The employee appeals the compensation judge’s denial of medical treatment.  The self-insured employer cross-appeals the award of permanent total disability benefits.  We affirm.

On August 14, 2009, Aida Besic, the employee, sustained an admitted work injury to her low back while working as a stocker for Wal-Mart Stores, the employer, who was self-insured for workers’ compensation liability.  The employee was pulling a box off the top of a pallet when she fell to the floor and experienced low back pain radiating into her right leg.  The employee treated with Dr. Douglas Sill at Allina Clinic Forest Lake on August 28, 2009.  The employee was diagnosed with low back pain with nerve root impingement, prescribed medications, recommended for physical therapy, and assigned work restrictions of no lifting over ten pounds, no bending, squatting, stooping, twisting, pushing, or pulling, and to alternate positions as needed.  On September 10, 2009, the employee treated with Dr. David Tosteson at Fairview Lakes Clinic.  Dr. Tosteson prescribed medication and recommended physical therapy, and later ordered an MRI scan which showed L4-5 degenerative disc disease.  On October 26, 2009, the employee was treated with an epidural steroid injection, which did not provide relief and gave her headaches.

On December 9, 2009, the employee was evaluated by Dr. Robert Wegner at Physicians Neck and Back Clinic.  Dr. Wegner opined that the employee was not a surgical candidate given the minor abnormalities noted on the MRI scan and a normal neurological examination.  He added that additional passive treatment would not result in resolution of her symptoms, but that acupuncture could be ordered through her primary provider.  He concluded that given her presentation, she was high risk for a suboptimal clinical outcome with that program.  The employee started physical therapy in December 2009, with no progress noted after eight sessions as of February 2010.  The employee had acupuncture treatment with Dr. Kevin Chatwin at Fairview Lakes Clinic starting in January 2010.  The employee reported some decrease in pain initially, but that the pain would return.

On February 26, 2010, the employee underwent a rehabilitation consultation with QRC Kristen Engelke.  The employee was found to be eligible for rehabilitation services.  The QRC noted that the employee had been off work since September 11, 2009.  The initial rehabilitation plan involved medical management and coordination of return to work with the same employer.

An April 2010 rheumatology consultation was negative.  After a follow-up with Dr. Tosteson on April 30, 2010, acupuncture treatment was continued.   The employee indicated she could do exercise and flexibility training at home.  On May 26, 2010, the employee was released to return to work with restrictions, including working four hours per day, five days per week.  The employee returned to work on June 1, 2010, and by June 30, she was restricted to working three days per week.  Dr. Tosteson recommended a repeat MRI scan of the lumbar spine, which was initially denied.  Acupuncture treatment continued through August 2010 with some improvement reported.  Additional physical therapy with traction starting in September 2010 increased the employee’s pain.  A repeat MRI scan on October 29, 2010, indicated degenerative disc disease at L4-5 and L3-4, and mild right facet arthrosis at L5-S1.

On December 30, 2010, the employee was evaluated by Dr. Randall Norgard at the employer’s request.  Dr. Norgard assessed right sacroiliac joint pain with pelvic rotational deformity and lumbar degenerative disc disease and degenerative joint disease.  Dr. Norgard opined that the employee’s work injury was related to her right sacroiliac joint condition but that her low back condition was degenerative and not related to her work injury, and recommended physical therapy.  He also recommended restrictions of working eight hours per day, five days per week, no lifting over 10 pounds, avoiding repetitive bending, stooping, and crouching, and changing positions every 20 to 30 minutes.  In February 2011, the employer offered the employee a full-time position as a greeter as temporary alternative duty until further notice.  The employee accepted this offer and returned to work at this position on February 6, 2011.

The employee was referred to Dr. John Sandness, a physical medicine and rehabilitation specialist, and began treating with him on March 3, 2011.  Dr. Sandness diagnosed superior subluxation of the right hemipelvis and right-sided piriformis syndrome.  A closed reduction of the pelvic ring subluxation and manipulation was completed.  Stabilization exercises for the right sacroiliac joint were suggested and a sacroiliac stabilization belt was recommended.  Dr. Sandness took the employee off work.  The employee continued to treat with Dr. Sandness for recurrent pelvic instability and for sacral, lumbar, and leg dysfunction with myofascial release, stretching, and muscle energy techniques.  In May 2011, the employee was treated at MAPS with trigger point injections, which provided relief.  Additional injections were done in June 2011.

