JAMES C. DITTEL, Employee/Appellant, v. NW. AIRLINES CO. and LIBERTY MUT. INS., Employer-Insurer/Respondents, and MIDWEST RADIOLOGY, THERAPY PARTNERS, MINN. DEP’T OF HUMAN SERVS., FERNBROOK CHIROPRACTIC, ALLINA MED. CTR., FAMILY HEALTH SERVS., UNITED HOSP., MEDICA HEALTH PLANS, NEUROLOGICAL ASSOCS. OF ST. PAUL, BLUE CROSS BLUE SHIELD OF MINN., and HEALTHEAST ST. JOSEPH’S HOSP., Intervenors.

The employee appeals the compensation judge’s denial of permanent partial disability benefits, permanent total disability benefits, and medical expenses. We affirm the denial of permanent partial and permanent total disability benefits. We affirm some of the medical expenses and reverse others.

James C. Dittel, the employee, worked for Northwest Airlines Company and its predecessor, Republic Airlines, as a baggage handler for 20 years. The employee sustained several work-related neck injuries over the years. On February 1, 1996, the employee injured his neck and right arm while lifting at work. He underwent a posterior right cervical hemi-laminectomy and discectomy at C6-7 and returned to his regular job in May 1996. The employee sustained additional neck, upper back, and arm strains and began receiving regular chiropractic care in 1998. On March 13, 2000, the employee was hit in the head by a hydraulic door, injuring his head and neck. He treated with chiropractic care and reached maximum medical improvement in October 2000. The employee sustained a neck strain injury on September 7, 2002, while lifting luggage. He again treated with chiropractic care.

In November 2002, an MRI of the employee’s cervical spine indicated worsening of the foraminal stenosis on the right side at C7. A neurosurgeon opined that surgery was possible, but the employee chose to continue conservative care. The employee treated with Dr. Anthony Ferrara, his primary care physician, who prescribed pain medication. In February 2003, an EMG indicated the presence of chronic C7 radiculopathy on the right and mild sensory median neuropathy localizing to the wrist, consistent with mild carpal tunnel syndrome. The employee continued conservative care and massage therapy. A November 2003 EMG showed improvement. No further treatment other than medication and a short trial of physical therapy for home stretching exercises was recommended.

On November 1, 2004, the employee injured his neck and right shoulder while lifting heavy baggage at work. The employee received chiropractic treatment at Fernbrook Chiropractic from November 3 through December 14, 2004. On November 12, 2004, the employee treated with Dr. Ferrara, who assessed right cervical radiculopathy, ordered an MRI, and referred the employee for a neurological evaluation. On November 16, 2004, the employee was evaluated by neurosurgeon Dr. Richard Gregory, who ordered physical therapy. The employee underwent twelve sessions of physical therapy from November 19 through December 17, 2004. On December 30, 2004, the employee underwent a C6-7 anterior cervical decompression and fusion surgery performed by Dr. Gregory. The employee had some complications while healing, and in July 2005, Dr. Gregory assigned the employee a permanent ten-pound lifting restriction. The employer could not accommodate this restriction. In September 2005, Dr. Gregory added restrictions of avoiding excessive bending and twisting of the neck, pounding and jarring movements, and prolonged neck flexion. By November 30, 2005, the employee was at maximum medical improvement and was assigned a 14.5 percent permanent partial disability rating for his cervical spine. The employee was examined by Dr. Richard Hadley at the employer and insurer’s request on November 30, 2005. Dr. Hadley opined that the employee’s 2004 work injury was a permanent aggravation of his pre-existing degenerative disc disease and a substantial contributory cause of his need for the fusion surgery.

The employee began working with a QRC and in April 2006 he attempted working as a limousine driver at a wage loss. In May 2007, a compensation judge awarded the employee a retraining plan for a four-year degree in accounting. The employee began the program in August 2007 and did well in his classes for the first semester of the program. During the second semester, he began to have difficulty in his classes due to various stressors, including marital problems, financial stress, caring for his disabled son, and neck pain. In February 2008, the employee began seeing a psychiatrist, Dr. Sushila Mohan, and a psychotherapist, Dr. Gary Schwery, Ph.D., for attention deficit disorder, obsessive compulsive personality disorder, depression, and anxiety. Dr. Mohan provided psychiatric medical management and Dr. Schwery recommended that the employee take a leave of absence from the retraining program to stabilize his mental health symptoms in May 2008. The employee had previously treated for depression and anxiety in the mid-1990s and was diagnosed with obsessive-compulsive disorder in 2000.

