CHAD GILBERTSON, Employee/Appellant, v. IDEACOM MID AM. INC. and AMTRUST GROUP, Employer-Insurer/Respondents and TWIN CITIES SPINE CTR., PHYSICIANS DIAGNOSTICS & REHAB, NORAN NEUROLOGICAL CLINIC, MINN. DEP’T OF HUMAN SERVS., UCARE/OPTUM, and TWIN CITES SURGERY CTR., Intervenors.

The employee appeals from the compensation judge’s determination that the employee’s May 14, 2015, work injury was temporary, and from the denial of some claims. As the compensation judge’s decision was supported by substantial evidence, including expert medical opinion, we affirm.

On May 14, 2015, the employee, Chad Gilbertson, was in an automobile collision while in the course and scope of his employment with the employer, Ideacom Mid-America, Inc.

The collision occurred in a parking lot on the employer’s premises. The employee’s vehicle was broadsided by a vehicle driven by a co-worker. The employee did not see the other vehicle and, was therefore surprised and unprepared for the impact. The employee estimated he was traveling 25 miles per hour and the other vehicle was traveling 25-30 miles per hour. The driver of the other vehicle described both vehicles as traveling at no more than 10 miles per hour at the time of impact. The other driver also testified that just prior to the collision, both of the vehicles were stopped and about 10-15 feet apart.

Damage to the body of the employee’s vehicle appeared minimal, however, the vehicle was not drivable as the right front wheel was broken. The cost of repair was estimated at $4,400.00, and given the value of the employee’s vehicle, amounted to a total loss.

The employee did not suffer any symptoms at the time of the collision, but later in the day began developing pain in his neck, upper back, and, to a lesser degree, his lower back. He self-treated until May 18, 2015, when he sought care from Dr. Richard Endris, a chiropractor. The employee exhibited symptoms of pain from the neck to the low back with the worst pain at the neck. Dr. Endris diagnosed neck, thoracic, rib, pelvis, wrist, jaw, and headache injuries. Most of Dr. Endris’s treatment notes were fairly consistent in showing progressive improvement of the employee’s symptoms. The employer and insurer accepted primary liability for admitted work-related injuries to the employee’s neck, mid-back, and low back.

The employee continued to treat with Dr. Endris over the next several months. The frequency of treatment was reduced from three times per week to once every other week. The employee described slow improvement of his neck and upper back pain during this time.

Due to the persistence of ongoing symptoms, Dr. Endris referred the employee for a neurological consultation. On October 10, 2015, the employee was examined by Dr. Susan Evans at Noran Neurological. The employee exhibited tenderness of the cervical paraspinal muscles and spasm at C5-6 and T1-2, and spasm at L4-5. Dr. Evans diagnosed a myoligamentous injury to the employee’s cervical, thoracic, and lumbar spine with cervicogenic headaches. As the employee’s symptoms were mostly in his neck and upper back, Dr. Evans ordered MRIs of the cervical and thoracic spine, which were done on October 12, 2015. Both scans were interpreted as normal.

The employee continued to complain of headaches and neck pain in 2015 and into 2016. In early 2016, Dr. Evans referred the employee to Physicians Diagnostics and Rehabilitation (PDR) for rehabilitation therapy, which the employee did not begin until February 2017. The employee also began receiving care at Noran from Dr. Adam Todd.

At the request of the co-worker’s automobile insurer, the employee was examined by Dr. Daniel Page, who issued a report dated February 9, 2017. Dr. Page diagnosed the employee’s condition caused by the May 14, 2015, collision as minor neck and back strains which had resolved. Dr. Page assessed the employee as giving minimal effort during the examination. Dr. Page reasoned that the type of injuries suffered by the employee should have resolved over a period of six weeks or by approximately June 25, 2015.

On March 1, 2017, Dr. Todd examined the employee due to continued complaints of persistent neck pain, back pain, and radiating symptoms into both legs.^[1] Dr. Todd ordered an MRI of the lumbar spine, which was performed that day and showed degenerative changes at L5-S1 with osteophyte formation, additional degeneration at L4-5, and a disc bulge at L5-S1.

On March 15, 2017, the employee was seen for rehabilitation therapy at PDR. Records indicated an Oswestry score of 57.^[2]

On April 24, 2017, Dr. Todd completed a Health Care Provider Report, assessing the employee at maximum medical improvement (MMI) with a 3.5 percent permanent partial disability (PPD) rating of the neck and a 3.5 percent PPD rating of the lumbar spine.

