The employer and insurer appeal from the compensation judge’s finding that the employee sustained a work-related Gillette-type^[1] bilateral carpal tunnel syndrome injury culminating on or about February 20, 2006, when she was laid off from her employment, and from the judge’s award of payment of the employee’s medical expenses, including payment for a recommended MRI scan of the right shoulder.  We affirm the finding of a Gillette injury and the award of all related medical expenses except those of the recommended right shoulder MRI scan.

Antonia Lopez was born in 1966 in El Salvador and came to the United States in 1999.  She attended school in El Salvador through the seventh grade and does not read or write English.  Spanish is her primary language, and she testified at the hearing with the aid of an interpreter.  In September 2001, Ms. Lopez [the employee] began working full time for Dura Supreme, Inc. [the employer], a manufacturer of cabinets, doors, and tables, at its plant in Howard Lake, Minnesota.  The employee initially worked as a sander, performing the job with vibrating sanding machines and also manually by hand.  Whether using a sanding machine or sanding by hand, the employee used both her right and left hands while applying firm pressure to the item being sanded.  The job also required frequent lifting and grasping and she worked full time at this job between September 2001 and January 2004.

On January 27, 2004, the employee was seen at the Allina Medical Clinic in Cokato with a history of an acute onset of right hand and forearm pain while working at her job on January 15, 2004, on which date the employer had been insured against workers’ compensation liability by American Compensation Insurance Company, with claims administered by RTW, Inc. [RTW].  The employee had no history of any medical treatment to her upper extremities prior to 2001.  Dr. Dan Johnson noted pain to palpation and swelling of the right forearm extensor muscles and diagnosed “tendonitis/myositis of the right arm.”  He prescribed a carpal tunnel splint and medications and recommended that the employee refrain from sanding for the remainder of the week.  Noting no improvement in her condition the following week, Dr. Johnson referred the employee to Allina orthopedist Dr. Henry Bernstein, who examined her on February 4, 2004.  Dr. Bernstein noted that the employee’s right forearm was noticeably larger than her left forearm, and he diagnosed “repetitive strain syndrome injury.”  A month later, on March 3, 2004, the employee reported to Dr. Bernstein that her right wrist pain was getting worse and that her left hand was also starting to hurt now.  Dr. Bernstein diagnosed possible carpal tunnel syndrome, continued to restrict the employee from heavy sanding activity at work, and recommended EMG studies of the median nerves in both hands.

On March 23, 2004, the employee was seen by Dr. David Falconer at Metropolitan Hand Surgery Associates, P.A., accompanied by a QRC from RTW.  The employee reported right elbow pain associated with repetitive sanding motions at work, as well as diffusely localized left arm pain.  Dr. Falconer diagnosed “right triceps extensor tendonitis and olecranon pain,” together with “mechanical overuses myalgias on the left forearm,” and he recommended a course of therapy and activity modification.  He advised the employee and her QRC that the employee’s exam was consistent with “signs of mechanical overuse [that] may not be amenable to direct correction or physical treatment.”  He anticipated the need for long-term functional limitations for symptom control and, upon completion of therapy, consideration of a functional capacities evaluation [FCE] for “suitable placement.”  Dr. Falconer told the employee’s QRC that he anticipated strongly recommending a permanent job change based on FCE testing, and he requested that she “appraise the claims examiner of this.”

The employee attended ten therapy sessions at NovaCare and returned to see Dr. Falconer on May 4, 2004.  The doctor noted that the employee’s pain complaints involving her forearms, upper arms, and hands were somewhat more diffuse and myalgic than on her previous visit.  Based on his review of the therapy notes, Dr. Falconer concluded that her pain was nonlocalizing and nonspecific to any particular orthopedic syndrome and appeared to have a much more functional component.  He recommended an EMG, a nuclear scan, and screening serologies to determine whether specific orthopedic modalities should be instituted.

