MARY E. HASTINGS, Employee/Appellant, v. INDEPENDENT SCH. DIST. NO. 912, SELF-INSURED/BERKLEY RISK ADMR’S CO., Employer/Cross-Appellant, and BLUECROSS BLUESHIELD OF MINN., MEDICA HEALTH PLANS/INGENIX, and ST. CLOUD HOSP., Intervenors.
WORKERS’ COMPENSATION COURT OF APPEALS
NOVEMBER 7, 2008
CAUSATION - SUBSTANTIAL EVIDENCE. Substantial evidence, including expert medical opinion, supports the compensation judge’s finding that the employee sustained a work-related mold allergy from August 2005 through November 2005 that had resolved as of November 20, 2005.
Determined by: Rykken, J., Johnson, C.J., and Pederson, J.
Compensation Judge: James F. Cannon
Attorneys: John Malone, Malone & Atchison, St. Cloud, MN, for the Appellant. Leslie M. Altman and Joshua T. Brinkman, Littler Mendelson, Minneapolis, MN, for the Cross-Appellant.
MIRIAM P. RYKKEN, Judge
The employee appeals the compensation judge’s finding that her work-related mold allergy had resolved as of November 20, 2005, and also appeals the compensation judge’s denial of her claim for temporary partial disability benefits related to her claim for a work-related mold allergy. The self-insured employer cross-appeals the compensation judge’s finding that the employee sustained a work-related mold allergy from August 2005 through November 2005 and the corresponding award of medical expenses. We affirm.
Mary E. Hastings, the employee, began working in 1985 as a social worker for Independent School District No. 912, the self-insured employer, in Milaca, Minnesota. The employee took a five-year leave of absence for child care from 1995 to 2000, and returned to work in 2000 for the employer as a social worker in the elementary school. In 2004, the employee was reassigned to her current position as a school counselor at the district’s senior high school.
Since 1995, the employee has treated for sinusitis, sinus headaches and pressure with chronic postnasal drainage. On May 12, 1999, the employee was tested for mold allergies; these test results were negative. Dr. Mohamed Yassin, an allergist, diagnosed the employee with vasomotor rhinitis and chronic sinusitis. In 2002, the employee began treating for eczema on her right cheek and scalp. The employee testified that she had received treatment several times before 2005 for sinus infections and had experienced symptoms of being sensitive to strong odors. On May 12, 2005, the employee was diagnosed with seborrhetic dermatitis and rosacea by Dr. Barry LaBine, a dermatologist.
The carpeting in the employee’s original student services office was cleaned over the summer of 2005 and left to dry without proper ventilation, which apparently led to mold growth. On August 15, 2005, the employee returned to work in the school’s student services office after summer break. The employee and two other staff members in that office noticed a musty odor and complained about the air quality. The employee began to develop a burning sensation in her eyes, the area from her cheekbones up to both eyes started to swell, and her face became red. She did not experience these symptoms outside of the office. The employee reported her symptoms to the principal several times in September and October 2005. The employee’s co-workers also experienced symptoms such as coughing, skin redness, congestion, hoarseness, and loss of voice.
The employee treated with Dr. LaBine for these symptoms. He concluded that the employee might have experienced a mold-related exacerbation to her dermatitis and referred her to Dr. Yassin. In November 2005, Dr. Yassin conducted tests on the employee, including a pulmonary function test which indicated normal lung function, and a skin prick test which was negative for mold allergies.
The employee filed an indoor air quality complaint form with the employer. On October 20, 2005, through an outside contractor, the Institute for Environmental Assessment (IEA), the employer began testing the air quality in various areas of the school, including the employee’s work area and other areas that had been the subject of air quality complaints. A November 14, 2005, report issued by IEA indicated that a high level of fungal spores, specifically Aspergillus versicolor, was detected in the area, which was described as unacceptable. After the report was issued, the employer moved the employee and her two co-workers to another area of the building, a computer lab. At first the employee did not notice any improvement in her symptoms, and noted an odor in the computer lab area as well. When books, files, and binders which had been moved from the old office were removed from the new area, the employee’s symptoms improved.
The employer went through an abatement process in November and December 2005. In late November 2005, IEA began conducting an abatement of the employee’s office, and the abatement process involved removing the carpeting, using a HEPA vacuum to remove spores from the air, and changing ceiling tiles. As part of that process, the carpet in the student services office was removed. A December 21, 2005, report from IEA advised the employer that air-sampling testing indicated that the level of mold in the office was reduced and that re-occupancy was acceptable.
