The employer appeals from the compensation judge’s finding that the employee’s work injury is a substantial contributing cause of an aggravation to her psychological condition. The employer further appeals from the findings determining the extent of the employee’s permanent partial disability both for her psychological condition and for a non-work-related condition potentially relevant to the issue of the employee’s threshold disability under Minn. Stat. §176.101, subd. 5(2). We affirm.

The employee, Theresa Danielson, began working for the self-insured employer, Range Regional Health Services, in 1998 as a food service worker. In 2002 she was assigned to work in a coffee shop in the Hibbing Hospital. On June 18, 2004, the employee sustained an admitted injury to her right shoulder when the shoulder “locked up” while she was attempting to pull on a stuck lever on an espresso machine.

The employee was initially treated by her family doctor with ibuprofen and physical therapy, and placed under work restrictions which resulted in her being off work. She continued to experience popping, clicking and tenderness in the right shoulder, and was diagnosed with a chronic impingement of the shoulder. She was referred to Dr. Daniel Lister, an orthopedic surgeon, who diagnosed an impingement syndrome of the right shoulder and recommended arthroscopic surgery.

On August 2, 2004, the employee underwent arthroscopic debridement of the shoulder and subacromial decompression. After this surgery, the employee at first showed some improvement, but by the fall of 2004, she was again having problems with catching and clicking in the shoulder. The employee was referred to another orthopaedic surgeon, Dr. Patrick G. Hall. Dr. Hall treated the employee with a subacromial injection on November 4, 2004, but this did not bring relief, and on December 9, 2004, Dr. Hall suggested further surgery.

On December 8, 2004, the employee was seen by Dr. Randall LaKosky, a psychiatrist at the Range Mental Health Center. The employee’s presenting complaints were stress and anxiety. She showed no obvious depression. The employee had previously treated at the Range Mental Health Center in 1993 for anger and insecurity associated with relationship problems, and again there with Dr. LaKosky from 1995 to 1997 for chronic phobia and migraine headaches following an automobile accident. She subsequently had sought no treatment for seven years. Dr. LaKosky diagnosed her with a generalized anxiety disorder and prescribed Klonopin.

On January 27, 2005, the employee returned to see Dr. LaKosky and stated that her anxiety and insomnia had improved. Dr. LaKosky wrote that the employee was “in good remission” of her anxiety disorder. He asked her to return in one month for a review of her medication.

On January 28, 2005, Dr. Hall performed surgery on the employee’s shoulder in the form of a right glenohumoral arthroscopy with a right shoulder subacromial athroscopy, bursectomy, a resection of the coracoacromial ligament, and an open distal clavicle excision. The employee made objective improvement but continued to complain of shoulder pain. She reported feeling small painful lumps at the site of the excision surgery. On April 21, 2005, Dr. Hall performed a minor surgical procedure during which he removed a tissue mass which he believed to be consistent with a small ganglion cyst.

The employee was seen again by Dr. LaKosky in May 2005. Her anxiety level was now higher again. She expressed concerns over the treatment for her work injury, and was having further financial and domestic problems with her husband, from whom she had just separated.

The employee continued to report pain and locking up of her right shoulder, and complained of weakness and limited motion. She was referred to Dr. Timothy Morton at the Duluth Clinic. Dr. Morton noted that the employee’s shoulder pain was severe and was limiting her progress in therapy. He diagnosed chronic right shoulder pain. On July 13, 2005, Dr. Morton told the employee that it was unlikely that further surgery would alleviate her symptoms. He referred her to Dr. Matthew Monsein for a chronic pain program. The employee cooperated with the pain program, but failed to improve significantly.

On August 19, 2005, the employee was seen again by Dr. LaKosky. She was still having considerable problems with anxiety, and now reported a small level of depression “because of all the trouble she is having trying to get her shoulder back to where it was.” She complained that surgeons seemed unwilling to fix her shoulder, and were merely sending her for pain management. Dr. LaKosky diagnosed the employee with an anxiety disorder which had been “in up and down remission.”

The employee returned to Dr. LaKosky for a medication review on September 28, 2005. She reported being more depressed and anxious, with problems sleeping, and described several complaints she had about the treatment she had received for her shoulder. Dr. LaKosky speculated that she might be developing a post-traumatic stress disorder.

On November 23, 2005, the employee was seen by Dr. LaKosky and reported continuing trouble with chronic pain. She reported that she had recently seen another physician who told her that further surgery would not benefit her shoulder. Dr. LaKosky noted the employee to be significantly depressed.

