The pro se employee appeals from the compensation judge’s denial of temporary total disability benefits and rehabilitation benefits resulting from alleged right lower extremity injuries on December 9, 1999, and/or December 28, 2005.  We affirm in part, vacate in part, and remand to the Judge for further consideration and additional findings.

Melvin A. Petrus [the employee], age fifty-nine at the time of the hearing below, began working for Minnegasco, n/k/a Center Point Energy, Inc. [the employer], on February 18, 1980.  He was hired into the employer’s training program, worked alongside licensed service technicians, attended school, and became a licensed gas fitter.  As a licensed gas fitter and customer service technician, his duties for the next twenty years involved delivering, installing, and servicing appliances, and they required frequent bending, stooping, twisting, and kneeling.

In about the summer of 1986, the employee began experiencing problems with his knees.  On August 13, 1986, after twisting his right knee while playing basketball, he was seen at Park Nicollet Medical Center, where he was diagnosed with a “1st to 2nd degree MCL sprain” and was given a knee immobilizer and prescribed two weeks of physical therapy.  Several years later, on about January 15, 1993, he injured his left knee while at work.  The employer admitted liability for the injury, and the employee underwent a partial medial meniscectomy on May 18, 1993, performed by orthopedic surgeon Dr. Joel Boyd.  Shortly after that surgery, the employee returned to light-duty work with the employer, and on July 19, 1993, he was released to return to work without restrictions by his family physician, Dr. Michael Schoenleber.  On August 9, 1993, Dr. Boyd rated the employee’s permanent partial disability at 3% of the whole body.

On July 5, 1994, the employee was evaluated at the Park Nicollet Urgent Care Center complaining of a one-week history of right knee pain.  He was diagnosed with tendinitis of the right knee and advised to avoid squatting and stairs.  The following week, the employee was seen in follow-up by Dr. Michael McGrail, to whom he reported an onset of right knee pain while walking from his truck at work.  He was treated conservatively with a knee immobilizer and was advised to ice the knee three to four times a day.  Within a month, the right knee had improved, and the employee was advised to gradually return to his usual service job.^[1]

The employee evidently got along well until December 20, 1994, when, noting no specific injury, he began to have pain in his left knee again.  A week later he was examined by orthopedist Dr. James Priest, who diagnosed “medial joint space arthrosis, status post-medial meniscectomy.”  He was placed on light duty and given a knee brace to wear.  On January 20, 1995, Dr. Priest released the employee with no limitations and with instructions to return to the clinic as needed.

The employee returned to Park Nicollet with bilateral knee complaints on March 19, 1996.  He provided a history of having difficulty straightening his knees following a kneeling episode while attempting to fix a washing machine.  He was diagnosed with a flare-up of “arthralgias” and restricted from kneeling or squatting.  On March 30, 1996, he was released to return to work without restrictions.

About three years later, in August of 1999, the employee was seen by Dr. Peter Koontz complaining of chronic soreness in his knees, with stiffness and tightness at the back of the them.  In a note dictated on August 26, 1999, Dr. Koontz reported that,

The following month, on September 17, 1999, the employee was seen at the Fairview Hiawatha Clinic, complaining of right knee pain stemming from an incident at work the previous day.  He reported that he was climbing into a truck, turned, rotated, and hyperextended his right knee.  He reported hearing a pop and having immediate pain.  He related that the pain had worsened over night and that he was now having trouble with weight bearing.  The doctor diagnosed right knee pain with “questionable MCL strain vs. medical meniscus tear” and recommended time away from work.

About a week later, the employer completed a First Report of Injury form related to the employee’s September 16, 1999, injury.  The injury was described as having occurred as the employee was replacing tools in his van, when his right knee “popped” while he was closing the van’s rear door.  The employer accepted liability for the injury and paid 1.2 weeks of temporary total disability benefits for the period of September 17, 1999, through September 28, 1999.

The employee returned to the Fairview Hiawatha Clinic on September 27, 1999.  He reported that he had been wearing a brace on his right knee and was now walking without difficulty, his pain coming mainly with bending and kneeling, which the doctor noted the employee did a lot of.  The employee’s diagnoses remained the same, and the doctor planned to send the employee to see orthopedist Dr. Thomas Raih for an evaluation, whom the employee had evidently seen before.

The employee was seen in follow-up by Dr. Koontz on October 13, 1999.  On that date, Dr. Koontz reported that “[t]hings are back to baseline which essentially means his knees hurt still, but not in the acute degree and severity that he had in September.”  The doctor recommended that the employee continue his use of Celebrex and reduce his trips up and down stairs.

