JERROLD V. ANDERSON, Employee/Appellant, v. TRADESMEN INT’L, INC., and NEW HAMPSHIRE INS. CO./AIG/SPECIALTY RISK SERVS., INC., Employer-Insurer, and ABBOTT NORTHWESTERN HOSP., MINNEAPOLIS ORTHOPAEDICS, MEDICA HEALTH PLANS/INGENIX, INJURED WORKERS PHARMACY, ALLINA MED. CLINIC, ST. CLOUD MED. GROUP, PRIMARY BEHAVIORAL HEALTH CLINIC, INC., FAIRVIEW ANDOVER CLINIC/UNIV. OF MINN. MED. CTR., NORAN NEUROLOGICAL CLINIC, CENTER FOR DIAGNOSTIC IMAGING, and CAMBRIDGE HOSP., Intervenors.
WORKERS’ COMPENSATION COURT OF APPEALS
FEBRUARY 11, 2010
CAUSATION - TEMPORARY AGGRAVATION. Substantial evidence, including expert opinion, supported the compensation judge’s finding that the employee’s work-related shoulder injury was merely temporary.
Determined by: Wilson, J., Pederson, J., and Rykken, J.
Compensation Judge: Gary M. Hall
Attorneys: Benjamin J. Heimerl and Michael B. Lammers, Germscheid, Heimerl & Lammers, St. Paul, MN, for the Appellant. Jay T. Hartman and Elizabeth Chambers-Brown, Heacox, Hartman, Koshmrl, Cosgriff & Johnson, St. Paul, MN, for the Respondents.
DEBRA A. WILSON, Judge
The employee appeals from the judge’s findings regarding the nature and extent of the employee’s right shoulder injury. We affirm.
The employee began work as an electrician in the early 1970’s, starting his own electrical company [Anderson Electric] in 1983 or 1984. He remained self-employed until November of 2006.
The employee sustained a number of work- and non-work-related injuries while self-employed, receiving related treatment for pulmonary problems, head and neck pain, headaches, bilateral carpal tunnel symptoms, concussion, low back pain, bilateral shoulder pain, bilateral knee pain, and right foot pain, among other problems.
With regard to his right shoulder, the condition at issue here, the employee was treated at Cambridge Medical Center on October 26, 2004, relating a history of having fallen off a ladder about 10 days earlier and experiencing right and left shoulder pain. X-rays of both shoulders at that time showed degenerative changes.
The employee was seen again at Cambridge Medical Center on November 5, 2004, complaining of right shoulder pain. He began physical therapy for both shoulders on November 23, 2004, and apparently ended that treatment on December 29, 2004, because of scheduled surgery on his right foot.
The employee was seen by Dr. Kimberly Williams on September 12, 2006, requesting a disability permit to use a crossbow. He indicated his need for the permit was related to shoulder problems. At that time, the employee indicated that he was unable to do much overhead work and felt that his shoulders were weak. He also felt that pain and weakness limited his ability to pull his hunting bows back. On exam, the employee had crepitus with rotation, resisted abduction was weak, and abduction beyond 90 degrees was difficult. Dr. Williams completed the employee’s disability permit.
On September 19, 2006, the employee was seen by Dr. R. Michael Patten for his bilateral shoulder pain. At that time, the employee indicated that he had fallen off of a ladder in 2000 and had experienced bilateral shoulder pain after that incident. He also indicated that the pain had improved after six to eight weeks but had begun again in 2004 when he stepped off of a plank. Dr. Patten diagnosed chronic right and left shoulder pain, and an MRI of the right shoulder performed on that date revealed moderate supraspinatus and subscapularis tendonitis, with moderate partial tearing of the supraspinatus, among other findings. Dr. Patten recommended further work up to include a Doppler ultrasound and an EMG. The employee expressed concern about the cost and apparently never completed those tests.
About two weeks later, on October 3, 2006, the employee was seen by Dr. Richard C. Birdwell. Dr. Birdwell made multiple diagnoses, including right shoulder impingement syndrome with a partial rotator cuff tear.
