The employee appeals from the compensation judge’s findings that the employee did not sustain an injury to his low back on March 7, 2005, or a Gillette injury to his low back on September 13, 2005, or February 7, 2006.^[1]  The employee also appeals the compensation judge’s determination that he did not sustain an injury to his neck on March 7, 2005.  The employee further appeals from the denial of temporary total disability benefits, of rehabilitation services, and of certain expenses.  The employer and insurer have cross-appealed the compensation judge’s award of medication expenses related to hypertension and the award of expenses for a neuropsychological evaluation.  We affirm.

Daniel C. Lagergren began working for Minnegasco in 1976.  By March 2005, Minnegasco was Centerpoint Energy and Mr. Lagergren was employed as a crew leader in the installation division of Centerpoint in Alexandria, Minnesota.  The employee’s division was involved with construction and maintenance for the employer.  As a crew leader, the employee’s duties were varied and could include operating equipment such as trucks and backhoes, hand digging with a shovel, doing paperwork, drafting, and locating gas lines.  Generally, the employee worked in a two or three-person team and most of his work was done in the field.

The employee was injured on the job on March 7, 2005.  The employee had no recollection of his injury but it appears that he fell off a ditch witch that was being loaded on a trailer.

The employee was brought to the Alexandria Clinic by a supervisor.  The employee complained of headaches and right shoulder pain but had no complaints of back or neck pain.  A CT scan of the head was done which showed a subarachnoid hemorrhage.  In addition, the employee was diagnosed with a right shoulder contusion, right clavicle fracture, and contusion of the chest wall.  The employee was transferred to St. Cloud Hospital for further treatment.

The employee was admitted to St. Cloud Hospital on March 7 with a chief complaint of confusion and traumatic head injury.  The symptoms related by the employee on admission were of a mild posterior headache, right shoulder pain, and some right-sided rib pain.  There were no complaints of breathing difficulties, chest pain, upper back pain, or pain in his legs, arms or lower back.  The employee was seen on March 8 by Dr. Anthony Bottini for a neurological consultation.  Dr. Bottini concluded the employee had “evidence of left temporal contrecoup contusion, a small amount of subarachnoid  hemorrhage without neurologic deficit.”  The employee was discharged on March 10 and advised to followup with Dr. Bottini in two weeks for a repeat CT scan.  He was advised not to drive.

The employer and its workers’ compensation insurer accepted liability for the March 7 injury and began paying workers’ compensation benefits, including temporary total disability benefits.

The employee was seen by Physician’s Assistant Lorinda Zigan at Dr. Bottini’s office on March 28, 2005.  The repeat CT showed evidence of resolving left temporal lobe contusion and no evidence of new hemorrhage or significant edema.  The employee reported symptoms of daily headaches and blurred vision in his left eye.  The employee’s pain medications were changed and he was told not to work or drive until six weeks from the injury.  The employee had also reported numbness on his anterior left thigh and P.A. Zigan concluded that this represented meralgia paresthetica.

The employee returned to see P.A. Zigan on April 18, 2005.  He reported that his headaches had improved, but that they still occurred on a daily basis.  He still reported considerable pain from his clavicle fracture and still had blurred vision in his left eye.  He was continued in his off-work status because of his right arm and it was noted that, “per head injury I think he has recovered quite well.”  A referral to ophthalmology was made for the burred left eye vision.  The employee was discharged from neurosurgery care.  The ophthalmology exam was normal.

Because of his continuing right arm pain, the employee was referred to Dr. Patrick Hurley at Alexandria Orthopaedic Associates.  In his assessment following the visit on May 20, Dr. Hurley diagnosed a closed fracture of the clavicle and recommended the use of a bone stimulator.  The employee was also told to use a sling and was released to work with restrictions of no lifting over five pounds with his right arm and no use of his right arm over waist level.  The employee also advised Dr. Hurley that he had experienced two episodes of memory loss since the work injury, and Dr. Hurley recommended that he see his family physician for this problem.