The employee was seen again at the Fairview Hiawatha Clinic on November 8, 1999, by Dr. David Rosenbaum.  Dr. Rosenbaum noted that the employee was being seen because of pain in his right knee for which he had been seen previously by Dr. Vogt, Dr. Koontz, and Dr. Raih.  He noted that, when Dr. Raih had seen the employee, Dr. Raih had “indicated that this was degenerative joint disease and that if his symptoms did not respond to NSAIDS that he would be a candidate for steroid injection.”  Dr. Rosenbaum injected the employee’s right knee with a steroid, and the employee had immediate pain relief.  The doctor recommended that the employee continue with light duty.  When he saw the employee again on December 6, 1999, Dr. Rosenbaum noted that the employee had shown only minimal improvement from the steroid injection that he had administered.  He diagnosed severe osteoarthritis, noting that the employee “can stand up to 15 minutes with a rest, can walk at work, can sit at work, cannot bend knees or kneel or squat,” and he planned on another referral to Dr. Raih.

In about January of 2000, the employee’s job duties began to change as he began working in more of a mentoring capacity, accompanying new technicians on service calls and familiarizing them with service work.

On January 18, 2000, the employee reported to Dr. Rosenbaum that he had seen Dr. Raih, who had told him that he was currently not a candidate for any surgical procedure.  The employee also advised Dr. Rosenbaum that he had been working steadily but was finding great difficulty in kneeling.  He described his current job as mostly instructing and supervising others, supposing that he could continue with his usual duties as long as he did not have to kneel more than once an hour.  Dr. Rosenbaum completed a report of work ability, restricting the employee from kneeling more than once an hour.

On March 23, 2000, the employee was examined at the request of the employer and insurer by orthopedist Dr. Jeffrey Dick.  Dr. Dick obtained a history from the employee, reviewed medical records, and performed a physical examination.  The employee reported to Dr. Dick that he had worked for the employer as a service technician for twenty years, and he explained that he had had an acute onset of pain in his right knee when he twisted it while putting tools into his van on August 23, 1999.  The employee described his regular work as heavy, but he explained that he had been on light duty since his injury.  In his summary of the medical records, Dr. Dick noted that the employee had been examined by Dr. Raih on December 9, 1999, whose x-rays of both knees had showed moderate degenerative changes, worse on the left side than on the right.  Dr. Dick noted that Dr. Raih had recommended Celebrex, continued light duty, specific restrictions against bending, kneeling, and standing for long periods of time, and re-evaluation in three months.  Dr. Dick diagnosed bilateral osteoarthritis of the knees, concluding that the employee’s right knee condition had been aggravated by a work injury on August 23, 1999, but that that injury had completely resolved by October 13, 1999, when the employee returned to baseline.  He related the employee’s ongoing symptoms and any need for restrictions to a pre-existing degenerative condition of the knees and not to the work injury, recommending that the employee continue with light duty work.

On June 23, 2000, the employer completed a First Report of Injury related to a claimed December 9, 1999, right knee injury.  On that form, the injury was described as having occurred as a result of the employee’s “normal work activities including kneeling, bending, walking,” with a notation that the employee had “degenerative bone disease, arthritis in both knees.”

The employee returned to see Dr. Rosenbaum on July 6, 2000.  At that visit, the employee reported severe pain in both knees and inability to do his usual work.  Dr. Rosenbaum noted “definite hypertrophy of the synovia of both knees, more on the right than the left.  There is pain when he steps or bends, particularly after he’s been sitting.”  The doctor recommended a series of Hyalgan injections to the right knee and restricted the employee from standing more than fifteen minutes at a time and from bending his knees, kneeling, or squatting.  He indicated further that the employee was permitted to walk short distances of up to thirty yards and that he was not restricted from sitting.

In July or August of 2000, the employee was transferred to a light duty job for the employer known as the Appliance Repair City Desk position.  In this job, the employee worked at locating parts for service technicians and sometimes retail customers.  The job was primarily a desk job, performed with a telephone with headset and a computer, but on occasion the employee would be required to get up and retrieve parts from the parts department personally.  During his tenure in this position, the employee was provided with ergonomic modifications to his work station, including an ergonomically designed chair, an adjustable footrest, shelving that could be moved, and a monitor that could be raised and lowered.

The employee was evidently examined at the request of the employer on August 15, 2000, by Dr. Robert Gorman at Park Nicollet.  Dr. Gorman evidently concluded that the employee had “severe bilateral osteoarthritis of his knees” and could not continue to work as a repair person because of his knee pain.  Dr. Gorman evidently reviewed an analysis of the Appliance Repair desk position and offered the opinion that the employee could perform that job on an ongoing basis.^[2]

Dr. Rosenbaum completed a Health Care Provider Report at the request of the employer and insurer on August 25, 2000.  The doctor diagnosed right knee pain secondary to a strain or sprain that had occurred as the employee climbed into his truck.  He concluded that it was too early to determine whether the employee had sustained any permanent partial disability, and he did not respond to the question of whether the employee had reached maximum medical improvement.

