Schindler Elevator Corporation and Zurich American (Schindler) appeal from the compensation judge’s findings that the employee sustained a Gillette injury to his left hip or low back on August 2, 2011, that the employee was permanently and totally disabled, and that chiropractic treatment was reasonable and necessary and the corresponding medical mileage was appropriate.  Schindler also appealed the compensation judge’s findings regarding the extent of certain injuries and apportioning 90 percent of liability for the employee’s permanent total disability to Schindler.  Self-insured Westinghouse Electric (Westinghouse) filed a cross-appeal raising apportionment issues which were to be considered only if the compensation judge’s decision was not affirmed on appeal.  We affirm.

In 1978, Dean Vogt, the employee, began working in elevator repair and installation for Otis Elevator.  Six months later, he left and started working for Westinghouse Electric, which was self-insured for workers’ compensation liability, with claims administered by Murphy & Beane.  Schindler Elevator Corporation, which was insured for workers’ compensation liability by Zurich American, with claims administered by Broadspire, purchased Westinghouse in 1989.  The employee sustained numerous injuries throughout his 34-year career.^[1]

On October 5, 1984, the employee fell 12 feet into a hole on a work site, landing on his left side.  The employee testified that he had neck, left shoulder, left hip, left leg, and low back pain from this injury.  The employee missed three weeks of work and received chiropractic treatment with Dr. Scott Murray at Lake Drive Chiropractic through December 1984.  On April 7, 1987, the employee fell and was thrown around when an elevator went out of control.  The employee’s head and shoulders went through the elevator’s false ceiling, and he landed on his left side.  The employee injured his neck, right shoulder, left hip, and left leg, and had ongoing headaches, left hip, neck, and groin pain after this injury.  The employee treated with Dr. Kevin Bailey at the Fridley Medical Center and underwent physical therapy at MultiCenter Physical Therapy.

On May 20, 1987, the employee fell when his right leg went through an elevator ceiling.  Afterwards, the employee had low back and buttock pain; he missed three weeks of work.  The employee was able to return to work without written restrictions, but he continued to have ongoing headaches and neck, hip, and back pain after these injuries and worked under self-imposed limitations on lifting, bending, and twisting.  The employee testified that he did not believe he fully recovered from these injuries.  In December 1988, the employee sought treatment for headaches and neck and left arm pain.  A December 1988 MRI scan indicated stenosis, spondylolysis, multiple level bulges, and spinal cord depression at C4-5 and C6-7.  In 1989, neurosurgeons recommended follow-up care, but not surgery.  The employee did not pursue additional treatment at that time.

After Schindler purchased Westinghouse in 1989, the employee injured his right hand and wrist on November 3, 1993, when his hand and wrist were crushed while he was unloading a truck.  The employee was treated extensively for this injury, including multiple surgeries performed by Dr. Matthew Putnam at University of Minnesota Medical Center.  On March 22, 1996, the employee injured his left shoulder trying to grab some rails that fell off a pile.  He treated with Dr. Philip Haley at Fridley Medical Center.  In July 1996, the employee underwent a left distal clavicle resection surgery.  The employee returned to work in January 1997 with a 25-pound lifting restriction.  The employee was able to work within these restrictions in a supervisory position.  On April 23, 1998, the employee reinjured his right wrist when it was slammed in a door at a retraining program; he required additional surgery to his right wrist.

On January 27, 2002, the employee was injured while emptying a heavy cart into a dumpster.  The employee treated with Dr. Orrin Mann at Fridley Medical Center, reporting injuries to his low back, left leg, left arm, mid back, and right shoulder.  Dr. Mann diagnosed low back strain, pelvic joint dysfunction, right fifth rib inspiratory dysfunction, thoracic strain, and referred myofascial symptoms in the left arm and left leg.  The employee had intermittent neck, thoracic, and low back pain, and received occasional chiropractic treatment with Dr. Murray at Lake Drive Chiropractic.  On November 5, 2002, the employee struck his head on an elevator car and then fell, injuring his neck and both shoulders.  He returned to Dr. Mann, who diagnosed closed head injury, neck strain, and headaches.  He treated again with Dr. Murray and returned to work on November 7, 2002.

