The employee appeals from the compensation judge’s finding that the employee did not sustain a consequential injury to her right hand and wrist as a result of her 1975 work-related left hand and wrist injury and from the judge’s decision that the employee’s claim for a consequential injury was closed out by a 1992 award on  stipulation.  The employee also petitions to vacate the 1992 award on stipulation based on substantial change in condition.  We reverse in part, remand in part, and deny the petition to vacate.

The employee sustained a significant work-related injury to her left hand and wrist on November 10, 1975,^[1] while working for the Minnesota Department of Human Services [the employer].^[2]  Dr. William Cooney has been the employee’s treating doctor for her left hand and wrist since 1975.  Although she moved to California in 1982, the employee continued to return to Minnesota for medical treatment with Dr. Cooney.

On March 2, 1991, the employee was involved in an automobile accident while driving to California from Minnesota where she had been treated by Dr. Cooney.  As a result of that accident, the employee injured her left knee and ribs, and the knee injury necessitated several surgeries.  The employee eventually filed a claim petition seeking various workers’ compensation benefits as a result of the 1991 automobile accident.  In May of 1992, the parties entered into a stipulation for settlement wherein the employee agreed to accept $75,000 in full, final, and complete settlement of any and all claims “arising out of Employee’s accidents of [November] 10, 1975, and March 2, 1991.”  The stipulation also indicated that, “[i]t is agreed that certain portions of future medical care and treatment arising out of the Employee’s injury of [November] 10, 1975, shall remain open as described below, however, any consequential injuries to any portion of Employee’s body other than her left hand and wrist alleged to have arisen in her accident of March 2, 1991, or otherwise, are foreclosed . . . .”

Eventually the employee developed right hand pain and soreness.  The first medical record of treatment for the right hand and wrist is from October 27, 1997, when the employee was seen in the emergency room of St. Mary’s Hospital, giving a history of having lifted wet laundry from the floor ten days previously and “has had worsened right wrist pain since.”  Doctors diagnosed a possible flexor carpi radialis tendon rupture at that time and placed the employee’s wrist in a supportive splint.  The employee treated with Dr. Cooney the next day, at which time he recorded that the employee had “felt a pop while lifting wet clothes.  Primarily, she is using just her right hand.  She felt a snap, and a lump formed.”  After reviewing an ultrasound, Dr. Cooney opined that it was unlikely that there was a tendon rupture and that it was “more likely the patient had a strain of the wrist causing swelling around the tendons which then aggravated the previous ganglion cyst, making it currently symptomatic.”  Treatment of the ganglion cyst was delayed, apparently because the employee was scheduled for surgery on her other wrist.^[3]

 The employee returned to Dr. Cooney on December 31, 1997, at which time he recorded a history of the employee having had swelling and tenderness in the right wrist after having fallen two weeks before.  X-rays did not reveal any fracture, but the employee’s wrist was placed in a plaster cast.

On May 29, 1998, Dr. Cooney issued a report indicating that “[d]uring the [employee’s] treatment for her left wrist, she was forced to use her right wrist related to daily activities and developing increasing pain in her right wrist which culminated in a full blown reflex sympathetic dystrophy.”  He further opined,

On October 21, 1998, the employee filed a medical request seeking, in part, payment of medical expenses incurred in treatment of her right hand and wrist.  The matter proceeded to an administrative conference, and in an order filed thereafter a compensation judge ordered the employer to pay the claimed expenses.  The employer then filed a petition for formal hearing, which came on for hearing on March 5, 1999.  In findings and order filed on May 4, 1999, the compensation judge found, in part, that the employee’s claim for a consequential injury to the right hand and wrist was foreclosed by the stipulation for settlement and that the employee did not prove that she had sustained a consequential injury to her right hand and wrist as a result of her work injury.  The employee appeals from these findings and also petitions this court to vacate the 1992 award on stipulation.

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 (1992).  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 employee contends that the compensation judge erred in concluding that the 1992 stipulation barred any claim the employee might have for future consequential injuries.  We agree.

