SCOTT A. ROZELL, Employee/Appellant, v. LTV STEEL MINING CO., and AIG/SEDGWICK CLAIMS MGMT. SERVS., INC., Employer-Insurer, and SPECIAL COMP. FUND.
WORKERS’ COMPENSATION COURT OF APPEALS
OCTOBER 25, 2010
CAUSATION - PSYCHOLOGICAL CONDITION. Where there was expert medical opinion that the employee’s psychological problems were related to his layoff from the employer, and where there was evidence that the employee’s psychotherapy sessions dealt not with stress related to the employee’s work injury but mostly with the employee’s interaction with family members, the compensation judge’s conclusion that the employee did not sustain a psychological injury consequent to his physical work injury was not clearly erroneous and unsupported by substantial evidence.
PERMANENT TOTAL DISABILITY - SUBSTANTIAL EVIDENCE. Where, based on expert medical opinion, the judge had rejected the employee’s claim that he had sustained a disabling psychological injury as a result of his work-related foot, ankle, and hip injuries, where there was evidence that suitable jobs were available to the employee, where the employee’s job search had been limited essentially to posting his resume on-line, and where the employee had unreasonably declined suitable job offers, the compensation judge’s denial of permanent total disability benefits was not clearly erroneous and unsupported by substantial evidence.
CAUSATION - TEMPORARY INJURY. Where the employee himself had testified that his injury was to his neck and mid-back and not to his lower back, and where there was expert medical and chiropractic support for the conclusion that the employee’s neck and mid-back injuries were only temporary, the compensation judge’s conclusion that the employee sustained only a temporary injury to his mid and upper back and no injury to his lower back was not clearly erroneous and unsupported by substantial evidence.
SETTLEMENTS - INTERPRETATION. Where the judge had found that the parties’ stipulation for settlement had closed out “all claims related to the big toe,” but where the language of the stipulation closed out only “medical expenses related to the toe surgery that [was] the subject of the pending Medical Request,” the compensation judge’s finding that “all” big toe-related claims were closed out was vacated.
Affirmed in part and vacated in part.
Determined by: Pederson, J., Rykken, J., and Johnson, C.J.
Compensation Judge: Jerome G. Arnold
Attorneys: Russell J. LaCourse, LaCourse Law Office, Duluth, MN, for the Appellant. Robin C. Merritt, Hanft Fride, Duluth, MN, for the Respondents. Thaddeus V. Jude, St. Paul, MN, for the Special Compensation Fund.
WILLIAM R. PEDERSON, Judge
The employee appeals from the compensation judge’s determination that the employee’s September 2, 1993, work injury is not a substantial contributing factor in any of his diagnosed psychological conditions; from the judge’s finding that the employee is not permanently totally disabled; from the judge’s finding that the employee suffered no permanent back injury resulting from his September 2, 1993, work injury; and from the judge’s conclusion that the parties’ 2007 stipulation for settlement “closed out all claims related to the big toe.” We affirm the judge’s denial of a psychological injury, his denial of permanent total disability benefits, and his finding that the employee suffered no permanent injury to his low back as a result of the September 2, 1993, injury, and we vacate that portion of Finding 79 indicating that the parties’ 2007 stipulation for settlement closed out all claims related to the big toe.
Scott A. Rozell [the employee] graduated from high school in Babbitt, Minnesota, in 1971. Following high school, he attended the Duluth Area Vocational Technical Institute and completed a two-year program in commercial and residential wiring. In November 1973, he began working for LTV Steel Mining Company [the employer], then known as Erie Mining, at its plant in Hoyt Lakes, Minnesota. The employee participated in an apprenticeship program there and became a shop electrician in the employer’s maintenance department. The job entailed work on electric motors, submersible pumps, and other equipment, some of which was very large and required the use of large and heavy tools. In 1983, the employee was laid off by the employer, and that fall he began a two-year degree program at Mesabi Community College in computer programming. He received an Associate of Arts and Science degree in 1985, having maintained a grade point average in excess of 3.00. The employee then worked for Team Electronics in Hibbing as a computer department manager and outside salesman through 1986, when he was called back to work by the employer. He remained with the employer as a shop electrician until the plant closed in January 2001.
On September 2, 1993, the employee sustained an admitted work injury to his left foot and ankle and left hip when he stepped on some debris while walking across the shop floor at the end of his shift. He also reported twisting his back on that date, but the employer and insurer disputed that a back injury had occurred. The employee was forty years old at the time and was earning a weekly wage of $726.91, according to the first report of injury and subsequent payments by the insurer.
The employee’s medical history is extremely long and complex. He evidently missed no time from work immediately following the September 2, 1993, incident and first sought medical attention on October 12, 1993, when he was seen by Dr. C. W. Decker at the Adams Clinic in Hibbing, complaining mainly of neck and mid-back discomfort. Dr. Decker obtained x-rays that showed degenerative changes “consistent with an old injury.” He believed that the employee had “aggravated a pre-existing problem by twisting his back.” The employee reported also that he had twisted his left ankle in the process, and the doctor noted that “it seems to be a bit uncomfortable but he is walking okay.” No treatment was recommended for the ankle at that time.
