The employee appeals from the compensation judge’s denial of her claim for benefits related to her cervical condition and from the judge’s denial of penalties.  We affirm.

In April of 1997, the employee began working for Dycast Specialties [the employer], a company that produces zinc and aluminum diecast parts used in a wide variety of industries.  For the first year and a half of her employment, the employee worked as a trimmer, trimming parts that had been casted.  This job required the employee to lift tubs of parts weighing 30 pounds or more on a regular basis.

The employee next worked for the employer as a machine center operator, using an air wrench to secure the casted parts in a vice, pushing a button to send the parts into a device for machining, and checking and packing the parts after completion of the machining process.  The employee testified that the air wrench operated using 30 pounds of pressure and that the wrench would kick and was capable of pulling her across the machine.  The employee’s machining job also involved lifting tubs of parts.

On May 18, 2007, the employee was assigned to machine one-pound aluminum parts known as stellars, connecting rods used in air conditioning systems.  Because the casting was not entirely accurate, the employee had to use a three-pound grinder to enlarge a hole to make the stellars fit the machine.  After enlarging the hole, the employee would put the stellars into the vice, but, because she had trouble getting the vice to open, she had to use a rubber mallet to pound on the air wrench she used to open the vice.  Once she secured the stellars in the vice, she would send them into the machine, where the machining process took three minutes per part.  While waiting for completion of the machining, the employee would use the grinder to ream the next part, and so on.

The employee testified that she began experiencing pain in her right arm, into her shoulder, while using the grinder, and shortly before the end of her shift, she reported her symptoms to the employer.  According to the First Report of Injury, the employee had injured her right “hand, arm, shoulder and back” while running the “air wrench” and “air grinder.”

The employee left work that day, a Friday, and rested over the weekend.  She testified, however, that her pain that weekend was severe and interfered with her sleep.  The employee then worked the following Monday and Tuesday, but her symptoms continued, and the employer sent her for treatment at the emergency room at Glacial Ridge Hospital.

In the emergency room note of May 23, 2007, Dr. Roderick Brown indicated as follows concerning the employee’s history, symptoms, and diagnosis:

The employee returned to see Dr. Brown on May 29, 2007, indicating that she had not experienced much improvement.  On exam, the employee complained of pain with “abduction and internal rotation about the right shoulder.”  Dr. Brown’s assessment was “persistent symptoms related to right subacromial bursitis and bicipital tendonitis [as well as] right carpal tunnel syndrome.”  The doctor administered two cortisone injections to the employee’s right shoulder, restricted the employee to left-handed work, and advised her to follow up on June 4, 2007, if her symptoms did not improve.  The employee elected instead to consult her usual health care provider, Jennifer Jahnke, a nurse practitioner at the Alexandria Clinic.

In an office note from the employee’s June 4, 2007, appointment, Ms. Jahnke indicated that the employee was complaining of arm pain that had not improved with treatment.  On review of systems, it was specifically noted that the employee had no neck pain or neck stiffness, and, on exam, the employee had full range of motion of the neck with no abnormal movement or masses.  Ms. Jahnke noted localized swelling and decreased range of motion, with pain, in the employee’s right shoulder, and she prescribed Relafen, advised the employee to stay off work for one week, and referred her to physical therapy.  On June 11, 2007, Ms. Jahnke released the employee to light-duty work, specifying that she perform absolutely no work with her right hand.

A few days later, on June 14, 2007, the employee had her initial physical therapy evaluation, performed by John Helgeson.  During this evaluation, the employee complained of pain into the arm when rotating her head to the right, and neck, arm, and shoulder pain with extension of her neck.  After performing various tests, Mr. Helgeson indicated that the employee had “signs and symptoms and testing confirming with 99% specificity that [she] has a cervical herniated disc.”

Shortly thereafter, in a note dated July 2, 2007, Ms. Jahnke, the nurse practitioner, indicated, too, that the employee had symptoms consistent with a herniated disc.  Subsequently, on July 16, 2007, Ms. Jahnke noted, for the first time, that the employee had been experiencing neck pain as well as shoulder pain that had started two months ago.  However, unlike the physical therapist, Ms. Jahnke indicated that the employee had full range of neck motion.

