The self-insured employers appeals from the compensation judge’s finding of permanent restrictions, from her award of gastric bypass surgery, from her finding that the employee was a candidate for bilateral knee replacement, and from her award of rehabilitation services.  The employee cross-appeals from the judge’s denial of her claims for treatment of a mental condition and for temporary total disability benefits.  We vacate the judge’s award of gastric bypass surgery and we affirm on all other issues.

Nancy Marquette, the employee, sustained an admitted injury to her left knee on August 6, 2004, while working as a janitor for Minneapolis Special School District #1, a self-insured employer.  On the date of her injury, the employee was 52 years old and was earning a weekly wage of $834.09.

On October 6, 2004, the employee saw Dr. Peter A. Badroos, who diagnosed a left knee joint sprain with persistent pain, placed the employee on light-duty, and assigned work restrictions.  An MRI scan of the employee’s left knee on December 27, 2004, showed degenerative changes, moderate knee joint effusion, and degenerative fraying of the anterior horn of the medial meniscus.  On March 15, 2005, Dr. Badroos continued to assess left knee pain with degenerative joint disease and opined that the employee had reached maximum medical improvement [MMI] with no permanent partial disability.  The doctor felt, however, that the employee’s condition warranted permanent restrictions of no squatting, kneeling, or climbing.

On March 31, 2005, Dr. Thomas Raih examined the employee on behalf of the self-insured employer.  In a report issued April 11, 2005, the doctor noted the employee was 5 feet 5 inches tall and weighed 300 pounds.  She had a slight limp bilaterally and complained of some anterior medial knee pain in both knees.  Dr. Raih diagnosed pre-existing osteoarthritis of both knees.  He opined that the employee had sustained a left knee strain in August 2004 resulting in no permanent disability and concluded that no further treatment was necessary.  Dr. Raih concluded that the employee would benefit from work restrictions but stated that these were due to the pre-existing degenerative osteoarthritis and increased stress from her weight, not to her personal injury.

Around April 15, 2005, the employee was called to a meeting with her superiors and was advised that the employer could no longer accommodate her work restrictions.  Her employment was terminated, and the employee has not returned to work since that date.

About a month later, on May 17, 2005, the employee saw Dr. Nancy Miller at the Allina Clinic complaining of problems with depression.  The doctor’s diagnosis was clinical depression exacerbated by the work injury.

On July 7, 2005, the employee was examined by orthopedic surgeon, Dr. Robert Meisterling, on referral from Dr. Badroos.  Dr. Meiserling diagnosed bilateral osteoarthritis and recommended total knee replacements.

Dr. John Rauenhorst, a psychiatrist, examined the employee in October 2005 at the request of the employer.  The doctor reported that the employee had had problems with depression since 1988, which had been treated with medication.  Dr. Rauenhorst diagnosed the employee with a Depressive Disorder, which he opined was unrelated to her personal injury.  The doctor stated that the employee had no permanent disability due to her depression and did not need restrictions or limitations on her work activities.

The employee returned to see Dr. Meisterling on April 6, 2006, for follow-up on her bilateral knee problems.  The doctor then concluded that the employee was not a surgical candidate, because of her obesity and young age.  He stated that the employee needed to pursue options for weight control with her primary care physician.

In a report dated September 12, 2006, Dr. Badroos stated that the employee’s August 2004 personal injury had permanently aggravated and accelerated the employee’s underlying left knee osteoarthritis.  The doctor opined that the employee also had sustained a consequential over-use injury to her right knee in the nature of an aggravation and acceleration of the underlying degenerative disease process. The doctor concurred with Dr. Meisterling’s recommendation for bilateral total knee replacement surgery, but he stated that he would not recommend surgery until the employee first accomplished significant weight reduction.

On September 26, 2006, the employee attended the first of five visits comprising a chronic pain evaluation with Dr. John Patrick Cronin, a licensed psychologist. In a letter to the employee’s attorney following his evaluation, Dr. Cronin opined that the employee was suffering from a chronic pain syndrome with depression that was causally related to her personal injury.  The doctor opined also that the employee was permanently and totally disabled from gainful employment and had sustained a 38% permanent partial disability rating.

