The employer and insurer appeal from the compensation judge’s decision awarding various benefits relating to the employee’s cervical condition.  We affirm in part, vacate in part, and modify in part.

The employee began working for Savanna Pallets, Inc. [the employer], a manufacturer of wood pallets, in the fall of 2010.  Apparently for some number of years before this, the employee had received periodic chiropractic care from Dr. Tim K. Setterquist.  The employee testified that he did not have health insurance and that he considered Dr. Setterquist’s adjustments to be “tune ups” for sore muscles, to help him stay healthy.  In September of 2011, the employee began receiving massage therapy at Structural Energetic Therapy, Inc., as well, at the suggestion of a coworker.  The employee testified he sought care there “just to get tuned up because at work you’re lifting a lot of heavy things you get sore.”  Both chiropractic records and massage records contain references to both back symptoms and neck symptoms.

On November 10, 2011, the employee struck his head on a light fixture at work.  He was wearing a hard hat, and the hat was not cracked or otherwise damaged in the incident.^[1]  The employee informed his supervisor that he had hit his head and was experiencing severe neck pain, and he asked to go home.  He also told his supervisor that he did not want medical treatment at the time.

The next day, on November 11, 2011, the employee sought chiropractic treatment from Dr. Setterquist.  Treatment notes from that visit contain no reference to the work incident.  However, the employee was also seen that day for massage therapy, and notes from Structural Energetic Therapy describe the injury, further indicating that the employee had not permitted Dr. Setterquist to adjust his cervical spine due to pain.

The employee was seen on December 14, 2011, by Dr. Michael Momont, who found weakened biceps and triceps reflexes and restricted range of motion on examination.  Dr. Momont took the employee off work pending completion of a cervical MRI, which was apparently performed on December 28, 2011.  The report from that scan was not offered as evidence, but Dr. Momont’s records reflect that the scan disclosed bulging discs but no significant stenosis.  Dr. Momont released the employee to light-duty work, and the employer accommodated Dr. Momont’s recommendations in that regard.

About a month later, the employee was seen by Dr. Derek Orton, who reviewed the December 28, 2011, MRI and ordered a CT scan.  The radiologist’s report from that CT scan was not offered as evidence.  The employee was subsequently treated by Dr. Paul Vollmar, a pain specialist.  Dr. Vollmar prescribed physical therapy and later a cervical epidural steroid injection.

In early June 2012, the employer and insurer had the employee evaluated by Dr. Paul Cederberg.  According to Dr. Cederberg, the December 28, 2011, MRI had disclosed “borderline small canal at C3 through C6 levels . . . [and] mild diffuse disc bulging at C5-6.”  Dr. Cederberg’s report further indicates that a CT scan performed on February 10, 2012, showed “straightening of the usual cervical lordosis, degenerative facet arthropathy on the right most significant at C2-3, no evidence of central spinal stenosis or foraminal stenosis . . . [and] no paravertebral soft tissue swelling and no focal disc herniation.”  Dr. Cederberg documented diminished grip strength and forearm atrophy on the employee’s right side.  The doctor later testified that he was at a loss to explain these findings, but he concluded that the employee’s ongoing cervical condition was not related to the November 10, 2011, incident at work.  He also indicated that the employee had no need of any restrictions related to his cervical condition.

On June 18, 2012, based on Dr. Cederberg’s report, the employer offered the employee his usual pre-injury job.  The employee testified that he did not feel capable of performing that work, that he declined that offer, and that he was not aware that the employer would have continued to provide light-duty work if he had submitted updated restrictions.  Susan Ohland, in charge of workers’ compensation issues for the employer, testified that the employee was informed about the availability of continued light-duty work at the June 18, 2012, meeting.  In any event, the employee did not return to work at that time.  A few days later, on June 22, 2012, Dr. Orton removed the employee from all work and referred him to Twin Cities Spine Surgeons.

The employee met with QRC Michael Anderson on July 13, 2012.  ORC Anderson concluded that the employee was qualified for rehabilitation services, and he developed a rehabilitation plan directed at returning the employee to work with the employer.

Dr. Amir Mehbod of Twin Cities Spine Surgeons referred the employee for another MRI scan.  Only the first page of the report from that scan was offered into evidence.  Dr. Mehbod described the scan as showing a disc herniation at C5-6 with “loss of ventral CSF space and right-sided foraminal stenosis.”  The employee was informed of a surgical option for treatment, a decompression, anterior cervical discectomy and fusion.  Dr. Mehbod also recommended that the employee avoid lifting more than 10 pounds and also avoid repetitive bending, lifting, and twisting.  The employer then offered the employee work within these limits.  The employee attempted the offered work for a few hours on two or three days in January 2013, but he ended up seeking treatment at urgent care.  The employee testified that Dr. Mehbod subsequently took him off all work pending surgery.

The matter came on for hearing before a compensation judge on January 22, 2013, for consideration of the employee’s claims for temporary total disability benefits after June 22, 2012, medical expense benefits, and approval of surgery.  The employer and insurer took the position that the November 10, 2011, injury was temporary and had resolved without any need for restrictions or need for further treatment.  The employer and insurer also contended that wage loss benefits were not payable because the employee had made no job search during the period in question.  Evidence included certain medical and rehabilitation records, the reports and deposition testimony of Dr. Cederberg, and testimony of the employee, the employee’s supervisor, and Ms. Ohlund, the employer’s workers’ compensation administrator.

