CHARLOTTE A. LOVE, Employee/Appellant, v. ALLINA HEALTH SYS, SELF-INSURED/GALLAGHER BASSETT SERVS., INC., Employer, and LIFE INS. CO. OF N. AM., HEALTHPARTNERS, ALLINA HEALTH SYS., TWIN CITIES ORTHOPEDICS, MINNESOTA DEP’T OF HUMAN SERVS., and MINNESOTA DEP’T OF EMPLOYMENT AND ECON. DEV., Intervenors.
WORKERS’ COMPENSATION COURT OF APPEALS
SEPTEMBER 1, 2010
CAUSATION - GILLETTE INJURY. Substantial evidence, including expert medical opinion and references in the employee’s medical records, supports the compensation judge’s finding that the employee did not sustain a Gillette injury to her right knee as a result of her work for the employer.
Affirmed as modified.
Determined by: Rykken, J., Johnson, C.J., and Stofferahn, J.
Compensation Judge: Kathleen Behounek
Attorneys: Charlotte A. Love, Employee pro se. Penny F. Helgren, Brown & Carlson, Minneapolis, MN, for the Respondent.
MIRIAM P. RYKKEN, Judge
The employee appeals from the compensation judge’s determination that the employee did not sustain a Gillette injury to her right knee as a result of her work activities, and from the related denial of her claim for reimbursement of medical treatment expenses, payment of temporary total disability benefits, permanent partial disability benefits, and rehabilitation benefits. We affirm, as modified.
Ms. Charlotte Love, the employee, began working for Allina Medical Center, the self-insured employer, in June 2002. As a certified medical assistant, the employee’s varied duties included taking patients to appointment rooms, administering shots, taking patients’ blood pressure and recording the results. She also was responsible for ordering supplies, carrying and unloading boxes of supplies, stocking patient rooms, and stocking shelves. According to the employee’s testimony, her work required her to walk or stand approximately seven hours per day. The employee testified that because of the busy office schedule and the number of patients she worked with, she needed to walk up and down the office hallways throughout the day, often at a very quick pace.
The employee claims to have sustained a Gillette injury to her right knee that culminated on or about November 4, 2008, and she directly attributes her injury to the amount of time she spent on her feet while at work. The employer denies primary liability, contending that the employee’s injury was personal in nature and was not causally related to her work.
Medical records in evidence refer to an incident in approximately mid-July 2008 when the employee caught her foot on a ledge while bowling, tripped and fell forward. The employee testified that this incident happened very quickly and that she could not recall whether she hit her right knee when she fell. She testified that it was a possibility and that she “caught” herself and felt some pain. The employee initially sat on the ground after she tripped, and then stood up, walked back to the seating area, sat down, and then continued to bowl with her other family members and friends. She testified that she felt fine after this incident but felt a little pain later when she returned home. She did not seek any medical treatment, as she felt no need to do so, but took ibuprofen and applied ice to her right knee. The employee also felt fine the next day and worked her normal duties; she missed no time from work as a result of this incident.
There is a limited reference to the employee’s right knee in a medical report dated August 17, 2008, at a time when the employee sought medical treatment for unrelated facial and neck injuries. There is no record of treatment or examination of the employee’s right knee on that date. The employee remained off work from mid-August through mid-September due to those injuries and eventually returned to her normal duties; she noticed no right knee symptoms or pain upon her return to work. In late September or early October, the employee’s workload increased, in part because the office was short staffed and in part due to extra work involved in staffing a flu shot clinic. Her right knee became stiff and painful, and by October 25, 2008, the employee sought emergency treatment for her right knee symptoms. At the hospital, she reported a flare-up of pain that had been present for 2 to 3 days and that her pain was at a level of “10” on a scale of 1 to 10. An emergency department chart note dated October 25, 2008, reflects a history provided by the employee that a month earlier she had slipped while bowling and had “missed the step up and landed on the edge on that on my kneecap - -.” The employee reported that she initially used Motrin and ice with some relief but that her swelling was interfering with her work and walking, and that her knee locked up “when first standing or trying to go faster.”
X-rays of the right knee showed no fracture or dislocation. The nurse practitioner who examined the employee at the hospital prescribed pain medication and advised her to avoid weight bearing as much as reasonably possible. She provided the employee with an ace bandage wrap and crutches for her use, and referred the employee for an orthopedic examination.
