The employer and insurer appeal the compensation judge’s findings as unsupported by substantial evidence.  The employer and insurer claim that the compensation judge erred in her rejection of the employer and insurer’s notice defense.  They further claim that the compensation judge erred in awarding wage loss in light of the employee’s voluntary departure from her employment.  The employer and insurer asks that we vacate the compensation judge’s finding of a 25 percent permanent partial disability.  The employee cross-appeals claiming that the compensation judge used the incorrect average weekly wage in awarding benefits.  We affirm in part, reverse in part, and vacate in part.

The employee, Joan Van Riper, worked for the employer, a manufacturer of corrugated board, beginning in 1997 with a break in employment for two years between 2002 and 2004.  The employer changed ownership and names over the years.  At the time of the injury, on June 29, 2010, the employer was known as Interstate Packaging Corp.  The employer was insured against workers’ compensation liability by Cincinnati Insurance Companies.

The employee obtained her GED in 1986 and attended, but did not graduate from, Riverland Technical College in Albert Lea majoring in microbiology with an intended occupational goal of waste water treatment.  She lived on a 12-acre farm with her husband.  She participated in baling hay for their horses twice a year, but limited her activity to driving the tractor.

In 2010, the employee performed jobs for the employer in the finishing department.  As a finisher, she worked on several machines.  She primarily worked on the slitter machine which required her to take sheets of corrugated board and glide them through the machine.  The sheets of board averaged in size of 24”x 36,” but there were times that the employee was required to process 80” x 110” size sheets.  In processing the larger sheets, she bent over and reached as far as she could overhead, moved the sheet around and put it into the machine.  She lifted the sheets overhead with both arms above shoulder height.  She handled several sheets at a time.  She was also required to lift a steel cage guard which was of unknown weight, but both the employee and her supervisor described it as in the area of 50 pounds.  The employee testified that she lifted the steel cage guard above her head.  The job description, attached as part of the employer’s exhibits, established that her job required her to lift up to 50 pounds.  The employee was also required to place a cap on finished stacks of corrugated board before each stack was wrapped for shipping.  This duty also required the employee to reach above her head.

From January through June 2010, the employee noticed pain while performing her job.  She noticed an extremely sharp burning pain in her left and right shoulders.  By noon, the pain traveled down her arm and around her elbow.  By the end of her shift, it was even more intolerable.  She testified that she “chalked it up to just wear and tear.”  In April, she began losing sleep due the severity of symptoms.  Her husband, who saw the employer’s plant operation, knew that the way she had to stack cardboard and put it into the machine was causing the shoulder problems.  He told her to go see a doctor and find out what was wrong.  She finally sought treatment with Wright Medical on June 29, 2010, with complaints of bilateral shoulder pain.  The notes reflect a history of lifting at her job as well as baling hay, but there is no indication in the office visit note that affirmatively links the bilateral shoulder pain to her work activities.  She testified that when she worked her job on the slitter machine lifting pieces of cardboard, it was extremely painful.  And during the extreme pain performing her work activities on the slitter machine, she said nothing to anyone at work.  She gave no notice.  In the past, she sustained work-related injuries during the course of her employment to her ankle, thoracic spine, and right thumb.  She testified that she notified the employer each time she suffered a specific injury at work, but did not understand that she was obligated to report an injury that came on gradually.  The employee worked in a lead position and served on the employer’s safety committee.  There is no evidence to suggest that the employee’s position on the safety committee supplied her with the understanding that a work injury could happen over time from minute repetitive trauma, but she was aware of the need to report a work injury to her employer.

