MARGARET JAAFARU, Employee/Appellant, v. CERENITY SENIOR CARE and BERKLEY RISK ADMIN. CO., Employer-Insurer/Respondents, and HEALTHPARTNERS, HEALTHEAST CARE SYS., and MINNEAPOLIS ORTHOPAEDICS & ARTHRITIS INST., Intervenors.

The employee appeals the compensation judge’s finding that her injury did not arise out of her employment and the denial of her claim for benefits.  We vacate and remand for further consideration in accordance with this decision.

Margaret Jaafaru is employed as a certified nursing assistant at a care facility operated by Cerenity Senior Care, the employer.  She has been employed there since 1997 and cares for patients in the Alzheimer’s unit on the fourth floor of the care facility.

While working on February 5, 2018, the employee took her morning break with a coworker.  The employee and her coworker descended the stairs from the fourth floor to the first floor where the breakroom is located.  The employee was three steps from reaching the first floor when she felt a pop and immediate pain in her left knee while descending from the landing to the next step.^[1]   She did not fall.  She was not twisting or pivoting at the moment she felt the pop.

Submitted into evidence were photographs depicting a portion of the stairway.  The photographs show that the stairs were concrete, well-lit, and free of debris and defect, and that the stairway had handrails.  An individual descending the stairs would need to proceed from a landing to a set of three steps before arriving at another landing, then turn left to another set of steps.^[2]

The employee sought medical care for her left knee the day after the injury.  A few weeks later, she treated with Dr. Paul Yellin of Summit Orthopedics.  In his office note dated February 28, 2018, Dr. Yellin stated that because the employee was asymptomatic prior to the injury, it was his opinion that her current symptoms were related to her work injury.  He noted that the injury did not involve a twisting mechanism.  Nonetheless, Dr. Yellin opined that the work injury aggravated the employee’s underlying osteoarthritis and degenerative meniscus tear revealed on her MRI scan.  The employee later treated with Dr. Douglas Becker of Minneapolis Orthopedics, who ultimately performed left knee arthroscopic surgery in the nature of a partial meniscectomy and lateral meniscus debridement.  Following the surgery, the employee was off work, returning as of October 7, 2018, with nearly full resolution of her symptoms.

The employee was evaluated on behalf of the employer and insurer by Dr. William Simonet, who issued an independent medical report (IME) dated October 26, 2018.  Dr. Simonet noted the history he took from the employee, including that she felt a pop while walking down steps and that she was not twisting.  He reviewed the employee’s medical records and x-ray scans of her left knee.  It was Dr. Simonet’s opinion that the employee did not suffer an injury on February 5, 2018, but instead experienced a symptomatic manifestation of an underlying pre-existing degenerative arthritic condition and meniscal tear.  He stated that “simply walking down stairs” was not a plausible mechanism of the employee’s injury.  According to Dr. Simonet, the employee’s condition was not causally related to the February 5, 2018, work injury.

The employee’s treating orthopedist, Dr. Becker, was asked to provide his opinion regarding causation.  In a narrative report dated February 25, 2019, Dr. Becker outlined his treatment notes and provided responses to interrogatories submitted by the employee’s counsel.   Dr. Becker noted that he believed the employee’s symptoms following the February 5, 2018, work injury were likely due to new meniscus tearing.  He opined that the employee’s work injury was consistent with an axial load and twisting injury while descending stairs, leading to meniscus tearing and aggravation of her arthritic condition.

The employee filed a claim petition seeking payment of medical expenses incurred in the treatment of her knee.  She made no claim for wage loss benefits.  The employer and insurer denied liability for the claimed injury.  The matter was heard by a compensation judge on March 7, 2019, for a determination of whether the employee had sustained a compensable injury on February 5, 2018, and whether the left knee surgery was reasonable, necessary, and causally related to that work injury.

In his Findings and Order issued May 2, 2019, the compensation judge denied the employee’s claims.  He found that the stairs on the employer’s premises did not increase the employee’s risk of injury and determined that the employee’s injury did not arise out of her employment. 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(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).

