CATHY M. PIETILA, Employee/Appellant, v. DEP’T OF HUMAN SERVS./MSOCS GROUP HOME 555 and STATE OF MINN., Self-Insured Employer/Respondent and ESSENTIA HEALTH, Intervenor.

The employee appeals the compensation judge’s finding that surgery was not reasonable and necessary to cure or relieve the effects of the employee’s left shoulder injury. We affirm.

An agitated client-patient grabbed the left arm of Ms. Cathy Pietila, the employee, and twisted it backwards over the back of a bench seat in a van on December 30, 2015. The employee had worked for the employer, Minnesota Department of Human Services-MSOCS Group Homes for 20 years and was 57 years old at the time of the work injury. Three weeks after the event, she sought treatment with Bruce E. Knutsen, M.D., at Essentia Health, who ordered an x-ray, diagnosed the employee with left shoulder pain, and referred her to physical therapy.

The employee previously tore her rotator cuff and labrum in 2004 when she was rear-ended in a motor vehicle accident. She underwent an open labral repair surgery in 2005 and she claimed that her condition ultimately resolved with no ongoing pain or restrictions.

Following the work injury, the employee treated conservatively, but did not improve. Dr. Knutsen suspected that the employee may have injured her superior labrum, biceps, or her rotator cuff. He referred her to orthopedist Justin S. Cummins, M.D.

Dr. Cummins ordered an MRI arthrogram which was performed on March 21, 2016. The scan indicated mild rotator cuff tendinopathy without evidence of full-thickness rotator cuff tear and moderate glenohumeral degenerative change. Upon reviewing the MRI results, he noted that there was no obvious labral tear. Dr.Cummins also stated that it was “hard to say for sure that she has injured the area.” (Ex. F., Mar. 22, 2016.) He ordered a cortisone injection which did not improve the employee’s shoulder pain. In April 2016, Dr. Cummins noted that the employee displayed a positive O’Brien test on examination. He questioned a possible tear of the subscapularis or biceps tendon pathology. Dr. Cummins recommended a left shoulder diagnostic arthroscopy with likely biceps tenodesis and possible rotator cuff repair. The employer denied the surgery.

On June 9, 2016, Dr. Cummins released the employee to work without restrictions. He completed a health care provider report on August 10, 2016, concluding that the employee had reached maximum medical improvement (MMI), as of June 9, 2016, noting that without benefit of surgery, he would assume she had plateaued. He also found she had no permanent partial disability rating associated with the December 30, 2015, left shoulder injury.

In September 2016, the employer fired the employee. Soon after, she found a job working 30 hours a week at Taco Bell where her daughter was a supervisor. The employee’s left shoulder pain continued.

The employer sought the medical opinion of two doctors. David Carlson, M.D., examined the employee and reviewed medical records dating back to the 2004 motor vehicle accident, the 2005 and 2016 MRI reports of the left shoulder, and medical reports for a number of conditions. Notably, there was a 2008 reference to left-sided neck pain with radiation to the left arm and upper back, and 2009 right shoulder surgeries. Dr. Carlson concluded that the December 30, 2015, injury to the left shoulder had resolved with MMI reached on June 9, 2016. While the employee reported decreased range of motion, Dr. Carlson found no evidence of any rotator cuff pathology. Dr. Carlson also opined that any symptoms of impingement were related to pre-existing impingement pathology which was not work-related.

The employer also sought the opinion of Leonard Jennings, M.D., who conducted a records review and did not examine the employee. Dr. Jennings concluded that the employee’s main pathology appeared to be associated with moderate degenerative arthritis in the glenohumeral joint. He also noted that there were no signs of impingement or arthritic changes in the acromioclavicular joint, and opined that arthroscopic surgery was not warranted.

The employee retained orthopedic surgeon, Mark Gregerson, M.D., for a supplemental medical opinion. Dr. Gregerson examined the employee and reviewed some medical records. Other than the MRI scan, it is not clear from Dr. Gregerson’s report what medical records he reviewed. He took the employee’s medical history, noting the prior 2005 left shoulder surgery and the employee’s claim that she had completely recovered. He diagnosed the employee’s condition as rotator cuff impingement, partial tearing, and degenerative changes of the left shoulder. He opined that any conditions of her shoulder or spine were significantly aggravated by her work duties.