On July 14, 2010, the employee underwent an MRI of the right shoulder that revealed a full thickness tear of the supraspinatus tendon.  On August 2, 2010, she saw Dr. Palit who noted that “she is quite active both at work and recreation.  She has a farm.  She bales hay and attends to horses, etc.  She described increasing pain in the right shoulder with overhead activity.”  Dr. Palit diagnosed her with a right torn rotator cuff and recommended surgery.  The employee filed a short term disability claim on August 13, 2010.  Within the disability form, the employee wrote that she did not intend to file a workers’ compensation claim because she could not pinpoint what caused the problem.  She underwent a right rotator cuff repair and subacromial decompression on August 25, 2010.  Following surgery, she received short term disability from August 26, 2010 to November 10, 2010, and long term disability benefits from November 11, 2010 to January 24, 2011.

At the time of her full release for the right shoulder, the employee sought treatment for her left shoulder pain on January 24, 2011.  Dr. Palit examined her again on March 21, 2011, and recommended an MRI of the left shoulder.  The MRI of March 24, 2011, showed a full thickness supraspinatus tendon tear.  Dr. Palit recommended arthroscopic surgery to repair the tear.  During surgery on May 11, 2011, Dr. Palit was unable to locate the rotator cuff tear.  He revised the postoperative diagnosis to left shoulder impingement and labral degeneration performing a decompression and debridement, but did not repair a full thickness tear that appeared on the MRI scan in March 2011.  The employee received short and long term disability benefits from May 25, 2011, to August 14, 2011.  In the disability claim form, she relayed her intent not to file a workers’ compensation claim, explaining that the condition was not related to work.  The employee was released to return to full duty work with the employer on August 15, 2011.

Nine months after a full release to work on May 15, 2012, the employee injured her right thumb at work while using a T-wrench to tighten bolts.  She reported the injury to her supervisor and he drove her to an urgent care clinic for medical treatment.  The employer and insurer admitted primary liability.  Restrictions of no use of the right hand were provided by her doctor.  The employer accommodated her restrictions with light duty work. 

On July 18, 2012, the employee was given a verbal warning for talking with a co-employee and wasting time during work hours.  She was upset and began washing windows with her left hand.  As she reached up, she felt a sharp burn in her left shoulder.  She told her supervisor that her shoulder hurt and she needed to go home.  The supervisor testified that he told her to give him a minute while he finished an order.  He heard the door shut, opened it and saw the employee pulling away in her vehicle.  The employee testified that she was in pain and wanted to get home.  She did not immediately go to the doctor and did not ask her supervisor to take her to urgent care as he did when she injured her thumb.  She went to her locker and left the work premises.

The employee sought treatment with the Mayo Albert Lea clinic on July 19, 2012, presenting with left shoulder pain while washing a window at work.  She was diagnosed with shoulder strain likely from overuse and was given light duty restrictions.  She also sought treatment for her right thumb with Dr. Eckstrom.  She underwent an injection of her right thumb on July 20, 2012, and reached maximum medical improvement (MMI) for the right thumb on the same day.  The employee was called into work and met with her supervisors on July 23, 2012.  At that time, the employer terminated her for leaving open a paint can and for leaving on July 18, 2012, without permission.

The employee sought treatment for the left shoulder with Dr. Steven Schulz on August 9, 2012.  He diagnosed a rotator cuff syndrome of the left shoulder indicating he expected her to reach MMI in 4 weeks.  He released her to full duty work.

The employee saw Dr. Robert Wengler on September 20, 2012.  Dr. Wengler was retained by the employee as a medical expert and did not treat the employee.  Dr. Wengler described the employee’s job activities as running a cardboard slitting machine requiring her to handle large sheets of board of varying sizes s “up to 86 x 110 inches.”  She picked up the boards, placed them on a slitting machine and forced them through the table.  The work was rapid and repetitive.  She maneuvered the sheets into different angles depending on the job.  Dr. Wengler opined that the employee suffered what may be considered a Gillette-type injury due to the repetitive activities she described having performed while working with cardboard.  He assigned a permanent partial disability (PPD) rating of 6 percent to the right shoulder under Minn. R. 5223.0450, subp. 3.A.(2).  He also assigned PPD ratings of 6 percent for a full thickness tear to the left shoulder, 5 percent for loss of forward elevation and 8 percent for limited abduction under Minn. R. 5223.0450, subp. 4.A.(1)(c) and 5223.0450, subp 4.B.(1)(c).  He recommended she undergo another MRI scan of the left shoulder.  He also believed she was surgical candidate.   He restricted her from returning to her job with the employer as a result of her left shoulder condition.  With respect to the thumb injury, he found that she had full range of motion and no ratable impairment.

