JULIETTE P. AKAKPO, Employee/Appellant, v. CHILDREN’S HEALTH CARE and BERKLEY RISK ADM’RS, Employer-Insurer/Respondents, and MEDICA HEALTH PLANS, HENNEPIN COUNTY MED. CTR., CTR. FOR DIAGNOSTIC IMAGING, PARK NICOLLET HEALTH SERVS., SILVERMAN ANKLE AND FOOT, and MINNEAPOLIS ORTHOPEDIC, Intervenors.

The pro se employee appeals the compensation judge’s denial of ongoing benefits. Because substantial evidence supports the compensation judge’s findings, we affirm.

Juliette Akakpo was born and raised in Togo in West Africa. She has lived in the United States for over 18 years and speaks both French and English. She worked in housekeeping for Children’s Hospital for 11 years beginning in 2004. As a housekeeper, the employee cleaned rooms, mopped floors, moved furniture, and took out trash. She testified that before August 25, 2015, she had no problems with her right ankle or knee.

On August 25, 2015, a nurse asked the employee to move a wheeled cart containing linen from outside a patient’s room. The employee unlocked the wheels with her foot and in doing so her right foot slipped.^[1] The employee “screamed” due to the pain and was taken to the emergency department at Abbott Northwestern Hospital.^[2] There she rated the pain at 10 out of 10. On examination, there was diffuse tenderness to the right foot, ankle and shin. No discoloration was noted. An x-ray of the foot and ankle was normal. The diagnosis was a sprain strain of the right foot. A few days later on August 31, 2015, she pointed to the dorsum of the foot as the main area of pain. She was released to return to unrestricted work. She returned to work, but complained of significant ongoing foot and ankle pain. Thereafter, she was intermittently disabled from work through January 1, 2016. The employer and insurer accepted liability.

The employee suffered a second injury on January 26, 2016. While at work and under restrictions, the employee sat in a chair that slipped from under her causing her to fall. She testified that she had pain in her knees, back, and up to her head, but the pain in her right knee and ankle were severe. The employer and insurer denied primary liability.

Before the employee suffered these two injuries, the record reflects that she had right lateral foot numbness, and chronic low back pain with subjective complaints outweighing objective findings. In August 2000, she claimed a low back injury due to lifting at work with a previous employer. She treated with Dr. Mary Arneson at Park Nicollet who noted on multiple occasions that the employee’s subjective complaints far exceeded the objective findings. Claiming she was unable to work, the employee saw Dr. John N. Dunne who noted that he had “no objective reason for her not to go to work….”^[3] After suspecting conversion reaction, Dr. Dunne referred her to a psychiatrist which the employee canceled. In an evaluation which was described as “adjunct to court proceedings,” she saw Michael A. Appleman, M.A., L.P., in 2001, who diagnosed her with conversion reaction so severe that it was unlikely that there will be much improvement.^[4] In 2009, she claimed she injured her left ankle at work. She was diagnosed with “flat foot” which was at baseline and likely bilateral.^[5] Again, the treatment records described the employee’s subjective pain complaints as outweighing the objective findings. She complained of left ankle pain in 2013. The medical record also reflects that after limping to and from the exam room, she was observed by two witnesses to walk normally at the conclusion of the medical appointment.^[6]

Following the injuries at issue in this litigation, on August 25, 2015, and January 26, 2016, the treatment records also describe similar responses to the pain. The employee was easily distracted from pain during examination.^[7] Her provider was suspicious of malingering behavior.^[8] The employee exhibited minimal amounts of swelling at the right ankle, and when distracted by the provider, the employee showed no problem with her right ankle.^[9] The employee requested work restrictions, but her provider “advised her that [he] did not have a medical reason at this time to restrict her from her job.”^[10]

The employee sought treatment with two orthopedic surgeons. She saw Lance M. Silverman, M.D., for her right foot and ankle pain. She saw Douglas A. Becker, M.D., for her right knee pain. Dr. Silverman diagnosed the employee with mild chronic calcaneofibular ligament sprain injury and noted a two millimeter osteochondrial lesion. He restricted the employee to a sit down job and to wearing an ankle brace for symptom control. After the examination and diagnostic studies were completed, Dr. Silverman recommended surgery in the nature of right lateral ankle ligament reconstruction. Likewise, Dr. Becker ordered an MRI of the right knee which showed a torn medial meniscus which he attributed to the January 26, 2016, injury. He recommended arthroscopic surgery in the nature of a partial medial meniscectomy and chondroplasty.

