RAYMOND H. BROWN, Employee/Cross-Appellant, v. WICKES FURNITURE and SPECIALTY RISK SERVS., INC., Employer-Insurer/Appellants, and PREFERRED ONE CMTY. HEALTH PLAN, MINNESOTA DEP’T OF HUMAN SERVS., MEDICA HEALTH PLANS, UNITED HOSP., and REGIONS HOSP., Intervenors.
WORKERS’ COMPENSATION COURT OF APPEALS
DECEMBER 4, 2008
TEMPORARY TOTAL DISABILITY - SUBSTANTIAL EVIDENCE; EVIDENCE - CREDIBILITY; EVIDENCE - EXPERT MEDICAL OPINION. Where the case was one of unusual medical complexity and credibility issues, where it was not unreasonable for the compensation judge to conclude that the employee was formally restricted from working during the four separate periods for which benefits were awarded, where the medical benefits at issue were stipulated to be reasonable and necessary, and where it was supported by expert medical opinion, the compensation judge’s award of temporary total disability and medical benefits was not clearly erroneous and unsupported by substantial evidence.
TEMPORARY TOTAL DISABILITY - WORK RESTRICTIONS; JOB SEARCH - SUBSTANTIAL EVIDENCE. Where the employee was formally released to work during one of the four denied periods, where there was no evidence that the employee was formally restricted from working for the other three denied periods, and where the employee offered no record of a job search, no evidence of reporting to the employer for lighter duty work, and no evidence of coordination with a QRC during any of the four denied periods, the compensation judge’s denial of temporary total disability benefits for four separate periods of the employee’s claim was not clearly erroneous and unsupported by substantial evidence.
Determined by: Pederson, J., Johnson, C. J., and Rykken, J.
Compensation Judge: Paul V. Rieke
Attorneys: David R. Vail, Soderberg & Vail, Minneapolis, MN, for the Cross-Appellant. Kathryn M. Perlinger, Brown & Carlson Law Office, Minneapolis, MN, for the Appellants. Kris Wittwer, Roseville, MN, for Intervenor United Hospitals.
WILLIAM R. PEDERSON, Judge
The employer and insurer appeal from the compensation judge's awards of various temporary total, medical, and other benefits. The employee cross-appeals from the judge’s denial of certain other temporary total disability benefits. We affirm.
Over the course of his life, Raymond Brown, who has a high school diploma and Job Corps training in customer service and auto mechanics, has worked at various jobs, including auto mechanic, retail sales clerk, security officer, and personal care attendant. Medical records as early as December 17, 2003, at Open Cities Health Center, Inc. [Open Cities], indicate that Mr. Brown has been a “body builder,” and he has evidently also aspired to being a professional wrestler. His medical records reveal that he has undergone treatment for his right shoulder since at least May of 2004 and for his low back since at least May of 2006. Regions Hospital records for May 11, 2004, indicate that he reported on that date “that last night he was walking in his kitchen to get to the refrigerator at approximately 2:30 a.m. when he slipped and fell landing on his right side with his arm tucked in next to his body on the right shoulder.” Mr. Brown’s final diagnosis on that date was “[r]ight AC separation.” HealthPartners records for September 21, 2004, a little over four months later, report that the employee’s “first issue” was still
that he has been having some shoulder discomfort. . . . . The patient reports that he has sustained multiple traumas to the shoulder. The patient is an aspiring professional wrestler [and] in the course of his work he does a lot of lifting. He reports that he has also absorbed multiple blows to his shoulder. He reports that the shoulder may have been dislocated 2 or 3 times in the past, but he cannot remember precisely. He reports that the shoulder presses do bother the shoulder.
On May 3, 2006, HealthPartners records indicate that Mr. Brown had called reporting that he had seen a chiropractor who had identified also
problems in lower back. For 2 months [patient] has been having back pain to lower back pain and neck area with headaches. Two weeks ago [symptoms] got worse and [patient] h[a]s been having to urinate more often but no urinary tract [infection] detected [patient] stated. [Patient] wondered if he should get a second opinion.
An emergency nursing record at United Hospital two days later, on May 5, 2006, documents a visit by Mr. Brown at which he complained of back and neck pain, noting that he had started weight training six months ago and that two weeks ago his pain had increased.