The employee attended physical therapy sessions directed at cervical complaints, and she also began using home cervical traction.  When she went off work in July 2007 at the recommendation of her treatment providers, the self-insured employer commenced payment of temporary total disability benefits.

On July 31, 2007, the employee underwent an MRI scan of her cervical spine.  The radiologist listed his conclusions as follows:

In mid-August of 2007, the employee was seen by Dr. Maria Zorawska, on referral from Ms. Jahnke.  In the history portion of her initial report, Dr. Zorawska wrote that the employee “performs a factory job [that] involves standing with a bent neck for hours.”  The employee apparently indicated to Dr. Zorawska that her “main pain [was] confined to the base of the neck and radiates to both arms,” with “numbness in the entire right upper extremity with numbness in the fingers involving 2nd, 3rd, and 4th fingers” and “some weakness at times.”  On examination, Dr. Zorawska found markedly decreased range of cervical motion, tenderness, and limited range of right shoulder abduction and forward flexion, due to pain.  She recommended facet injections at C4-5 bilaterally, continued use of home cervical traction, and an EMG.

The employee underwent the facet injections, and the EMG was performed on September 25, 2007.  According to Dr. Zorawska, the test was “[s]uggestive but not fully diagnostic of Pronator Teres Syndrome on the right side.”^[1]  The report contains no findings or references to cervical radiculopathy.

On October 25, 2007, the employee returned to full-time, light-duty work for the employer, sorting parts.  Upon the employee’s return to work, the employer discontinued payment of temporary total disability benefits, but no Notice of Intention to Discontinue Benefits [NOID] was served or filed at that time.

On October 30, 2007, the employee underwent bilateral C4-5 medial bundle branch blocks of the facet nerves supplying the C4-5 facets.  When the procedure relieved the employee’s symptoms, she was considered a candidate for a rhizotomy.  A few weeks later, in mid-November 2007, the employee underwent a rehabilitation consultation and began receiving rehabilitation assistance.

The employee underwent an independent medical examination on December 6, 2007, performed by Dr. Richard Strand.  In his report of that date, Dr. Strand concluded that the employee was suffering from degenerative disc disease and degenerative spondylosis resulting in cervical stenosis, which he related to her age, heavy smoking, and genetics.  He found no connection between the employee’s cervical condition and her work activities and no evidence of any acute or Gillette^[2] injury to her cervical spine.  Finally, he indicated that the employee had reached maximum medical improvement from “her alleged aggravation of May 18, 2007,” with “ongoing symptoms related to her preexisting disease.”  By letter dated December 19, 2007, the employer served the employee with a copy of Dr. Strand’s report.  In that letter, the employer notified the employee that they had accepted her claim by mistake and would no longer pay benefits because her condition was not related to her employment.  About two weeks later, the employee obtained legal counsel.

The employee underwent the recommended rhizotomy on December 21, 2007.  She continued to work for the employer until April 8, 2008, when she was laid off due to the unavailability of light-duty work.  In May of 2008, the employer served and filed the NOID relating to their discontinuance of temporary total disability benefits in October of 2007.

The employee claimed entitlement to various benefits as a result of her alleged May 18, 2007, work injury, and the matter came on for hearing before a compensation judge on January 7, 2009.  The primary issue was the nature and extent of the claimed injury, more particularly, whether the employee’s cervical condition was work-related.  Other issues included the employee’s entitlement to wage loss benefits, the employee’s weekly wage, and whether the employer was liable for a penalty based on their failure to file an NOID and failure to pay the employee temporary partial disability benefits upon her return to work in October 2007.  Evidence included the employee’s medical and rehabilitation records, the employee’s testimony, and the report and deposition testimony of Dr. Strand.