On May 30, 2017, the employee filed a medical request for surgery as recommended by Dr. Cummins. The matter was heard on September 1, 2017. While the employer stipulated to an injury to the left shoulder on December 30, 2015, they disputed the nature and extent of the injury. The compensation judge denied the medical request for surgery, but awarded payment to the intervenor, Essentia Health, for medical treatment through June 9, 2016. The employee appeals the denial of surgery.

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).

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), summarily aff’d (Minn. June 3, 1993).

On appeal, the employee seeks a reversal of the compensation judge’s decision, arguing that the findings upon which the decision is based are not supported by substantial evidence. She argues that the expert opinion adopted by the judge must be one based on evidence or enough facts to form a reasonable opinion, and not based on speculation or conjecture. Because the MRI scan itself was not reviewed by Dr. Carlson in rendering his opinion, but was reviewed by Drs. Cummins and Gregerson, the employee argues that Dr. Carlson did not have sufficient evidence to form the basis of his opinion.^[1] Furthermore, the employee asserts that this court can substitute or adopt the opinions of Drs. Cummins and Gregerson and grant the medical request for the surgery. We are not persuaded.

It is well established that a compensation judge’s choice of expert opinions must be upheld unless the opinion lacked adequate factual foundation. Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985). An expert opinion which includes the facts upon which the expert relied and the basis for the opinion is generally sufficient to establish foundation. An opinion need only be based on “enough facts to form a reasonable opinion that is not based on speculation or conjecture.” Gianotti v. Indep. Sch. Dist. 152, 889 N.W.2d 796, 802, 77 W.C.D. 117, 124 (Minn. 2017) (citing Wenner v. Gulf Oil Corp., 264 N.W.2d 374, 381 (Minn. 1978)).

In this case, Dr. Carlson’s opinion was adequately founded and not based on speculation or conjecture. Dr. Carlson physically examined the employee, took a history from the employee, and reviewed multiple medical records. Furthermore, Dr. Cummins’ records appear to support Dr. Carlson’s opinion that the employee’s injury had resolved as of June 9, 2016. Following the review of the MRI arthrogram, Dr. Cummins noted in the office visit records that there was no obvious labral tear. He also stated that it was “hard to say for sure that she has injured the area.” (Ex. F.) By June 9, 2016, Dr. Cummins had determined that the employee’s left shoulder condition was at MMI. He found no permanent partial disability associated with the left shoulder and released the employee to return to work without restrictions. Dr. Cummins did not draft a narrative report outlining his opinion. The compensation judge could reasonably conclude that Dr. Cummins’ chart notes did not fully support the employee’s assertion that the proposed surgery was causally related to the December 30, 2015, work injury.

Dr. Carlson also reviewed medical reports that the other medical experts did not discuss including several dated between 2004 and 2013 when the employee sought treatment for the left shoulder, left-sided neck, right shoulder, left arm and hand, and low back. Furthermore, Dr. Carlson referenced the MRI arthrogram report of March 21, 2016, in his narrative and noted that it showed mild rotator cuff tendinopathy without evidence of full thickness rotator cuff tear and with moderate glenohumeral degenerative changes. These findings were supported by the employee’s expert, Dr. Gregerson, who reviewed the March 21, 2016, MRI scan and report and said, “I agree with the findings noted in the radiology report.” (Ex. E.) There was only one MRI report in the record and it was the same one discussed by Dr. Carlson. The fact that Dr. Carlson did not review the MRI scan itself does mean that his opinion lacked foundation. See Ny v. E.A. Sween Co., 72 W.C.D. 639, 663 (W.C.C.A. 2012).

Because Dr. Carlson had adequate foundation upon which to base his opinion, the judge did not err in adopting it. We therefore affirm the compensation judge’s denial of arthroscopic surgery of the left shoulder.