Also in May 2008, Dr. Ferrara referred the employee to Dr. Nadeem Iqbal for a neurological consultation for evaluation of neck pain which radiated down his right arm. An MRI indicated a stable fusion at C6-7, degenerative changes from C3 through C5, and possible moderate to severe narrowing of the right C6-7 and C4-5 foramen. An EMG indicated chronic irritation of the C7 muscles, but Dr. Iqbal opined that the employee’s symptoms were most likely related to anxiety and recommended physical therapy for neck strengthening. The employee was evaluated again by Dr. Gregory, who had no surgical recommendations and referred the employee to Dr. Bradley Helms for a physical rehabilitation evaluation.

On July 30, 2008, Dr. Helms ordered a CT myelogram and recommended that the employee hold off on the physical therapy he had started until after the results of the CT were known. The CT myelogram had similar results to the recent MRI. The employee was taking pain medication as needed. On August 25, 2008, Dr. Helms indicated that they would “opt to continue with therapy for the time being.” (Joint Ex. 17.) On October 28, 2008, Dr. Helms noted that the employee was doing well with his neck pain and that the employee could go to school or job search from a workers’ compensation standpoint. On that same date, Dr. Helms also ordered another round of four to six sessions of physical therapy until the employee reached maintenance therapy. The employee would be tapering off physical therapy and then released to a home care program after four or five visits. In December 2008, the employee was discharged from physical therapy.

On July 30, 2008, the employee was again evaluated by Dr. Hadley, the employer and insurer’s independent medical examiner, who opined that the employee’s work injury was a substantial contributing cause of the employee’s need for work restrictions, but that no further treatment or testing was necessary.

In 2009, Dr. Ferrara completed a physical capacities evaluation form for the employee’s social security disability application, which indicated that the employee could sit/stand for two hours per day, could not perform fine manipulation or repetitive motion, no lifting over ten pounds, and no kneeling, crawling, or crouching. He also stated that the employee was prevented from working full time due to fatigue and that pain medication caused attention and concentration problems.

On April 13, 2009, Dr. Helms opined that the employee was at maximum medical improvement. The employee requested a driving restriction based on his medication use on April28, 2009. On May 1, 2009, Dr. Helms stated that the employee was not to drive within two hours of taking his medication and that he had some restrictions related to his neck injury, but that the employee did not qualify for disability due to his neck. On June 1, 2009, the employee was awarded social security disability benefits as of August 24, 2007, based on the employee’s chronic neck and arm pain secondary to degenerative disc disease of the cervical spine, attention deficit disorder, obsessive-compulsive disorder, depressive disorder, asthma, sleep apnea, and persistent fatigue. The employee’s functional capacity was listed as sedentary, no more than four hours per day, sitting for two hours, and no lifting over ten pounds. The decision also stated that the employee had no transferable job skills.

The employee continued to treat with Dr. Helms and Dr. Ferrara for pain management. The employee saw Dr. Helms on November 2, 2009, reporting neck pain. Dr. Helms indicated that the employee was at maximum medical improvement and should focus on core strengthening and range of motion. The employee was served with notice of maximum medical improvement on December 15, 2009.

Dr. Ferrara referred the employee to Dr. Iqbal for a neurological consultation for symptoms of neck discomfort and numbness in both hands in June 2011. Dr. Iqbal opined that the employee likely had bilateral carpal tunnel syndrome and ordered a nerve conduction and EMG study, an MRI of the cervical spine, and wrist splints. The MRI did not show any changes and the EMG was consistent with mild to moderate left bilateral carpal tunnel syndrome. The employee was diagnosed with carpal tunnel syndrome and underwent carpal tunnel release surgery in December 2011. The employee continued to see Dr. Ferrara for pain medication. At the hearing, the employee testified that he continued to have neck pain flare-ups several times per week.