In December 2003, the employee sought treatment with Dr. Haley for neck pain, bilateral shoulder pain, arm pain and numbness, and paresthetic and numb sensations in the hands.  Dr. Haley ordered a cervical spine MRI, which indicated congenital cervical spine with stenosis and degenerative changes, broad based disc protrusion and mildly flattened cervical cord at C6-7, and degenerative anterolisthesis at C5-6.  Dr. Haley referred the employee to a surgeon, Dr. Garry Banks, from Advanced Spine Associates.  Dr. Banks evaluated the employee on January 15, 2004, and diagnosed multilevel degenerative disc disease of the cervical spine, right C5-6 severe foraminal stenosis, and central and left disc herniation at C6-7 with mild cord flattening.  January 31, 2004, bilateral shoulder scans indicated left shoulder intrasubstance tear of the distal supra and infra spinatus and moderate to severe biceps tendonitis, as well as right shoulder partial thickness rotator cuff tear and degenerative changes of the acromioclavicular joint.  Dr. Banks recommended a left shoulder evaluation with Dr. Haley before consideration of surgical intervention for the neck.  Dr. Haley recommended left shoulder surgery.

On April 20, 2004, Dr. Haley performed left shoulder rotator cuff repair surgery, left biceps tenodesis, and left carpal tunnel release at Minnesota Orthopedic Surgery Center.  The employee returned to work with restrictions on his left arm and continued to follow up with Dr. Haley.  In 2005, the employee treated with Dr. Haley for chronic left hip and left leg pain.  The employee reported having chronic left leg pain and gradual loss of motion since the 1987 injury.  In 2007, the employee experienced increased symptoms in his left leg.  A July 2007 lumbar spine MRI indicated degenerative changes and left disc protrusion at L3-4.  A left hip MRI indicated degenerative osteoarthritic changes.  The employee experienced ongoing symptoms over the years and sought chiropractic treatment at times.  In August 2009, the employee treated with Dr. Kevin Bailey for chronic low back pain with lumbar disc disease and degenerative osteoarthritis.  An August 2009 lumbar MRI indicated multilevel degenerative changes, moderate central canal stenosis at L3-4 and L4-5, and moderate left neural foraminal narrowing at L2-3, L3-4, and L5-S1.  The employee was treated with lumbar epidural injections in August 2009 and in October and November 2010, which provided temporary relief.

In March 2011, the employee treated with Dr. Bailey, reporting low back and left hip pain.  He was referred to Dr. Daniel Hanson at Midwest Spine Institute.  An arthrogram of the left hip indicated progressive arthritis.  Dr. Hanson assessed lumbar spinal stenosis and referred the employee to Dr. Cyril Kruse at Twin City Orthopedics.  Dr. Kruse treated the employee’s severe osteoarthritis of the left hip with a cortisone injection in April 2011, then recommended hip replacement surgery.

On August 2, 2011, the employee sustained a specific left hip and low back injury when he fell while loading a truck and experienced severe left hip pain.  The compensation judge also found that the employee sustained Gillette injuries to his low back, left hip, and right hip culminating on August 2, 2011.  Dr. Kruse took the employee off work on August 3, 2011.

The employee began working with QRC Steven Kurenitz in September 2011.  In October 2011, the employee underwent left hip replacement surgery.  The employee returned to work in January 2012 with restrictions of no lifting over 50 pounds and no crawling.  In September 2012, Dr. Kruse adjusted the employee’s restrictions to no lifting over 20 pounds and no bending, twisting, or climbing, and indicated that these restrictions were permanent.  The employee was terminated from employment in September 2012 when the employer could not accommodate his restrictions.  A proposed job placement plan and agreement was signed by the employee in October 2012.  The employee underwent vocational testing and conducted a job search.  The QRC testified that the employee cooperated with the rehabilitation plan but that he was not employable based on his age, his years in one industry, and the cumulative effects of his injuries.

On May 30, 2012, the employee underwent an independent medical evaluation with Dr. Thomas Raih at Schindler’s request.  Dr. Raih found that the employee had sustained a permanent neck injury, apportioned 50 percent to the 1978 and April 1987 injuries and 50 percent to congenital spinal stenosis; a permanent low back injury, apportioned 50 percent to the 1984 injury and 50 percent to the August 2011 Gillette injury; a permanent left hip injury, apportioned equally to the 1984 and 1987 injuries; and temporary injuries in January and November 2002.

