VICTOR LEMUS PANTOJA, Employee/Appellant, v. IFP-INNOVATIVE FOOD PROCESSORS, INC., and BERKLEY HATHAWAY HOMESTATE INS. COS., Employer-Insurer/Respondents, and ALLINA MED. CLINIC and BLUE CROSS BLUE SHIELD OF MN, Intervenors.

The employee appeals from the compensation judge’s findings as to the nature and extent of his work injury and from the denial of his claim for benefits.  We affirm the compensation judge’s decision.

Victor Lemus Pantoja sustained an injury on July 22, 2019, in the course of his employment as a machine operator for Innovative Food Processors.  He slipped and fell while walking, landing on his back.

The employee sought medical care on July 24, 2019, at Allina Health Faribault, where he saw Dr. George Wagner.  At that appointment, the employee complained of pain in his entire spine as well as pain in his left arm and weakness in both legs.  Dr. Wagner diagnosed a contusion to the low back and provided physical restrictions.  On August 2, 2019, the employee saw Dr. Sakina Schak at the same clinic and reported mid and low back pain with radiation to his left knee and burning pain in the middle of his back spreading to his shoulder blades.  Imaging showed no acute bone injuries or abnormalities in the thoracic or lumbar spine but did reveal chronic bilateral spondylolysis.  A lumbar MRI, done on August 14, 2019, showed degenerative findings at L4-5 and L5-S1.  The employee began therapy at Wieber Physical Therapy and also participated in the Webex program at the Courage Kenny Rehabilitation Institute for 26 sessions.  The employee reported no improvement in his symptoms following this treatment.

The employee saw Dr. Timothy Garvey for a surgical consultation on December 18, 2019.  Dr. Garvey diagnosed a lumbar sprain superimposed on isthmic spondylolisthesis.  He did not find any left-sided lumbar nerve root compression, but nevertheless suggested decompression and fusion surgery from L4 to the sacrum if the employee found his symptoms to be intolerable.

On March 2, 2020, the employee was evaluated by Dr. Joel Gedan at the request of the employer and insurer.  Dr. Gedan concluded the employee did not have lumbar radiculopathy, that the disc protrusion on the right at L5-S1 was not related to his symptoms, that the employee did not have chronic regional pain syndrome, that the employee’s examination demonstrated symptom magnification, and that the employee had reached maximum medical improvement (MMI) as of March 2, 2020, with no further medical care related to the work injury needed.

The employee consulted Dr. Orlando Charry-Rodriguez on June 24, 2020. Dr. Charry-Rodriguez noted that the employee had not had any relief in his symptoms from his previous treatment and recommended a chronic pain program.  In August 2020, Dr. Charry-Rodriguez administered a series of epidural injections, but the employee’s condition did not improve.

The employee returned to Dr. Garvey on October 7, 2020.  Following that visit, Dr. Garvey prepared a narrative report at the request of the employee’s attorney.  Dr. Garvey opined that the employee’s spondylolisthesis “clearly predated” the employee’s work injury; however, if the employee was relatively asymptomatic before the work injury and had persistent documented symptoms since that time, then the work injury had substantially aggravated the pre-existing condition.  Dr. Garvey continued to recommend multi-level decompression and fusion surgery.

The employee saw Dr. John Sherman for an orthopedic independent medical examination on December 9, 2020.  In his report, Dr. Sherman stated that the employee’s subjective complaints were “far in excess of any objective findings.”  Dr. Sherman concluded that the employee required no restrictions, had sustained no permanent partial disability from the work injury and needed no further medical treatment related to the work injury.

The employee sought another surgical opinion, this time with Dr. Ciro Vasquez, on December 17, 2020.  Dr. Vasquez believed the employee’s symptoms were due to left-sided L5 radiculopathy and recommended a fusion at L5-S1.  Dr. Charry-Rodriguez also provided an additional narrative report dated January 5, 2021, in which he diagnosed chronic musculoskeletal and neuropathic pain secondary to an L5 spondylosis and L5-S1 spondylolisthesis, which he concluded was “likely” due to the slip and fall at work.

The employee’s claims were heard by a compensation judge on February 3, 2021.  The decision of the compensation judge was served and filed March 5, 2021.  In his decision, the compensation judge summarized in detail the employee’s extensive medical records as well as the employee’s testimony.  The compensation judge found that the preponderance of the evidence supported a determination that “the employee’s July 22, 2019 work injury is no longer a substantial contributing factor to his low back condition and that he reached MMI no later than March 2, 2020." (Finding 25.)  The employee’s claims were denied.

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).

As the compensation judge noted in his Findings and Order, the issues in this case were whether the work injury of July 22, 2019, was a continuing factor in his low back condition, whether the employee was totally disabled as a result of the injury and whether the employee had reached maximum medical improvement from the work injury.  The issues presented to the compensation judge were determined by the medical evidence presented by the parties.

In his  findings, the compensation judge cited to the records and reports generated in the employee’s treatment and discussed the findings and conclusions made by the numerous providers the employee had seen, including those he saw at the request of the employer and insurer. The compensation judge set out the results of his review in 25 factual findings.  Based on his consideration of the medical evidence and the testimony of the employee, the compensation judge determined that the employee’s work injury was no longer a substantial contributing factor in the employee’s continuing back complaints.  The employee’s claims were accordingly denied.

The employee has appealed that determination.  He contends that his claim was supported by objective medical evidence that was not rebutted by the employer and insurer and that the compensation judge ignored this evidence.  We are not convinced.

It is undisputed that the employee suffers from a back condition, but there is little agreement as to the nature or severity or appropriate treatment of that condition among the medical professionals who have reviewed the matter.  Treatment recommendations have ranged from physical restrictions to physical therapy to Dr. Garvey’s most recent recommendation for multilevel lumbar decompression and fusion surgery.  The employee relies on Dr. Garvey’s opinion as the most “objective.”  However, while some radiographic studies suggest a possible diagnosis of isthmic spondylolisthesis, Dr. Garvey concluded that this condition predated the employee’s work injury.  He suggested that the work injury might have aggravated this condition but based that possibility solely on the employee’s subjective complaints and history.  Dr. Garvey’s opinion was contradicted by the opinions of Dr. Gedan and Dr. Sherman.  Although the employee discounts these doctors’ opinions, they clearly had sufficient foundation.

The compensation judge accepted the opinions of Dr. Gedan and Dr. Sherman in denying the employee’s claim.  When this court reviews a factual determination made by a compensation judge, our inquiry is whether the compensation judge’s “findings of fact and order were clearly erroneous and unsupported by substantial evidence in view of the entire record as submitted.”  Minn. Stat. § 176.421, subd. 1.  It is well established that the compensation judge as the trier of fact has the discretion to choose between competing medical opinions.  Schuette v. City of Hutchinson, 843 N.W.2d 233, 74 W.C.D. 169.  (Minn. 2014).  Although the employee alleges in his brief that the opinions of Drs. Gedan and Sherman lacked foundation because they had not considered “relevant” records and radiographic studies, those claims are not supported by a review of the evidence.

The decision of the compensation judge is supported by substantial evidence in the record.  We affirm the decision.