On May 23, 2006, the Mr. Brown [the employee] became employed with Wickes Furniture [the employer], at a job that required him to perform heavy physical tasks, including the moving of furniture weighing several hundred pounds. Apparently about three weeks later, on June 19, 2006, after lifting at work, the employee went off work with severe low back pain that seemed to have developed beginning with an onset of left calf pain about four days earlier while climbing a ladder and lifting. The employer admitted liability for an injury on June 15, 2006, and after a few days off work the employee returned to his regular duties without restrictions. Treatment notes at Regions Hospital on September 3, 2006, some three months later, indicate that the employee reported slipping off his kitchen counter the previous night, “injuring his low back and right hip,” and that he “denies previous injury.” On October 30, 2006, the employee underwent a physical examination at Now Care Occupational Medical Center, where notes indicate a conclusion that the employee was able to work, that he did not need further evaluation, and that his trunk, back, neck, and upper extremities were all normal.
The employee continued thereafter to perform his regular heavy work duties at the employer without difficulty until December of 2006. On Friday December 22, 2006, the employee was seen by Dr. May Heu at Open Cities, “complaining of back pain since this morning.” Dr. Heu noted that “[t]his first occurred five months ago when he was lifting a dresser. Apparently he woke up with the pain. He has difficulty moving.” Noting that the employee reported “[n]o recent accidents or injuries” and was “[n]ot in acute distress,” Dr. Heu diagnosed “[b]ack pain, musculoskeletal in nature,” prescribed Flexeril and ibuprofen and a trial of trazodone, and released the employee to “[r]eturn to clinic if not improved.” Dr. Heu signed her treatment notes on December 27, 2006. The employee had been thirty years old on December 22, 2006, and had been earning a weekly wage of $432.56.
On December 28, 2006, the employee was examined also by Dr. Chang-Jiang Zheng at HealthPartners, who noted a history of
development of progressively worse low back pain, Rt shoulder pain after lifting a heavy box at work. The box was large and difficult to stabilize. [The employee] felt sharp pain (in Rt chest and low back) during the lifting. It became worse and severe fairly quickly. He sought care from MD and was given flexeril. Apparently he developed allergy to the med (lip swelling and SOB) and had to D/C flexeril. He reports severe pain with any movement, particularly the Rt side of his body. Lying down on floor seems helpful.
Past medical history is reviewed and found to be non-contributory. No prior [history] of low back pain or shoulder pain.
Noting also that the employee was “[n]ot in acute distress,” Dr. Zheng diagnosed acute low back pain and an acute sprain of the right shoulder, both work related, and he restricted the employee from working until January 1, 2007. The following day, on December 29, 2006, in two memoranda addressed “To Whom it May Concern,” Dr. Heu certified that she had seen the employee on December 22, 2007, and she released the employee to return to work.
On that same date, December 29, 2006, the employer completed an “Accident Investigation Report,” indicating that on December 27, 2006, the employee had reported injuring himself at work on December 22, 2006. The hand-written report appears to quote the employee as stating,
I first had hurt my back in June of this year and I thought it was better but I went to pick up a headboard and bed to [missing words] and the same pain came back but worse th[a]n before. I left work [illegible] thinking nothing of it, but later that night the pain got worse.
Attached to that report is a similarly hand-written statement, dated January 2, 2007, by one Travis Jewell, evidently one of the employee’s coemployees, in which Mr. Jewell states, “When me and Ray were working on Thursday, I did not notice anything was wrong with him, me and him lifted everything together and he seemed just fine. We unloaded the truck and put the stuff together from the truck and when I left he looked normal to me.”
