The employer and insurer appeal the compensation judge’s determination that the employee’s work injury was a substantial contributing factor in his permanent partial disability and need for medical care.  We affirm.

Douglas Isler was injured in a work-related auto accident on December 20, 2007.  He was taken by ambulance to Unity Medical Center where he complained of pain in his cervical area and left hip.  Some tenderness was noted over the C5-6 vertebrae and the left iliac crest.  He was sent home with a prescription for pain medication and instructions to rest and use heat for his symptoms.

Mr. Isler was 48 years old at the time of his work injury, and he had worked for Domino’s as a delivery driver for more than 10 years.  He testified that about six or seven years before the 2007 injury, he had been in another work-related collision and had injured his neck.  Mr. Isler stated that he saw a doctor, was told that there was nothing wrong with him, and his symptoms went away after three days.  He testified he never had neck pain after that and had no restrictions on his activities.

Mr. Isler began treating with Dr. Sean Flood on January 8, 2008, for pain in his neck and lower leg.  Dr. Flood diagnosed the lower leg pain as being due to a contusion sustained in the collision and assessed a cervical strain for which he prescribed pain medication.  Mr. Isler continued to treat with Dr. Flood for his cervical pain and, at his direction, had physical therapy that made his symptoms worse.  Also at Dr. Flood’s direction, the employee had an MRI in March 2008 that was read as showing “chronic appearing degenerative changes” in his cervical spine.  At his last appointment with Dr. Flood on March 12, 2008, Mr. Isler still had neck pain and tenderness at C7 and T1.

Mr. Isler then saw Dr. Ana Groeschel at the Noran Neurological Clinic in July 2008.  After an examination in which she found a mild decrease in the employee’s cervical range of motion and “paracervical spasms,” Dr. Groeschel assessed a cervical strain and referred Mr. Isler to Physicians Neck & Back Clinic (PNBC) for “more advanced physical therapy.”

The employee began a program of physical therapy at PNBC in August 2008 and completed the program in October after attending 18 sessions.  The assessment made at PNBC in October was that the employee had made good progress “objectively” and reported 50 percent improvement in his neck pain.

Mr. Isler continued to treat with Dr. Groeschel for his neck pain and headaches, receiving prescription pain relief medication.  He also decided to try chiropractic care and began treating with Dr. Hebeisen at Advanced Health, P.A., in June 2009.  He had 20 appointments for treatment of neck pain and headaches, with his last visit being September 1, 2009.  Although Dr. Groeschel had not referred Mr. Isler to this clinic, she was aware of his care there.

In February 2010, Dr. Groeschel noted pain at the extremes of range-of-motion testing, tenderness in the paracervical muscles, and a trigger point in his left trapezius.  The employee reported continuing headaches and neck pain that varied from 3 to 8 on a 10 point scale.  Mr. Isler received a therapeutic trigger point injection at that time and continued to treat with Dr. Groeschel.

Mr. Isler’s medical bills were paid in part by State Farm Insurance, his no-fault carrier.  At the request of State Farm, Mr. Isler was evaluated by a chiropractor, Dr. Michael Kohout, who wrote a report dated August 10, 2010, after his evaluation of Mr. Isler.  Dr. Kohout’s opinion was that the December 2007 injury that Mr. Isler had sustained was a musculoskeletal ligamentous strain that had resolved and did not require further treatment.

In response to a request from the employee’s attorney, Dr. Groeschel provided a report of October 12, 2010, in which she provided her opinion that “the patient has a chronic cervical strain and cervicogenic headaches that date back, and is wholly attributed, to the motor vehicle collision that happened on December 20, 2007.  These are considered to be permanent injuries.”

Mr. Isler was seen three times in 2011 at the Noran Clinic and received trigger point injections at those appointments.  At the last of those appointments on July 1, there was discussion of possible Botox injections.  Dr. Robert Jacoby at Noran Clinic evaluated Mr. Isler for that treatment and provided a Botox injection in February 2012.  Mr. Isler returned to Dr. Groeschel in August, and she referred him to Minnesota Advanced Pain Specialists (MAPS).

Mr. Isler was seen at MAPS on August 22, 2012, and was begun on a physical therapy program and also received lidoderm patches for his neck pain.  Mr. Isler also received “diagnostic cervical medial branch blocks at C2 left, C3 left, and C4 left levels.”  In November 2012, the records from MAPS indicated the employee’s condition had improved with physical therapy and he was considered to be a candidate for a medial branch radiofrequency procedure.  That procedure had not taken place as of the date of hearing.