On June 2, 2011, the employer again offered the employee a full-time position as a greeter, working from 10:30 p.m. to 7:00 a.m.  The employee did not accept this offer, citing Dr. Sandness’s opinion that she remain off work.  In July 2011, an EMG indicated acute radiculopathy at L4-5 and L5-S1 on the right.  Dr. Sandness noted there was an absence of nerve compression on the two MRI scans.  Dr. Sandness diagnosed right-sided noncompressive radiculopathy affecting the right L4-5 and S1 nerve roots and recommended three months of acupuncture treatment.  The employer denied the request for approval of acupuncture treatment, but approved three weeks of physical therapy.  In July 2011, the employee began acupuncture treatment with a different provider through her health insurer, which continued through November 2011.  Dr. Sandness later noted that the employee’s pelvis subluxation was considered stable since August 3, 2011.

On August 1, 2011, Dr. Sandness assigned work restrictions of working up to four hours per day, no lifting except from knee to shoulder up to 10 pounds occasionally, no bending, stooping, or twisting, sitting up to 30 minutes per hour in a chair with back support, walking up to 30 minutes per hour at a time up to 75 percent of work day, and standing up to 15 minutes at a time.  The employer offered the employee a part-time position as a greeter working from 10:30 p.m. to 2:30 a.m. within these restrictions.  The employee accepted this position.

On October 12, 2011, the employee was evaluated for rehabilitation needs by Dr. Todd Holmes, who opined that the employee had sustained a work injury to her sacral spine and right lower extremity and that her treatment had been reasonable, and recommended mobilization treatment.

On December 21, 2011, the employee was again evaluated by Dr. Norgard at the employer’s request.  Dr. Norgard opined that the employee’s right sacroiliac joint sprain/strain had resolved but that the employee had chronic lower back and right leg pain, that work restrictions were necessary, and that she was entitled to permanent partial disability.  He also opined that Dr. Sandness’s treatment was reasonable and necessary through August 24, 2011, but that acupuncture treatment suggested at that time was not reasonable and necessary, the employee was not a candidate for further formal medical treatment, and the employee was at maximum medical improvement as of December 21, 2011.  Dr. Norgard recommended a functional capacities evaluation.

In February 2012, the employee underwent a functional capacity evaluation.  At that time, the employee was working for the employer as a greeter four hours per day.  The employee did not complete the evaluation.  She demonstrated the ability to function at a sedentary level for about two hours with modification, but her productivity level was not considered acceptable for a common employment environment.  The conclusion was that the employee did not function at a level that would be considered employable during the evaluation, with a note that the “extent of her limited function and her symptoms were out of proportion with what would be expected with [her] diagnosis.”  (Employee’s Ex. E.)  The employee continued to treat with Dr. Sandness.  By March 15, 2012, Dr. Sandness opined that the employee was at maximum medical improvement and that her restrictions were permanent.

In April 2012, the employee was told that the employer could no longer accommodate her restrictions because she could not work in a stocker position and the employer had no positions open within her restrictions.  Placement services were approved for the employee on April 24, 2012.  After a placement meeting on May 15, 2012, a job placement plan and agreement indicated that the employee would conduct a part-time job search with the assistance of placement specialist Mary Carter.  The employee participated in the job search by attending meetings and following up on job leads.  Her job search was difficult due to her restrictions and limited experience.  In March 2013, the employee indicated that she would like to work, but that she was in constant pain and did not know how she could.  She continued to stay in contact with the placement vendor.  The employee’s job search continued through December 2013.

The employee returned to Dr. Sandness in October 2012 and was treated with topical medication.  Dr. Sandness recommended a chronic pain evaluation.

On August 14, 2013, the employee was evaluated by Dr. Robert Wengler.  Dr. Wengler opined that the employee had discogenic back pain, right lower extremity sciatica into the L4-5 distribution and had 12% permanent partial disability, and also that acupuncture and medication treatment was reasonable and necessary.  He also opined that the employee’s August 14, 2009, work injury was a substantial contributing factor to her ongoing low back condition, present impairment, and need for medical treatment and physical restrictions.  Dr. Wengler also indicated that arbitrary physical restrictions were redundant at that time and stated “I don’t think she could be productive in any way given her present physical findings.”  (Employee’s Ex. B.)

The employee underwent an independent vocational evaluation with Kate Schrot, a rehabilitation consultant, at the employer’s request.  In a report dated December 5, 2013, Ms. Schrot opined that the employee was capable of performing unskilled work within Dr. Sandness’s restrictions.  The employee told Ms. Schrot that she was in too much pain to be able to work in any capacity.