When he next saw the employee on July 20, 2004, Dr. Falconer noted that her nuclear scan and serologic screening were essentially negative.  The EMG, performed on May 11, 2004, was remarkable for a mild, bilateral carpal tunnel syndrome of a low-grade nature.  In addition, he noted that “[c]linically she has had a job change, on subjective basis and she is now on a cleaning janitorial position.”  He reviewed a job description for this position and noted in some detail its requirements in his office note.  The doctor recommended a course of therapy and suggested that she continue to use her wrist braces at work and at night when she sleeps.  Noting that her present light duty job appeared to be going well and that her employer had offered it to her permanently, Dr. Falconer approved the position.

The employee attended a course of therapy at Phenomenal Rehabilitation during August and September of 2004, and she returned to see Dr. Falconer on October 19, 2004.  The doctor noted that she remained on light duty but had persisting symptoms.  He expressed concern that her “global symptoms” seemed to be more than just carpal tunnel syndrome.  Her splints were not helping, and therapy was making her worse.  He recommended a cortisone injection to see if her carpal tunnel problem showed some response.  A month later, on November 23, 2004, Dr. Falconer noted that the employee had been treated with supportive splints, had changed jobs, and generally was doing fairly well with some low-grade symptoms.  The doctor advised her that she would probably have to live with these symptoms and that she should stay at her present job as a “permanent assignment.”

The employee returned to Dr. Falconer on February 22, 2005, reporting that she remained at her light duty job, where her hand symptoms were largely but not totally resolved.  The doctor noted that she still had occasional numbness and tingling that woke her from sleep at least once a week and sometimes more frequently.  He advised her to stay on her permanent light duty restrictions, and he referred her for one further EMG, noting that “unless [the] EMG is significantly or dramatically worse, no further intervention would be recommended.”

The employee underwent an EMG of her right upper extremity on March 3, 2005, and returned to see Dr. Falconer on April 5, 2005.  The doctor noted at that time that the EMG had revealed a subtle increase in sensory latency compared to the employee’s previous EMG, but he did not believe that it represented either a worsening or an improvement in her condition.  The employee expressed concern about the pain in her hands, and Dr. Falconer explained that that was the basis for her permanent restrictions and recommended continued splinting.  The doctor concluded that the employee had reached maximum medical improvement [MMI] and did not require surgery.  He went on to state, however, “If she has a major significant flare-up with documented EMG worsening she may need to file a new Gillette injury and I have explained through a translator the nature of this process and clarified it with her QRC.”  Dr. Falconer discharged the employee from care based “on a chronic restriction, chronic need for splints and at MMI as of 4-5-05.”

On July 1, 2005, the employer’s workers’ compensation insurance coverage changed, with the new coverage provided by Forest Products Commercial Self-Insured Group, with claims administered by Meadowbrook Claims Services [Meadowbrook].

On October 10, 2005, the employee was seen at the Catalyst Medical Clinic, complaining of neck and back pain that she attributed to lifting a heavy garbage bag at work on September 23, 2005.  The attending doctor noted tenderness to palpation over the back and neck muscles with an essentially normal range of motion.  No other injuries were noted, and the doctor referred the employee for physical therapy.  Two weeks later, on October 24, 2005, the doctor noted a “complete turnaround” in the employee’s shoulder and back pain, the employee reporting that she felt “100% normal.”  Physical therapy and work restrictions were therefore ceased, and the employee was determined to be at MMI and released to return to work.

