The employee, Mary Gordenier, fell twice while working for the employer, The Original Mattress Factory, in December 2007.  The first fall occurred on December 13, 2007, and the employee sustained injuries to her low back, right hip, and head as a result.  The second fall occurred on December 21, 2007, and the employee sustained additional injuries to her left wrist, left knee, and low back as a result.  The employer and insurer admitted liability for injuries to the employee’s lumbar spine, bilateral hips, left thumb, and bilateral wrists.

The employee continued medical treatment but was not able to return to work.  The employer and insurer sought an independent medical examination with Dr. Mark Friedland on July 7, 2008.^[1]  The employee was complaining of symptoms including right gluteal and posterior thigh pain extending to the knee, and Dr. Friedland stated that the employee “admits to having experienced longstanding chronic cervical and low back pain since involvement in a motor vehicle accident in 1971.”  The employee also reported that her lumbar symptoms “pretty much went away” after the accident, but she did have ongoing low back flares and required “maintenance” chiropractor care.  In addition to taking a history from the employee and conducting a physical examination, Dr. Friedland reviewed voluminous medical records ranging from 1971 up to the date of the IME, including records from the accident and other clinic and chiropractic records.^[2]

Dr. Friedland ultimately concluded that the employee sustained only temporary injuries as a result of the December 13, 2007 injury.  He also determined that the employee sustained mere contusions as a result of the December 21, 2007 injury.  He based his conclusions on the employee’s long history of pre-existing medical treatment for low back issues and the employee’s reported diffuse total body pain, examination findings, and a diagram of symptoms reported to the employee’s chiropractor on July 18, 2007, which Dr. Friedland equated to the employee’s complaints after the falls at work in December 2007.^[3]  Dr. Friedland also noted the employee’s history of mental health issues and treatment.

In a September 22, 2008 report, Dr. Robert Wengler opined that the employee was continuing to suffer from low back problems in the nature of a “discogenic component”^[4] as the result of her injuries in December 2007.  He did not believe that clinical examination findings supported a diagnosis of sacroiliac disease, and he explained that right lower extremity symptoms were radicular in nature, secondary to destabilization of either one or both of the degenerative discs in the lower back.  He noted significant prior problems with the employee’s spine over the years before the work injuries, and he stated that the employee did have a history of low back pain and bilateral lower extremity radicular symptoms that the employee related to the December 2007 falls.

In 2009, the parties entered into a stipulation for settlement with regard to both of the employee’s 2007 injury dates, and the Office of Administrative Hearings served and filed an award on stipulation on August 7, 2009.  In the stipulation, the employer and insurer did “acknowledge”^[5] the employee’s December 2007 work injuries, but they specifically asserted that “the employee has sustained, at most, temporary aggravation of her pre-existing and underlying orthopedic conditions involving the spine and that she has otherwise recovered from all the admitted work injuries herein.”^[6]  The parties settled the employee’s claims on a full, final, and complete basis, but they specifically left open future claims for medical expenses “related to the low back only, provided they are proven to be reasonable and necessary costs of medical care causally related to the injury of December 13/14, 2007 and/or December 21, 2007 . . . .”^[7]  The employee withdrew any claims involving consequential bladder issues and mental health issues.  The stipulation resolved the employee’s claims for other benefits, including potential permanent total disability benefit claims.  There was no language in the stipulation that the parties were agreeing that the employee’s injuries were permanent in nature.

On October 15, 2009, the employee presented to Dr. Kristoffer Breien at Summit Orthopedics for an evaluation of her “right hip region.”^[8]  Dr. Breien noted that the employee had a “long complex history involving her multiple body systems.”^[9]  The employee reported a fall two years earlier, and Dr. Breien noted that “she says that set off the whole cascade of events.”^[10]  Dr. Breien examined the employee and noted that he suspected piriformis irritation in the right hip, and he stated, “It may be referred from her back or her SI joint, but it is pain right over the piriformis.”^[11]  Dr. Breien then recommended a piriformis tendon sheath injection.