On April 25, 2017, Dr. Endris wrote a report, describing the employee as suffering from a chronic strain/sprain of the cervical and thoracic spine, and chronic misalignment of the lumbar spine, ribs, and extremities, which Dr. Endris believed was causally related to the work-related motor vehicle collision. He placed no restrictions on the employee’s ability to work subject to tolerance, and diagnosed permanent damage to the C1, T2, and T5 vertebral bodies and to the jaw, as well as chronic headaches. He concluded that some of the employee’s low back symptoms were unrelated to the motor vehicle collision.

The employee was seen by Dr. Todd on June 7, 2017. He reported persistent neck and back pain and some improvement from the PDR rehabilitation program. The employee no longer complained of radiating symptoms into both legs.

On June 26, 2017, the employee was examined at PDR by Dr. Gary Johnson. Having completed 28 rehabilitation visits, the employee assessed himself as 30 percent better than when he started, although earlier in the program, he had reported a 50 percent recovery rate. The employee was assessed as having successfully completed the program, and was urged to follow a self-directed maintenance program over the next six months. The employee’s Oswestry score was 46.

At the request of the employer and insurer, Dr. Gary Wyard examined the employee and issued a report dated June 20, 2017. Dr. Wyard interpreted the employee’s MRI findings as normal and noted a lack of objective findings in the employee’s medical records to substantiate the employee’s complaints of pain. Dr. Wyard diagnosed the employee with a probable myofascial strain of his neck and back.

On July 20, 2017, the employee underwent an epidural steroid injection in the L5-S1 disc space. A few weeks later, he reported intermittent bilateral lumbar radiculopathy to a nurse practitioner at Noran Neurological.

Dr. Todd authored a report dated October 23, 2017. Therein, he diagnosed the employee with chronic cervical and lumbar strains, post-traumatic headaches, and aggravation of lumbar spondylosis, and opined the May 14, 2015, motor vehicle collision was the primary cause. He considered the employee’s injuries to be permanent, and advised the employee to avoid repetitive bending and twisting of the neck and back, repetitive outstretching of the arms or above the shoulders, static positioning of the neck, and lifting over 30 pounds.

On November 18, 2017, the employee underwent an MRI of the low back, which showed severe degenerative disc disease at L5-S1, moderate degenerative disc disease at L4-5, and spondylosis at T11 through L4. Another radiologist later read the same MRI and observed conditions not previously noted, including stenosis, spondylosis, and disc bulges, and suggested that the employee consult with a surgeon.

In a record dated December 5, 2017, Dr. Thomas Kraemer, of PDR, related all of the employee’s spinal diagnoses, symptoms, and need for care to the May 14, 2015, motor vehicle collision.

On January 23, 2018, the employee was examined by Dr. Benjamin Mueller at Twin Cities Spine with a primary concern of low back pain radiating to both sides. The employee described being broadsided in a motor vehicle collision at high speeds. He exhibited full range of motion of the neck, but limited range of motion of the low back. Dr. Mueller diagnosed the employee with spinal pain following a motor vehicle collision and disc degeneration without significant stenosis at L4-S1. There were no acute findings and Dr. Mueller recommended the employee undertake core training and back strengthening.

The employee underwent a neuropsychological evaluation on April 10, 2018, by Dr. Sonia Mosch, which involved extensive interviews and the administration of numerous psychological tests. Dr. Mosch concluded the employee had a chronic psychiatric disease presenting as a personality disorder, somatization tendencies, depression/anxiety, and chronic pain. She also considered that the employee was suffering from the effects of narcotic medication. Dr. Mosch opined the employee’s psychological issues were inhibiting his ability to deal with his chronic pain as well as creating other issues, such as memory loss and concentration difficulties.

On May 16, 2018, the employee was seen by Dr. Todd to discuss Dr. Mosch’s findings. Dr. Todd described a vicious cycle between the employee’s injury symptoms and his psychological condition. On June 20, 2018, Dr. Todd authored another report, diagnosing cervical, thoracic, and lumbar injuries, caused by the motor vehicle collision, along with headaches and an aggravation of lumbar spondylosis.