Upon follow-up with the employee on January 4, 2007, Dr. Zheng noted that the employee’s low back pain was “still significant” but that his right rotator cuff strain had “apparently improved or nearly resolved,” and the doctor released the employee to return to work restricted from lifting over twenty-five pounds, from pushing over thirty pounds, and from doing any repetitive bending or twisting at waist level, provided he could take frequent breaks and changes of postures. On January 16, 2007, the employee was examined also by Dr. Rita Wallace-Reed at HealthPartners, who assessed low back pain with no neurologic deficit but right shoulder “near dislocation and abduction” and “concern for a possible labral tear/injury,” noting that the employee had level ten pain on a scale of one to ten in both his right shoulder and his low back and right hip, with no improvement in the latter since his injury. X-rays of the shoulder revealed mild AC joint separation, and the following day, January 17, 2007, the employee was seen at the emergency room at United Hospital regarding his continuing complaints of lumbar pain. An x-ray of the employee’s pelvis proved negative, but the employee was restricted from lifting or carrying over ten pounds occasionally and against doing any pushing or pulling. Notations at that same facility on January 23, 2007, indicate that the employee had had a trigger point injection the previous week and was scheduled to have an MRI scan the following week and that he was restricted from working until February 1, 2007.
On March 7, 2007, the employee was terminated by the employer for “job abandonment.” On March 26, 2007, the employee was seen by Dr. Sarah Hammes at the Health East Rice Street Clinic [Health East], requesting “paperwork filled out today indicating that he is unable to seek work due to his pain and short-term disability.” Upon examination, Dr. Hammes diagnosed right shoulder pain consistent with chronic tendinosis of the rotator cuff, together with low back pain, both consequent to a work-related injury on December 22, 2006. Noting that the employee “essentially has been unable to work since December, but over the last month he has been supervising a move from one apartment to another,” Dr. Hammes restricted the employee from working until June 1, 2007, and referred him to Midwest Spine Institute [MSI], indicating that she would evaluate the employee again on June 1, 2007.
On April 5, 2007, the employee filed a claim petition, alleging entitlement to temporary total disability benefits from December 22, 2006, to March 4, 2007, and to temporary partial disability benefits continuing from March 5, 2007, consequent to work injuries to his low back, to the right side of his chest, to his right rib cage, and to his right shoulder sustained on May 15, 2006, and December 22, 2006. This claim was subsequently amended to allege temporary total disability continuous from December 22, 2006, consequent to injuries on June 15 rather than May 15, 2006, in addition to injuries on December 22, 2006.
Records of Dr. Hammes on May 8, 2007, report a plan for treatment of the employee’s low back pain and right shoulder tendonitis, including pain medications, rehabilitation, and a right shoulder injection performed on that date. The employee had apparently not yet been seen at MSI, and Dr. Hammes made that referral again, and the employee was seen there on June 6, 2007, by Dr. Stefano Sinicropi. Dr. Sinicropi diagnosed moderate to severe right sacroiliac joint dysfunction and mild right shoulder impingement, restricted the employee from working for three weeks, and referred the employee to chiropractor Dr. Casey Smith for his expertise in S1 joint dysfunction, with anticipation of significant pain relief. A report of Dr. Hammes at Health East on June 14, 2007, indicates that the employee was at that time “still currently disabled until further evaluation by the spine clinic,” where he was to be seen in about three weeks, “and they will determine if he is able to return to work or not.” Dr. Hammes’s notes indicate further that the employee was “optimistic about returning to work and has a job lined up for Best Buy later this summer if he is allowed to return to work.”
On August 6, 2007, the employee was examined by orthopedist Dr. Paul Yellin at Summit Orthopedics, on referral by Dr. Hammes, for evaluation of his right shoulder. Dr. Yellin diagnosed a probable labral tear and ordered an MRI scan.
On August 15, 2007, the employee was examined for the employer and insurer by orthopedic surgeon Dr. Gary Wyard. Upon interview and examination of the employee and review of his medical records, Dr. Wyard concluded that the employee had not sustained any significant aggravation of his back or right shoulder as a result of any work activities on May 15 or December 22, 2006, that his subjective low back complaints were out of proportion with any objective findings, that his diagnosis included gross functional overlay, and that his work injuries were only temporary in nature and not a substantial contributing factor in his current condition. Dr. Wyard essentially reiterated these conclusions in an eventual follow-up report on August 30, 2007, after reviewing numerous additional medical records.
On August 16, 2007, the employee underwent the MRI scan of his right shoulder that was ordered by Dr. Yellin. The scan was read to reveal moderate degeneration and tearing of the superior glenoid labrum “consistent with a degenerative or longstanding SLAP lesion,” tearing of the inferior glenoid labrum with separation and displacement of a labral flap, early glenohumeral osteoarthritis, moderate tendinitis with moderate degeneration and fraying and a small articular surface tear, and bursitis. On August 20, 2007, Dr. Yellin referred the employee to orthopedic surgeon Dr. Eric Khetia, also at Summit Orthopedics, for evaluation regarding possible surgery.