In January 2006, evidently as a result of the attempted abatement and the reduced level of mold found as a result of the follow-up testing, the employer asked the employee and her two co-workers to resume working in the student services office. The employee’s symptoms returned, and she began treating with Dr. Thomas Sult at the Integra Care Clinic on January 11, 2006. After examining the employee and reviewing the 2005 air testing results, Dr. Sult concluded that the employee’s “symptoms and story are quite compelling for environmental mold contamination resulting in acquired hypersensitivity to mold. Unfortunately, once a hypersensitivity is acquired, the hypersensitivity will persist for some time, and even small previously tolerated doses of mold will trigger amplified symptoms.” In a January 26, 2006, report to the employer, Dr. Sult indicated that the employee was allergic to mold and was reacting to residual amounts of mold in her office. He recommended that the employee be moved out of that area of the school and referred the employee to an allergy specialist. The employee was allowed to relocate again.
In February 2006, the employee underwent IgE testing for mold allergies, which indicated no evidence of IgE mediated mold allergy. Dr. Sult found this result insignificant.
Also in February 2006, the employer installed HEPA filters in the employee’s former office in the student services area. The employee again attempted to return to the student services office, but her symptoms returned. The company conducting the abatement process was scheduled to perform a walk-through inspection of the building on February 21, 2006. On February 17, 2006, the building’s custodians removed and replaced ceiling tiles that had any water stains, and painted over any stained tiles which could not be replaced. The employee evidently learned that this maintenance and painting work would occur and believed that this repair was intended to cover up evidence of water damage, so she returned to school that evening and took photographs of the damaged tiles. The employer’s superintendent testified that replacement of ceiling tiles was part of the building’s ongoing maintenance schedule.
The employee moved back to the computer lab area from late February 2006 through June 2006. On March 8, 2006, and March 29, 2006, additional air sampling tests were conducted in the student services office. Much lower levels of fungal spores were found. No abatement was recommended after this testing.
The employee was examined by Dr. Vincent Marinkovich, an immunologist, on May 24, 2006, and was tested for allergies using an IgG test. Dr. Marinkovich concluded the employee showed a strong antibody response to 11 of 13 molds commonly found in water-damaged indoor spaces, she was not atopic and her IgE levels were negative as expected, and that the employee suffered from fungal hypersensitivity. Dr. Marinkovich prescribed a nasal spray medication. In June 2006, the employer offered the employee and her co-workers three different work locations. The employee reported experiencing symptoms while in all three locations. The computer lab area where she had worked in November 2005 was not one of the locations offered.
In August 2006, the employer sent the employee a letter indicating that the employee would be located in the student services office for the upcoming school year. The employee responded that she had attempted to return to that office three times in the summer of 2006 and experienced symptoms each time. The employee therefore was located in the media center in the fall of 2006, but the employee experienced reactions there and in other parts of the building. The employee continued to work but missed some time due to ongoing symptoms, and began treatment with injections. The employee also reported having symptoms while in other locations off school property. In February 2007, the employee reported improvement in her symptoms with the injections.
In a March 27, 2007, report, Dr. Marinkovich indicated that the employee was exposed to mold at work and became hyperreactive “allergic” to molds, and had ongoing exposure at work to molds. In May 2007, the employer replaced the abatement company it had been using with a different company, Johnson Controls. A representative of that new abatement company advised of ventilation concerns in the building. In the summer of 2007, Johnson Controls located fungi in some air control units, including near the office areas where the employee worked in 2005 and 2007. In the fall of 2007, the employer started an HVAC decontamination project, including application of fungicide to air control units.
On March 28, 2006, the employee filed a claim petition for medical expenses, Roraff fees, costs, and temporary partial disability benefits based on a work-related mold allergy due to exposure to mold in the employer’s building. The employer denied the claim and a hearing was held over two days on June 27, 2007, and October 10, 2007. Extensive evidence was submitted into the record, including the employee’s medical records as well as reports documenting the inspections, testing and analysis completed by companies with whom the employer had contracted for abatement and air quality testing and control. Testimony was presented by the employee; representatives from the Institute for Environmental Assessment and from Johnson Controls, companies which had performed environmental air quality testing and abatement for the employer; an elementary teacher employed by the employer; a staff person who was one of the employee’s co-workers; the employer’s school superintendent; and Dr. Richard Morris.
