The employee appeals from the compensation judge’s finding that counseling for her chronic pain and depression is limited to a maximum of 12 sessions.  We affirm.

The employee sustained a work-related injury to her low back on June 27, 2001, while working for Casey’s General Store [the employer].  She underwent an anterior/posterior fusion in September of 2002, and a second surgery in October 2002, to relieve nerve impingement caused by a bone fragment.  The surgeries did not relieve her symptoms, and the employee has continued to experience low back pain that runs down into her legs and feet.  The employee has been rated as having a 21% permanent partial disability of the whole body and has been adjudicated to be permanently totally disabled.

The employee uses a TENS unit, takes medication, and has tried cortisone shots, a brace, and physical therapy to treat her condition.  The employee’s treating doctor, Dr. Struthers, recommended counseling.^[1]  The employee was seen by licensed psychologist Douglas Henning, at the Douglas County Hospital, on March 11, 2004.  The employee indicated that her reason for coming in was “really get frustrated, pain everyday.”  Her stated goal for treatment was to “learn coping skills to deal with chronic pain.”  Mr. Henning diagnosed the employee as having major depression, single episode, and chronic pain with psychological factors.  The employee has seen Mr. Henning for individual psychotherapy on more than 30 occasions since that time.  The employer and insurer paid for more than 25 of those sessions before discontinuing payment based on Minn. R. 5221.6600, subp. 2F(3), which provides for a maximum of 12 sessions.

The employee filed a medical request for payment of Mr. Henning’s outstanding charges and ongoing treatment.  The employer and insurer responded, in part, that the requested treatment exceeded that allowed by the treatment parameters.  When the matter proceeded to a medical conference, the employer and insurer prevailed.  The employee then requested a formal hearing, which was held on December 22, 2005.  In findings and order filed on January 23, 2006, the compensation judge found that there had been no request for a departure from the treatment parameters and that Minn. R. 5221.6600, subp. 2F(3), was controlling, and he denied the employee’s request for further counseling.  The employee appeals.

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).

The employee contends that the judge erred in finding that the employee’s treatment for depression falls under the treatment parameter dealing with chronic management.  We are not convinced.

While the employee alleges that Mr. Henning’s treatment is focused on “[the employee’s] depression with associated suicidal tendencies,” there is no evidence to support that argument.  Chronic pain is listed as a targeted problem on 26 of the 30 progress notes prepared by Mr. Henning.  Mr. Henning testified that the employee’s work injury was a substantial contributing factor in the employee’s development of chronic pain and depression, but he also testified that 80% of people who experience chronic pain “also have a diagnosable depression that goes along with that.”  He further testified that the chronic pain and depression are very related, that they “really are coexisting,” and “[s]o I think the chronic pain problems and her depression are intricately related within herself and they really are hard to separate from the other family issues.”  No evidence was submitted to establish that Mr. Henning is rendering different treatments for the different diagnoses, or that he has one treatment plan for chronic pain and a different one for depression.  In addition, while the employee testified that she has thought about suicide “quite a few times” and has talked to Mr. Henning about that, Mr. Henning’s progress notes each indicate either that there was “no indication” for a risk assessment of “suicidality” or that the employee denied suicidal thoughts.  And, in his deposition, Mr. Henning did not mention the employee having suicidal tendencies or that he was treating her in an attempt to prevent suicide.

Minn. R. 5221.6600 deals with “Chronic Management.” and provides in part as follows:

At oral argument, counsel for the employee argued that major depression, single episode, is not covered by this treatment parameter and that Minn. Stat. §176.135, providing generally for the provision of reasonable and necessary treatment, therefore governs.  We disagree.

Minn. R. 5221.6600, subp. 1, provides that an employee may be a candidate for chronic management if she continues with symptoms and physical findings after all appropriate nonsurgical and surgical treatment has been rendered and if her condition prevents the resumption of the regular activities of daily life.  Employee’s counsel agreed at oral argument that the employee is post- nonsurgical and surgical treatment, and the employee testified that she cannot do the household chores that she used to do, that she no longer has an active lifestyle, and that she is unable to work.  The employee has been adjudicated to be permanently totally disabled and testified that she receives social security disability benefits.  The employee clearly meets the criteria set forth in the treatment parameter for chronic management.

In addition, Minn. R. 5221.6600, subp. 2F(1), provides that individual psychological counseling is indicated if the employee has one or more of the problems listed in subp. 1A.  It is therefore apparent that this treatment parameter covers those “problems” listed in subp. 1A, and both depression and chronic pain syndrome are addressed in that subpart.

Finally, the fact that the employee has not been formally diagnosed with “chronic” depression is not determinative of the outcome here.  While Mr. Henning initially diagnosed the employee as having “major depression, single episode,” he acknowledged in deposition testimony that,

Because the employer and insurer have already paid for more than the 12 sessions allowed by the governing treatment parameter, and because there was no claim for a departure from this parameter, the judge’s decision denying payment for additional counseling sessions is affirmed.