Dr. Kristen Zeller Hack performed a right SI joint injection on October 22, 2009.  The employee reported complete resolution of her back pain with hip pain remaining following the injection.  In a note dated October 26, 2009, Dr. Zeller Hack indicated that a great deal of the employee’s pain was contained in the lateral aspect of the gluteal area near the posterior aspect of her hip.  Dr. Zeller Hack stated, “This was a result of a fall that she sustained.  She has been quite severely disabled secondary to this.”^[12]  The doctor proceeded with a right-sided piriformis injection, and the employee reported “complete resolution of her butt pain and hip pain.”^[13]

The employee saw Dr. Zeller Hack again on November 4, 2009.  The doctor noted the employee’s report of a fall two years earlier and that she “really did not have any back issues prior to that and then developed some lumbar spine problems.”^[14]  Dr. Zeller Hack stated that the employee was currently dealing with SI joint issues and piriformis syndrome.  She stated, “with piriformis, a lot of times there is a lumbar spine injury, that can throw the piriformis into spasm and that can linger on and continue to irritate people.  This is what I think likely occurred with Ms. Gordenier.”^[15]  The employee continued her course of treatment related to piriformis disorder in the right hip area, including rehabilitation, and she underwent additional injections with Dr. Zeller Hack at various locations in the right hip area.

In the meantime, the employee was also having urologic issues, and she was treating this condition with a urologic stimulator.  The employee’s physicians opined that the stimulator was interfering with her ability to manage and treat the piriformis disorder; therefore, it was determined that the stimulator needed to be moved to the opposite side of the employee’s body.

In February 2013, the employee filed a medical request seeking payment for treatment relating to piriformis disorder as well as payment for the procedure to relocate the urologic stimulator.  In the medical request, the employee argued that the treatment sought was related to her low back and that all treatment related to the piriformis disorder was reasonable, necessary, and causally related to the 2007 injuries.

The employer and insurer filed a medical response restating their position that the treatment sought was not reasonable, necessary, and causally related to the 2007 injuries.  They further stated that the piriformis treatment and stimulator were unrelated to the employee’s low back, and they cited their independent medical examination in support of their position.

Under Minn. Stat. § 176.106, the case was initially scheduled for an administrative conference at the Office of Administrative Hearings.  After Compensation Judge James Kohl spoke with the parties on April 1, 2013, the attorney for the employee as well as the attorney for the employer and insurer agreed to waive their right to an administrative conference and proceed directly to a full evidentiary hearing.  Judge Kohl issued an order canceling the administrative conference and referring the case for hearing and block assignment before a different compensation judge.  In accordance with Minn. Stat. § 176.106, the case was set for hearing on June 11, 2013 before Compensation Judge Cheryl LeClair-Sommer.

On May 7, 2013, the employee filed a pretrial statement in which she stated that the issues to be decided included “Whether medical treatment related to piriformis disorder is reasonable, necessary, and causally related to the December 14, 2007 and December 21, 2007 work injuries.”  The employer and insurer filed their pretrial statement on May 28, 2013.  They stated a number of issues to be decided, including:

The employer and insurer had scheduled the employee for another independent medical examination with Dr. Friedland on May 22, 2013.  However, the employee did not attend that examination, and the compensation judge granted a continuance of the hearing until the examination could be completed.