On February 7, 2006, ten months after being released, the employee returned to see Dr. Falconer in follow-up of her carpal tunnel complaints.  The doctor noted that she continued working at her same job but “now has a significant increase in symptoms with increased pain, mild pain to the lateral elbow and posterior scapular suggesting a worsening.”  The employee continued to have hand numbness, but she complained of more frequent nocturnal symptoms that disrupted her sleep almost every night despite her use of splints.  Based on the employee’s increasing complaints, Dr. Falconer recommended repeat EMG testing, assigned temporary functional restrictions and limitations, and recommended continued splinting.  The doctor stated also that

A repeat EMG of the employee’s right upper extremity was performed on March 2, 2006.  The neurologist concluded that the employee continued to have mild dysfunction of the median nerve at the wrist, characterized by mild prolongation of the distal motor and distal sensory latencies, those latencies now, however, significantly improved from what they were on the previous study of March 3, 2005.

The following day, March 3, 2006, the employee filed a claim petition alleging injuries to her left and right upper extremities on January 15, 2004, September 23, 2005, January 3, 2006, and February 20, 2006, claiming entitlement to temporary total disability benefits continuing from February 20, 2006.  RTW and Meadowbrook both denied liability for the claimed injuries.

The employee was next seen by Dr. Falconer on April 7, 2006, accompanied by a QRC intern.  She completed a confidential health history form during the visit and traced the onset of her pain to sanding doors on the job on January 15, 2004.  Dr. Falconer discussed the employee’s very mild carpal tunnel findings on her 2005 EMG, noting that her recent EMG was even better, having revealed again “very mild or borderline changes . . . , normal motor latencies, weak pain threshold and poor effort on EMG.”  He stated that these findings were a strong indication against surgery and reassured her that no nerve damage was likely, although he did not think that she was a good candidate to return to highly repetitive factory work.  He told her that he did not consider her totally disabled, administered a cortisone injection to her right carpal tunnel, and released her with restrictions.

Dr. Falconer saw the employee for the last time on April 28, 2006.  He noted at that time that the employee’s sensory latencies on EMG were very minimally higher than normal and that she had demonstrated a low pain threshold and poor effort on her EMG testing.  The employee reported that her April 7 cortisone injection had actually made her worse, but the doctor continued his recommendation against surgery.  Concluding that he had exhausted all treatment options and recommendations, the doctor referred the employee to Sister Kenny Rehabilitation for therapy, suggesting that she might consider an FCE to set permanent work restrictions to assist her in finding more appropriate work.  With that, he discharged the employee from care, to return p.r.n.

On May 30, 2006, the employee was examined by orthopedist Dr. Jeffrey Husband at the request of the employer and RTW.  Dr. Husband obtained a history from the employee with the aid of an interpreter, reviewed her medical records, and performed a physical examination.  In a report dated June 1, 2006, Dr. Husband opined that the employee had developed symptoms consistent with carpal tunnel syndrome on January 15, 2004, as a result of her work activities.  He concluded that she no longer had signs or symptoms consistent with that diagnosis and that there was, in fact, no objective evidence to support an organic diagnosis.  He opined further that the employee did not sustain specific or Gillette injuries on September 23, 2005, January 3, 2006, February 7, 2006, or February 20, 2006.  Dr. Husband was of the opinion that the employee had reached MMI from any work injury when she was examined by Dr. Falconer on April 5, 2005, and he had no recommendations for additional medical treatment.

In a letter to the employee’s counsel on September 29, 2006, Dr. Falconer reviewed his treatment of the employee between March 23, 2004, and April 28, 2006.  He concluded that the employee had EMG-proven mild carpal tunnel syndrome, inappropriate for surgery but still requiring functional restrictions of continued splint use and avoidance of repetitive grasp and grip activities.  He opined that she was at MMI and had sustained a ratable impairment of 3% of the whole person for each hand under Minnesota Rules  5223.0470, subpart 2B(3).  Finally, Dr. Falconer opined that “[the employee’s] treatment care including therapy, diagnostic testing and functional limitations are reasonable and necessary to cure or relieve the patient from the effects of her work aggravated condition due to the developmental nature of carpal tunnel in relationship to overuse and work activities.”