On the second day of the hearing, Dr. Richard Morris, a specialist in allergy and immunology, testified on behalf of the employer. Dr. Morris had not examined the employee, but had reviewed the employee’s medical records and the air quality testing results and reports. Dr. Morris advised that to diagnose a mold allergy in an individual, he would perform an IgE test. In reviewing the employee’s medical records, Dr. Morris found no evidence that the employee had a mold allergy. Dr. Morris opined that the IgG test performed by Dr. Marinkovich does not indicate an allergic reaction, but only that the person tested had been exposed to that substance. Dr. Morris also opined that the employee’s symptoms indicated contact dermatitis or eczema, but admitted that swelling around the eyes could be a symptom of a mold allergy. He also stated that “hypersensitivity” is a generic term, and that if a person allergic to mold is exposed to elevated levels of mold in a room, after abatement the person would no longer react in that room. Dr. Morris indicated that he did not have an opinion as to whether the employee had sustained a work-related injury as a result of her exposure to mold, stating that he did not have enough information to form that opinion since he had not examined the employee.
In Findings and Order served and filed March 25, 2008, the compensation judge found that the employee had sustained a work-related injury in the nature of a mold allergy due to significant mold exposure from August 2005 through November 2005, and awarded payment of related medical expenses incurred during that limited period of time. The compensation judge determined that the employee’s mold allergy was temporary and fully resolved as of November 20, 2005, when the employee was transferred from the original student services office and was no longer exposed to significant mold levels in the workplace. The compensation judge denied the employee’s claim that she was entitled to temporary partial disability benefits from November 22, 2005, through the date of the hearing. The compensation judge concluded that the record contained insufficient evidence to support the employee’s claim that she had required time off from work as a result of her symptoms, and that the record contained no medical slips or reports from any physician that showed the employee had required time off work for medical treatment of her symptoms. The compensation judge also denied the employee’s claim for payment of medical expenses incurred after November 20, 2005.
The employee appeals the compensation judge’s finding that her work-related mold allergy had resolved as of November 20, 2005, and also appeals the compensation judge’s denial of her claim for temporary partial disability benefits related to her claim for a work-related mold allergy and the corresponding denial of medical expenses incurred after November 20, 2005. The self-insured employer cross-appeals the compensation judge’s finding that the employee sustained a work-related mold allergy from August 2005 through November 2005 and the corresponding award of medical expenses.
STANDARD OF REVIEW
In reviewing cases 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. 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, “[f]actfindings are clearly erroneous only if the reviewing court on the entire evidence is left with a definite and firm conviction that a mistake has been committed.” Northern States Power Co. v. Lyon Food Prods., Inc., 304 Minn. 196, 201, 229 N.W.2d 521, 524 (1975). 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 the evidence or not reasonably supported by the evidence as a whole.” Id.
The employer cross-appeals the compensation judge’s finding that the employee sustained a work-related mold allergy from August 2005 through November 2005. The employer argues that the employee had pre-existing skin conditions of eczema and rosacea, and that her symptoms were related to those conditions. Dr. Morris testified that the employee’s symptoms of swelling around the eyes and red, inflamed skin were consistent with rosacea or eczema, but admitted that swelling around the eyes could be a symptoms of a mold allergy. Dr. Sult indicated that the employee was allergic to mold and was reacting to residual amounts of mold in her office. Dr. Marinkovich indicated that the employee was exposed to mold at work, became hyper-reactive, and was allergic to molds.
The employer also argues that skin prick testing for allergies did not indicate that the employee has a mold allergy and that the testing relied upon by Dr. Marinkovich is not a medically accepted method of diagnosing allergies. Dr. Marinkovich tested the employee using an IgG test and concluded the employee showed a strong antibody response to 11 of 13 molds commonly found in water-damaged indoor spaces, that she was not atopic and her IgE levels were negative as expected, and that the employee suffered from fungal hypersensitivity. Dr. Morris opined that the IgG test performed by Dr. Marinkovich would not indicate an allergic reaction, but only that the person had been exposed to that substance. Dr. Morris indicated that to diagnose a mold allergy, he deemed it necessary to perform an IgE test. In reviewing the employee’s medical records, Dr. Morris found no evidence that the employee had a mold allergy. All of the employee’s IgE tests were negative. We note that it is the compensation judge's responsibility, as trier of fact, to resolve conflicts in expert testimony. Nord v. City of Cook, 360 N.W.2d 337, 342, 37 W.C.D. 364, 372 (Minn. 1985). In addition, Dr. Morris indicated at the hearing that he did not have an opinion as to whether the employee had sustained a work-related injury as a result of her exposure to mold, stating that he did not have enough information to form that opinion since he had not examined the employee.
