DEBRA K. KARSKY, Employee/Appellant , v. TRI CTY. COOP OIL ASS’N and RAM MUT. INS. CO., Employer-Insurer/Respondents, and BLUE CROSS BLUE SHIELD MN/BLUE PLUS, STEVENS CMTY. MED. CTR., ST. CLOUD ORTHOPEDICS, ACMC HEALTH, HEARTLAND ORTHOPEDIC SPECIALISTS, CTR. FOR DIAGNOSTIC IMAGING, ANTHEM BLUE CROSS BLUE SHIELD, Intervenors.

The employee appeals from the compensation judge’s denial of her claim petition. We affirm.

Debra Karsky was in the course of her employment as a manager at a café operated by her employer on August 2, 2011, when she slipped and fell on a wet floor.  She went to the emergency room at Essentia Health in Graceville, Minnesota where she was diagnosed with having sustained a right elbow injury and a mild head injury.  Her elbow was wrapped, her arm placed in a sling, and she was provided with pain medication.

The employee saw Dr. James Green at Stevens Community Medical Center in Morris the next day.  Dr. Green noted possible avulsion fractures in the right elbow.  No treatment was provided and, because the employee told Dr. Green she could modify her work duties as she needed, no restrictions were provided.  When the employee returned to see Dr. Green two weeks later, she told him her right shoulder was bothering her.  On examination, Dr. Green reported her shoulder motion was “full and pain-free and good strength.”  No treatment was provided at that visit, but the employee was kept on light duty.

The employee had a history of right upper extremity problems predating her 2011 injury.  The employee was treated in 2001 for right epicondylitis and was also diagnosed with possible early mild carpal tunnel syndrome.  The employee was involved in a motor vehicle accident in 2004 which resulted in neck pain, right trapezius pain, and right-sided back pain.  In 2005, the employee had an MRI scan of the right shoulder which showed degenerative changes in the AC joint.  Surgery was recommended, but the employee declined that option.

Following the August 2, 2011, work injury, the employee continued to treat with Dr. Green.  In October 2011, Dr. Green concluded the employee had EMG evidence of ulnar neuropathy in her right arm.  In January 2012, Dr. Green performed ulnar nerve transposition surgery.  The employee reported some reduction in her symptoms after this procedure, but an EMG in August 2012 was said to show conjoined neuropathy at the right elbow.

Thereafter, the employee saw a number of doctors for right upper extremity symptoms.  Various treatment modalities were provided but no significant improvement was noted.  In April 2015, the employee treated with Dr. Brent Barnstuble at Stevens Community Medical Center, who was of the opinion that the employee’s right upper extremity symptoms were both personal and work-related.  In January 2016, Dr. Barnstuble stated the employee’s symptoms were worsening, most likely from her diagnosed carpal tunnel syndrome.  He felt the work injury might be a component of those symptoms.

In January 2017, the employee was seen at Heartland Orthopedics in Alexandria, Minnesota for a second opinion about her continued right shoulder pain.  The employee was diagnosed with right shoulder bursitis, right shoulder pain and unspecified neuropathy.  A cortisone injection was provided but the employee reported no significant relief from this procedure.

The employee was evaluated by Dr. Paul Cederberg on behalf of the employer and insurer on December 5, 2017.  In addition to the history he obtained from the employee, Dr. Cederberg reviewed the employee’s medical records and performed an examination.  He noted pre-existing right rotator cuff tendinopathy and right ulnar neuropathy.  Dr. Cederberg diagnosed radial and ulnar avulsion fractures of the right arm that had healed and that were related to the work injury.  In his opinion, no further treatment and no restrictions were necessary for the work injury.

The employee had an MRI scan done of her right shoulder at Heartland Orthopedics in January 2018.  It was read as showing impingement syndrome and bursitis of the right shoulder. Dr. Jefferson Brand at Heartland Orthopedics wrote a letter dated August 6, 2018, in which he responded to inquiries from the employee’s attorney.  Dr. Brand stated that, in his opinion, the employee’s right shoulder condition and need for surgery were “related to her work activity on August 2011.”  He recommended right shoulder arthroscopic surgery.  On August 28, 2018, Dr. Brand performed surgery consisting of subacromial decompression, distal clavicle resection, biceps tenodesis, and rotator cuff repair.

Dr. Cederberg was deposed on April 11, 2019.  He restated the conclusions and opinions he had expressed in his December 2017 report.  He also testified that the employee’s surgery in August 2018 was not related to the work injury.

The employee’s claim petition was heard by a compensation judge on April 29, 2019.  The employee’s claims as presented at the hearing were that, as a result of a specific injury on August 2, 2011, or of a Gillette injury culminating on that date, she was entitled to various periods of temporary total disability and temporary partial disability benefits from July 2016 to the date of hearing and continuing; payment of medical expenses, including the surgery done by Dr. Brand; and rehabilitation services.