On November 3, 1993, the employee returned to the Adams Clinic and was examined by his primary care physician, Dr. Mark Wagner. At that visit, he reported that he had had continual pain in his foot, knee, and back since his accident. Dr. Wagner obtained an x-ray of the left ankle, assessed a possible fracture of the distal tibia, and referred the employee to orthopedist Dr. Mark Carlson for consultation on his foot and for follow-up on his knee, on which Dr. Carlson had performed previous surgeries. Around this same time, the employee treated for about nine months with chiropractor Dr. Arne Luoma, for his mid and upper back pain.
The employee saw Dr. Carlson on December 7, 1993, for left ankle pain and complaints of “interscapular back pain of a chronic nature.” Dr. Carlson diagnosed chronic posterior tibial tendonitis of the left ankle and chronic muscular back pain. He recommended a brace for the ankle and physical therapy for the ankle and back. The employee noted minimal improvement with therapy, and on March 14, 1994, Dr. Carlson recommended continued bracing, anti-inflammatories, and bilateral flexible orthotics. By May 25, 1994, however, the employee reported to Dr. Carlson that he was having problems with the orthotics and was frustrated with his lack of progress. Dr. Carlson did not have any other treatment options to offer and recommended a second opinion from a foot specialist. Dr. Wagner subsequently referred the employee to foot and ankle specialist Dr. Lowell Lutter.
Dr. Lutter examined the employee on August 9, 1994, diagnosed posterior tibial tendon dysfunction, and recommended an MRI to determine the severity of the injury and whether surgery would be recommended. The MRI, performed on August 31, 1994, showed a Type I posterior tibial tendon tear. When seen in follow-up on November 9, 1994, the employee reported that he continued to work with some difficulty. The doctor recommended that the employee undergo an operative procedure which would entail “imbrication posterior tibial tendon and graft.” The employee later testified that after his injury he primarily performed bench work because he had difficulty pushing heavy parts and couldn’t climb ladders. He stated that the employer was very good about accommodating him.
The employee evidently continued working full time for the employer until the plant closed in January 2001. He sought no treatment for his left foot or ankle between April 11, 1995, and the plant closing, but periodically he did see Dr. Wagner and Dr. Luoma for upper and mid-back pain. In a report issued August 18, 1998, Dr. Luoma indicated that the employee had reached maximum medical improvement [MMI] by April 21, 1998, with 0% permanent partial disability. Dr. Wagner had recommended a functional capacities evaluation [FCE] for the employee’s “back pain syndrome,” and testing was done at Arrowhead Rehabilitation on August 25 and 26, 1998. At the FCE, the employee complained of “soreness” in his mid-back region and between his shoulder blades, which radiated up to the central neck. The therapist noted decreased tolerance to elevated work secondary to complaints of pain, and she recommended that the employee change positions frequently and take brief stretch breaks. In a report completed September 2, 1998, Dr. Wagner also reported that the employee had reached MMI for his 1993 work injury, but he provided a 2% permanent partial disability rating for the employee’s foot and ankle condition using a Weber approach and ratings of 3.5% and 2.5% for the employee’s cervical and thoracic spine, respectively. Dr. Lutter also provided a 2% rating for the employee’s foot and ankle condition in a report on September 3, 1998. The employer and insurer evidently at some point paid the 2% rating for the foot and ankle.
Following the plant closing, the employee collected unemployment compensation and entered a displaced worker training program, enrolling in a computer networking technologies program at Mesabi Range Community and Technical College [MRCTC] in the fall of 2001.
On August 24, 2001, more than six years since his last exam, the employee returned to see Dr. Wagner for evaluation of his left foot. The employee reported that he never did require surgery but had just basically put up with it for the entire time. He was now reporting more pain and wondered what he could do. Dr. Wagner arranged for an updated MRI and referred the employee back to Dr. Lutter, who saw him on October 3, 2001. The employee described to Dr. Lutter a popping and snapping sensation in the left medial and longitudinal arch while doing some walking the previous spring. He noted gradually increasing pain and discomfort and an increased pronation on the left side compared to the right. He described also some paresthesia of the great toe as well as a snapping sensation. Dr. Lutter diagnosed a progression of the employee’s posterior tibial tendon tear and dysfunction and a flexor hallucis longus impingement at the back of the ankle. An MRI scan of the left ankle and foot was conducted, and on November 13, Dr. Lutter recommended exploration of both the posterior tibial tendon at its insertion and the flexor hallucis longus tendon.
On January 23, 2002, at the request of his college counselor, the employee was seen for a psychological evaluation by licensed psychologist Dr. Marian Flammang at the Duluth Clinic. The employee reported that he had had considerable difficulty during his first semester learning in a class on computer theories that was taught from books rather than utilizing computer labs. He had been unable to complete the class, “which caused him emotional distress, and threatened the loss of his college funding, as well as his unemployment compensation.” He acknowledged to Dr. Flammang that he had experienced a number of stressful events over the past few years, referring particularly to the closing of the mine. Dr. Flammang administered a number of tests and concluded that the employee met criteria for Attention-Deficit/Hyperactivity Disorder [ADHD], a predominantly inattentive type. During the evaluation, the employee also reported issues with his sleep pattern, and Dr. Flammang encouraged him to see a sleep disorders specialist if his sleep problem did not resolve with treatment for ADHD.