Dr. Friedland conducted a second IME on September 3, 2013.^[16]  He took an updated history from the employee, performed a physical examination, and reviewed updated medical records, including the urologic records, Dr. Wengler’s report, and the records from Dr. Breien and Dr. Zeller Hack.  Dr. Friedland opined that the employee’s 2007 work injuries had fully resolved no later than March 20, 2008.  He indicated that piriformis syndrome was an uncommon neuromuscular disorder caused by fibrosis or excessive tightness of the piriformis muscle at the gluteal region, and the symptoms would not be the diffuse pain described by the employee, but they would follow a more neurogenic pattern.  Dr. Friedland opined that the employee’s symptom description, including her description of relief after injections to various different locations in her hip and low back area, was consistent with a placebo effect and was not diagnostic of any anatomic explanation.  Dr. Friedland also stated that the movement of the bladder stimulator would not have been necessary to treat the piriformis disorder, and he opined that many of the other treatments at issue would have been excessive and redundant.  Furthermore, he opined that any ongoing use of medications was contraindicated.

The case proceeded to hearing on October 31, 2013.  At the beginning of the hearing, Compensation Judge LeClair-Sommer listed the issues, and she stated that the first issue to be decided was “the nature and extent of the December 13th in 2007 and December 21, 2007, [injuries] that’s whether the [injuries are] temporary or ongoing.”^[17]  No party objected to, corrected, or modified this statement.

The compensation judge, in her findings and order, ultimately determined that Dr. Friedland’s opinions were persuasive.  She stated that “The December 13, 2007, and December 21, 2007 work injuries resolved by March 2008, according to the opinion of Dr. Friedland, which was accepted in its entirety.”^[18]  The compensation judge went on to find that the 2007 work injuries had not been proven to be a substantial contributing factor to the diagnosis of the employee’s piriformis condition.  She based this finding on the opinions of Dr. Friedland and his determination that the employee did not exhibit objective findings of piriformis syndrome on examination.

The compensation judge further determined that the employee’s work injuries were not substantial contributing factors in the medical treatment expenses at issue, including the movement of the bladder stimulator from one side to the other.^[19]  The compensation judge also denied the various medical expenses claimed, including the intervention claims, reimbursement of out-of-pocket expenses, prescription medications, pharmacy expenses, medical mileage, and parking costs.  The employee appeals.

The employee argues that the compensation judge’s findings and order should be vacated as exceeding the scope of her authority and addressing issues beyond the scope of the medical request.  We are not persuaded by the employee’s arguments.

Although there were some delays in the litigation, this case proceeded under the expedited hearing process as outlined in Minn. Stat. § 176.106.  When an administrative conference is initially scheduled before a compensation judge, the judge “may refuse to hold an administrative conference and refer the matter for a settlement or pretrial conference or may certify the matter to the Office of Administrative Hearings for a full hearing before a compensation judge.”^[20]  The employee relies on Minn. Stat. § 176.106, subd. 7, for her argument that the compensation judge improperly expanded the scope of the hearing.  Minn. Stat. § 176.106, subd. 7, allows parties to request a full de novo hearing after issuance of a decision following an administrative conference.  Minn. Stat. § 176.106, subd. 7, is similar to Minn. Stat. § 176.238, subd. 6(b), which outlines the expedited hearing procedure for discontinuing compensation.  Minn. Stat. § 176.238, subd. 6, states that “the hearing shall be limited to the issues raised by the notice or petition unless all parties agree to expanding the issues.”  This limitation of issues is also applied in expedited hearings held pursuant to Minn. Stat. § 176.106.^[21]  “Limiting the issues to those raised in the initial request is primarily a question of fairness.”^[22]  Therefore, the proper inquiry on appeal is whether a party has had sufficient notice of an expanded claim or issue, including primary liability issues, to present its case.^[23]

The shortened timeline imposed by expedited proceedings underscores the importance of a discussion on the record between the compensation judge and the parties to confirm the scope of the hearing and the issues to be decided.  At the start of the hearing, the compensation judge stated on the record what issues she would determine as a result of the hearing.  The compensation judge specifically stated that she would determine the nature and extent of the December 2007 injuries and whether the injuries were “temporary or ongoing.”^[24]  The compensation judge then restated that first issue in her written findings and order as “What is the nature and extent of the December 13, 2007, and December 21, 2007 work injuries (temporary or ongoing)?”^[25]

The employee argues that the medical request she filed did not seek a determination on the permanency of the admitted 2007 low back injuries.  She argues that the medical request dealt with a very narrow issue and that the hearing was intended to address only treatment related to piriformis disorder.  The employee maintains that there was never an agreement between the parties to expand the scope of the medical request, and that it was improper for the compensation judge to determine that the employee’s injuries were temporary in nature.  Given the facts in the record we are not persuaded by the employee’s arguments for the reasons stated below.

