The employer and insurer appeal from the compensation judge’s finding that the employee is a qualified employee for the purpose of rehabilitation services and his award of rehabilitation benefits pursuant to Minn. Stat. § 176.102.  We affirm.

Dana Goetzinger (the employee) is a high school graduate and was 58 years old at the time of hearing.  The employee was working as a retail clerk at K-Mart Corporation (the employer) on January 25, 1983, when she injured her low back.  On this date while at work, the employee fell backwards off a one-foot platform and landed on her feet.  She immediately felt low back pain.  Initial X-rays indicated a partially ruptured disc.

The employee testified her duties included frequent bending, stooping, lifting boxes of clothing and other items in excess of 25 pounds, including overhead lifting, and moving clothing display racks.  The parties stipulated to an average weekly wage of $148.04.  In addition to wages for a 40-hour week, the employer provided medical, life, and disability insurance.

The employee was referred to the Mayo Clinic neurosurgery department with excruciating pain and evidence of cauda equina syndrome.  A laminectomy was performed on February 10, 1983, at the L5 level with removal of a massive extruded disc.  Four large fragments of disc were removed and her spinal canal was decompressed.  Post operatively, the employee continued to experience low back pain and radiating pain into the lower extremities.  The pain has been chronic and consistent throughout the years.

In December 1989, the employee was provided permanent work restrictions by Dr. John Merritt at the Mayo Clinic including no frequent lifting or carrying of more than 25 pounds, no frequent bending at the waist, and to observe good body mechanics and proper back skills at all times to avoid further injury.

Between 1985 and 1998, the employee provided in-home daycare services, then worked for a daycare center, and later provided daycare through the Rochester, Minnesota, school district.  The employee was unable to continue this type of work as the frequent bending and lifting aggravated her low back condition.

Rehabilitation services were provided by the employer and insurer in 1999.  The employee obtained a position as a resident assistant at an assisted living facility, variously known as Wynwood Company, Alterra Wynwood, and Madonna Meadows.  The employee worked 32 hours per week at $7.50 per hour.  Medical benefits were included.

In July 1999, the employee was examined by Dr. John Dowdle at the request of the employer and insurer.  Dr. Dowdle opined the employee’s need for ongoing medical care and treatment was substantially attributable to the employee’s 1983 injury and the doctor assigned work restrictions of no lifting over 25 pounds, avoid repetitive bending, and avoid prolonged single-position-type activities.

In April 2001, the employee underwent a second surgery involving a bilateral partial laminectomy and removal of a protruded disc at the L4 level.  The employee returned to an administrative position with Wynwood/Madonna Meadows as a resident services and housekeeping coordinator.  In 2008, the employee’s position was eliminated due to the economic downturn.

The employee then obtained work at Shopko, earning $9.00 per hour.  Her duties included moving display cases which exceeded her physical restrictions.  The employee voluntarily terminated this employment after a few weeks.

The employee began working for a Kwik-Trip convenience store in September 2009 earning $9.25 per hour.  The employee’s job duties included food and bakery preparation, kitchen clean-up, and the unloading and carrying of foodstuffs.  The employee testified her duties frequently required her to lift and carry more than 25 pounds, exceeding her restrictions.  The employee resigned from this employment in March 2012.

Shortly thereafter, the employee applied for a housekeeping assistant position at the Mayo Clinic Charter House.  The clinic required a pre-placement functional capacity evaluation (FCE).  The FCE indicated the employee could lift up to 25 pounds waist to floor occasionally and could perform static forward bending only occasionally.  The clinic determined they could not accommodate the employee’s limitations and did not offer the position to her.

In May 2012, the employee sought rehabilitation services.  The employee met with a qualified rehabilitation consultant (QRC) on May 18, 2012, who determined the employee was eligible for rehabilitation assistance.  A rehabilitation plan was prepared that same day.  The employee found work as a part-time cook at St. Pius Catholic School which she began on August 22, 2012.  During the school year, the employee works 4 hours per day, 20 hours per week, at a wage of $9.20 per hour.  The employee enrolled in the employer’s health insurance plan for which the employee pays $402.00 a month.

