The employee appeals from the compensation judge’s denial of temporary total disability benefits from May 22 through August 11, 2014, the judge’s reliance on the opinion of the independent medical examiner that the employee was physically capable of performing a light duty job offered by the employer on January 12, 2015, that she failed to accept, the judge’s finding that the employee was not entitled to temporary total disability benefits after February 20, 2015, and the judge’s finding that medical services provided by the Noran Neurologic Clinic were not reasonable and necessary.  We affirm.  In addition, under the facts of this case, we determine that Minn. Stat. § 176.101, subd. 1(i), is inapplicable and vacate that portion of the Findings and Order.

The employee is a naturalized immigrant who resides in Willmar, Minnesota, with her husband and children.  The employee began working for the self-insured employer, Jennie-O Turkey Store, in September 2011.  In April 2012, she transferred to the Daypack and Packaging department.  The employee’s job duties from April 2012 through December 2013 involved repetitive, fast-paced work handling turkey ham products that generally weighed between 2 to 5 pounds.  On occasion, she handled larger hams or whole turkeys weighing from 10 to 13 pounds.  The work was generally performed in front of her body, at or slightly above waist level.

On October 25, 2013, the employee was seen by the employer’s on-site nurse, Wendy Robbin, reporting she had awakened with left upper extremity and neck soreness that she attributed to her work duties.  She was seen again by the company nurse on December 6, 2013, reporting soreness in her entire left upper extremity.

On December 9, 2013, the employee sought treatment from Dr. Ryan Davis at Affiliated Community Medical Center (ACMC), reporting a one month history of left-sided neck pain, left arm pain, numbness, and tingling.  The doctor ordered a cervical MRI scan, and permitted the employee to return to work with restrictions of no lifting over 10 pounds and allow work at a somewhat slower pace.  The December 10, 2013, MRI study showed minimal/minor disc bulging at C3-4 and C5 to C7 with no clinically significant foraminal compromise.  The employer accommodated the employee’s restrictions beginning December 10, 2013.

The employee returned to see Dr. Davis on December 31, 2013, reporting her overall symptoms had improved slightly.  She brought in workers’ compensation forms and Dr. Davis referred the employee to Occupational Medicine for further evaluation by Jeff Enstad, a certified nurse practitioner (CNP), the clinic specialist in the area of worker’s compensation injuries.

The employee was seen by CNP Enstad beginning on January 10, 2014.  Mr. Enstad diagnosed a left cervical strain/sprain and left shoulder rotator cuff/bicipital tendinitis.  CNP Enstad provided conservative care, recommending Tylenol for pain, icing of the neck and shoulder, and ordering physical therapy and massage therapy.  CNP Enstad released the employee to return to work with light-duty restrictions of no lifting/carrying or pushing/pulling with the left arm over 2 pounds, then 3 pounds, and then 5 pounds, no overhead reaching with the left arm, and avoiding repetitive motion with the left arm and working with the left arm outstretched.  The employer provided the employee with light-duty work consistent with these restrictions.

The employee’s neck and left shoulder pain gradually decreased, although she continued to report intermittent neck pain and persistent left shoulder pain.  The employee was last seen by CNP Enstad on May 5, 2014. The employee reported her neck felt “better,” although she continued to have some ongoing left shoulder pain.  The employee’s cervical examination was normal.  The employee’s left shoulder range of motion was full and rotator cuff strength was 5/5, with minimal tenderness over the bicipital tendons anteriorly.  CNP Enstad diagnosed improved chronic neck pain and improved chronic left shoulder tendinitis, and released the employee to return to work without restrictions beginning May 5, 2014.

The employee did not return to her normal work duties, but continued to perform light-duty work at the employer after May 5, 2014.  On May 21, 2014, the employee left work early to attend a school event for one of her children.  She returned to the employer at approximately 2:00 p.m.  Upon arrival, she was informed the work-line was almost done and was sent home.