On August 24, 2012, the employee underwent an independent medical evaluation with Dr. Paul Dworak at Westinghouse’s request.  Dr. Dworak opined that the employee’s 1984 and 1987 injuries were not permanent injuries.  He also opined that the employee’s left hip, neck, and low back conditions were not related to the work injuries at Westinghouse and that the employee had not sustained any Gillette injury on August 2, 2011.  If the employee had sustained a 2011 Gillette injury, he determined that Westinghouse would be liable for less than 10 percent, if at all.  He concluded that the employee was not permanently totally disabled and could work for Schindler at his prior position with restrictions.

In November 2012, Dr. Kruse opined that the employee should no longer pursue looking for employment and gave his “strongest recommendation that [the employee] be considered permanently and totally disabled from employment.”^[2]  In January 2013, Dr. Kruse indicated the employee’s 1978, April 1987, and November 2002 injuries were each one-third responsible for the employee’s cervical disability; his 1996 and November 2002 injuries were equally responsible for his left shoulder injury; his November 2002 injury was responsible for his right shoulder injury; and multiple injuries contributed to the patient’s culmination of hip replacement, including the injuries in October 1994, April 1987, May 1987, and August 2011, apportioned 25 percent each.  He also found that the employee had sustained a Gillette injury to the right hip on August 2011.  Dr. Kruse repeated his opinion that the employee was permanently and totally disabled from any gainful employment, even sedentary work.

The employee filed multiple claim petitions, the last one on January 4, 2013, for permanent total disability and permanent partial disability for various injuries.  On April 18, 2013, the employee underwent a vocational evaluation with QRC David Berdahl at Schindler’s request.  QRC Berdahl opined that the employee had employment opportunities available to him in entry level positions and that his job search was not reasonable.

A hearing was held on May 28, 2013.  The compensation judge found that the employee was permanently and totally disabled from November 2012 and apportioned liability 90 percent to Schindler and 10 percent to Westinghouse.  The judge found that the employee’s disability from August 2011 through November 2012 was solely related to the August 2011 injury.  The compensation judge also awarded permanent partial disability for various injuries and apportioned liability between the two employers.^[3]  Schindler appeals the finding of permanent total disability and the manner in which it was apportioned as well as the extent of permanent partial disability and the apportionment of permanent partial disability.^[4]  Schindler also appeals the compensation judge’s findings regarding the extent of the employee’s injuries, that chiropractic treatment was reasonable and necessary, that medical mileage was appropriate, and that the employee sustained a Gillette injury on August 2, 2011.^[5]  Westinghouse also cross-appeals the apportionment of permanent total disability and of permanent partial disability, but only if the compensation judge’s decision is not affirmed 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.^[6]  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.^[7]  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.^[8]  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.”^[9]

On appeal, Schindler disputes that the employee met his burden of proof regarding a Gillette^[10] injury.  Schindler asserts that the medical evidence is not sufficient to support the compensation judge’s finding of a Gillette injury to the low back and left hip, arguing that the evidence did not show a “basic, rudimentary explanation of the connect between the work and disability.”^[11]  We disagree.  To establish a Gillette injury, an employee must “prove a causal connection between [his or her] ordinary work and ensuing disability.”^[12]  The employee related his symptoms of pain and stiffness in his lower back, left hip and left leg to his day-to-day job duties as well as specific work injuries on the job.  The medical evidence in the record reflects more than a decade of the employee’s reported symptoms that show a relationship to his daily job duties by recorded complaints of pain, clinical findings on examination, medical assessments, and recommended treatment.  Drs. Kruse and Raih also related the employee’s symptoms to his work activities.  In a January 25, 2013, report, Dr. Kruse stated:  “Multiple injuries contributed to the [employee’s] culmination of [left] hip replacement.”^[13]  He apportioned 25 percent of liability for the left hip to the August 2, 2011, injury.  The employee’s complicated medical history of a repetitive strain injury on a specific injury was reconciled by the compensation judge.^[14]  Dr. Kruse specifically noted that the employee had sustained a Gillette injury to his low back on August 2, 2011.  Dr. Raih also opined in his July 6, 2012 report, “Given the nature of [the employee’s] work over 34 years at the same place of employment with repetitive lifting, bending, and stooping activities, it would be reasonable to assess that this employment is a significant contributing factor to his low back condition in the form of a Gillette type injury culminating on August 2, 2011.”^[15]  Here, there is sufficient proof of a Gillette injury, and we affirm.

