The employer and insurer appeal the compensation judge’s denial of their petition to discontinue temporary total disability (TTD) benefits.  We affirm.

The employee, Michael Hill, began working as a delivery driver for the employer, Federal Express, in 2018, working four 10-hour shifts per week.  He loaded his delivery truck each day with packages weighing from a few ounces to as much as 75 pounds, then delivered the packages to customers.  At each stop, the employee would get out of the truck, step into the back of the truck to retrieve the package, step out, walk to the customer’s drop-off location, deliver the package, and return to the truck.  He estimated he made 50 to 100 stops in a typical day.

In early May 2023, when getting into his delivery truck, the employee felt a pull or strain in his left calf extending to his left foot.  He did not think much of it and expected the symptoms would resolve.  Instead, his symptoms worsened and he developed pain in his left calf.  On May 10, 2023, he saw Dr. Daniel Palmquist of the Raiter Clinic for pain in two of his left toes.  He told Dr. Palmquist that he was unaware of any trauma, but that he did a lot of walking for his job as a delivery driver for the employer.  The examination was normal, including normal sensation in his feet.

At Dr. Palmquist’s recommendation, the employee saw Dr. Kenneth Ripp of the Raiter Clinic on May 15, 2023, for discoloration of his left foot, pain, and difficulty walking.  He denied any trauma, but mentioned that he drove a delivery truck and jumped in and out of it all day long.  Dr. Ripp diagnosed a calf strain and took the employee off work for a week.  The employee returned to Dr. Ripp on May 18, 2023, with ongoing symptoms of pain in his left foot.  He reported that his symptoms were improving, but that he was still unable “to bear weight on it normally.”  (Ex. C.)  Examination showed tenderness and discoloration of the foot and ankle area.  Dr. Ripp took the employee off work for another week.  The employee also told Dr. Ripp that he would report his left leg pain as a work-related injury.^[1]

On May 25, 2023, Dr. Ripp reexamined the employee and noted discoloration in his left foot and diminished pulses on the left compared to the right.  He diagnosed a left calf and Achilles tendon strain, stating:

The employee began physical therapy to treat his left lower leg pain, weakness, and reduced motion at Cloquet Community Hospital on June 7, 2023.  He also continued to see Dr. Ripp regularly.  By early August, the employee reported to Dr. Ripp that he was making little progress with physical therapy and he had difficulty walking a single block.  Dr. Ripp suspected chronic regional pain syndrome (CRPS) as the likely diagnosis and ordered more tests.

By June 21, 2023, the employer and insurer had admitted liability for the work injury and began paying benefits, including medical expenses and TTD benefits.

The employee underwent an August 29, 2023, MRI scan which showed no acute abnormalities to explain the employee’s ongoing left leg symptoms.  After an ultrasound of the employee’s left leg showed an occluded segment of the left distal femoral artery, Dr. Ripp referred the employee to a vascular surgeon for an evaluation.  Responding to the employer and insurer’s request for specific restrictions, Dr. Ripp limited the employee to seated work, with brief standing and walking breaks, no climbing, and no driving.  The employee continued to treat with Dr. Ripp through 2023, for subjective complaints of pain and difficulty walking as well as objective findings of tenderness, occasional color changes, and reduced pulses.  The employee also discontinued smoking.

On September 19, 2023, the employee underwent an ultrasound at St. Luke’s Hospital which showed moderate left leg arterial disease and no findings on the right leg.  An examination by Dr. Douglas Hood showed no palpable pulses in the left leg, no pressure on the left great toe, and a normal pulse and pressure examination of the right leg and toe.  Dr. Hood diagnosed atherosclerosis of the left leg arteries, noting that sudden onset in the left leg without significant disease affecting the right leg was unusual for atherosclerotic disease and that thrombotic/embolic occlusion should be considered.

