The pro se employee appeals the August 8, 2019, Findings and Order of a compensation judge denying his claims.  Because substantial evidence supports the findings of the compensation judge, we affirm.

The employee, Habtemicael Teclehaimanot, holds degrees in accounting, management, and economics.  He worked as an accountant for the employer, TCF Financial Corporation, beginning his employment in 2007.

The employee started in the employer’s cash utilization department as a reconciler.  In December 2009, he was transferred to the accounts payable department.  Within months of being transferred, the employee began experiencing pain in his neck and upper extremities.  Over time, his symptoms included pain and stiffness in the neck, with reduced range of motion, pain in his bilateral shoulders, arms, elbows, right thumb, and wrists, bilateral carpal tunnel syndrome, and lower back pain.  The employee reported these symptoms to the employer, identifying his ergonomically incorrect workstation as the source of his symptoms.

On February 11, 2010, the employee began receiving physical therapy treatment for neck and upper back pain attributed in part to posture problems.  One of the treatment goals was for the employee to use his computer for 80 percent of his work day without pain.  The employee attended physical therapy regularly until May 21, 2010.  The therapist noted that the employee utilized poor posture, even following repeated cues.  Therapy was concluded with the employee’s goals not met.

After the employee complained of the problems regarding his workstation, the employer arranged for an ergonomic study to be done by Brian Huseby, a board-certified safety professional with 30 years of experience in ergonomics.  Mr. Huseby is employed by Sentry, the workers’ compensation insurer of the employer.  In the ergonomic assessment done on April 29, 2010, Mr. Huseby recommended that the employee receive a document holder and a telephone headset/shoulder rest.  He also recommended that the employee be allowed to take mini-breaks and change positions every 20 minutes when working at a keyboard, and that the employee’s chair should be replaced to provide full back support and allow seat adjustments.  Various adjustments were recommended for the employee’s keyboard and regarding the height of his computer monitor.  Finally, a larger computer mouse and a wireless telephone headset were recommended.  Some changes to the employee’s workstation were made consistent with those recommendations.

On June 11, 2010, the employee underwent an MRI scan of his neck.  The scan showed degenerative disc disease at multiple levels and a disc protrusion at C5-6 effacing the spinal cord.  A later MRI scan of the neck was done on November 2, 2012, showing the C5-6 disc was now herniated causing mild deformity of the left C6 nerve root.  On the same date, the employee had an MRI scan of his low back, which showed multi-level facet osteoarthritis, most pronounced at L5-S1.

In December 2010, the employee began receiving chiropractic treatment from Dean Bruns, D.C.  On January 12, 2011, Dr. Bruns recommended that an ergonomic assessment of the employee’s workstation be performed.  The employee described some benefit from the application of heat and traction and the treatment was discontinued on January 18, 2011.

Mr. Huseby completed a second ergonomic assessment on January 25, 2011, and recommendations were made similar to those in the first assessment.  Adjustments of the location of the employee’s telephone were also recommended.

On May 15, 2012, Mr. Huseby completed a third ergonomic assessment, and again recommended mini-breaks for the employee.  The employee’s chair was noted to be in good condition, of the proper height, and with good back support.  Adjustments to keyboard tray and keyboard height were recommended.  Mr. Huseby found the monitor and document holder to be in proper order and were able to be adjusted by the employee.

On December 19, 2012, the employee was examined by Sherief Mikhail, M.D., of Minnesota Spine Rehab.  The employee complained of pain in his neck, low back, and right wrist. Dr. Mikhail diagnosed cervical and lumbar radiculopathy, and right carpal tunnel syndrome.  He recommended splinting of the employee’s right wrist and an active rehabilitation program to treat the neck and low back.  Over the course of the next several years, the employee followed up with Dr. Mikhail with similar complaints.  The employee connected his symptomology to an ergonomically incorrect workstation.  Dr. Mikhail opined that the employee’s diagnoses were work-related.  Absent from Dr. Mikhail's treatment notes is any description of the employee’s workstation other than the employee’s statement that the workstation was not ergonomically adjusted.  Dr. Mikhail also recommended various anti-inflammatories and pain medications.  He limited the employee, at various times, to no work and later to restrictions of minimal lifting, carrying, pushing, and pulling.  On February 25, 2013, Dr. Mikhail recommended that the employee receive an ergonomically correct workstation including a sit/stand desk and that the employee be allowed to change positions as needed.