The employee returned to work for the employer on May 31.  The employer, as part of its union contract, had a program to return injured employees to employment within their restrictions and the employee was given a number of light-duty tasks to perform at the Alexandria facility.  He was paid his usual wage and temporary total disability benefits were discontinued.

The employee returned to see P.A. Zigan on June 15, 2005, for evaluation of his claimed memory loss.  The history taken on that date indicates he had no pain or weakness in his lower extremities, no pain in his neck or radiating into his arms, no vision difficulties, and no headaches.  He continued to have pain in the right clavicle and he reported that his memory difficulty consisted of forgetting people’s names and losing his train of thought in conversation.  P.A. Zigan recommended referral to neurology for further workup of this issue.  The employee was otherwise released to return to work with no restrictions.

On June 17, 2005, the employee saw Dr. Kevin Xie for a neurological consultation.  The history he provided to Dr. Xie was of experiencing language difficulty; he would forget what he needed to talk about and it would take a “long time for the words to come out.”  There were no other complaints and the physical examination was normal.  Dr. Xie made no diagnosis and recommended an MRI and EEG.  Dr. Xie also recommended that the employee not drive for six months after the work injury.  No MRI took place, apparently because the employee had wire in his jaw from an earlier motor vehicle accident.  The EEG was unremarkable.

Dr. Hurley saw the employee on June 22 and July 20 for continuing care of the employee’s fractured clavicle.  As of July 21, the employee was released to return to work without restrictions by Dr. Hurley for the clavicle condition.  Dr. Hurley found the employee to be at maximum medical improvement for this condition as of September 29, 2005, and concluded the employee had no permanent partial disability from the clavicle fracture.

The employee had a DOT physical at the Alexandria Clinic on August 12, 2005, by Dr. Bruce Wymore.  His history noted the work injury in March and stated, “he is currently asymptomatic.”  His physical examination was normal.  On the health history form the employee completed for the examination, he indicated he had no chronic low back pain or spinal injury or disease.  The employee passed the physical examination and was considered qualified for a commercial driver’s license.

The employee returned to his regular assignment of crew leader on July 21, 2005.  At that time, there were no restrictions on his physical activity other than the driving prohibition set by Dr. Xie.  The employee testified that the other workers still generally did the heavier lifting for him.  As of September 7, 2005, the employee once again had his driver’s license and performed his usual duties including the operation of equipment.  The employee also signed up for a voluntary project known as the Midwest project in which he would work on weekends and travel to other locations to work on special assignments.  This project involved considerable overtime for the employee.

The first reference to low back pain in the employee’s medical records is in the September 13, 2005, office notes of Dr. Douglas Griffin, the employee’s family doctor at Broadway Medical Center in Alexandria.  He told Dr. Griffin that in general he was feeling well, although

On October 14, 2005, Dr. Bottini completed a Health Care Provider Report in which he found the employee to be at MMI from his head injury.  Dr. Bottini’s report indicated that he would not rate the employee’s permanent partial disability and he did not provide any work restrictions for the employee.

The employee returned to Dr. Griffin on November 8, reporting ongoing problems with his left leg being sore and pain radiating into his back.  Dr. Griffin recommended an MRI or CT scan and stated, “given the mechanism of fall, he could have sustained an injury to the back and is experiencing some radiculopathy there.”

The CT scan was done at Douglas County Hospital on December 2, 2005, and was read as showing:

The employee then returned to Dr. Griffin on December 23.  He told Dr. Griffin

The employee first saw Dr. Hillman on February 7, 2006.  He reported to her that his back and leg pain began after his work injury and that his back and leg pain had worsened since that time.  Dr. Hillman made a number of recommendations which included further diagnostic testing and physical therapy for the low back.  She recommended “neuropsych testing to further evaluate the safety concerns that he has with work and the memory issues since his head injury.”  Dr. Hillman prescribed Cymbalta and  took the employee off work because she did not want him driving or operating heavy equipment while he was starting the medication.  Dr. Hillman indicated the employee would likely be released to work with restrictions if there were no cognitive side effects from the medication.

