The employee appeals from the judge’s finding that his claim for permanent partial disability benefits was closed out by a prior stipulation for settlement.  We affirm.

The employee sustained a work-related low back injury and left inguinal hernia injury on August 8, 1985, while working for Travel Host Motel of Duluth [the employer].^[1]  The employee first sought treatment for the hernia and then began treatment for his low back problems.

The employee was seen by chiropractor Dr. Daniel Dock on February 28, 1986, complaining of increasing pain over the left SI joint.  The office note from that exam references a “loss of bladder control,” and Dr. Dock referred the employee to the Mayo Clinic.  Later that same day, the employee called Dr. Dock, stating “that the dribbling is just steadily getting worse” and that the SI pain was getting unbearable.  Dr. Dock advised him to go to the Mayo Clinic.

The employee was admitted to Mayo that night.  According to the admission note, “for past few days [the employee] has noted increased urinary frequency and some dribbling with voiding.”  He was diagnosed with mechanical low back pain and continued to receive treatment from Dr. Dock thereafter.

The employee underwent a lumbar laminectomy at L4 and a partial laminectomy at L3 in June of 1986.  In findings and order filed on November 14, 1986, these surgeries were found to be causally related to the employee’s 1985 work injury.

In February of 1988, the employee underwent surgery in the form of a left sacroiliac fusion.  Then, in July of 1989, the employee underwent a laminectomy at L4 on the left side.  That surgery included removal of scar tissue and foraminotomy.

In March of 1990, the employee underwent additional surgery in the form of a laminectomy at L4 on the left, with debridement of scar tissue on the lateral recess and then a lumbar fusion at the L4-5 level.  Later that month, the employee was readmitted to the hospital for relief of a hematoma at the site of the previous lumbar laminectomy.

On February 6, 1991, the employee was seen by Dr. R.T. Rutka, complaining that he “wasn’t voiding enough.”

On July 2, 1991, a medical conference was held on a medical request filed by the employee.  At that conference, the issues in dispute were listed as follows: the causal relationship between the employee’s admitted work injury to the lumbar spine and the employee’s cervical spine condition; the reasonableness and necessity of an MRI scan; and Dr. Dock’s charges for chiropractic treatment of the employee’s cervical spine condition.   The medical specialist found a causal link between “the work related lumbar spine injury and his frequent falls which led to the cervical spine injury” and awarded payment of the MRI and Dr. Dock’s charges.

On August 13, 1991, the employee saw Dr. Craig Anderson at the Skyline Family Medical Center for urinary incontinence and increasing back pain with leg weakness.  He gave a history of “loss of urine after voiding over the last wk, since a fall.”  The employee was admitted to St. Luke’s Hospital later that day, complaining of back pain, leg pain, leg weakness, and urinary incontinence.  The next day, the employee was seen by Dr. John Streitz, of Duluth Urology, for a urology consultation.  Dr. Streitz took a history indicating that the employee’s incontinence problems had begun three months before and had remained stable until eleven days ago, when he had developed increasing problems with urinary incontinence.  The doctor’s conclusion was “neurogenic vesical dysfunction, type unknown.” The employee was discharged from the hospital on August 17, 1991.

The employee called Superior Neurosurgery on August 19, 1991, reporting increased concern over leg pain and loss of bladder control, stating that he had had some more tests done.  He was told to contact the provider that performed those tests and have the results forwarded to the clinic.

The employee was seen at St. Luke’s Hospital again on August 23, 1991, with complaints of leg pain and voiding difficulty.  At that time, he gave a history of no change since his discharge on August 17, 1991, his complaints being “voiding frequently during the night with some dribbling.”  The doctor’s assessment included “unclassifiable neurogenic voiding disability.”

The employee was seen on September 20, 1991, by neurosurgeon Dr. Richard Freeman at Superior Neurosurgery, in follow up for his loss of bladder control.  Dr. Freeman noted, “[i]n view of the bladder dysfunction it is suspected that there may have been some damage to the bladder innervations over the sacral promontory as a result of lumbar disc surgery.”

In November of 1991, the parties entered into a stipulation for settlement.  The stipulation indicated that “the matter is currently before the Division” on the employer and insurer’s request for formal hearing in response to the July 15, 1991, medical decision and order.  That stipulation provided that the employer and insurer would pay the employee $153,500 “in full, final and complete settlement of all claims which Employee may now have or may have at any point in the future arising out of his compensable injury,” with the exception of “reasonable and necessary medical expenses arising out of the compensable injuries to his cervical and lumbar spine” and claims “for payment of nursing services.”  The stipulation also indicated that medical and chiropractic bills “currently outstanding, as reflected on Exhibit A attached hereto,” would be paid by the insurer.  Exhibit A included charges for treatment at Superior Neurosurgery, St. Luke’s Hospital, and Duluth Urology.  Permanent partial disability benefits were closed out on a full, final, and complete basis.  An award on stipulation was filed on November 22, 1991.