The employee filed a claim petition on November 9, 2012.  The following month on December 6, 2012, she saw a nurse practitioner at North Iowa Family Health care claiming she was fired from her job due to her work injuries and established a record for the first time of alleged verbal abuse by a supervisor.  The employee complained of left shoulder pain and had limited range of motion.  The plan was to obtain a new MRI.

On December 12, 2012, the employee underwent an MRI which was compared to the previous MRI scan of March 24, 2011.  The full thickness tear was again observed as well as a new articular surface region of partial tearing.  The impression was a focal full thickness supraspinatus tear which was very small, measuring 3 mm AP, and supraspinatus tendinopathy suggesting advanced fibrillation or partial thickness tear.  The employee sought treatment with Dr. Eric J. Potthoff, D.O., at Mason City Clinic Orthopedics.  Dr. Potthoff took the employee’s medical history.  The employee stated she had left shoulder pain since she injured it while washing a window at work in July 2012.  No mention was made of the Gillette-type injury earlier determined by Dr. Wengler.  Dr. Potthoff recommended arthroscopic surgery.  On January 8, 2013, Dr. Potthoff placed her on light duty restrictions of no lifting, pushing, pulling with the left upper extremity.  On February, 11, 2013, the employee underwent a left rotator cuff repair performed by Dr. Potthoff.  He noted in the operative report that the employee had a 90 percent tear of the supraspinatus tendon.   The employee was released to return to work with restrictions on March 27, 2013.

The employee saw Dr. Mark Friedland at the employer and insurer’s request.  Dr. Friedland issued a report on April 9, 2013, stating that the employee qualified for a 6 percent PPD rating to the right shoulder and a 2 percent PPD rating to the left shoulder.

Dr. Potthoff examined the employee on June 18, 2013.  On examination, the left shoulder demonstrated full active range of motion equal to the right shoulder in abduction, as well as forward flexion.  Two months later, on August 14, 2013, the employee began a new job working part-time.  On August 16, 2013, Dr. Potthoff determined that the employee was at MMI and recommended a functional capacities evaluation for determining permanent restrictions.

The matter was tried before a compensation judge on April 15, 2014, and June 9, 2014.  Further evidence was submitted by the parties post-hearing.  At the hearing, the parties stipulated the average weekly wage (AWW) for the June 29, 2010, and May 15, 2012, injuries was $571.71 and $540.48 respectively.  The findings and order filed on September 12, 2014, found that the employee suffered a Gillette-type injury to both shoulders on June 29, 2010.  The compensation judge found that the employee suffered a work related right thumb injury on May 15, 2012.  She further found that the employee’s May 15, 2012, injury was a substantial contributing cause of the aggravation of the employee’s left shoulder Gillette-type injury.  The compensation judge found that the employee was entitled to 25 percent PPD as determined by Dr. Wengler.   The compensation judge ordered payment of TTD from August 12, 2010, to January 25, 2011; May 10, 2011, to August 15, 2011, and July 20, 2012, to August 13, 2013, based on an AWW of 571.71 and temporary partial disability (TPD) from August 14, 2013, to the present and continuing based on an AWW of $540.48.