The employee also underwent an independent vocational evaluation, including a manual transferable skills analysis, with QRC Craig Galvin.  In a report dated December 6, 2013, Mr. Galvin opined that the employee had no transferable skills.  On December 19, 2013, the employer filed a rehabilitation request for a change in the rehabilitation plan with additional job search through the Minnesota Resource Center.  The parties agreed to change QRCs to Mr. Galvin in January 2014.  In March 2014, QRC Galvin noted that the employee had no return-to-work options with the original employer and that Dr. Sandness had indicated that the employee should not work or job search.  In addition, social security disability benefits had been approved.  Further treatment had not been approved and the employee was using personal insurance for treatment.  The employee had returned for acupuncture treatment in August 2012 and continued through October 2014.  During this time, the employee reported little change and often stated that she was in constant pain.

In June 2014, the employee indicated that she was not interested in attending a pain clinic or chronic narcotic pain management and that she was unable to participate in physical therapy or an exercise program.  Dr. Sandness stated “it is not realistic to contemplate return to work for this patient.”  (Employee’s Ex. G.4.)  He noted that the employee “believes that nothing will help her pain and that she will have to just learn how to cope with the pain for the rest of her life.”  (Id.)

The employee underwent another independent medical examination with Dr. Norgard on September 18, 2014.  Dr. Norgard opined that the employee’s treatment with Dr. Sandness and her acupuncture treatment after August 24, 2011, was not reasonable and necessary, and that the employee was able to work full time with restrictions.

The employee has reported multiple work injuries with other employers before the 2009 work injury.  Three of these injuries resulted in litigation: her right wrist in 2000, her right arm, neck, and low back in 2002 after a slip and fall injury, and her right arm in 2006.  The parties agreed to settle these claims.  At the employee’s deposition in this matter, the employee was questioned regarding these injuries and the related litigation.  The employee denied that she had ever filed a workers’ compensation claim before the 2009 work injury.

The employee had extensive treatment for these prior injuries and for chronic pain syndrome, depression, and anxiety.  The employee reported low back pain in 2000.  After her work injury in early 2002, she reported low back pain with no radiculopathy.  In July 2002, she treated at Hennepin County Medical Center and reported low back pain radiating into her right leg.  A July 26, 2002, lumbar spine MRI scan indicated mild degenerative disc disease at L4-5.  By August 2002, the employee had been diagnosed with chronic pain syndrome.  In December 2003, the employee treated for significant back pain.  A January 2004 MRI scan showed L4-5 degenerative disc disease with a bulging disc primarily on the left.  The employee was evaluated at the Mayo Clinic in February 2004 for low back pain which occasionally radiated into the right leg.  She was referred to the Mayo Clinic Spine Center and diagnosed as having pain without evidence of underlying spinal disease or nerve root compression.  Chronic pain management was advised.  The employee continued to report low back pain over the next three years.  In September 2008, she treated with Dr. Tosteson for right lower back pain radiating into the right leg.  Dr. Tosteson recommended physical therapy.  An MRI scan in November 2008 was negative.  The employee was discharged from physical therapy in December 2008.

The employee filed a claim petition on July 12, 2012, for the August 2009 injury for permanent partial disability benefits; an amended claim petition on May 2, 2013, which added a consequential psychological injury and claimed permanent total disability benefits from and after September 16, 2012, and medical expenses; and a statement of attorney fees on March 14, 2014.  The employer filed a rehabilitation request on December 19, 2013.  A hearing addressing these pleadings was held on October 14, 2014.  When questioned at the hearing regarding her denial of previous work injuries and the related litigation, the employee repeatedly said that she had forgotten about them because of her pain.  The statement of attorney fees was withdrawn at the hearing.

The compensation judge awarded permanent total disability benefits and some medical treatment, and denied permanent partial disability benefits for a psychological or psychiatric condition, the employer’s request for a change in the rehabilitation plan, an intervention claim for unemployment benefits, acupuncture treatment after August 22, 2011, medication provided from July 2, 2013, through April 3, 2014, most treatment with Dr. Sandness after August 24, 2011, and treatment at HealthPartners after August 22, 2011, as not reasonable and necessary.  The employee appeals the denial of medical treatment and the employer cross-appeals the award of permanent total disability benefits.

In reviewing cases 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.  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, “[f]actfindings are clearly erroneous only if the reviewing court on the entire evidence is left with a definite and firm conviction that a mistake has been committed.”  Northern States Power Co. v. Lyon Foods Prods., Inc., 304 Minn. 196, 201, 229 N.W.2d 521, 524 (1975).  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.”  Id.

