JOELY JOHNSON, Employee/Appellant, v. PROVIDE CARE, INC., and SFM MUT. INS. CO., Employer-Insurer/Respondents.

The employee appeals the compensation judge’s decision granting the employer and insurer’s petition to discontinue benefits.  We affirm.

Joely Johnson, the employee, worked for Provide Care, Inc., the employer, for a period of time in 2019, and returned to work for the employer in 2022.  She was working as a house manager for the employer on March 24, 2024, when she developed low back and neck pain after shoveling heavy, wet snow at a group home operated by the employer.

Prior to the March 24, 2024, incident, the employee had received treatment for cervical, thoracic, and lumbar spine pain at multiple clinics and emergency departments for several years before she began working for the employer.

In December 2012, the employee saw Dr. Amir Mehbod at Twin Cities Spine Center for back and right lower extremity pain.  She was diagnosed with disc degeneration, disc herniation, and stenosis at that time.  A 2013 lumbar MRI scan revealed multilevel spondylosis, L4-5 degenerative spondylolisthesis with moderately severe central stenosis, moderate L3-4 central stenosis with disc and facet degeneration, as well as disc and facet degeneration at L5-S1 with stenosis encroaching or mildly impinging L5.  A September 2015 cervical MRI scan showed cervical spondylosis with disc degeneration from C4 to T1.

In October 2015, the employee sought treatment for neck and low back pain at Twin Cities Spine Center.  The employee reported increased pain with activity.  An MRI scan of the employee’s cervical spine revealed multi-level degenerative changes with disc bulging at multiple levels and she was assessed with multilevel cervical spondylosis and prescribed physical therapy.  In 2017, the employee was diagnosed with multilevel degeneration and stenosis of the cervical and lumbar spine.  She also reported that she had been disabled since approximately 2011.

The employee was seen by Dr. Jeffrey Cox at Allina Health Cambridge Clinic for unspecified back pain in November 2017.  In February 2018, she was seen again for recurrent moderate pain in her thoracic spine and, in May 2018, for chronic right shoulder and right thoracic pain.  A May 2018 thoracic MRI scan demonstrated thoracic spondylosis with multilevel degeneration and facet arthropathy as well as narrowing of the spinal canal from T2 to T10.  In November 2018, Dr. Cox noted that the employee had consulted a spine specialist and that no surgery had been recommended.

In May 2019, the employee reported low back pain which radiated into her right upper buttock, groin, and upper thigh.  The employee consulted with a chiropractor in June 2019 for a gradual onset of symptoms in her lumbar spine radiating to her right leg which occurred when she was lifting, sitting, twisting, and bending.

The employee saw Dr. Cox in October 2019 for daily thoracic pain of more than one year’s duration which was aggravated by standing and twisting.  In November 2019, the employee was evaluated for cervical, thoracic, and lumbar pain.  The employee reported she had been diagnosed with cervical, thoracic, and lumbar spine disc degeneration and was referred to United Pain Center.

After a slip and fall while working for the employer on December 23, 2019, the employee reported pain in her right shoulder, ribs, and hip.  X-rays of her right shoulder and ribs were negative.  On December 26, 2019, the employee complained of right upper extremity pain and reported a history of inoperable lumbar spinal stenosis and degenerative joint disease.  The employee was taken off work until January 1, 2020.  After an attempted return to work without restrictions, she was taken off work again until January 21, 2020.

The employee was evaluated for non-work-related chronic, continuous low back complaints by a nurse practitioner at United Pain Clinic in February 2020.  The employee was diagnosed with chronic bilateral lumbar pain without sciatica, chronic bilateral thoracic pain, and chronic radicular cervical pain, and subsequently underwent trigger point injections.

The employee returned to her chiropractor for complaints of cervical, thoracic, lumbar, and right leg pain in February 2020.  She reported that her symptoms began after a slip and fall in December 2019.  The symptoms occurred while lifting, sitting, twisting, and turning.  Treatment continued until September 2020.