On March 18, 2010, the employee attended a weight loss surgery informational meeting at St. Paul Surgeons, Ltd.  The employee signed an informed consent form (Pet. Ex. A-3-E.), which gave the employee details on a VBG Laparoscopic Adjustable Gastric Banding procedure and a Roux-En-Y Gastric Bypass procedure, both by an open and a laparoscopic approach.  The consent form further provided:

Dr. Raih re-examined the employee on April 7, 2010.  The doctor again diagnosed bilateral degenerative osteoarthritis and stated that the employee’s personal injury was only a temporary aggravation of that condition.  The doctor opined that the employee was a candidate for bilateral knee replacement but that the need for that surgery was due to her pre-existing condition, not the work injury. Dr. Raih further stated that the employee would benefit from a weight reduction program prior to surgery due to the difficulty of the surgery and rehabilitation. In an addendum report issued December 6, 2010, the doctor opined that the employee was a candidate for bariatric surgery, but he reiterated his opinion that the need for that surgery was unrelated to the employee’s work injuries.

The employee filed a claim petition alleging a permanent injury to her left knee on August 6, 2004, an injury to her right knee as a consequence of her left knee injury, and a psychological injury.  The employee sought entitlement to temporary total disability benefits, approval of a weight reduction program, and mental health treatment.  Following a hearing, the compensation judge found the employee had permanent restrictions as a result of her left knee injury and found she sustained an injury to her right knee as a consequence of the left knee injury.  The judge found the employee was a candidate for bilateral knee replacement and that a gastric bypass procedure for weight reduction was reasonable and necessary medical care to treat the employee’s knee injuries.  The judge further ordered the employer provide the employee with a qualified rehabilitation consultant of her choice.  The judge found the employee failed to prove her psychological condition was caused or aggravated by her personal injury.  Finally, the compensation judge found the employee failed to cooperate with rehabilitation and failed to conduct a reasonable and diligent search for employment within her restrictions during the periods of claimed disability. Accordingly, the compensation judge denied the employee’s claim for temporary total disability benefits.  The employer appeals from the compensation judge’s finding that the employee has permanent restrictions caused by her personal injury, from the award of gastric bypass surgery, from the finding that the employee was a candidate for bilateral knee replacement, and from the award of rehabilitation services.  The employee appeals from the compensation judge’s denial of her claim for treatment of a mental condition and from the denial of her claim for temporary total disability benefits.

The compensation judge, in reliance on the opinion of Dr. Badroos, found that the employee required permanent restrictions due to her knee injuries.  The appellant contends that Dr. Badroos’ opinion lacks the level of credibility and clarity necessary to establish liability for permanent restrictions and that Dr. Raih’s opinion was more adequately founded.  The appellant argues that the judge’s finding that the employee sustained a permanent injury to her left and right knee must therefore be reversed.  We disagree.

Dr. Badroos examined the employee on multiple occasions and was familiar with the employee’s history and her course of treatment for her knee conditions.  We have stated on many occasions that this level of expertise provides adequate foundation for a medical expert’s opinion.  See, e.g., Caizzo v. McDonald’s, 65 W.C.D. 378 (W.C.C.A. 2005).  Although Dr. Raih provided a contrary expert opinion, it is the compensation judge’s responsibility, as a trier of fact, to resolve conflicts in expert testimony.  Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985).  The compensation judge’s finding that the employee had permanent restrictions due to her knee injuries is affirmed.

The appellant appeals from the compensation judge’s order that the employer pay for the recommended gastric bypass surgery.  It contends that there is insufficient evidentiary support for the judge’s conclusion that gastric bypass surgery is reasonable and necessary treatment.  We disagree.

Dr. Badroos, Dr. Meisterling, and Dr. Raih all agreed that the employee was a candidate for bilateral knee replacement surgery, but each opined that the employee needed to lose weight before any surgery is performed.  Dr. Badroos and Dr. Raih commented that a gastric bypass may be an appropriate solution for weight reduction, but neither perform that procedure.  The employee attended an informational meeting with St. Paul Surgeons, Ltd., to learn about different weight loss surgeries.  The informed consent form that she signed sets forth a number of preconditions for any bariatric surgery, including a health screening at the clinic, a psychological assessment, and a surgical evaluation.  Pending these evaluations, it is premature to determine whether the employee is a candidate for bariatric surgery and, if so, what type of surgery may be appropriate. Therefore, the compensation judge’s finding that gastric bypass surgery is reasonable and necessary and her order that the employer pay for gastric bypass surgery are both vacated as premature.

The compensation judge found also the doctors had recommended that the employee undergo a gastric bypass procedure for weight reduction prior to proceeding with knee replacement surgery.  The appellant appealed from this finding as well.  Whatever its legal significance, the finding has evidentiary support in the opinions of Dr. Badroos and Dr. Raih.  Notwithstanding our vacation of the judge’s order of the surgery itself, the employer is liable for the reasonable and necessary costs associated with an evaluation of whether the employee is a candidate for a weight loss program including bariatric surgery.