In November of 2006, after the employee’s electrical firm ran into financial difficulties, the employee went to work for Tradesmen International, Inc. [the employer].
On December 7, 2006, the employee experienced an electrical shock while working for the employer. Then on January 3, 2007, the employee fell on ice, also in the course and scope of his employment. He received treatment for numerous complaints in multiple body parts after these incidents, including treatment for symptoms in his right wrist, right shoulder, right buttock, neck, back/low back, bilateral knees, and internal organs.
Another MRI of the employee’s right shoulder was performed on January 31, 2007. That MRI showed a small tear of the supraspinatus tendon and a partial thickness tear of the distal subscapularis tendon. An MRI performed on November 1, 2007, was interpreted to show “focal intrasubstance and deep surface partial-thickness near full-thickness tear of anterior supraspinatus tendon fibers.” On December 11, 2007, the employee underwent arthroscopic surgery on his right shoulder.
The January 3, 2007, injury was originally admitted, and the employer and insurer paid the employee temporary total disability benefits from February 26, 2007, through March 11, 2007. On March 15, 2007, however, the employer and insurer filed a notice of intention to discontinue benefits, alleging that the employee’s claimed injury was preexisting and that temporary total and medical benefits had been paid under a mistake of fact. The matter proceeded to an administrative conference, after which the employee filed an objection to discontinuance.
The employee filed a claim petition on May 2, 2007, claiming, in part, injury to the right shoulder, neck, low back, right hand, right wrist, hip, abdomen, bowels, and knees as a result of the January 3, 2007, injury. The two pleadings were consolidated and came on for hearing on July 2, 2009. At that time, the issues included, in relevant part, the nature and extent of the January 3, 2007 injury, whether that injury was a temporary aggravation that had since resolved, whether the employee had developed a consequential psychological injury as a result of any of the injuries, whether the employee’s musculoskeletal conditions were the result of preexisting conditions, whether the employee was entitled to either temporary total disability or permanent total disability benefits continuing from March 15, 2007, whether the employee had reached maximum medical improvement, whether the employee required work restrictions, whether medical expenses were reasonable and necessary and causally related to the injury, and whether the employee was entitled to benefits for permanency of the right shoulder. In findings and order filed on September 14, 2009, the compensation judge made various findings regarding the claimed injuries to the employee’s internal organs, right wrist, bilateral shoulders, bilateral knees, low back, neck, and psychological conditions. The employee appeals solely from the judge’s finding that the January 3, 2007, injury resulted in a mild, temporary aggravation of the employee’s preexisting right shoulder condition.
STANDARD OF REVIEW
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 (2008). 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, 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 evidence or not reasonably supported by the evidence as a whole.” Northern States Power Co. v. Lyon Food Prods., Inc., 304 Minn. 196, 201, 229 N.W.2d 521, 524 (1975).
While the employee listed five issues in his brief on appeal, that brief addresses only one: whether substantial evidence supports the judge’s decision concerning the nature and extent of the employee’s January 3, 2007, shoulder injury. The employee further restricted his argument on appeal to alleged differences between three MRIs submitted into evidence, arguing, “the only explanation for the difference in these objective tests is the employee’s work injury.” Specifically, the employee argues that the pre-injury MRI in September of 2006 did not show a tear of the supraspinatus tendon, but the post-injury MRIs of January 2007 and November 2007 did show a tear of that tendon. We are not persuaded.
We note initially that the radiologist’s report from the September 19, 2006, MRI states, in part, that “[t]here appears to be focal thinning of the supraspinatus tendon, as noted on images 10 and 11 of series 301, consistent with moderate partial tearing.” (Emphasis added). And, Dr. Birdwell indicated in his October 3, 2006, office note that this MRI “did show partial rotator cuff tearing with impingement syndrome, without full thickness tear.”