On appeal, Schindler contends that the compensation judge erred in determining that the medical treatment records and testimony were not sufficient to persuade the judge that the 1978 neck injury was a permanent injury and second, that the combination of the employee’s many physical disabilities were permanent, work-related injuries that resulted in the employee being physically permanently and totally disabled.^[16]  First, in determining that the employee’s 1978 injury was temporary, the compensation judge found the testimony and medical records insufficient to establish a permanent injury in 1978.  In doing so, the compensation judge rejected the opinions of Drs. Kruse and Raih that portions of the employee’s permanent partial disability should be attributed to this injury.

As to the second argument, Schindler points to Dr. Dworak’s report in which Dr. Dworak found the 2002 injuries to be temporary injuries.  The question before this court, however, is not whether there is evidence in favor of Schindler’s argument but whether there is substantial evidence to support the decision of the compensation judge.^[17]  In determining that the employee’s injuries were permanent injuries, the compensation judge relied on the employee’s testimony and the opinion of Dr. Kruse.  No objection has been made to the foundation for Dr. Kruse’s opinion and generally, in such circumstances, the compensation judge’s decision, based upon a choice of medical opinions, will not be reversed.^[18]  The compensation judge did not accept Dr. Kruse’s opinions on the permanent aggravation of the 1978 injury but did accept Dr. Kruse’s opinions on the permanent aggravation of the 2002 injuries.  A compensation judge is not obligated to accept all of a medical opinion and may accept only part of it.^[19]  We find substantial evidence supports the decision of the compensation judge that the employee’s injury in January of 2002 was a permanent aggravation of the employee’s low back condition and that the employee’s injury in November of 2002 was a permanent aggravation of the employee’s neck and left shoulder condition and a new permanent injury to the right shoulder.

Schindler contends that substantial evidence does not support the compensation judge’s determination that the employee is permanently and totally disabled as of November 7, 2012.  Specifically, Schindler argues the judge erred in finding permanent and total disability based upon the medical opinion of Dr. Kruse and the vocational testimony of Mr. Kurenitz.  It is Schindler’s position that Dr. Kruse’s assignment of permanent work restrictions was evidence that the employee was not totally disabled.  We are not convinced by this argument.

In his November 7, 2012 report, Dr. Kruse stated:

An employee is totally disabled when the employee’s physical condition, in combination with “age, training, and experience, and the type of work available in [the] community, causes [the employee] to be unable to secure anything more than sporadic employment resulting in an insubstantial income.”^[21]  Total disability is permanent if it is likely to exist “for an indefinite period.”^[22]

Dr. Kruse determined that the employee had cumulative permanent physical disabilities that prevented him from pursuing employment.  Dr. Kruse also assigned permanent work restrictions which was part of the need for addressing the possibility of a return to work plan.  Dr. Kruse was of the opinion that the employee not return to work but if required to do so that any job would be within the outlined permanent restrictions.  We recognize that in some cases, the assignment of permanent work restrictions may preclude a finding of permanent total disability.  However, the assignment of work restrictions by itself does not rule out an award of permanent total disability.  We see no inherent contradiction in these two opinions.  And we see no basis for concluding that the compensation judge’s reliance on Dr. Kruse’s opinion as part of the evidence to support a finding of permanent total disability was unreasonable.  The compensation judge accepted Dr. Kruse’s opinion that “the combination of the employee’s many physical disabilities due to [his] injuries resulted in the employee being physically permanently and totally disabled.”^[23]  Moreover, the judge specifically rejected Dr. Dworak’s and Dr. Raih’s opinion that the employee was not totally disabled.  Conflicts in expert medical testimony and other reliable evidence must be resolved by the compensation judge.^[24]  The compensation judge also relied on the QRC’s testimony that the employee made a diligent job search, cooperated with his rehabilitation plan, and was not employable.  The testimony of the employee, together with the medical and vocational opinions, adequately support the compensation judge’s finding that the employee is permanently and totally disabled.  This finding must be affirmed under the substantial evidence standard of review.