At the request of the employer and insurer, the employee was seen by David Carlson, M.D., for a medical examination on January 31, 2013.  Dr. Carlson submitted his report to the employer and insurer on February 13, 2013.  Dr. Carlson had the various ergonomic studies, as well as medical records from Allina Clinics and Minnesota Spine Rehab, among other documents, to review.  Dr. Carlson’s physical exam noted that the employee exhibited a limp at the beginning of the exam but that he walked out of the exam without a limp.  During questioning with Dr. Carlson, the employee was able to move his neck from side to side and up and down without restriction, pain complaints or pain behaviors, yet when he was asked to bend his neck specifically by Dr. Carlson, he was unable to make those range of motions.  The employee reported that he could not heel to toe walk, bend at the waist, or make other motions during the exam, but was observed to make all of those motions while meeting with Dr. Carlson.  The employee reported tenderness “pretty much globally” for the neck, shoulders, forearms, down to his legs.  Dr. Carlson opined that there was no objective medical evidence to provide any specific medical condition or injury and that the employee essentially had a normal exam with subjective complaints “well out of proportion to his clinical objective exam findings.”

A fourth ergonomic assessment by Mr. Huseby was done on March 28, 2013, and again included a recommendation of mini-breaks.  Various adjustments of the workstation were also recommended.

On April 22, 2013, Dr. Mikhail rated the employee’s permanent partial disability (PPD) at 10 percent due to his neck under Minn. R. 5223.0370, subp. 3.C(2) and another 10 percent due to his low back under Minn. R. 5223.0390, subp. 3.C(2).  Dr. Mikhail’s notes continually reaffirm the need for the employee to have an ergonomically correct workstation and bemoaning the delays by the employer in providing the recommended ergonomic adjustments.

At the employer and insurer’s request, Jonathan Reynolds, Ph.D., P.T., performed a functional capacity evaluation (FCE) of the employee and the modified workstation.  Dr. Reynolds submitted a report dated May 23, 2014.  Dr. Reynolds noted the employee, “presented with numerous non-organic signs, including five out of a possible seven Waddell signs^[1].  His reports of his pain were unreliable and exaggerated.  His movement patterns were noted to improve when he was distracted.  In some instances, his pain behaviors completely disappear.”  In his report, Dr. Reynolds also noted the employee failed to put forth maximum voluntary effort and that his perceived function was inconsistent with his actual function.  Dr. Reynolds found that while he did make some ergonomic recommendations, the employee’s workstation “was close to ideal.”  Dr. Reynolds recommended a wireless mouse, a Bluetooth headset, a document holder that must be placed on the side of the monitor or on the desk, and some adjustments to the keyboard relative to desk height.  He also recommended changes in postures every 20 minutes and one-minute breaks every hour.

At a follow-up with Dr. Mikhail on November 15, 2013, the employee reported that the workstation was almost completely functional.  At his last visit with Dr. Mikhail, on July 28, 2014, the employee reported that the ergonomic changes were completed and have been helpful.  Dr. Mikhail also noted that PPD was unlikely to result from the aggravation of the employee’s condition, but that the employee was not yet at MMI.

On February 13, 2014, the employee was examined by Michael Forseth, M.D., for right thumb pain and clicking.  Dr. Forseth diagnosed stenosing tenosynovitis from repetitive motion and performed an injection to address the symptoms.  The employee received treatment for similar complaints of pain in both right and left thumbs and several fingers through 2017.

The employee underwent cervical and lumbar MRI scans on February 17, 2014.  The scan of the low back showed moderate stenosis.  The scan of the neck showed multi-level spondylosis and stenosis with effacement or impingement on several nerve roots.  Another lumber MRI scan on June 17, 2015, showed multiple levels of degenerative disc disease.

William Simonet, M.D., performed a medical examination of the employee at the request of the employer and insurer and wrote a report dated March 14, 2014.  Dr. Simonet noted that that the employee had normal spine alignment and motion but when asked to demonstrate range of motion “of his neck, he suddenly holds himself very rigidly claiming that he can't move his neck at all.”  He complained of diffuse tenderness despite having a normal sensory exam.  He had the same rigidness and inability to exhibit range of motion with the lumbar spine when asked to do so, but full range of motion when distracted.  Dr. Simonet diagnosed a “somatoform pain disorder (hypochondriasis)” with a long history of multiple symptoms out of proportion to objective findings.  Dr. Simonet was of the opinion that the employee’s workstation did not cause, accelerate, or exacerbate any of the employee’s diagnoses or conditions, and in fact the employee had an no objective evidence of any injury and that his complaints are “unexplainable and excessive of objective pathology.”  He stated, “I don't think that the patient is malingering on a volitional basis.  I think his symptoms are more on a psychiatric basis.  He simply has somatoform disorder and hypochondriasis.  He simply perceives that every ache and pain in his body is of some significance.  He perceives that any movement of his body causes injury.  Frankly, quite the opposite is true.”