Also in late November 2005, the employee experienced a “snap” in her upper right extremity. She was seen in urgent care and had additional diagnostic testing. Dr. Morton concluded that she had re-injured her right shoulder. On December 16, 2005, he wrote that “it is difficult to imagine that the patient would tolerate a regular work schedule of any kind (including sedentary work).” He opined that the employee had reached maximum medical improvement.

The employee was examined by Dr. Scott Yarosh, a psychiatrist, on December 20, 2005, on behalf of the self-insured employer. Dr. Yarosh expressed the view that the employee had “a fragile and relatively weakened character structure” which was “more susceptible to longer term duration of physical symptoms” following an injury. He agreed that the employee suffered from chronic pain syndrome that developed following her 2004 work injury. He also believed that the employee’s emotional status had been “destabilized” following the work injury, but opined that no more than a three-month period of psychological destabilization could reasonably be attributed to the accident. In his view, the employee’s psychological problems thereafter were solely the result of the multiplicity of other ongoing stressors in her life. Dr. Yarosh did not consider the employee’s psychological condition to be of a severity such as to disable her from employment.

Over the first several months of 2006, Dr. LaKosky saw the employee several times and noted that she continued to be significantly depressed. She was now taking Adderall, an antidepressant, and had reported that this was giving some relief.

The employee returned to Dr. Morton in May 2006. Dr. Morton’s examination revealed multiple trigger points along the right cervical musculature, right lateral middle trapezius, and right triceps. The employee was only able to abduct her right arm to about 90 degrees. Cervical horizontal rotation was limited bilaterally. Dr. Morton’s diagnosis was of chronic right shoulder pain with secondary myofascial pain and depression. He suggested trigger point injections. The injections were performed on May 30, 2006, but failed to provide relief.

In a letter dated May 30, 2006, Dr. LaKosky wrote that the employee’s longstanding anxiety disorder had been aggravated by her work-related shoulder injury, and that the work injury had caused the addition of a chronic pain syndrome and major depression. Although he viewed the depression as minimally in remission, he did not think that there would be a full remission of the depression in the foreseeable future. He did not consider the employee psychologically capable of engaging in sustained employment.

The employee’s shoulder continued to be followed by Dr. Morton, whom the employee saw periodically through June 6, 2006. She continued to show multiple trigger points in the musculature on and adjacent to the right shoulder. Dr. Morton offered the opinion that the employee was unemployable due to her chronic pain.

On August 6, 2006, Dr. LaKosky wrote a letter providing a Weber^[1] rating for the employee’s depression of 30 percent, considering it more severe than conditions rated at 20 percent under Minn. R. 5223.0360, subp. 7D(2), but less severe than conditions rated at 40 percent under subpart 7D(3) of the same rule. He noted that the employee’s depression was in partial remission, but that she could expect to have ongoing problems with it. The doctor offered the opinion that the depression was causally related to the employee’s work injury and subsequent shoulder problems, the failure of surgery to relieve her shoulder condition, and her consequent inability to work at her previous job.

The self-insured employer paid the employee permanent partial disability based on a three percent permanency rating made by their examining physician, Dr. Richard Strand. They also paid temporary total disability compensation through June 2006, at which point the employee had reached 104 weeks of temporary total disability and her entitlement to that benefit ceased.

The employee then filed a claim petition alleging that she was permanently and totally disabled. She claimed further permanency for the right shoulder based on a rating made by Dr. Morton, as well as a 30 percent permanent partial disability for her depression, consistent with the Weber rating given by Dr. LaKosky. In addition, the employee asserted that she was subject to further ratable disability based on a non-work condition, relevant to the question of whether the employee met the threshold disability requirements for permanent total disability under the Workers’ Compensation Act. The employer denied that the employee was permanently totally disabled and disputed both the permanency ratings claimed and causation for any consequential psychological condition.

The Minnesota Department of Human Services made assistance payments to the employee in January and April 2007, totaling $530.07. The department intervened seeking reimbursement from any benefits awarded to the employee.

The matter came on for hearing before a compensation judge on June 21, 2007. Following the hearing, the judge found that the employee was not permanently totally disabled and that she had not proven any additional permanent partial disability relative to her shoulder condition. The judge found that the employee had sustained a consequential psychological injury, and rated that condition at 20 percent permanent partial disability. The judge also found that the employee had established that a 22 percent permanency rating was warranted by her non-work condition. The judge also ordered that the intervenor, Department of Human Services, be reimbursed the assistance payments made to the employee out of the permanency awarded. The self-insured employer appeals.

