NIGUSSIE D. TEKLE, Employee/Appellant, v. JBS USA, LLC/SWIFT PORK CO., SELF INSURED/SEDGWICK CLAIMS MGMT. SERVS., Employer/Respondent, and SANFORD HEALTH, AVERA, UCARE, SPECIALTY ORTHOPEDICS, MINN. DEP’T OF LABOR & INDUS./VRU, and MINN. DEP’T OF HUMAN SERVS./BRS, Intervenors.

The pro se employee appeals from the compensation judge’s findings that the employee failed to prove he suffered work-related injuries to his low back on March 30, 2011, to his right shoulder and/or left thumb on June 1, 2012, to his right eye on October 30, 2012, and to both legs as of November 10, 2012, and/or a Gillette injury^[1] to his low back, right shoulder, left thumb, bilateral legs, and/or bilateral knees culminating on December 27, 2012. Concluding that substantial evidence supports the compensation judge’s determinations, we affirm.

The employee is a permanent resident who emigrated from Ethiopia in 1997. He was 58 years old at the time of the hearing. He completed high school and two years of agricultural college in Ethiopia, and had worked as an administrator for a district agricultural office before emigrating to the United States. The employee began working in the pork-processing plant of the self-insured employer in April 2001.

While working for the employer, the employee reported a number of injuries including an injury to his back on March 30, 2011; pain in the right shoulder and arm and in the left arm and left thumb culminating on June 1, 2012; an injury to his right eye on October 30, 2012; and swelling in both legs culminating on November 10, 2012. (Exhibits 6, 7, 8, 9.) The employee also claimed Gillette-type injuries to his low back, legs, knees, right shoulder, and left thumb culminating on December 27, 2012, his last day of work with the employer.

The employee received extensive medical treatment beginning on July 10, 2012, and continuing through December 2, 2015, the date of hearing, including medication, physical therapy, MRI scans, a bone scan, EMG/nerve conduction studies, evaluation and treatment with various specialists, corticosteroid injections, a hand/thumb splint, several surgeries, and imposition of ongoing work restrictions.

Multiple independent medical examinations were performed in the course of the case. On December 14, 2012, the employee was examined by Dr. Gary Wyard at the request of the self-insured employer. The doctor noted normal neck, elbow, left thumb, knee, and low back examinations, and an essentially normal examination of the right shoulder except some restricted active range of motion with full passive range of motion. Dr. Wyard opined that any injury to the right shoulder or left thumb was temporary and had resolved by October 31, 2012. The doctor further opined the employee was capable of working full duty without restrictions and had reached maximum medical improvement (MMI). Following issuance of Dr. Wyard’s report, the employee was placed on medical leave by the employer on December 27, 2012, and has not worked since.

The employee was examined by Dr. Loren Vorlicky at the request of the employer on April 22, 2014. Dr. Vorlicky concluded the employee’s right shoulder complaints of June 1, 2012, were a manifestation of a pre-existing degenerative condition and that any injury to the left thumb on June 1, 2012, was, at most a mild exacerbation of pre-existing arthritis in the joint that had resolved. The doctor noted a normal examination of both knees and hips, and minimal findings related to the low back. Dr. Vorlicky opined the employee was not in need of further medical treatment, had reached MMI, and could work without restrictions.

On October 1, 2014, the employee was seen by Dr. Wengler for an orthopedic consultation. Dr. Wengler noted limited motion in both shoulders due to tendinitis and impingement. He saw no evidence of residual impairment in the left thumb. Dr. Wengler further noted chronic low back pain secondary to multilevel degeneration; post-arthroscopic surgical treatment of both knees; and treatment for thoracic outlet syndrome with sensory loss in the left hand. Dr. Wengler opined the employee’s orthopedic problems were the consequence of multiple stresses to his musculoskeletal system during the course of his employment and considered all of his impairments to be the product of Gillette injuries culminating on December 27, 2012.

This proceeding was initiated by the filing of a claim petition by the employee on November 4, 2013. The case was heard by a compensation judge at the Office of Administrative Hearings on December 2, 2015. The employee was represented by an attorney at the hearing. In Findings and Order served and filed January 9, 2016, the compensation judge adopted the opinions of Dr. Wyard and Dr. Vorlicky and found the employee failed to prove he suffered work-related injuries on any of the claimed dates for any of the claimed body parts.

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.”^[2] 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.” Where evidence conflicts or more than one inference may reasonably be drawn from the evidence, the findings are to be affirmed. ^[3] 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.” 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.”^[4]

The pro se employee essentially re-argued his case, asserting the evidence shows he suffered multiple injuries, including injuries to his right shoulder, left thumb, right eye, both legs, both knees, and low back while working for the employer. In his letter brief to the court the employee described in great detail his understanding of his various medical conditions and attributes all of them to his work at the employer’s pork-processing plant.