That same day, on May 21, 2014, the employee sought treatment from Jon Haefner, D.C., at Meridian Disc Institute, complaining of neck, left shoulder, upper back, and low back pain.  Dr. Haefner excused the employee from work from May 22 to May 28 to avoid aggravation of her condition.  The employee provided Dr. Haefner’s off work slip to Nurse Robbin on May 22, 2014.  Although the employee remained in the employ of the employer, she did not return to work at Jennie-O thereafter.  The employee continued to treat at Meridian Disc Institute through August 25, 2014.  She testified she did not benefit from this treatment.

On referral by Dr. Haefner, the employee was seen by Dr. John Damergis at the Noran Neurological Clinic on July 8, 2014.  The employee reported neck pain, left upper extremity numbness and weakness, and low back pain.  Dr. Damergis diagnosed a cervical overuse injury on October 25, 2013, with cervical spasms and a C5-6 disc herniation, and a work-related injury on May 21, 2014, resulting in lumbar myoligamentous pain syndrome.  Based on findings of left upper extremity weakness and shoulder pain, the doctor ordered an MRI scan of the left shoulder to rule out rotator cuff damage.  Dr. Damergis took the employee off work indefinitely.

The July 8, 2014, MRI scan of the left shoulder revealed a high grade distal supraspinatus tendon tear.  Dr. Damergis reviewed the scan and recommended that the shoulder be evaluated by an orthopedist.  On July 11, the employee was contacted by phone and informed of the MRI scan results and Dr. Damergis’s order for an orthopedic referral.

On August 12, 2014, the employee was seen by Dr. Eric Nelson, Heartland Orthopedic Specialists.  Dr. Nelson concluded the MRI scan showed a 90% bursal-sided supraspinatus tear with associated subacromial impingement and recommended surgery.  On August 26, 2014, the employee underwent a left shoulder arthroscopy with subacromial decompression and rotator cuff repair.  The employee followed-up with Dr. Nelson postoperatively and the employee’s off-work status was continued.  Physical therapy was initiated in September 2014 to increase strength and improve range of motion in the left shoulder.  The employee experienced ongoing significant pain and stiffness, and in early October 2014, a repeat MRI scan was taken of the left shoulder.  On October 9, 2014, Dr. Nelson advised the employee the study was appropriate for a postoperative rotator cuff repair and indicated that her shoulder pain and stiffness was likely related to early adhesive capsulitis.

The employee returned to see Dr. Damergis on October 15, 2014.  The doctor observed the employee had been referred to an orthopedist for her left shoulder and that she continued to receive treatment for the neck and low back at Noran Clinic.

On November 19, 2014, Dr. Damergis provided a letter report on behalf of the employee.  The doctor opined, in part, that the employee’s work activities were a substantial contributing cause of the employee’s neck, low back, and left shoulder conditions culminating in October 2013.  Dr. Damergis recommended the employee remain off work through January 15, 2015, to focus both on physical therapy for the left shoulder and to institute therapies for the neck and low back.

By letter report dated November 21, 2014, Dr. Nelson stated that repetitive use of the upper extremities is a very common aggravating or substantially contributing source of rotator cuff problems, and that the employee’s job duties requiring repetitive reaching, pushing, and pulling were consistent with an injury culminating on October 25, 2013.  The doctor observed that a high grade partial thickness tear can show good range of motion and good strength, as indicated in CNP Enstad’s evaluations, but present with significant pain.  Dr. Nelson stated this does not typically go on to uneventful healing with physical therapy, but gradually becomes worse and can require surgical intervention.  The doctor stated the employee was improving but was not yet fully recovered, and did not anticipate a release to “unlimited activities,” without restrictions, until at least six months following her surgery, that is, by February 26, 2015.  He further opined the employee should not use her left upper extremity for work-related activities at that time.

