MARY JO NEWGARD-GRAY, Employee/Appellant, v. THE TRAVELERS COS., INC., and NEW HAMPSHIRE INS./CONSTITUTION STATE SERVS., Employer-Insurer/Respondents, and HIGH POINTE SURGERY CTR., BALDWIN AREA MED. CTR., NURSE ANESTHESIA SERVS., MEDICA HEALTH PLANS, and STANDARD INS. CO./TROVER SOLUTIONS, Intervenors.

The employee has appealed the determinations of the compensation judge that she did not sustain work related injuries to both upper extremities either as a result of a specific injury on August 12, 2013, or as the result of a Gillette injury.^[1] We affirm.

Mary Jo Newgard-Gray had been a workers’ compensation claims adjuster for more than 30 years when she went to work for Travelers in that capacity in 2007. Her job was essentially desk work, using her computer to enter and retrieve claim information as well as handling 40 to 50 phone calls each day. Ms. Newgard-Gray had about 100 files when she began at Travelers and when she left in 2014, she had approximately 200 files.

On August 12, 2013, the employee’s office was being moved from one side of the building to the other. For the move, the employee placed her desk equipment and files in boxes and then put the boxes on a cart. As she was doing so, she felt a pop in her neck which was followed by pain in her neck and down her left arm. The employee reported the incident to her supervisor a few days later and when the pain did not go away, she went to her usual medical providers at the Baldwin Clinic.

At the Baldwin Clinic, the employee reported posterior neck stiffness with “left upper extremity paresthesia and numbness/tingling.” She was referred for physical therapy. The employee later was referred for an MRI scan which was done on September 23, 2013.

The MRI was read as showing “minimal discogenic degeneration change at C5-6 resulting in minimal spinal cord stenosis and mild left neuroforaminal stenosis.” The employee was subsequently referred to St. Croix Orthopaedics where she saw Dr. Bruce Bartie on October 17, 2013. She advised Dr. Bartie that she had left arm paresthesia down to her ring and little finger. After his examination of the employee and his review of the MRI, Dr. Bartie concluded there was an annular tear and disc prolapse at C5-6 which were causing the employee’s symptoms. Dr. Bartie recommended an epidural steroid injection which was done on October 29, 2013.

When she returned to Dr. Bartie on December 5, 2013, the employee reported the epidural steroid injection had provided her two months of relief. He found no active motor radiculopathy and did not recommend surgery. An additional epidural injection was done on December 18, 2013, and the employee reported 80 percent pain relief after this procedure.

The employee continued her regular employment with Travelers during this time with no lost time from work. The employer did an ergonomic assessment of the employee’s work station and some modifications were made. The employee testified the modifications did not help her symptoms. The employee’s last day at Travelers was approximately April 28, 2014. She then went to work as a paralegal for the law firm of Heacox, Hartman, Koshmrl, Cosgriff & Johnson.

The employee continued to treat at St. Croix Orthopaedics, primarily with Dr. Erik Kirksson. When Dr. Kirksson saw the employee on March 12, 2014, he commented that the numbness the employee was experiencing in her fourth and fifth fingers was usually associated with problems at the C8 level, not C6. He noted however, that the C6 level was most likely the source of the employee’s left arm pain since the positive left C6 injections supported that diagnosis.

In May 2014, Dr. Kirksson added a diagnosis of suspected left ulnar neuropathy. The employee was referred for nerve conduction studies and an EMG. Dr. Kirksson concluded that the studies showed left medical neuropathy consistent with carpal tunnel syndrome. He also stated that there was evidence for chronic inactive left C6 radiculopathy and no evidence of a left ulnar neuropathy.

Dr. Kirksson recommended consultations with Dr. Nicholas Meyer and with St. Croix Orthopaedics. Dr. Meyer took a history from the employee when he saw her on December 1, 2014. He recorded a complaint of bilateral hand pain with “onset sudden. Duration: 05/01/2013.” After review, Dr. Meyer decided that left carpal tunnel release and left ulnar nerve transposition surgery should be done. This surgery was done on January 29, 2015.

