The employee appeals from the compensation judge’s determination that the medical treatment at issue was not related to his 1986 work injury and from the resultant denial of the employee’s claim for medical expenses.  We affirm.

Hal Johnson sustained an admitted work injury to his right shoulder on September 25, 1986, while doing assembly work for SICO, Inc.  The employee initially treated at Park Nicollet Medical Center with Dr. Mark Engasser.  Dr. Engasser diagnosed right rotator cuff tendinitis and, in April 1987, advised the employee that he had no further treatment recommendations other than to modify his work activity.

The employee then saw Dr. Donald Miller, who performed two surgeries on the employee’s right shoulder.  The first, on January 5, 1988, was arthroscopic surgery in which an anterior acromioplasty and partial excision of the subacromial bursa were done.  The second surgery, on September 27, 1988, was an open anterior acromioplasty, and subacromial bursectomy.  The employee testified that he had substantial relief from the procedure.  The employee testified that Dr. Miller concluded he was at maximum medical improvement in early 1990 and placed work restrictions on the use of his right shoulder.  Dr. Miller’s diagnosis after the September 1988 surgery, was “1. Residual impingement syndrome right shoulder.  2. Symptomatic right acromioclavicular joint.”  According to Dr. Barron’s review of the records, Dr. Miller released the employee with restrictions of no lifting over 30 pounds and no repetitive lifting or reaching away from the body with the right arm.

In November 1989, the parties entered into a full, final and complete settlement of all claims related to the employee’s right shoulder injury with the exception of medical expenses.  An award on stipulation was issued November 15, 1989.

The employee testified that he did not treat for right shoulder problems between 1990 and 2004.  During that time, the employee saw his family doctors for a variety of health concerns and there is no reference in any of those records to right shoulder complaints.  The employee also had left shoulder problems during that time and Dr. Corey Welchlin at the Center for Specialty Care in Fairmont, Minnesota, did surgery on the employee’s left shoulder in October 1998 and April 1999.  There is no reference to any right shoulder complaints in those records. There is some indication that the left shoulder condition is the result of a work injury but there are no details in the record.

The employee testified that he had not worked since 1992 and relied upon VA benefits for post-traumatic stress disorder and Social Security Disability benefits for diabetes.  The employee stated that he had been compliant with the restrictions placed on the use of his right shoulder by Dr. Miller.

The employee testified that in 2004, he noted pain in his right shoulder after lying on it while he was sleeping.  The employee said the symptoms were the same as those that he had between 1986 and 1990.  After the pain progressed, he sought medical care and saw Dr. Emmett McEleney on July 16, 2004.  X-rays taken on that date showed post-surgical changes consistent with distal clavicle resection and findings of calcific tendinitis.  The employee’s complaints to Dr. McEleney were pain with lifting or overhead activities.  Dr. McEleney diagnosed right rotator cuff tendinopathy and recommended an MRI.

The MRI done on August 12, 2004, was read by Dr. McEleney as showing a rotator cuff tear, and Dr. McEleney recommended surgery.  In his chart note of August 16, 2004, Dr. McEleney commented on causation, stating “I do believe this is related to his original work-related injury, just a natural progression of his arthropathy/tendinopathy.”  No further discussion was provided.

Dr. McEleney did surgery on the employee’s right shoulder on September 2, 2004, performing “1. Repair right rotator cuff.  2. Decompression of subacromial space via Neer acromioplasty.”  While recovering from surgery, the employee apparently aggravated his shoulder during physical therapy.  Ultimately, Dr. McEleney diagnosed a recurrent rotator cuff tear and surgery was done on March 8, 2005, to repair the tear.
The employer and insurer denied liability for the employee’s surgery, and the employee filed a medical request on November 9, 2004, seeking payment of expenses related to the care and treatment for his right shoulder beginning in 2004.

The employee’s medical records were reviewed by Dr. Stephen Barron on behalf of the employer and insurer and he issued a report on December 9, 2004.  Dr. Barron concluded that “In my opinion the medical treatment for the right shoulder beginning in 2004 bears no relationship to the 1986 injury from which he reached maximum medical improvement on June 14, 1989, with an intact rotator cuff.  In my opinion, any changes seen on the MRI scan or any operative intervention for rotator cuff tear is not related to the specific incident of September 25, 1986, but to the natural progression of degeneration of the right shoulder which would bear no relationship to any work injury in 1986.”