On this date, the employee was working in the pop tongue department. The work area featured adjustable stands, the height of which was modified by use of a hand crank. The crank was not properly replaced and fell, hitting the employee in the right lower back. The employee received five days of massage therapy at JBS Health Services after which the swelling subsided and his back improved. No treatment records were submitted for this incident. Dr.Wyard noted a normal low back examination on December 14, 2012. Dr. Vorlicky opined the March 30, 2011, injury was mild in nature, and was no more than a contusion that would have resolved by April 5, 2011. Substantial evidence supports the compensation judge’s finding that the employee failed to establish a specific, permanent injury to his low back on March 30, 2011.

On June 1, 2012, the employee reported pain in the right shoulder/arm that developed while working in the employer’s pop tongue department. The employee received care at JBS Health Services and was then referred to Avera Specialty Clinic where he was seen by physician assistant (PA) Ryan Willems on July 10, 2012. On examination of the right shoulder there was slight swelling, tenderness over the supraspinatus tendon and acromioclavicular (AC) joint, and decreased range of motion. PA Ryan ordered an MRI scan and restricted the employee from any use of the right arm, lifting over 10 pounds, and any pushing or pulling.

The July 12, 2012, MRI study revealed mild right shoulder tendinitis, AC joint osteoarthritis, and an incidental benign enchondroma in the humeral head. The employee was referred for physical therapy. On August 20, 2012, PA Ryan noted that work restrictions had gone well and the employee had full range of motion in the right shoulder but some pain with elevation of the arm. Work restrictions and physical therapy were continued. On September 17, 2012, the employee reported physical therapy had not improved his pain and PA Ryan referred the employee to an orthopedic specialist for further evaluation.

The employee was seen by Dr. James Donohue, an orthopedic surgeon, on September 26, 2012. The doctor assessed right shoulder pain with MRI evidence of an impingement syndrome. Dr. Donohue provided a subacromial corticosteroid injection and ordered an isokinetic shoulder strengthening program. The doctor stated he did not anticipate any significant impairment as a result of the June 1, 2012, injury. In follow-up on October 31, 2012, Dr. Donohue noted significant gains in strength and endurance in the right shoulder with mild to moderate residual symptoms. The doctor “believe[d] prognosis [was] quite guarded based on significant subjective complaints in the absence of any objective findings.”^[5] The employee was last seen by Dr. Donohue on November 29, 2012, after completion of shoulder therapy. The employee complained of a significant increase in discomfort when assigned to work in a cooler. Dr. Donohue again noted significant subjective complaints with minimal objective findings. The doctor continued the employee’s restrictions, recommended he work in a warmer environment, and discharged the employee from his care.

In his December 14, 2012, independent medical examination (IME), Dr. Wyard noted the employee was performing light-duty work doing counting at the employer’s plant. On examination, the employee had some restricted active range of motion in the right shoulder, but full passive range of motion, and an otherwise normal examination. The doctor interpreted the right shoulder July 2012 MRI scan as essentially normal. By report dated December 27, 2012, Dr.Wyard concluded medical treatment for the employee’s shoulder was reasonable and necessary until October 31, 2012, when Dr. Donohue indicated there were no objective findings to support the employee’s subjective complaints. Dr. Wyard opined that any injury to the shoulder was temporary and had resolved, the employee needed no additional care or medical treatment, and he was capable of working full duty without restrictions.

On March 6, 2013, the employee, on his own, sought treatment from Dr. Timothy LeeBurton at Specialty Orthopedics for a variety of complaints including right shoulder pain. On examination, right shoulder range of motion was slightly limited with normal motor strength and stability. There was no evidence of any nerve pathology. An April 2013 examination of the right shoulder was essentially normal. Dr. LeeBurton provided a cortisone injection into the right subacromial space and referred the employee for a second opinion.

The employee was seen by Dr. Jason Hurd at the Sioux Falls Orthopedic and Sports Medicine Clinic on May 17, 2013. On examination, the doctor noted full range of motion, tenderness over the AC joint, and a positive impingement sign. Dr. Hurd’s impression was right shoulder impingement syndrome and AC joint osteoarthritis with a history of overuse. The doctor recommended continued conservative management.