The core of the employee’s argument at hearing and on appeal is that she had ongoing issues with her low back that led to the development of piriformis disorder and that this condition was causally related to the 2007 injuries.  The medical request stated that all treatment related to the piriformis disorder was reasonable, necessary, and causally related to the 2007 low back injuries.  The employer and insurer’s medical response stated that the treatment sought was not reasonable, necessary, and causally related to the 2007 injuries, and they argued that the employee’s condition was unrelated to the employee’s low back.  In their pretrial statement, the employer and insurer asked the compensation judge to decide whether the treatment was related to the 2007 low back injuries or, in the alternative, had the employee fully recovered from the effects of those work injuries.  They also asked the compensation judge to determine the nature and extent of employee’s disability following the claimed work injury, the symptoms and complaints associated with the work injury, and whether or not the piriformis disorder was related to those symptoms.

The employer and insurer also indicated in their medical response that they would be relying, in part, on the opinions of their independent medical examiner, Dr. Friedland.  Dr. Friedland opined that the employee’s 2007 work injuries had fully resolved no later than March 20, 2008 and that the employee’s piriformis syndrome was an uncommon neuromuscular disorder caused by fibrosis or excessive tightness of the piriformis muscle at the gluteal region.  By contrast, the employee presented medical evidence from Dr. Breien and from Dr. Zeller Hack, including Dr. Zeller Hack’s statement that “with piriformis, a lot of times there is a lumbar spine injury, that can throw the piriformis into spasm and that can linger on and continue to irritate people.”^[26]

An inquiry by a compensation judge at the beginning of a hearing as to the scope of the hearing provides the parties with a realistic understanding as to what will be considered during the hearing as well as a reasonable expectation as to what each party may accomplish as a result of the hearing.  Here, the compensation judge stated on the record at the beginning of the hearing her understanding of what each party was seeking as a result of the hearing.^[27]  Counsel did not object to, modify, or correct the compensation judge’s statement.  We find that the compensation judge’s statement of the issue to be addressed was straightforward and clear, and it provided sufficient notice that the nature and extent of the employee’s injuries were at issue.  As such, the compensation judge’s finding of temporary work injuries is consistent with the reasonable expectations of the parties as defined at the hearing, and we cannot conclude that the compensation judge undermined the basic principles of the scope of an expedited hearing, thereby exceeding her authority pursuant to the statute and rules.  Because the employee had sufficient notice of the issues that would be determined at the hearing, including the nature and extent of the injuries, we conclude that the compensation judge did not improperly expand the issues decided at the hearing.^[28]

The employee further argues that in deciding that the employee’s work injuries were temporary in nature, the compensation judge improperly modified the terms of the stipulation, which will effectively deny payment for benefits that were agreed upon in the stipulation.  In addition, the employee argues that the compensation judge’s finding that the employee’s injuries were temporary in nature will likely bar future necessary and reasonable medical treatment for her low back under the principles of collateral estoppel and res judicata.

We see nothing in the language of the stipulation that expressed, inferred, or implied an agreement by the parties that the employee’s injuries were permanent in nature.  In fact, the employer and insurer maintained their causation defenses and expressly asserted that the employee sustained “at most, temporary aggravation[s] of her pre-existing and underlying orthopedic conditions, involving the spine and that she has otherwise fully recovered from all the admitted work injuries . . . .”^[29]  By doing so, the employer and insurer kept open, for future determination, the issue of the nature and extent of any injuries sustained by the employee in December 2007.  We see no specific meaning with respect to the language used in the stipulation that was modified by the compensation judge’s determination of the facts and legal issues arising between the parties.  The stipulation left open the issue of the nature and extent of the 2007 work injuries, and the compensation judge was permitted to resolve the stated issues on a case-by-case basis.