On November 20, 2000, the employer and insurer filed a Notice of Insurer’s Primary Liability Determination, indicating that liability for a December 9, 1999, injury had been accepted and that temporary partial disability benefits had been commenced on August 21, 2000

The employee’s medical history with respect to his knees remained unremarkable for about the next five years, until June 29, 2005, when the employee was evaluated for bilateral knee pain by Dr. Paul Dworak.  The employee reported pain in both knees along with pain in his calf if he attempted to walk more than half a block.  The doctor noted that the employee is a diabetic and had sores over the pretibial region of his leg.  He reported symptoms of progressive left knee pain and others consistent with arterial vascular claudication.  Standing AP x-rays of the employee’s knees showed “severely advanced osteoarthritis of bilateral knees with total loss of the medial compartment joint space and advanced patellofemoral arthrosis with a varus deformity, left worse than right.”  The doctor concluded that the employee had an “end staged osteoarthritis” in his knees bilaterally, for which the only definitive treatment would be a total knee arthroplasty on the more symptomatic left knee.  One complication, however, he noted, was the apparent development of arterial insufficiency in the employee’s lower extremities.  The doctor later obtained arterial studies and concluded that vascular disease in the employee’s lower extremities was a significant impediment to surgery in that part of his body.

In December 2005, the employee handed an unsigned physician’s statement to the employer’s Disability Management Administrator, Rose Lusian, which he represented was from Dr. Schoenleber.  The statement indicates that the employee has significant restrictions, including a restriction against using the left hand more than two hours a day or the right hand more than four hours a day.  He also restricted the employee from lifting more than ten pounds, and he prohibited him from doing any bending, stooping, squatting, kneeling, carrying, or climbing.  At a meeting of the employee, Ms. Lusian, and the employee’s supervisor, Todd Norgren, the parties concluded that if the employee could not use his arms he could not perform the essential functions of his job at the Appliance Repair desk.  The employee then requested that he be placed on medical leave, and that request was granted by the employer.  At that point, the employee made application for long-term disability benefits with CIGNA.

On December 21, 2005, in a brief unaddressed letter separate from his office notes, Dr. Schoenleber reported that the disabilities and limitations documented on his recent medical report were permanent.  He stated that the employee has advanced arthritis in his knees but was prevented from having surgery because of peripheral vascular disease.  He stated further that the employee’s chronic pain in his knees and back prevented him from performing his job duties.

In a follow-up letter on January 9, 2006, addressed “Dear Reader,” Dr. Schoenleber wrote:

On April 17, 2006, the employee filed a claim petition for workers’ compensation benefits, alleging that he sustained injuries to his knees and back while employed by the employer and that he was entitled to temporary total disability benefits continuing from December 28, 2005.  He claimed injury dates of February 1, 1997, August 23, 1999, September 16, 1999, December 9, 1999, and a Gillette-type injury^[3] culminating on December 28, 2005.  In an amended answer to the claim petition filed August 3, 2006, the employer admitted a temporary injury on September 16, 1999, but it denied liability for the remaining alleged injuries.

At the request of the employer and insurer, the employee was examined by orthopedist Dr. Paul Wicklund on July 24, 2006.  Dr. Wicklund reviewed the employee’s medical records, performed an examination, and issued a report dated August 2, 2006.  He arrived at a number of diagnoses for the employee, including “degenerative arthritis, bilateral knees, with varus deformities.”  Dr. Wicklund did not specifically reference a 1999 right knee injury in the history or discussion portions of his report, but he did state,

On September 11, 2006, Dr. Schoenleber prepared a letter to the employee’s attorney regarding the employee’s disability and its relationship to his work.  The doctor reported that the employee “had a work-related injury to his right knee in 1999 and had subsequent arthroscopy.”  He went on to state,

The matter came on for a hearing before a compensation judge on September 12, 2006.  Prior to the start of the hearing, the employee apparently elected to withdraw his claims for injury to his back and left lower extremity.  He further narrowed his claim related to his right lower extremity to the alleged injury dates of December 9, 1999, and December 28, 2005.  The employer and insurer denied liability for the employee’s claimed 2005 Gillette injury, and they asserted that any payments related to the alleged December 9, 1999, injury were made under mistake of fact and law.  Issues presented to the compensation judge for determination were as follows: (1) whether the employee sustained a personal injury to his right lower extremity on either December 9, 1999 or December 28, 2005; (2) if so, (a) what is the nature of either injury; (b) is either injury a substantial contributing factor in the claimed temporary total disability benefits, continuing from December 28, 2005; (c) is the intervenor entitled to reimbursement; (d) are the employer and/or insurer obligated to provide an on-site job analysis and a functional capacities evaluation to the employee; and (e) did the employee give timely notice of the alleged December 28, 2005, injury to the employer.  In a findings and order issued November 13, 2006, the compensation judge found that the employee sustained a temporary injury in the nature of a strain to his right lower extremity in 1999, from which he recovered within a few weeks of the incident.  The judge found also that the employee “has not sustained any work related injury to his right lower extremity after 1999” and that the employee did give timely notice of his alleged Gillette injury to the employer.  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 (2006).  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 Notice of Appeal, the employee contends that the compensation judge “did not consider all aspect[]s of injur[ie]s acknowledged and disputed by Centerpoint [that] contributed to employee[’s] inability to perform job assigned.”  In response, we would note first of all that only the employee’s right knee condition and the claimed injury dates of December 9, 1999, and December 28, 2005, were at issue before the judge.  While the record undeniably reflects the employee’s long history of chronic back pain, any claim for benefits related to a back injury at work was withdrawn before trial.  Similarly, the employee’s claims regarding his left lower extremity were also withdrawn.