The compensation judge issued her Findings and Order on June 26, 2019.  She denied the employee’s claims.  The employee has 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).

On appeal, the employee contends that the compensation judge erred in denying her claim by adopting Dr. Cederberg’s opinion.  She argues that her claim was supported by substantial evidence in the form of medical records and conclusions of her treating doctors.  She alleges that the compensation judge erred in failing to accept that evidence as a basis for accepting her claim.

The employee’s claim that she sustained an injury as the result of a fall arising out of and in the course and scope of her employment was never denied by the employer and its insurer.  At issue at the hearing was the nature and extent of the employee’s injury.  The employee claimed that the work injury was a substantial contributing factor to her continued disability and need for treatment.  The position of the employer and insurer was that the August 2, 2011, injury was temporary, had resolved, and any ongoing disability was the result of the employee’s pre-existing condition.  Determination of this medical issue required the compensation judge to consider competing medical opinions.

The compensation judge adopted the opinion of Dr. Cederberg.  The employee argues that the compensation judge erred in doing so because Dr. Cederberg’s opinion lacked foundation.  We conclude the employee’s argument on this point is not supported by the evidence.

Dr. Cederberg reviewed the employee’s medical records, performed an examination, and he was cross-examined in his deposition as to his knowledge of the employee’s condition.  This information provided adequate foundation for Dr. Cederberg’s opinion.  Ouassaddine v. Rosemount Aerospace, Inc., 79 W.C.D. 521 (W.C.C.A. 2019).  It was not error for the compensation judge to admit Dr. Cederberg’s report and testimony into evidence.

The employee also challenges the compensation judge’s reliance on Dr. Cederberg’s opinion and cites to the medical records and opinions of some of her treating physicians which contradict the opinion of Dr. Cederberg.  It is the function of the compensation judge to consider competing medical opinions and the compensation judge’s decision in that regard will not be reversed so long as the accepted opinion has adequate foundation.  Nord. v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 364 (Minn. 1985); Smith v. Quebecor Printing, 63 W.C.D. 566, 577 (W.C.C.A. 2003), summarily aff’d (Minn. Aug. 15, 2003); Carda v. Minn. Dep’t of Human Servs., 79 W.C.D. 649 (W.C.C.A. 2019).  The compensation judge did not err in relying on the opinion of Dr. Cederberg as to the nature and extent of the employee’s work injury.

The employee also claims she sustained a Gillette injury culminating on August 2, 2011, and it was error for the compensation judge not to make that finding.  A Gillette injury is the result of repeated trauma or aggravation of a pre-existing condition which ultimately results in disablement.  Gillette v. Harold, Inc., 257 Minn. 313, 321-22, 101 N.W.2d 200, 205-06, 21 W.C.D. 105, 111-13 (1960).  To establish a Gillette injury, an employee must prove a causal connection between ordinary work and the resulting disability.  Steffen v. Target Stores, 517 N.W.2d 579, 581, 50 W.C.D. 464, 467 (Minn. 1994).  Establishment of a Gillette injury depends primarily on medical evidence.  Marose v. Maislin Transp., 413 N.W.2d 507, 40 W.C.D. 175 (Minn. 1987); Polfliet v. Northern Lights Distrib., No. WC14-5691 (W.C.C.A. Aug. 7, 2014).  The employee presented no evidence or testimony at the hearing that her usual activity as a manager at the restaurant led to her disability.  The employee also presented no medical opinion establishing a connection between the employee’s usual work activity and her claimed disability.  The compensation judge’s denial of a Gillette injury claim is affirmed.

The employee also argues that the compensation judge erred in denying her claim because her claim was supported by substantial evidence.  The employee refers to some of her treating doctors who, the employee states, supported her claim that her August 2, 2011, work injury resulted in right shoulder, right elbow, right ulnar nerve, and right wrist/hand injuries.  According to the employee, these reports constitute a preponderance of evidence which required awarding her claim.  We disagree.  The record of medical treatment for the employee’s upper extremity begins in 2001, ten years before her injury and reflects differing histories, complaints, examination results, diagnoses, and causation opinions.  Contrary to the employee’s position, establishing causation is not a matter of counting the number of opinions on each side of an issue.

As we stated previously, the choice between competing medical opinions is for the compensation judge to make and we will not disturb that decision so long as the medical opinion relied upon by the compensation judge has adequate foundation.  We have already considered the issue of foundation for Dr. Cederberg’s opinion and we agree with the compensation judge that there was adequate foundation for that opinion.  That being so, Dr. Cederberg’s opinion as set forth in his reports and deposition testimony constitutes substantial evidence to support the compensation judge’s decision.

The decision of the compensation judge is supported by substantial evidence in the form of a well-founded medical opinion.  The decision is affirmed.