On September 20, 2023, the employee was examined by Dr. William Simonet at the request of the employer and insurer.  Dr. Simonet diagnosed the employee with vascular claudication of the left leg secondary to an occluded femoral artery.  He opined that the employee did not suffer from CRPS.  Although conceding that he was not a specialist regarding vascular disease, he opined that the employee’s vascular claudication was age specific, had developed over many years, was caused or accelerated by the employee’s smoking history, and that the work injury played no role in the diagnosis.  Consequently, he opined that because there was no work injury, there was no need for work restrictions based upon the claimed work injury.  Based upon Dr. Simonet’s report, the employer and insurer denied payment for additional medical treatment.

On December 18, 2023, the employer and insurer filed a notice of intention to discontinue (NOID) the employee’s TTD benefits.  The notice stated:

On February 6, 2024, the employee was examined by Dr. Benjamin Jorgensen of Essentia Health.  Dr. Jorgensen diagnosed the employee with severe superficial femoral artery disease.  He recommended a three-month walking program, a change in medication, and a diagnostic angiogram.

On April 17, 2024, the employee was examined by Dr. Ronald Vessey and by Dr. Matthew Monsein at the request of the employer and insurer.  In his May 1, 2024, report, Dr. Vessey opined that the employee suffered from severe atherosclerotic peripheral vascular disease affecting his left leg.  He stated that neither the employee’s work injury nor his work activity played any role in the employee’s diagnosis.  He also found no evidence of CRPS.  Meanwhile, in his report dated May 7, 2024, Dr. Monsein concluded that while the employee exhibited many signs and symptoms of CRPS, the employee did not have a diagnosis of CRPS because a different diagnosis of peripheral vascular disease better explained the employee’s condition.^[3]  Dr. Monsein also opined that the employee’s diagnosis included persistent and chronic pain which was not caused by the work injury.  Finally, he noted that while the employee may have had a mild left calf strain/sprain from the work injury, that condition would have resolved in four to six weeks.

The reports of Drs. Vessey and Monsein were provided to the employee and his counsel on May 13, 2024, two days before the scheduled evidentiary hearing on the employer and insurer’s petition to discontinue benefits.  The employee objected to the submission of this evidence and the additional bases for the employer and insurer’s legal position.  The compensation judge gave the employer and insurer the option to conduct the hearing on May 15 with only Dr. Simonet’s opinion or to agree to a 60-day continuance to allow the employee additional time to prepare and to gather any contrary evidence.  The employer and insurer did not respond, and the compensation judge ordered a continuance, indicating that the employer and insurer needed to amend their petition to discontinue to include the opinions of Drs. Vessey and Monsein as additional bases for their position.

On May 14, 2024, Dr. Ripp issued a report at the request of the employee’s attorney.  Dr. Ripp opined that the employee’s underlying calf pain was aggravated by getting in and out of his delivery truck, which caused a strain in the muscle complex that led to the development of CRPS.  He also noted that peripheral vascular disease would not have had a sudden onset of pain but a slower onset of claudication.  (Ex. J.)

On June 3, 2024, the employer and insurer amended their petition to discontinue benefits to include reliance on the opinions of Drs. Vessey and Monsein.  Specifically, the employer and insurer alleged that the employee’s weekly TTD benefits should be terminated because 1) he did not suffer a work-related injury that developed into CRPS; 2) any injury he suffered related to his employment on May 18, 2023, had resolved and was not related to his current symptoms; 3) he suffered vascular insufficiency of the left lower extremity and/or severe atherosclerotic peripheral vascular disease which was not work related; and 4) he did not have any work restrictions related to the claimed work-related injury.

On June 11, 2024, the employee returned to Dr. Jorgensen.  He reported significant improvement due to increased activity, but continued to have pain in the left leg after walking short distances.  Blood pressure measurements showed significant reduction in the left leg versus the right.  Dr. Jorgensen stated that the blood pressure differences were consistent with arterial claudication, but that the acute onset of the pain symptoms could be related to a work injury and CRPS.  Dr. Jorgensen recommended a more dedicated walking program for three months, then consideration of an angiogram.  He cautioned that the angiogram and subsequent intervention might not improve the employee’s symptoms if they were caused by CRPS.

On July 11, 2024, the employee saw Dr. Ripp, who noted improvement in the employee’s leg color.  The employee reported being able to walk about a block before resting, but was unable to walk another block after resting.