The employee underwent the recommended surgery for his left foot on February 27, 2002, performed by Dr. Lutter’s associate, Dr. Diane Palkert. The surgery consisted of debridement of the left flexor hallucis longus [FHL] tendon, debridement and advancement of the left posterior tibial tendon, reinforcement of the posterior tibial tendon with the flexor digitorum longus [FDL] tendon, and repair of the spring ligament.
The employee thereafter attended physical therapy and returned to see Dr. Palkert on July 23, 2002. He reported noting progressive deformity of his foot and an inability to obtain adequate support from the braces that he had tried. Dr. Palkert diagnosed progressive planovalgus deformity secondary to the employee’s posterior tibial tendon dysfunction. She did not think that his current problem could be resolved with bracing, and she recommended that he consider a calcaneal osteotomy and possible medial column fusion or lateral column lengthening. About fifteen months later, on October 21, 2003, the employee complained to Dr. Palkert of daily pain and difficulty being on his feet for any length of time. The doctor’s diagnosis remained the same, and she continued to believe he needed some type of fusion. The employee expressed reservations about proceeding with another surgery.
On December 2, 2003, the employee was examined by orthopedist Dr. Scott McGarvey at the request of the employer and insurer. In a report issued December 4, 2003, Dr. McGarvey diagnosed a posterior tibial tendon tear followed by failed reconstruction repair. He noted that the employee had gone on to a more severe acquired flat foot deformity. Dr. McGarvey recommended that the employee consider subtalar arthodesis with iliac crest bone grafting. He thought that this would provide a more stable hindfoot, which he hoped would improve the employee’s function and reduce some of his medial hindfoot pain.
About a year later, on December 28, 2004, the employee sought treatment at the Duluth Clinic with psychiatrist Dr. Michael Messer. He told Dr. Messer that he had been laid off from work in 2001 and had had a depressive episode with attention difficulties while attending college. He reported that while he was depressed he hadn’t cared much about his studying and had not completed his studies. He described his current symptoms as including depression, lack of motivation, problems with attention, finding it hard to read and to retain information, decreased energy, and weight gain. He said that he had crying spells, difficulty controlling his emotions, and fleeting suicidal thoughts. He claimed that he slept only three to four hours per night. On examination, the employee was restless, his mood and affect were depressed, and he was inattentive and showed poor memory. Dr. Messer diagnosed major depression and ADHD and prescribed Prozac and Concerta. The employee treated with Dr. Messer for his depression through August 11, 2005, when he decided to pursue psychiatric care closer to his home at Range Mental Health Center.
The employee was evaluated by Dr. Shawna Benson, at the Range Mental Health Center on September 27, 2005, and he was thereafter regularly seen by Dr. Benson for psychotherapy and by psychiatrists Dr. Timothy Magee and Dr. Emery Ulrich for medication management.
On November 18, 2005, the employee was seen by orthopedist Dr. Wade Lillegard for left great toe pain following the employee’s having inadvertently kicked a safety gate while barefoot. An x-ray was taken, and Dr. Lillegard diagnosed left great toe pain consistent with post traumatic synovitis of the IP joint, with some mild underlying degenerative joint disease. The doctor administered an injection to the IP joint.
On October 6, 2006, the employee underwent a rehabilitation consultation with QRC Kim Eisenhuth of Mesabi Rehabilitation Services. In reviewing the employee’s relevant history, Ms. Eisenhuth noted that, in addition to completing programs of study in 1973 and 1985, between 2001 and 2003 the employee had attended MRCTC in Eveleth, Minnesota, and had received a one-year diploma in Microsoft Networking. During the summer of 2001, the employee had also attended a class offered through his union in computer hardware A+ programming and had received a certificate for completing that training. The employee described his current symptoms as affecting his left ankle, left great toe, left leg and knee, and upper back. He indicated that these symptoms had resulted in limitations in sitting, standing, walking, bending, kneeling, stooping, twisting, and climbing stairs. Ms. Eisenhuth found the employee eligible for rehabilitation services, and she developed a rehabilitation plan with a goal of his returning to work with a different employer.
On October 10, 2006, the employee and his QRC attended an appointment with Dr. Wagner, who had not seen the employee for his ankle since 2002 or for his back since 1998. The employee reported to Dr. Wagner that he had hired an attorney and wanted some evaluations done prior to an impending court date. Dr. Wagner assessed chronic foot pain and dysfunction as well as low back pain. He referred the employee for an orthopedic consultation related to his left foot and for an FCE related to his back.