Based on the procedural history, the discussion on the record between the compensation judge and the parties on the issues she would decide, and the evidence in the record, including the stipulation for settlement, the compensation judge did not improperly expand the scope of the hearing when she determined that the employee’s injuries were temporary in nature.  We affirm.

The employee argues that the compensation judge erred by denying the requested medical treatment for piriformis disorder, including movement of the urologic stimulator, and that substantial evidence indicates that the employee’s treatment for piriformis disorder was reasonable, necessary, and causally related to the work injuries.  She argues that a number of medical providers, including Dr. Zeller Hack, link the employee’s treatment for piriformis issues to her low back injuries.  She also argues that the employee did not have chronic pain syndrome or similar issues, as Dr. Friedland characterized it, and that although Dr. Friedland opined that the employee’s injuries had resolved, the employer and insurer continued to pay temporary total disability benefits for more than a year before the settlement.

Generally, voluntary payment of benefits does not preclude a later denial of liability for those benefits paid.^[30]  Payment of benefits in this case prior to the settlement did not amount to an admission of liability for a permanent injury as the employee argues, and there was no allegation of prejudice to the employee in this case such that the employer and insurer would be prevented from later arguing that the 2007 injuries had resolved.

With regard to the nature and extent of the employee’s injuries, the compensation judge found that Dr. Friedland’s opinions were more persuasive than those of the employee’s treating physicians and Dr. Wengler.  This court will generally affirm the factual determinations of a compensation judge that are based on the choice between expert opinions, “so long as the accepted opinion has adequate foundation.”^[31]  On July 7, 2008 and September 3, 2013, Dr. Friedland obtained a history from the employee and conducted a physical examination.  He also reviewed the employee’s medical records in detail, dating back to a motor vehicle accident in 1971.  This level of knowledge is sufficient to afford foundation for the opinions of a medical expert.^[32]

The compensation judge went to great lengths to explain her choice to credit Dr. Friedland’s opinions over those of the employee’s treating physicians.  She cited the employee’s preexisting medical treatment prior to the work injury, including treatment to the low back, dating back to 1971.  The compensation judge noted the pain diagram that the employee completed with her chiropractor in July 2007, about six months before her work injuries, which was similar to the symptoms that the employee reported when she treated initially after her injuries in December 2007.  The compensation judge cited Dr. Friedland’s opinion that the piriformis syndrome would follow a more specific neurogenic symptom pattern and that the employee’s examination findings do not objectively support a piriformis diagnosis.  The compensation judge explained that she found it persuasive that Dr. Friedland had reviewed the employee’s extensive medical records, while her treating physicians had not.  The compensation judge also discussed the employee’s mental health history and noted that the employee’s treating physicians had not considered “the possibility that psychological factors may be a factor in the employee’s response to physical symptoms.”^[33]

Finally, the compensation judge explained in her memorandum of law that the employee’s treating physicians reached their piriformis diagnosis based, in part, on the employee’s self-reports and her reported relief responses to various treatments, including injections.  This explanation includes, implicitly, an indication that the compensation judge did not find the employee’s reports to her doctors and her own assessment of her symptoms to be sufficient to establish causation.  This type of assessment is left to the compensation judge, and we will not disturb it on appeal.^[34]

Generally, it is not the role of this court to reevaluate the testimony and evidence presented and choose different inferences from that evidence than the compensation judge.^[35]  The compensation judge did not err in determining that the employee sustained temporary injuries at work in December 2007, and because that determination is supported by substantial evidence, we affirm the compensation judge’s denial of the requested medical treatment.