The employer and insurer appeal the compensation judge’s findings that the employee had work restrictions and that he was not at maximum medical improvement as of the date of the hearing, and from the denial of their request to discontinue the employee’s temporary total disability benefits.  We affirm.

On August 15, 2012, Craig Wigant, the employee, injured his lumbar spine while performing job activities for Wallboard, Inc., the employer, which was insured for workers’ compensation liability by Acuity.  The employee felt a sharp pain in his lower back when the boom truck he was driving hit a bump in the road, causing the driver’s air seat to bottom out, hit the floor, and then bounce back up.  He and a co-worker then delivered and unloaded a trailer of sheetrock, which required the employee and his co-worker to lift and carry 180-pound loads of sheetrock 10 to 12 times.  The employee also made another sheetrock delivery with a co-worker which required less manual lifting.  At the next delivery, the employee was unable to assist his co-worker with lifting the sheetrock.  The employee’s pain increased throughout the morning, and he reported the injury to the employer’s dispatcher.  He then drove himself to Minnesota Occupational Health in his own vehicle.

The employee was treated on the same day by Dr. Daniel Foley, who diagnosed moderate to severe low back strain, prescribed medication, took the employee off work, assigned work restrictions, and referred the employee for physical therapy at Summit Orthopedics Physical Therapy.  The employee also sought treatment with his chiropractor, Heidi Salonek, D.C.  On August 20, 2012, the employee treated with Dr. Vijay Eyunni at Minnesota Occupational Health and reported some improvement in his low back pain.  Dr. Eyunni diagnosed lumbar strain with spasm and released the employee to work with lifting restrictions, which were decreased after a few weeks.  The employee attempted to return to work driving a forklift on September 10 and 11, 2012, but he experienced increased pain on both days.  On September 12, 2012, the employee returned to Dr. Eyunni, who noted that the employee had aggravated his condition during his attempt to return to work and increased the employee’s restrictions.  The employee treated with Dr. Eyunni again on September 25, 2012, reporting increased pain radiating into his left leg.  The doctor referred the employee for a lumbar MRI scan.

The October 4, 2012, MRI scan indicated a small ventral disc herniation at L5-S1 with no neural compression or stenosis and a small ventral annular tear without sac compression or stenosis at L2-3, which Dr. Eyunni considered unremarkable.  The employee continued physical therapy without much improvement.  Dr. Eyunni referred the employee to Dr. Nicholas Wills at Summit Orthopedics for a spinal consultation.  The employee reported sharp, aching pain on the left side of his low back and buttock to Dr. Wills, who assigned work restrictions and treated the employee with pain medication.  In November 2012, Dr. Wills recommended an MRI scan of the pelvis, which indicated no abnormalities.  Dr. Wills did not recommend surgery and referred the employee back to Dr. Eyunni.

At the request of the employer and insurer, the employee underwent an independent medical examination on December 21, 2012, with Dr. Jeffrey Nipper, an orthopedic surgeon.  Dr. Nipper read the employee’s lumbar spine and pelvis MRI scans as normal and opined that any lumbar strain injury would have resolved within six weeks.  He further stated that no treatment after that time period was reasonable and necessary.  Dr. Nipper also indicated that the employee had reached maximum medical improvement by the end of September 2012 and that he did not need any work restrictions.

In December 2012, Dr. Eyunni referred the employee to Dr. Kristen Zeller-Hack at Summit Orthopedics for a determination of whether the employee was a candidate for injection treatment.  Dr. Zeller-Hack diagnosed a sacroiliac joint sprain/strain and recommended an injection and a postural restorative rehabilitation program after examining the employee on January 21, 2013.  Dr. Zeller-Hack treated the employee with a left-sided sacroiliac joint injection on February 8, 2012, which resulted in significant relief of the employee’s pain.  The employee began the postural restoration program with physical therapist Stephanie Kinsella, but the employee testified that this treatment was interrupted when the insurer stopped paying for the employee’s medical treatment.  After a delay, treatment recommenced when the employee was able to continue his medical insurance in late April 2013.

The employee experienced increased pain in late March 2013 and returned to Dr. Zeller-Hack on April 16, 2013.  The doctor treated the employee with another injection and recommended a sacroiliac stabilization belt.  The employee had substantial pain relief after the injection.  The employee followed up with Dr. Eyunni on April 25, 2013.  The treatment plan at that time was for the employee to continue work restrictions and the postural restoration program, to return to Dr. Zeller-Hack for determination of whether a third injection was necessary, and to have a functional capacities evaluation after the postural restoration program was completed.

The employer and insurer filed a notice of intention to discontinue the employee’s temporary total disability benefits in January 2013.  The employee filed an objection to the discontinuance, and a hearing was held on May 2, 2013.  In her Findings and Order dated June 3, 2013, the compensation judge determined the employee’s work-related injuries to be a lumbar strain and sacroiliac joint pain with pelvic instability and severe sprain.  The judge further determined the employee had ongoing work restrictions and had not reached maximum medical improvement.  On the basis of these findings, the judge denied the employer and insurer’s request to discontinue wage loss benefits.  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.^[1]  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.^[2]  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.^[3]  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.”^[4]

The compensation judge found that the employee had not reached maximum medical improvement and had ongoing restrictions.  The employer and insurer argue on appeal that these findings are not supported by substantial evidence.  We are not persuaded by the employer and insurer’s argument.