In January 2007, the employee settled her claims for workers’ compensation benefits arising out of the claimed injuries of January 15, 2004, September 23, 2005, January 3, 2006, and February 20, 2006, on a full, final, and complete basis.  Only limited future medical claims and Roraff attorney fees^[2] were left open.  The employer and both insurers retained all defenses, including their respective denials of primary liability, to any future claims by the employee.  An award on stipulation was served and filed on February 1, 2007.

On December 14, 2007, almost twenty months after being discharged from Dr. Falconer’s care, the employee was seen by orthopedist Dr. Rajan Jhanjee at the Buffalo Clinic.^[3]  Dr. Jhanjee diagnosed bilateral carpal tunnel syndrome, right greater than left, and right shoulder impingement syndrome.  He noted that the employee had continued symptoms and that he had injected her right carpal tunnel multiple times.  On examination, the doctor reported that the employee had “significant pain in the right shoulder with range of motion, positive impingement tests.  Positive Tinel over the right median nerve over the carpal tunnel.”  Dr. Jhanjee injected the employee’s right shoulder and the carpal tunnel area of her right wrist.  He indicated also his plan to obtain an MRI of the employee’s right shoulder.

On April 10, 2008, the employee filed a claim petition, seeking to establish primary liability for alleged work injuries on January 15, 2004, September 23, 2005, January 3, 2006, and February 20, 2006, along with payment for treatment of her bilateral carpal tunnel syndrome and approval of and payment for the MRI recommended by Dr. Jhanjee.  The employer and both insurers continued to deny liability for the employee’s alleged injuries.

On June 5, 2008, the employee was examined by orthopedist Dr. Larry Stern at the request of the employer and Meadowbrook.  Dr. Stern obtained a history, reviewed medical records, and performed a physical examination.  In a report issued on that date, Dr. Stern diagnosed overuse syndrome, left and right upper extremities, and mild bilateral carpal tunnel syndrome, right slightly worse than left.  Dr. Stern opined that the alleged work injury of January 15, 2004, was the sole substantially contributing factor in the employee’s complaints of bilateral upper extremity pain.  Regarding the alleged injury on September 23, 2005, Dr. Stern noted that the employee’s chief complaints were of right shoulder pain and back pain.  He noted further that, according to her medical records, the employee went on to have 100% improvement by October 24, 2005.  As for the alleged injuries in 2006, Dr. Stern opined that the increasing symptoms that the employee reported to Dr. Falconer on February 7, 2006, were “exactly the same kind as previously noted following the initial evaluation of the January 15, 2004, injury date.”  The EMG ordered by Dr. Falconer at that time, instead of showing worsening symptoms, actually showed an improvement.  Therefore, Dr. Stern believed, the employee’s increased symptoms in 2006 were “a manifestation of her preexisting symptom complex, which never went away following their initiation in January 2004.”  He did not find the employee’s physical exam suggestive of either significant bilateral carpal tunnel syndrome or significant right shoulder impingement syndrome or rotator cuff pathology.  Therefore, Dr. Stern concluded that the treatment recommended by Dr. Jhanjee was not reasonable or necessary to cure and relieve the employee’s symptoms.  Nor did he believe the proposed treatment was causally related to the alleged work injuries of September 23, 2005, January 3, 2006, and February 20, 2006.

Dr. Husband re-examined the employee on behalf of the employer and RTW on June 30, 2008.  In a report dated July 1, 2008, Dr. Husband again opined that the employee’s subjective symptoms were not substantiated by objective findings, and he found no objective basis for a diagnosis of either bilateral carpal tunnel syndrome or right shoulder impingement syndrome.  Dr. Husband did not believe that any medical treatment provided since his previous exam on May 30, 2006, had been reasonable and necessary, and he again concluded that the claimed injury of January 15, 2004, was not a substantial contributing factor in any need for additional medical treatment.  It also remained his opinion that the employee did not sustain injuries on September 23, 2005, January 3, 2006, or February 20, 2006.

