The employee appeals the compensation judge’s denial of a claimed work-related Gillette^[1] injury.  Substantial evidence supports the compensation judge’s decision, and we affirm.

In 1982, Greg Denisen, the employee, was hired by Hormel Foods Corporation (Hormel), the self-insured employer.  For 30 years, he performed multiple tasks, including a task he began in 2007 which involved overhead pushing of 1,000-pound racks on a rail system.  Also in 2007, after shoveling snow at home, the employee felt right-sided shoulder and right-sided neck pain.^[2]  The symptoms were consistent with cervical radiculopathy and an MRI on December 17, 2007, confirmed mild compression of the spinal cord at the C6-7 level on the right with likely compromise of the exiting right C6-7 nerve root.  In January 2008, surgery was recommended and set, but shortly before the surgery, the employee reported that he had not stopped smoking and agreed to delay surgery.^[3]  He subsequently underwent an injection of the right C6-7 nerve root, improved 95 percent, and continued working without restrictions.  The employee had no more right-sided shoulder and neck symptoms.

In 2014, the employee began a new job for the employer as a forklift operator.  The forklift was loaded high with totes requiring the employee to shift gears with his right arm, drive in reverse twisting his head to look back, and rely on his left arm and shoulder to steer the wheel.  While he described the steering wheel as one without power steering, the forklifts were equipped with power steering.

On April 15, 2018, the employee reported to Hormel’s onsite medical provider Medcor that he was having left shoulder pain making it difficult to perform his work.  The employee saw Eun Jong Kim, M.D., who diagnosed left shoulder rotator cuff tendinitis made worse by use of the forklift.  An MRI of the left shoulder showed moderate and low-grade changes.  When an injection failed to resolve the shoulder pain, Michael Eckstrom, M.D., recommended an MRI of the cervical spine.  The employee testified that he wanted to continue performing unrestricted work, but by October 30, 2018, he could not continue working and voluntarily retired from Hormel.

A cervical spine MRI in 2019 showed mild to moderate degenerative changes at C3-4, C5-6, and C6-7, mild to moderate foraminal narrowing at C3-4 and C5-6, and moderate to severe foraminal narrowing and a posterior disc-osteophyte complex mildly indenting the ventral cord at C6-7.  An EMG indicated left-sided C7 radiculopathy.  Mayo Clinic neurosurgeon W. Richard Marsh, M.D., recommended an anterior cervical discectomy and fusion (ACDF) of the C6-7 level and possibly the C5-6 level.  Jeremy Fogelson, M.D., confirmed that a two-level ACDF from C5-6 to C6-7 made the most sense.  Surgery was set for September 1, 2020.^[4]

The employer denied liability and retained Eric Deal, M.D., to conduct an independent medical examination.  Dr. Deal examined the employee, took a medical history, reviewed multiple medical records, drafted a narrative report dated December 31, 2018, and testified by deposition.  Dr. Deal opined that the employee’s cervical spine condition was related to an underlying degenerative condition and not to a work injury.  Dr. Deal explained that these degenerative changes were not unexpected regardless of what the employee did at work or at home.  He noted that degenerative findings on the right side, as the employee had in 2007, would very commonly occur on the left side.  He concluded that the employee experiencing musculoskeletal symptoms while turning his head at work did not equate to a Gillette injury causing neurologic impingement.

The employee retained Robert Wengler, M.D., who examined the employee, took a medical history, reviewed multiple medical records, drafted a narrative report, and testified by deposition.  In his August 12, 2019, report, Dr. Wengler asserted, incorrectly, that the employee’s symptoms in 2007 were on the left side.  He opined that the employee performed heavy work at Hormel since 1982, which aggravated symptoms of his degenerative disc disease at the C6-7 level.  Dr. Wengler also opined that during the employee’s decades of working for the employer, he developed a Gillette injury culminating in 2018.  He restricted the employee to 10 pounds lifting, no repetitive bending, stooping, pushing, or pulling.  Rating the employee’s permanent partial disability at 22 percent, Dr. Wengler determined that the employee’s condition met the criteria established under Minn. R. 5223.0370, subp. 4E.  He concluded that the employee was totally disabled.

 The employee claimed he had sustained a Gillette injury to his left shoulder, neck, and/or upper extremity on or about April 15, 2018.  After a hearing on July 31, 2020, the compensation judge found that the employee failed to meet his burden to prove a Gillette injury and denied the employee’s claim for benefits.  The employee appeals.

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).

In denying the employee’s claim of a Gillette injury, the compensation judge determined the employee’s condition was caused by his long-standing degenerative cervical spine condition, not his work activities.

A Gillette injury is a result of repeated trauma or aggravation of a preexisting condition which results in a compensable injury when the cumulative effect is sufficiently serious to disable the employee from further work.  Gillette v. Harold, Inc., 101 N.W.2d 200, 206, 21 W.C.D. 105, 115 (Minn. 1960).  In order to establish a Gillette injury, an employee must prove a causal connection between the employee’s ordinary work and the resulting disability.  Steffen v. Target Stores, 517 N.W.2d 579, 581, 50 W.C.D. 464, 467 (Minn. 1994).  Whether an injury occurs as a result of repetitive minute trauma caused by the performance of work-related duties is an ultimate question of fact for the compensation judge to determine.  Gunderson v. McNeilus Cos., 73 W.C.D. 401, 409 (W.C.C.A. 2013).  Determination of a Gillette injury primarily depends upon medical evidence based on adequate foundation.  Steffen, 517 N.W.2d at 581, 50 W.C.D. at 467; see also Marose v. Maislin Transp., 413 N.W.2d 507, 512, 40 W.C.D. 175, 182 (Minn. 1987).  However, the determination of whether an employee sustained a Gillette injury is not solely dependent on medical testimony, and the compensation judge should consider the nature and extent of the employee’s work duties in deciding whether those activities caused the disability.  Gunderson, 73 W.C.D. at 409.