At the request of the employer, the employee was seen on November 19, 2014, by Dr. Mark Friedland, an orthopedic surgeon.  The employee complained of pain from the left shoulder to the elbow and had limited range of motion in the left shoulder.  The doctor opined the employee had sustained a minor cervical strain/sprain on or about October 25, 2013, from which she had fully recovered by at least May 5, 2014.  Dr. Friedland further opined that the employee did not sustain a left shoulder injury as a result of her work activities at the employer.  Rather, in the summary portion of his report, Dr. Friedland concluded that medical treatment of the employee in March 2011 was consistent with a left shoulder partial thickness rotator cuff tear at that time, and opined that the rotator cuff tear had been present for an extended period of time.  Nonetheless, he stated that the care and treatment provided for the left shoulder, including the MRI scan and Dr. Nelson’s care and treatment, including the left shoulder surgery, was reasonable and necessary.

Regardless of causation, Dr. Friedland stated the employee should continue physical therapy for the rehabilitation of her shoulder and anticipated the employee would fully recover by approximately February 26, 2015.  He recommended restrictions on the use of the left upper extremity to include no lifting of more than 1 to 2 pounds with the left arm, no use of the left hand above waist level, and avoid overhead reaching or working with the left arm outstretched.

The employee continued to treat with Dr. Nelson and attend physical therapy.  On January 8, 2015, the doctor noted the employee was getting better, but was still quite stiff.  Dr. Nelson’s impression was adhesive capsulitis or a “frozen shoulder,” which he felt was best treated by continuing stretching exercises and taking Naproxen.  The chart note indicates the employee requested a report of workability for the employer, but Dr. Nelson indicated he was “concerned with her going back to work with as stiff as her shoulder is,” and stated he wanted to wait until the next follow-up to discuss it further.  (Ex. M, 1/8/15.)

On January 12, 2015, the employer sent a letter to the employee offering her a modified position in the Daypack department that accommodated the November 19, 2014, restrictions of Dr. Friedland.  The employee was given until February 20, 2015, to accept or reject the position.  The employee did not respond to the employer’s offer of light-duty employment.

The employee was seen by CNP Ann Rechtzigel at Noran Neurological Clinic on January 15, 2015, for treatment of her neck and low back conditions.  The CNP issued a report of workability continuing the employee off work until her next appointment with Dr. Damergis on April 16, 2015.

The employee returned to see Dr. Nelson on February 5, 2015.  The doctor noted the employee was doing better and felt that “we are close to a breakthrough for her shoulder range of motion.”  (Ex. M, 2/5/15.)  He stated he did not feel she would harm her shoulder if she pushed her range of motion at physical therapy.  On March 5, 2015, Dr. Nelson indicated the employee’s range of motion had improved and stated she should continue physical therapy focusing on stretching and strengthening the shoulder.

On February 9, 2015, and March 23, 2015, Dr. Friedland provided supplemental reports after review of additional medical records from the offices of Dr. Damergis and Dr. Nelson, including their letter reports.  Dr. Friedland stated review of the additional records did not change the opinions rendered in his IME report of November 19, 2014, including the work restrictions he recommended for the employee.

Following a hearing, the compensation judge found the employee sustained a temporary Gillette injury to the cervical spine that resolved by May 5, 2014, and that the employee sustained a permanent left shoulder Gillette injury on October 25, 2013, but sustained no compensable injuries on May 21, 2015.  The compensation judge denied temporary total disability (TTD) benefits from May 22 through August 11, 2014, but awarded TTD benefits from August 12, 2014, through February 20, 2015.

In addition, the judge found the employee refused a job offer made by the employer for work the employee was physically capable of performing.  The suitable job offer expired on February 20, 2015, and the employee’s entitlement to TTD ceased on that date.  The judge awarded payment of medical expenses incurred for treatment by Dr. Nelson, the employee’s treating orthopedist for the left shoulder, but denied medical bills incurred for treatment at the Noran Neurological Clinic.  The employee appeals from the denial of TTD benefits and the denial of the Noran Neurological Clinic medical expenses.

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 argues the denial of temporary total disability benefits after May 21, the last day the employee worked at the Jennie-O Turkey Store, until August 12, 2014, when she began treating with Dr. Nelson, is clearly erroneous and not supported by the evidence as a whole.  The employee asserts the compensation judge misinterpreted the evidence and failed to articulate what restrictions or limitations he assumed the employee had during this period of time.  The employee contends that the only opinions regarding work restrictions during this time period were those of Dr. Haefner and Dr. Damergis, both of whom took the employee off work.