On September 15, 2008, the employee filed a medical request, seeking payment of medical expenses incurred by the employee at the Buffalo Clinic.

In January 2009, the employee and the employer/RTW entered into a partial stipulation for settlement, purporting to be a Pierringer-type settlement,^[4] closing out all of her future claims for medical expenses with respect to the alleged work-related Gillette-type injury of January 15, 2004, as well as any other known injuries that the employee may have sustained while the employer was insured by American Compensation Insurance Company/RTW up to July 1, 2005.  The employee expressly reserved her right to pursue her claims related to injuries that she allegedly sustained while the employer was insured by Meadowbrook.  An award on stipulation was issued February 6, 2009.

The employee’s claim petition and medical request were consolidated for hearing.  About a week before the hearing, in a letter to employee’s counsel on June 5, 2009, Dr. Jhanjee reported the following:

The employee’s claim petition and medical request solely against the employer/Meadowbrook came on for a hearing before a compensation judge on June 11, 2009.  The following issues were presented to the judge: (1) whether the employee sustained work-related Gillette-type bilateral carpal tunnel syndrome injuries on September 23, 2005, January 3, 2006, and/or February 20, 2006, due to her work activity for the employer; and (2) whether the medical treatment for which the employee claimed payment, including the recommended MRI scan of the right shoulder, constituted medical treatment that was reasonable and necessary and causally related to a work-related Gillette-type bilateral carpal tunnel syndrome injury on September 23, 2005, January 3, 2006, and/or February 20, 2006.  Evidence offered at hearing included testimony by the employee, records from the employee’s treating medical providers, and the IME reports of Drs. Husband and Stern.

At hearing, the employee testified that she first developed right upper extremity problems in January 2004, while performing her job as a sander for the employer.  She testified that, because she favored her right arm and used her left arm more frequently, she developed similar problems in her left arm by the spring of that same year.  She did not recall how long she remained on the sanding job, but she remembered that at some point the employer took her off the sanding job and gave her a cleaning position.  She indicated that the employer changed her job because it was aware of her restrictions and understood that she could no longer do sanding.  Although she no longer used vibrating sanding machines, her cleaning job, she testified, also required the repetitive use of her arms and hands, and her symptoms continued to worsen while she performed that job.  The employee testified that Dr. Falconer’s recommendation of permanent restrictions on April 28, 2006, was the first such recommendation that she had been issued.  She testified also that her symptoms and pain in 2006 were about the same as they had been in 2004.

In a findings and order issued August 24, 2009, the compensation judge found that the contemporaneous medical records, the September 29, 2006, letter from Dr. Falconer, the June 5, 2009, letter from Dr. Jhanjee, and the employee’s credible testimony all supported the conclusion that the employee sustained a work-related Gillette-type bilateral carpal tunnel syndrome injury on or about February 20, 2006, when she was laid off from her employment with the employer.  He found that the employee did not sustain Gillette-type injuries on September 23, 2005, and/or January 3, 2006, as alleged.^[5]  He concluded that the medical claims asserted by the employee, including the recommended MRI of the right shoulder, constituted medical treatment that was “reasonable and necessary due to, and causally related to, the employee’s work-related Gillette-type bilateral carpal tunnel syndrome injury of February 20, 2006.”  The employer and Meadowbrook appeal.

On appeal, the Workers’ Compensation Court of Appeals must determine whether “the findings of fact and order [are] clearly erroneous and unsupported by substantial evidence in view of the entire record as submitted.”  Minn. Stat. § 176.421, subd. 1 (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 employer and Meadowbrook appeal from the compensation judge’s determination that the employee sustained a Gillette-type injury in the nature of bilateral carpal tunnel syndrome culminating on or about February 20, 2006, as a result of her work activities for the employer.  While acknowledging that the employee may have manifested symptoms of an unresolved pre-existing condition in February of 2006, the employer and Meadowbrook contend that there is insufficient evidence to establish causation and that there is no ascertainable event by which to date such an injury.  The judge’s factual findings relative to the employee’s increased symptoms and permanent restrictions, they contend, are unsupported by the record and, therefore, require reversal of the judge’s finding of a Gillette injury on the date alleged.  While we believe that this case presents a close factual question, we find substantial evidence in the record to support the judge’s finding of a Gillette-type bilateral carpal tunnel syndrome injury culminating on or about February 20, 2006.