On referral from Dr. Wagner, the employee was evaluated for left foot and left knee pain by Dr. Lillegard on November 7, 2006. The employee reported that his pain was related more to his great toe, aggravated by the push-off phase of walking. The doctor assessed left great toe IP pain secondary to degenerative joint disease [DJD], and left knee pain secondary to patellofemoral DJD. He believed that both conditions were aggravated by the employee’s overpronation from his acquired flatfoot condition. The employee stated that he had obtained good results from his injection a year ago, and Dr. Lillegard again administered an injection to the IP joint. The doctor released the employee to sedentary, desk-type work only, with the proviso that he be permitted to get up occasionally and move about. On December 8, 2006, Dr. Wagner modified Dr. Lillegard’s earlier restrictions and released the employee to “light duty.” He assessed chronic foot pain but prescribed no medication for it.
The employee commenced a job search assisted by placement specialist Teresa Lerol on December 11, 2006, having advised his QRC that “he did not want to work directly with other people.” On January 4, 2007, in response to her job leads, the employee told Ms. Lerol, “forget it, I am not going to do it, and nobody is going to make me.” He continued, “I do not do paperwork and I am not going to. I am not looking for a job; I am looking for proper training. I am having problems with my depression and nobody is going to make me do anything.” On January 15, 2007, Ms. Lerol spoke with the employee about scheduling a meeting to review her concerns about his resume. She explained that, until a resume was agreed upon, she was unable to actually call employers in order to inquire about possible employment positions.
Before a meeting with Ms. Lerol could take place, on January 24, 2007, the employee saw psychiatrist Dr. Emery Ulrich. Dr. Ulrich adjusted the employee’s medication and noted also that, “it seems like the best plan of attack has to do with working with his lawyer and settling his industrial claims so that he has an insured income.” The following day, the employee telephoned Ms. Lerol to inform her that Dr. Ulrich did not want him to engage in job search or anything that may add stress to his life. This was confirmed by Dr. Ulrich in a letter to QRC Eisenhuth on January 25, 2007, in which he stated,
It is my belief that at this time, Mr. Rozell is unable to participate in vocational rehabilitation due to his fluctuating depression and anxiety. He carries the diagnosis of ADD and suffers from fluctuating memory, poor concentration, irritability and anger. Mr. Rozell has a very poor frustration tolerance and is unable to tolerate stress without increasing his mental illness symptoms. It would be very difficult for him to participate in job modification and job development training at this time as the added stress of having to participate in this rehabilitation program would more than likely cause an exacerbation in his symptoms.
On April 16, 2007, the employee returned to see Dr. Lillegard for evaluation of a new problem with the left great toe. The employee told the doctor that about a week or two earlier he had started developing some mild soreness and swelling over his great toe. He then had simply stood up from a chair and felt a pop with immediate pain and swelling over the dorsum of the foot. Dr. Lillegard consulted with foot specialist Dr. A. Douglas Spitalny, who diagnosed an extensor tendon rupture and suggested tendon repair and an IP joint fusion.
The employee was examined at the request of the employer and insurer by orthopedist Dr. Nolan Segal on April 30, 2007. In a 24-page report issued June 4, 2007, Dr. Segal addressed the employee’s numerous musculoskeletal complaints and concluded, in part, that the employee had sustained a minor and temporary strain to his mid and upper back and a minor twisting injury to his left ankle on September 2, 1993. The doctor found also that the employee had multilevel arthritic changes throughout his spine unrelated to his work injury. He noted that the employee had been markedly overweight for virtually all of his adult life, “which would certainly put increased strain on his lower extremity joints and on his spine.” He also found that the employee had significant arthritis in his right knee and evidence of some mild tricompartmental arthritis of his left knee, which he found was also unrelated to the employee’s 1993 injury or to any alleged gait abnormalities stemming from that injury. Dr. Segal opined that the employee’s ruptured extensor tendon and the surgery recommended by Dr. Spitalny to correct that problem had nothing to do with the 1993 injury. He concluded that the employee had sustained no ratable permanent partial disability relative to his cervical, thoracic, or lumbar spine and did not require any specific treatment for his back. Dr. Segal concluded that the employee required restrictions, but he felt that he was capable of working at sedentary work.
In August 2007, the parties agreed to a settlement of certain portions of the employee’s workers’ compensation claim. A stipulation for settlement, signed August 21, 2007, provided in part as follows:
A. Employer and Insurer agree to pay and Employee agrees to accept the total sum of $100,000.00 in full, final, and complete settlement of all past and future claims for temporary partial disability, temporary total disability, and permanent partial disability workers’ compensation benefits as a result of any and all injuries or occupational diseases sustained while in the employment of Employer, including, but not limited to the 9/2/1993 date of injury, and including any consequential injuries as of the date of this settlement, EXCEPT that potential future claims for permanent total disability and medical treatment for the 9/2/1993 left lower extremity and back shall remain open, excluding the pending toe surgery, subject to Employer’s and Insurer’s defenses, including reasonableness, necessity, and causation.
B. Employee agrees to pay from the amounts paid in settlement all medical expenses related to the toe surgery that is the subject of the pending Medical Request, and agrees to hold Employer and Insurer harmless from any claims for payment of such medical expenses.