The employer and insurer appeal the compensation judge’s findings and order arguing that she erred in finding a Gillette-type injury occurred on June 29, 2010, to both shoulders.  They argue that the compensation judge erred in finding that the May 15, 2012, right thumb injury caused an aggravation to the left shoulder.  They further argue that the judge erred in awarding 25 percent PPD based on Dr. Wengler’s rating which occurred before the employee underwent a surgical repair of the rotator cuff.   The employer and insurer argue that the compensation judge’s findings are replete with errors not supported by substantial evidence and that the she failed to make a credibility determination and provide the basis for the same with respect to all witnesses.  The employer and insurer appeal the finding that the employee gave proper notice of the Gillette-type injury.  Further, they appeal the order granting wage loss benefits asserting the employee voluntarily abandoned her employment.

In her cross appeal, the employee argues that the compensation judge should have used the stipulated average weekly wage of $571.71 for all wage loss benefits for the left shoulder.

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 (2014).  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, 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 evidence or not reasonably supported by the evidence as a whole.”  Northern States Power Co. v. Lyon Food Prods., Inc., 304 Minn. 196, 201, 229 N.W.2d 521, 524 (1975).

“[A] decision which rests upon the application of a statute or rule to essentially undisputed facts generally involves a question of law which [the Workers’ Compensation Court of Appeals] may consider de novo.”  Krovchuk v. Koch Oil Refinery, 48 W.C.D. 607, 608 (W.C.C.A. 1993).

Substantial evidence exists to support the compensation judge’s conclusion that the employee suffered a Gillette-type injury to both shoulders on June 29, 2010.  Based on the medical records, the MRI scan reports, the employee tore her rotator cuff bilaterally.  She first sought medical care for both shoulders on June 29, 2010.  Only Dr. Wengler finds a causal connection between the employee’s work activities and the development of her bilateral shoulder complaints.  The compensation judge relied upon Dr. Wengler’s opinion in finding that the employee’s work activities on or around June 29, 2010, were a substantial contributing factor to the development of the bilateral shoulder injuries.  Pursuant to Nord v. City of Cook, 360 N.W.2d 337, 342-43, 37 W.C.D. 364, 372-73 (Minn. 1985), the trier of fact’s choice between experts whose testimony conflicts is usually upheld unless the facts assumed by the expert in rendering his opinion are not supported by the evidence.  Here, the medical evidence and the description of the job duties support the compensation judge’s findings that the work activity was a substantial contributing factor to the bilateral shoulder injuries culminating on June 29, 2010.  We affirm.

Substantial evidence also exists to support the judge’s finding that the employee gave timely notice to the employer of the occurrence of the injury.  The compensation judge determined that the employee credibly testified that she was unaware that the gradual worsening of the condition of her shoulders could result in a compensable injury or that such an injury could be reported to her employer.  In her memorandum, the compensation judge describes the Minnesota Supreme Court’s holding in Anderson v. Frontier Communications, 819 N.W.2d 143, 72 W.C.D. 417 (Minn. 2012), stating that the Anderson court “recently relied upon a[n] existence of a medical opinion that connects the employee’s condition to work duties as sufficient to trigger the running of the notice period.”  The test is whether the employee knew or should have known that the injury was work related.  Id.  There is no requirement that the employee obtain a medical report before the connection is made.  The statutory time for giving the required notice begins to run, not from the time there exists a medical opinion on causation, but rather, from the time it becomes reasonably apparent to the employee that the injury has resulted in, or is likely to cause, a compensable disability.  Issacson v. Minnetonka, Inc., 411 N.W.2d 865, 867, 40 W.C.D. 270 (Minn. 1987), citing Rebiski v. Pioneer Tel. Co., 262 N.W.2d 424 (Minn. 1978); Barcel v. Barrel Finish, 304 Minn. 536, 232 N.W.2d 13, 28 W.C.D. 4  (1975); Clausen v. Minnesota Steel Co., 186 Minn. 80, 242 N.W. 397, 7 W.C.D. 146 (1932).  Professor Larson has explained that “the time period for notice or claim does not begin to run until the claimant, as a reasonable person, should recognize the nature, seriousness and probable compensable character of his injury or disease.”  3 A. Larson, The Law of Workmen’s Compensation 78.41(a)(1983).  Knowledge of the cause is construed to mean sufficient information concerning the nature of an injury or illness, its seriousness and probable compensability to move a reasonable person to make inquiry concerning her rights.  Bloese v. Twin City Etching, Inc., 316 N.W.2d 568, 34 W.C.D. 491 (1982).  The Bloese court rejected any requirement that an employee’s knowledge begins when she receives a medical opinion concerning causation.  Id.  at 572.