Dr. LaKosky offered the opinion that the employee’s work injury was a substantial contributing cause of her psychological condition. The compensation judge accepted Dr. LaKosky’s expert psychological opinion. Questions of medical causation fall within the province of the compensation judge. Felton v. Anton Chevrolet, 513 N.W.2d 457, 50 W.C.D. 181 (Minn. 1994). It is the function of the compensation judge to resolve conflicts in expert medical testimony, and his choice of expert opinion is usually 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). Where evidence is conflicting or more than one inference may reasonably be drawn from the evidence, the findings of the compensation judge are to be upheld. Redgate v. Sroga’s Standard Serv., 421 N.W.2d 729, 734, 40 W.C.D. 948, 957 (Minn. 1988).

The appellant, however, contends that the compensation judge’s finding of causation for the employee’s psychological condition must nonetheless be reversed. The appellant points out that the compensation judge denied additional permanent partial disability the employee had sought for the shoulder injury, finding that, despite the employee’s claims of debilitating physical symptoms, there was insufficient objective evidence of an anatomic condition sufficiently extreme to explain the level of symptoms necessary for the further rating under the permanency rules. Citing Westling v. United Vegetable Farms, slip op. (W.C.C.A. Apr. 29, 2004), as a factually similar case, the appellants contend that the employee failed to show by objective clinical findings that her claimed extent of right upper extremity and shoulder pain and limitations were the result of the 2004 work injury, and thus that a psychological injury consequential to those factors was itself related to the injury.

We disagree. This case resembles Westling only in superficial details. There, the employee’s work injury was a fungal infection, sporotrichosis, which at first caused swelling and pain in his left forearm. These symptoms gradually abated with treatment and the employee’s physicians concluded that the infection was over. Subsequently, the employee developed a severe arthropathy with pain in his left ankle, left knee, left hip, and right shoulder, and crepitus in both knees. His physicians attributed these symptoms to an unknown etiology. The employee also developed a consequential pyschological condition causally related to his new symptoms. The compensation judge found that the work injury was a substantial contributing cause of the psychological condition, although there was no medical opinion relating the new symptoms to the employee’s earlier fungal infection. This court reversed, holding that in cases involving medically complex or uncommon conditions, a compensation judge’s expertise alone was insufficient to permit a finding of causation in the absence of supporting expert medical opinion.

Unlike Westling, there is here no dispute that the employee has ongoing disability from an admitted work injury. The question on which the judge found insufficient objective evidence was solely one of the severity of her symptoms, and whether they warranted an award of permanency greater than that which the employer conceded was payable. We do not see the judge’s findings on that issue as necessarily inconsistent with the finding that the effects of the work injury were still sufficient to support a causal link between the physical injury and a consequential psychological condition.

The employer further contends that the compensation judge’s decision on causation was based on an erroneous view of the record and thus unsupported by substantial evidence. Specifically, they point to language in Finding 31 in which the compensation judge found that the employee had undergone prior psychological treatment for phobia and anxiety, but that she “had never undergone psychiatric care or treatment for depression” prior to the date of her work injury. The employer cites to a chart note by Dr. LaKosky from September 20, 1995, during the employee’s treatment for an anxiety condition, in which he noted that the employee “is becoming quite depressed and nervous secondary to marital problems” and that he was “going to add an antidepressant . . . and refer her for some counseling.”

We note, however, that Dr. LaKosky was specifically asked in his deposition testimony to explain his statement that he had not previously diagnosed the employee with a significant depressive disorder before the shoulder injury, in light of these very chart notes. He responded that there was a distinction between brief periods of situational depression, and clinical depression as defined by “the DSM,”^[2] which required that there be severe depression for at least two weeks. Dr. LaKosky testified that the employee, prior to her work injury, had not exhibited a condition of clinical depression, despite having had some very short episodes of feeling depressed in response to her marital situation at that time. In Finding 32, the compensation judge phrases essentially the same finding in terms which appear to distinguish between transitory and clinically significant levels of depression, stating that “the employee now, for the first time, suffers Major Depression with anxious features” (emphasis added). As the judge’s findings may have been based on the distinction between short-term depression and clinical depression as offered by Dr. LaKosky, we cannot conclude that these findings were clearly contrary to the evidence.