The settlement was approved by an Award on Stipulation served and filed on August 23, 2007.
Following the settlement of his claim, the employee began attending psychotherapy sessions with psychologist Mary Carpenter. Ms. Carpenter noted some improvement in the employee’s depression because his settlement had allowed him to buy his daughter and his son some big ticket items that he had promised, to have his garage sided, and to have some trees taken down. She continued to believe, however, that he did not have the energy to sustain consistent competitive employment. By November 20, 2007, the employee was again anxious about his finances and was considering filing for Social Security disability benefits [SSDI]. Ms. Carpenter recommended that he get his application started and not wait until he is out of money. In the assessment portion of her progress note, Ms. Carpenter stated, “the goal is to secure a monthly income to relieve the financial guilt that continues to feed his depression. His inability to work is real, and there’s not much he can do about it.”
In February 2008, the employee applied for SSDI benefits and was referred for residual physical and mental functional capacity assessments by disability determination services [DDS] and a psychological evaluation by psychologist Dr. John Huber. At his evaluation by Dr. Huber on March 17, 2008, the employee reported that one of his doctors did not want him to return to work because he needs surgery on his foot and that his psychiatrist did not want him to do a job search. When asked what disability he was claiming, he responded, “the depression part of it is supposed to keep me from doing a job search.” Dr. Huber diagnosed major depressive disorder, recurrent, and ADHD. He described the employee’s abilities as follows:
His psychological work-related abilities appear to be somewhat variable. As long as he stayed on medication, he appears to be able to understand and follow at least simple instructions but would need reminders. His ability to consistently sustain attention and concentration is moderately impaired. His ability to carry out work-like tasks with reasonable persistence and pace on a consistent basis is markedly impaired, as shown by his 2 recent failures at jobs. He appears able to respond appropriately to brief and superficial contacts with coworkers and supervisors, and to be able to tolerate low levels of stress and pressure in the workplace.
On July 10, 2008, the employee filed a claim petition for permanent total disability benefits beginning August 24, 2007, the day following approval of the earlier stipulation for settlement. The employee also claimed retraining benefits under Minnesota Statutes section 176.102, subdivision 11(c). The employer and insurer denied liability for the benefits claimed.
In June 2009, the insurer’s claim representative advised QRC Eisenhuth that he was exploring the use of Catalyst RTW, a company that assisted injured workers in returning to work from their home. By October, the employee was offered participation in the program, but the QRC did not believe it would be suitable, in light of the employee’s interests and abilities and his anger and frustration issues. She also believed that it was unsuitable because the wage offered would not restore the employee to the economic status he would have enjoyed without his disability.
The employee underwent a vocational evaluation by Richard VanWagner on September 14, 2009, at the request of the employer and insurer. In his report dated October 5, 2009, Mr. VanWagner opined that the employee was not permanently and totally disabled from all but sporadic employment at insubstantial wages. He found the employee to have considerable transferable skills, that he had the ability to function in at least sedentary employment, and that employment was available within the employee’s labor market at his skill and education levels. Mr. VanWagner opined that the employee “has not performed a reasonable and diligent job search and has not performed any other activities that suggest that he has any interest whatsoever in working in the competitive labor market in a job in an occupation for which he has the skills, training, expertise, and residual functional capacities.”
On September 17, 2009, the employee’s attorney obtained an employability assessment of the employee by certified rehabilitation counselor John Witzke. In a report dated October 8, 2009, as subsequently reiterated in his testimony at trial, Mr. Witzke opined that, considering the employee’s age, his physical and mental challenges, his education and training, and the employment market in his community, the employee was not competitively employable and would not be able to obtain and sustain substantial, gainful work activity.
On October 15, 2009, in response to a letter from the employee’s attorney, Dr. Ulrich opined that the employee was still unable to participate in any vocational rehabilitation due to the continued fluctuation of his depression and anxiety. In a follow-up letter on November 17, 2009, Dr. Ulrich also stated that he did not believe that the employee would be able to function within the required capacity of the job proposed by Catalyst RTW. He did not believe that the employee’s symptoms were under enough control for him to be effectively employed. Regarding causation, Dr. Ulrich stated,
It is my opinion that [the employee’s] disabilities are directly related to his original physical injury, which caused ongoing stress and exacerbation in his mental health symptoms. It is also my opinion that Mr. Russell did not suffer from Major Depression prior to his injuries and that his depression is directly related to his 1993 work injury.
Psychologist Mary Carpenter also reviewed the job offer from Catalyst RTW and in a letter to the employee’s QRC on November 5, 2009, she stated that she did not believe that the employee would be able to function within that capacity. She referred to the employee’s disrupted sleep pattern and his volatile and erratic mood swings as reasons for the employee’s inability to effectively function at that job. Ms. Carpenter opined also that the employee’s disabilities were directly related to his original physical injury, which had caused ongoing stress and exacerbation of his mental health symptoms.