The employee testified at the hearing that he did not experience any side effects from the medication after a couple of days but he did not advise Dr. Hillman of that fact.  Dr. Hillman kept the employee off work and as of the date of hearing in October 2007, the employee had not returned to work.  The employer and insurer refused to reinstate temporary total disability benefits and denied payment of medical expenses, claiming that the continuing treatment was not related to the work injury.

Dr. Hillman saw the employee again in March, May, and June 2006.  His symptoms and findings on examination were unchanged.  There were no changes in Dr. Hillman’s recommendations.  Because of the issue of insurance coverage, the testing recommended by Dr. Hillman did not take place until August 2006.

A neuropsychological evaluation was done by Dr. Jeffrey Kearney at St. Cloud Neurobehavioral Associates on August 4, 2006.  In a detailed history that focused on his head injury, the employee also discussed his low back problems and advised Dr. Kearney that “in November he went deer hunting and the pain became much worse.”  The employee was given a battery of tests, and Dr. Kearney concluded “taken as a whole, the present results are largely within normal limits.  There is evidence of very mild verbal memory difficulty noted.”  With regard to a return to work Dr Kearney stated “there are no apparent safety or supervision restrictions.  From a cognitive standpoint, there really is nothing to suggest that Mr. Lagergren could not return to work.”

The employee was also seen by Dr. Sam Elghor at the Pain Clinic in Douglas County Hospital on August 31, 2006, for treatment of the employee’s low back.  Dr. Elghor recommended a lumbar epidural steroid injection which was done on September 7, 2006.  The employee reported the injection was not effective.

The employee returned to Dr. Hillman on October 24 and the testing results were noted.  Dr. Hillman concluded that an on-site job analysis should be done before the employee was released to work.  The analysis was done and the employee returned to Dr. Hillman on December 7.  The employee was not released to work at that time because Dr. Elghor was going to perform a radio frequency denervation procedure to the low back.

When the employee returned to Dr. Hillman on January 3, 2007, the history noted that “in addition to his low back pain, he brought up headaches today.  He reports that his attorney told him that he had a problem on the CT scan of his cervical spine and that that was causing his headaches.”  Dr. Hillman concluded that further review of the employee’s cervical condition was called for.

In subsequent visits, Dr. Hillman recommended further testing and evaluation of the employee’s cervical complaints, memory complaints and headaches, and low back symptoms.  In March 2007, the employee was referred by Hillman for a neurology consultation for his memory issues and headaches to Dr. Janiece Aldinger.  In May 2007 when he returned to Dr. Aldinger, the employee also referred to sleep difficulties, and Dr. Aldinger’s recommendations were limited to that issue.  In his May visit, the employee also referred to his left thigh numbness and, for the first time, right thigh numbness.  Dr. Aldinger concluded these symptoms were due to meralgia paresthetica related to his obesity.

The employee testified at the hearing.  It was his testimony that he had begun having low back pain right after his work injury in March 2005.  His back pain increased after he returned to his regular duties in July, especially when he worked overtime.  The employee introduced a diary which he stated he had started keeping after his return to work in May.  In the diary he noted his symptoms and absences from work.  The employee also testified to continuing memory problems following his head injury.  The employee’s spouse testified to the memory problems she had noticed in the employee since the work injury.

The employee also presented his medical records into evidence.  Included were reports from his family physician, Dr. Griffin, in which Dr. Griffin opined that the employee’s low back condition was related to his work activity based on a letter from the employee’s attorney setting out hypothetical facts.  In addition, Dr. Griffin prepared a report dated September 19, 2005, in which he stated that the employee’s hypertension had been aggravated by his injury and the medication he had received for the treatment of that injury.

Ione Tollefson, a QRC, testified as to the actions she had taken on behalf of the employee.  The employer and insurer had refused to pay for Ms. Tollefson’s services.  It was their position that since the employee had been released to return to work without restrictions for his head injury and clavicle fracture, the employee was not a qualified employee and therefore not eligible for rehabilitation services.