As a general rule, injuries from repeated trauma result in a compensable personal injury when their cumulative effect is sufficiently serious to disable the employee from further work.  Carlson v. Flour City Brush Co., 305 N.W.2d 347, 33 W.C.D. 594 (Minn. 1981).  Case law does not, however, require an automatic determination that the culmination of the employee’s Gillette injury is the first day of total disability.  It is not mandatory that an employee be totally disabled from work activity or suffer wage loss in order to conclude that a Gillette injury has occurred.  Johnson v. Lakeland Bean Co., 39 W.C.D. 884 (W.C.C.A. 1987).  Rather, a compensation judge may consider other “ascertainable events” to find an earlier culmination date.  Schnurrer v. Hoerner-Waldorf, 345 N.W.2d 230, 36 W.C.D. 504 (Minn. 1984).  The date on which minute trauma culminates in a Gillette-type injury is not so much a medical question as a question of ultimate fact for the compensation judge.  Id.

In his findings and order, the compensation judge analyzed the evidence in considerable detail and emphasized that he found credible and medically supported the employee’s testimony regarding a progressive worsening of her upper extremity symptoms over a period of time during which she claimed that a Gillette injury was occurring.  At Finding 7, the judge stated:

With regard to Finding 7, the employer and Meadowbrook contend that the judge’s finding that the employee would need permanent work restrictions for the “first time” following an FCE in 2006 is incorrect.  They argue that Dr. Falconer had assigned restrictions at his first visit with the employee on March 23, 2004, that he never lifted them, and that he first referred to them as “permanent restrictions” as early as February 22, 2005.  They argue further that, while she may have testified to worsening or increased symptoms in response to leading questions by her attorney, the employee also testified, on both direct and cross-examination, that the severity of her symptoms in February of 2006 was the same as it had been when she first developed her problems, while performing the heavy duty sanding job in 2004.  Moreover, they argue, Dr. Falconer had recommended a job change and had approved the employee’s “light duty” cleaning position in July 2004.  His recommendation that she refrain from highly repetitive factory work was not a new recommendation in 2006, they argue, nor was his recommendation that she be given a cortisone injection and undergo an FCE.  She had previously received a cortisone injection in October 2004, they note, and an FCE had been discussed with the employee’s QRC as early as March 23, 2004.  These facts, they argue, coupled with the employee’s improved objective findings on her March 2, 2006, EMG do not support a finding of a Gillette injury in 2006.  Further, they contend that, at the time of her lay-off by the employer, the employee was not disabled from work and was physically capable of working within the restrictions that had been placed on her when she reached MMI on April 5, 2005.  Lastly, they contend, the judge incorrectly stated in Finding 10 that Dr. Falconer and Dr. Jhanjee opined that the cleaning job was a substantial factor in the employee’s need for ongoing treatment or work restrictions, and their reports are not legally sufficient to meet the employee’s burden of proof.

We concede that the evidence as to causation is thin with respect to the employee’s work activities after she reached MMI on April 5, 2005.  It would have been particularly helpful had the employee obtained reports from her treating doctors addressing the significance of the work activities during Meadowbrook’s coverage period, especially in light of RTW’s settlement with the employee in 2009.  It is apparent from the record that the employee was working under restrictions ever since 2004.  While Drs. Falconer and Jhanjee indicated in their reports that the employee had sustained bilateral carpal tunnel syndrome as a result of her work activities, no specific analysis was offered by either doctor differentiating the employee’s condition before and after April 5, 2005.  In contrast, Drs. Stern and Husband, who did address that specific issue, found expressly that the employee did not sustain work injuries on September 23, 2005, January 3, 2006, or February 20, 2006, as alleged.  However, notwithstanding its lack of detail, we find the expert medical opinion that supports the employee’s position to be minimally adequate to support the judge’s finding of liability in this case.