On November 19, 2014, the employee was again evaluated by Dr. Hadley at the employer and insurer’s request. Dr. Hadley diagnosed chronic neck pain from multilevel cervical spine disc disease with foraminal stenosis and agreed that a ten pound lifting restriction continued to be reasonable and was causally related to the 2004 work injury. He also opined that the employee was in need of no further specific treatment for the 2004 injury, but that anti-inflammatory medication was reasonable treatment for the injury.

In January 2015, Dr. Ferrara indicated that the employee’s diagnosis included degenerative disc disease of the cervical spine and depression and listed the employee’s restrictions as no lifting over ten pounds, no bending, twisting, jerking or overhead lifting, no highly repetitive work, and no working in a stressful environment. Dr. Ferrara opined that the employee had a 20 percent permanent partial disability rating under Minn. R. 5223.0360, subp. 7.D.(2) for his psychological condition and that the employee’s 2004 work injury was a substantial contributing cause of his disability. In a January 28, 2015, letter, Dr. Mohan, the employee’s psychiatrist, stated that she had treated the employee for psychiatric medical management since 2008, prescribing Prozac, Strattera, and Seroquel for obsessive-compulsive disorder, attention deficit disorder, and depression. She opined that the employee could not hold a competitive full-time job due to his difficulty with focusing his attention, obsessive thinking, depression, and easy distractibility. She did not rate the employee’s permanent partial disability.

The employee worked with QRC Michael Stern from June 2005 through October 2009 when the parties agreed that vocational rehabilitation services should be suspended. In a February 3, 2015, report, Mr. Stern opined that there were no jobs within the employee’s capability based on Dr. Ferrara’s work restrictions from 2009. He also opined that the employee was unable to maintain the persistence and pace necessary to work on a sustained basis due to his psychiatric/psychological conditions. At the hearing, Mr. Stern admitted that if the employee’s psychiatric/psychological conditions were able to be managed with treatment and the employee’s restrictions were as specified by Dr. Gregory, a job search would not be futile. The employee did not perform a job search after he stopped his retraining program. QRC Mark Steward prepared an independent vocational report in July 2015. He opined that the employee was employable at a lower wage than his date of injury job and identified ten sedentary job openings for which the employee had transferable skills. He did not assess how the employee’s psychiatric condition would affect the employee’s job search and presumed they could be managed medically.

On April 25, 2015, the employee underwent a psychological evaluation with Dr. Marvin Logel, Ph.D., at the employer and insurer’s request. Dr. Logel diagnosed the employee with obsessive-compulsive disorder with obsessive thinking and heightened somatic preoccupation, unspecified attention deficit hyperactivity disorder, and passive aggressive personality traits, and opined that the employee exaggerated his symptoms. Dr. Logel determined that the employee’s symptoms were not consistent with the diagnosis of a depressive disorder and concluded that the employee’s psychological conditions were not causally related to his work injury. He did not recommend work restrictions related to his psychological conditions and indicated that the employee would benefit from the structure that work would provide.

The employee filed a claim petition for medical expenses and permanent total disability benefits in August 2009. In February 2015, the employee filed an amended claim petition which listed a cervical spine injury and a consequential psychological condition and added a claim for permanent partial disability for his psychological condition. The employer and insurer admitted primary liability for the cervical spine injury as a permanent aggravation of his degenerative disc disease and a substantial contributing cause of his need for fusion surgery, but denied primary liability for the psychological condition. The employee claimed permanent total disability from the time he left the retraining program, permanent partial disability for his psychological condition, and medical expenses. After a hearing on July 15, 2015, the compensation judge denied the permanent partial and permanent total disability claims and several of the medical expense claims. The judge awarded a rehabilitation consultation and some medical expenses. The employee appeals.

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(3). 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).

