The employer and insurer appeal the compensation judge’s findings that the employee sustained Gillette^[1] injuries to his neck, low back, and right wrist on October 22, 2010, and that the employee was entitled to temporary total disability benefits after December 27, 2011.  We affirm.

In April 2008, Volodymyr Ilemskyi, the employee, immigrated to the United States from the Ukraine; he was 52 years old.  While he lived in the Ukraine, the employee was a musician and a director of a cultural center.  In May 2008, he began working for Japs-Olson, the employer, which was insured for workers’ compensation liability by CNA Insurance Company, Inc.  The employee worked as a binder helper for machinery that bundles and sorts paper for printing and binding, which required him to handle and wrap bundles of paper.

In the spring of 2010, the employee began to experience numbness in three fingers of his right hand.  In July 2010, the employee testified that he was working on a specific machine and noticed low back pain, so his supervisor moved him to another machine for the rest of the day.  The employee started working longer shifts and testified that he had difficulty working the 12 hour shifts and that his condition worsened.  He continued working through October 22, 2010.

The employee reported low back pain to the employer on October 23, 2010, and indicated that he could not work that day.  He treated with Dr. Jacob Mirman at Life Medical on October 25, 2010, reporting low back pain for four to five days and numbness in his right hand fingers.  Dr. Mirman diagnosed lumbar strain and possible carpal tunnel syndrome, and referred the employee to Dr. Leon Frid, a chiropractor at Life Medical.  The employee treated with Dr. Frid on October 26, 2010, reporting low back pain, radicular pain in his arms and legs, upper back pain, neck pain, and numbness in his right fingers.  Dr. Frid assessed neck, lumbar, and thoracic strain, lumbar and cervical disc displacement, sciatica, and cervical radiculitis.  An October 28, 2010, lumbar spine MRI scan indicated multi-level degenerative disc disease, a disc herniation at L4-5, and bulging and mild central canal stenosis at L4-5 and L5-S1.  An October 28, 2010, cervical spine MRI scan showed degenerative disc disease at C5-6 and C6-7 with bulging discs at multiple levels.  Dr. Frid recommended physical therapy, which the employee began the next day.  The employee reported some improvement with treatment. 

The employee was off work until November 1, 2010, when he returned to work with restrictions of 8 hour days, 40 hour weeks, no lifting over thirty pounds, and limited bending and twisting.  The employer did not always have light duty work available.  By November 16, 2010, the employee was reporting 40 percent improvement.  He worked in light duty positions as available until December 4, 2010.  At that time, he was told the employer had no more light-duty work available and his position was terminated.  The employee completed a rehabilitation consultation with Stephen Paulsrud, a qualified rehabilitation consultant (QRC) with the Department of Labor and Industry in March 2011.  QRC Paulsrud contacted the employer and confirmed that no light duty work was available.  The employer indicated that the employee would be considered for returning to work if he had no restrictions.  QRC Paulsrud concluded that the employee was eligible for rehabilitation assistance, including job search assistance.^[2]

The employee continued to treat with Dr. Frid throughout the fall of 2010.  In November 2010, the employee began receiving low level laser therapy on his wrist.  In January 2011, Dr. Frid completed a health care provider report which listed the employee’s diagnoses as cervical/lumbar disc syndrome and radiculopathy with no evidence of pre-existing or other conditions affecting the employee’s disability.  The report also indicated that the employee was injured at work and that the employee’s disability was caused, aggravated, or accelerated by employment activity.  Dr. Frid also stated that the employee was not at maximum medical improvement (MMI) and recommended continued conservative care, physical therapy, and epidural injections.  On January 28 and February 4, 2011, the employee treated with Dr. Nina Bacaner at Life Medical for his right hand numbness.  She diagnosed carpal tunnel syndrome and indicated that the employee would be considered for surgery if the employee did not improve in four weeks.  At that point, the employee was reporting to Dr. Frid that his low back pain was 90 percent better.  A week later, he was reporting that he was 70 to 80 percent better, but he continued to report low back pain and right finger numbness.  In April 2011, he reported a decrease in low back pain and that he was 90 percent improved.

The employee underwent an independent medical examination with Dr. Paul Wicklund on April 19, 2011.  Dr. Wicklund diagnosed the employee with a resolved temporary low back strain and opined that the employee’s degenerative changes predated October 2010 and had not worsened as a result of his work injury.  He also stated that the employee’s work activities had not caused his neck complaints or his carpal tunnel syndrome.  Dr. Wicklund found that the employee was at maximum medical improvement for his neck and low back conditions as of January 22, 2011, but was not at maximum medical improvement for his carpal tunnel syndrome.  Dr. Wicklund opined that the employee’s carpal tunnel syndrome was caused by the employee’s prior musical career where he played an accordion-type instrument.  He also noted that the employee chose not to undergo carpal tunnel release surgery.