The employee’s claim presented two issues for determination by the compensation judge.  First, whether the employee’s injury was caused by her use of the stairs on her employer’s premises.  Second, if causation is established, whether the employee’s injury arose out of her employment.  The judge failed to consider the first issue, and we vacate and remand for further findings.

The compensation judge was presented with causation opinions from two of the employee’s treating physicians, Dr. Yellin and Dr. Becker, and the IME opinion of Dr. Simonet.  The judge found that Dr. Yellin diagnosed the employee with a degenerative meniscus tear and osteoarthritic condition, both of which he believed were aggravated by the work injury.  (Finding 6.)  The judge also made a finding that the employee treated with Dr. Becker, and that Dr. Becker performed surgery.  (Findings 7 and 8.)  However, none of the findings reflect Dr. Becker’s causation opinion that the employee suffered a meniscus tear and aggravation of her arthritis as a result of an axial load and twisting injury while descending stairs.  Similarly, the findings make no mention of Dr. Simonet or his opinion that the employee’s condition was due to her pre-existing arthritic condition and not due to her use of the stairs.

In this case, the judge did not evaluate and discuss the medical evidence, nor did he weigh, consider, and choose between opposing medical expert opinion.  In Finding 11, the judge states, “neither Dr. Yellin nor Dr. Becker opined that the stairs themselves were the cause of the employee’s injury or increased the employee’s risk of injury.”  Contrary to the judge’s finding, both Dr. Yellin in his treatment notes, and Dr. Becker in his narrative report, opined that the employee’s pre-existing condition was aggravated by her descent of the stairs on February 5, 2018.  Dr. Becker further stated in his narrative report that the employee’s symptoms were a result of the work injury, that her mechanism of injury was consistent with an axial load and twisting injury causing a meniscal tear, and that the work injury resulted in both a meniscal tear and an aggravation of her arthritis.  (Ex. A.)  While the employee stated she was not twisting when she felt the pop and pain in her knee, the photographic evidence shows that descending the stairs at the location where the employee indicated she was injured requires turning to the left.  Even the compensation judge found that when she was descending the stairs, “the employee turned to her left and stepped on the first step when she felt her left knee pop.”  (Finding 4.)  To the extent causation was mentioned in the Findings and Order, the judge’s statement is not supported by evidence in the record.

The compensation judge’s denial of the employee’s claim instead focused solely on the second issue of whether the employee’s injury arose out of her employment.  Whether an injury arises out of employment is not a medical question.  It is a legal question, and one that is subject to de novo review.  See Hohlt v. Univ. of Minn., 897 N.W.2d 777, 77 W.C.D. 509 (Minn. 2017).

In an analysis as to whether the employee’s injury arose out her employment, the judge considered the adequacy of the medical opinions of Dr. Yellin and Dr. Becker.  At Finding 11, he stated, “Dr. Yellin and Dr. Becker do not explain how stairs could increase the employee’s risk of meniscus injury.”  (Finding 11.)  In his memorandum, he stated, “the employee did not provide any medical evidence or expert opinions showing that stairs increased her risk of injury.”  According to the judge, the employee did not meet her burden because she provided no medical evidence of an increased risk, no evidence of a defect in the stairs, no evidence of “other circumstances” present in Roller-Dick^[3] such that she could not use the handrail, and because her injury was not caused by a fall on the stairs.  The compensation judge erred in his conclusion.  An employee’s use of stairs increases his or her risk of injury.  See Forrest v. Children’s Health Care, 79 W.C.D. 31, 37 (W.C.C.A. 2018), summarily aff’d (Minn. Jan. 8, 2019) (“The stairs on an employer’s premises constitute an increased risk of injury, and for an employee … who is in the course of her employment and is injured on stairs located on her employer’s premises, the claim is compensable under Minnesota law.”); Lein v. Eventide, 78 W.C.D. 587 (W.C.C.A. 2017), summarily aff’d (Minn. Oct. 2, 2018).

Because the judge did not adequately address causation, we vacate and remand for further fact finding on this issue.