The employer and insurer appeal from the compensation judge’s decision that the employee continued to suffer from the effects of her work-related shoulder injury as of the hearing date and also from the judge’s findings as to weekly wage, maximum medical improvement, and the employee’s job search efforts.  We affirm.

On August 31, 2011, the employee began working as an operations clerk for Vitran Express [the employer], a trucking operation.  This job involved primarily data entry and “10-key” work, with the employee operating the ten keys on the right of the keyboard with her right hand.  Her shift began at 6:30 p.m. and ended at 3:00 a.m. the next morning.  She was hired to work five days per week, for $12.50 an hour.  The employee started the job on a Wednesday, and she worked three days that week.  She was off the following Monday, Labor Day, and was not paid for the holiday, but she worked the remaining four days of that week.  During her third week on the job, the employee again worked only four days, having arranged to take that Friday, September 16, 2011, off before beginning her employment.

On September 16, 2011, the employee sought treatment from Dr. Margo Hutchison, an occupational medicine specialist, complaining of right shoulder pain that she attributed to the set-up of her work station.  In the office note from that consultation, Dr. Hutchison wrote,

The employer and insurer accepted liability for an injury occurring effective September 8, 2011, and assigned the employee to light-duty work.  The employee then performed the light work beginning Monday, September 19, 2011, through Wednesday, September 21, 2011, when she was terminated for failing to “meet [her] 90-day probationary period.”

The employee subsequently continued to treat with Dr. Hutchison, who kept her under restrictions except from mid November 2011 to early December 2011.  The employee testified that she asked the doctor to suspend her restrictions at that time so that she would have a better chance of securing work with a temporary agency.  She also testified that her symptoms increased when she tried activities inconsistent with her previous restrictions.

On December 2, 2011, the employee underwent an MRI of her right shoulder.  According to the radiologist, “[t]he findings would be most suspicious for partial-thickness degenerative tearing and tendinopathy.”  About ten days later, the employee received a cortisone injection.  Medical records indicate that the treatment was somewhat helpful in alleviating her symptoms.

The employer and insurer sought to discontinue temporary total disability benefits on several grounds, and the matter ultimately came on for hearing before a compensation judge on April 30, 2012.  Issues at that time included the employee’s weekly wage, whether the employee continued to suffer from the effects of her admitted shoulder injury, whether the employee had reached maximum medical improvement [MMI], and whether the employee had conducted a reasonably diligent search for work.  Evidence included the employee’s medical and wage records and the reports of Dr. Mark Thomas, the employer and insurer’s independent medical examiner.  The employee was the only witness to testify.

In a decision issued on May 30, 2012, the compensation judge concluded that the employee had sustained a work injury to her right shoulder on September 8, 2011, which had not resolved as of the date of hearing; that the employee had not reached MMI from the effects of the injury; and that the employee’s job search had been adequate under the circumstances.  As such, the judge denied the employer and insurer’s petition to discontinue temporary total disability benefits.  The judge also concluded that the employee’s weekly wage on the date of injury was $500.00, as the employee had claimed.  The employer and insurer 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 (2012).  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 records of Dr. Hutchison, the employee’s treating physician, indicate that the employee injured her right shoulder as a result of repetitive work activities at a work station with poor ergonomics.  In his first report, Dr. Thomas, the employer and insurer’s expert, seemingly agreed, concluding that the employee had a mild rotator cuff tendonitis or bursitis and that “[r]epetitive use of the right shoulder and arm would be a consistent mechanism with her current complaints.”  Subsequently, in a report dated March 14, 2012, Dr. Thomas noted that his opinions had “not changed in any substantial way,” including his “opinions regarding the cause of [the employee’s] shoulder condition.”  At the same time, however, later in this second report, Dr. Thomas observed that the employee had worked for the employer for only a short time, and he then wrote that the employee’s shoulder condition was not the result of a Gillette injury^[1] but rather a specific incident that the employee had described, in which she was reaching and felt an acute onset of pain.^[2]  Dr. Thomas then reiterated his earlier opinion that the employee required no ongoing restrictions or treatment related to her injury as of November 10, 2011, the date of his first examination.

On appeal, the employer and insurer argue that Dr. Hutchison’s opinion as to a repetitive use or Gillette injury lacks foundation because the employee did not perform keyboarding “100%” of the time, as indicated in Dr. Hutchison’s records, and because Dr. Hutchison did not explain how the employee’s work activities caused the injury.  Therefore, according to the employer and insurer, the only properly founded medical opinion was that of Dr. Thomas, who reported that the employee had sustained a specific injury, not a Gillette injury, and that the specific injury had resolved.  Based on this analysis, the employer and insurer contend that the compensation judge erred by failing to make an express finding as to whether the employee’s work injury was Gillette or specific and that, in any event “substantial evidence demonstrates that the employee sustained a specific injury . . . and that the employee recovered from the affects [sic] of that injury.”