The employee filed a claim petition in January 2015, seeking various benefits she claimed were due as the result of her August 12, 2013, injury.

The employee was evaluated on behalf of the employer and insurer by Dr. Mark Friedland who set out the results of the examination and his opinions in his report dated June 22, 2015. Dr. Friedland took a detailed history from the employee that made up 5 pages of his report. He also conducted a physical examination and reviewed records from the employee’s medical providers.

Dr. Friedland concluded that the injury of August 12, 2013, was an aggravation of a chronic pre-existing C5-6 degenerative disc disease which resulted in an annular tear and disc bulge causing left-sided radicular symptoms. He also opined that the injury did not affect the employee’s right side, given the lack of right-sided symptoms in the record. He was also of the opinion that the injury was a temporary aggravation given the lack of cervical spasm rigidity on exam and the June 9, 2014, EMG study which noted inactive left C6 radiculopathy.

Dr. Friedland found no connection between the work injury and the employee’s carpal tunnel and cubital tunnel symptoms since those were peripheral nerve syndromes not associated with a cervical injury. He also noted the employee’s medical history of what he considered peripheral nerve symptoms in 1999 and as well as from 2003 to 2005.

Dr. Friedland opined there had been no Gillette injuries to the wrist. He noted that while there was reference in the record of aggravated symptoms after doing repetitive work at Travelers and the Hartman law firm, the employee also stated to her doctor in May 2014 and November 2014 that driving aggravated her symptoms. Dr. Friedland believed that those complaints were consistent with “a genetic predisposition to upper extremity compressive neuropathic syndromes.”

Dr. Friedland provided a deposition on August 21, 2015, in which he reiterated his findings and conclusions.

A narrative report dated June 24, 2015, was prepared by Dr. Kirksson at the request of the employee’s attorney. Dr. Kirksson reviewed his treatment of the employee’s upper extremity symptoms. It was his opinion that the August 20, 2013, injury, as well as the employee’s repetitive work activity at Travelers, were substantial contributing factors in the employee’s bilateral arm complaints.

The employee was also evaluated by Dr. Robert Wengler at the request of her attorney. Dr. Wengler reviewed medical records, took a history, and conducted an examination. Dr. Wengler assessed “discogenic cervical spine pain and radicular symptoms into the left upper extremity. I believe the single ‘ulnar nerve’ symptoms in the right arm are radicular in nature originating in the cervical spine.” In his cover letter to the employee’s attorney, Dr. Wengler provided a permanent partial disability rating for the cervical spine. He also stated “I do not believe that she had tardy ulnar nerve palsy in the left elbow. Carpal tunnel difficulties may be considered as being resulted from a Gillette injury she did at Travelers.”

The employee’s claim petition was heard by compensation judge Cheryl LeClair-Sommer on September 9, 2015, and October 27, 2015. The compensation judge issued her Findings and Order on January 4, 2016. In her Findings and Order, the compensation judge identified a number of issues for determination. The issues relevant to this appeal were: 1. whether the employee’s injury on August 12, 2013, in addition to being an injury to the cervical spine with left-sided radiculopathy, was also an injury which resulted in bilateral carpal tunnel syndrome and/or bilateral cubital tunnel syndrome; and 2. whether the employee had a Gillette injury in the nature of bilateral carpal tunnel syndrome.

The compensation judge determined that the August 2013 injury was a cervical injury with left upper extremity radiculitis. She also found there was no work-related carpal tunnel injury. The employee has appealed these findings.

This court must determine whether substantial evidence supports the decision of the compensation judge on two related issues: 1. the nature and extent of the August 12, 2013, injury; and 2. whether the employee sustained a Gillette injury to both wrists resulting in bilateral carpal tunnel syndrome.

Both issues are issues of medical causation and require properly founded medical opinions for determination by the compensation judge. Bender v. Dongo Tool Co., 509 N.W.2d 366, 49 W.C.D. 511 (Minn. 1993); Westling v. Untiedt Vegetable Farm, slip op. (W.C.C.A. Apr. 29, 2004).