Maximum medical improvement “means the date after which no further significant recovery from or significant lasting improvement to a personal injury can reasonably be anticipated, based upon reasonable medical probability, irrespective and regardless of subjective complaints of pain.”^[5]  A medical opinion indicating the employee has or has not reached maximum medical improvement may be based upon physical restrictions, a history of improvement, current treatment, or proposed future treatment.^[6]  The finding of maximum medical improvement is one of ultimate fact and “it is the responsibility of the compensation judge to evaluate the employee’s condition as documented by medical records, medical opinions and other data and circumstances.”^[7]  When more than one inference may reasonably be drawn from the evidence, the findings of the compensation judge are generally upheld.^[8]

The record contains conflicting medical opinions.  The employer and insurer rely on Dr. Nipper’s opinion from his January 8, 2013, report, which was completed after his evaluation of the employee on December 21, 2012.  In his report, Dr. Nipper concluded the employee sustained a temporary sprain/strain that resolved within six weeks because after that time period, the employee was unable to localize dermatomal patterns in his left lower extremity and his neurological examination was normal.^[9]  Based on nondermatomal patterns of pain, coupled with evidence of normal MRI findings and a normal examination, Dr. Nipper was of the opinion that the employee’s subjective complaints were inconsistent with the objective findings and that the employee was misrepresenting his current condition.  Dr. Nipper also indicated that the employee had reached maximum medical improvement by the end of September 2012, that no treatment after that time was reasonable and necessary, and that the employee did not need any work restrictions.

The compensation judge, however, did not adopt Dr. Nipper’s opinions and instead based her decision on other medical evidence in the record.^[10]  The judge specifically noted that Dr. Zeller-Hack diagnosed the employee with low back and sacroiliac joint pain with pelvic instability and severe sprain after examining him on January 21, 2013.  The doctor indicated that the employee walked with an antalgic gait favoring his left side and that the employee had sustained a twisting of the pelvis injury when the truck went through a jarring motion.  She also opined that sacroiliac joint injuries are slow to heal and that the employee’s treatment up to that point for his low back was not entirely effective for his injury, and recommended injection treatment and a postural restoration rehabilitation program.  The judge emphasized that the employee was still undergoing treatment since, a few days before the hearing, Dr. Eyunni recommended that the employee continue the lifting restrictions and the postural restoration program, return to Dr. Zeller-Hack for determination of whether a third injection was necessary, and possibly undergo a functional capacities evaluation after the conclusion of the postural restoration program.

The Workers’ Compensation Court of Appeals will generally affirm a compensation judge’s decision based on the choice between expert opinions as long as the accepted opinion has adequate foundation.^[11]  Disagreements among medical experts’ opinions must be resolved by the compensation judge after a thorough review of the medical evidence in the record.^[12]  In her memorandum, the judge explained why she chose not to accept the medical opinions of Dr. Nipper over the medical opinions of Dr. Zeller-Hack and Dr. Eyunni.  She noted that all of the employee’s treatment with Dr. Zeller-Hack occurred after Dr. Nipper’s evaluation of the employee and that there were a number of medical records from Dr. Eyunni and physical therapist Kinsella which were not available for Dr. Nipper’s review.  The compensation judge reviewed those records and presented a detailed medical history beyond the employee’s history contained in Dr. Nipper’s report.

The compensation judge considered all of the medical evidence on the employee’s need for ongoing restrictions and treatment to ultimately reach a determination on the issue of maximum medical improvement.  Dr. Eyunni imposed work restrictions and noted measured improvement in clinical status while the employee continued a course of treatment involving postural restoration therapy and sacroiliac joint injections under the direction of Dr. Zeller-Hack.  The work restrictions remained in place after September of 2012, and were in place on the date of the hearing.  The history of the employee’s condition as described by the employee at hearing and recorded in the treating physician’s medical records were the bases upon which the medical opinions of Dr. Zeller-Hack and Dr. Eyunni were made.  The medical opinions by the treating physicians persuaded the judge that the employee’s condition had not stabilized by the date of the hearing.  Although Dr. Nipper gave specific support for his opinions that the employee reached maximum medical improvement by the end of September 2012 and did not require work restrictions as a result of the work injury, the evidence he was missing from his review was material evidence that the compensation judge considered relevant to the issues in the case.  Thus, the judge did not give Dr. Nipper’s medical opinion the same weight as the medical opinions contained in the records of Dr. Zeller-Hack and Dr. Eyunni.^[13]  We therefore conclude that the compensation judge did not err by rejecting the opinion of Dr. Nipper and accepting the medical opinions from the treating physicians on these issues.  Substantial evidence supports the compensation judge’s findings that the employee had ongoing work restrictions and had not reached maximum medical improvement as of the date of the hearing.  Accordingly, we affirm the compensation judge’s denial of the employer and insurer’s request to discontinue the employee’s temporary total disability benefits.