The employee argues that the compensation judge erred by not awarding permanent partial disability benefits of at least 10 percent under Minn. R. 5223.0360, subp. 7.D.(1), for a mental health condition, relying on Dr. Ferrara’s opinion that the employee was entitled to a 20 percent rating under Minn. R. 5223.0360, subp. 7.D.(2). The employee claims that his symptoms from chronic neck pain contributed to his depression, relying on Dr. Mohan’s and Dr. Ferrara’s opinions. The judge denied the employee’s claim for permanent partial disability for a mental health condition, finding that his psychiatric/psychological problems were not substantially caused by his work injuries. The judge noted that the employee had received psychiatric care for depression and anxiety in the 1990s and was diagnosed with obsessive-compulsive disorder in 2000. The employee reached maximum medical improvement for his cervical spine injury in November 2005. In February 2008, the employee began treating with Dr. Mohan and Dr. Schwery for obsessive-compulsive disorder, attention deficit disorder, and depression. The records indicate that the employee expressed some concern about the workers’ compensation litigation as the hearing approached, but before that, the discussions were about life and relationship issues.

Dr. Logel diagnosed the employee with obsessive-compulsive disorder with obsessive thinking and heightened somatic preoccupation, unspecified attention deficit hyperactivity disorder, and passive aggressive personality traits, and opined that the employee exaggerated his symptoms, but did not diagnose depressive disorder, and concluded that the employee’s psychiatric conditions were not causally related to his work injury. He did not recommend work restrictions and indicated that the employee would benefit from working. The employee claims that Dr. Logel’s opinion that the employee did not have depression was not well-founded given the employee’s symptoms. The question of foundation goes to an expert’s qualification to render an opinion. The competency of a witness to provide expert medical testimony depends upon the degree of the witness’s scientific knowledge and the extent of the witness’s practical experience with the subject of the offered testimony. Drews v. Kohl’s, 55 W.C.D. 33, 37-38 (W.C.C.A. 1996) (citing Reinhardt v. Colton, 337 N.W.2d 88, 93 (Minn. 1983)), summarily aff’d (Minn. July 11, 1996). Dr. Logel took a history from the employee, interviewed the employee, conducted psychological testing, and reviewed his medical records and tests. This level of knowledge affords adequate foundation for a doctor to render an expert medical opinion. Id. at 38-39 (citing Grunst v. Immanuel-St. Joseph Hosp., 424 N.W.2d 66, 68, 40 W.C.D. 1130, 1132-33 (Minn. 1988)). The employee’s concerns go to the persuasiveness or weight to be given Dr. Logel’s opinion, not to a lack of foundation.

The ultimate determination of medical causation is within the province of the compensation judge. Felton v. Anton Chevrolet, 513 N.W.2d 457, 50 W.C.D. 181 (Minn. 1994). Where there is adequate foundation for the opinion adopted by the judge, this court generally upholds the judge’s choice among medical experts. See Nord v. City of Cook, 360 N.W.2d 337, 342-43, 37 W.C.D. 364, 372-73 (Minn. 1985). The judge did not err by adopting the adequately founded opinion of Dr. Logel. The judge emphasized that the employee did not have any psychological restrictions and concluded that the employee’s psychiatric/psychological conditions reflected etiological factors that predated his work injuries and were not consequential to the work injuries. Substantial evidence supports the judge’s finding that the employee’s psychiatric/psychological conditions were not related to his cervical spine symptoms, and the judge did not err by denying the employee’s claim for permanent partial disability for those conditions. We affirm.

Under Minn. Stat. § 176.101, subd. 5, an employee is permanently totally disabled when a work injury “totally and permanently incapacitates the employee from working at an occupation which brings the employee an income,” and meets the appropriate threshold rating of permanent partial disability. In this case, the employee would have to meet a threshold of at least 17 percent permanent partial disability. The compensation judge did not make any findings regarding whether the employee had met the appropriate threshold because he denied the employee’s permanent total disability claim on the basis that the employee had not conducted a job search.

The employee asserts that if the compensation judge’s denial of the employee’s claim for permanent partial disability related to his mental health condition is affirmed, the judge’s findings related to his claim for permanent total disability should be vacated. The employee argues that other factors considered when determining if an employee is permanent totally disabled, such as the employee’s age, education, training and experience, “may only be considered in determining whether an employee is totally and permanently incapacitated after the employee meets the threshold criteria.” Minn. Stat. § 176.101, subd. 5. The employee cites Rezaie v. Wal-Mart Stores, Inc., 70 W.C.D. 334 (W.C.C.A. 2010), where this court reversed an award of permanent total disability benefits without a showing that the employee had met the statutory threshold, stating that “[w]ithout a finding that the employee has met the applicable statutory threshold, the employee cannot be determined to be permanently totally disabled for purposes of receipt of permanent total disability benefits.” Id. at 340.