The employee’s husband testified that he knew that the employee’s work was causing her shoulder pain.  The employee testified that she did not report the injury because she could not pin-point the cause of her shoulder pain.  She also testified that she was afraid of getting fired from her job for reporting a work injury.  She testified that she felt intense pain while performing a repetitive job and that pain increased over the course of the work day.  She testified that at her first break at 9:00 a.m., the pain was located right around the top of the shoulder.  She returned to work and at the break at noon, the pain traveled down her arm to the elbow.  At noon it got more intense.  At the end of the shift, it was more intolerable.  It is evident that work caused an aggravation of her shoulder pain based on her testimony.  The employee was on the employer’s safety committee up until a month before the claimed injury.  She testified that one of the items of discussion on the safety committee was the fact that employees need to be aware of reporting injuries.  She was also not uneducated having attempted to obtain a degree in microbiology to work in waste management.  She testified that she previously promptly notified the employer for all other injuries she had while at work.  However, she testified that she did not understand that a gradual increase in symptoms as she experienced with her shoulders was a workers’ compensation injury.  Following employment termination, she promptly obtained the opinion of Dr. Wengler tying the shoulder injury to the work activities.  With these facts, it is conceivable that it was reasonably apparent to the employee as a reasonable person that her work activities aggravated her shoulder pain in June 2010 and that it was a compensable disability.  More than one inference may be possibly drawn from the evidence.  The trier of fact determined that the employee credibly testified that she did not become aware of the connection of the shoulder condition to work activities until she had Dr. Wengler’s report in September 2012.^[1]  When the evidence conflicts or when more than one inference may reasonable be drawn from the evidence, the compensation judge’s findings are to be affirmed.  We therefore affirm the compensation judge’s finding that the employee gave timely notice to the employer.

Substantial evidence supports the compensation judge’s finding that the employee did not abandon her job.  The employer and insurer argue that the employee walked off or abandoned the job and is therefore not entitled to wage loss benefits.  Substantial evidence does not support the notion that the employee intended to abandon her job.  What is clear is that she was in pain, had pain in her left shoulder and right thumb, and wanted to get home.  She told a supervisor that she was leaving.  She made attempts to contact the employer explaining her situation.  As a matter of law, a “voluntary termination [does] not preclude a claim for benefits upon proof of wage loss attributable to the disability.” Fielding v. George A. Hormel Company, 439 N.W.2d 12, 41 W.C.D. 942 (Minn. 1989).  The employee leaving the workplace to care for her injury was reasonable under the circumstances.

The compensation judge’s award of TTD benefits from the date of her employment termination through August 13, 2013 is also supported by the evidence.  Based on the record, the employee was released to return to work without restrictions for her left shoulder on August, 9, 2012, by Dr. Schulz.  One month later, on September 20, 2012, Dr. Wengler restricted her from returning to her prior position with the implication that she was under restrictions from the date of termination until she was released to return to work by her treating doctors.  The award of TTD benefits is affirmed.

