HEADNOTES

CAUSATION - SUBSTANTIAL EVIDENCE. Substantial evidence supports the compensation judge=s finding that the employee sustained a temporary aggravation of his pre-existing low back condition on October 24, 2000, and that the aggravation had resolved within two days of the incident.

Affirmed.

Determined by Johnson, C.J., Wilson, J., and Stofferahn, J.

Compensation Judge: Gary P. Mesna

OPINION

THOMAS L. JOHNSON, Judge

The employee appeals the compensation judge=s finding that the employee=s personal injury of October 24, 2000, was a temporary aggravation of a pre-existing condition that resolved after two days. We affirm.

BACKGROUND

Terry Stange, the employee, began working for the State of Minnesota, Department of Transportation, the employer, in 1987. In November 1989, the employee sustained a personal injury to the low back for which the self-insured employer admitted liability. Ultimately, Dr. Paul Matson, an orthopedic surgeon, performed a microlaminectomy and discectomy at the L6-S1 level.[1] In December 1997, the employee sustained a second personal injury to the low back. In January 1998, Dr. Matson performed a second surgery to repair a disc herniation at L5-6. In March 1998, Dr. Matson released the employee to return to work subject to restrictions on lifting, pushing and pulling. In May 1999, the employee saw Dr. Michael B. Rath, his family physician, complaining of low back pain. The employee stated he did not believe his back pain had significantly improved following the surgery.

Dr. Mark C. Engasser, an orthopedic surgeon, examined the employee on August 31, 1999, at the request of the insurer. The doctor obtained a history of the employee=s work injuries in 1989 and 1997, reviewed the employee=s medical records and performed a physical examination. The employee stated he currently had very little back pain, denied any leg pain and stated he had no difficulty sitting, standing or walking. Dr. Engasser diagnosed status-post microlaminectomy and discectomy at L6-S1 and L5-6, secondary to the employee=s work injuries. The doctor opined the employee had reached maximum medical improvement (MMI), rated an 11 percent whole body disability,[2] and assigned restrictions on the employee=s work activities. Dr. Engasser felt the employee was not in need of additional medical care, but recommended a home strengthening and flexibility program.

The employee returned to see Dr. Matson in November 1999 complaining of a flare-up of low back pain after cleaning culverts at work. Dr. Matson diagnosed a myofascial lumbar strain secondary to a work exacerbation and instituted physical therapy. By January 3, 2000, Dr. Matson reported the employee=s condition had improved. However, on January 26, 2000, the employee reported progressive back pain, and Dr. Matson recommended another month of physical therapy. In February 2000, the doctor recommended a TENS unit on a trial basis.

On October 26, 2000, the employee returned to see Dr. Rath and gave a history of having twisted his back on October 24, 2000, while working on a survey crew. The employee denied falling but said his work activities required him to walk on uneven terrain. On examination, Dr. Rath found no vertebral tenderness, mild paravertebral tenderness, and negative SI joint pain with essentially a full range of motion. The doctor diagnosed a mild exacerbation of low back pain and ordered physical therapy. The employee saw Dr. Matson on November 6, 2000, and gave a history of increasing low back symptoms due to walking on uneven ground at work. The employee=s neurological examination was intact and straight leg raising was negative. The doctor stated the employee should avoid walking on uneven ground. The employee underwent a functional capacity assessment in January 2001. With slight modifications, Dr. Matson approved the restrictions set forth in the evaluation. In an office note dated February 21, 2001, Dr. Matson observed the employee=s Acurrent injury was an exacerbation of prior injuries and does not represent a new injury.@ (Resp. Ex. 26.)

Dr. Engasser re-examined the employee on June 5, 2001. The employee gave a history of a re-injury to his back on October 24, 2000 while walking through muddy fields at work. The employee reported his back was worse since that time, with radiating pain into his left leg. Dr. Engasser opined the employee=s increased symptoms in October 2000 were a temporary exacerbation of his pre-existing low back condition and not a new injury. The doctor concluded that, beyond an increase in existing symptoms, he found no new pathology or symptoms. Dr. Engasser opined the employee had reached MMI from the effects of the temporary aggravation.

The employee saw Dr. Rath on July 10, 2001, with complaints of continued low back pain with radiation into both legs. The doctor diagnosed chronic back pain with subjective complaints of more pain without new objective findings. By report dated September 27, 2001, Dr. Matson stated a recent MRI scan did not show any new changes. The doctor further opined the employee had an aggravation of his prior work injury in the fall of 2000, which the doctor opined was a permanent aggravation.

