The employer and insurer appeal the compensation judge’s finding that the employee’s request for a referral to a brain trauma specialist is reasonable and necessary medical treatment in this case.  We affirm.

On January 26, 2010, Patrick K. Ploog, the employee, was injured when he fell while working as an over-the-road truck driver for Premier 94 Truck Services, Inc./Long Haul Trucking, the employer, which was insured for workers’ compensation liability by Midwest Safety Group/Administrative Claim Services, Inc., the insurer.  The employer and insurer admitted that the employee sustained left shoulder and left elbow injuries and paid various workers’ compensation benefits.  The employee also claimed that he hit his head when he fell.  The employee was able to continue working and sought treatment the next day at the Buffalo Hospital emergency department.  The medical records from the hospital show that the employee complained of headache, left upper extremity pain, and left side/rib pain.  In addition, examination indicated a contusion to the employee’s forehead and a head CT scan had negative results.  The employee was transferred by ambulance that night to North Memorial Hospital for further examination.

The employee was ultimately diagnosed with a left radial head fracture, possible rotator cuff tear, and possible left carpal tunnel syndrome from a wrist contusion.  On March 30, 2010, the employee underwent an arthroscopic left shoulder rotator cuff repair and left carpal tunnel release surgery, performed by Dr. David Labadie.  On June 2, 2010, the employee was examined by Dr. Labadie.  The employee reported experiencing tremors in his left forearm, hand, and fingers.  The doctor recommended the employee undergo a neurology evaluation.

On June 15, 2010, the employee was examined by Dr. Masood Ghazali at the Minneapolis Clinic of Neurology.  The employee reported falling and hitting his head, left shoulder, and left elbow.  The employee indicated that he started noticing the tremors five to six weeks before the examination.  Dr. Ghazali observed continuous opening and closing of the employee’s left hand and wrist movements during examination that were varying in their intensity and severity, and opined that the tremors were not related to the employee’s work injury.  The employee was treated by his personal physician, Dr. Thomas Styrvoky on July 16, 2010.  Dr. Styrvoky noted persistent tremors in the employee’s left upper extremity.  The employee and Dr. Styrvoky discussed considering a second neurology opinion.

On July 20, 2010, the employee was evaluated by Dr. Michael D’Amato at the employer and insurer’s request.  Dr. D’Amato noted persistent tremor of the wrist and hand with obstructed active range of motion due to the tremor, but opined that the employee’s tremor condition was likely fabricated and exaggerated.

On October 15, 2010, the employee was again examined by Dr. Styrvoky.  The doctor assessed left frozen shoulder with rotator cuff injury and persistent tremor involving the left upper extremity and recommended a consultation with Dr. Daniel Buss, a shoulder specialist.  Dr. Buss examined the employee on October 27, 2010, and noted that the employee had a clinched left fist and obvious constant tremor. The employee reported that he had hit his head on January 1, 2010, that the tremor condition had been progressing since his surgery in March 2010, and that it was limiting his daily activities.  Dr. Buss assessed chronic brain trauma to brain stem/cerebellar injury or hypotensive result from surgical positioning, continued shoulder pain, and progressive arm tremor.  Dr. Buss recommended that the employee consult with a brain trauma specialist for further evaluation and treatment, and that the employee should return for a reevaluation of his shoulder once the symptoms with his tremor improve.

On December 9, 2010, the employee filed a medical request for approval of a consultation with a brain trauma specialist for evaluation and treatment, based on Dr. Buss’s opinion.  The employer and insurer filed a medical response on December 16, 2010, denying the request.  After an administrative conference, the employer and insurer filed a request for formal hearing on February 23, 2011.  The employer and insurer denied that the employee sustained a closed head injury on January 26, 2010, and claimed that a consultation with a brain trauma specialist was not reasonable, necessary, or causally related to the employee’s January 26, 2010, work injury.

On March 28, 2011, the employee was examined by Dr. James Allen at the employer and insurer’s request.  Dr. Allen opined that the employee’s left hand clinching and tremor condition was based on a conversion reaction and was not causally related to his work injury, and that a consultation with a brain trauma specialist was not required to evaluate and treat the employee’s tremor condition.

A hearing was held on April 29, 2011.  The compensation judge found that the referral to a brain trauma specialist was reasonable and necessary medical treatment.  The employer and insurer 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.^[2] 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.^[3]  Fact findings are clearly erroneous if the reviewing court, looking at the entire evidence, is left with a definite and firm conviction that a mistake has been committed.^[4] 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 the evidence or not reasonably supported by the evidence as a whole.”^[5]

The employer and insurer appealed the compensation judge’s finding that the employee hit his head on January 26, 2010.  At the hearing, the employer and insurer denied that the employee sustained a brain stem injury or a closed head injury on January 26, 2010.  The compensation judge found that when the employee fell on January 26, 2010, he hit his head and landed on the left side of his body with the left shoulder, left arm, and left hip hitting the ground.^[6] In their statement of facts, the employer and insurer claim that the Buffalo Hospital medical records do not mention any trauma to the employee’s forehead. We note that the medical records from the Buffalo Hospital Emergency Department dated January 27, 2010, clearly state that on examination the employee had a contusion on his forehead.  Several of the employee’s medical records indicate that he reported hitting his head on January 26, 2010.  The employee testified at the hearing that he hit his head on that date.^[7]  Substantial evidence supports the compensation judge’s finding that the employee hit his head when he fell on January 26, 2010, and we affirm.

The employer and insurer also contend that the compensation judge committed an error of law when he determined that a referral to a brain trauma specialist to evaluate or rule out an alternative explanation for the employee’s left upper extremity tremors was reasonable and necessary to cure and relieve the effects of the work injury without finding that the employee’s tremors were related to the work injury.  They argue that the evidence at hearing compels a conclusion that the work injury is not a substantial contributing factor in the employee’s left upper extremity tremors, and therefore, the referral is not reasonable or necessary.

An employer and insurer are required to furnish any medical treatment “as may reasonably be required at the time of the injury and any time thereafter to cure and relieve from the effects of the injury.”^[8]  Referral for diagnostic testing to evaluate or rule out an alternative explanation or treatment for a work injury is generally compensable, whether or not the condition or diagnosis evaluated is found to be work-related.^[9] The employee has an extensive and complicated medical history.  The tremors may be produced by a single cause or various causes, related or unrelated to the work injury.  The referral by Dr. Buss to a brain trauma specialist will help identify the relationship between the work injury and the employee’s tremors.  The compensation judge was not required to find that the employee’s tremors were causally related to the employee’s work injury in order to find that the recommended evaluation was reasonable and necessary.

The employer and insurer also argue that because Dr. Buss’s referral was for evaluation and treatment of the employee’s tremor condition and not for an evaluation to determine the cause of the employee’s tremors, the compensation judge erred by finding that the referral was reasonable and necessary to evaluate or rule out an alternative explanation for the employee’s condition.  We disagree.  The issue before the compensation judge was whether the recommended referral was reasonable and necessary.  There was conflicting evidence as to the cause of the employee’s tremor condition.  The compensation judge could reasonably conclude that the additional evaluation was reasonable and necessary medical treatment.

We affirm the compensation judge’s finding that the referral by Dr. Buss to a brain trauma specialist is reasonable and necessary to cure and relieve the effects of the employee’s January 26, 2010, work injury.