In September 2011, Dr. Frid assigned restrictions of 8 hour days, 40 hour weeks, no lifting over 40 pounds, and limited bending and twisting of the cervical and lumbar spine.  Dr. Frid opined that the employee was at maximum medical improvement for his neck and low back condition, and rated the employee at 10 percent permanent partial disability for the cervical spine and 10 percent for the lumbar spine.  Dr. Frid did not give an opinion on maximum medical improvement for the employee’s carpal tunnel syndrome or rate that condition.

On May 8, 2012, the employee treated at Hennepin County Medical Center (HCMC) emergency department for left-sided head and neck pain, which was assessed as occipital nerve irritation.  On January 9, 2013, the employee treated again at HCMC for midline low back pain with radiation into the left leg.  A lumbar spine MRI scan indicated multilevel degenerative changes, mild to moderate bilateral foraminal stenosis at L4-5, and left paracentral herniation at L5-S1.  The employee returned on February 19, 2013, reporting low back and left leg pain.  Dr. Christopher Roark at HCMC recommended 12 weeks of physical therapy and an epidural steroid injection.  In May 2013, Dr. Frid completed a return to work assessment indicating that the employee could perform light duty work with permanent restrictions of no lifting over 40 pounds, and no repetitive climbing, bending, squatting, or kneeling.

The employee filed a claim petition for medical expenses and mileage, temporary total disability benefits, temporary partial disability benefits, and permanent partial disability benefits.  After the hearing below was completed on September 20, 2013,^[3] the compensation judge found that the employee had sustained Gillette injuries to his neck, low back, and right wrist on October 22, 2010, that he was entitled to temporary partial and temporary total disability benefits as claimed, that he was entitled to permanent partial disability benefits for his neck and low back, and that the intervenors were entitled to reimbursement.  The employer and insurer appealed the compensation judge’s findings that the employee had sustained neck, low back, and right wrist Gillette injuries, and all benefits awarded except an intervenor’s interest that was awarded to the employer for disability payments.  On appeal, the employer and insurer addressed the Gillette injuries and the award of temporary total disability benefits from September 28, 2011, through May 20, 2013.

In reviewing cases on appeal, this court 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.  It is well established that where more than one inference may reasonably be drawn from the evidence, the inferences drawn by the factfinder may not be disturbed on appeal.  Hengemuhle v. Long Prairie Jaycees, 358 N.W.2d 54, 59, 37 W.C.D. 235, 240 (Minn. 1984).   It is not the role of this court to make our own evaluation of the probative value of the evidence and testimony submitted.  Whether we might have viewed the evidence differently is not the point, but whether the findings of the compensation judge are supported by evidence that a reasonable mind might accept as adequate.  Redgate v. Sroga’s Standard Serv., 421 N.W.2d 729, 40 W.C.D. 948 (Minn. 1988).

The compensation judge found that the employee had sustained Gillette injuries to his neck, low back, and right wrist on October 22, 2010, when he first lost time from work.  To establish a Gillette injury, an employee must “prove a causal connection between [his or] her ordinary work and ensuing disability.”  Steffen v. Target Stores, 517 N.W.2d 579, 581, 50 W.C.D. 464, 467 (Minn. 1994); see also Gillette v. Harold, Inc., 257 Minn. 313, 101 N.W.2d 200, 21 W.C.D. 105 (1960); Carlson v. Flour City Brush Co., 305 N.W.2d 347, 350, 33 W.C.D. 594, 598 (Minn. 1981) (a Gillette injury from repeated trauma results in a compensable injury when the cumulative effect is sufficiently serious to disable an employee from further work).  While evidence of specific work activities causing specific symptoms leading to disability may be helpful, whether an employee has sustained a Gillette injury “primarily depends on medical evidence.”  Id.  This determination is not solely dependent on medical testimony, however, and the compensation judge should also consider the nature and extent of the employee’s work duties in determining legal causation.  “Ultimately, it is the responsibility of the compensation judge to weigh all of the evidence in the case to decide whether the work activities caused the disability.”  Aderman v. Care Free Living Retirement Home, slip op. at 6 (W.C.C.A. Apr. 27, 2000).

The employer and insurer argue that substantial evidence does not support the compensation judge’s findings that the employee sustained Gillette injuries to his neck, low back, and right wrist, claiming in part that the employee’s testimony of his job duties was not credible.  The employee testified that he experienced pain in his low back in the summer of 2010 when he worked on a certain machine for 3.5 hours, then was moved to a different machine for the rest of the day; he did not report an injury that day.  The employer and insurer dispute the employee’s account, claiming the machine does not have a record of the employee being “punched in” on it for exactly 3.5 hours any day that summer.  The machine did have the employee recorded as “punched in” on it for more than 3.5 hours on some days.  A witness for the employer and insurer admitted that another employee could have finished working on the machine without the employee being signed out and the other employee “punching in.”  Further, the judge found the employee’s testimony credible.  The assessment of a witness’s credibility “is the unique function of the trier of fact.”  Even v. Kraft, Inc., 445 N.W.2d 831, 835, 42 W.C.D. 220, 225 (Minn. 1989).  It is not the role of this court to re-evaluate the credibility of witnesses or reweigh the evidence, but solely to assess whether there is sufficient evidence in the record to support the judge’s decision.  Redgate v. Sroga’s Standard Serv., 421 N.W.2d 729, 734, 40 W.C.D. 948, 957 (Minn. 1988).