The employee was referred back to Dr. Hurd by a family practitioner in August 2013. When seen on September 17, 2013, the employee reported he had been working with a chiropractor with fairly significant improvement of his symptoms. On examination, the employee continued to have full range of motion, a positive impingement sign, and very mild tenderness over the AC joint. The doctor recommended the employee continue with chiropractic care, and stated he had nothing further to offer. The employee returned to Dr. Hurd for periodic rechecks in 2014 and 2015, and was provided corticosteroid injections for relief of his symptoms.

In his IME report of May 14, 2014, Dr. Vorlicky stated that on examination, the employee was non-tender over the AC joint bilaterally, had normal rotator cuff strength, and mildly limited range of motion in both shoulders. The doctor diagnosed AC joint osteoarthritis and rotator cuff tendinitis and concluded the employee’s subjective complaints far outweighed his objective findings. Dr. Vorlicky opined the employee’s symptoms on June 1, 2012, were nothing more than a manifestation of an underlying pre-existing right shoulder condition and that the employee had reached MMI.

There is substantial evidence to support the conclusion that, at most, the employee suffered a temporary aggravation of a pre-existing right shoulder degenerative condition that resolved, and that the employee did not establish a Gillette injury to the right shoulder culminating on December 27, 2012. We, accordingly, affirm.

On July 1, 2012, the employee reported to the employer that he developed pain in the left thumb while working in the pop department culminating on June 1, 2012. At the September17, 2012, visit with PA Ryan, the employee noted mild numbness, swelling, and slight deformity of the interphalangeal joint as a result of an injury to the thumb. PA Ryan provided work restrictions of no grasping or pulling with the left arm and no work over shoulder level bilaterally.

The employee reported left thumb pain when seen by Dr. Donohue on September 26, 2012. The doctor assessed mild inflammation of the thumb secondary to pinching activities with light duty. The employee was restricted from repetitive pinching with the left thumb. On October 17, 2012, Dr. Donohue explained to the employee he had pre-existing arthritis in the left thumb and recommended a thumb splint to avoid motion and pressure in the thumb.

On October 31, 2012, Dr. Donohue observed the employee had no significant objective findings other than mild swelling in the thumb joint. The employee was referred to Dr.Scott McPherson, a hand specialist, who on November 19, 2012, assessed advanced degenerative joint disease in the thumb that could have been aggravated by work activities. Dr.McPherson provided a corticosteroid injection and continued the same work restrictions.

On December 14, 2012, Dr. Wyard noted a normal left thumb examination with full range of motion and no deformity, swelling, or redness. The doctor concluded the employee may have temporarily aggravated his pre-existing left thumb degenerative joint disease and opined the aggravation resolved by October 31, 2012.

The employee returned to Dr. McPherson on January 2, 2013, for follow-up reporting some relief from the injection. The employee was advised to wear the thumb splint as needed and to avoid repetitive gripping, grasping, or torqueing of the left hand.

On January 2, the employee additionally complained of numbness and tingling in the left thumb, index, and long finger. Dr. McPherson ordered an EMG/nerve conduction study to rule out possible carpal tunnel syndrome. The upper extremity study, completed on March 6, 2013, was normal with no evidence of any upper extremity entrapment neuropathy, cervical radiculopathy, or brachial plexopathy.

The employee was also seen by Dr. LeeBurton on March 6, 2013, complaining of left hand numbness and pain. The employee returned to the doctor on May 17, 2013, reporting left hand weakness and loss of muscle mass in the left hand. A repeat EMG on May 28, 2013, was again normal.

In August 2013, the employee was referred to Sanford Physical Medicine and Rehabilitation for further evaluation of his left hand. On October 14, 2013, the employee was examined by Dr. Susan Assam who ordered a thoracic outlet test. The study was abnormal, and the employee was eventually referred to Dr. Gregory Schultz at Sanford Vascular Associates. Dr.Schultz concluded the employee had clinical findings very typical of thoracic outlet syndrome, and on February 17, 2014, performed a left supraclavicular first rib resection and scalenectomy to address the employee’s thoracic outlet syndrome. The employee experienced significant improvement in his left hand symptoms following the surgery.

In his independent medical examination of April 22, 2014, Dr. Vorlicky noted full motion of all the employee’s digits and negative grind test of the thumbs. The doctor diagnosed interphalangeal joint arthritis and opined the arthritic changes seen on x-rays of the employee’s left thumb pre-dated the alleged injury. In Dr. Vorlicky’s opinion, any June 1, 2012, left thumb injury was, at most, a mild exacerbation of the employee’s pre-existing osteoarthritis that would have resolved within three to four weeks. Dr. Vorlicky further opined the employee’s left thumb problem was not related to thoracic outlet syndrome, if any, and opined that if the employee did have thoracic outlet syndrome, his work activities had no bearing on the development of the condition.