In this case, however, permanent total disability benefits were not awarded. The compensation judge denied permanent total disability benefits because the employee did not conduct a job search and such a search was not shown to be futile. The threshold requirement need not be addressed before other defenses may be considered by a judge in denying permanent total disability benefits. See Dillon v. Schmitty & Sons School Buses, Inc., No. WC09-116 (W.C.C.A. Oct. 21, 2009) (judge’s determination that an employee had not met the threshold requirement was vacated, but the judge’s denial of permanent total disability benefits was affirmed on basis that the employee had not made a reasonably diligent job search).

The employee also argues that substantial evidence does not support the denial of permanent total disability benefits. “[A] person is totally disabled if [the employee’s] physical condition, in combination with [the employee’s] 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.” 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). The question of whether an employee has met the burden of proving permanent total disability is a question of fact for the compensation judge. Atkinson v. Goodhue County Co-op Elec. Ass’n, 55 W.C.D. 150, 160 (W.C.C.A. 1996), summarily aff’d (Minn. Sept. 20, 1996).

“[T]he concept of ‘total disability’ depends upon the employee’s ability to find and hold a job, and not on [the employee’s] physical condition.” McClish v. Pan-O-Gold Baking Co., 336 N.W.2d 538, 542, 36 W.C.D. 133, 139 (Minn. 1983) (citing Findorff v. Pinkerton’s, Inc., 295N.W.2d 373, 376, 33 W.C.D. 48, 52 (Minn. 1980)). While “[e]mployees who are capable of work must make a diligent job search to establish total disability,” Redgate v. Sroga’s Standard Serv., 421 N.W.2d 729, 733, 40 W.C.D. 948, 954 (Minn. 1988), a diligent job search is not necessarily prerequisite to a finding of permanent total disability. Boryca v. Marvin Lumber & Cedar, 487 N.W.2d 876, 879, 47 W.C.D. 136, 142 (Minn. 1992). An injured employee need not make a diligent search for work when such a search would obviously be futile. See Scott v. Southview Chevrolet Co., 267 N.W.2d 185, 188-89, 30 W.C.D. 426, 432 (Minn. 1978).

The compensation judge found that the employee’s work restrictions were not as restrictive as those given by Dr. Ferrara at the time the employee was awarded social security disability benefits in 2009, but noted that the doctors generally agreed that the employee had a ten-pound lifting restriction and should avoid overhead lifting, bending, twisting, and jerking as specified by Dr. Gregory in 2005. The employee has not conducted a job search, and claims that a search is not required in this case since it would be futile. In a February 3, 2015, report, QRC Stern opined that there were no jobs within the employee’s capability based on Dr. Ferrara’s work restrictions from 2009. At the hearing, however, QRC Stern admitted that if the employee’s psychiatric/psychological conditions were able to be managed with treatment and the employee’s work restrictions were not as strict as those assigned by Dr. Ferrara in 2009, a job search would not be futile. QRC Steward presumed the employee’s psychiatric/psychological conditions could be managed medically and opined that the employee was employable at a lower wage than his date of injury job. The compensation judge recognized that the employee’s job pool was limited, but noted that the employee’s psychiatric/psychological conditions had been well managed with medication and concluded that his psychiatric/psychological conditions did not completely exclude him from work. Substantial evidence supports the compensation judge’s findings that a job search would not be futile and that the employee was not permanently and totally disabled, and we affirm.

The employee also appeals the compensation judge’s denial of various medical expenses. The employer and insurer are liable for medical treatment reasonably required to cure and relieve the employee from the effects of a personal injury. Minn. Stat. § 176.135, subd. 1(a). The reasonableness and necessity of medical treatment under the statute is a question of fact for the compensation judge and the employee has the burden of proof. Hopp v. Grist Mill, 499 N.W.2d 812, 48 W.C.D. 450 (Minn. 1993).