On August 31, 2007, the employee was seen by Jacob Guth, Dr. Sinicropi’s physician’s assistant at MSI, who diagnosed, in addition to a torn right labrum, low back pain with right lower extremity radiculitis and clinical evidence of sacroiliac joint dysfunction, and he recommended an MRI scan of the lumbar spine. According to records of PA Guth dated September 25, 2007, the lumbar MRI scan was conducted and read to reveal an annular tear at L5-S1, with a small central disc bulge but no evidence of any significant central or foraminal narrowing.
Dr. Khetia had ordered an injection to treat the employee’s inflamed labrum on September 14, 2007, and on October 30, 2007, he performed on the employee’s right shoulder an arthroscopic rotator cuff repair, an arthroscopic SLAP repair, an arthroscopic subacromial decompression, and a glenoid chondroplasty with labral debridement. Upon follow-up with the employee on November 21, 2007, Dr. Khetia noted that “he really has no significant complaints,” that “[h]e is currently not wearing his sling and states he left it at home,” and that he had “[n]o drainage and no erythema or ecchymosis. He has full elbow and wrist range of motion. He can externally rotate to neutral and abduct to approximately 45 degrees with no discomfort.” With that Dr. Khetia released the employee with a recommendation that he pursue a monitored course of physical therapy and return for a recheck in one month. We find no record of a follow-up appointment with Dr. Khetia.
Apparently the employee subsequently obtained a part-time job requiring only minimal lifting, which he performed until at least January of 2008. On January 25, 2008, he returned to Health East, requesting of Dr. Hammes an opinion indicating that he was unable to work. Dr. Hammes declined to accommodate his request, indicating that she had not formally evaluated his low back or shoulder pain in the past six months and noting that he had been receiving treatment at Summit Orthopedics and MSI for these ongoing problems. She indicated instead that “he may be able to do some light duties depending on what his surgeons have said and if so he is not disabled.”
On February 28, 2008, Dr. Wyard testified by deposition, essentially reiterating, after review of additional medical records, his conclusions in his report of August 15, 2007.
The matter came on for hearing on March 13, 2008. Issues at hearing included the employee’s entitlement to temporary total disability benefits continuing from December 23, 2006, based on work-related injuries at the employer on June 15, 2006, and December 22, 2006, including subissues as to causation by the work injuries, adequacy of the employee’s job search during the periods at issue, and whether the employee’s work injuries were a substantial contributing factor in his need for apparently about $23,999.36 worth of medical expenses, which were stipulated to have been reasonable and necessary. The employee testified at hearing in part that he had injured himself at work on December 22, 2006, in the process of maneuvering a heavy bed that began to come apart. He testified that, as he attempted to grab a falling portion of the bed, he felt pain in his neck, right hip, rib cage, right shoulder, and low back. He testified that, subsequent to the incident, he first attempted just to rest at the employer’s premises but then decided to leave the job. He testified that he then “proceeded to tell Diane” Burke, his supervisor, “what was going on” and that he was taking off early. When he started to leave the parking lot, he testified, his condition “exploded,” and he fell to the ground. Ms. Burke subsequently testified that the employee asked to go home early on December 22, 2006, only so that he could do something with his girlfriend. Although by January 4, 2007, he had been released to return to at least light duty work, the employee testified that he returned a call to a Mike Korso at the employer’s corporate headquarters about January 4, 2007, and “just told him I couldn’t do the job any more. They tried to get me to go in and do light-duty, but I couldn’t do anything.” Ms. Burke testified that the employer was “waiting on some kind of a doctor’s release,” but there is no evidence that any was ever received, and the employee did not report for work. The employee also acknowledged in his testimony that, at the time of hearing, his right shoulder was actually in better condition than it had been prior to December 22, 2006.