Dr. Wyard issued an updated report, also dated June 20, 2018, after again examining the employee at the request of the employer and insurer. Dr. Wyard opined the employee’s symptoms were disproportionate to the objective findings shown on examination, and diagnosed the employee with longstanding degenerative disc disease in the spine. It was his opinion that MMI would have been reached within approximately one month of the automobile collision.

The employee filed a claim petition seeking wage loss and medical benefits. The matter came on for hearing before a compensation judge on June 27, 2018. The compensation judge issued a Findings and Order on August 8, 2018, finding the employee’s injuries were temporary in nature based upon acceptance of the opinions of Dr. Page and Dr. Wyard. In particular, the compensation judge concluded that the preponderance of the evidence established the employee sustained a temporary musculoligamentous injury to his neck, mid back, and lower back, with associated headaches, and that the injuries resolved by the conclusion of the rehabilitation program at PDR on June 26, 2017. She found the care the employee received through that date was reasonable, necessary, and causally related to the work-related motor vehicle collision, with the exception of the lumbar MRI performed on March 1, 2017. Consequently, the compensation judge ordered all medical expenses through June 26, 2017, except the March 1, 2017, lumbar MRI, to be paid by the employer and insurer, whether in the form of reimbursing the employee for out-of-pocket expenses or paying intervenors Noran Neurological and PDR. Because the compensation judge found the injuries were temporary and had resolved by June 26, 2017, payment for any medical care the employee underwent after that date was denied. She denied the intervention claims of other intervenors whose claims commenced after June 26, 2017. She also denied intervention claims of other potential intervenors who had failed to intervene. The employee appealed.

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).

The employee argues on appeal that substantial evidence does not support the compensation judge’s findings that his neck, thoracic, and lumbar spine injuries were temporary and resolved by June 26, 2017, and that the March 2017 MRI was not causally related to the work injury. The employee asserts the compensation judge erred in relying upon the opinions of Dr. Page and Dr. Wyard instead of the opinions of Dr. Todd and Dr. Endris.

The compensation judge noted that Dr. Todd and Dr. Endris had consistently reported muscle spasms at the time of the injury and over the following 12-18 months. She found these reports persuasive in determining the duration of the work injury. However, the compensation judge was more persuaded by the clinical observations made by the PDR physicians, by Dr. Mueller, and by Dr. Wyard, as to the temporary nature of the injury. The compensation judge concluded the March 2017 MRI was not related to the work injury because it was occasioned by symptoms radiating into the employee’s legs, which did not begin until February 2017, nearly two years after the collision.

It is well established that this court will not set aside the decision of a compensation judge who relies upon one expert’s well-founded opinion over that of another. Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985). The compensation judge’s reliance on the opinions of Dr. Page and Dr. Wyard is well supported by the medical evidence. The record establishes the employee primarily complained of neck and upper back pain for about the first 20 months following the work injury and gradually those symptoms improved. While Dr. Page and Dr. Wyard opined the employee’s injuries should have resolved within four to six weeks, the compensation judge did not accept that portion of those opinions. Instead, she relied upon medical evidence which established musculoligamentous strains of the neck and low back may take longer to resolve in concluding that the employee’s injuries had resolved by the completion of the rehabilitation program at PDR.

Likewise, the compensation judge found the employee’s low back condition began to worsen, but not until over a year following the work injury. Her conclusion that this worsening low back condition was not related to the work injury is well supported by the medical evidence, as there was little mention of low back pain or radiating pain in the medical records until approximately 20 months after the collision.

In reaching her decision, the compensation judge noted a number of persuasive factors. The employee was obese and had lumbar degeneration symptoms prior to the work injury, and he remained obese after the work injury. The collision was low impact, and the employee had no initial symptoms. Further, cervical and thoracic MRI scans taken about five months after the collision were normal. The compensation judge concluded the employee’s testimony lacked credibility and noted the employee’s lack of effort and/or non-cooperation during Dr. Page’s examination and in other medical care. The compensation judge considered the documented improvement of the employee’s neck and upper back symptoms, the worsening of his low back symptoms 20 months after the injury, and that myoligamentous injuries were diagnosed following the collision with later MRI scans showing pre-existing degeneration.

Because of her thorough discussion and analysis of the evidence, her credibility assessments, and her choice of well-founded expert opinion, we affirm the compensation judge’s decision.