As the judge noted in his decision, the employee testified that her work activities, in both her sanding and her cleaning job, required repetitive and pressing use of her hands and wrists.  She testified that both jobs aggravated her upper extremity symptoms, specifically implicating the cleaning job’s tasks of washing windows and mirrors and emptying trash cans.  The judge did not mention the employee’s testimony in which she indicated that her symptoms were the same in 2006 as they had been in 2004, but, given his repeated reference to the employee’s “credible” testimony, the judge obviously resolved any apparent inconsistencies in the employee’s favor.  And it is apparent that Dr. Falconer, at least on February 7, 2006, was also impressed by a worsening of the employee’s clinical presentation.

The assessment of credibility is uniquely the function of the trier of fact.  Brennan v. Joseph G. Brennan, M.D., 425 N.W.2d 837, 839-40, 41 W.C.D. 79, 82 (Minn. 1988).  It is not the role of this court to evaluate, independently, the probative value of a witness’s testimony.  Redgate v. Sroga’s Standard Serv., 421 N.W.2d 729, 734, 40 W.C.D. 948, 957 (Minn. 1988).  Rather, this court must give due weight to the compensation judge’s opportunity to observe the witness and judge her credibility, and, where there is conflicting evidence or evidence from which more than one inference may reasonably be drawn, we must affirm the compensation judge.  Even v. Kraft, Inc., 445 N.W.2d 831, 834, 42 W.C.D. 220, 225 (Minn. 1989), citing Hengemuhle, 358 N.W.2d at 59-60.  Here, where the employee testified through an interpreter, the judge’s opportunity to observe the testimony is particularly important, and we defer to the judge’s assessment of the employee’s credibility regarding the progressive worsening of her upper extremity symptoms.

The judge clearly found that the employee’s claim of a Gillette injury in February 2006 was supported also by the contemporaneous medical records.  Prior to his questionable conclusion in Finding 7 that the employee would need permanent restrictions “for the first time” following an FCE, the judge had just noted in the preceding finding, Finding 6, the employee’s release by Dr. Falconer to work with restrictions and splint supports when she was found by the doctor to be at MMI on April 5, 2005.  On February 7, 2006, Dr. Falconer, who was fully aware of the employee’s duties at her cleaning job, documented a significant change in her symptoms, such that he recommended repeat EMG testing and opined that “[t]his clinical worsening does appear sufficient to define a new onset of symptoms and a new Gillette injury sufficient to define additional liability and responsibility as previously discussed.”  Although he had previously suggested that a new Gillette injury would require a major significant flare-up “with documented EMG worsening,” Dr. Falconer apparently did not find it necessary in February 2006 to have EMG findings of a worsened condition before finding a new Gillette injury.  He was clearly in a position to compare the employee’s symptom complaints in February 2006 with those that he had previously observed.  He went on at that time to administer a cortisone injection, the first such injection in almost a year and a half, and also referred the employee for a course of physical therapy at Sister Kenny Rehabilitation.  In light of this history and of the employee’s testimony, it was not unreasonable for the judge to find that the employee sustained a Gillette injury about the time she returned to Dr. Falconer.  Although it is also apparent that the employee had been working under physical restrictions with cortisone injection treatment before February 2006, the judge evidently found the additional injection in April 2006, together with Dr. Falconer’s desire to further define the employee’s work restrictions with an FCE, to be supportive of his finding of a new injury.

