DAWN E. EVE, Employee/Appellant, v. ABOUT U, INC., and SFM, Employer-Insurer/Respondents, PRIME WEST HEALTH, MAYO CLINIC, BLUE CROSS BLUE SHIELD OF MINN. BLUE PLUS, TRISTATE BRAIN & SPINE INST., SANFORD BEMIDJI MED. CTR., Intervenors.

Dawn Eve, the employee, appearing pro se, appeals from the compensation judge’s findings that she failed to establish that her work related injury on January 26, 2012, resulted in more than temporary exacerbations of her pre-existing conditions, and that these aggravations resolved by February 26, 2012.

The employee, Dawn Eve, has a complex prior medical history which includes cervical and thoracic impingement syndrome, vertebral subluxation with upper extremity paresthesia, numbness in some of the fingers of the right hand, a bilateral shoulder strain/sprain, lumbosacral sprain/strain, pain in the right leg, right forearm and right ankle pain, an injury to her right eye, a closed head injury, and mild concussion syndrome with various sequelae. She continued to treat for some of these conditions through at least 2011.

On January 26, 2012, the employee worked for the employer, About U, Inc., as a personal care attendant. Her job duties included daily care for her own 76-year-old mother. On that date, the employee fell while helping her mother out of a chair. The employee was unsure how she landed from the fall, but did not think that she hit her head. She testified that she felt pain in her neck and upper spine.

On January 27, 2015, the employee was seen at Advanced Chiropractic. The hand written notes from this initial visit indicate that the employee had been “hurting for a long time” but that her pain was acutely aggravated and/or exacerbated by the accident.

On January 28, 2012, the employee was seen by Dr. Richard L. Stennes at the Emergency Department of Sanford Health Clinic in Bemidji for complaints of neck pain and some paresthesia on the left index finger and thumb. The employee had initially noted severe pain in her neck but after visiting a chiropractor began to notice paresthesias in the left index finger and thumb. Dr. Stennes diagnosed an acute cervical strain at C6, with muscle spasm and paresthesia. Pain medications were prescribed and the employee was referred for an MRI of the cervical spine.

The employee started physical therapy at Peak Performance Outpatient Rehabilitation on February 6, 2012.

A cervical MRI was done on February 9, 2012, and was interpreted as showing degenerative disc changes at C5-6 and C6-7 suggestive of cervalgia.

On February 14 2012, the employee was seen by William Muller, M.D. She was assessed with cervical neck pain from degenerative disc disease, and advised to follow up at the Mayo Clinic.

The employee was seen at the Internal Medicine Department at the Mayo Clinic on February 24, 2012. She was diagnosed with severe cervical stenosis with left hand weakness and left index finger numbness. She was referred to the Mayo Spine Center, where she was seen the same day. She was diagnosed with a left C6 disc protrusion with foraminal narrowing and ventral cord deformity, left cervical radiculopathy, and a small right-sided disc protrusion at C5 with foraminal narrowing without right-sided symptoms. The employee was provided with a tens unit, a prescription for physical therapy, and a soft cervical collar. She was referred for evaluation by a neurosurgeon.

On February 29, 2012, the employee was evaluated by Dr. W. Richard Marsh, a neurosurgeon. The employee reported that her pain had improved by 70-80 percent. Surgery was not recommended.

Since March of 2012, the employee has continued to treat for a variety of conditions with the Sanford Medical Center, the Mayo Clinic, the Hennepin County Medical Center, Choice Physical Therapy, True North Health Care, Minnesota Functional Neurology & Chiropractic, Advanced Chiropractic, Stember Chiropractic, and Physicians of Minnesota. Among the conditions treated have been problems with the neck, shoulders, forearms, and wrist, as well as headaches, tinnitus, anxiety, vision disturbances, post concussive syndrome, and a sleep disorder.

On January 17, 2013, the employee underwent an independent medical examination (IME) with Tilok Ghose, M.D. Dr. Ghose opined that the employee’s January 26, 2012, injury resulted in a cervical strain/sprain that had resolved by February 26, 2012. He considered treatment through that date reasonable and necessary. Dr. Ghose noted the employee’s prior history of neck and back pain, arthralgia and fatigability, and felt those might be contributing to the need for her ongoing treatment after she recovered from the January 26, 2012, injury. Dr. Ghose opined that the subsequent progression of her cervical spine condition was inconsistent with the reported mechanism of injury.

The employee saw Sunny S. Kim, M.D., at Tristate Brain & Spine Institute on June 21, 2013. Dr. Kim recommended that the employee undergo an anterior cervical discectomy and fusion at C5-6 and C6-7.

On May 4, 2014, the employee underwent an evaluation by Dr. T. Scott Douglass, a specialist in internal and occupational medicine, at the request of her attorney. By this time, the employee was reporting neck and shoulder pain, pain into the dorsum of her left hand and index finger, and weakness in her upper body. She had been having difficulty with concentrating, headaches, vision and reading problems, insomnia and anxiety, tinnitus and sleep apnea, and thought that she might have sustained a concussion during the January 26, 2012, injury. Dr. Douglass considered it likely that the January 26, 2012, injury either caused or significantly aggravated or accelerated the employee’s cervical spondylosis, disc disease, and cervical left arm radiculopathy. He believed that she had developed chronic synovitis in the left shoulder due to guarding as a result of the neck injury. He considered her hearing loss and sleep apnea to be unrelated to her injury. He offered no opinion on the employee’s visual problems. Dr. Douglass opined that the employee was capable only of sedentary work.

The employee was subsequently seen for independent medical evaluations by several further physicians, some at the request of her own attorney and others at the request of the employer and insurer. The finding of several of these physicians will be discussed at greater length below.

