The self-insured employer appeals from the compensation judge’s decision as to the nature of the employee’s admitted work injury and from the judge’s award of medical expenses.  We affirm the judge’s decision as modified to reflect that, with respect to medical expenses, the employer is liable only for those expenses causally related to the employee’s cervical condition.

The employee began working as a millwright for Honeywell, Inc. [the employer], in 1978.  On February 19, 2000, while trying to unjam a roller conveyer at work, the employee struck his head on an overhead beam.  The force of the blow knocked him back onto the conveyer and gave him a headache, but he did not lose consciousness.

The employee consulted the company nurse a few days after the work incident, complaining of neck pain, and the nurse referred him to Dr. Thomas Oas, at North Memorial Clinic.  Dr. Oas assessed a cervical strain, prescribed anti-inflammatories, and recommended restrictions on lifting, reaching, and grasping.  As of March 2, 2000, the employee’s neck pain was better, but he still had “some discomfort with rotating fully side to side.”  Dr. Oas continued the employee’s restrictions and advised him to return for a follow up the next week.

On March 9, 2000, Dr. Oas recorded that the employee had full range of motion and indicated that he could work without restrictions as of March 20, 2000.  However, on March 13, 2000, the employee notified Dr. Oas that his neck had gotten “really stiff” over the preceding weekend, and Dr. Oas consequently referred the employee for physical therapy.

On March 22, 2000, Dr. Oas reported that the employee’s neck pain was nearly gone.  However, noting that the employee had three sessions of physical therapy remaining, Dr. Oas continued the employee’s restrictions.  After a follow-up appointment on April 5, 2000, Dr. Oas allowed the employee to return to his usual work as a millwright, but the doctor also noted that the employee’s “neck pain [was] not totally gone.”  A month later, on May 4, 2000, Dr. Oas reported that the employee was “doing well,” that he had no restrictions, and that his neck was “doing ok.”  At that point, Dr. Oas discharged the employee from care, writing that he did not foresee any ongoing problems.

The employee continued to work at his usual job without further treatment until February of 2001, when he sought evaluation at Park Nicollet Clinic for bilateral arm numbness.  According to clinic notes, the employee reported having awoken with shoulder pain and bilateral arm numbness and tingling earlier that week, after having lain in bed for a couple of days.  The employee also mentioned his prior work-related neck injury.  Cervical x-rays showed mild degenerative changes at C6 and C7.  The doctor prescribed a Medrol Dosepak, writing that the employee would need further evaluation if his symptoms did not clear.  Notes from this and a subsequent visit reflect that the employee was not complaining of any neck pain at that time, and examination findings relative to the employee’s neck were normal.

On February 21, 2001, the employee underwent a cervical MRI scan, with contrast.  According to the radiologist’s report, the scan revealed a loss of cervical lordosis, “perhaps due to muscle spasm,” a broad-based disc bulge with shallow left paracentral herniation at C5-6, and a broad-based disc bulge and mild stenosis at C6-7.  An EMG was apparently within normal limits.

On March 4, 2001, a doctor at Park Nicollet called the employee “regarding physical therapy for his neck and arm pain.”  Two weeks later, on March 19, 2001, Dr. Mary Ann Ryken noted that the employee had normal, pain-free range of cervical motion and that his resolving bilateral arm numbness was probably related to “prolonged compressive positioning” from his time in bed the weekend before his symptoms began.  In early April of 2001, Dr. Ryken indicated that the employee’s condition was still apparently resolving.  She also reported that the employee had no functional deficits at that time.

In June of 2001, the employee saw Dr. Oas again.  While noting that he did not have all of the employee’s records, Dr. Oas concluded that the employee’s current symptoms were not related to the February 2000 work injury.
In August of 2001, the employee was still experiencing some upper extremity numbness, but the Park Nicollet doctor, this time Dr. Eric Shenk, found no evidence of neurological abnormality and indicated that the employee could return for additional care as needed.

On July 11, 2003, nearly two years after the end of his treatment for bilateral arm numbness, the employee consulted Dr. Oas again, complaining of neck cracking and pain over the previous four to five weeks.  The employee asked Dr. Oas if his neck symptoms might be related to his February 2000 work-related neck injury; Dr. Oas did not think so but deferred a final assessment pending review of the employee’s complete medical records.  On July 16, 2003, the employee returned to Dr. Oas with more severe symptoms, including radiating left arm pain.  Dr. Oas suspected a cervical radiculitis and informed the employee that he should see his own physician for treatment.  At that time, Dr. Oas reiterated that the employee’s neck condition was not related to the February 2000 work injury.

Also on July 16, 2003, the employee was seen at the Park Nicollet Clinic.  The physician’s assessment was neck pain with radiculopathy, and he scheduled an MRI scan.  That scan, performed on July 18, 2003, disclosed a herniated disc at C5-6, which had increased since the prior scan and was mildly indenting the spinal cord on the left, and slightly increased bulging and degenerative changes at C6-7.

On July 22, 2003, the employee was seen by Dr. Andrew J. Smith, another Park Nicollet physician.  In the history portion of the report from that consultation, Dr. Smith recorded as follows:

The employee made a good recovery following the surgery, testifying that he has no continuing neck or arm complaints whatsoever.  In November of 2003, he was released to return to his usual job as a millwright, with no restrictions.