In a decision issued on April 3, 2013, the compensation judge concluded that the employee’s November 10, 2011, work injury was a substantial contributing cause of the employee’s cervical condition and need for treatment through the hearing date, that the employee was entitled to temporary total disability benefits as claimed, that recommended facet injections, listed on a medical request, were reasonable and necessary treatment, and that surgery was not reasonably required to treat the effects of the work injury.  The judge also ordered the employer and insurer to pay for an EMG and ordered the employee to provide Dr. Mehbod with a complete copy of all records pertaining to treatment of his cervical spine prior to the November 10, 2011, injury.  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 employer and insurer contend that substantial evidence does not support the compensation judge’s conclusion that the November 10, 2011, work incident substantially caused the employee’s cervical condition and need for treatment through the date of hearing.  More specifically, the employer and insurer maintain that the compensation judge improperly shifted the burden of proof, ignored evidence of preexisting symptoms and treatment, and relied on a medical opinion lacking in foundation.  We are not persuaded by any of the employer and insurer’s arguments on this issue.

With respect to the burden of proof, the employer and insurer contend that the judge erroneously required the employer and insurer to prove that there was an intervening cause of the employee’s disability after the November 2011 incident.  We disagree.  The judge did indeed note in his memorandum that there was “no evidence of an intervening event that may have caused” the findings disclosed on the diagnostic scans, as reflected in physicians’ records.^[2]  However, as the employer and insurer acknowledge, one of their defenses to the employee’s claim was that the employee’s neck condition was caused by other incidents or events.  As such, the compensation judge’s observation likely resulted from the employer and insurer’s causation defense, as opposed to the judge improperly requiring “the employer to disprove that the injury arose out of and in the course of employment.”

We also reject the employer and insurer’s contention that the judge “ignored the evidence” regarding prior events and cervical treatment.  On the contrary, the judge detailed the employee’s pre-injury symptoms and treatment in his findings.

Finally, the employer and insurer are simply incorrect in their assertion that the judge “improperly adopt[ed] the opinion of Dr. Mehbod” and/or Dr. Momont^[3] when reaching his conclusion on causation.  We see no indication that the compensation judge based his causation decision on any expert’s opinion, and in fact neither Dr. Mehbod nor Dr. Momont offered any express opinion on that issue.  Rather, as he explained it in his memorandum, the judge’s reasoning on the causation issue was as follows:

The compensation judge awarded the employee temporary total disability benefits from June 22, 2012, through the date of hearing, except for those partial days in January 2013 when the employee attempted and was paid for work at the employer.  The employer and insurer contend that the judge’s award is clearly erroneous and unsupported by substantial evidence, in that the employee refused the employer and insurer’s offer of suitable work on June 18, 2012, and then failed to make any job search.  These arguments have no merit.

The employer and insurer offered the employee his pre-injury job on June 18, 2013, based on Dr. Cederberg’s opinion that no restrictions were necessary.  The employee reasonably rejected that offer given treating physicians’ consistent recommendations that the employee limit his activities.  According to Ms. Ohlund, the employee was told at this same meeting that the employer and insurer would continue to provide the employee with light work if he obtained updated restrictions from his treating doctors.  The judge concluded, based on the employee’s testimony, that the employee misunderstood about the employer and insurer’s willingness to provide modified work.  Contrary to the employer and insurer’s arguments, the judge’s conclusion as to what the employee understood is not inconsistent with the judge’s finding that Ms. Ohlund was credible in her testimony as to the employer’s “policy of accommodating injured workers.”

Furthermore, Dr. Orton restricted the employee from all work for a period after June 22, 2013, and, in any event, the employee’s rehabilitation plan did not call for the employee to look for other work.  When an employee has a rehabilitation plan, the issue is not so much whether the employee conducted a diligent job search as whether the employee made a good-faith effort to cooperate with rehabilitation efforts.  See Bauer v. Winco/Energex, 42 W.C.D. 726 (W.C.C.A. 1989).  The aim of the employee’s rehabilitation plan was to return the employee to suitable work with the employer, and there is no evidence that the employee failed to cooperate with his QRC.

Substantial evidence supports the compensation judge’s award of temporary total disability benefits, and we affirm that decision as well.

The employer and insurer content that the compensation judge exceeded his jurisdiction by making findings and/or orders on matters not submitted to him for decision.  There is some merit to some of these arguments.

The compensation judge ordered the employer and insurer to pay for the EMG recommended by Dr. Cederberg, the employer and insurer’s independent examiner.  We see no indication that the employee was seeking payment for or approval of this procedure, and we therefore vacate the finding and related order.

The employer and insurer also contend that the judge exceeded his jurisdiction by awarding facet joint injections as recommended by Dr. Mehbod.  The employer and insurer acknowledge that this claim was listed on the medical request that resulted in a request for formal hearing, filed by the employer and insurer.  However, the employer and insurer contend, by the time of hearing, “Dr. Mehbod’s’ recommendation had evolved into one for surgery; the parties expressly agreed at the hearing that the surgery was the requested medical procedure.”  We are not convinced by this argument.  There is nothing in the record that definitively establishes that the employee had abandoned his claim for facet injections.^[4]  We therefore decline to modify the judge’s decision in this regard.  Presumably, if facet injections are no longer recommended, the employee will not undergo them in any event.

The employer and insurer also dispute the judge’s order making them responsible to pay for “the epidural steroid injections at C2-3,” “recommended by Dr. Orton.”  Dr. Orton recommended a facet injection at C2-3, not an epidural steroid injection, on June 22, 2012.  Therefore, in keeping with our prior discussion on facet injections, we modify the judge’s order accordingly.^[5]

Finally, the judge ordered the employee to “provide Dr. Mehbod with complete copies of all records pertaining to treatment or evaluation of the employee’s cervical spine prior to the November 10, 2011 injury.”  We question the employer and insurer’s standing to challenge this order, in that it requires nothing of them.  Still, the judge’s order to this effect is unnecessary and irrelevant to any of the issues presented to him for decision.  We therefore vacate that order.^[6]