The employee was examined by Dr. Wynn Kearney on January 10, 2013.  Her current symptoms include chronic, recurrent low back pain and radiculopathy into the lower extremities, primarily on the left side.  The doctor noted the employee has continued to have a 25 pound restriction on lifting on an occasional basis, and that bending or heavier frequent lifting is not advisable.  Dr. Kearney opined that the employee’s 1983 injury substantially contributes to the employee’s current low back and left leg condition.

The employer and insurer challenged the necessity for rehabilitation assistance, and if so warranted, whether the need for rehabilitation assistance was causally related to the 1983 injury.  A hearing was held before a compensation judge at the Office of Administrative Hearings.  In a Findings and Order, served and filed March 18, 2013, the compensation judge found that the 1983 work injury continues to be a substantial contributing factor to the employee’s ongoing disability and need for restrictions; that the employee is permanently precluded from returning to the work she held at the time of the injury; and that the employee has a desire to work full-time and can be expected to return to suitable gainful employment with the provision of rehabilitation services.  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).

Minn. Stat. § 176.102 governs the vocational rehabilitation process.  Minn. Stat. § 176.102, subd. 1(b), states that rehabilitation

The employer and insurer contend there is no evidence that disability resulting from the employee’s 1983 injury precludes the employee from engaging in her usual and customary occupation at the time of injury.  In January 2013, Dr. Kearny provided restrictions of no repetitive lifting of any kind; no lifting on a regular basis over 25 pounds from floor to waist level only; no repetitive flexion at the waist; and the ability to change positions from sitting to standing or walking on a regular basis.  In unappealed findings, the compensation judge found that the employee’s work as a customer service representative at K-Mart required her to lift more than 25 pounds, repetitively bend and stoop, and move display racks (finding 2), and that the employee has continued to experience recurrent symptoms and has had numerous flare-ups in her back pain (finding 21).  The compensation judge adopted Dr. Kearney’s opinion that the employee’s 1983 work injury continues to be a substantial contributing factor to the employee’s ongoing disability and restrictions.  The judge additionally accepted as credible the employee’s testimony that she is unable to engage in the customer service work that she held at the time of the injury.  It is the province of the compensation judge to determine the weight and credibility to be given to witnesses’ testimony.  See Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985) (medical expert testimony); Even v. Kraft, Inc., 445 N.W.2d 831, 835, 42 W.C.D. 220, 225 (Minn. 1989) (testimony of the employee).  There is substantial evidence in the record to support the compensation judge’s finding that the employee is permanently precluded from returning to work that she held at the time of the injury and we affirm.

Evaluation of the employee’s economic status, for the purposes of rehabilitation pursuant to Minn. Stat. § 176.102, includes comparison of the employee’s wages, fringe benefits such as health, life and disability insurance, the opportunity for future income and advancement, and other factors such as the employee’s age, education, interests, skills and employment history.  See Minn. R. 5220.0100, subp. 34; Gackstetter v. Johnson/Midwest Coca Cola Bottling, 511 N.W.2d 439, 50 W.C.D. 51 (Minn. 1994); Keklah v. Gebert's Floor Coverings, 511 N.W.2d 437, 50 W.C.D. 80 (Minn. 1994).

The employer and insurer argue the employee is not entitled to rehabilitation benefits on the basis that no wage replacement benefits are due and owing as the employee’s current wages are in excess of her average weekly wage at the time of her injury.  Wage replacement benefits such as temporary total disability benefits and temporary partial disability benefits are based on the mathematical difference between the date-of-injury weekly wage and current weekly wages.  An employee’s eligibility for rehabilitation services is analyzed differently and is determined by comparing the employee’s “economic status” pre- and post-injury, applying the factors outlined in the statute and applicable rules.  See, e.g., Tottenham v. Eaton Char-Lynn Corp., 43 W.C.D. 71. 81-82 (W.C.C.A. 1990).

The employer and insurer argue the employee currently enjoys an economic status at least equal to that which she would have enjoyed without her disability as, at the time of her injury, the employee was in an entry level position making $148.04 per week or approximately $3.70 an hour.  The appellants assert that, at least since 1999, the employee has been employed in entry level positions at a wage equal to or in excess of her pre-injury wage.