The matter came on for hearing before a compensation judge on January 4, 2006, for resolution of the employee’s claim for temporary total disability benefits, permanent partial disability benefits, and medical expenses.  At hearing, the parties agreed that the employee had sustained an injury arising out of and in the course of his employment with the employer on February 19, 2000, and that the employee’s medical treatment had been reasonable and necessary.  The employer maintained, however, that the February 2000 injury was merely a temporary strain/sprain that did not contribute to the employee’s later disability or need for surgery.

At the beginning of the hearing, a discussion was had regarding the employer’s objection to medical bills from Park Nicollet, which did not intervene in the matter.  According to the claim summary, the employee was seeking payment of $9,615.90 in medical expenses for treatment at Park Nicollet; however, the actual bills from Park Nicollet reflected a balance of zero, either because Blue Cross/Blue Shield, which did intervene, had paid those bills, or because of an accounting practice by Park Nicollet applicable to overdue bills.  In any event, counsel for the employer contended that, given the unexplained discrepancies, a representative of Park Nicollet should be required to appear to explain exactly what had happened.  Counsel also requested the opportunity to take the deposition of Dr. Smith, the employee’s surgeon, post hearing.  That request was denied.  Evidence submitted at hearing included the employee’s medical records, a July 2, 2004, causation report by Dr. Smith, and an April 21, 2005, report from Dr. David Webster, the employer’s independent examiner.

In a decision issued on January 20, 2006, the compensation judge concluded that the employee’s February 19, 2000, work injury was a substantial contributing cause of the employee’s claimed temporary total disability, permanent partial disability, and need for medical treatment, including surgery.  The employer appeals.^[2]

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 (2004).  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 the 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).

In his July 2, 2004, report, Dr. Smith wrote as follows on the issue of causation:

On appeal, the employer acknowledges that conflicts in expert opinion are to be resolved by the trier of fact.  See Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985).  The employer argues, however, that Dr. Smith’s opinion is faulty because the doctor assumed that the employee had ongoing neck and arm symptoms after the February 2000 work injury, an assumption the employer contends is not borne out by the employee’s testimony or the medical records, and because it is unclear exactly which medical records Dr. Smith reviewed before rendering his opinion.  We are not persuaded.

Initially, we note that the employer did not object to Dr. Smith’s report at hearing.  As such, the alleged defects in that opinion go to weight, not foundation.  See Drews v. Kohl’s, 55 W.C.D. 33 (W.C.C.A. 1996).  As for the employer’s argument that it is not clear how familiar Dr. Smith was with the employee’s prior medical records or history, it is reasonably inferable, based on his report, that Dr. Smith reviewed most if not all of the records concerning employee’s treatment for neck and/or arm symptoms.^[3]  Finally, it may be true that the employee testified, on cross-examination, that he had not reported neck symptoms during his evaluation for arm pain and numbness beginning in February 2001.  However, at another point at hearing, the employee testified that he had been experiencing intermittent headaches, neck stiffness, and problems turning his head “every few days” or “on and off” by the time of his February 2001 treatment.  A judge is entitled to accept all or any part of a witness’s testimony.  City of Minnetonka v. Carlson, 298 N.W.2d 763, 767 (Minn. 1980).

As the compensation judge herself noted, the evidence in this case is “not overwhelming.”  However, even Dr. Webster, the employer’s independent examiner, did not rule out the work injury as the cause of the employee’s need for surgery, concluding instead that causation could not be determined.  Given the opinion of Dr. Smith, who was the employee’s treating surgeon, we cannot conclude that the judge’s causation decision is clearly erroneous or unsupported by the record as a whole.  We therefore affirm on this issue.

In her findings, the compensation judge determined as follows with regard to the Park Nicollet medical expenses claimed by the employee at hearing:

On appeal, the employer acknowledges that an employee may pursue payment of a medical bill, regardless of whether the medical provider has intervened in the proceedings.  See Adams v. DSR Sales, Inc., slip op. (W.C.C.A. Mar. 12, 2004).  The employer argues, however, that the judge erred in ordering payment to Park Nicollet and North Medical Clinic,^[4] because it is not possible to tell what charges remain outstanding.  Accordingly, the employer contends, “it cannot be determined the nature of the charges the clinics may claim,” and, “[i]f one cannot determine then the nature of the charges, one cannot determine the reasonableness and necessity nor causal relationship of those possible charges to any admitted work injury.”

The employer’s argument is not entirely without merit.  The evidence concerning the claimed medical expenses is rather vague, and counsel for the employer raised legitimate concerns at the beginning of the hearing before the compensation judge.  However, the employer also expressly agreed at hearing that the treatment at issue was reasonable and necessary; the only question was causation.  Now that causation for the employee’s neck condition and resulting surgery has been established, it should be a simple matter to determine the employer’s liability.  At the same time, the compensation judge’s decision is arguably too broad, in that she found all treatment to be causally related, without specific evidence to support that conclusion.  Therefore, to the extent that the compensation judge’s decision can be read to require the employer to pay medical expenses unrelated to the employee’s cervical condition, we modify that decision.^[5]