In a report dated November 16, 2011, Dr. Groeschel provided her opinion that the employee had a permanent partial disability as the result of his work injury.  She referred to the MRI showing degenerative changes and to the “persistent objective clinical findings” in examination.  Based on those findings, Dr. Groeschel rated the employee as having 10 percent permanent partial disability under Minn. R. 5223.0370, subp. 3.C.(2).

The employee was evaluated by Dr. Tilok Ghose on behalf of the employer and insurer on March 31, 2012.  In his report, Dr. Ghose stated there were no objective findings on examination, although the employee complained of tightness in his cervical spine.  Dr. Ghose’s conclusion was that the employee’s pain was the result of the employee’s pre-existing degenerative condition reflected in the MRI.  He further concluded that the employee’s work injury had been a temporary soft-tissue injury that resolved within three months with no permanent partial disability.  Dr. Ghose stated the employee’s medical care after March 27, 2008, had not been reasonable and necessary to treat the 2007 work injury.

The employee’s claim petition was heard by Compensation Judge Paul Rieke on November 27, 2012.  Issues for determination consisted of the employee’s claim for permanent partial disability as rated by Dr. Groeschel and whether the medical treatment received by the employee was reasonable, necessary, and related to the work injury.  State Farm, MAPS, and HealthPartners intervened for reimbursement of medical expenses.

The compensation judge found that the employee had sustained 10 percent permanent partial disability as the result of his work injury and awarded that benefit to the employee.  He also awarded the intervenors’ claims for reimbursement of medical expenses except for that portion of State Farm’s claim relating to its payment to Advanced Health, P.A., concluding there was insufficient evidence to establish that treatment at that clinic was reasonable and necessary.

The employer and insurer have appealed the compensation judge’s decision.

The employer and insurer have raised the issue of the standard of review to be used by this court in the present case.  When this court reviews a compensation judge’s factual findings, we are to determine if the findings are supported by substantial evidence.  Minn. Stat. § 176.421, subd. 1.  Substantial evidence is defined as evidence that a reasonable mind might accept as adequate.  If substantial evidence exists to support the compensation judge’s findings, the findings are to be affirmed by this court.  Hengemuhle v. Long Prairie Jaycees, 358 N.W.2d, 54, 37 W.C.D. 235 (Minn. 1984).  Pelowski v. K-Mart Corp., 627 N.W.2d 89; 61 W.C.D. 276 (Minn. 2000).

The employer and insurer argue on appeal that Hengemuhle does not apply here because this is not a review of contested facts.  They contend instead that this case involves essentially undisputed facts and, in such a situation, this court’s review should be a de novo consideration of whether the compensation judge’s findings are in accord with the statute.  See Dorr v. National Marrow Donor Program, 70 W.C.D. 690, 693 (W.C.C.A. 2010).  We are not convinced.

The first issue for determination was identified by the compensation judge as being whether the employee’s work injury was temporary or permanent.  In considering this issue, the compensation judge was presented with competing medical opinions.  Drs. Kohout and Ghose were of the opinion that the work injury was temporary and had completely resolved so that the employee had no permanent disability or need for medical care.  In contrast, Dr. Groeschel concluded that the employee’s cervical pain was a result of his work injury, that the employee was entitled to a rating of permanent partial disability as a result of the injury, and that the employee’s medical care was necessary and related to his work injury.

In reviewing the decision of a compensation judge based upon a choice between medical opinions, this court often cites to Nord v. City of Cook, 360 N.W.2d 337, 342, 37 W.C.D. 364, 371 (Minn. 1985).  We note that in Nord, the compensation judge, relying on the opinion of an independent medical examiner, denied a claim that the employee’s heart attack was related to his employment.  This court reversed the compensation judge, finding that because of errors in the assumptions made by the examiner, reliance on the opinion of the examiner did not represent substantial evidence that would support the decision of the compensation judge.  The reversal of the compensation judge’s decision was appealed to the Minnesota Supreme Court.  In its decision, the Supreme Court held that “[t]he WCCA did apply the correct standard, the substantial evidence test, in reaching its conclusion.”  Based on the holding in Nord, we conclude that when we review a compensation judge’s decision based on the choice between differing medical opinions, our review must determine if substantial evidence supports the compensation judge’s decision.

The employer and insurer argue that substantial evidence does not support the compensation judge’s decision because the compensation judge found a permanent work injury despite “uncontroverted evidence” that the employee had degenerative changes in his cervical spine as demonstrated by the MRI.  They claim the compensation judge had to ignore this evidence in making his decision.  It is indeed uncontroverted that the MRI showed degenerative findings in the employee’s cervical spine, but that finding alone does not require a conclusion that the work injury was temporary.  Further, there is no basis for concluding that the compensation judge ignored the MRI results.