The employee appeals the compensation judge’s findings that acupuncture treatment after August 22, 2011, medication provided from July 2, 2013, through April 3, 2014, most treatment with Dr. Sandness after August 24, 2011, and treatment at HealthPartners after August 22, 2011, were not reasonable and necessary.  The employee argues that the denied treatment is compensable since it relieves the employee’s symptoms.  An employer must furnish such medical and surgical treatment for a work-related injury “as may reasonably be required at the time of the injury and any time thereafter to cure and relieve from the effects of the injury.”  Minn. Stat. § 176.135, subd. 1(a).  The phrase "cure and relieve from the effects of the injury" is construed to mean cure or relieve.  See Castle v. City of Stillwater, 235 Minn. 502, 51 N.W.2d 370, 17 W.C.D. 103 (1952).  The employee also argues that the denial of medical treatment is inconsistent with the employee’s 25% permanent partial disability as stipulated by the parties, citing Peterson v. Kandi Kourts, 45 W.C.D. 528 (W.C.C.A. 1991) as holding that finding ongoing treatment not to be reasonable or necessary is inconsistent with a permanent injury.  The case, however, does not state that all treatment for a permanent injury must be considered reasonable and necessary.  Id. (denial of treatment was based on doctors’ opinions that assumed the work injury was not permanent).

The reasonableness and necessity of medical treatment under Minn. Stat. § 176.135 is a question of fact for the compensation judge which will not be overturned unless it is clearly erroneous and unsupported by the record as a whole.  See Hopp v. Grist Mill, 499 N.W.2d 812, 48 W.C.D. 450 (Minn. 1993).  A compensation judge may consider many factors when assessing whether certain medical treatment was reasonable and necessary, including the following:  the employee’s opinion as to relief obtained; the provision of services on a scheduled rather than an as-needed basis; the duration of relief from symptoms and whether symptoms recur; the use of alternative medical care; whether the employee is psychologically dependent on treatment; evidence as to a reasonable treatment plan; documentation of the details of treatment; whether the frequency of treatment is warranted; the cost of treatment in light of the relief obtained; an employee’s overall activities and the extent of ability to work; and the potential for aggravation of an underlying condition.  See Horst v. Perkins Restaurant, 45 W.C.D. 9 (W.C.C.A. 1991), summarily aff’d (Minn. July 10, 1991).  Not all factors apply in all cases, and the weight to be attached to any given factor will vary from case to case.  Olson v. Allina Health Sys., 59 W.C.D. 37, 43 (W.C.C.A. 1999).

When a factual determination by a compensation judge is appealed, the question for this court is whether the determination is supported by substantial evidence.  Minn. Stat. § 176.421, subd. 1; Hengemuhle v. Long Prairie Jaycees, 358 N.W.2d 54, 37 W.C.D. 235 (Minn. 1989).  In this case, the judge noted that the employee had an incredible amount of conservative care, and that none of the treatment or diagnostic testing had provided lasting or significant relief.  The employee repeatedly reported that she had constant pain.  The years of acupuncture and medical treatment did not result in improvement other than occasional temporary relief of the employee’s condition.  The judge concluded that the usefulness of the treatments had been exhausted since her condition had remained essentially unchanged for the last several years.

In addition, Dr. Sandness noted that the employee’s pelvis subluxation was stable since August 3, 2011.  The employee was released to return to work in August 2011 with restrictions of working four hours per day, no lifting, pushing and pulling over 10 pounds, no lifting below knee height, no bending or stooping, occasional twisting, standing and walking up to 30 minutes per day, and standing in place up to 15 minutes per day.  The employee’s symptoms were unchanged during later appointments.  Dr. Norgard opined that the employee had pre-existing low back pain which had not resolved and that the employee’s treatment with Dr. Sandness and her acupuncture treatment after August 24, 2011, was not reasonable and necessary.  Where evidence is conflicting or more than one inference may reasonably be drawn from the evidence, the findings of the compensation judge are to be upheld.  Redgate v. Sroga’s Standard Serv., 421 N.W.2d 729, 734, 40 W.C.D. 948, 957 (Minn. 1988).  It is the function of the compensation judge to resolve conflicts in expert medical testimony, and his or her choice of expert opinion is usually upheld unless the facts assumed by the expert in rendering his opinion are not supported by the evidence.  See Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985).  Substantial evidence supports the compensation judge’s findings regarding the denied treatment, and we affirm.