On or about June 4, 1996, the employee was assisting a neighbor in adjusting a tractor blade when he experienced numbness in and an inability to move his left leg.  He was subsequently seen at the Community Hospital in Spooner, Wisconsin, where it was noted that he had considerable lumbar pain and difficulty voiding.  He was provided with a Foley catheter.

The employee was seen at the Spooner Clinic on June 17, 1996, and noted difficulty with urination.  A catheterization was performed to drain urine but, on follow up on June 19, 1996, it was noted that the employee was still having difficulty with urine retention.

On June 26, 1996, the employee was seen at the Duluth Clinic for continuing urination difficulties, and, on October 25, 1996, he underwent placement of a suprapubic catheter and cystoscopy.

In November of 1997, Dr. Hess treated the employee with injections and medications for relief of pain in the employee’s left groin and in the area of the suprapubic catheter.

On February 5, 1998, the employee underwent surgery to augment the bladder, performed by Dr. Steve Siegel at United Hospital in St. Paul.  His recovery was complicated by wound dehiscence and infections, and he remained in the hospital until March 3, 1998.

The employee filed a medical request on May 3, 1999, seeking payment of medical expenses related to treatment of the back and bladder, and, in a findings and order filed on July 25, 2000, a compensation judge found the employer and insurer were liable for more than $139,000 in medical expenses related to the employee’s incontinence and bladder problems, because those conditions were “secondary to the work injury of August 8, 1985, and the treatment and surgeries secondary to the back injury.”  This court affirmed that decision.  Munn v. Travel Host Hotel, slip op (W.C.C.A., Mar. 15, 2001).

On September 24, 2008, the employee filed a claim petition seeking benefits for a 30% permanent partial disability, related to his bladder condition.  That matter proceeded to hearing, and, in a findings and order filed on November 20, 2009, a different compensation judge found that the 1991 stipulation for settlement barred the employee’s claim.  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 (2008).  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).

On appeal, there is no dispute that the employee has a 30% permanent partial disability related to his bladder condition.  The only issue is whether that claim for permanency is closed out by the 1991 stipulation for settlement.  The employee contends that the compensation judge incorrectly interpreted applicable case law in denying the employee’s claim for permanency and that his decision is clearly erroneous and unsupported by substantial evidence.  We are not persuaded.

The compensation judge relied in part on the case of Jefferson v. Griggs Cooper, No. WC09-143 (W.C.C.A. October 26, 2009), in concluding that the employee’s claim was barred by the settlement agreement.  In Jefferson, this court held that a stipulation for settlement that closed out claims for a right leg injury precluded later claims for right knee problems where the employee had right knee complaints prior to the settlement.

The employee contends that the judge’s reliance on Jefferson was misplaced, citing instead to the cases of Sweep v. Hanson Silo Company, 391 N.W.2d 817, 39 W.C.D. 51 (Minn. 1986), and Fitzsimmons v. Alberta Gas Chemical, Inc., slip op. (W.C.C.A. June 27, 1995), as support for his contention that a stipulation covers only those claims that are specifically mentioned in the agreement.  Because, the employee argues, the stipulation for settlement in the instant case did not mention injury to the bladder, claims for that condition remain open.  While making this argument, the employee admits that the 1991 stipulation does not mention which specific injuries were to be closed out, and that, while the stipulation provides for a full, final, and complete settlement of claims “arising out of his compensable injury,” the stipulation does not define or otherwise describe what was meant by the term compensable injury.^[2]

The medical request and administrative decision that preceded the 1991 stipulation for settlement described the issue as being whether the employee’s cervical spine condition was causally related to the 1985 work injury, and the specific expenses at issue were bills from two medical providers - - Northern MRI and Dr. Dock.  However, the stipulation for settlement references, as Exhibit A, a list of “medical and chiropractic bills currently outstanding,” and includes an agreement that these bills be paid by the insurer.  Exhibit A lists not only bills from Northern MRI and Dr. Dock but also bills from Superior Neurosurgery, St. Luke’s Hospital, and Duluth Urology, among others.  Although no medical records were attached to the stipulation for settlement, records submitted at the hearing in the instant proceeding reflect that the employee had received treatment for bladder problems from each of those providers.  As such, the employee had obviously been claiming medical bills related to treatment for a bladder condition at the time of the stipulation, and those disputed claims were in fact resolved by the settlement.

The facts of this case do not fall neatly into existing case law.  However, the parties knew that the employee had been undergoing treatment for a bladder condition at the time of the stipulation for settlement.  Dr. Freeman had, prior to the settlement, related the employee’s bladder condition to the work injury, and the stipulation for settlement included payment of medical bills for treatment of a bladder condition.  Under these circumstances, and given the language in the stipulation, the compensation judge did not err in concluding that the settlement agreement closed out the employee’s claim for permanent partial disability of the bladder.  We therefore affirm the judge’s decision in its entirety.