In finding permanent partial disability from the work injury, the compensation judge stated, “The employee’s testimony, the medical records revealing the ongoing nature of the employee’s symptoms and cervical functional loss of use, the ongoing need for treatment, and the opinions of Dr. Groeschel are supportive of this conclusion.  Although the employee had a degenerative condition of the cervical spine pre-existing his work injury, the evidence demonstrates that the work injury has been a significant contributing aggravating cause of the employee’s present cervical permanent disablement.  The parties do not disagree with the 10% whole body permanent partial disability rating but rather just the cause of such disablement.”  (Finding 13.)

The employee testified that he had no cervical symptoms before the work injury, and he testified as to the continuing symptoms he had after that.  The history of his injury and symptoms he provided to his doctors and to the independent examiners was consistent and was consistent with his testimony at the hearing as well.  The employer and insurer allege the employee was not credible because he expressed some uncertainty on details of five years of treatment but the compensation judge noted that, “[a]lthough at times the employee’s testimony appeared to be uncertain for dates and events which happened several years prior to the present hearing, the Court found his testimony to be credible especially with respect to his physical condition prior to the work injury and after the work injury up to the present date.”  (Finding 12.)  Credibility of a witness is uniquely within the province of the compensation judge.  Tews v. Geo. A. Hormel & Co. 430 N.W.2d 178, 41 W.C.D. 410 (Minn. 1988); Strohecker v. Mike’s Auto Repair & Tire, No. WC12-5437 (W.C.C.A. Aug. 7, 2012).

The compensation judge considered the opinions of Dr. Kohout and Dr. Ghose that the employee’s condition was the result of pre-existing degenerative changes as reflected by the MRI but rejected those opinions in favor of Dr. Groeschel’s opinion.  The compensation judge stated that, “[t]his physician’s opinions are determined to more accurately reflect the nature and extent of the employee’s work injury.”  (Finding 10.)  As noted in the Noran Clinic records, Dr. Groeschel was aware of the findings from the MRI, she was the employee’s primary treating doctor from July 21, 2008, until the date of hearing, and she had the employee’s medical records, including those from PNBC after his referral there.  This information was adequate to establish foundation for a medical opinion.  Scott v. Southview Chevrolet, 267 N.W.2d 185, 30 W.C.D. 426 (Minn. 1978); Harding v. Leigh Corp., No. WC07-211 (W.C.C.A. Feb. 12, 2008).

The records show that Dr. Groeschel found spasms in the employee’s cervical spine on a number of occasions.  That finding, combined with the MRI results, fulfills the requirement for a rating of 10 percent permanent partial disability under Minn. R. 5223.0370, subp. 3.  The challenge to Dr. Groeschel’s opinion made by the employer and insurer is essentially that Dr. Groeschel’s findings of cervical spasms are contrary to other medical records, especially those of Dr. Flood.  While that argument may affect the weight to be given to Dr. Groeschel’s opinion, it does not require the compensation judge to reject the opinion.  Finally, we note in this regard that at the hearing the employer and insurer agreed the employee had 10 percent disability under that section, a section which requires “persistent objective clinical findings.”

It is apparent that the compensation judge concluded the employee had sustained a permanent work injury with 10 percent permanent partial disability based on the employee’s credible testimony, the medical records showing a consistent history since the date of injury, and Dr. Groeschel’s well-founded opinion.  We conclude substantial evidence supports the compensation judge’s decision on this issue and it is affirmed.

The employer and insurer have also appealed the compensation judge’s determination that the employee’s medical care was reasonable and necessary and related to the work injury, and from the compensation judge’s award to the intervenors.^[1]  The argument advanced by the employer and insurer on this issue is that the employee testified he received no benefit from the treatment.  It is true that the employee stated a number of times in the hearing that he had not noticed improvement after some of his treatment.  But it is also clear from reviewing the employee’s testimony that his main complaint with his medical care was that he was not cured and still had neck pain.  The medical records reflect improvement in the employee’s condition and the compensation judge correctly noted that “the employee now has some weeks where he does not experience pain.”  (Finding 14.)  Medical care for a work injury is to “cure and relieve” the effects of the employee’s work injury.  Minn. Stat. § 176.135, subd. 1.  The fact that the medical care does not cure the injury does not mean that it was not reasonable or necessary.  Castle v. City of Stillwater, 235 Minn. 502, 51 N.W.2d 370, 17 W.C.D. 103 (1952); Bryant v. Honeywell, Inc., slip op. (W.C.C.A. April 25, 2003).  We find substantial evidence in the record to support the compensation judge’s finding on this issue.

The findings and order of the compensation judge are affirmed.