The employee was seen for an independent psychiatric exam on behalf of the employer and insurer by Dr. Thomas Gratzer on December 12, 2009. Dr. Gratzer conducted a psychiatric interview, reviewed the employee’s extensive medical records, and obtained a Minnesota Multiphasic Personality Inventory [MMPI], conducted and interpreted by clinical psychologist Dr. Marvin Logel. In a 39-page report dated December 24, 2009, Dr. Gratzer diagnosed major depressive disorder, in partial to full remission, attention deficit disorder by history, and mixed personality traits. He found that the employee’s mixed personality traits and attention deficit disorder predated and were unrelated to the September 2, 1993, work injury. He further opined that the employee had not developed psychiatric sequelae relative to the physical stresses of the work injury. He concluded that the employee had developed symptoms of a major depression in relation to psychosocial stresses separate from the physical stresses of his September 2, 1993, injury, which included loss of employment due to economic issues, vocational stresses, and family stresses. In Dr. Gratzer’s opinion, the employee’s work injury was not a substantial contributing factor in the development of his major depression. Nor did Dr. Gratzer believe that the employee was in need of any psychiatric restrictions or limitations relative to his major depression. He concluded that employment activities, including the job offered by Catalyst RTW, would likely have a therapeutic benefit for the employee.
The matter came on for hearing before a compensation judge on January 22, 2010. Issues included (1) whether the employee is permanently and totally disabled, (2) whether the employee has suffered a psychological injury as a result of his September 2, 1993, foot and ankle injury, and (3) the extent of the employee’s September 2, 1993, injury. Witnesses at trial included the employee, the employee’s spouse, QRC Eisenhuth, and vocational expert Witzke. Documentary evidence included the employee’s voluminous medical and rehabilitation records, as well as the reports from the employer and insurer’s experts, Dr. Segal, Dr. Gratzer, and vocational expert VanWagner. In a findings and order issued March 23, 2010, the compensation judge determined as follows: that the employee did not sustain a psychological injury consequent to his work injury of September 2, 1993; that the employee did not suffer a permanent injury to his back as a result of that work injury; that, in his August 2007 settlement, the employee had closed out all claims related to his left great toe; and that the employee had not been permanently and totally disabled since August 24, 2007. The employee appeals.
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).
“[A] decision which rests upon the application of a statute or rule to essentially undisputed facts generally involves a question of law which [the Workers’ Compensation Court of Appeals] may consider de novo.” Krovchuk v. Koch Oil Refinery, 48 W.C.D. 607, 608 (W.C.C.A. 1993).
1. Psychological Condition - Contributing Cause
The compensation judge attributed the employee’s psychological condition to the layoff and shutdown of the employer’s taconite facility in 2001. He adopted Dr. Gratzer’s opinion that the employee’s mixed personality traits and attention deficit disorder predated and were unrelated to the work injury, and he also adopted the doctor’s opinion that the employee had developed symptoms of major depression in relation to psychosocial stresses separate from the physical stresses of his injury. The employee contends that neither the judge nor Dr. Gratzer addressed the significant effects of the employee’s failed 2002 surgery on the development of his major depression. It was after that surgery, he contends, that he was left with severe foot pain and an undisputed limitation to sedentary work. He argues that, without considering his post-surgical pain and limitations, the conclusion that his work injury is not a substantial contributing factor in any of his mental health conditions is unsupported by substantial evidence. In contrast to Dr. Gratzer’s opinions, he argues, Dr. Ulrich and psychologist Carpenter, who did consider the employee’s chronic pain, opined that the work injury is a substantial contributing factor in the employee’s psychological condition and limitations. We are not persuaded.
Where a work-related physical injury causes, aggravates, accelerates or precipitates a mental injury, that mental injury is compensable. See Hartman v. Cold Spring Granite Co., 243 Minn. 264, 67 N.W.2d 656, 18 W.C.D. 206 (1954). It is not necessary that the physical injury be the sole cause of the mental injury; it is sufficient if the work-related physical injury is a substantial contributing factor in the mental injury. Miels v. Northwestern Bell Tel. Co., 355 N.W.2d 710, 715, 37 W.C.D. 164, 170 (Minn. 1984). It does not necessarily follow, however, that the physical injury caused the mental injury just because the mental injury followed the physical injury. In the present case, there is evidence to support the employee’s position that his work injury and subsequent failed surgery were a substantial contributing factor in the development, aggravation, or acceleration of his psychological condition. Under this court’s standard of review, however, the issue is not whether the evidence will support alternative findings, but whether substantial evidence supports the judge’s factual findings. See Land v. Washington Co. Sheriff’s Dep’t, slip op. (W.C.C.A. Dec. 23, 2003). Where evidence conflicts or more than one inference can be drawn from the evidence, the compensation judge’s findings must be upheld. Redgate v. Sroga’s Standard Serv., 421 N.W.2d 729, 40 W.C.D. 948 (Minn. 1988).