Contrary to the employee’s suggestion, the findings on that 2006 MRI are consistent with the findings on the January 31, 2007, MRI, performed four weeks after the work injury. Regarding the supraspinatus tendon, the January 2007 MRI report noted, “[t]here is a moderate tendinopathy of the distal supraspinatus with visualization of a tiny area of partial-thickness tearing of [its] articular surface fibers anteriorly.” (Emphasis added). Similarly, the November 2007 MRI referenced by the employee also showed “a focal intrasubstance and deep surface partial-thickness near full-thickness tear of anterior supraspinatus tendon fibers.” (Emphasis added).
In his findings and order, the judge found the opinion of Dr. William Simonet to be “most persuasive with regard to the claimed orthopedic injuries.” Dr. Simonet conducted an independent medical examination of the employee, for the employer and insurer, on June 29, 2007. At his deposition, taken on May 30, 2008, Dr. Simonet testified that he had reviewed the report from the September 19, 2006, MRI and the actual scan films from the January 31, 2007, and November 2007 MRIs. In Dr. Simonet’s opinion, the 2006 MRI showed focal thinning consistent with a partial thickness tear of the supraspinatus tendon, and the January 31, 2007, MRI confirmed that partial thickness tear. It was also his opinion that the employee had impingement syndrome both before and after the work injury, and he noted no change in the wear of that tendon from September 2006 to January 2007. Dr. Simonet further testified that the January 2007 MRI showed no sign of an acute injury, such as “evidence of bleeding or resolving hematoma or resolving injury,” and that there was no significant change between the January 2007 and November 2007 scans. In his report of July 5, 2007, Dr. Simonet opined that the January 2007 injury “may have caused a mild, temporary aggravation” of the employee’s preexisting conditions. However, Dr. Simonet testified that the January 2007 injury did not cause or contribute to the employee’s right shoulder condition. More specifically, Dr. Simonet testified that the findings on MRI following the work injury, with regard to the supraspinatus tendon, subscapularis tendon, biceps tendon, acromioclavicular joint, glenohumeral joint, and glenoid labrum, were not causally related to the work injury and that there were no significant changes between the September 2006 MRI and the January and November 2007 MRIs.
A compensation judge’s choice between expert opinions is usually upheld unless the facts assumed by the expert in rendering his opinion are not supported by the evidence. Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985). The employee makes no argument about facts assumed by Dr. Simonet. Rather, his entire argument is that the MRIs show differences that can only be attributable to the work injury.
The medical records, including the reports from the three referenced MRIs, together with the written report and testimony of Dr. Simonet, provide substantial evidence to support the judge’s findings regarding causation of the employee’s right shoulder condition and the temporary nature of the work injury. Those findings are therefore affirmed in their entirety.
 The employee had extensive medical treatment both before and after the work injuries in question. The medical records received into evidence at the 2009 hearing were voluminous. The only issue raised in the employee’s brief on appeal relates to the right shoulder injury, specifically, to three MRIs of the right shoulder. We have therefore restricted our background primarily to right shoulder information.
 Much of this information is contained in the hypothetical submitted as Deposition Exhibit 3 at the May 2008 deposition of Dr. William Simonet. In his findings and order, the compensation judge specifically adopted that hypothetical as a substantially fair and accurate representation of the relevant factual and medical history. While the employee appealed from that finding, he acknowledged in his brief on appeal that Deposition Exhibit 3 is “a fair representation of the relevant factual/medical history of this case.”
 The findings portion of that MRI report referred to thinning of the supraspinatus tendon, but, in the conclusion portion of the MRI report, the reference is to the subscapularis tendon.
 A repeat MRI of the right shoulder performed on January 15, 2008, showed no changes in the subscapularis tear and postoperative changes to the supraspinatus tendon.
 The employee merely requested a remand for findings on the other issues.
 In their brief on appeal, the employer and insurer mistakenly indicate that Dr. Simonet had reviewed the actual film from the September 2006 MRI. Dr. Simonet testified that he reviewed the films from the MRIs performed at Minneapolis Orthopedics and CDI. The September MRI was performed at Cambridge Medical Center.