The employee was seen by Dr. Elmer Salovich on October 27, 2008. According to the employee’s testimony, she provided a history to Dr. Salovich that she had fallen while bowling but that she was fine after that, and that her work involved continuous walking up and down hallways. Dr. Salovich ordered an MRI scan of the employee’s right knee, which was conducted on October 27, 2008, and which showed a tear of the medial meniscus. Due to the meniscal tear, Dr. Salovich referred the employee to Dr. Kayvon Riggi for a surgical consultation. At an examination with Dr. Riggi on November 4, 2008, the employee reported a history of two to three months of progressive pain and swelling in her right knee. Dr. Riggi’s chart note of November 4 includes a reference that the employee’s “pain began after a sudden twisting mechanism of injury while bowling.” Dr. Riggi’s impression was that the employee’s symptoms were secondary to a symptomatic unstable tear of the medial meniscus. He found no sign of underlying degenerative arthritis, no sign of ligamentous or patellar instability, and no sign of referred pain from the hip. He discussed with the employee both conservative and surgical treatment options, and recommended a right knee arthroscopic partial medial meniscectomy due to the employee’s persistent and progressive pain. Dr. Riggi also provided work restrictions for light duty work prior to surgery, limiting her to three days of work per week and standing for no more than four hours per day.
The employee reported to the employer that she had sustained an injury. According to the first report of injury, the employee related that her right knee symptoms had worsened during the past several weeks. In its notice of primary liability determination, filed on December 2, 2008, with the Minnesota Department of Labor and Industry, the employer denied primary liability for the claimed injury, contending that the employee’s injury was personal in nature.
Dr. Riggi performed surgery on the employee’s right knee on November 24, 2008, in the nature of an arthroscopic partial right medial meniscectomy. At a follow-up appointment with Dr. Riggi on December 19, 2008, the employee reported intermittent stiffness, and did not yet feel ready to return to work on her feet on a full time basis. By then, she walked with a cane and no longer used pain medications. Dr. Riggi determined that the employee could attempt to return to work without restrictions beginning January 19, 2009, and recommended strengthening exercises for the employee.
On January 16, 2009, the employee reported to Dr. Riggi that her pain and swelling had decreased steadily, that she no longer used a cane, but that she had difficulty with stairs and felt that her leg was weak. Dr Riggi referred the employee to a physical therapist for a strengthening and exercise program and restricted the employee from work until March 1, 2009. Dr. Riggi outlined his opinion concerning the cause of the employee’s right knee condition, stating, in part, as follows:
She has questions about whether this might be a work-related injury. We reviewed her presentation and history. Her bowling injury was at the end of July 2008. She was off work because of an eye injury for two months. Her knee pain did not begin until she stood for eight hours a day at work beginning in mid September. Her pain was exacerbated by her work activities.
With regard to causation, it certainly is possible that the prolonged standing at work contributes to the development of the symptomatic meniscus tear, especially given the time course of the pain.
The employee did not return to work for the employer following surgery. On February 23, 2009, the employee filed a claim petition, seeking temporary total disability benefits from November 24, 2008, and continuing, as well as payment of medical expenses. She later amended her claim to include permanent partial disability benefits based upon a 3% whole body permanency rating assigned by Dr. Riggi.
Following an examination on April 7, 2009, Dr. Riggi concluded that the employee was slowly and steadily improving and that her knee range of motion was supple and pain free and her gait was normal, without antalgia. He anticipated slow steady progress for a full year after her knee surgery. He again concluded that the employee’s “work activities were a significant contributing factor to the development of her symptomatic medical meniscus tear.”
On May 15, 2009, the employee was examined by Dr. Paul Wicklund at the request of the employer. Dr. Wicklund diagnosed a right medial meniscus tear, post-surgery. He concluded that the employee’s walking up and down hallways between mid-September and November 4, 2008, did not cause, aggravate or accelerate, or in any other way affect the employee’s right medial meniscus and that no Gillette injury had occurred during that time. He also stated “that the bowling incident was the probable cause of her medial meniscus tear.” Dr. Wicklund determined that the employee had reached maximum medical improvement three months after her knee surgery, and that she required no work restrictions. In addition, he concluded that the employee would have been disabled from work for four weeks following her surgery, and that she would have been able to work on a light duty basis thereafter.
In late June 2009, the employee sought medical care for left leg symptoms. On July 9, 2009, the employee resigned from her position with the employer, citing increased health concerns and other issues.