The record in this case is extensive, and, contrary to the employee’s argument, we find no basis to conclude that the judge focused only on the initial injury rather than the entire record as it impacts the employee’s condition. The compensation judge issued 99 separate findings with numerous references to the medical record. Dr. Palkert, Dr. McGarvey, and Dr. Segal all refer to the employee’s failed posterior tibial tendon surgery, and the judge referenced the opinions of each of these doctors. Similarly, Dr. Gratzer reviewed the employee’s medical records and painstakingly referenced many of those records in his 39-page report. The compensation judge and Dr. Gratzer were undoubtedly aware of the employee’s complete history, including the failed tendon repair surgery in 2002.
Dr. Gratzer conducted a clinical interview of the employee and obtained an MMPI interpreted by Dr. Logel. He diagnosed mixed personality traits and attention deficit disorder predating and unrelated to the employee’s work injury, and, in his opinion, the September 2, 1993, injury was not a substantial contributing factor in the development of the employee’s diagnosed major depression. In reliance on Dr. Gratzer’s opinions, the judge concluded that the employee’s psychological problems were related to his layoff in 2001 with the shutdown of the employer’s taconite facility. He noted in his memorandum that, after the employee’s unemployment benefits ceased, “the employee’s psychological condition gradually deteriorated due to his unemployment and the financial stress accelerated by virtue of the employee’s mixed personality traits brought on by not having an income source.” The judge’s conclusion is supported by Dr. Gratzer’s opinions. There is no suggestion here that Dr. Gratzer lacked foundation for his opinions. As Dr. Gratzer had adequate foundation for his opinions, the compensation judge could reasonably adopt and rely upon them. See Nord v. City of Cook, 360 N.W.2d 337, 342-43, 37 W.C.D. 364, 372-73 (Minn. 1985) (a 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).
While relying primarily on Dr. Gratzer’s opinion, the judge also noted that the employee’s psychotherapy sessions, particularly those with Dr. Benson, dealt not with stress related to the employee’s work injury but mostly with the employee’s interaction with family members. In his memorandum, the judge stated,
The employee’s psychological treatment providers within six months of the August, 2007 settlement encouraged the employee to apply for disability benefits believing that upon employee’s being granted disability benefits his financial stress would diminish and employee’s depression would resolve. From and after late 2007 the employee used the psychological provider’s off-work status to avoid anything he didn’t want to do and when he needed or wanted to do something outside his restrictions he did so without any apparent concern in either his physical or mental condition. Simply put the employee suffers from a psychological condition unrelated to his work injury which he has used to buttress his claim for permanent total disability benefits.
The compensation judge found that the evidence did not adequately relate the employee’s psychological condition to his physical injuries. In performing its review function, the Workers Compensation Court of Appeal must “give due weight to the compensation judge’s evaluation of the credibility of the witnesses, and uphold findings based on conflicting evidence, or evidence from which more than one inference might reasonably be drawn.” Turek v. Northfield Freezings, 652 N.W.2d 265, 267, 62 W.C.D. 622, 624 (Minn. 2002). Because substantial evidence supports the compensation judge’s decision that the employee’s work injuries were not a substantial contributing factor in the development of the employee’s psychological condition, that decision is affirmed.
2. Permanent Total Disability
An employee is permanently and totally disabled “if his physical condition, in combination with his age, training, 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. Co., 278 Minn. 79, 83, 153 N.W.2d 130, 133-34, 24 W.C.D. 290, 295 (1967). This court has concluded further that “[p]ermanent total disability is primarily dependent on the employee’s vocational potential, rather than his physical condition.” Thompson v. Layne of Minn., 50 W.C.D. 84, 100 (W.C.C.A. 1993); see also McClish v. Pan-O-Gold Baking Co., 336 N.W.2d 538, 542, 36 W.C.D. 133, 139 (Minn. 1983) (the concept of total disability depends on the employee’s ability to find and hold a job, not on his or her physical condition). Normally, therefore, “employees who are capable of work must make a diligent job search to establish total disability.” Redgate v. Sroga’s Standard Serv., 421 N.W.2d 729, 733, 40 W.C.D. 948, 954-55 (Minn. 1988). This does not mean, however, that a job search is a pre-requisite to entitlement to benefits in cases where the job search would be futile. See Scott v. Southview Chevrolet Co., 267 N.W.2d 185, 188-89, 30 W.C.D. 426, 432 (Minn. 1978). Nevertheless, although a diligent job search may not be an absolute prerequisite to an award of total disability benefits, the lack of a job search still goes to the weight of the assertion that the employee is totally disabled. See id., 267 N.W.2d at 189, 30 W.C.D. at 432; see also, e.g., Redgate, 421 N.W.2d at 733, 40 W.C.D. at 954.