The employee’s claim was heard by Compensation Judge William Johnson on April 26, 2005, with the record closing on May 27, 2005.  In his Findings and Order, served and filed July 14, 2005, the compensation judge denied the employee’s claims, finding that the employee failed to meet his burden in establishing causation between his work injury and the need for treatment in 2004.  The compensation judge adopted the opinion of Dr. Barron.  The employee appeals.

The issue before the compensation judge was whether the medical treatment received by the employee in 2004, including surgical repair of a rotator cuff tear, was causally related to his work injury in 1986.  In cases which are medically complex, a properly founded medical opinion providing a causal relationship is necessary.  Bender v. Dongo Tool Co., 509 N.W.2d 366, 49 W.C.D. 511 (Minn. 1993); Westling v. Untiedt Vegetable Farm, slip op. (W.C.C.A. April 29, 2004).  Such is the case here.

The compensation judge was presented with two medical opinions on the issue of causation.  Dr. McEleney, in his chart note of August 16, 2004, stated the condition was related to the work injury, “just a natural progression of his arthropathy/tendinopathy.”  Dr. Barron, in his report of December 8, 2004, concluded there was no causal relationship.  The compensation judge accepted the opinion of Dr. Barron.

We find evidence in the record which supports the compensation judge’s conclusion that Dr. Barron’s opinion was more persuasive.  Dr. Barron reviewed the medical records from the employee’s treatment in 1986 through 1990.  There is no indication that Dr. McEleney had those records available or reviewed any previous medical records.  The diagnosis from 1986 through 1990 was of impingement syndrome and the MRI done in 1989 showed no residual impingement.  Dr. Barron found that factor to be of significance in reaching his opinion while Dr. McEleney did not explain how the 1989 findings were consistent with his opinion.

In his decision, the compensation judge referred to Dr. McEleney’s lack of explanation for his opinion as a reason for not accepting that opinion.  On appeal, the employee argues that, in so doing, the compensation judge required a standard of proof from the employee which was not expected from the employer and insurer since Dr. Barron, according to the employee, also failed to provide an explanation for his opinion.  This argument confuses a standard of proof with persuasiveness.

Since Dr. McEleney apparently had adequate foundation for his opinion, his bare statement that the employee’s present condition was causally related to the 1986 work injury may serve as support for the employee’s claim.  It is a rare case, however, where a party’s medical opinion is unopposed.  In the present case, the employer and insurer presented a well-founded medical opinion in opposition to that presented by the employee.  The question for the compensation judge at that point is which opinion is more persuasive.  The compensation judge found Dr. McEleney’s opinion less persuasive and it was appropriate for him to identify one of the reasons he found it to be so.  The compensation judge did not determine that the employee failed to meet a required standard of proof; the compensation judge determined that the medical opinion offered by the employee was less persuasive than the medical opinion offered by the employer and insurer.

The employee also argues in his brief that his right shoulder problems in 2004 were the natural consequences of his left shoulder problems and surgery in 1998 and 1999.  For support, the employee cites to a number of cases which it is argued stand for the proposition that the natural consequences flowing from a work injury are compensable as well.  There is, however, no evidence at all in the present case that the 2004 symptoms were related in any way to the left shoulder surgery five years previously.  The employee’s testimony that he began sleeping on his right side after his left shoulder surgery does not establish a causal relationship in the absence of any evidence as to how that activity led to the right shoulder symptoms.  Simply because the right shoulder symptoms in 2004 followed chronologically the left shoulder surgery in 1999 does not establish, by itself, a causal relationship.

We agree with the employer and insurer that this case is essentially one which involves the compensation judge’s choice between competing medical opinions.  Making that choice is uniquely within the province of the compensation judge and a decision which follows from the acceptance from one of the competing opinions will generally not be reversed by this court.  Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985); Bushong v. Georgia Pacific Corp., slip op. (W.C.C.A. January 14, 2003).  The decision of the compensation judge is affirmed.