By findings and order filed April 11, 2008, the compensation judge concluded in part that the employee’s injury of June 15, 2006, was a temporary aggravation of a pre-existing low back condition, that that injury had resolved by October 30, 2006, and that it was not a substantial contributing factor in the employee’s present complaints. Neither party has appealed from this conclusion. The judge concluded also, however, at Findings 11, 21, 22, 23, and 26, that the employee also sustained work-related injuries to both his low back and his right shoulder on December 22, 2006, which did contribute substantially to his ongoing condition at least through November 21, 2007, and perhaps longer, conceding at Finding 11 that the employee’s version of his injury did not completely correspond to the investigation report of December 27, 2006. In support of his conclusion, the judge noted at Finding 11, with emphasis in his memorandum, that “[t]he employer and insurer have accepted primary liability for the employee’s December 22 work injury but maintain that the injury was only a temporary aggravation of the employee’s prior physical condition lasting three months,” although “no benefits have been paid to the employee.” The judge concluded specifically, at Finding 21, that the employee’s December 22, 2006, low back injury was a substantial contributing factor in his low back condition from the date of the injury until September 25, 2007, and that the employee’s right shoulder injury on December 22, 2006, was a substantial contributing factor in his condition from the date of injury until November 21, 2007, after which date, the judge concluded, no benefits were due. At Finding 22, the judge concluded that, due to either or both of these December 22, 2006, injuries, the employee was temporarily totally disabled from December 28, 2006, through January 4, 2007, from January 23, 2007, through February 1, 2007, from March 26, 2007, through July 5, 2007, and from October 30, 2007, through November 21, 2007. “These dates,” the judge found, “represent the times when the medical records indicate the employee was physically totally unable to work either due to his back condition or right shoulder condition.” The judge concluded in that same finding that, although, considering the heavy nature of his job with the employer, it was not unreasonable for the employee not to return to work for the employer during the interim periods when he was released by his doctors to work, the employee was not entitled to benefits during the interim periods because he failed to present sufficient evidence of a diligent job search during those interim periods.
In addition to wage replacement benefits, the judge also awarded , at Findings 23, 24, and 25 and Order 3, payment of the $18,292.36 in medical expenses at issue, reimbursement of $1,234.24 in General Assistance paid to the employee by intervenor Minnesota Department of Human Services during periods for which benefits were awarded, and reimbursement to the Minnesota Department of Employment and Economic Development of any unemployment compensation that is determined to have been paid to the employee during those periods, with the temporary total disability benefits reduced by those reimbursed amounts. Finally, at Finding 26, the judge also awarded a rehabilitation consultation to determine the employee’s eligibility for rehabilitation services that might be required with respect to lingering effects of his shoulder surgery. The employer and insurer appeal from the judge’s award of these benefits and the temporary total disability benefits, and the employee cross-appeals from the judge’s denial of temporary total disability benefits during the interim periods between December 23, 2006, and March 13, 2008, for which benefits were not awarded under Finding 22.
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.
We would note initially, with regard to both the employer and insurer’s appeal and the employee’s cross-appeal in this case, that, as both parties have suggested, this is an extremely complicated case factually. This is true not only with regard to its being a double injury case - - both low back and shoulder - - but also with regard to the multiplicity of medical providers involved and the issues of credibility that appear evident in various ostensible conflicts between the employee’s testimony and records of his medical history. As our standard of review, stated just above, makes clear, a factfinder’s conclusion is entitled to substantial deference from this court. 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").
1. The Employer and Insurer’s Appeal
The compensation judge concluded at Finding 11 that the employee had sustained personal injuries to his low back and right shoulder on December 22, 2006. At the conclusion of that finding, the judge asserted that “[t]he employer and insurer have accepted primary liability for the employee’s December 22 work injury but maintain that the injury was only a temporary aggravation of the employee’s prior physical condition lasting three months.” The judge reiterated this conclusion in his very brief memorandum, in which he emphasized that “[t]he employer and insurer have admitted and continue to admit primary liability for [the employee’s claimed injuries]” (underscoring in the memorandum). Implicitly concluding further, at Finding 22, that the employee was totally restricted and so not required to search for work during four separate periods, totaling about nineteen weeks, of his claim, the judge awarded temporary total disability benefits for those periods during which the employee was totally restricted.