William T. Simonet, M.D., performed an independent medical examination (IME) on behalf of the employer and insurer.^[11] He examined the employee’s right foot and ankle and her right knee. He diagnosed the employee’s right foot and ankle condition as pain without objective evidence of pathology. Furthermore, he found the employee’s symptoms were out of proportion to the objective examination findings. In reviewing the MRI scan, he agreed with Dr. Silverman that it showed residual chronic calcaneal fibular ligament sprain with tiny two millimeter osteochondral lesion, but Dr. Simonet concluded that there was no evidence of marrow edema or instability. He opined that the MRI showed no indication of inflammation and the lesion was old, inconsequential and not symptomatic.

With respect to the right knee, Dr. Simonet diagnosed right knee pain without objective evidence of pathology. He opined that the employee complained of lateral sided knee pain, but the finding on the MRI scan was on the nonconcordant side and would not explain the cause of her lateral knee symptoms. While citing the employee’s long history of chronic low back pain prior to the alleged work injuries, Dr. Simonet noted that the low back complaints were also not related to the work injuries. With respect to both claimed injuries, Dr. Simonet concluded that the employee needed no further medical care or treatment, she was not restricted to work, she had reached MMI, and she had no whole body impairment.

The employee filed a claim petition on January 11, 2016, for the foot and ankle injury occurring on August 25, 2015, and later amended the claim petition to include a claim for the ankle and knee injuries allegedly occurring on January 26, 2016. The employer and insurer filed a petition to discontinue benefits in March 2016. The employee filed three medical requests including requests for right ankle and right knee surgery as recommended by Dr. Silverman and Dr. Becker respectively.

The matter came on for hearing before Compensation Judge Kathleen Behounek on June 7, 2016. The compensation judge found that the employee‘s foot and ankle injury of August 25, 2015, had resolved without the need for restrictions. She found that the claimed January 26, 2016, injury was not compensable. She further found that the medical treatment and recommended surgery were not causally related to either injury. The employee, who was represented by counsel at the hearing, appeals pro se.

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(3). 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).

On appeal, the pro se employee argues that the judge adopted Dr. Simonet’s opinion without “any investigations.” While we agree that the statute grants a compensation judge the power to make an independent investigation of the facts alleged in a petition, it is not required.^[12] A compensation judge is under no statutory obligation to independently investigate the IME’s opinion. All disputed issues of fact arising under this chapter are determined by a preponderance of the evidence, and in accordance with the principles laid down in Minn. Stat. § 176.001. “Preponderance of the evidence means evidence produced in substantiation of a fact which, when weighed against the evidence opposing the fact, has more convincing force and greater probability of truth.” Minn. Stat. § 176.021, subd. 1a.

In addition to offering evidence from her own medical experts, the statute requires that an employee submit to a medical examination by the employer’s doctor. Minn. Stat. § 176.155, subd. 1. Evidence related to health care must be submitted by party through written report. Minn. Stat. § 176.155, subd. 5. The employee is entitled to cross-examine the IME. Id. In this case, Dr. Simonet testified in a deposition prior to the hearing. Through her attorney, the employee was able to cross examine Dr. Simonet. The compensation judge explained that she reviewed Dr. Simonet’s deposition testimony and report. The compensation judge also reviewed the evidence and specifically, the reports of the employee’s medical experts, Drs. Silverman and Becker. The compensation judge found Dr. Simonet’s opinion more persuasive. The compensation judge’s choice of an expert is undisturbed where the facts assumed by the expert are supported by the evidence. Nord v. City of Cook, 360 N.W.2d 337, 342-43 (Minn. 1985)(citing Klapperich v. Agape Halfway House, Inc., 281 N.W.2d 675, 680 (Minn. 1979); McDonald v. MTS Sys. Corp., 43 W.C.D. 83 (W.C.C.A. 1990), summarily aff’d (Minn. July 13, 1990)). Because the facts assumed by Dr. Simonet are supported by the evidence, we affirm.

