 2004, Dr. Krenzke wrote a memo to the employee’s attorney, in which he stated that the employee had been “a patient of mine since Sept. 1992, so I am well aware of her past history, and the condition of her spine with relation to pre-existing condition.” He indicated that it was his opinion that the employee’s “work activities, especially in regards to ergonomic issues, were the cause of her cumulative effect work comp claim of 8/28/02, and are a substantial contributing factor in her ongoing low back pain.” Dr. Michener saw the employee again on September 30, 2004, for an annual physical examination, on which date the doctor, reporting that the employee “notes continuing trouble with her myofascial pain/fibromyalgia,” diagnosed “[c]hronic myofascial pain, under fair control at this time.”
Liability for the employee’s April 12, 2002, low back and left hip injury was still being contested at the time, and the employee’s entitlement to payment of certain ongoing medical consequences of that injury came on for hearing on October 1, 2004, before Compensation Judge Jane Gordon Ertl. By findings and order filed October 28, 2004, Judge Ertl concluded that the employee was entitled to payment of those medical expenses.
On January 2, 2005, able by then to walk up to three miles a day, the employee returned to work for H & R Block. On January 7, 2005, the employee was seen at the Houston Chiropractic Clinic, where records note, “Fibromyalgia acting up across shoulders; lower back also flared up past week or so.” The employee saw Dr. Michener again on February 7, 2005, on which date the doctor noted that the employee’s “chief complaint [is] that she is ‘not good.’ She reports numerous insignificant musculoskeletal complaints including backache, leg pain, and arm pain.” Dr. Michener diagnosed “[s]ignificant flare of underlying fibromyalgia,” prescribed Celexa for depression, and wrote a letter “to whom it may concern,” advising that the employee
has been bothered with fibromyalgia and myositis symptoms intermittently for several years. These result in pain, discomfort and aches in several different locations of her body. . . . At this time working more than about six hours per day causes significant flare in her discomfort. She would certainly appreciate any work place or work duty modifications that can be employed to help improve her comfort.
In neither her treatment notes nor her letter on that date did Dr. Michener relate the employee’s symptoms to any injury at work in 2002, nor did she restrict the employee from working. Upon follow-up on March 7, 2005, Dr. Michener noted that the employee had recently quit her job upon H & R Block’s inability to accommodate her restrictions but that the employee had since then been feeling and doing much better. Dr. Michener’s diagnosis on that date was “[a]nxious depression, with underlying fibromyalgia. Significant improvement with Celexa.” About seven months later, on October 12, 2006, the employee returned to the Winona Clinic for an annual exam with Dr. Michener, who noted, under “[c]hief complaint,” that the employee was “[f]eeling Well. Likes job, but [has] financial issues w/former owner of business - - embezzlement,” that “[s]ince work has been so stressful, she’s wondering if her Celexa could be increased,” that she had “numerous and various pain complaints - - headaches, legs, back (due to vacuuming at work),” but that “[n]umerous pain complaints are not new for her.” Dr. Michener listed the employee’s problems as “[m]yalgia and myositis, unspecified,” increased the employee’s Celexa prescription, and under “Impression and Plan” stated “Well Adult Exam - Female.”
On January 17, 2007, the employee filed a claim petition, alleging entitlement to temporary total disability benefits from February 26, 2003, to January 1, 2004, from April 16, 2004, to January 1, 2005, and from January 31, 2005, to August 1, 2005, all consequent to work injuries to her “Back, Hip, and Leg” on April 12, 2002, and August 28, 2002. In its subsequent answer, the employer admitted temporary work injuries on the dates alleged, but it denied that those injuries were unresolved or that any benefits were still owing.
On July 30, 2007, the employee was examined again for the employer by Dr. Randa. In his report on that date, after a detailed review of the employee’s current symptomology and her employment and medical history since the date of the doctor’s previous, February 2004, examination of the employee, Dr. Randa diagnosed “[c]omplaints of lumbosacral pain” and “[c]hronic psychogenic pain syndrome.” He stated in part,
Clearly, [the employee’s] current subjective complaints are long-standing and preexisted the work activity of April 2002 and August 2002. In my judgment, [the employee’s] diffuse pain complaints including her low back and lower extremity complaints are not plausibly related to the work activity of April 2002 or August 2002. Any conceivable strain injury which may have occurred from the work activity, as described, would have had more than ample opportunity to resolve. [The employee’s] current complaints simply reflect her preexisting condition, in my judgment.