While it would have been helpful if Dr. Falconer and Dr. Jhanjee had been more specific about a particular Gillette injury date, and while we acknowledge that neither doctor specifically opined that the employee’s cleaning job was a substantial contributing factor in the employee’s need for medical treatment, we nevertheless agree with the judge that the employee’s claim is adequately supported by those doctors’ reports, particularly Dr. Falconer’s.  As noted earlier, Dr. Falconer clearly understood the requirements of the employee’s cleaning job, and he recited those job requirements in detail in his July 20, 2004, office note.  In response to a question regarding causation of the employee’s need for medical treatment and functional restrictions, Dr. Falconer opined that the employee’s treatment and restrictions were reasonable and necessary because of “the effects of the employee’s work-aggravated condition due to the repetitive nature of her job duties and the developmental nature of carpal tunnel in relationship to overuse and work activities.”  Given the entire context of Dr. Falconer’s treatment of the employee, in particular his office notes after February 7, 2006, the judge could reasonably accept Dr. Falconer’s narrative report as supportive of the employee’s claim.

With regard to the injury date selected by the judge, the employer and insurer argue that, because the judge based his determination on a mistaken analysis of the employee’s need for “permanent restrictions” and on an alleged increase in symptoms, the judge’s finding of a Gillette injury date must be reversed.  The date on which the employee was laid off by the employer, they argue, cannot be viewed as an “ascertainable event” under applicable law.  We are not persuaded.  We have affirmed the judge’s factual determination that on February 7, 2006, the employee experienced a significant increase in her symptoms, beyond a mere manifestation of her pre-existing condition.  Given that factual affirmance, the judge’s finding of a new Gillette injury on February 20, 2006, the date, less than two weeks later, on which the employee was laid off from the employer, was not unreasonable.  The date of a Gillette injury is a question of ultimate fact for the compensation judge.  See Pettis v. Metal Matic, slip op. (W.C.C.A. Jan. 18, 2000).  In this case, where Dr. Falconer defined a new onset of symptoms and effectively a new Gillette injury on February 7, 2006, we find no error in the compensation judge’s dating the injury at February 20, 2006.

We acknowledge that the record clearly contains expert opinion and other medical evidence that supports the defenses raised by the employer and insurer.  The issue on appeal, however, is whether there is adequate evidence in the record to support the determination of the compensation judge, not whether there is evidence to support a contrary conclusion.  See, e.g., Land v. Washington County Sheriff’s Dep’t, slip op. (W.C.C.A. Dec. 23, 2003).  Considering the entire record as submitted, we cannot conclude that the judge’s decision is so unsupported by the record as to justify reversal.  We therefore affirm the judge’s finding of a bilateral carpal tunnel syndrome injury culminating on February 20, 2006.

We cannot, however, find any substantial evidence to support the compensation judge’s award of an MRI scan of the employee’s right shoulder.  The only work-related personal injury found by the judge was a bilateral carpal tunnel syndrome injury on February 20, 2006, and the MRI scan was recommended in diagnosis of a right-shoulder impingement syndrome, not carpal tunnel syndrome.  The first reference to a diagnosis of right shoulder impingement syndrome occurs in Dr. Jhanjee’s office note of December 14, 2007, nearly two years after the employee was laid off by the employer.  No history is provided, by either Dr. Jhanjee or the judge, regarding the causal relationship of this condition to the employee’s work activities for the employer or to the carpal tunnel syndrome work injury for which benefits are here being awarded.  Dr. Falconer treated the employee for two years and never referenced any impingement syndrome.  Moreover, both Dr. Stern and Dr. Husband were asked to examine the employee’s right shoulder, and neither of them found evidence of impingement syndrome.

Given the record presented, substantial evidence does not exist to support the compensation judge’s award of payment for the recommended right shoulder MRI scan, which the judge found “reasonable and necessary due to, and causally related to, a work-related Gillette-type bilateral carpal tunnel syndrome injury on February 20, 2006.”  We therefore reverse the judge’s award of payment for the scan.