Finally the employee presented the deposition testimony of Dr. Hillman.  Dr. Hillman provided information about her treatment of the employee.  She also provided her opinions on the  causation issues involved in the employee’s claims.  Those opinions will be reviewed later in this decision.

The employer and insurer had the employee evaluated on two occasions by Dr. Richard Galbraith, a neurologist.  Dr. Galbraith prepared a report following each examination and he also testified by deposition.  It was Dr. Galbraith’s opinion that the employee had sustained a subarachnoid hemorrhage and clavicle fracture on March 7, 2005, and that those injuries had resolved by the date of his first evaluation, April 7, 2006.  Dr. Galbraith also concluded that the employee’s low back and cervical complaints were not the result of his work injury or his employment.  Dr. Galbraith stated that the employee’s hypertension had not been aggravated by the treatment for his work injury.  Dr. Galbraith also concluded that any memory difficulties were consistent with the age of the employee who was 62 on the date of injury.

Rich Decker, the employee’s supervisor, testified at the hearing.  He said that the employer had a program it had negotiated with the union which would allow for the return to work of any employee with any restrictions.  In accordance with that program, the employee was placed in a variety of light-duty positions when he was released in May 2005.  The employee had also volunteered to work on the Midwest project.  Work on the project was voluntary as was the overtime which was a part of the project.  Mr. Decker testified to three job offers made to the employee after February 2006, and he also testified to a conversation he had had with the employee in which the employee told him that he did not intend to return to work.

The hearing on the employee’s claims took place on September 13, 2007, before Compensation Judge Bradley Behr.  The record closed on October 13, and the compensation judge’s Findings and Order was issued on December 11, 2007.  The compensation judge denied the employee’s claim that his low back and cervical conditions were the result of the March 2005 injury or his work activity after July 20, 2005, denied the employee’s claim for temporary total disability benefits, denied the employee’s claim for rehabilitation services, and denied charges for a driving evaluation and for physical therapy at Northwest Industrial Rehabilitation Services.  The employee has appealed from these findings.  The compensation judge awarded charges for the neuropsychological testing and for medication for hypertension.  The employer and insurer have cross-appealed from these findings.

Both the employee in his appeal and the employer and insurer in their cross-appeal contend the compensation judge erred in his findings on a number of issues.  The question for this court is whether the findings of the compensation judge are supported by substantial evidence when considering the record as a whole.  If substantial evidence is found to exist, the decision of the compensation judge is to be affirmed.  Hengemuhle v. Long Prairie Jaycees, 358 N.W.2d 54, 37 W.C.D. 235 (Minn. 1984).

The employee’s position at hearing was that he had sustained a Gillette injury to his low back which culminated either on September 13, 2005, or February 7, 2006.  The employee argues that the compensation judge erroneously concluded that the employee’s low back condition was the result of factors which were not considered causative by any medical opinion, such as obesity.  We disagree.  The compensation judge did not determine the cause of the employee’s low back condition in this case nor was he required to do so.  In order to recover workers’ compensation benefits, the employee had the burden of establishing that his low back condition was related to his employment.  The compensation judge found that the employee failed to establish that claim by a preponderance of the evidence.

The employee on this issue relies on the opinions of Drs. Griffin and Hillman who provided causation reports based on information sent to them by the employee’s attorney.  As pointed out by the compensation judge, however, that information was not consistent with the evidence presented at the hearing.  For example, the letter sent to both doctors made reference to the employee’s left thigh numbness as being related to his low back complaints.  However, the evidence was undisputed that the numbness first mentioned in March 2005 and referred to in the medical records thereafter  was due to meralgia paresthetica, a condition not related to the employee’s lumbar spine but instead related to obesity.  Contrary to the hypothetical given to Drs. Griffin and Hillman, there was no evidence of low back problems in the medical records before September 2005.