On February 27, 2015, Robert Wengler, M.D., performed a medical examination at the request of the employee’s former attorney and submitted a report.  Dr. Wengler stated that “the common denominator [of the employee’s multiple orthopedic complaints] appears to be due to the degenerative changes demonstrated in the cervical and the lumbar spine.  His demeanor and pain behavior appeared to be exaggerated, although I believe the neck pain, the headaches, the limited motion of the cervical spine, the radicular symptoms into the periscapular regions, and both upper extremities are secondary to discogenic disease in the cervical spine.”  Dr. Wengler went on to state that the degenerative changes “undoubtedly predated his assignment to cash utilization department.  The ‘poor workstation’ which he describes apparently caused stresses to the spine which rendered deteriorated motion segments of the spine to be symptomatic.  As such, his neck and low back problems may be considered the product of a Gillette injury.”  Dr. Wengler assessed various PPD ratings for the neck and low back.  At that time Dr. Wengler did not believe the employee had specific injuries to either hands or either thumbs.  Dr. Wengler stated that the employee exhibited exaggerated pain behavior and had diffuse tenderness to “virtually every part of his body that is examined.”

The employee obtained physical and occupational therapy at Abbott Northwestern Hospital.  In June 2015, the therapist noted 5 of 7 Waddell signs, an Oswestry^[2] score of 80 percent, and a Neck Disability^[3] score of 82 percent.  On July 27, 2015, the physical therapist reported that the “patient continues to report high pain levels even though he moves fairly easily around the clinic.”  On July 29, 2015, the physical therapist noted that the employee was observed removing his sandal, bending and twisting to do so, without any signs of pain behavior, but when getting onto an exercise bicycle, without bending, he “complained of the pain and made noises indicating pain.”  On the same date, the therapist noted that the employee had low back symptoms radiating into both legs, and that the employee had numerous Waddell findings making exam findings difficult.  He showed non-anatomic weakness and sensory distribution of both his upper and lower extremities.

On August 21, 2015, an MRI scan of the employee’s left shoulder was completed.  It showed a partial thickness tear of the supraspinatus tendon of moderate severity.

On October 21, 2015, at physical therapy, the therapist was unable to assess certain measurements and testing because “everything/every motion was painful.”  On the same date the therapist noted numerous inconsistencies in pain behavior throughout the evaluation, stating, “patient was observed walking into clinic at normal gait speed and reached into overhead locker without hesitation.  He was also able to climb onto stationary bike and UBE [upper body ergometer] without any pain behaviors, however, when asked to climb onto treatment table, he reported 10/10 pain and was very slow and guarded with all of his motions.”

Additional MRI scans were performed on August 9, 2016.  The scan of the neck showed progressive degenerative disc disease and a left paracentral disc herniation at C5-6.  The low back scan showed degenerative disc disease.  The left shoulder scan showed the tear of the supraspinatus tendon.

Dr. Simonet issued a second report to the employer and insurer on August 10, 2018, following an examination of the employee.  Dr. Simonet highlighted various medical records he received from the employer and insurer, including the FCE done by Dr. Reynolds, and medical records from at least eight separate medical providers.  He also reviewed CD images of scans from three separate providers.  Dr. Simonet made similar observations of the employee freely moving about the examination room and then unable to move very well when asked to do so.  He also noted the employee’s diffuse nonspecific complaints.  Dr. Simonet made the same diagnosis of somatoform disorder and hypochondriasis and opined that the employee did not have any significant orthopedic symptoms or diagnosis, and that regardless, none of the employee’s symptoms can be explained by his workstation.