The medical opinions in this case were provided by Drs. Kirksson, Wengler and Friedland. Each opinion was based on a review of medical records, a history provided by the employee, and a physical examination. This information is sufficient to provide foundation for a medical opinion. Grunst v. Immanuel-St. Joseph Hosp., 424 N.W.2d 66, 68, 40 W.C.D. 1130, 1132-33 (Minn. 1988); Allee v. JN Johnson Sales & Serv., Inc., 75 W.C.D. 359 (W.C.C.A. 2015).

“In weighing medical evidence, a compensation judge has the discretion as trier of fact to choose between competing and conflicting medical experts’ reports and opinions.” Schuette v. City of Hutchinson, 843 N.W.2d 233, 237, 74 W.C.D. 169, 173 (Minn. 2014). The compensation judge’s decision, when it is based on this choice of expert, will generally be affirmed by this court if the opinion relied upon has adequate foundation. Nord v. City of Cook, 360 N.W.2d 337, 342-343, 37 W.C.D. 364, 372-373 (Minn. 1985); Smith v. Quebecor, 63 W.C.D. 566 (W.C.C.A. 2003).

Further, in adopting a medical opinion, the compensation judge is not required to accept the entire opinion of a medical expert but may accept that part which the compensation judge concludes is supported by the evidence. City of Minnetonka v. Carlson, 298 N.W.2d 763, 767 (Minn. 1980); Meyers v. Minn. Elec. Supply Co., 69 W.C.D. 405, 417 (W.C.C.A. 2009). With these considerations in mind we turn to an evaluation of the issues and evidence.

The first issue here is the nature and extent of the injury resulting from the incident described by the employee as having occurred on August 12, 2013. The parties agreed at hearing that the injury was at least an injury to the cervical spine with radiculitis into the left arm. Dr. Wengler and Dr. Friedland agreed on this point but disagreed as to whether the injury was temporary or permanent.

The employee claimed that the work incident was also a substantial contributing factor in the development of what were variously described as left ulnar nerve/cubital tunnel and left carpal tunnel symptoms as well as right upper extremity symptoms with right carpal tunnel syndrome. The employee’s claims as to these additional symptoms were supported by Dr. Kirksson.

Neither Dr. Wengler nor Dr. Friedland supported these additional claims of the employee. The compensation judge stated in her memorandum that she found the opinion of Dr. Friedland to be more persuasive on this issue.

In her brief to this court, the employee contends that Dr. Friedland actually agreed with the employee’s claims of a more extensive injury and quotes from Dr. Friedland’s deposition to support this claim. After a review of the deposition, we find this argument to be based on a mischaracterization of Dr. Friedland’s testimony. The quote is one sentence taken out of context from a longer answer by Dr. Friedland in which he clearly refutes the employee’s claim. Reading his report and testimony, it is clear that Dr. Friedland rejected the claim of an injury beyond the left arm radiculitis from the cervical injury. Also, as we noted previously, the employee’s IME, Dr. Wengler, agreed with this position.

We find substantial evidence to support the compensation judge’s denial of the employee’s claim on this issue.

The second issue on appeal is whether substantial evidence supports the compensation judge’s denial of the employee’s claim that she experienced bilateral carpal tunnel syndrome as a result of her work with the employer. The employee, in her brief on appeal, argues that this conclusion is not supported by the evidence and contends that the opinions of the employee’s treating doctors should have been adopted by the compensation judge.

At the hearing, the employee testified that the arrangement of her work station and the repetitive nature of her work activity resulted in bilateral hand and wrist symptoms. The compensation judge concluded, as noted in her memorandum, that this testimony was not corroborated by the medical records.

The compensation judge also accepted Dr. Friedland’s opinion that the employee was genetically predisposed to compressive neuropathies considering the employee’s history of wrist symptoms going back to 1999. The compensation judge also accepted the opinion of Dr. Friedland that the medical literature does not provide a correlation between typing and carpal tunnel or cubital tunnel syndromes.

We find substantial evidence supports the compensation judge’s decision on this issue.

The decision of the compensation judge is affirmed.