The employer and insurer appeal from the compensation judge’s finding that the employee’s congenital condition was aggravated or accelerated by the employee’s May 27, 2004, work injury.  We affirm.

The employee was working for Pro Floor, Inc. [the employer], as a carpet installer on May 27, 2004, when he felt a pop in his neck and left shoulder while loading a roll of carpet pad into a van.  He subsequently developed pain, which worsened over the next few days.  On May 30, 2004, the employee sneezed and the pain increased.  He sought treatment at Urgent Care on May 31, 2004, and was diagnosed with a left trapezius strain.

On June 2, 2004, the employee was seen by Dr. Peter Marshall, who treated the employee for a trapezius strain, recommended light-duty work, and ordered physical therapy.  Three months later, the employee asked for a second opinion, and Dr. Marshall referred him to neurologist Dr. Dianne Wolf, who examined the employee on October 13, 2004.  At that time, the employee complained of pain in the left trapezius area and in the neck.  Noting sensory loss over the left shoulder and up to the face, Dr. Wolf diagnosed a left trapezius strain and ordered an MRI.

The MRI was performed on November 8, 2004, and the employee returned to Dr. Wolf on December 19, 2004, at which time she informed him that the MRI revealed a Chiari type I malformation^[1] and a syrinx^[2] in the cervical cord from C3 to T3.  She referred the employee to a neurosurgeon.

The employee was seen by neurosurgeon Dr. Andrew Freese on January 13, 2005.  Dr. Freese reviewed the MRI and noted a “significant syrinx extending through multiple levels, as well as evidence of a Type 1 Chiari malformation, with significant extension of the cerebellar tonsils below the foramen magnum.”  Dr. Freese recommended surgery.

On May 4, 2005, Dr. Freese wrote to the employee’s attorney, explaining that the employee’s Chiari abnormality was “congenital”and had been present for a significant period before the work injury but that the employee had been asymptomatic prior to that injury.  It was Dr. Freese’s opinion that the employee’s condition had been significantly exacerbated and aggravated by the work injury.

On May 22, 2005, the employee filed a medical request and a claim petition seeking temporary total disability benefits continuing from January 13, 2005, outstanding medical expenses, and payment of the proposed surgery.  The employer and insurer disputed the employee’s claims and had the employee examined by Dr. Mark Larkins on May 7, 2005.  In his report of May 25, 2005, Dr. Larkins opined that Chiari malformation is a congenital malformation that was not caused by the injury of May 27, 2004.

The claim petition and medical request proceeded to hearing.  In findings and order filed on August 12, 2005, a compensation judge determined that the employee’s condition had been aggravated or accelerated by the work injury and ordered payment of temporary total disability benefits and the proposed surgery.  The employer and insurer appeal.

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).

On appeal, the parties agree that Chiari malformation is a congenital condition and that the employee requires surgery to treat this condition.   The employer and insurer argue, however, that the compensation judge,

We acknowledge that, in her office note of December 9, 2004, Dr. Wolf characterized the Chiari malformation with syrinx as “a personal health issue.”  However, Dr. Wolf went on to state that the condition “became symptomatic with a work-related incident.”  Similarly, Dr. Larkins testified that the employee’s work injury caused the Chiari malformation to become symptomatic and that he did not disagree that the work injury accelerated the employee’s shoulder, facial, and neck symptoms.

Moreover, the records of Dr. Freese clearly state that, while the employee’s Chiari malformation was not caused by the work injury, it was substantially aggravated or accelerated by that event.  Dr. Freese also indicated that the proposed surgery “has a significant chance of improving [the employee’s] symptoms.”^[3]  While the employer and insurer hint at foundational deficiencies in Dr. Freese’s opinion, we find none.  According to his letterhead, Dr. Freese is a professor at the University of Minnesota and Vice Chairman and Director of Spinal Neurosurgery.  Clearly he has the training and education to render a medical opinion on this issue.  In addition, his records reflect that he had an adequate history of the employee’s injury and knowledge of the employee’s prior treatment.  The compensation judge expressly adopted the opinion of Dr. Freese, and the judge’s choice between expert opinions is generally upheld unless the facts assumed by the expert in rendering his opinion are not supported by the evidence.  Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985).

The employer and insurer’s second argument on appeal is that the compensation judge erred “by improperly considering evidence submitted by the employee after the record closed on June 26, 2005.”  In making this argument, the employer and insurer refer to an August 2, 2005, report by Dr. Freese.  The compensation judge did not mention this report in his findings and order, and the report is not in the file.  We therefore find no basis to conclude that the judge improperly relied on evidence outside of the hearing record.

An employee need not prove that a work injury is the sole cause of his or her disability, see, e.g., Swanson v. Medtronics, 443 N.W.2d 534, 42 W.C.D. 91 (Minn. 1989), and, if a work injury combines with a pre-existing condition to produce disability, the entire disability is compensable, Vanda v. Minn. Mining & Mfg. Co., 300 Minn. 515, 218 N.W.2d 458, 27 W.C.D. 379 (1974).  In the present case, the opinion of Dr. Freese adequately supports the compensation judge’s decision that the employee’s work injury substantially aggravated the employee’s pre-existing congenital condition, substantially contributing to the employee’s disability and need for surgery.  We therefore affirm the judge’s decision in its entirety.