There is no dispute that there was an elevated level of mold located in the employee’s work space, the student services office, from August 2005 through November 20, 2005. The employee testified that her symptoms of swelling by her eyes and the burning sensation on her skin were new starting in August 2005. The compensation judge relied upon Dr. Sult’s and Dr. Marinkovich’s opinions, the employee’s testimony regarding her symptoms, and the presence of elevated levels of mold in the employee’s office area, and found that the employee had sustained a work-related mold allergy due to mold exposure from August 2005 through November 20, 2005. Substantial evidence supports these findings, and we affirm.
The employee appealed the compensation judge’s finding that her work-related mold allergy had resolved as of November 20, 2005. The compensation judge found that after November 20, 2005, the employee was no longer exposed to elevated levels of mold, relying on the air quality tests in the record. After that date, and based on the test results, the testing contractor concluded that the employee’s work space was considered acceptable for occupancy. Relying on Dr. Sult’s and Dr. Marinkovich’s opinions, the employee argues that after her initial exposure, she became hypersensitive and now reacts even while she is in different locations. Dr. Sult opined that the employee experienced environmental mold contamination which resulted in an acquired hypersensitivity to mold, which will persist for some time and “even small previously tolerated doses of mold will trigger amplified symptoms.” Dr. Marinkovich opined that the employee had become hyperreactive “allergic” and had ongoing exposure to molds.
The employee testified that she began experiencing these mold allergy symptoms in many different locations, including different places in the school building. No mold was found in those locations other than the presence of mold similar to that found in the outside air. Dr. Morris testified that the term “hypersensitivity” is not a scientific term, and that the employee’s mold allergy testing was negative. The compensation judge noted that the employee was no longer exposed to higher levels of mold in the workplace and that her ongoing symptoms were similar to those she experienced as a result of her pre-existing conditions of eczema and dermatitis. The compensation judge concluded that the employee did not have an ongoing mold allergy after November 20, 2005. Concluding that substantial evidence supports the judge’s determination, we affirm.
The employee also appeals the compensation judge’s denial of her claim for temporary partial disability benefits related to her claim for a work-related mold allergy. The employee’s claims for temporary partial disability are dated beginning November 22, 2005. In addition, the employee appeals from the denial of medical expenses that she incurred after November 20, 2005. The compensation judge found, and we have affirmed, that the employee’s work injury had resolved as of November 20, 2005. When an employee’s injury has resolved and there is no residual disability related to the work injury, the employee is not entitled to wage replacement benefits. Kautz v. Setterlin Co., 410 N.W.2d 843, 40 W.C.D. 206 (Minn. 1987). The compensation judge did not err by denying the employee’s claims for temporary partial disability benefits from November 22, 2005, and medical expenses after November 20, 2005. We affirm.
 Aspergillus versicolor is a species of mold with organisms that have been found in human infections of the lungs, bronchi, and occasionally the central nervous system. Dorland’s Illustrated Medical Dictionary, 160 (29th ed. 2000).
 HEPA is an acronym referring to a High Efficiency Particulate Arresting filter, which is used to remove particles from the air.
 See footnote 5.
 At Finding No. 12, the compensation judge referred to the allegations that the employer had attempted to cover evidence of water damage, and stated that “[t]here is no need to reach a specific finding as to whether or not any employer representative instructed maintenance staff to change ceiling tiles or paint them to cover up water damage prior to the IEA inspection, in order to reach a determination on the issues in this matter.”
 Dr. Morris testified that Ig stands for immunoglobulin, and that the immune system has five types of Ig labeled G, M, A, D, and E. He opined that IgE is the immunoglobulin that causes allergy, and that IgG testing only indicates that the employee has been exposed to a substance, not that she is allergic to that substance. According to Dr. Morris, there are several types of test to determine the level of IgE, including a skin prick test, a skin entodermal test, or a particular type of blood test.