In a report dated July 15, 2009, Dr. Riggi responded, as follows, to a question on whether the employee’s work activities culminating on or about November 4, 2008, were a substantial contributing factor in the employee’s current disability and need for surgery:
This is a difficult question to answer with absolute certainty. [The employee] was diagnosed with a medial meniscus tear. An MRI performed at Abbott Northwestern Hospital on 10/27/2008 was read by Dr. Tillotson. The tear was confirmed at the time of diagnostic arthroscopy performed at Abbott Northwestern Hospital on 11/24/2008. Meniscus tears can have multiple causes. In medicine, this is referred to as a multifactorial condition. A meniscus tear can occur on a purely traumatic basis from a single event. A meniscus tear can occur on a degenerative basis, i.e., it can develop slowly over time simply from age. A preexisting asymptomatic meniscus tear can suddenly become symptomatic, i.e., the cause of one’s pain following an episode of trauma. This trauma can be a sudden acute event or this trauma can be a repetitive overuse injury. With this as a background, it should be more clear when I state that this is a difficult question to answer with certainty. In [the employee’s] case, she describes an episode of pain after an injury that occurred while bowling in July of 2008. She has stated that this pain resolved spontaneously. She notes that she was working on her feet for long hours in September of 2008, and this is when her knee became much more painful requiring additional evaluation and treatment. Given this history, I do believe that the work activities in the fall of 2008 were a substantial contributing factor to the development of a symptomatic meniscus tear which ultimately required knee arthroscopy on 11/24/2008.
On January 4, 2010, the employee was re-examined by Dr. Paul Wicklund at the request of the employer, apparently in part to address claims related to the employee’s left knee condition. At the examination, the employee reported her right knee felt “totally normal,” with no pain and no swelling, and that she felt she had fully recovered. As to the employee’s right knee condition, Dr. Wicklund concluded that her right knee injury was unrelated to her work, and, specifically, was unrelated to walking long distances or carrying supplies in a hallway at work.
An evidentiary hearing was held on January 12, 2010, to address the employee’s claim petition. At issue was whether the employee sustained a work-related injury to her right knee on November 4, 2008, and whether she was entitled to payment of temporary total and permanent partial disability benefits, medical expenses, and rehabilitation assistance. The evidence submitted into the record included selected medical records as well as reports from Drs. Riggi and Wicklund. The employee and two representatives from the employer testified at the hearing; Dr. Wicklund testified by deposition.
In her findings and order, the judge denied the employee’s claim, concluding that the evidence did not establish that she had sustained a Gillette injury to her right knee as a result of her work activities with the employer. The compensation judge accepted Dr. Wicklund’s opinion that the employee’s work for the employer did not represent a significant contributing cause of her right medial meniscus tear. The judge found Dr. Wicklund’s opinion to be “persuasive and consistent with the facts” of the case and adopted his opinion when rendering her decision. As a result, the compensation judge denied the employee’s claim in its entirety.
The employee appeals.
The compensation judge found that the employee had not injured her right knee as a substantial result of her work for the employer. The employee appeals, arguing that the evidence, including her description of her job duties and Dr. Riggi’s medical report, demonstrates that she sustained an injury while working for the employer. She contends that a portion of the findings have no evidentiary support, and that the compensation judge failed to credit the proper medical testimony and that she took certain portions of the record out of context. She also argues that the judge erred by relying on the opinion of a physician that was rendered outside the scope of that physician’s competence.
A Gillette injury is a gradual breakdown of a body part or an aggravation of a pre-existing condition as the result of repetitive, minute trauma in the performance of an employee’s ordinary work activities. Gillette v. Harold, Inc., 257 Minn. 313, 101 N.W.2d 200, 21 W.C.D. 105 (1960). To establish a Gillette injury, the employee must “prove a causal connection between her ordinary work and ensuing disability.” Steffen v. Target Stores, 517 N.W.2d 579, 581, 50 W.C.D. 464, 467 (Minn. 1994). The determination of a Gillette injury “primarily depends on medical evidence.” Id. (citing Marose v. Maislin Transp., 413 N.W.2d 507, 40 W.C.D. 175 (Minn. 1987)). In this case, Dr. Riggi concluded that the employee’s right knee condition was causally related to her work injury; Dr. Wicklund concluded that it was unrelated to her work. The compensation judge accepted Dr. Wicklund’s opinion on the issue of whether the employee’s right knee condition was related to her work.