In February 2020, the employee underwent cervical, thoracic, and lumbar MRI scans. The cervical scan showed degenerative disc disease at C5-7 and loss of the normal cervical lordosis. The thoracic scan revealed moderate spinal canal narrowing at T6-7 and T9-10 as well as moderate to severe narrowing at T8-9.  The lumbar scan showed lumbar spondylosis, degenerative anterolisthesis of L4 on L5, moderate narrowing of the spinal canal at L3-4, moderate to severe narrowing at L4-5, impingement of the right L5 nerve root, and diffuse disc bulge at L5-S1.

By June 2020, the employee reported that pain disrupted her sleep every night.  She also reported that an allergist recommended no further injections due to an allergic reaction, that she had fallen a few times since the last visit, and that she was receiving acupuncture before her work shifts with good results.  She further shared that she was working full time out of need and that on her days off she was spending half of the day in bed.

In August 2020, the employee reported that she had been diagnosed with complex regional pain syndrome (CRPS) of the left leg.  The employee treated at United Pain Clinic for chronic pain complaints related to CRPS through 2022.

In October 2021, the employee underwent thoracic and cervical MRI scans.  The thoracic scan showed mildly exaggerated thoracic kyphosis, diffuse disc degeneration, and multilevel facet arthropathy and spondylosis with no significant changes compared to the February 2020 scan.  The cervical MRI scan showed straightening of the normal cervical lordosis, potential impingement of the left C6 nerve root, impingement of the right C7 nerve root, mild narrowing of the spinal canal at C3-4 and C4-5, and moderate narrowing of the spinal canal at C5-6 and C6-7.  A follow up with neurosurgery was recommended for the thoracic spinal stenosis condition.

On May 5, 2022, the employee was seen at United Pain Clinic for symptoms of high stress, inability to sleep caused by hip and back pain, and degenerative disc disease.  An EMG indicated that she had bilateral carpal tunnel syndrome.

The employee returned to work for the employer in August 2022.  In her position, the employee provided support to residents of a group home operated by the employer in adjoining townhomes.  The residents required assistance in attending medical appointments and with their daily living activities.  In July 2023, the employee was promoted to house manager which required her to supervise staff, perform training, and cover shifts for staff.

At a follow-up appointment at United Pain Center on January 30, 2023, the employee reported cervical pain.  X-rays taken on February 21, 2023, indicated degenerative disc disease at C5-6 and C6-7 with thickening of the cervical ligament.  The employee reported shooting pain in the right Achilles tendon and symptoms of right arm carpal tunnel syndrome in November 2023.

While working for the employer on March 24, 2024,^[1] the employee developed low back and neck pain after shoveling heavy snow at one of the employer’s group homes.  After the work injury, the employee treated with her chiropractor, Dr. Daniel Anderson, for low back, upper back, neck, and right arm pain.  He began daily chiropractic treatment, took her off work, prescribed a TENS unit, and referred her for an MRI scan.  A lumber spine scan performed on April 4, 2024, demonstrated degenerative anterolisthesis at L3 and L4, which was more prominent than on the 2013 MRI scan, and revealed multilevel spondylosis and facet, sacroiliac, and hip arthrosis.  Dr. Anderson returned the employee to work on April 15, 2024, with restrictions of no lifting over ten pounds, repetitive twisting, vacuuming, mopping, or sweeping, but after an exacerbation of her symptoms the next day, he again took her off work.  The employee continued to see Dr. Anderson for difficulty lifting, sitting, twisting, turning, bending, walking, and standing.

At the request of the employer and its insurer, surveillance of the employee was conducted on May 8, 10, and 16, 2024, and an investigative report summarizing the surveillance was issued on May 20, 2024.  The video surveillance exhibited the employee driving, walking without an altered gait or using a cane, standing, sitting in her car, bending at the waist, shopping at a store and a garage sale, reaching overhead, pushing a shopping cart, bagging purchased products, and carrying four bags of purchases up three steps at her home.  She performed these physical activities slowly but without assistance, difficulty, or observable pain behavior.