Schindler argues that the apportionment findings by the compensation judge regarding injuries included as permanent or excluded as resolved are not supported by substantial evidence as discussed above and therefore the foundational grounds of all of the apportionment findings must be re-evaluated.  Schindler also argues that the compensation judge’s finding regarding permanent total disability apportionment is not supported by the medical records and is not consistent with the judge’s findings apportioning permanent partial disability of the various injuries.  We disagree.

The compensation judge apportioned liability for the employee’s permanent total disability as 10 percent to the 1984 and 1987 injuries, divided equally, while the employee worked for Westinghouse and 90 percent to the post-1989 injuries while the employee worked for Schindler.  The liability apportioned to Schindler was divided 30 percent to the November 1993 injury, 10 percent to the March 1996 injury, 10 percent to the November 2002 injury, and 50 percent to the August 2011 Gillette and specific injuries.  Equitable apportionment is the process of sharing common costs between insurers in a fair manner that reflects the way in which the costs are incurred by the industry.^[25]  Equitable apportionment is based on the fundamental principle that each liable employer or insurer should be responsible for its proportional share of the employee’s disability^[26] where the employee sustained a compensable injury with each employer or insurer and the injury is a substantial contributing cause of the employee’s current disability.^[27]

Under Minnesota Workers’ Compensation law, equitable apportionment is not solely a medical determination, but is an ultimate finding of fact based on all the circumstances of a case.  Factors considered in determining apportionment include the nature and severity of the initial injury, the employee’s physical symptoms following the initial injury and before the second injury, the nature and severity of the second injury, and the period of time between the injuries.^[28]  There is no requirement that the permanent total disability apportionment ratings correlate with the apportionment of the permanent partial disability ratings.

The compensation judge stated in her memorandum that she did not completely accept any of the doctors’ apportionment opinions, but she carefully considered their opinions.  The judge stated that while the 1984 and 1987 injuries were significant events which contributed to the employee’s permanency to the hip, low back, and neck conditions, the employee was able to work a significant period of time after these injuries.  The judge concluded that the later injuries played a more significant role in the continued deterioration of the employee’s condition and apportioned 90 percent of the liability for the permanent total disability to the employee’s injuries at Schindler.  The compensation judge considered the evidence in the entire record and carefully determined how liability should be apportioned in this case.  In essence, the judge used the doctrine of equitable apportionment as designed to secure a just and equitable allocation of the cost against work injury.

Given the evidence in the record, it would not be appropriate for this court to choose different inferences from the facts than the compensation judge.^[29]  Substantial evidence supports the compensation judge’s finding regarding the extent of these injuries and the apportionment of liability for the employee’s permanent total disability, and we affirm.

Schindler also appeals the compensation judge’s finding that the chiropractic care was reasonable and necessary and that the corresponding mileage for that treatment was compensable, arguing that there is no evidence in the record to support the treatment as reasonable and necessary medical treatment.  For this reason, Schindler maintains that intervenor National Elevator Industry should not be reimbursed for the disputed treatment and expenses nor should the employee be reimbursed for the related mileage expense.  We disagree.

The medical treatment disputed started in December of 2012, not before the 2011 injury as argued by Schindler.  The progress notes from Dr. Murray’s records corroborate the employee’s testimony that the employee was improving with chiropractic care and making progress during the treatment.  The employee’s mileage exhibit coincides with the dates at issue for chiropractic treatment beginning in December 2012.  Substantial evidence supports the compensation judge’s finding regarding reasonable and necessary chiropractic care and corresponding mileage for that treatment and we affirm.  Consequently, the award of reimbursement to intervenor National Elevator Industry is affirmed.

The compensation judge did not award immediate reimbursement from Westinghouse for Schindler for benefits paid, stating that Schindler’s petition for contribution did not have a statement with detailed information regarding benefits paid for which they are claiming reimbursement.  Schindler argues that the notice of intention to discontinue (NOID) was submitted as an exhibit with an attached list of the benefits paid so that contribution could have been awarded.  We note there are no specific dates of service on the list attached to the NOID and no corresponding records indicating which condition or injury was being treated.  Based upon the evidence submitted, the judge did not err by failing to award immediate payment of contribution.

In its cross-appellant’s brief, Westinghouse indicated that the issues listed were only to be considered by this court if the decision below was not affirmed.  Since we have affirmed the compensation judge’s decision, we will not address the issues raised by Westinghouse’s cross-appeal.