The employer and insurer also dispute the employee’s description of the amount of effort required to perform his job, claiming that other witnesses contradicted his testimony, and assert that his description affected the foundation of his treating doctors’ opinions.  Again, the assessment of the witnesses’ credibility is for the compensation judge.  The employer and insurer disputed how much lifting was required in these positions, but admitted lifting was involved in stacking the bundles.  For example, the employee testified that he had to lift and carry 90 pound bundles every 15 seconds for stacking.  A witness for the employer and insurer testified that the bundles weighed 50 to 60 pounds, and were stacked every 30 to 60 seconds.  In another position, the employee moved boxes of bundles weighing 20 to 30 pounds about every 10 seconds.  Regardless of whose testimony the compensation judge accepted, this evidence shows that these positions required substantial lifting and carrying.

The employer and insurer also claim that the employee’s treating physicians did not have adequate foundation since they were not aware of the employee’s actual job duties, and that the employee did not explain how any specific task led to or exacerbated his symptoms.  The employee counters that none of the doctors could likely explain the differences amongst the machines the employee used but that they all understood that the employee’s position required repetitive grasping and lifting of paper, which was adequate foundation of the employee’s work activities for the doctors’ opinions.  See Drews v. Kohl’s, 55 W.C.D. 33, 38-39 (W.C.C.A. 1996), summarily aff’d (Minn. July 11, 1996).  We agree.  We also note that the record does not indicate that the employer and insurer objected at the hearing to the employee’s treating doctors’ opinions as lacking foundation.

The judge was clearly aware of the conflicting evidence regarding the employee’s job requirements and the medical opinions.  The evidence shows that the employee’s job required repetitive lifting of paper bundles averaging 50 pounds for at least some periods of time.  The employee testified regarding his symptoms and his worsened condition.  The compensation judge could reasonably conclude that the employee’s work activities were causally related to his neck, low back, and wrist conditions.  The judge chose to accept Dr. Frid’s opinion over that of Dr. Wicklund regarding the employee’s neck and low back conditions.  He also chose Dr. Bacaner’s opinion that the employee’s carpal tunnel condition was related to the employee’s work activities with the employer over Dr. Wicklund’s opinion that this condition was not work-related but was related to his prior musical career.

As the trier of fact, it is the compensation judge’s responsibility to resolve conflicts in expert medical testimony; where there is adequate foundation for the opinions adopted by the judge, this court will normally uphold the compensation judge’s choice among medical experts.  See Nord v. City of Cook, 360 N.W.2d 337, 342-43, 37 W.C.D. 364, 372-73 (Minn. 1985).  The compensation judge did not err by relying on the employee’s testimony or by choosing the employee’s treating doctors’ opinions over those of Dr. Wicklund.  Substantial evidence supports the compensation judge’s findings that the employee sustained Gillette injuries to his neck, low back, and right wrist on October 22, 2010, and we affirm.

The compensation judge awarded temporary total disability benefits through May 20, 2013.  The employer and insurer argue the employee is not entitled to temporary total disability benefits after December 27, 2011, claiming that he had reached maximum medical improvement for his wrist condition no later than September 22, 2011, when Dr. Frid found that the employee had reached maximum medical improvement for his low back and neck conditions.  Maximum medical improvement is defined as “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 . . . .”  Minn. Stat. § 176.011, subd. 13a. Factors to be considered in the question of maximum medical improvement include the history of improvement, current treatment, pre‑existing conditions, and proposed treatment.  Hammer v. Mark Hagen Plumbing & Heating, 435 N.W.2d 525, 529, 41 W.C.D. 634, 639 (Minn. 1989).

While Dr. Frid indicated that the employee’s wrist was 80 percent improved, he did not find the employee at maximum medical improvement for his wrist condition in September 2011 and did not give him a permanent partial disability rating for that condition.  Dr. Wicklund also found that the employee was not at maximum medical improvement for the wrist condition as of April 2011, and recommended carpal tunnel release surgery.  Dr. Bacaner indicated that surgery could be considered for the employee’s carpal tunnel syndrome in February 2011.  The employee has not undergone carpal tunnel release surgery.  There is no medical opinion addressing maximum medical improvement for the employee’s wrist condition in the record and none was served on the employee.  Substantial evidence supports the compensation judge’s award of temporary total disability benefits after December 27, 2011, and we affirm.