In Sweep v. Hanson, 391 N.W.2d 817, 39 W.C.D. 51 (Minn. 1986), the Minnesota Supreme Court held that a stipulation was broader than permissible where it purported to close out claims for work-related injuries for which an employee had made no claim and which were not a subject of dispute between the parties at the time of the settlement.  Relying on Sweep, this court has held that stipulation language is impermissibly broad where it purports to compromise claims for consequential injuries that were not in existence and not a subject of dispute between the parties.  See Munkelwitz v. Bladholm Bros., slip op. (W.C.C.A. July 28, 1993) (alleged consequential left knee injury not closed out in full and final stipulation settling right knee injury where there was no evidence or claim of left knee injury at the time of settlement); see also Golen v. J.C. Penney Co., slip op. (W.C.C.A. Oct. 27, 1993) (full, final, and complete settlement closing out all claims “past, present and future, known or unknown, relating to the personal injury” did not close out a claim for consequential depression, where there was no evidence or claim of a psychological injury at the time of the stipulation).  Accordingly, we conclude here that the 1992 stipulation for settlement did not close out the claimed consequential right hand and wrist injury, and we reverse the compensation judge’s finding to the contrary.

The employee contends that inconsistent findings by the compensation judge compel the conclusion that her right hand and wrist condition is a compensable consequence of her work-related left wrist condition.  We agree that the judge made inconsistent findings, but we do not agree that those inconsistencies compel a finding of compensability as to the employee’s right hand and wrist.

The compensation judge at Finding 7 found in part:

Notwithstanding our conclusion that the judge erred in rejecting Dr. Cooney’s opinion on foundation grounds, we might have affirmed the judge’s ultimate conclusion if there were any indication, in her decision, that the judge had another, legitimate basis for denying the employee’s claim.  The employer contends that the compensation judge “found” that the employee’s right hand and wrist problem was caused by the laundry lifting incident in October of 1997 and the fall in December of 1997.  While the judge made findings outlining treatment following those incidents, she never made an ultimate finding that those incidents were the sole cause of the employee’s right hand and wrist condition.  Neither did the judge ever indicate that she found the employee’s testimony or the opinions of Dr. Cooney to be lacking in credibility.  The judge also did not expressly accept a contrary causation opinion; in fact, it appears that no contrary causation opinion was offered.

For all of the reasons indicated above, we are compelled to vacate the judge’s decision as to the claimed consequential injury and remand the matter for reconsideration and additional findings on that issue.  On remand, the judge should give specific reasons for whatever findings she might make on that issue.  The issue of the compensability of medical expenses incurred in treatment of the employee’s right hand and wrist should also be addressed.  We do not intend to imply that the judge must award the benefits in dispute, only that she must make findings adequate to resolve the dispute and to provide a reasonable basis for review in the event of another appeal.  The judge should base her decision on the current record.

The employee petitions to vacate the 1992 award on stipulation on the basis of a substantial change in condition. For pre-July 1992 awards, the inquiry is limited to the extent of improvement or worsening of the injury; the change in the employee’s condition need not be unanticipated.  Franke v. Fabcon, Inc., 509 N.W.2d 373, 49 W.C.D. 520 (Minn. 1993).

A number of factors may be considered in determining whether an award should be vacated based on a substantial change in condition, including:

The employee did not discuss the Fodness factors in her petition to vacate.  No medical records from 1992, or earlier, were introduced, so there is no evidence of what the employee’s diagnosis was at the time of the award on stipulation.  However, Dr. Cooney did state, in his July 15, 1999, affidavit, that the employee has developed medial epicondylitis in the left elbow that was not present in May of 1992.  Thus, it appears that there has been a change in diagnosis.

At oral argument, counsel for the employee contended that the employee was working and going to school at the time of the award on stipulation but is unable to work at this time.  The employer denies that allegation, and language in the stipulation itself would suggest that the employee was not working at the time of the stipulation for settlement, as the employee was claiming “ongoing weekly benefits for temporary total disability.”  Therefore, even assuming that the employee is physically unable to work at the current time, her situation has apparently not changed in this regard since the time of the award.^[6]

The employee makes no allegations of increased permanent partial disability.  The stipulation reflects that the employee was claiming 48% permanent partial disability of the left hand and wrist, and no medical records were provided that would indicate that any doctor has subsequently rated the employee as having greater permanency.

The employee has had more extensive medical treatment to the left hand and wrist since the time of the award on stipulation, and Dr. Cooney indicated that surgery was not indicated or contemplated at the time of the award on stipulation.  However, less emphasis is placed on this factor where, as here, medical expenses have not been closed out by the award.

Dr. Cooney does relate the employee’s current symptoms to her work injury.  However, because there is no evidence of a change in the employee’s ability to work or any increase in her permanent partial disability, and because medical expenses were left open as they relate to the left hand and wrist, we find an inadequate basis for vacating the award on stipulation, and we deny the employee’s petition.