The employee filed a claim petition on June 13, 2015, and the employer and insurer answered denying liability. The matter came on for hearing before a compensation judge of the Office of Administrative Hearings on October 14, 2015. Among the issues at the hearing were whether the employee had sustained an injury to her cervical spine, and whether she had sustained a head injury in the form of a traumatic brain injury. Following the hearing, the compensation judge found that a preponderance of the evidence supported a finding that the work injury was a temporary aggravation of her pre-existing cervical condition and to a pre-existing brain injury, which aggravation fully resolved no later than February 26, 2012. The judge also found that the employee failed to show that her work injury was a substantial contributing factor to her ongoing cervical condition or brain injury, and that the employee was not temporarily totally or permanently totally disabled as a result of the January 26, 2012, work injury. The employee appeals.

The Workers compensation court of appeals must affirm the findings of fact of a compensation judge unless the findings are clearly erroneous and unsupported by substantial evidence in view of the entire record as submitted at the hearing^[1]. Although we review all the evidence, we “must give due weight to the compensation judge’s opportunity to evaluate the credibility of the witnesses and must uphold findings based on conflicting evidence or evidence from which more than one inference might reasonably be drawn.” Pelowski v. K-Mart Corp., 627 N.W.2d, 89, 92 (Minn. 2001).

The compensation judge determined that the employee’s work injury was no more than a temporary exacerbation to her pre-existing cervical condition or brain injury. The judge further determined that both conditions fully resolved no later than February 26, 2012. The compensation judge also determined that the employee failed to prove that her conditions and disability after February 26, 2012, were due to her January 26, 2012, injuries. The pro se employee on appeal contends that the compensation judge’s determinations are erroneous and not supported by substantial evidence in the record. The employee argues that the independent medical examiners relied on by the judge were biased and therefore the compensation judge must be reversed. Accordingly, we consider whether the findings of fact by the compensation judge are clearly erroneous and unsupported by substantial evidence in view of the entire record as submitted, which would justify reversing the findings and order in this case.

Five independent medical examiners provided narrative opinions concerning the nature and extent of the employee’s work injuries. The employee was examined by Dr. Ghose on January 17, 2013. The employee presented Dr. Ghose with multiple symptoms, which included headaches, tinnitus, neck pain, left hand numbness, frozen shoulder, and insomnia, and which Dr. Ghose found to be lacking in objective support and showed no particular pattern. He also noted the employee’s past medical history of arthralgias and fatigue. After a review of the employee's medical records and an examination, Dr. Ghose reported that the employee’s “current condition and diagnosis is subjective complaints of pain with no objective findings in her cervical, thoracic or lumbar spine,” and he concluded that the employee sustained no more than a temporary cervical injury that had resolved by February 26, 2012, with no restrictions or permanent partial disability causally related to the work injury.

The employee was seen by Dr. Larkins at the request of the employer and insurer on September 3, 2014. Dr. Larkins noted the inconsistencies in the employee’s self-reported history and the history contained in the medical records. After a review of the medical records and a physical examination of the employee, Dr. Larkins reported that the work injury did not substantially contribute to the employee’s current diagnosis. He also reported that the work injury was a temporary aggravation of an ongoing problem that would have resolved within three months.

The employee was seen by independent medical examiner, Dr. Bushara at the request of the employer and insurer on June 17, 2015. Dr. Bushara reported the work injuries to the spine on January 26, 2012, were sprain or strain injuries which temporarily exacerbated preexisting and symptomatic degenerative spine disease. Dr. Bushara also reported that if any head injury occurred on January 26th it was a mild traumatic brain injury that occurred without loss of consciousness and resolved within 4 to 6 weeks without sequelae.^[2]

Drs. Ghose, Larkins, and Bushara were provided extensive and complete medical records with an accurate foundational history. The facts assumed by Drs. Ghose, Larkins, and Bushara in rendering their separate opinions is supported by the evidence in this case. The employee’s claim of bias is not supported by the record.

The employee was seen by her own independent medical examiner, Dr. Douglass on May 4, 2014.^[3] Dr. Douglass examined the employee and concluded that the employee’s cervical conditions were “more likely than not” caused or significantly aggravated by her January 26, 2012, work injury. Dr. Douglass recommended restrictions and was of the opinion that the employee could not return to her work as a PCA.

The employee was evaluated by Dr. Robert A. Wengler on August 17, 2015. Dr. Wengler also noted the employee’s varied and unusual symptoms presented at the time of her examination. Dr. Wengler noted in his report “an unusual litany of complaints which, after some sorting out, may be secondary to a spine injury involving the C5-6 and C6-7 discs. She undoubtedly had advance degenerative changes at multiple levels prior to the January 26, 2012 event although she maintains that she had no ongoing cervical spine difficulties prior to that . . . . Assuming the accuracy of her assertions that she had no ongoing cervical spine difficulties, her present problems may be related to the January 26, 2012 incident.”^[4]

The compensation judge adopted the medical opinions of Drs. Ghose and Bushara over the medical opinions of the other doctors and determined the work injuries to be temporary. Any treatment or disability continuing after February 26, 2012, was found by the judge to be unrelated to the work injuries sustained in January of 2012.

A compensation judge’s choice between conflicting medical expert opinions is generally to be upheld by this court unless the facts assumed by the expert are not supported by the record.^[5] The possibility that another judge or this court might have weighed the evidence differently, or relied on a different expert’s opinion, provides no basis for a reversal in this case.

Based on the contents of his written findings and memorandum, we conclude that the compensation judge thoroughly reviewed and considered the entire record of evidence in this case. We cannot conclude that the judge made a clear error in relying on the opinions of Drs. Ghose and Bushara. Because there is substantial evidence to support the compensation judge’s decision, and the judge did not commit any clear error of law, we must affirm the compensation judge’s decision in its entirety.