It was Dr. Randa’s opinion that the employee’s work injuries were not substantial contributing factors in either her current subjective pain complaints or her diagnosis of fibromyalgia and chronic myofascial pain syndrome. The doctor opined further that the employee required no further medical intervention or chiropractic care relative to her 2002 work injuries, that she required no specific physical restrictions consequent to those injuries, and that she should pursue a regular exercise program and increase her activity level. He reiterated his 2004 opinion that the employee reached MMI with regard to her 2002 work injuries by November 28, 2002, having incurred a 0% permanent partial disability under Minnesota Rules 5223.0390, subpart 3A. Dr. Randa’s report was served on the employee by letter dated August 21, 2007.
On November 9, 2007, Dr. Krenzke wrote a memo to the employee’s attorney, indicating that it was his “opinion that a gravity inversion machine and a therapeutic hot tub would both be very beneficial for [the employee], to help alleviate her low back pain due to her workplace injury of 2002 and also her chronic myofascial syndrome.” Dr. Randa testified by deposition on February 4, 2008, essentially reiterating the opinions expressed in his report of July 30, 2007. On February 19, 2008, the employee filed an amendment to her claim petition, alleging entitlement also to payment of medical expenses in the amount of $6,816.48 and to compensation for a permanent partial disability to 3.5% of the whole body.
The matter came on for hearing on February 26, 2008, again before Compensation Judge Ertl. Issues at hearing included the following: (1) the employee’s entitlement to temporary total disability benefits from February 26, 2003, to January 1, 2004, from April 16, 2004, to January 1, 2005, and from January 31, 2005, to August 1, 2005, including subissues of (a) causal relationship to the work injuries, (b) work-related restrictions, and (c) diligence of the employee’s job search; (2) the employee’s entitlement to payment of medical, chiropractic, therapeutic, and related expenses in the amount of $6,816.48; (3) the employee’s entitlement to permanent partial disability compensation for a 3.5% whole-body impairment; (4) whether the employee’s injuries were temporary; and (5) whether the employee had reached MMI as of November 28, 2002, as asserted on reports of Dr. Randa served on March 19, 2004, and August 21, 2007. By findings and order filed March 25, 2008, the compensation judge denied the employee’s claims in their entirety, concluding that the employee had reached MMI with regard to her work injuries by the time she was evaluated by Dr. Randa on February 18, 2004, with service of his report on March 19, 2004, and that those injuries were temporary aggravations that had fully resolved by October 1, 2004. The employee appeals.
STANDARD OF REVIEW
In reviewing cases on appeal, the Workers’ Compensation Court of Appeals must determine whether “the 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. Similarly, “[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, “unless 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 Injury Ending October 1, 2004
It is uncontested that the employee sustained work-related injuries at the employer in April and August of 2002. At Finding 15, the compensation judge concluded that the employee had reached MMI with regard to those injuries by the date of her February 18, 2004, examination by Dr. Randa, whose report to that effect was served on the employee on March 19, 2004. At Finding 17, the judge concluded further that those injuries were temporary aggravations of a preexisting condition and that those temporary aggravations had resolved for workers’ compensation purposes by October 1, 2004, the date of the employee’s previous hearing before the same judge on entitlement to medical expenses, at which the employee prevailed. The employee contends that substantial evidence does not support these conclusions. With regard to MMI, she argues that her own testimony is substantial evidence of the fact that she was continuing to improve with regard to her work injuries “long after the alleged date of maximum medical improvement given by Dr. Randa.” She argues that several of her treatment programs, such as her gravity inversion and aquatic therapy, were recommended specifically to relieve her work-related low back and hip pain, not pain brought about by her fibromyalgia, and that these treatments continued to relieve her condition “subsequent to her alleged MMI date.” With regard to the judge’s finding that her work injuries had resolved by October 1, 2004, the employee cites again her own testimony to the effect that her injuries “exponentially increased beginning with her employment with [the employer]” and that she was not diagnosed with fibromyalgia until after leaving that employment in February 2003, well after sustaining her work injuries in April and August of 2002. She argues further, again citing only her own testimony, that, although she was simultaneously being treated for both her low back injury and her fibromyalgia pain, the former was continuous and distinct from the latter, and “her lower back and hip pain was substantial and significantly affected her ability to work after October 1, 2004.” We are not persuaded.