On August 12, 2016, the employee was seen by Jackson Maddux, M.D., of Twin Cities Orthopedics.  The employee presented to Dr. Maddux with “multiple pages of all the various visits and evaluations that he has had over the years,” including MRI reports.  Dr. Maddux noted an essentially normal examination although he suggested that the symptoms were non-orthopedic and perhaps neurologic.  The employee then treated with Nadeem Iqbal, M.D., of Neurological Associates of St. Paul on October 4, 2016.  Dr. Iqbal diagnosed the employee with a fibromyalgia syndrome noting that other than a partial thickness tear of the left supraspinatus tendon of the shoulder, “there was nothing on imaging to account for his symptoms.  Patients [sic] exam shows inconsistent effort, tearfulness, and much anxiety surrounding his work.”  Dr. Iqbal “strongly recommended patient start an antidepressant and see a psychologist.”

Dr. Wengler performed a second examination of the employee at the request of Dr. Mikhail.  In a report dated September 26, 2018, Dr. Wengler noted x-rays of the right shoulder showed early degenerative changes of the AC joint.  He reviewed the employee’s various MRI scans.  Dr. Wengler diagnosed the employee as having discogenic cervical spine pain, bilateral subacromial impingement of the shoulders, an incomplete tear of the rotator cuff of the left shoulder, bilateral carpal tunnel syndrome, and trigger fingers on both thumbs and both middle fingers.  He considered the employee to be a candidate for discectomy, decompression, and fusion at C5-6.  He attributed the employee’s orthopedic problems “to stresses that occurred during his employment at what [the employee] described as ‘bad’ workstations ….”  Dr. Wengler provided various PPD ratings for the employee’s neck, bilateral shoulders, wrists, upper extremities, thumbs, and middle fingers.

Dr. Simonet issued a final report on December 12, 2018, after having reviewed additional medical records.  These additional records, including the reports of Dr. Wengler, as well as at least seven additional providers, did not change Dr. Simonet’s opinion.  Dr. Simonet noted that while the employee did have a partial thickness tear of the rotator cuff, this was an age-related condition and not related to the employee’s workstation.  Dr. Simonet felt the same regarding the degenerative disc disease at C5-6.  Dr. Simonet disagreed with Dr. Wengler’s assessment that the neck condition was suitable for surgery and with Dr. Wengler’s PPD assessments.

The employee eventually made claims of Gillette^[4] injuries, to various body parts, culminating on January 14, 2010, May 10, 2012, January 29, 2014, February 28, 2014, May 2015, October 2016, and May 6, 2017.  When the employer and insurer denied liability, the employee filed a claim petition seeking wage loss, PPD, and medical benefits.  The claim petition was amended three times, and a second claim petition was later filed.  The employee was represented by three different attorneys, but eventually proceeded to trial pro se.

At trial, the employee testified that when he was transferred from one department to another in 2009, he was no longer at the same station and the new station was ergonomically incorrect.  He testified that his symptoms started occurring after this 2009 transfer.  He stated his chair did not hold him correctly, was not compatible with his desk or keyboard, and did not support him at the correct height.  He also testified that his computer mouse did not fit.

Mr. Huseby testified that each ergonomic assessment involved him meeting the employee, talking with the employee, observing the employee at various positions, both standing and sitting at his workstation, measuring heights and distances of the workstation relative to the employee and then making recommendations on both equipment changes and behavioral changes of the employee.

The employee testified that after the recommendations for ergonomic changes, there was a delay in implementation, some of the delays taking three-and-a-half years, and that the changes were done cheaply and were ultimately unhelpful.  He testified that the ergonomic changes simply amounted to the employer offering him different chairs that were brought in from different office spaces, and reams of paper to raise or lower his monitor.  He admitted that he received a wireless mouse and eventually a sit/stand desk, although he testified that this took six months to implement from the time it was first recommended.  He argued at trial that the delays by the employer in implementing the suggestions of the ergonomics specialists further contributed to his symptoms.

Christian Iverson testified for the employer.  He was the individual who hired the employee in 2007.  Mr. Iverson was present when the employee was transferred in 2009 and stated that although the employee went to a different cubicle, he was on the same floor and used the same type of cubicle, desk, and equipment that he had prior to his transfer.  Mr. Iverson also testified that in 2018 due to downsizing, five people in the employee’s department lost their jobs, including the employee.

In support of his claims, the employee relied upon the medical records and on the medical opinions of Dr. Wengler.  In neither opinion did Dr. Wengler identify what he knew about the employee’s workstation other than the employee reporting it to be “bad.”  There was no testimony on this issue.  The employee testified that he did not give Dr. Wengler copies of the various ergonomic studies performed on the employee and his workstation.