The employer and insurer’s argument here is misdirected, in that they admitted and continue to concede that the employee sustained a work-related injury to her right shoulder effective September 8, 2011.  Given this concession, the question became whether the employee’s admitted injury continued through the date of the hearing, as the employee contended, or whether it had resolved by November 2011, as the employer and insurer alleged.  At that point, whether the injury was Gillette or specific was irrelevant and, contrary to the employer and insurer’s argument, case law requirements for establishing causation for a Gillette injury are simply inapplicable.  Specifically, Steffen v. Target Stores, 517 N.W.2d 579, 50 W.C.D. 464 (Minn. 1994), has nothing to do with determining whether any given injury - - either Gillette or specific - - is ongoing or temporary.  And, finally, again contrary to the employer and insurer’s argument, we are aware of no case law requirement that an employee offer a medical opinion specifically addressing the question of whether that employee continues to suffer from the effects of an admitted work injury.  Rather this is a decision to be made on all the relevant evidence, including medical records and the employee’s testimony.

The employee’s right shoulder injury is admitted.  The MRI scan provides objective evidence of injury, and there is no evidence of any preexisting condition.  The employee’s testimony and her medical records reasonably establish that she continues to experience symptoms related to that injury.  The judge’s decision is affirmed.

The compensation judge concluded that the employee had not reached MMI as of the hearing date, and this decision is supported by substantial evidence.  Dr. Hutchison recommended that the employee undergo an EMG, which had not yet been performed as of the hearing date.  The employer and insurer declined to authorize the test, and the employee testified that, although she had health insurance, she was concerned about payment.  We reject the employer and insurer’s contention that the employee unreasonably delayed medical treatment to delay a finding of MMI.  Cf. Gaida v. Tri City Paving, 60 W.C.D. 233 (W.C.C.A. 2000).  And, finally, because a finding as to MMI is one of ultimate fact, the compensation judge was not required to accept the opinion of Dr. Thomas.  See Hammer v. Mark Hagen Plumbing & Heating, 435 N.W.2d 525, 41 W.C.D. 634 (Minn. 1989).  The judge’s decision on this issue is also affirmed.

The employee has been released to work since her first consultation with Dr. Hutchison on September 16, 2011, most of the time with restrictions, but also for several weeks in late 2011 without restrictions.

The employee testified that she was released without restrictions for a limited period only because she hoped to secure employment with a temporary agency.  She also testified that her symptoms continued and in fact increased when she did not comply with the limitations previously recommended by Dr. Hutchison.  Under these circumstances, we cannot conclude that the compensation judge erred in denying discontinuance based on the employee’s supposed ability to work with no restrictions for a short time in November into December 2011.

The compensation judge also concluded that the employee’s job search was sufficiently diligent to warrant continued temporary total disability benefits.  On appeal, the employer and insurer contend that substantial evidence does not support the judge’s decision on this issue.  We disagree.

We acknowledge that the employee submitted no job search records and that she did not look for work every day.  However, her circumstances substantially mitigate her arguable lack of diligence in her efforts to secure alternate work.  Specifically, she had no rehabilitation assistance for most of the period in question.  She was only receiving about $150 a week in wage loss benefits, which was all she had to pay her bills.  She had no working car, she had no internet access at her house, and the library and job center were located several miles away.  Once the weather turned bad, she reasonably declined to make the hour and half walk there.  She also testified that she went to the job center or library to look for work whenever she could get a ride or bus fare from her daughter and that she also pursued employment by “networking.”  Given this evidence, the compensation judge could reasonably conclude that the employee’s efforts to look for work were adequate under the circumstances.  See e.g., Redgate v. Sroga’s Standard Service, 421 N.W.2d 729, 40 W.C.D. 948 (Minn. 1988).

The employee testified that a representative of the employer named Carrie Dacus hired her to work a 40-hour week for $12.50 an hour.  Her shift was from 6:30 p.m. to 3:00 a.m.  She only worked about a week before she was injured, and, because of the Labor Day holiday, she did not work or get paid for 40 hours.  In fact, the employee did not work a 40-hour week in any of her three weeks of employment prior to her termination.  The compensation judge nevertheless concluded that the employee’s weekly wage on the date of injury was $500.00, obviously calculated by multiplying the employee’s hourly rate by 40 hours.

The employer and insurer contend that the compensation judge’s decision as to weekly wage is unsupported by evidence given the employee’s actual earnings.  We are not persuaded.  The employer and insurer chose not to offer any evidence to refute the employee’s testimony as to the terms of her employment.  Given the holiday and another prearranged day off during the employee’s short tenure with the employer, the judge could reasonably conclude that the employee’s actual earnings were not “a fair approximation of [the employee’s] probable future earning power which has been impaired or destroyed because of the injury.”  Knotz v. Viking Carpet, 361 N.W.2d 872, 874, 37 W.C.D. 452, 455 (Minn. 1985).  As the supreme court has noted, “sometimes it is as important to reject as it is to accept a brief recent-wage experience, if a realistic approximation of future wage loss is to be obtained.”  Bradley v. Vic’s Welding, 405 N.W.2d 243, 246, 39 W.C.D. 921, 924 (Minn. 1987).  The judge’s weekly wage decision is therefore affirmed.