The employee also argues that the judge refused to see her doctors’ papers and photographs of the injury which she attached to her brief. She stated both in her brief and at oral argument that she wanted to present her evidence to the judge, but the judge “didn’t want to see [her] medical report, injurie pictures and she did not even call to [her] work place to investigate for [her] injuries.” (Sic.) ^[13] At the hearing, the employee was asked about the swelling of her foot. The employee answered that she had a photograph of her foot when she was at the emergency department.^[14] She said that the photograph showed that her foot was in fact swollen.^[15] She asked the court if it was possible to show those photographs.^[16] However, they were not offered into evidence at any time during the trial.

Medical evidence in support of the employee’s claims was introduced, admitted and reviewed by the compensation judge. On the record before her, the judge found Dr. Simonet’s opinion more persuasive which was well within her discretion. We disagree that we must now consider the photographs appended to the employee’s brief. The photographs were not offered as evidence at the trial. Generally, this court is limited to reviewing the record as submitted to the compensation judge. Minn. Stat. § 176.421 subd. 1(3). While the employee attached copies of the photographs to her appeal brief, we do not have the authority to consider evidence that was not part of the record before the compensation judge. See Minn. Stat. § 176.421, subd. 6; see also Gollop v. Gollop, 389 N.W.2d 202, 203, 38 W.C.D. 757, 758 (Minn. 1986); Land v. Washington County Sheriff’s Dep’t, slip op. (W.C.C.A. Dec. 23, 2003). Therefore, we will not consider the photographs appended to the employee’s brief.

Finally, the employee argues that evidence does not support the compensation judge’s denial of the employee’s claims. We disagree. Substantial evidence supports the compensation judge’s findings here. The judge reviewed the record, heard testimony from the employee, and reviewed the transcribed deposition of Dr. Simonet. She found that Dr. Simonet’s opinion was persuasive and consistent with the evidence. Dr. Simonet explained some of the inconsistencies in the medical records. He noted that the employee had reported pain complaints in her right foot with diffuse complaints through the lower extremity with an initial diagnosis of right mid-foot pain. After an MRI was ordered of the area and the findings were normal, the employee’s pain complaints then focused on the right ankle.

There were also inconsistencies in the record as to how the incident occurred. The employee first reported that the injury occurred when she released or lifted the break on the wheel. The August 31, 2015 treatment note specifically states that there was not a twisting injury. The first time she provided a history that her ankle “inverted” was during the examination with Dr. Silverman in February 2016, over 6 months after the August 25, 2015 injury. The compensation judge could reasonably infer from the foregoing evidence that no inversion occurred in the August 25, 2015 injury.

Likewise, the judge concluded that there were inconsistencies in the employee’s testimony and history of the January 26, 2016 injury. The employee reported knee complaints to the lateral side of her knee which were inconsistent with the MRI findings of a tear of the medial meniscus. Dr. Simonet noted that it was not until after the MRI that the employee started complaining of symptoms to the medial side of her knee. The compensation judge could reasonably infer from this evidence that the employee did not suffer a compensable work injury on January 26, 2016. Such an inference depends upon credibility determinations by the compensation judge. Such determinations are within the province of the trier of fact and are not disturbed by this court, unless manifestly contrary to the evidence. See Even v. Kraft, Inc., 445 N.W.2d 831, 42 W.C.D. 220 (Minn. 1989). We find no basis on which to reverse the compensation judge’s findings and, therefore, we affirm.