The matter came on for hearing before a compensation judge on July 29, 2024.  The employer and insurer’s bases for petitioning to discontinue the employee’s TTD benefits were identified by the compensation judge as: 1) whether the effects of the employee’s work injury had resolved; 2) whether the employee’s ongoing symptoms were related to a personal condition; and 3) whether the employee no longer had work restrictions related to the work injury.  (T. 6.)  Counsel for the employer and insurer agreed with that recitation and, during closing arguments, concluded by stating:

The employee testified at the hearing that within a few days of his first symptoms, he felt tingling in his toes which continued but less often, and that he still had sharp pain in his left calf, although it was improving.  He no longer had discoloration of his leg or foot, which he attributed to the physical therapy treatment.  The employee also testified that his walking program, recommended by Dr. Jorgensen, was to walk 30 minutes per day, but to stop when the pain would worsen.  He had some improvement but walked much slower than he used to and struggled with walking on stairs.  He had discontinued many activities including golfing and fishing.

On September 9, 2024, the compensation judge issued a findings and order denying the employer and insurer’s petition to discontinue benefits.  She considered the employee’s testimony credible and found the employer and insurer did not meet their burden to show the effects of the employee’s work injury had fully resolved without restrictions.  In her memorandum, the compensation judge stated that the opinions of Drs. Ripp and Jorgenson were persuasive and in line with other medical evidence in the record.  She also noted the employer and insurer failed to prove that the employee’s peripheral vascular disease was the sole cause of his disability.  The employer and insurer appeal.

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).  When the findings are supported by substantial evidence, the Workers’ Compensation Court of Appeals must defer to the compensation judge. Lagasse v. Horton, 982 N.W.2d 189, 202 (Minn. 2022).  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); see also Smith v. Carver Cnty., 931 N.W.2d 390, 79 W.C.D. 495 (Minn. 2019).

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); see also Busch v. Advanced Maint., 659 N.W.2d 772, 778-79, 63 W.C.D. 277, 284 (Minn. 2003).

The employer and insurer appeal from the compensation judge’s denial of their petition to discontinue benefits.  First, they argue that the compensation judge used the wrong standard in considering the petition to discontinue.  Second, they assert that the compensation judge erroneously treated the case as if primary liability and the nature and extent of the work injury had been established.  Third, they contend that substantial evidence does not support the compensation judge’s finding that they did not meet their burden of proving the employee had recovered from the effects of the work injury.  We are not persuaded.

When an employer and insurer have admitted liability and have been paying wage loss benefits for more than 60 days, those benefits may not be discontinued until a NOID has been filed.  Minn. Stat. § 176.238, subd. 1; see also Minn. Stat. § 176.221, subd. 1.  Once that occurs, an employee may request an expedited administrative conference.  Minn. Stat. § 176.238, subd. 3.  The only issues considered in an expedited conference, unless expanded by mutual agreement of the parties, are those raised in the NOID.  Minn. Stat. § 176.239, subd. 6.  A discontinuance of wage loss benefits is allowed when the employer and insurer have established “reasonable grounds” to discontinue the employee’s benefits.  Id.  A party dissatisfied with the decision may object and request a full de novo evidentiary hearing before a compensation judge.  Minn. Stat. § 176.239, subd. 8.

The employer and insurer in this case admitted primary liability for the employee’s claimed injury and paid benefits.  After having received Dr. Simonet’s opinion, they filed a NOID under Minn. Stat. § 176.238, subd. 1, seeking to discontinue the employee’s wage loss benefits.  By administrative decision, a compensation judge found no reasonable grounds to discontinue the employee’s TTD benefits.  The employer and insurer filed a petition to discontinue benefits, and later an amended petition to discontinue benefits, attaching the reports of Drs. Vessey and Monsein.  A de novo evidentiary hearing was held with the alleged bases for discontinuance expanded to include those raised by all three medical expert opinions.  By findings and order, the compensation judge found that the employer and insurer had not shown that the effects of the work injury had resolved without restrictions.  It is from this decision that the employer and insurer appeal to this court.