We would note at the outset that the compensation judge’s conclusion as to MMI at Finding 15 was that the employee reached MMI “by the time she was evaluated by Dr. Randa on February 18, 2004,” not, as the employee’s argument implies, by “the alleged date of maximum medical improvement given by Dr. Randa,” which was November 28, 2002, nearly fifteen months prior to the 2004 date specified by the judge. Whether or not there exists substantial evidence that the employee’s work injured condition was continuing to improve and continuing to respond to treatment subsequent to November 28, 2002, is not here at issue. What is here at issue regarding MMI is whether or not substantial evidence supports the judge’s finding that MMI was reached by February 18, 2004. We conclude that the medical record subsequent to February 18, 2004, is essentially bare of material reference to specifically low back injury specifically related to the employee’s work on April 12 and August 28, 2002, essentially all of that record referencing instead attention to and treatment of the far more nebulous consequences of the employee’s preexisting chronic myofascial pain and subsequent fibromyalgia syndromes. We conclude that the compensation judge’s finding as to MMI was not unreasonable in light of the employee’s post-February 18, 2004, medical record. With regard to the judge’s finding of ultimate resolution of the employee’s lower back work injury by October 1, 2004, we can only reiterate that we find little material reference to that injury in the employee’s medical records for over half a year prior to October 1, 2004. Nor is the employee’s own testimony, though substantial, sufficient to overcome the equally substantial contrary inference to be drawn from the employee’s medical records, particularly in light of the expert opinions of Dr. Randa, upon which the compensation judge has in large part relied. 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); Nord v. City of Cook, 360 N.W.2d 337, 342-43, 37 W.C.D. 364, 372-73 (Minn. 1985) (the 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). Because they were not unreasonable, we affirm the compensation judge’s conclusions that the employee had reached MMI with regard to her work injuries by February 18, 2004, with notice served on the employee as of March 19, 2004, and that the employee’s April and August 2002 work injuries were temporary aggravations that had resolved fully by October 1, 2004. See Hengemuhle, 358 N.W.2d at 59, 37 W.C.D. at 239.
2. Temporary Total Disability
The employee has claimed entitlement to temporary total disability benefits from February 26, 2003, to January 1, 2004, from April 16, 2004, to January 1, 2005, and from March 31, 2005, to August 1, 2005. We have affirmed the compensation judge’s conclusion that the employee’s work injuries had resolved no later than October 1, 2004, thereby rendering moot the employee’s claim for benefits during the period March 31, 2005, to August 1, 2005, and for that part of the period April 16, 2004, to January 1, 2005, that postdates October 1, 2004. See Kautz v. Setterlin Co., 410 N.W.2d 843, 40 W.C.D. 206 (Minn. 1987) (an employee is not entitled to continuing compensation where he or she has no residual disability related to the work injury). At Findings 7 and 10, respectively, the compensation judge denied benefits also for the periods February 26, 2003, to January 1, 2004, and April 16, 2004, to January 1, 2005, including that part of the latter period that predates October 1, 2004. At unappealed Finding 6, the compensation judge noted in part that there was no record of any job search by the employee from the time she left work with the employer on February 25, 2003, up until she started working for H & R Block on January 2, 2004, and at unappealed Finding 8 the judge noted that the employee did not submit a job search record after finishing her seasonal work with H & R Block on April 15, 2004. In her memorandum, the judge explained her denial of wage replacement as follows: (1) during the periods of her claim, “the employee did not have a formal release from all work and generally took herself off work”; (2) “[t]he employee’s disability contentions are . . . complicated by her preexisting condition” and by the fact that “[b]y September of 2004, Dr. Michener did not include work related low back complaints in her diagnosis”; (3) the employee “did not establish that it would be futile to seek work”; and (4) “Dr. Randa,” on whose opinion the judge relied, stated that “‘[t]here was nothing which would preclude [the employee] from engaging in work activities that would be appropriate for her.’”
In her brief, the employee cites case law to the effect that neither a formal restriction from all work nor even a written restriction from certain work is required for an award of wage replacement under the statute. With regard to the period February 26, 2003, to January 1, 2004, she argues that her doctor ordered work restrictions subsequent to her leaving the employer and that those restrictions “rendered her virtually unable to work in her area or a surrounding area, especially given her educational and work backgrounds,” her residence being in a small town of about a hundred people and she being forty-seven years old at the time and having few transferable skills. With regard to all periods of her claim, the employee cites her testimony to having conducted a continuous job search once she felt physically able to work, noting that there was no rebuttal to that testimony. With regard specifically to the period April 16, 2004, to January 1, 2005, the employee argues that she was “extremely weak and in immense pain” upon completing her seasonal work with H & R Block and that her work restrictions were subsequently increased, “so that she was limited to sitting jobs in which she could not lift anything over 10-15 pounds.” We are not persuaded that the judge’s denial of wage replacement was unsupported by the evidence.