In his consultation report of October 1, 2014, Dr. Wengler stated he saw no evidence of any residual impairment in the left thumb, other than some numbness which was probably a residual of the thoracic outlet syndrome. Dr. Wengler did not directly opine the employee’s thoracic outlet syndrome was work-related, but believed the employee’s numerous orthopedic problems were the consequence of multiple stresses to his musculoskeletal system that developed during the course of his employment.

No doctor opined that the employee has any residual impairment of the thumb, and substantial evidence supports the finding that the employee failed to establish a compensable injury to the left thumb. The employee did not specifically claim a work-related thoracic outlet injury. Substantial evidence, however, supports the conclusion that the employee did not suffer a Gillette-type injury to the left hand in the nature of thoracic outlet syndrome culminating on December 27, 2012. We affirm.

On October 30, 2012, the employee reported water splashed into his right eye while performing light-duty inspection of food residue on tongues. On November 6, 2012, the employee was seen by Dr. Raphael Peralta at Avera Specialty Clinic reporting right upper eyelid swelling and pain that started about six days previously after pig’s blood splashed on the right side of his face at work. On examination, there was a small abscess on the right upper eyelid. The employee was prescribed Keflex ointment for 10 days and advised to apply warm compresses. By November20, 2012, the abscess had resolved but the employee reported some itchiness and sandy feeling in the right eye. He was diagnosed with conjunctivitis, prescribed eye drops, and instructed to return if his symptoms persisted.

On December 7, 2012, the employee was seen at Johnson Eye Clinic. He reported the right eyelid abscess had resolved, but the eye subsequently became red and painful and the eye drops he had been given did not help. The optometrist diagnosed unspecified inflammation of the eye and prescribed steroid drops. On December 12, 2012, the employee reported the right eye felt completely back to normal. The employee returned to Johnson Eye Clinic on December 26, 2012, reporting left eye discomfort. The optometrist noted the right eye was doing well, and prescribed steroid drops for the left eye. By letter dated January 23, 2013, the optometrist diagnosed acute iritis, likely aggravated by work activities, and stated the condition resolved 7 to 10 days after treatment with steroid.

The employee testified that as a result of the October 30, 2012, incident, he has to use medication drops to prevent itching, redness, and pain in the eyes. JBS Nurse’s notes indicate, however, that the employee complained of red, sore eyes as early as May 2004. In October 2013 and May 2014, the employee was seen at Worthington Ophthalmology. The ophthalmologist diagnosed chronic, mild blepharitis^[6] and prescribed medication. The ophthalmologist opined on both occasions that he saw no problem related to the employee’s history of being splashed in the eye a year or two previously at work resulting in an abscess on the eyelid. Substantial evidence supports the finding that the employee failed to establish a specific, permanent injury to the right eye on October 30, 2012, and we affirm.

At his March 6, 2013, consultation with Dr. LeeBurton the employee complained of bilateral knee pain. A March 12, 2013, MRI scan of the right knee revealed a small tear of the medial meniscus with a small ganglion cyst and a mass at the posterior aspect of the knee. On follow-up on March 15, 2013, the employee complained of debilitating right knee pain, stating it was the worst of his ailments at the time. He reported no recent traumatic events. The employee elected to proceed with a right knee diagnostic arthroscopy which was performed on March 20, 2013, with good results.

Following the surgery, the employee complained of increasing left knee pain and on June 12, 2013, underwent left knee arthroscopic surgery. The employee had a slower recovery from the second surgery, but by August 13, 2013, Dr. LeeBurton noted no left knee joint pain, knee joint swelling, or joint stiffness, and discharged the employee from his care.

On December 14, 2012, Dr. Wyard noted a normal knee examination. In December 2013, the employee’s family physician noted full range of motion in both knees without pain. In his May 14, 2014, IME report, Dr. Vorlicky concluded that post bilateral knee arthroscopies, the employee had a completely normal examination of the knees. In his opinion there was nothing in the medical records to support any work injury or work-related activities that were related to the employee’s knee problems.

The employee reported to Dr. Wengler that prolonged standing and twisting resulted in pain in both knees for which he underwent arthroscopic surgery. On examination there was full range of motion in both knees. Dr. Wengler did not offer an opinion regarding an injury specifically to the knees, but simply opined that all of the employee’s orthopedic complaints were the result of Gillette injuries to the musculoskeletal system as a result of the employee’s work activities.

There is nothing in the employee’s treatment records to indicate the employee’s knee problems beginning in 2013 were related to his work activities. Medical examinations post-surgery reflect normal knee examinations. Substantial evidence supports the finding that the employee failed to establish a compensable, work-related injury to the knees.