The employee argues that Dr. Riggi clearly explained the basis for his opinion, and cites to the recitation of the history in Dr. Riggi’s January 16 and February 17, 2009, chart notes. She also contends that Dr. Wicklund did not adequately explain the basis for his conclusions that the employee’s right knee condition and surgery were unrelated to her work. She argues that Dr. Wicklund misstated facts as outlined in the history portions of the medical records, and that the compensation judge perpetuated these errors by relying on Dr. Wicklund’s opinion. The employee also argues that Dr. Wicklund ignored uncontradicted evidence that demonstrated the employee suffered no injury while bowling that was serious enough to cause her to seek treatment. In a related argument, the employee contends that Dr. Wicklund had no physical evidence on which he could render an opinion about the cause of a meniscus tear because that tear had been repaired before he examined her. In summary, the employee argues that Dr. Riggi’s causation opinion was the only opinion that is supported by the evidence in the record. We are not persuaded.
The compensation judge reviewed the various medical records and medical opinions submitted into evidence. She also heard testimony from the employee and other witnesses at the hearing, and had the transcript from Dr. Wicklund’s deposition available for her review. Dr. Wicklund examined the employee, reviewed her medical records, and took a medical history from the employee. This level of knowledge constitutes adequate foundation for an expert opinion. See Grunst v. Immanuel-St. Joseph Hosp., 424 N.W.2d 66, 40 W.C.D. 1130 (Minn. 1988); Suess v. St. Jude Med., Inc., No. WC09-155 (W.C.C.A. Nov. 25, 2009). There is no requirement that a physician must examine the employee before treatment in order for that physician’s opinion to have adequate foundation. The judge did not err by accepting Dr. Wicklund’s opinion that the employee’s work activities, and specifically the amount of walking she performed at work, did not substantially contribute to the employee’s right knee condition.
Both Dr. Riggi and Dr. Wicklund had foundation for their medical opinions. The compensation judge reviewed both opinions and outlined each in her memorandum. It is the compensation judge's responsibility, as trier of fact, to resolve conflicts in expert testimony. Nord v. City of Cook, 360 N.W.2d 337, 342, 37 W.C.D. 364, 372 (Minn. 1985). As we have held in other cases as well, this court will generally affirm a compensation judge’s decision which is based on a choice between competing medical opinions. Perry v. ADB Constr., Inc., 68 W.C.D. 491 (W.C.C.A. 2008). In this case, the judge found Dr. Wicklund’s opinion to be persuasive and consistent with the facts of the case, and adopted his opinion in concluding that the employee did not sustain an injury to her right knee as a result of her work activities with the employer.
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).
We have reviewed the evidence submitted into the record, along with the briefs prepared by the parties, and acknowledge that there is evidence in the record that could support a claim that the employee sustained a Gillette injury - - including the employee’s description of the onset of her right knee symptoms and the opinion prepared by Dr. Riggi. Under our standard of review, however, where evidence is conflicting or more than one inference may reasonably be drawn from the evidence, the compensation judge’s findings are to be affirmed. Id. at 60, 37 W.C.D. at 240. The issue on appeal is not whether the record would have supported a claim for a Gillette injury, but whether the judge’s decision is supported by evidence that a reasonable mind might accept as adequate. Reel v. Loftness Specialized Farm Equip., slip op. (W.C.C.A. Feb. 3, 2004). In this case, the compensation judge reviewed the evidence and testimony submitted into the record and concluded that the evidence did not establish a Gillette injury during the employee’s work for the employer. The compensation judge’s finding is supported by substantial evidence in the record as a whole, including the medical opinion issued by Dr. Wicklund and references in medical records, and we therefore affirm her finding.
 Gillette v. Harold, Inc., 257 Minn. 313, 101 N.W.2d 200, 21 W.C.D. 105 (1960).
 There is a reference in the October 25, 2008, chart note that the employee had been seen at an urgent care clinic one week earlier, although the record does not contain such a medical report.
 In advance of the evidentiary hearing, the employee claimed a left knee injury as well; at the hearing, that claim was withdrawn from consideration, and therefore we have not addressed the employee’s medical treatment to her left knee.
 We note that Finding No. 11 and the first sentence of the compensation judge’s order list an injury date of February 23, 2009. The date of injury was not at issue at the hearing, and the parties all cited to a claimed injury date of November 4, 2008. The reference to an injury date of February 23, 2009, is an obvious typographical error; it was on that date that the employee filed her claim petition. For those reasons, we modify the judge’s finding and memorandum to instead list an injury date of November 4, 2008.