The employer and insurer raise three arguments on appeal.  First, the employer and insurer contend that the compensation judge erred by failing to use the “reasonable grounds” standard in considering their petition to discontinue benefits.  We disagree.  The reasonable grounds standard applies at expedited conferences on a NOID under Minn. Stat. § 176.239, subd. 6, not at a de novo hearing on a petition to discontinue where the issue is whether the employer and insurer had proven a basis to discontinue the employee’s benefits by a preponderance of the evidence.  Minn. Stat. § 176.238, subd. 5; see also Minn. Stat. § 176.021, subd. 1a. 

Second, the employer and insurer argue that in making her findings, the compensation judge erroneously assumed primary liability had been determined.  We are not convinced.  While the employer and insurer had asserted a retroactive denial of primary liability in their NOID and had presented evidence on the issue of primary liability, this issue was not raised at the hearing on the petition to discontinue.  The employer and insurer chose not to pursue their primary liability defense for purposes of the de novo hearing.  Counsel for the employer and insurer specifically stated in closing arguments that while the matter before the compensation judge “sounds a lot like liability,” that was not at issue.  (T. 75.)  Further, the issues articulated at the hearing included whether the employee’s work injury had resolved and whether the employee still needed restrictions due to her work injury.  The phrasing of these two issues necessarily suggests the existence of a work injury.  Thus, to the extent the compensation judge “assumed” a work injury, it was done so at the request of the parties by the presentation of the issues.

We acknowledge that the compensation judge stated in her memorandum that the employee “sustained” a muscle strain when stepping into his delivery truck.  While using the word “sustained” could suggest that the employee suffered a work injury, a statement in a compensation judge’s memorandum is not a finding of fact.  See Bennetts v. United Hosp., No. WC13-5618 (W.C.C.A. Feb. 18, 2014); Minn. Stat. § 176.371 (a memorandum shows the basis for the decision).  The compensation judge also made no findings regarding the nature and extent of the employee’s injury, whether any injury was temporary or permanent, whether restrictions are appropriate for the alleged injury, any need for medical care, or other aspects of the employee’s potential claims for benefits.  Rather, her findings were limited to whether the employer and insurer met their burden of proving the employee’s work injury resolved without need for further work restrictions.  As counsel for the employer and insurer noted at the hearing, there was a pending claim petition where many of these other issues were set to be tried in September 2024.

Third, the employer and insurer argue that substantial evidence fails to support the finding that the employer and insurer had not met their burden of proving the employee’s work injury resolved without need for further work restrictions.  Substantial evidence supports a compensation judge’s findings where there is evidence in the record that a reasonable mind might accept as adequate.  Hengemuhle, 358 N.W.2d at 59, 37 W.C.D. at 239.  Here, the opinions of Drs. Ripp and Jorgensen were accepted by the compensation judge as more persuasive than those of Drs. Simonet, Vessey, and Monsein.  This court will not overturn a compensation judge’s choice of medical expert opinion when the opinions are well founded.  Mattick v. Hy-Vee Foods Stores, 898 N.W.2d 616, 621, 77 W.C.D. 617, 624 (Minn. 2017); Erickson v. Grand Itasca Clinic & Hosp., No. WC21-6413 (W.C.C.A. Nov. 16, 2021) (citing Hudson v. Trillium Staffing, 896 N.W.2d 536, 540, 77 W.C.D. 437, 442 (Minn. 2017)).

The employer and insurer assert that the only reasonable explanation for the employee’s left leg symptomology and need for restrictions is that he suffers from peripheral artery disease.  While there is medical evidence to support this explanation from the employer and insurer’s three medical experts, there is also contrary medical evidence to support another reasonable explanation for the employee’s symptoms and restrictions.  Dr. Hood noted that peripheral artery disease would not suddenly appear in one leg without a presence in the other.  Dr. Ripp, aware of the employee’s peripheral artery disease, also found evidence of CRPS consistent with his work activities and injury.  In addition, Dr. Jorgensen agreed that the employee had peripheral artery disease but also had CRPS.  Substantial evidence supports the compensation judge’s finding that the employer and insurer had not shown that the effects of the work injury had fully resolved without restrictions, and we affirm.