The employee asserted he suffered injury to both legs as a result of exposure to the cold. He testified that while doing light duty for the employer a supervisor assigned him to work in the cooler. The employee stated he was not provided with appropriate clothing, his legs became swollen from the cold, and he experienced permanent damage to his legs and feet. He also maintains the cold precipitated the onset of his diabetes.

The employee complained of leg pain and swelling to multiple medical providers, but there is little evidence of any physical examination findings or treatment to the lower legs for cold exposure. In his May 14, 2014, report Dr. Vorlicky opined that work activity in a cold environment had nothing to do with the employee’s lower extremity complaints, and that the employee’s subjective complaints of bilateral leg pain were out of proportion to any objective findings. Dr. Wengler opined the employee has no residual impairment to the lower extremities due to any exposure to cold, and that the employee’s allegation that his type 2 diabetes is related to exposure to cold is without foundation.

Substantial evidence supports the compensation judge’s determination that the employee failed to show he suffered a compensable injury to his legs, and we affirm.

The employee asserted his back continued to bother him over the years since the May 30, 2011, incident, and claimed a Gillette injury to his low back culminating on December 27, 2012, as a result of his work activities with the employer.

When seen by Dr. Wyard on December 14, 2012, the employee complained of pain and discomfort in his low back. On examination there was tenderness to the small of the back but no spasm or sciatic joint tenderness. Dr. Wyard concluded the employee had a normal low back examination and was neurologically intact.

When seen by Dr. LeeBurton on March 6, 2013, the employee complained of low back pain of unknown duration. A lumbar spine MRI scan on March 23, 2013, showed minimal degenerative spondylosis at L5-S1 with moderate foraminal narrowing without definitive nerve root impingement. On May 28, 2013, the employee reported hip pain, present for some time. Examination of the hip was essentially normal and X-rays of the pelvis and lateral hip showed no obvious pathology.

The employee was seen at Worthington Family Medicine in November and December 2013. Lumbar range of motion and neurological examination were normal. The physicians noted that x-ray and MRI studies were suggestive of minimal arthritic changes.

The employee was seen by Dr. Assam in January 2014 who ordered a repeat MRI scan. The scan revealed a disc bulge to the right at L5-S1 possibly irritating the S1 nerve root. In March 2014, the employee returned to Dr. Assam who noted full range of motion with pain to palpation over the SI junction. A non-steroidal anti-inflammatory medication was prescribed. The employee continued to receive treatment for his low back symptoms through the date of hearing, including medication and periodic epidural steroid injections.

On April 22, 2014, Dr. Vorlicky noted tenderness about the lumbosacral junction. The employee had full and painless range of motion of both hips. The doctor concluded the employee’s MRI findings were minimal and were consistent with his general age group with very mild degenerative changes. Dr. Vorlicky opined the degenerative changes were not related to any work activities.

In his October 2014 consultation, Dr. Wengler noted the employee presented with chronic low back pain secondary to multilevel degenerative disc disease without definitive nerve root impingement. Dr. Wengler provided a permanency rating for the lumbar spine, but did not provide a specific opinion with respect to work-relatedness of the employee’s low back condition, again simply attributing all of the employee’s musculoskeletal problems to a Gillette injury culminating on December 27, 2012, without further explanation.

There is substantial evidence in the record to support the conclusion that the employee did not establish a compensable, work-related injury to his low back, and we affirm.

In his memorandum, the compensation judge rejected the causation opinion of Dr.Wengler, and stated he found the opinions of Dr. Wyard and Dr. Vorlicky more persuasive. The employee argues that the judge improperly relied on the opinions of the employer’s medical experts. He asserts that Dr. Wyard did not pay attention, listed incorrect information, and was unethical and unprofessional. The employee also asserts that Dr. Vorlicky was late for the IME, was not equipped for the examination, denied the facts, and his reasoning was unprofessional.

Dr. Wyard and Dr. Vorlicky interviewed the employee, performed a physical examination, and reviewed his medical treatment records. This level of knowledge affords adequate foundation for a doctor to render an expert medical opinion.^[7] As a general rule, where there is adequate foundation for the opinions adopted by the judge, this court will uphold the compensation judge’s choice among medical experts.^[8] In this case, the facts assumed by Drs.Wyard and Vorlicky in rendering their opinions are supported by the evidence in the case. 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 on the facts presented in this case.

Finally, in reviewing the transcript we noted numerous entries of “unintelligible.” The court obtained and reviewed a DVD copy of the digital record. After listening carefully to the record, we are satisfied the transcript accurately reflects the testimony given at the hearing.