The appellant contends that the employee failed to establish by a preponderance of the evidence that the need for bilateral knee replacement surgery was caused by her work-related injury.  The appellant argues that, lacking credible evidence, the compensation judge’s order for bilateral knee replacement should be reversed.

The compensation judge did not order the employer to pay for knee replacement surgery.  The judge found only that the employee was a candidate for bilateral knee replacement.  We have affirmed the compensation judge’s finding that the employee sustained permanent injuries to both knees as a result of her personal injury.  Dr. Badroos opined that the employee needs bilateral knee replacement as a result of her personal injury, but the doctors agree that the employee must first lose weight.  The finding that the employee is a candidate for knee replacement surgery is supported by substantial evidence and is affirmed.

The compensation judge found that the employee’s personal injury did not aggravate or accelerate the employee’s pre-existing depression.  The employee contends that, in reaching this conclusion, the compensation judge erroneously relied on the opinions of Dr. Rauenhorst.  The employee contends that Dr. Rauenhorst’s opinions lacked foundation, were founded on inaccurate assumptions, ignored certain facts, and were unreasonable conclusions.  For these reasons, the employee contends that the compensation judge’s finding should be reversed.  We are not persuaded.

The competency of a medical expert to provide an expert opinion depends upon both the extent of the scientific knowledge of the expert and the expert’s practical experience with the matter that is the subject of the expert opinion.  Drews v. Kohl’s, 55 W.C.D. 33 (W.C.C.A. 1996) (citing Reinhardt v. Colton, 337 N.W.2d 88 (Minn. 1983).  Dr. Rauenhorst is a licensed physician, and he obtained a history from the employee, reviewed her medical records, and twice conducted a mental status examination.  This level of knowledge is sufficient to afford foundation for the opinions of a medical expert.  See e.g., Ciazzo v. McDonald’s, 65 W.C.D. 378 (W.C.C.A. 2005).

There is substantial evidence of record which, had it been accepted by the compensation judge, would support a finding that the employee’s personal injury caused or accelerated her depressive condition.  However, it is not the function of this court on appeal to assess whether substantial evidence might support a factual conclusion contrary to that reached by the compensation judge.  Rather, this court’s function on factual review is only to determine whether substantial evidence exists to support the conclusion actually reached by the judge.  Redgate v. Sroga’s Standard Serv., 421 N.W.2d 729, 40 W.C.D. 948 (Minn. 1988).  It is the compensation judge’s responsibility as the trier of fact to resolve conflicts in expert testimony.  Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985).  The compensation judge adopted the opinions of Dr. Rauenhorst whose opinions were adequately founded, and the compensation judge could reasonably rely upon them.  The compensation judge’s finding is, therefore, affirmed.

The employee appeals from the compensation judge’s finding that the employee failed to cooperate with the rehabilitation assistance provided to her and failed to conduct a reasonable and diligent search for employment within her restrictions.  Based on these findings, the judge denied the employee’s claim for temporary total disability benefits.  The employee contends that these findings are unsupported by substantial evidence.  We are not persuaded.

The employee initially received vocational assistance through the Department of Labor and Industry commencing in August 2006.  A rehabilitation plan was prepared with a goal of returning the employee to work with a different employer, and a job placement coordinator was assigned.  The rehabilitation file was then closed in August 2007, due to the employee’s failure to make contact with the coordinator and to participate in the rehabilitation plan. The employee then received additional vocational assistance through the Department, beginning in October 2009.  The employee entered into a job placement plan and agreement.  The employee’s then QRC, Michael Haire, provided the employee with job leads and asked her to complete job logs to document her efforts seeking employment.  Mr. Haire testified that the employee did not follow up on the job leads provided her, did not provide the job logs in a timely fashion, and failed to return telephone calls from the QRC.  Based on this evidence, the compensation judge could reasonably conclude that the employee failed to cooperate with rehabilitation efforts.  On that basis, the compensation judge could reasonably deny the employee’s claim for temporary total disability benefits.

The compensation judge ordered the employer to provide the employee with a qualified rehabilitation consultant of her choice.  The employer appeals from this order, contending that the employee is not a qualified employee because she has no restrictions.  Further, the appellant contends that the judge erred in awarding rehabilitation assistance because the employee has no interest in returning to work, as evidenced by her prior failure to cooperate with rehabilitation. We are not persuaded.

We have affirmed the compensation judge’s finding that the employee has permanent restrictions resulting from her work injury and is not able to return to work with the employer.  The employee expressed a desire and willingness to return to work.  The compensation judge reasonably concluded the employee could benefit from rehabilitation assistance.  The employee remains eligible for rehabilitation assistance, and the compensation judge’s order is affirmed.