In the present case, the employee’s claim that he is permanently and totally disabled is substantially based on his claim that he sustained a compensable psychological injury as a result of his work injuries. The compensation judge rejected the employee’s claim of a consequential psychological injury, and we have affirmed that determination of the judge. The vocational opinions of QRC Eisenhuth and vocational expert Witzke were premised in large part on the treating psychiatrist’s and psychologist’s opinions that the employee is unable to participate in vocational rehabilitation, which were contradicted by the opinion of Dr. Gratzer, as adopted by the compensation judge, that the employee was not in need of any restrictions related to his depression. The judge also adopted the opinions of Dr. Segal as to the employee’s spinal injuries and his ability to work full-time with restrictions related to his left foot, right knee, spine, and shoulders. While not expressly adopting the opinions of vocational expert VanWagner, it is evident from the judge’s findings and memorandum that he accepted Mr. VanWagner’s opinion that the employee has considerable transferrable skills, has the ability to function in at least sedentary employment, and that there are job opportunities available for the employee within the skill and educational levels he possesses. The employee has not been involved in a formal job search since placement was discontinued in January 2007. Consequently, during the period in which the employee is seeking permanent total disability benefits, his job search has essentially consisted only of his posting his resume on-line. In his memorandum, the judge stated, “the employer/insurer’s vocational expert Richard VanWagner probably put it best when he opined that the employee is unemployed because he does not want to work, preferring instead to rely on his applications for disability benefits.”
The judge’s finding on permanent disability is based on his resolution of a conflict in expert testimony. The judge adopted the opinions of Dr. Gratzer over those of Dr. Ulrich and psychologist Carpenter, and he adopted the opinions of vocational expert VanWagner over the opinions of QRC Eisenhuth and vocational expert Witzke. It is not the role of this court to reassess credibility determinations or to reweigh the evidence but solely to assess whether there is sufficient evidence in the record to support the judge’s decision. Redgate v. Sroga’s Standard Serv., 421 N.W.2d 729, 734, 40 W.C.D. 948, 957 (Minn. 1988). The compensation judge found that the employee failed to do any job search that might be deemed reasonable and diligent enough to support a claim for permanent total disability benefits. He also found that the employee unreasonably declined job offers that would have generated sustained gainful employment. Substantial evidence in the record supports his conclusion that the employee has failed to show that the condition of his left foot in combination with his age, training, experience, and the type of work available in his community causes him to be unable to secure anything more than sporadic employment resulting in insubstantial income. We therefore affirm the judge’s denial of permanent total disability benefits. See Hengemuhle, 358 N.W.2d at 59, 37 W.C.D. at 239.
3. Permanent Back Injury
At Finding 94, the compensation judge found that the employee did not suffer a low back injury on September 2, 1993, and that any injury to the employee’s neck and mid-back was temporary in nature and had resolved without residuals. The employee contends that the judge’s finding is unsupported by substantial evidence in the record. He argues that the employee reported mid and upper back pain as early as his first visit on October 12, 1993, and that he has continued to experience chronic pain in those areas of his spine since that time. He argues further that there is no medical evidence that the employee had ongoing back pain prior to his 1993 work injury. Moreover, he argues, Dr. Wagner, who has seen the employee on multiple occasions, opined in 1998 that the employee had sustained permanent injuries to his cervical and thoracic spine as a result of that work injury. We are not persuaded.
We note initially that the employee expressly testified that he did not sustain any injury to his low back on September 2, 1993. He indicated that his back injury was to his neck and mid-back. The compensation judge’s finding that the employee did not sustain an injury to his low back on September 2, 1993, is supported by the employee’s own testimony. Moreover, the judge’s conclusion that the employee’s neck and mid-back injury was only temporary and had resolved without residuals is supported by the detailed report of Dr. Segal as well as the chiropractic records of Dr. Luoma. Dr. Luoma had indicated on August 18, 1998, that the employee had reached maximum medical improvement with 0% permanent partial disability related to the 1993 injury, and Dr. Segal’s opinions are based on a history obtained from the employee, a physical examination, and a complete review of the employee’s extensive medical records.
Because there exists substantial evidence in the record to support the judge’s findings, the judge’s determination that the employee sustained only a temporary injury to his mid and upper back on September 2, 1993, and no injury to his lower back on that date is affirmed.
4. Claims Related to the Left Big Toe
The employee contends that the compensation judge erred when, in Finding 79, he interpreted the parties’ 2007 stipulation for settlement as closing out “all claims related to the big toe.” He therefore requests that we vacate that conclusion. We agree.
Upon review of the stipulation for settlement, it appears that the only benefits specified as closed out by the stipulation are claims for temporary partial disability, temporary total disability, permanent partial disability, and “medical expenses related to the toe surgery that [was] the subject of the pending Medical Request.” The referenced Medical Request referred to the surgery recommended by Dr. Spitalny. All claims other than these specified benefit claims remained open. We therefore vacate that portion of Finding 79 in which the judge stated that the August 2007 stipulation for settlement “closed out all claims related to the big toe.”
 In claim petitions subsequently filed with the Department of Labor and Industry in 2006, 2008, and 2009, the employee claimed a weekly wage of $850.00. The issue was not raised at the hearing below.
 The employee had undergone right knee arthroscopic surgeries in 1981, 1990, and 1992.
 See Weber v. City of Inver Grove Heights, 461 N.W.2d 918, 43 W.C.D. 471 (Minn. 1990).
 As reflected in a Notice of Benefit Payment served on September 5, 2007, by the insurer. See Special Compensation Fund exhibit 2.