The employer and insurer contend that these findings of the compensation judge are unsupported by substantial evidence. They argue initially that “[i]t has always been the Employer/Insurer’s position that the December 22, 2006, work injury was denied,” citing as examples their notice of denial of liability, their pretrial statement, and their cover letters to Dr. Wyard, submitted into evidence as Employer’s Exhibit 4. They argue that any admission of a December 22, 2006, work injury as a temporary aggravation was as an alternate argument, based on the opinion of Dr. Wyard and merely intended to limit the injury to temporary status, should the compensation judge find the employer and insurer liable for it. In further appeal from the judge’s awards, they contend the following: (1) that “the employee was not a credible witness”; (2) that the judge’s awards were “based on chart notes from medical providers who were not provided with accurate factual foundation”; (3) that, during the first three of the four periods for which benefits were awarded, (a) the employee’s failure to search for work was not excusable, (b) the employee had just been authorized to work and was according to medical records not in any acute distress, and (c) the employee was for at least part of the period released to work or inconsistent in his recounting of the injury; and (4) that the judge “did not provide an analysis of the medical opinions in the case,” citing in support of this latter contention this court’s decision in McClellan v. Up North Plastics, slip op. (W.C.C.A. Oct. 18, 1994), which sets out six factors for consideration in determining whether a work aggravation is temporary or permanent. We are not persuaded.
We acknowledge that the employer and insurer appear to have maintained a denial of liability for a December 22, 2006, work injury. The issue appears to us to be essentially moot, however, given the judge’s implicit crediting of the causation and other opinions of the employee’s treating doctors over the opinion of Dr. Wyard. We acknowledge further that, given the facts as we have recounted them above, the employee’s account of events in this case has been several times inconsistent at best, by the compensation judge’s own conclusion in his memorandum that “[t]here are several instances in which the employee’s testimony is determined to be unreliable or contradictory.” But inconsistencies or even apparent misrepresentations in a witness’s statement do not disqualify from evidence all of the facts attested to by that witness, and, as we have noted above, a factfinder personally present at that witness’s testimony is in the best position to assess the credibility of that witness’s statements and to judge which of them to credit and which not to credit. Again, 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).
To the extent that the employer and insurer’s foundational challenge appears to be based on the treating doctors’ reliance on the employee’s account of his injury, our conclusion here as to the employee’s credibility extends also to the employer and insurer’s challenge of the accepted medical opinions on foundational grounds. Nor was it unreasonable for the compensation judge to conclude that the employee was formally restricted from working during the four separate periods for which the judge awarded benefits. Dr. Zheng’s records for December 28, 2006, expressly restrict the employee from all work from that date until January 1, 2007, and it was not unreasonable for the judge to conclude that that restriction extended until January 4, 2007, the date on which Dr. Zheng expressly released the employee to return to light duty. Similarly, United Hospital records for January 23, 2007, expressly restrict the employee from working until February 1, 2007. Nor is there any real ambiguity in Dr. Hammes’s March 26, 2007, restriction of the employee from working until June 1, 2007, her implicit extension of that restriction on May 8, 2007, before its expiration, until the employee could be seen at MSI, Dr. Sinicropi’s MSI extension of that restriction for three weeks on June 6, 2007, and Dr. Hammes’s further extension of it for three weeks on June 14, 2007.
Finally, with regard to the employer and insurer’s contention that the judge did not provide a sufficient analysis of the medical opinions in this case, we will only reiterate our earlier suggestion, that, particularly under the unusually complex facts of this case, the compensation judge’s assessment of the various expert opinions and his choice among them was not unreasonable and so warrants our deference. Further, while the factors for consideration set forth in McClellan, which include medical opinions on the issue, may be useful in assessing the permanence of a work injury, neither methodical application of those criteria nor express detailed comparative analysis of all relevant expert opinion is required of a judge for a basic finding of an employer’s liability for a work injury and its consequent treatment, which was here stipulated to have been reasonable and necessary. Because they were not unreasonable, we affirm the compensation judge’s finding of liability for a work injury and his awards of temporary total disability and medical benefits. See Hengemuhle, 358 N.W.2d at 59, 37 W.C.D. at 239.