“[A] person is totally disabled if his physical condition, in combination with his age, training, and experience, and the type of work available in his community, causes him to be unable to secure anything more than sporadic employment resulting in an insubstantial income.” Schulte v. C. H. Peterson Constr., 278 Minn. 79, 83, 153 N.W.2d 130, 133-34, 24 W.C.D. 290, 295 (1967). Generally speaking, “employees who are capable of working must make a diligent job search to establish total disability even if maximum medical improvement has not yet been reached.” Redgate v. Sroga's Standard Serv., 421 N.W.2d 729, 733, 40 W.C.D. 948, 954 (Minn. 1988). A disabled employee need not necessarily conduct a diligent search for employment as a prerequisite to being found totally disabled if he or she is not “capable” of work - - i.e., if such a search would be futile, id., but the fact that the employee has not sought post-injury work may go to the evidentiary weight of the assertion that the employee is totally disabled. See Scott v. Southview Chevrolet Co., 267 N.W.2d 185, 188-89, 30 W.C.D. 426, 432 (Minn. 1978). The reasonable diligence of a job search is to be viewed within the scope of assistance provided by the employer and insurer, Okia v. David Herman Health Care Ctr., 38 W.C.D. 261 (W.C.C.A. 1985), but even where rehabilitation assistance is not provided the employee must generally still make a reasonably diligent effort to find employment as best he can on his own. Mattson v. State, Dep’t of Pub. Safety, 48 W.C.D. 77, 80 (W.C.C.A. 1992), rev'd on other grounds, 494 N.W.2d 884, 48 W.C.D. 84 (1993).
We grant that a doctor’s formal restrictions are not necessarily a prerequisite to an award of wage replacement where there is ample other evidence of physical disability. In this case, however, the only evidence of the employee’s disability at the time she resigned from her job with the employer in February of 2003 is the employee’s own uncorroborated testimony, which it was the compensation judge’s prerogative to discount, particularly in the face of contrary evidence, such as the absence of any reference to physical difficulty in the employee’s resignation notice, in addition to the absence of any doctor’s restrictions. See Brennan, 425 N.W.2d at 839-40, 41 W.C.D. at 82 (assessment of a witness's credibility is the unique function of the trier of fact). Further, as the compensation judge noted in Findings 6 and 8, the employee submitted no record of a job search for the periods at issue either before or after Dr. Michener in June of 2003 and Dr. Nelson two months later issued restrictions against more than light sedentary work. Nor did she, as the judge suggested in her memorandum, offer the testimony of any vocational expert that work was not available to someone of her restrictions and circumstances in her labor market, instead of simply deciding on her own that a more diligent job search would be futile. As it stands, we cannot say that it was unreasonable for the judge to deny the employee’s claim, in light of the paucity of evidence presented in support of it. Therefore, because it was not unreasonable, we affirm the judge’s conclusion that the employee has not established entitlement to temporary total disability benefits for the period February 26, 2003, to January 1, 2004, or for the period April 2004 to January 1, 2005. See Hengemuhle, 358 N.W.2d at 59, 37 W.C.D. at 239.
3. Medical Expenses
The employee alleged entitlement to payment of a total of $6,816.48 in medical expenses - - $550.00 for treatment at the Houston Chiropractic Center, $1,298.81 for prescription medications, $1,788.99 for a recommended hot tub and a recommended gravity inversion table, $125.00 for recommended YMCA aquatic therapy, and $3,053.68 for medically-related mileage expenses. As was the case with the employee’s claims for temporary total disability benefits for periods postdating October 1, 2004, that portion of the employee’s medical expense claim that is for expenses incurred after October 1, 2004, is rendered moot by our affirmance of the compensation judge’s finding that the employee’s work injury had resolved by that date. This effectively eliminates in its entirety the employee’s claim for payment for the hot tub and the gravity inversion table, which were recommended by Dr. Krenzke on November 9, 2007, over three years after resolution of the employee’s work injury as here affirmed.