Further, despite the employee’s comments in his brief to 29 years of heavy physical labor, neither Dr. Griffin nor Dr. Hillman were asked to find a Gillette injury on those facts.  Instead, the question given to them asked the doctors to assume a traumatic injury to the low back on March 7, 2005, followed by very physical work activity between July 20, 2005, and September 13, 2005, or February 7, 2006.  As the compensation judge pointed out in his memorandum, while the employee had complaints in the area of his low back and legs when he saw Dr. Griffin on September 13, 2005, Dr. Griffin’s diagnosis was of obesity and deconditioning and not any type of low back condition.  Dr. Griffin did not restrict the employee’s work activity in any way.  Finally, the hypothetical information provided to Dr. Griffin and Dr. Hillman made no mention of the history provided to Dr. Kearney that the employee’s back and leg problems had become worse after deer hunting in November 2005.

We conclude there is substantial evidence to support the compensation judge’s finding that the employee failed to establish a Gillette injury to his low back on September 13, 2005, or February 7, 2006.

The employee also claimed at the hearing that he injured his low back when he fell on March 7, 2005.  The employee relied for that position on Dr. Hillman’s opinion as set forth in her deposition.  In the deposition, Dr. Hillman stated that her opinion was based on the fact that the employee had no back problems before the fall and had back problems after the fall.  No further explanation was provided.

It appears from the discussion at the deposition that the Dr. Hillman was influenced by an assumption that the employee’s left thigh numbness was diagnostic of his low back problems.  As we noted previously, the employee’s physicians concluded that his thigh numbness was due to  meralgia paresthetica, associated with his obesity.  No physician found this symptom to be related to any lumbar problem.  In addition, as the compensation judge noted in his memorandum, there was no explanation for the lack of treatment for low back problems for more than six months following the injury.

The employee also relied in part on the diary he states he maintained after his return to work in May 2005.  While that diary indicates the employee had continuing low back pain which caused him to miss work, those entries are inconsistent with the lack of medical care for low back symptoms and the absence of any mention of low back symptoms by the employee before September 2005.  The employee had extensive medical treatment with numerous providers for a variety of complaints between March and September, 2005, and at no time was there any reference to low back pain.  If the low back symptoms were as severe as the employee now alleges, we believe those complaints would have shown up in the records somewhere.

We conclude the compensation judge’s determination on this issue is supported by substantial evidence.

The employee argues that the compensation judge erred in finding that he did not injure his neck when he fell in March 2005.  The employee states that there are numerous references to neck pain in the medical records and that his headaches could be due to a cervical condition.

While we find, at best, minimal mention of neck or cervical complaints in the record before January 2007, we do not consider this issue on that basis.  We note instead that there is no medical opinion connecting any cervical condition to the work injury.  Dr. Hillman’s opinion on this point was limited to stating that such a connection was “possible.” That testimony falls far short of the standard required in medical testimony.  Sullivan v. Hagstrom Constr. Co., 244 Minn, 69 N.W.2d 805, 18 W.C.D. 279 (1955).

The decision of the compensation judge on this issue is affirmed.

The employee claimed temporary total disability benefits from February 7, 2006, when Dr. Hillman took him off work.  The employee argues that the compensation judge’s denial of that claim was contrary to the evidence.

The record is clear that the employee was taken off work by Dr. Hillman so that the employee could adjust to new medication, Cymbalta.  Cymbalta was prescribed for the employee’s back and leg pain.  Even though the employee adjusted to Cymbalta within a few days, Dr. Hillman kept the employee off work because of the low back condition.  Since we have affirmed the compensation judge’s decision that the low back condition was not work related, the employee’s absence from work for this condition does not result in temporary total disability for purposes of workers’ compensation.