On May 20, 2024, the employee was seen in consultation by radiologist Dr. Sharad Chopra at Rayus Radiology Maple Grove.  Dr. Chopra remarked that the employee’s chronic low back pain had worsened after shoveling snow.  He reported that the employee had multilevel degenerative lumbar spondylosis with central stenosis at L3-4 and L4-5 with low back and bilateral lower extremity pain that had persisted despite conservative therapy, and he recommended a lumbar epidural injection.  The employee also returned to United Pain Clinic in May 2024, complaining of difficulty driving and increased pain when sitting too long, doing dishes, and looking down at her phone.  She was assessed with chronic lumbar spine pain and was prescribed medication.

The employee underwent an independent medical examination performed by Dr.  Paul Wicklund on June 4, 2024, at the request of the employer and insurer.  In conjunction with his examination, Dr. Wicklund reviewed the employee’s medical and chiropractic records, as well as the surveillance video.  A report issued by Dr. Wicklund on July 3, 2024, stated that the employee had no objective clinical findings to support her subjective low back pain complaints and that the physical findings on examination were all present before the March 2024 shoveling event.  Dr. Wicklund opined that the employee did not sustain a new injury or aggravate her preexisting degenerative cervical, thoracic, or lumbar disc disease when shoveling snow in March 2024 and that any symptoms the employee had after the shoveling incident were idiopathic and related to her preexisting condition because there were no changes “in the structure” of her back.  (Ex. 2.)  Dr. Wicklund also opined that the employee could continue to work, as demonstrated in the surveillance video showing her functioning normally on May 8 and 10, 2024.

On July 10, 2024, a representative of the employer contacted the employee about returning to work following receipt of Dr. Wicklund’s report.  The employee responded that Dr. Anderson was keeping her off work and that she would not be able to return to work any time soon.  A letter to the employee indicated that she had voluntarily terminated her employment with the employer effective July 11, 2024.

The employee continued to receive treatment, including a follow up at United Pain Clinic on July 30, 2024, for stabbing, burning pain primarily in her lumbar spine.  Chiropractic adjustments, acupuncture, and use of the TENS unit provided the employee two to four hours of pain relief.  A left L4-5 transforaminal epidural steroid injection was performed on August 16, 2024, for discogenic lumbar pain.

The employee saw Dr. Mehbod on September 9, 2024, reporting symptoms of worsening low back pain, bilateral pain radiating down both legs, and muscle spasms experienced after shoveling snow.  On examination, the employee had paraspinal muscle spasms and decreased motion in the lumbar spine.  After reviewing her recent lumbar MRI scan, Dr. Mehbod thought the employee’s condition was related to her L3-4 and L4-5 degenerative spondylolisthesis.  He noted that the employee’s shoveling incident significantly worsened her symptomatology and recommended that she continue with non-operative care.

Chiropractic care from Dr. Anderson continued through September 25, 2024, and during that time, the employee was not released to return to work.

The employer and insurer filed a notice of intention to discontinue benefits on July 3, 2024.  An administrative conference was held, and a decision was issued on August 13, 2024, determining there were no reasonable grounds to discontinue the employee’s benefits.  The employer and insurer filed a petition to discontinue on August 15, 2024, which came on for hearing before a compensation judge on October 17, 2024.  In a decision dated November 15, 2024, the compensation judge granted the petition to discontinue, finding the employee had sustained a temporary aggravation of her preexisting condition which resolved by June 4, 2024, and that the employee was not entitled to benefits as of July 3, 2024.  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).  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).

On appeal, the employee asserts that the compensation judge’s finding that the employee’s work injury caused a resolved temporary aggravation of her preexisting spinal condition is not supported by substantial evidence in the record.  She also argues that the compensation judge overlooked evidence which demonstrated a gap in care for her back complaints before the shoveling incident, her increased symptoms after that incident, her assigned work restrictions, and the change in her pain disability index.  The employee also emphasizes that, in his September 9, 2024, medical note, Dr. Mehbod stated that the employee’s work incident significantly worsened her symptomatology.  We are not persuaded.