The expenses at the Houston Chiropractic Center for which the employee claims entitlement to payment were incurred from April 26, 2004, to December 12, 2007. Only those incurred prior to October 1, 2004 - - about a third of the total - - are not rendered moot by our holding as to resolution of the employee’s work injury by that date. The employee contends that her “chiropractic treatments at Houston Chiropractic were conducted after she had begun employment with [the employer],” that “she would receive hip adjustments to deal with the pain caused by bending over and pulling medical files in the course of her duties,” and that “[t]hese expenses are directly attributable to the injuries sustained at [the employer].” As the compensation judge has suggested in her memorandum, however, it is difficult to decipher from the records of the treatment at issue exactly what area of the body was being treated on the dates for which treatment reimbursement is being sought - - sometimes it being an area or areas of her cervical spine or head or shoulders or her fibromyalgia condition in addition to her lower back complaints. Particularly given Dr. Randa’s supporting opinion that none of the employee’s chiropractic care was related to the employee’s April and August 2002 work injuries, we cannot conclude that the judge’s denial of the employee’s petition for payment of her expenses at the Houston Chiropractic Center was unreasonable. Though not express, it is implicit in the compensation judge’s discussion of the employee’s claim for payment of $1,298.81 in prescription medications, many of which prescriptions post-date the October 1, 2004, resolution of the employee’s work injury, that the judge accepted also Dr. Randa’s opinion that the employee was not in need of prescription medication for her work injuries. Id. Nor was it unreasonable for the compensation judge to deny the employee’s claims for payment of mileage expenses related to medical treatment, absent any records to support a contention that those expenses were for obtaining compensable treatment prior to October 1, 2004. Because they were not unreasonable, we affirm the compensation judge’s denials of the employee’s claims for payment of medical expenses. See Hengemuhle, 358 N.W.2d at 59, 37 W.C.D. at 239.
4. Permanent Partial Disability
The employee sought compensation for a permanent impairment totaling 3.5% of her whole body, in keeping with the rating of Dr. Nelson pursuant to Minnesota Rules 5223.0390, subpart 3B, which authorizes compensation to that extent for “[s]ymptoms of pain or stiffness in the region of the lumbar spine, substantiated by persistent objective clinical findings, that is, involuntary muscle tightness in the paralumbar muscles or decreased range of motion in the lumbar spine, but no radiographic abnormality.” Minn. R. 5223.0390, subp. 3B. At Finding 16, the compensation judge denied that claim, relying instead on the 0% rating of Dr. Randa, pursuant to Minnesota Rules 5223.0390, subpart 3A, which provides for that rating for “[s]ymptoms of pain or stiffness in the region of the lumbar spine not substantiated by persistent objective clinical findings, regardless of radiographic findings.” Minn. R. 5223.0390, subp. 3A. The employee argues that she demonstrated continued pain and reduced range of motion in the lumbar spine at her examinations by Dr. Nelson, that her “treating physician’s opinion should be given ample weight,” and that “[w]ith the addition of [the employee’s] credible testimony relative to her condition, substantial evidence supports” the employee’s claim. We are not persuaded.
The issue on appeal is not whether the appellant’s position is supported by substantial evidence but whether there is substantial evidence to support the conclusion of the compensation judge. See Land v. Washington County Sheriff’s Dep’t, slip op. (W.C.C.A. Dec. 23, 2003). Moreover, while a finder of fact may, in appropriate circumstances, choose to afford greater weight to the opinion of a treating physician, the judge is not required to do so. Caven v. Ag-Chem Equip. Co., Inc., slip op. (W.C.C.A. Sept. 14, 1993). Although the opinion of Dr. Nelson may have been substantial evidence to support a contrary conclusion by the judge, Dr. Randa’s opinion constitutes substantial evidence to support the conclusion actually reached by the judge. See Nord, 360 N.W.2d at 342-43, 37 W.C.D. 364 at 372-73. Because it was supported by expert medical opinion and was not otherwise unreasonable, we affirm the compensation judge’s rating of the employee’s permanent partial disability at 0%, pursuant to the opinion of Dr. Randa and Minnesota Rules 5223.0390, subpart 3A.
 Medical records submitted into evidence document continued treatments by Dr. Krenzke right up through December 12, 2007, thirteen of which treatments span the dates April 12, 2002, through April 22, 2003, the employee’s eventual medical claim apparently including all subsequent treatments of Dr. Krenzke beginning May 14, 2003 (the treatment and billing records of Dr. Krenzke are somewhat ambiguous).
 At Finding 16, the judge expressly relied on the opinion of Dr. Randa with regard to permanent partial disability, and in her memorandum the judge indicated that she relied on the opinion of Dr. Randa that the employee had reached maximum medical improvement by the time of the doctor’s February 18, 2004, examination of the employee and that she accepted his opinion regarding chiropractic care after April 26, 2004. The employee’s entitlement to treatment expenses incurred up through October 1, 2004, the date of the judge’s previous hearing in this matter, has become the law of the case, pursuant to the judge’s findings and order filed October 28, 2004.