On March 11, 2002, the employee got out of bed in the morning and experienced a severe onset of back and leg pain. The employee returned to see Dr. Matson. A lumbar myelogram showed an extradural defect at L6-S1 on the left, some midline disc bulging, and a possible left lateral disc protrusion at L5-6. An EMG showed chronic left L5 radiculopathy without signs of ongoing denervation, which Dr. Matson stated was consistent with the employee=s prior surgery and the recurrent changes noted on the lumbar myelogram and MRI scan. In May 2002, Dr. Gene Swanson examined the employee on referral from Dr. Matson. The doctor opined the employee might have epidural fibrosis around the S1 nerve root on the left side and that the L5-6 disc protrusion might aggravate the S1 nerve root. Dr. Swanson felt it reasonable to consider another microlaminectomy.

Dr. Engasser re-examined the employee on April 9, 2002. The doctor opined the employee suffered a recurrent disc herniation at L6-S1 on the left since his prior examination in June 2001. Dr. Engasser opined this ongoing problem resulted from the employee=s 1997 injury and did not result from a new injury in 2000.

On June 6, 2002, Dr. Matson performed a left-sided microlaminectomy and discectomy at L6-S1. In September 2002, the employee returned to work with the employer at a light-duty job.

The employee filed a claim petition claiming a third personal injury on October 24, 2000, and alleging an underpayment of temporary total and temporary partial disability benefits based upon his wage on that date. The case was heard by Compensation Judge Mesna on February 20, 2003. In Findings and Order filed March 10, 2003, the compensation judge found the increase in low back symptoms in October 2000 constituted a minor temporary flare-up or exacerbation of the employee=s pre-existing low back condition. The judge found the exacerbation lasted for about two days until October 26, 2000. Thereafter, the judge found the employee=s complaints, disability and treatment were the result of the continued manifestation of the prior work injuries of 1989 and 1997. Because no disability benefits were payable as a result of the temporary flare-up of October 24, 2000, the compensation judge denied the employee=s claim for underpayment of benefits. The employee appeals.

DECISION

The employee argues his testimony supports his claim that he sustained a permanent aggravation on October 24, 2000. Specifically, the employee points to his testimony regarding his work on a survey crew on October 12, 2000. He contends this job required him to walk on rough and uneven ground causing a new injury.

But there was a couple of times I slid, you know, cause we were out in the -- the freshly plowed fields. . . . We were out in, you know, freshly plowed fields and it was muddy, you know, I mean, you know, and the plows, you know, I mean, they=re almost knee high out of their furrows. And there=s, you know, several times I slipped . . . And, you know, so I mean there was not one specific time, but there was -- you know, there was numerous times of slipping and sliding and falling down, actually, you know, so --

(T. 39-40.)

The medical evidence, the employee contends, shows he was physically doing reasonably well until the injury of October 24, 2000. Thereafter, Dr. Matson=s records reflect the employee had increased and persistent low back pain with radiation of pain into both legs. By report dated September 27, 2001, Dr. Matson reported this pain was different from the employee=s prior back pain. Dr. Matson opined the employee had an aggravation of his prior injury in the fall of 2000 and stated this was a permanent aggravation of the employee=s pre-existing condition.

The employee argues the compensation judge erroneously failed to consider the foregoing and other credible evidence of record which supported his claim. Accordingly, the employee asks this court to reverse the decision of the compensation judge and remand the case for determination of what benefits are due the employee.

Certainly, as the employee argues, there is evidence which would support an award of benefits to the employee. On appeal, however, the issue is not whether the evidence would support a result contrary to the decision made by the compensation judge. Rather, it is the function of this court to determine whether Athe findings of fact and order were 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, Athey 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, A[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, Aunless 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.

Dr. Rath examined the employee several times after the October 24, 2000 incident and concluded the employee sustained only a mild exacerbation of his low back pain. Dr. Engasser opined the October 24, 2000 incident was at most a temporary aggravation. As the compensation judge noted, Dr. Engasser examined the employee both before and after the October 24 incident, which placed him in a good position to compare the employee=s condition before and after that incident. The compensation judge accepted the opinions of Dr. Engasser. Although Dr. Matson opined the October 24, 2000 injury permanently aggravated the employee=s low back condition, it is the function of the compensation judge, as trier of fact, to choose between conflicting medical opinions. Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985).

The opinions of Drs. Engasser and Rath that the October 24, 2000 injury was temporary is evidence which a reasonable mind might accept as adequate. The compensation judge accepted Dr. Engasser=s opinion and denied the employee=s claims. We cannot conclude the judge=s conclusion is clearly erroneous because the decision is supported by substantial evidence. The decision of the compensation judge must, accordingly, be affirmed.