Questions of medical causation fall within the province of the compensation judge.  Felton v. Anton Chevrolet, 513 N.W.2d 457, 50 W.C.D. 181 (Minn. 1994).  The Minnesota Supreme Court has stated:

The compensation judge decided this case based on the medical documentation offered into evidence by the parties and found Dr. Wicklund’s opinion to be more persuasive than any opinions or statements made by the treating doctors.  The employee contends that no reasonable grounds exist to support the judge’s decision to adopt Dr. Wicklund’s opinion over the treating doctors’ opinions, in particular Dr. Mehbod’s September 9, 2024, treatment note.  By asserting in her brief that Dr. Wicklund is not a spine specialist, that he commonly performs examinations for insurance companies, and that he only saw the employee for a short time on one occasion, the employee impugns the competency of Dr. Wicklund’s opinion.  The qualifications of an expert, however, go to the weight to be given to the opinion by the compensation judge, not to admissibility of the opinion.  See Ruether, 455 N.W.2d at 477, 42 W.C.D. at 1121.

The competency of a witness to provide an expert medical opinion “depends upon both the degree of the witness’ scientific knowledge and the extent of the witness’ practical experience with the matter which is the subject of the offered [opinion].”  Reinhardt v. Colton, 337 N.W.2d 88, 93 (Minn. 1983).  Dr. Wicklund performed an independent medical examination of the employee at the request of the employer and insurer, as allowed under Minn. Stat. § 176.155.  An examination of the employee, taking a history, and a review of the medical records, along with a doctor’s experience and training, provide a level of knowledge sufficient to establish a doctor’s competence to render an expert opinion, which was met in this case by Dr. Wicklund.  See Drews v. Kohl’s, 55 W.C.D. 33, 38-39 (W.C.C.A. 1996) (citing Grunst v. Immanuel-St. Joseph Hosp., 424 N.W.2d 66, 68, 40 W.C.D. 1130, 1132-33 (Minn. 1988)), summarily aff’d (Minn. July 11, 1996).

The employee also asserts that Dr. Wicklund’s opinion, that her worsened condition was caused by her preexisting condition, overlooks evidence of her increased symptoms after the work injury.  This argument challenges the foundation of Dr. Wicklund’s opinion.  An expert’s opinion lacks adequate foundation when (1) the opinion “does not include the facts and/or data upon which the expert relied in forming [the] opinion,” (2) it does not “explain the basis for [the] opinion,” or (3) “the facts assumed by the expert in rendering an opinion are not supported by the evidence.”  Hudson v. Trillium Staffing, 896 N.W.2d 536, 540, 77 W.C.D. 437, 442 (Minn. 2017) (internal citations omitted).

Dr. Wicklund reviewed the medical evidence and concluded that the work incident was not the cause of the employee’s ongoing condition.  Evidence in the record, including the employee’s extensive treatment for her preexisting degenerative cervical, thoracic, and lumbar disc disease, supports his conclusion.  The opinion of Dr. Wicklund was well founded and competent, and the compensation judge’s reliance on his opinion was not in error.^[2]

Based upon our review of the record on appeal, including review of the employee’s medical treatment records, Dr. Mehbod’s causation note, surveillance video, and the employee’s testimony, we conclude that substantial evidence supports the compensation judge’s finding that the employee’s back injury sustained on March 24, 2024, was temporary in nature and had resolved. The compensation judge’s decision not to incorporate the specific statement of Dr. Mehbod on September 9, 2024, into her findings does not indicate that she failed to consider that statement or that she failed to adequately address the employee’s physical condition or medical care received for her back condition.  A compensation judge is not required to refer to every piece of evidence introduced at hearing.  Regan v. VOA Nat’l Housing, 61 W.C.D. 142, 149 (W.C.C.A. 2000), summarily aff’d (Minn. Apr. 6, 2001).  Based upon the totality of the evidence, we conclude the compensation judge did not err as a matter of law in granting the employer and insurer’s petition to discontinue benefits.

Evidence in the record in this case is subject to differing interpretations from which the compensation judge could have drawn different conclusions.  Because the compensation judge’s decision is supported by substantial evidence, including the opinion of Dr. Wicklund, and is not unreasonable or clearly erroneous, we affirm.