The compensation judge found the employee was released to return to work without restrictions by CNP Enstad on May 5, 2014, and that the employee did not return to her normal pre-injury job, but continued to work full-time light-duty from May 5 through May 21, 2014.  He rejected the opinions of Dr. Haefner and Dr. Damergis regarding the nature of the employee’s injuries, and found, in an unappealed finding, that the employee failed to prove she sustained Gillette injuries to the cervical spine, lumbar spine or left shoulder culminating on May 21, 2014.  In the absence of a new injury to, or an aggravation of, her cervical or left shoulder injury, the judge reasonably concluded the employee failed to prove she had restrictions that precluded her from continuing to work light-duty at the employer between May 22 and August 11, 2014.

The employee additionally argues that, based on the judge’s findings, it can be assumed that during this period of time the employee was suffering from her ongoing left shoulder condition.  Dr. Damergis first saw the employee on July 8, 2014.  Due to findings of left upper extremity weakness and shoulder pain, he ordered an MRI scan to rule out possible rotator cuff damage.  The doctor took the employee off work indefinitely.  The scan revealed a high grade supraspinatus tendon tear and, following review of the scan on July 10, 2014, Dr. Damergis referred the employee for an orthopedic evaluation.  Arguably the employee’s left upper extremity pain and weakness, along with the MRI findings, contributed to Dr. Damergis’s decision to take the employee off work.

It could equally be argued, however, that the employee was able to perform light-duty work despite her left arm pain up to that point, and that it was not until Dr. Nelson recommended surgical intervention on August 12, 2014, that the employee was temporarily totally disabled.  Although Dr. Nelson did not provide an off-work slip until August 19, 2014, stating the employee would be unable to work as of August 26, 2014, the day on which the surgery was scheduled, the compensation judge, not unreasonably, concluded that, in light of his finding that the employee sustained a permanent left shoulder Gillette injury, the employee was entitled to TTD commencing on the date of Dr. Nelson’s initial examination of August 12, 2014.  We affirm.

At the hearing, the employer contended the employee refused suitable work offered by the employer, and that her claim for temporary total disability benefits from and after February 20, 2015, is precluded by Minn. Stat. § 176.101, subd. 1(i).  (Findings and Order, Statement of Issues, no. 5).  The compensation judge accepted the opinion of Dr. Friedland with respect to the employee’s work restrictions, and found the employee was physically capable of performing the light-duty job offered by the employer on January 12, 2015.  In light of her failure to accept the job offer, the judge found the employee’s entitlement to temporary total disability benefits ceased on February 20, 2015.

The employee contends the judge’s reliance on Dr. Friedland’s work restrictions is clearly erroneous.  She asserts that Dr. Friedland did not provide any opinion regarding the employee’s physical condition and need for restrictions in January 2015; his only examination was in November 2014.  Additionally, the employee asserts Dr. Friedland was not aware of the worsening of the employee’s left shoulder condition in January 2015 when Dr. Nelson suspected a “frozen shoulder,” kept the employee off work, and recommended ongoing physical therapy.  We disagree.

At the time of his November 19, 2014, independent medical examination, Dr. Friedland noted pain from the left shoulder down to the elbow and limited range of motion of the left shoulder due to the employee’s recent surgery.  The doctor opined the employee should continue post-operative physical therapy for rehabilitation of the left shoulder, and anticipated the employee would fully recover from, and reach maximum medical improvement, for her left shoulder by approximately February 26, 2015, taking into account the usual healing time for such an injury and surgery.  Dr. Friedland recommended restriction of use of the left upper extremity to include no lifting of more than 1-2 pounds with the left arm, no use of the left hand above waist level, and avoidance of outstretched or overhead reaching with the left arm “currently.”