The employer cross-appeals the compensation’s judge’s finding that the employee is permanently and totally disabled.  The compensation judge found that the employee was permanently and totally disabled as of September 16, 2012, through the date of the hearing, and that her August 14, 2009, work injury was a substantial contributing factor in this disability.  Minn. Stat. § 176.101, subd. 5(2), defines permanent total disability as any “injury which totally and permanently incapacitates the employee from working at an occupation which brings the employee an income.”  The statute further provides that “totally and permanently incapacitated” means that the employee’s physical disability in combination with the requisite level of permanent partial disability causes the employee to be “unable to secure anything more than sporadic employment resulting in an insubstantial income.”  Minn. Stat. § 176.101, subd. 5(2); see also Schulte v. C.H. Peterson Constr. Co., 278 Minn. 79, 83, 153 N.W.2d 130, 133-34, 24 W.C.D. 290, 295 (1967) (physical disability in combination with age, training, experience, and type of work in the community).  “Permanent total disability is primarily dependent on an employee’s vocational potential, rather than his physical condition.”  Thompson v. Layne of Minn., 50 W.C.D. 84, 100 (W.C.C.A. 1993), summarily aff’d (Minn. Jan. 19, 1994); see also O’Neil v. J Craft, Inc., 72 W.C.D. 681, 698 (W.C.C.A. 2012).

QRC Galvin testified at the hearing that the employee should not have been required to conduct a job search at all since she had no transferable skills and no job goals.  He stated that vocational testing should have been completed before a job search was started.  He also noted that Dr. Sandness had taken the employee off work.  He verified that the employee was not interested in attending a chronic pain program, but stated that the potential for that treatment would not change his opinion.  The employer argues that the QRC’s opinion is not supported by the evidence since the QRC accepted Dr. Sandness’s assessments and opinions regarding work restrictions and medical issues, which were derived from the employee’s reports of pain.  The employer also argues that the QRC and Dr. Sandness were not aware of the employee’s previous work injuries.

The compensation judge found that “the employee’s failure to reveal details about prior workers[’] compensation claims and depositions extremely troubling.”  (Memorandum at 7.)  The judge found that the employee’s explanation for her forgetfulness about past litigation and injuries being caused by her pain not convincing.  The judge inferred that the employee “wished to improve her chances of recovery in the current case by failing to reveal her past injuries and litigation experience.”  (Id.)  The employer argues that the employee’s statements regarding her disability and any opinion derived from the employee’s statements are unreliable and therefore that those statements as well as the QRC’s and Dr. Sandness’s opinions have no evidentiary value.

Assessment of the credibility of a witness is the unique function of the trier of fact.  Brennan v. Joseph G. Brennan, M.D., P.A., 425 N.W.2d 837, 839-40, 41 W.C.D. 79, 82 (Minn. 1988).  The judge noted that she was extremely cautious in weighing the employee’s testimony.  (Memorandum at 8.)  Further, as the employee noted, the judge was specifically referring to the employee’s testimony regarding past litigation and injuries as not credible, not all of the employee’s testimony and statements.  A factfinder generally “may accept all or only part of any witness’ testimony.”  Proffit v. Minn. Harvest Apple Orchard, 48 W.C.D. 215, 219-20 (W.C.C.A. 1992) (quoting City of Minnetonka v. Carlson, 298 N.W.2d 763, 767 (Minn. 1980)), summarily aff'd (Minn. Mar. 3, 1993).  The judge was not required to discount all of the employee’s statements based on her lack of credibility regarding some of her testimony.

The employer further argues that the other factors cited by the judge, the unsuccessful job search and the inability to accommodate the employee in a job as a greeter, do not support the permanent total disability determination.  The employer claims that since the employee’s work restrictions and job search parameters were tainted by her unreliable reports, the job search should not be a factor.  The employee participated in a lengthy job search, about 17 months, with extensive assistance from a placement specialist.  In addition, the second QRC opined that this job search was not even necessary since the employee had no transferable job skills.  The judge did not err by considering the unsuccessful job search as a factor.  The employer also claims that its inability to accommodate the employer in the greeter job should not be considered since that position was temporary as a matter of policy.  There was no indication that the employer could accommodate the employee in any position.

The judge concluded that the employee’s pre-existing conditions and restrictions from her work injury combined to render her permanently and totally disabled.  The judge emphasized the employee’s unsuccessful job search, the QRC’s testimony, the employee’s testimony regarding her current activity level, and the employer’s inability to accommodate the employee’s continued employment in making this determination.  The judge rejected the employer’s argument, that a better job search would yield positive results, as extremely speculative.  The judge found the additional job search after September 16, 2012, would be futile given the employee’s physical restrictions, age, training, experience, and previously unsuccessful job search.

Given Dr. Wengler’s opinion that the employee could not be productive in any way given her physical findings, Dr. Sandness’s opinion that a return to work was not realistic for the employee, the QRC’s opinion that the employee had no transferable skills and was permanently and totally disabled, and the conclusion of the functional capacities evaluation that the employee did not function at a level that would be considered employable, substantial evidence supports the compensation judge’s finding that the employee has been permanently and totally disabled since September 16, 2012, and we affirm.