On appeal, the employee argues that the compensation judge erred in failing to consider the employee’s detailed testimony regarding his job duties.  He also argues that the judge erred in finding that Dr. Wengler’s opinion was based on a cursory understanding of the employee’s job duties.  Finally, he argues that substantial evidence proves that the employee indeed suffered a Gillette injury.  We are not persuaded.

The judge did not fail to consider the employee’s testimony about his job duties.  A compensation judge is not required to refer to or discuss all the evidence introduced at a hearing.  Regan v. VOA Nat’l Hous., 61 W.C.D. 142, 149 (W.C.C.A. 2000), summarily aff’d (Minn. Apr. 6, 2001); see also Ruby v. Casey’s Gen. Store, 71 W.C.D. 535, 550 (W.C.C.A. 2011), summarily aff’d (Minn. Sept. 28, 2011); Lowell v. Lee Stamping, 63 W.C.D. 304, 308 (W.C.C.A. 2003), summarily aff’d (Minn. Apr. 29, 2003).  Moreover, the compensation judge’s findings indicate that he considered the employee’s job duties.  The judge found that the employee’s work with the employer involved heavy and labor-intensive jobs and that the job as a forklift operator required the employee to drive backwards while looking over his shoulder.  It is not the role of this court to evaluate the probative value of witness testimony or to choose different inferences from the evidence than the compensation judge.  Redgate v. Sroga’s Standard Serv., 421 N.W.2d 729, 734, 40 W.C.D. 948, 957 (Minn. 1988).

It was also reasonable for the compensation judge to adopt Dr. Deal’s opinion over Dr. Wengler’s opinion regarding the causal connection between work activities and the employee’s cervical spine condition.  The compensation judge was persuaded by the opinion of Dr. Deal, who testified that the employee’s condition was degenerative in nature and that his work activities were not a substantial contributing factor to the neural impingement at the C6-7 level.  The employee asserts that the compensation judge should have adopted Dr. Wengler’s opinion that the employee sustained a Gillette injury culminating in 2018 after decades of working for the employer due to the heavy work he had performed since 1982 and driving the forklift since 2014.

As the trier of fact, it is the compensation judge’s responsibility to resolve conflicts in expert testimony.  Nord v. City of Cook, 360 N.W.2d 337, 342-43, 37 W.C.D. 364, 372-73 (Minn. 1985).  The compensation judge specifically rejected Dr. Wengler’s theory that the employee’s symptoms dating back to 2005, 2007, and 2008 were all attributable to an ongoing Gillette injury culminating in 2018 and determined that Dr. Deal’s medical opinion was more in line with the employee’s medical records.  This court will not reverse the compensation judge on that issue where the opinion relied upon by the compensation judge has adequate factual support.  See Smith v. Quebecor Printing, Inc., 63 W.C.D. 566, 573 (W.C.C.A. 2003), summarily aff’d (Minn. Aug. 15, 2003).  Dr. Deal’s medical opinion was adequately founded, and the compensation judge did not err in adopting it.

Finally, substantial evidence supports the compensation judge’s findings that the employee did not suffer a Gillette injury despite evidence that the employee’s preexisting condition may have been aggravated by his work activities.  We recognize that a preexisting physical condition does not disqualify a claim of a work injury arising out of employment where the employment aggravated, accelerated, or combined with the preexisting condition to produce a disability for which compensation is sought.  See Gillette, 101 N.W.2d at 207, 21 W.C.D. at 115 (Minn. 1960).  The employee, however, has the burden to show a causal connection between the work activities and the ensuing disability.  The employee’s testimony alone is generally not sufficient to establish this connection.  Gunderson, 73 W.C.D. at 409.  While the employee’s testimony can be a factor, the compensation judge determined the employee’s testimony alone, in this case, was not enough to establish a connection under a Gillette injury theory.

Here, the compensation judge determined that the employee lacked reliable medical evidence to establish the necessary causal connection between the employee’s forklift job and the aggravation of his degenerative condition, noting that no consistent medical evidence tied the employee’s pain complaints to his work activities.  In 2007, the employee complained of right-sided shoulder and neck symptoms and an MRI showed impingement on the right C7 nerve, but no evidence of left-sided impingement.  Later scans showed a significant change with clear impingement at the C6-7 and C5-6 levels on the left side and corresponding left-sided symptoms.  While a physical change was evident, there was a paucity of reliable medical opinion that the employee’s changes were caused from his work driving the forklift.  The theory posited by Dr. Wengler, that the employee’s current neck symptoms and his symptoms going back to 2005, 2007, and 2008 were all due to an ongoing Gillette injury, was not persuasive in light of the fact that Dr. Wengler incorrectly described the employee’s preexisting symptoms.  Furthermore, the treating physicians did not offer a medical causation opinion.^[5]  The compensation judge reasonably concluded that Dr. Deal’s opinion, that the employee’s symptoms were not related to his work activities, was consistent with the employee’s medical records.

The compensation judge was free to choose among the conflicting medical experts’ opinions on whether the employee suffered a Gillette injury.  See Schuette v. City of Hutchinson, 843 N.W.2d 233, 237, 74 W.C.D. 169, 173 (Minn. 2014).  The judge adopted Dr. Deal’s opinion, which was well supported by the evidence.  Substantial evidence supports the compensation judge’s finding that the employee’s work activities did not cause a Gillette injury to the employee’s cervical spine or resulting disability, and we affirm.