The compensation judge issued his Findings and Order on August 8, 2019, denying the employee’s claims.  The compensation judge accepted the testimony and opinions of the employer and insurer’s witnesses and rejected the opinions of Dr. Wengler.  The employee appealed.

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).

As an initial procedural matter, the employer and insurer, relying on Carpenter v. Woodvale, Inc., 400 N.W.2d 727, 39 W.C.D. 430 (Minn. 1987), argue that the employee’s notice of appeal is insufficient in that he did not enumerate any specific findings by the compensation judge as being appealed.  The employer and insurer also move to exclude the reply brief of the employee under Minn. R. 9800.0900, subp. 5, because they claim the employee submitted new arguments and 650 pages of new evidence.

In Carpenter, the pro se appellant failed to enumerate findings, state what exactly he was appealing, describe an intent to appeal, or appear before the W.C.C.A. to explain his intent.  Here, while the employee did not specifically enumerate any findings of the compensation judge as being appealed, he filed a multi-page document detailing his disagreement with essentially every finding of the compensation judge.  Unlike the pro se appellant in Carpenter, the details of the pro se employee’s disagreement with the compensation judge’s decision are more than adequate.

We agree that submitting new evidence to our court is not allowed, and we grant the employer and insurer’s motion to strike this newly submitted evidence.  See Minn. Stat. § 176.421, subd. 6 (on appeal, the W.C.C.A. examines the record before the compensation judge); see also Vagts v. Tromco Elec., 48 W.C.D. 622, 625 (W.C.C.A. 1993) (generally, W.C.C.A. review is limited to the evidence submitted to the compensation judge).  Nevertheless, we decline to grant the motion of the employer and insurer to strike the reply brief and have considered all arguments raised by the employee.  The employee has been pro se at trial and on appeal and we give some leeway to pro se litigants attempting to comply with court rules.  See Carpenter, 400 N.W.2d at 729, 39 W.C.D. at 433.

As to the merits of the employee’s appeal, he argues that the testimony and reports of Mr. Iverson, Dr. Reynolds, and Mr. Huseby, were not credible because they were all employees of the employer and/or the insurer.  The employee also disputes the issues identified by the compensation judge, as well as the compensation judge’s order.  Finally, the employee argues that the compensation judge acted as a second defense attorney by accepting the defense evidence and defense arguments and not accepting his evidence and his arguments.

The employee’s appeal is primarily based on disagreement with the outcome.  As he asserts, there is objective evidence of certain medical conditions.  For example, the record shows a partial thickness tear of the left rotator cuff, a disc herniation impinging on the C5-6 nerve root, degenerative disc disease of the lumbar and cervical spine, trigger finger, and carpal tunnel syndrome.  Further, the employee made complaints regarding his workstation being not ergonomically correct, and the employer provided four separate ergonomic assessments which resulted in some modifications to the employee’s workstation.

While the employee presented evidence regarding his medical condition, there was minimal evidence connecting the workstation’s ergonomics to the employee’s diagnoses and need for care.  While Dr. Wengler and Dr. Mikhail opined that there was a causal link from the employee’s workstation to his diagnoses and need for care, there was no evidence showing what Dr. Wengler or Dr. Mikhail knew about the workstation.  The record reflects that they were told by the employee that the workstation was ergonomically unsound.  The record reveals no other details.  There is no doubt that the employee sincerely believes that his pain is related to his workstation.  As Dr. Simonet noted, the employee is not malingering.  Further, while the compensation judge still could have been persuaded by and accepted the opinions of Dr. Wengler and Dr. Mikhail, he did not.  Instead, the compensation judge accepted the opinions of Dr. Simonet, Dr. Reynolds, and Mr. Huseby.  When there are conflicting opinions and where the opinions have adequate foundation, a compensation judge’s choice of which opinions to accept is generally upheld by this court.  Nord v. City of Cook, 360 N.W.2d 337, 342-43, 37 W.C.D. 364, 372-73 (Minn. 1985).  While the employee argues that the compensation judge was acting as a second defense attorney, our review of the record shows that the compensation judge was acting as an unbiased decision maker, weighing competing pieces of evidence and reaching a conclusion based on that evidence.  Because substantial evidence supports the compensation judge’s decision, we affirm.