In addition, the lack of earlier treatment for clinical depression was only one of several factors on which the compensation judge relied in deciding to adopt Dr. LaKosky’s opinion on causation. The judge noted that both Dr. LaKosky and the employer’s psychiatric examiner, Dr. Yarosh, considered the employee to have a relatively fragile personality with a greater susceptibility to developing psychological ramifications from even relatively minor difficulties. In his memorandum at page 12, the judge particularly discusses the employee’s lack of any psychological treatment from 1997 to 2004, and her gainful employment during that period, which he considered demonstrated that she had been able to handle the other stressors in her life until the effects of the work injury were added.

Overall, we conclude that the compensation judge’s finding that the employee’s work injury was a substantial contributing cause of her psychological condition is supported by substantial evidence, and affirm.

Dr. LaKosky offered a Weber rating assessing permanency for the employee’s consequential psychological condition at 30 percent, considering it worse than conditions rated at 20 percent under Minn. R. 5223.0360, subp. 7D(2), but less severe than conditions rated at 40 percent under subpart 7D(3) of the same rule. The compensation judge found that the employee’s condition was consistent with the 20 percent rating under subpart 7D(2).

The employer appeals the rating on the basis that Minn. R. 5223.0360, subd. 7, is the rule applicable to the rating of an organic brain injury, and expressly does not apply to primary psychiatric disturbances. They further argue that the rating must be reversed in that the employee’s condition does not meet the rule’s requirement that “mild emotional disturbances be present at all times . . . ,” contending that the evidence indicates that the employee’s condition waxes and wanes and that there are brief periods of remission.

The rating in this case, however, was made pursuant to Weber and Minn. Stat. § 176.105(1)(c), as the disability schedules do not include a schedule for rating the employee’s psychological condition. We have previously upheld the use of Minn. R. 5223.0360 as a basis for a Weber rating of psychological condition, including depressive disorders. See, e.g., Fossey v. K-Mart Corp., slip op. (W.C.C.A. Aug. 21, 2002). As we have frequently held, and again noted in that case,

The judge also found that the employee had established that a 22 percent permanency rating was warranted by a non-work condition diagnosed as a pelvic floor dysfunction. The question of a rating for this non-work condition was raised solely for the purposes of determining whether the employee met the disability threshold requirements for permanent total disability.^[3] The rating was made pursuant to Minn. R. 5223.0590, subp. 4C, which requires that conditions under its scope exhibit signs of organic disorder with anatomic loss or alteration. The appellants argue that, as no gross anatomic changes were found in the examination of the affected areas, the medical evidence fails to demonstrate that these factors were met. We note, however, that anatomic alteration need not require gross physical changes, and that where more subtle changes are involved in an organic disorder, these may be demonstrated inferentially by indirect testing results, such as EMG studies. Here, we note that the employee’s non-work condition exhibited abnormal results in several indirect measures of anatomic function which were interpreted by the employee’s physicians as consistent with their diagnosis of her condition. See, e.g., the testing results for manometry, dynamic MR fluoroscopy, and EMG testing, as described at various places in Exh. T. In light of these test findings, and of the medical records on this condition taken as a whole, we cannot conclude that the compensation judge’s rating was clearly erroneous or unsupported by substantial evidence.

An intervenor, the Minnesota Department of Human Services, paid the employee subsistence benefits during January 2007 and emergency assistance in April 2007. The compensation judge ordered that the employer reimburse the intervenor for these payments from the permanent partial disability benefits awarded to the employee. The appellant argues that the intervenor’s payments are not subject to reimbursement. The employer contends that the employee was not entitled to, and was not awarded, wage loss benefits for the months in which the intervenor made the payments, but was awarded only permanent partial disability compensation. Characterizing the basis of any reimbursement as a matter solely of avoiding an employee’s double recovery, and further viewing the payments made to the employee by the Minnesota Department of Human Services as essentially the equivalent of wage benefits, they argue that there is no basis for reimbursement to the intervenor department in this case.

We disagree and affirm the compensation judge. Minn. Stat. § 176.191, subd. 4, governs reimbursement to the Department of Human Services from a workers’ compensation award. That statute provides, in pertinent part, that

The express language of this statute clearly requires that amounts paid to an employee pursuant to a program administered by the Department of Human Services as the result of the effects of an injury subsequently found compensable under the workers’ compensation act must be reimbursed from any award of workers’ compensation benefits, expressly including permanent disability. It appears from this language that the intent of the statute was to create what is, in essence, a lien on workers’ compensation benefits in favor of the Department of Human Services. We therefore affirm the order reimbursing the department from the permanent partial disability awarded.