The employee argues that the compensation judge erred by denying payment for treatment related to the employee’s carpal tunnel condition with Dr. Iqbal. In June 2011, Dr. Ferrara referred the employee to Dr. Iqbal for a neurological consultation for symptoms of neck discomfort and numbness in both hands. Dr. Iqbal opined that the employee likely had bilateral carpal tunnel syndrome and ordered a nerve conduction and EMG study, an MRI of the cervical spine, and wrist splints. The MRI did not show any changes and the EMG was consistent with mild to moderate left bilateral carpal tunnel syndrome. The employee was diagnosed with carpal tunnel syndrome and underwent carpal tunnel release surgery in December 2011. The claimed expenses include the consultation and testing in June 2011, but also additional testing in December 2011 before the surgery.

The compensation judge noted that numbness in the hands was a new symptom and found that the carpal tunnel syndrome condition was not substantially caused by the work injury, and denied all expenses related to this treatment. The employee argues that the initial treatment for this condition was causally related to the work injury because the evaluation and testing were needed to determine whether the symptoms were related to his cervical fusion. We agree. A referral to a medical specialist or for diagnostic testing to evaluate or rule out an alternative explanation or treatment for a work injury may be compensable even when the condition or diagnosis evaluated is determined not to be causally related to the work injury. See, e.g., Caizzo v. McDonald’s, 65 W.C.D. 378, 383 (W.C.C.A. 2005); Reid v. Isanti Tire & Auto Care, 62 W.C.D. 370, 380 (W.C.C.A. 2002). The June 2011 consultation and testing which established the carpal tunnel diagnosis are compensable. We reverse the compensation judge’s denial of payment for the June 2011 neurological consultation and testing.

The employee also claims that the compensation judge erred by denying payment for some of his chiropractic treatment. After the November 1, 2004, work injury, the employee received chiropractic treatment on November 3 and 4, 2004. On November 12, 2004, the employee treated with Dr. Ferrara, who referred the employee for a neurological evaluation with Dr. Gregory on November 16, 2004. Dr. Gregory ordered physical therapy and the employee underwent twelve sessions of physical therapy from November 19 through December 17, 2004. The judge awarded payment for the chiropractic treatment on November 3 and 4, 2004, but denied payment for treatment on December 8, 10, and 14, 2004. The judge found that the later treatment was not reasonable and necessary, noting that the employee was also receiving physical therapy during that time as ordered by Dr. Gregory, and that the chiropractic treatment had not been ordered by a treating physician. Substantial evidence supports the judge’s finding, and we affirm.

The employee received physical therapy treatment from May 30, 2008, through December 22, 2008. The compensation judge awarded payment for the treatment in May and June 2008, noting that physical therapy records were submitted for those treatments and that Dr. Iqbal had recommended physical therapy for neck strengthening. The judge noted that there are no treatment records for the remainder of the treatment and that it was unclear whether a physician recommended these visits. While there are no treatment records from the physical therapy provider for all of the dates, there are records from Dr. Helms regarding some of the physical therapy treatment at issue. In August 2008, Dr. Helms ordered continued physical therapy, and on October 28, 2008, Dr. Helms ordered another round of four to six sessions of physical therapy. Contrary to the judge’s observation that the physical therapy treatment after June was not clearly recommended by a physician, the physical therapy treatment from late August through December 2008 was specifically ordered by Dr. Helms. We reverse the judge’s denial of payment for the physical therapy at issue.

The compensation judge also denied payment for massage therapy from June 2012 through July 2015 as not reasonable and necessary or causally related to the employee’s work injury. The employee argues that the massage therapy provided relief of the employee’s pain and therefore should be compensable. The judge noted that massage therapy was not recommended by a physician and that there were no treatment records for that therapy. Substantial evidence supports the judge’s finding, and we affirm.

Finally, the employee also appealed the compensation judge’s denial of payment for treatment with psychiatrist Dr. Mohan and psychologist Dr. Schwery from February 2008 through 2015. The judge denied the claim after finding that the employee’s psychiatric/ psychological conditions were not substantially caused by his work injury. That finding was affirmed above, and we therefore affirm the corresponding denial of payment for this treatment.