On November 19, 2014, Dr. Friedland had Dr. Nelson’s treatment records only through September 4, 2014.  Dr. Nelson first noted pain and stiffness likely due to adhesive capsulitis (“frozen shoulder”) in a chart note dated October 9, 2014.  In his November 21, 2014 letter report, Dr. Nelson stated the employee was improving but was not yet fully recovered.  He did not anticipate releasing the employee to “unlimited activities” until at least February 26, 2015, “without restrictions.”  Given the employee’s limited range of motion and postoperative stiffness in the shoulder, he opined the employee should not use her left arm for work-related activities at that time.

The judge found that Dr. Nelson declined to provide work restrictions on January 8, 2015, and did not discuss the employee’s ability to work at subsequent appointments on either February 5 or March 5, 2015.  In his memorandum, the judge noted the employee’s follow-up visit on January 8, 2015, and observed the employee requested a workability report, but Dr. Nelson was concerned about her going back to work with her shoulder as stiff as it was and deferred discussion of work restrictions until the next visit.  The judge noted there was nothing in the employee’s next appointment on February 5, 2015, to indicate that work restrictions or the recent January 12, 2015, job offer were discussed.  When asked if she discussed with Dr. Nelson her ability to return to work, the employee testified that she had not asked him.  (T. 111, 140-41.)

By report dated March 23, 2015, Dr. Friedland reported he had reviewed Dr. Nelson’s November 21, 2014, letter report and additional medical records from September 23, 2014, to February 5, 2015, and stated the additional information did not in any way change the opinions rendered in his IME report of November 14, 2014.  There is adequate foundation for Dr. Friedland’s opinions, and we find the judge did not err in adopting Dr. Friedland’s work restrictions.  There is substantial evidence to support the compensation judge’s denial of temporary total disability benefits after February 20, 2015, when the job offer expired.^[1]

We, however, vacate that portion of the compensation judge’s decision to the extent it is based on application of Minn. Stat. § 176.101, subd. 1(i).^[2]  The employer denied liability for any benefits from and after May 5, 2014, and the employee was paid no TTD through the date of the hearing.  Minn. Stat. § 176.101, subd. 1(i), specifically provides that TTD benefits shall cease if the employee rejects a suitable job offer.  Accordingly, the statute applies only when an employee is actually being paid TTD compensation at the time the “cessation event” occurs.  Falls v. Coca Cola Enters., Inc., 726 N.W.2d 96, 67 W.C.D. 22 (Minn. 2008); Spoelstra v. Wal Mart Stores, 74 W.C.D. 65 (W.C.C.A. 2014).  The employee was not receiving or being paid temporary total disability benefits at the time of the employer’s job offer.  Hence, Minn. Stat. § 176.101, subd. 1(i) - - which would bar any future receipt of TTD benefits - - is not applicable in this case.^[3]

The employee argues that the denial of payment of medical bills incurred for treatment at the Noran Neurological Clinic is clearly erroneous and contrary to the weight of the evidence.  The employee asserts there is uncontroverted medical evidence that the MRI scan of the left shoulder and office visit of July 8, 2014, the EMG of July 10, 2014, and the office visits of August 13, 2014, September 24, 2014, October 15, 2014, and January 15, 2015, were reasonable and necessary.  She further contends the judge failed to make a finding as to whether the treatment at Noran Clinic was causally related.

Contrary to the employee’s arguments, the judge found the employee’s initial evaluation and left shoulder MRI scan at the Noran Clinic on July 8, 2014, were reasonable and necessary to cure and relieve the effects of her October 25, 2013, left shoulder injury, and awarded payment of these medical expenses.

Moreover, the judge, accepting the opinions of CNP Enstad and Dr. Friedland, concluded the employee’s cervical injury had resolved no later than May 5, 2014, and that the employee failed to prove she sustained Gillette injuries to her cervical spine or lumbar spine culminating on May 21, 2014.  After July 8, 2014, care of the employee’s left shoulder was transferred to Dr. Nelson, and the records of Noran Clinic are consistent with treatment for the neck and low back found not work-related by the judge.  Dr. Friedland specifically opined that none of the care or treatment undertaken at the Noran Clinic, including the EMG study and cervical trigger point injections, was medically reasonable.  The judge, accordingly, denied the post-July 8, 2014, medical treatment at the Noran Clinic.  We affirm.