Substantial evidence does not support the compensation judge finding of a 25 percent PPD rating to the employee’s shoulder condition and we therefore reverse the issue of PPD.  The compensation judge based her decision on Dr. Wengler’s September 20, 2012, report.  Dr. Wengler examined the employee before the left shoulder surgery.  He rated the employee with a 25 percent PPD rating based on the following:

       1.   Right shoulder, 6 percent pursuant to Minn. R. 5223.0450, subp. 3.A.(2) for a full thickness tear.
2.   Left shoulder, 6 percent pursuant to Minn. R. 5223.0450, subp. 3.A.(2) for a full thickness tear.
3.   Left shoulder, 5 percent pursuant to Minn. R. 5223.0450, subp. 4.A.(1)(c) for loss of range of forward elevation.
4.   Left shoulder, 8 percent pursuant to Minn. R. 5223.0450, subp. 4.B.(1)(c) for loss of range of abduction.

Dr. Wengler prematurely rated PPD for loss of range of motion.  Five months after Dr. Wengler’s report, the employee underwent surgery for the left shoulder on February 11, 2013.  Following the left shoulder surgery, the range of motion findings were normal.  On April 14, 2014, Dr. Friedland testified that the medical records of Dr. Potthoff established a normal range of motion and normal strength in both shoulders in August 2013.  Consequently, Dr. Friedland assigned no PPD rating as there was no loss of range of motion for the left shoulder.  Under Grashorn v. Boise Cascade Corp., slip op (W.C.C.A. Mar. 6, 2002), it is an error to award PPD benefits for loss of range of motion of the shoulder where that loss was completely alleviated by surgery prior to the hearing.  Here, where the range of motion was normal, the 5 and 8 percent ratings are unsupported by the evidence, and the finding that the employee is entitled to PPD due to a loss of range of motion is reversed.

Substantial evidence supports the judge’s finding that the employee is entitled to a 6 percent rating for a full thickness rotator cuff tear of the left shoulder.  Dr. Wengler rated the left shoulder tear as a full thickness tear before the surgery based on the MRI finding that there was a full thickness tear.  In the operative report of February 11, 2013, the surgeon, Dr. Potthoff notes that the left shoulder tear was not fully torn, rather only 90 percent torn.  Minn. R. 5223.0450, subp. 3.A. provides “for dates of injury from July 1, 1993, through August 3, 2010, chronic rotator cuff tear demonstrated by medical imaging study, with or without surgical repair” establishes a 6 percent rating for a full thickness tear.  The employer and insurer argue that based on the operative report establishing a 90 percent tear, not a full tear, Dr. Friedland correctly rated the employee’s left shoulder at 2 percent for a partial thickness tear.  The employee argues that because the imaging studies showed a full thickness tear on the left, the employee is entitled to a 6 percent rating.  Based on the plain language of Minn. R. 5223.0450, the medical imaging study showed a full thickness tear and therefore the employee is entitled to 6 percent for the left shoulder.  We also affirm the finding that the employee is entitled to a 6 percent rating for the right shoulder full thickness tear under Minn. R. 5223.0450, subp. 3.A.(2) as supported by substantial evidence.

We vacate the finding that the May 15, 2012, work injury to the right thumb aggravated the employee’s left shoulder Gillette-type injury.  (Finding 23.)  The compensation judge found that the employee sustained a consequential injury to her left shoulder as a result of the May 15, 2012, right thumb injury.  She awarded wage loss benefits from July 18, 2012, based on the AWW for the May 15, 2012, date of injury.  The employee argues in her cross-appellant reply brief and at oral argument, that she did not claim a “consequential injury” or aggravation to the left shoulder that occurred on July 18, 2012, and asked that the finding be vacated.  Both the employee and the employer and insurer agree that this finding was an error.  Because we vacate the finding that an aggravation of the left shoulder occurred July 18, 2012, we also must vacate the finding and order that the employee is entitled to an AWW of $540.48 for wage loss after August 14, 2013.  The parties stipulated to an average weekly wage of $571.71 on June 29, 2010, when the employee suffered a Gillette-type injury to both shoulders.  Therefore, the employee is entitled to wage loss based on the stipulated average weekly wage for the June 29, 2010, Gillette-type injury of $571.71.  Both TTD and TPD shall be paid based on the AWW of $571.71.^[2]