In a decision issued on January 27, 2009, the compensation judge found, in relevant part, that, on May 18, 2007, the employee had sustained a sprain/strain of her right upper extremity and shoulder, which had resolved by the time of Dr. Strand’s examination on December 6, 2007.  The judge also concluded that the employee’s work had not aggravated or accelerated the employee’s cervical condition, and the judge expressly accepted Dr. Strand’s opinion on this issue.  All benefits from and after October 25, 2007, the date of the employee’s return to work, were denied on causation grounds.  The judge also denied the employee’s claim for penalties.  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 (2008).  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 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).

The employee claims that the compensation judge erred in concluding that the May 18, 2007, injury did not aggravate or accelerate the employee’s cervical condition, arguing first that the judge erred as a matter of law by failing to analyze the evidence using the factors contained in Wold v. Olinger Trucking, Inc., slip op. (W.C.C.A. Aug. 24, 1994).^[3]  Wold, however, is primarily applicable when the issue is whether the claimed work injury was temporary or permanent.  In the present case, the issue was even more fundamental: whether the employee had injured her cervical spine, at all, as a result of her work activities.  This issue is one of medical causation.

As previously noted, the compensation judge expressly accepted the causation opinion of Dr. Strand, who testified that the employee’s cervical degenerative disc disease is related to age, genetics, and tobacco use.  According to Dr. Strand, the employee’s work activities were not the kind that “place forces on the cervical spine,” and Dr. Strand also pointed to medical records from 1995, referencing cervical x-ray findings of “space narrowing” and “forminal narrowing,” as evidence of the longstanding and degenerative nature of the employee’s underlying cervical condition.  As Dr. Strand explained it, the onset of the employee’s cervical symptoms - - a month or more after her work injury - - was mere coincidence.

On appeal, the employee complains that the compensation judge did not explain “why he rejected [the employee’s] claim that the work activities on May 18, 2007, were a substantial contributing factor to the onset of her cervical symptoms on the day of the admitted work injury.”  (Emphasis added.)  The obvious weakness in this argument is, of course, that the compensation judge did not accept the employee’s testimony that she experienced neck pain or other cervical symptoms that day, explaining in his memorandum as follows:

The employee also argues that the compensation judge’s award of benefits through October 24, 2007, is inconsistent with his conclusion on causation, in that it was obvious that all medical treatment rendered after June 14, 2007, was directed toward the employee’s neck, not any upper extremity condition.  We are not persuaded.  As noted by the judge, above, the employee at least for a time exhibited symptoms consistent with an upper extremity injury, including shoulder swelling, and Dr. Strand testified that that the employee’s use of the torque wrench could have irritated her pronator or median nerve.  The judge’s award of benefits into October of 2007 was likely related to the judge’s decision to give the employee the benefit of the doubt as to the duration of that upper extremity injury.  We would also note that the employer had already paid the employee temporary total disability benefits up to the date of her return to work, and her entitlement to those benefits was not the primary issue here.

The employee further contends that she has experienced neck pain and symptoms from and after May 18, 2007, and that she is not responsible for the failure of health care providers to accurately record these complaints, and she also alleges that Dr. Strand’s causation opinion is simply not plausible.  These arguments, however, were for the compensation judge to weigh.  It is also worth noting that the employee did not offer any expert testimony or even a narrative physician’s report explaining the alleged connection between the employee’s ongoing cervical complaints and her work activities.

The compensation judge was entitled to accept Dr. Strand’s opinion on causation.  See Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985).  We therefore affirm the judge’s decision that the employee’s cervical condition is not work-related.^[1]

The employer discontinued payment of temporary total disability benefits when the employee returned to full-time, light-duty work on October 25, 2007.  The employer did not file an NOID, however, until May of 2008.  The employee contends that the compensation judge erred in denying penalties, arguing as follows regarding the harm the employee allegedly suffered due to the late filing:

Just as importantly, the compensation judge denied the employee’s claim for benefits beginning October 25, 2008, on causation grounds, and we have affirmed the judge’s decision on that issue.  As the supreme court noted in Cassem v. Crenlo, Inc., 470 N.W.2d 102, 108, 44 W.C.D. 484, 495 (Minn. 1991), “it makes no sense to penalize the insurer for stopping payments it did not owe.”  Id.  The judge’s denial of penalties is affirmed.