In 1999, following rehabilitation assistance, the employee obtained a full-time position as a resident assistant with employer-paid fringe benefits, including health insurance.  In 2001, she was promoted to an administrative position as a resident services and housekeeping coordinator.  In 2008, the employee lost her employment with Wynwood/Madonna Meadows for economic reasons.  The employee began her current employment at St. Pius Catholic School in August 2012.  This employment, while at a higher hourly wage - - $9.20 per hour - - is part-time, only 20 hours a week, and only nine months out of the year.^[2]

In addition, although the employee has health insurance through her current employer, she pays $402.00 per month for her medical coverage.  The employer and insurer contend that fringe benefits as a component of economic status is the critical issue in this case.  They first assert that the testimony as to whether the medical benefits provided by K-Mart were “fully paid” is equivocal.  The employee testified that she received health benefits through K-Mart and was “almost positive” they were provided by the employer and she did not think there was any deduction from her salary for these benefits.  (T. 20-21.)  This is sufficient evidence to support the compensation judge’s finding that K-Mart provided employer-paid health insurance.

The employer and insurer further argue that the change from fully funded medical insurance to partially funded medical coverage is consistent with current employment economics and is not in any way causally related to, or connected with, her disability.  Therefore, the appellants argue, the employee cannot demonstrate that she needs rehabilitation benefits “because of the effects of a work-related injury or disease.”  Minn. R. 5220.0100, subp. 22.  The question is not, however, whether a single factor is “causally related” to the disability, but whether the employee’s economic status, considering her wages, benefits, opportunity for income and advancement, and other employment-related factors, as a whole, is as close as possible to that which the employee would have enjoyed without the disability.

The employee’s QRC testified that the employee’s current job does not return her to a suitable economic status comparing wages over the time span since the injury - - 30 years - - with cost of living increases and the substantial cost of health insurance through her current employer.  The compensation judge found the QRC’s testimony persuasive and adopted her opinion.  Whether post-injury employment produces an economic status as close as possible to that which the employee would have enjoyed without disability is a question of fact for the compensation judge.  Erickson v. City of St. Paul, 67 W.C.D. 516 (W.C.C.A. 2007); Kimball v. St. Mary’s Duluth Clinic, No. WC09-112 (W.C.C.A. May 27, 2009).  Substantial evidence supports the compensation judge’s determination and we affirm.

The employer and insurer contend the employee is ineligible for rehabilitation services because she voluntarily quit suitable employment.  The appellants maintain the employee was earning a higher wage at Kwik Trip and left the job for personal reasons unrelated to her work injury.  Regardless of whether or not the employee left her job with Kwik Trip due to her disability, a voluntary quit does not preclude an employee from later receiving rehabilitation benefits.  Eligibility may be reestablished if the employee requests and cooperates with renewed rehabilitation assistance or otherwise makes a reasonably diligent search for work.  Johnson v. State, Dep’t of Veterans Affairs, 400 N.W.2d 729, 39 W.C.D. 367 (Minn. 1987); Tottenham, 43 W.C.D. at 80-81.  The employee in this case sought and obtained the assistance of a QRC and job placement vendor and obtained employment within a matter of months after leaving her Kwik Trip employment.  The fact that the employee successfully secured part-time work demonstrates a diligent job search.

Finally, the employer and insurer assert that K-Mart provided rehabilitation assistance in 1999, resulting in suitable employment at Wynwood/Madonna Meadows.  The employee held that position until 2008.  Thereafter, the employer and insurer assert, the employee independently secured and maintained employment consistent with her pre-injury economic status without rehabilitation benefits or services.  As discussed previously, however, there is substantial evidence to support the judge’s conclusion that the employee’s current part-time, less-than-full-year job is not economically suitable.  Further, as noted by the judge in his memorandum, the evidence supports the conclusion that the employee has a desire to work full time and has attempted several different employment positions, since the Wynwood/Madonna Meadows job, that were beyond her physical limitations.

From shortly after the 1983 injury to the present, the employee has demonstrated a high motivation to work and has been employed in one capacity or another, with or without the provision of rehabilitation services.  This is to her credit, and to the benefit of the employer and insurer.  The fact that the employee has been successful on her own in the past is not a reason to deny her rehabilitation assistance in the present.  The employee is now 58 years old, with a high school education, an employment history of entry level jobs, and a 30-year history of a significant work-related disability.  The compensation judge reasonably concluded she is likely to benefit from rehabilitation services.

There is substantial evidence to support the compensation judge’s determination that the employee is not in a job which produces an economic status as close as possible to that which the employee would have enjoyed without the disability and would benefit from the provision of rehabilitation services.  We, accordingly, affirm.