2. The Employee’s Cross-Appeal
Having awarded the employee about nineteen weeks of temporary total disability benefits during those four periods of his claim when he was clearly under a doctor’s restriction from working, the compensation judge denied the employee about forty-one weeks of claimed benefits during periods interim to those periods, when the judge found the employee to have been released to work but not diligently searching for work. The employee contends that the judge’s denial of benefits during four of these interim periods was unsupported by substantial evidence. (1) With regard to the period January 5, 2007, to January 22, 2007, the employee acknowledges that he was released to work with restrictions, but he contends that he had not yet then been terminated by the employer and yet was offered no work within his restrictions, arguing that a doctor’s slip had been faxed to the employer and that, by its own admission, the employer was merely waiting for that slip. (2) With regard to the period February 2, 2007, to March 25, 2007, the employee contends that he was neither released by his doctor to return to work nor terminated yet by the employer, arguing that he therefore had no obligation to search for work. (3) With regard to the period July 5, 2007, through October 29, 2007, the employee contends that, although he was “still currently disabled” in the words of Dr. Hammes, he was nevertheless actively seeking work, as evidenced by Dr. Hammes’s note of June 14, 2007, to the effect that the employee was “optimistic about returning to work and has a job lined up for Best Buy later this summer if he is allowed to return to work.” (4) And with regard to the post surgical period continuing from November 22, 2007, the employee contends that he was then still disabled, that he had arranged to work with a QRC upon his release to work, upon his completion of a regimen of injections the first of which had been administered only one day before the hearing. The employee contends in the end that his “doctors have not released him to work until very recently, if at all.” We are not persuaded.
With regard to the January 5 to 22, 2007, period, we conclude that it was not unreasonable for the judge to deny benefits during a whole month when the employee apparently had opportunity to at least report to his employer for any work that might be available for him and apparently did not do so, evidently on the mere presumption that light duty work was simply not available for him. With regard to the period February 2 to March 25, 2007, it was not unreasonable for the compensation judge to conclude that the employee was again released to work, since the only formal restrictions from work offered into evidence relative to that period were United Hospital notations on January 23, 2007, restricting the employee from working until February 1, 2007. Nor did the employee evidently report directly to the employer for any available work during that two-month period. With regard to the period July 5 to October 29, 2007, it was not unreasonable for the judge to conclude here either that the employee was released to work, since Dr. Hammes’s report on June 14, 2007, indicated that he was still disabled only until further evaluation at MSI about three weeks hence, and there is no evidence that the employee was ever totally restricted from working by MSI after that early July evaluation. Indeed, Dr. Hammes herself noted that the employee was already by mid June “optimistic about returning to work” and even had a job lined up for later in the summer, though there is no evidence that such a job had ever actually been secured or was ever actually performed. Finally, with regard to the post surgical period continuing from November 22, 2007, three weeks after his October 30 surgery, it was not unreasonable for the judge to conclude that the employee was no longer totally disabled, since Dr. Khetia’s notes for November 21, 2007, report the employee to have “no significant complaints,” to be voluntarily operating without a sling, and to be capable of physical therapy. Nor is there, aside from the employee’s own less than dependable testimony, any evidence that the employee’s continuing delay in returning to work right up until the date of the hearing was in coordination with a QRC. We affirm the compensation judge’s denial of wage replacement during periods interim to the employee’s formal restriction from work.
Because it was not at all unreasonable under the complex facts of this case, we affirm the compensation judge’s decision in its entirety. See Hengemuhle, 358 N.W.2d at 59, 37 W.C.D. at 259.
 This figure is the sum of the $5,707.00 in outstanding medical bills that are itemized in Hearing Exhibit L and the $18,292.36 in claims by six intervenors that are itemized by the compensation judge in Finding 23. The record is unclear to us as to how or whether these two figures may be integrated.
 Depending on the result of a rehabilitation consultation as to the employee’s eligibility for services related to possible lingering effects of his shoulder surgery.
 See footnote 1.
 At the heading to his argument, the employee cites five periods for which the judge denied benefits, but he briefs the judge’s denials of benefits for only the final four of those periods, excluding an initial four-day period from December 23 to December 27, 2006. We consider any appeal from that initial period waived. Cf. Minn. R. 9800.0900, subp. 1 (“Issues raised in the notice of appeal but not addressed in the brief shall be deemed waived and will not be decided by the court.”).