At Finding 41, the judge determined that “[t]he preponderance of the evidence is that the employee sustained a temporary injury in the nature of a strain to his right lower extremity in 1999 and that he recovered from the effects of that within a matter of a few weeks after that incident.”  Although the employee has appealed from “all” of the judge’s findings, his brief does not address this finding of the judge.  “Issues raised in the notice of appeal but not addressed in the brief shall be deemed waived and will not be decided by the court.”  Minn. R. 9800.0900, subp. 1.  That being said, we would point out that “[t]he burden is on the employee to prove by a fair preponderance of the evidence that [he] is entitled to workers’ compensation benefits,” Fisher v. Saga Corp., 463 N.W.2d 501, 501, 43 W.C.D. 559, 560 (Minn. 1990), and we find no clear evidence of a December 9, 1999, injury reflected in the medical records.

In finding a temporary injury, the judge evidently accepted the employee’s testimony regarding an incident on or about the date alleged but found no supporting evidence of its significance.  Given the sparsity of the evidence on this issue, the judge’s conclusion is reasonable.  In addition, the judge found Dr. Schoenleber’s opinion to be lacking on foundational grounds.  To establish an adequate foundation, the facts upon which an expert relies for his or her opinions must be supported by the evidence.  See McDonald v. MTS Sys. Corp., 43 W.C.D. 83, 87 (W.C.C.A. 1990), citing Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985).  In the present case, Dr. Schoenleber referred to a 1999 injury in his report of September 11, 2006, but he did not indicate when or how that injury occurred.  More importantly, he then mistakenly stated that the 1999 injury was followed by arthroscopic surgery.  Given the evidence submitted regarding the significance of the injury of December 9, 1999, the judge’s finding of a temporary injury is supported by adequate evidence in the record, and we affirm.

At Finding 42, the judge determined that “[t]he preponderance of the evidence is that the employee has not sustained any work related injury to his right lower extremity after 1999.”  The employee argues that his medical condition is not related to any one incident but to the steady degeneration of his knee caused by the physical stress of doing his job as a service technician for many years.  He argues that the judge’s analysis too narrowly focused on his work during the last five and one-half years of his employment rather than on the entirety of his work for the employer.  We agree.

A Gillette injury is a personal injury caused not by a specific event but by the effects of minute trauma over time.  That trauma results in a compensable injury when the cumulative effect is sufficiently serious to disable an employee from further work.  Gillette v. Harold, Inc., 257 Minn. 313, 318, 101 N.W.2d 200, 204-05, 21 W.C.D. 105, 110 (1960), citing Balow v. Kellogg Co-op. Creamery Ass’n, 248 Minn. 20, 24, 78 N.W.2d 430, 433 (1956).  In order to establish a Gillette injury, it is the employee’s burden to “prove a causal connection between [his or her] ordinary work and ensuing disability.”  Steffen v. Target Stores, 517 N.W.2d 576, 581, 50 W.C.D. 464, 467 (Minn. 1994).  A determination of a Gillette injury “primarily depends on medical evidence.”  Id.

In his opening statement to the compensation judge, counsel for the employee alluded to the employee’s long career as a customer service technician for the employer and to the physical requirements of that job.  Although it is apparent that the employee contended also that his condition progressively worsened after 1999, we do not believe the record as a whole can be construed to narrowly view the employee’s Gillette claim as encompassing only the last five and one-half years of his employment.  The issue for the judge was whether the employee’s work activities for the employer were a substantial contributing factor in causing, aggravating, or accelerating the employee’s degenerative arthritis in his right knee, not solely whether the work activities after 1999 played such a role.  It is apparent that both Dr. Schoenleber and Dr. Wicklund considered the employee’s work history in rendering their causation opinion.  We agree with the employee that the judge too narrowly construed the employee’s claim of a Gillette injury.  We therefore vacate Finding 42, and we remand to the compensation judge for reconsideration of the issue of the employee’s Gillette injury and the employer and insurer’s defenses.