The employer appeals from the compensation judge’s award of a neurological consultation.  The basis of the employer’s appeal is that the compensation judge determined that the employee’s perianal pain was not causally related to her work injury, and as such, the requested neurological consultation is not compensable.  We remand it to the compensation judge for clarification of the apparent contradiction in Finding 18 and 19.

On September 22, 2010, while in the employ of Schwan’s Global Supply Chain, Inc., the employee, Adelina Cid, suffered an injury to her low back.  This injury was admitted.  Over the course of the subsequent three years, the employee underwent three decompression surgeries at right L4-5.  The employee underwent decompression surgery on May 31, 2011, and May 10, 2012.  Prior to her eventual third decompression surgery which took place on September 5, 2013, the employee began experiencing pain to the right of her anus.

On May 24, 2012, the employee presented with complaints of pain to the right of her anus.  A colonoscopy was recommended, performed, and paid for by the employer.  She had initially been assessed with hemorrhoids, but her pain persisted.  She began treating with Dr. Bryan Lynn of Summit Orthopedics in August of 2012 with complaints of perianal pain, as well as continued pain in her low back.  At that time, Dr. Lynn noted that the employee had had extensive evaluation of her anal discomfort, including a visit to a proctologist who could point to no abnormalities.

In January 2014, Dr. Lynn ordered an MRI in an attempt to identify a source of the employee’s pain complaints, and one was performed on February 28, 2014.  The MRI did not identify abnormalities to explain the employee’s symptoms.  Dr. Lynn’s March 4, 2014, office visit was described by the employee’s QRC.  In his report, the QRC explained that Dr. Lynn had recommended that the employee obtain a referral from her personal physician for a neurological exam to further address her perianal pain.

In the meantime, the employee continued to experience low back and right radicular pain.  Ultimately, a third decompression surgery was performed at L4-5 on September 5, 2013.  The employee’s low back pain had been assessed by Dr. Robert Wengler and by Dr. John Dowdle.  The employee’s perianal pain was not considered by these physicians prior to 2014.  In his October 29, 2014 report, Dr. Wengler stated that the perianal pain is related to the right lower extremity sciatica that is residual to the September 2010 disc herniation at L4-5.  And, in his August 19, 2014, report, Dr. Dowdle opined that the employee’s perianal pain is not related to her back condition or work injury on the basis that the L5 nerve distribution does not affect the perianal nerve.

This matter came on for hearing before Compensation Judge Miriam Rykken on January 14, 2015, on the employee’s request for formal hearing filed August 28, 2014, arising from a medical request dated May 16, 2014, which sought approval for the neurological consultation recommended by Dr. Lynn.  Identified at hearing as issues to be resolved were whether the employee’s perianal pain was causally related to her work injury, whether the neurological consultation is reasonable, necessary, and causally related to the work injury, and entitlement to attorney’s fees.

By Findings and Order dated February 5, 2015, Judge Rykken found that the preponderance of the evidence did not demonstrate that the employee’s perianal pain was casually related to the admitted September 22, 2010, work injury to her low back, but, that the preponderance of the evidence did demonstrate that a neurological consultation is reasonable and necessary for purposes of determining if the perianal pain is causally related to the work injury.  The employer appeals award of the neurological consultation.

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, 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), summarily aff'd (Minn. June 3, 1993).

The employer asserts that because the compensation judge found the employee’s perianal pain to not be causally related to the work injury, and that finding was not appealed, the award of the neurological consultation is contradictory to the causation finding.  The employer argues that because the employee’s perianal pain has been found to be not causally related to the work injury, no further “rule-out” measures can be compensable, and the neurological consultation must be denied.

At Finding 18, the compensation judge found, “[t]he preponderance of the evidence in the record does not demonstrate that [sic] employee’s perianal pain is causally related to the employee’s work injury of September 22, 2010.”  Then, at Finding 19, the compensation judge found, “[t]he preponderance of the evidence, however, demonstrates that a neurological consultation is reasonable and necessary for the purpose of determining if the employee’s perianal pain is causally related to the September 22, 2010 work injury.”  In her supporting memorandum, the compensation judge explained that the evidence submitted was insufficient to make a causation determination, but that a possible connection to the work injury should be explored.  The compensation judge went on state that this connection should be ruled out “prior to a conclusion on causation.”

It is relatively well-settled that diagnostic evaluations, such as the neurological consultation at issue here, are to be awarded for purposes of ruling out non-work-related causes of an employee’s current condition or symptoms.  See Klaven v. Northwest Med. Ctr., slip op. (W.C.C.A. Sept. 24, 1991).  Such evaluations are compensable whether the condition is found to be work-related or not.  Ploog v. Premier 94 Truck Servs., Inc., 72 W.C.D. 45 (W.C.C.A. 2012) (citations omitted).  According to the employer, because the employee’s perianal pain was specifically found to be not causally related to the work injury, the requested consultation is not compensable.  The employer cites to this court’s decisions in Borresch v. Stevens Community Med. Ctr., slip op. (W.C.C.A. Feb. 8, 2008) and Schweigert v. St. Louis Cty. Fed. Savings, slip op. (W.C.C.A. May 18, 1990), in which requested “rule-out” measures were denied upon a determination that the employees’ symptoms were not causally related to the work injury.

Upon this court’s reading of the Findings and Order, the employer’s argument that the finding of no causation and the award of the consultation as a “rule-out” measure are contradictory to one another is not without merit.  Further, consideration of the memorandum of the compensation judge does not provide clarification of this apparent contradiction.  It is not clear whether the compensation judge rejected a causal relationship between the admitted work injury to the low back and the current perianal symptoms, but was not ruling out a perianal-related injury as a result of the September 22, 2010, incident.  It is also not clear whether the compensation judge rejected a causal relationship between the L5 condition and the perianal symptoms, but was not ruling out sources of pain from the low back at levels other than L5.  Because the findings of the compensation judge, whether considered with or without her supporting memorandum, cannot be reconciled, this court remands the matter to the compensation judge for clarification with regard to the issue of causation.