The employee cites to references in Dr. Hillman’s records to “safety concerns” as a reason for taking the employee off work.  The employee argues that this evidence supports an award of temporary total disability benefits because the safety concerns were related to his head injury.  Specifically, there was alleged to be a concern because the employee’s job required him to work around natural gas lines and equipment and these duties could be dangerous because of the employee’s memory difficulties.  This concern did not arise until February 2006, when the employee had been working in his usual position for more than six months and there was no evidence of danger to the employee, co-workers, or the public.  Also, Dr. Kearney’s testing showed that the employee’s memory was generally within normal limits.  We conclude that there was no basis in these alleged safety concerns to take the employee off work and no basis in these facts for an award of temporary total disability benefits.

The compensation judge’s denial of temporary total disability benefit is affirmed.

At the hearing, the employee claimed reimbursement for a driving evaluation done on August 7, 2006.  The compensation judge denied the claim and the employee argues he erred in doing so.

There was little evidence presented as to the reason why the driving evaluation was  thought to be necessary.  The employee took a DOT physical on August 12, 2005, and did not indicate at that time that there was any difficulty in his driving.  The employee was released to drive as of September 7, 2005, and there is nothing in the record to suggest that there was any difficulty with his driving after that date.  Even after Dr. Hillman recommended an evaluation, the employee continued to drive, including doing some driving while on vacation in Montana.  Given these facts, the justification for the driving evaluation is not found in the evidence.

We find substantial evidence to support the compensation judge’s decision on this issue.

In order to be entitled to rehabilitation services, an employee must be a qualified employee under Minn. R. 5220.0100, subp. 22, which requires an employee to be precluded from returning to his usual occupation by reason of the work injury.

In the present case, the compensation judge found that the employee’s work injuries were not disabling and were not factors in preventing the employee from returning to work.  Substantial evidence supports that finding and, therefore, the compensation judge’s conclusion that the employee was not a qualified employee and not entitled to rehabilitation services is affirmed.

The intake records from Northwest Industrial Rehabilitation indicate that the referral from Dr. Hillman was for the employee’s low back condition.  Dr. Hillman’s records in which she discussed the results of the therapy also demonstrate that the therapy was for the employee’s low back pain.  The employee’s argument in his brief that a period of work hardening would have been appropriate given his head injury is found not be persuasive since the employee had worked for more than six months with no restrictions on a full-time basis.  We find the compensation judge’s determination on this issue to be supported by substantial evidence.

At the hearing the employee claimed reimbursement of expenses he incurred for treatment of his hypertension.  His claim was based on the opinion of his general practice physician Dr. Griffin.  The compensation judge accepted the employee’s claim on this issue.

On cross-appeal, the employer and insurer argue that the compensation judge erred in his determination.  They contend that the compensation judge failed to consider that the employee had intermittent high blood pressure readings before his work injury and that the compensation judge did not consider the effect of the employee’s weight and his pre-existing hypertension. In support of their position, Dr. Galbraith’s opinion is cited.

In his memorandum, the compensation judge carefully considered the arguments raised by the employer and insurer and concluded that the opinion of Dr. Griffin was more persuasive than that of Dr. Galbraith.  The choice between competing medical opinions is for the compensation judge to make, and we find substantial evidence in the form of Dr. Griffin’s opinion supports the compensation judge’s decision on this issue.  Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985).

In their brief, the employer and insurer also claim that it was error for the compensation judge to award ongoing hypertension medication.  There is no such award in the compensation judge’s decision.  The compensation judge awarded payment of those hypertension expenses submitted at the hearing.

The compensation judge ordered the employer and insurer to pay for the neuropsychological testing done by Dr. Kearney in August 2006.  The employer and insurer have cross-appealed on this issue, asserting that the testing was not reasonable or necessary because the employee had been released to work without restrictions from his head injury and because the testing results were essentially within normal limits.

The employee had complained of memory problems which he attributed to his head injury since May 2005.  The employee consistently identified memory loss as a symptom from then on.  The employee’s release to return to work has nothing to do with whether or not his claimed memory loss was a consequence of his work injury which might require medical care.  Given these circumstances, the finding by the compensation judge that the neuropsychological testing was reasonable and necessary treatment is affirmed.  The fact that the testing showed the employee’s memory to be within normal limits does not mean that the decision to order the testing was inappropriate.