KATHLEEN A. BRADSHAW, Employee/Appellant, v. EDUSERV TECH. and ACCEPTANCE INS. CO./BERKLEY RISK ADMR’S, Employer-Insurer/Respondents.

The pro se employee appeals the compensation judge’s denial of her claim of ongoing disability from a 1993 right wrist injury.  We affirm.  The employee also petitions to have set aside an Award on Stipulation served and filed March 4, 1996.  We deny the petition.

On August 2, 1993, Kathleen A. Bradshaw, the employee, suffered an injury to her right wrist while working for EduServ Technologies, the employer.  An accident report and a first report of injury completed in September 1993 indicated that the employee had experienced soreness after repeatedly turning her right wrist while opening mail.  (Employee’s Ex. E.)  The employee underwent treatment for a symptomatic right wrist, and eventually reported symptoms in her right arm and shoulder.  She received multiple diagnoses, including right wrist strain, carpal tunnel syndrome, reflex sympathetic dystrophy (RSD), synovitis, fibromyalgia, and gout, by various physicians.

The employee initially treated with Dr. Malcolm Gillespie at United Hospital, who recommended work restrictions and use of a splint.  The employee also treated with Dr. Karen Ryan, a physiatrist, for right wrist pain and swelling.  Her work restrictions and splint use were continued.  Dr. Ryan suggested that an arthrogram might be needed.  Electrodiagnostic studies, a bone scan, and a June 23, 1994, MRI scan were read as normal and surgery was not recommended.  In July 1994, the employee began receiving physical therapy at Metropolitan Hand Therapy and Rehabilitation, with limited improvement of her symptoms.  A therapy note dated July 8, 1994, indicated that the therapist strongly suspected “ongoing ulnar collateral ligament component of TFCC [triangular fibrocartilage complex] injury with resultant radiocarpal tightness.”  (Employee’s Ex. J.)  In September 1994, neurologist Dr. Lowell Baker diagnosed RSD in the employee’s right arm and also found that she had right shoulder tendinitis and adhesive capsulitis.

On June 23, 1995, Dr. Jeffrey Husband conducted an independent medical examination (IME) of the employee.  At the time of the examination, the employee was working four hours per day using her left hand to retrieve microfilm documents.  The employee’s chief complaints were listed as right wrist and forearm pain, neck tightness, and shoulder stiffness.  The employee reported that at the time of the injury in August 1993, she was using a machine that required her to pull thousands of documents per day and that after four to five months, she developed right wrist symptoms.  Dr. Husband did not observe signs of RSD and diagnosed psychogenic pain of the right upper extremity or a somatization disorder.  Given a remote possibility that the employee had RSD, he recommended one stellate ganglion block and if she had significant relief, further treatment could follow.  If she did not have relief, he believed she would be at maximum medical improvement.  He also stated that the employee could work in her current position eight hours per day.  (Employee’s Ex. E.)

In December 1995, the employee filed a claim petition seeking various benefits against the employer, alleging she had developed RSD in her right arm as well as right shoulder tendinitis and adhesive capsulitis as a result of her August 2, 1993, work injury.  The employer and its insurer settled with the employee for $10,000, less $2,200 in attorney fees, with medical expenses left open in a stipulation for settlement.  An Award on Stipulation was served and filed March 4, 1996.  The employee also agreed to voluntarily resign from her employment with the employer.  (Employee’s Ex. E.)

The employee continued to seek treatment for her right shoulder, arm, and wrist.  In December 1997, she was diagnosed with mild degenerative joint disease and mild chronic pain syndrome.  She continued to report right arm and right leg pain in 1999, 2001, and 2003, and was diagnosed with probable fibromyalgia in 2001.  (Employee’s Ex. J.)  In January 2010, the employee was treated at an emergency room for right leg pain and shortness of breath.  In February 2011, the employee complained of pain all over, which was again diagnosed as fibromyalgia.

Medical records indicate that the employee reported falling twice in 2011 and experienced throbbing pain in her right arm as well as tingling and numbness in her right elbow.  No fracture was found.  (Employee’s Exs. H, I.)  In September 2013, the employee reported bilateral elbow pain and left shoulder pain.  She was diagnosed with left shoulder impingement with some rotator cuff tendinopathy, which was treated with an injection.  Summit Orthopedic records from the summer of 2015 state that the employee reported bilateral hand numbness, tingling, and radiating pain since she had fallen.  She was diagnosed with bilateral carpal tunnel syndrome by Dr. Richard Anderson of Summit Orthopedics and underwent right carpal tunnel and cubital tunnel release on November 18, 2015.^[1]  (Employee’s Exs. B, H.)  The employee reported persistent pillar and wrist pain after the surgery.

On April 22, 2016, the employee underwent a right wrist MRI scan which indicated degenerative changes, postoperative changes, and no discrete tendon tears, but “[h]eterogeneity throughout the triangular fibrocartilage, with at least fraying of the foveal and ulnar styloid attachment.”  (Employee’s Exs. H, I.)  The scan also noted intrasubstance degeneration and fraying along the central disc and a possible full-thickness perforating defect in that area.  The employee underwent a surgical evaluation for her right hand by Dr. Marco Rizzo at the Mayo Clinic in September 2016.  Surgery was not recommended after an EMG was read as normal and an ultrasound over the hook of the hamate and the ulnar region of the right wrist indicated no obvious lesion in the volar aspect of her hand.  (Employee’s Ex. H.)  A pain program was recommended.

In a letter dated December 30, 2016, the employee’s treating physician, Dr. Edwin Burrell of Entira, opined that the employee’s chronic right hand and wrist pain was a direct result of her 1993 work injury.  (Employee’s Exs. I, J.)  The employee sought treatment for burning hand pain at an emergency room on January 7, 2017.  After x-rays and an ultrasound were negative, the employee was diagnosed with chronic right wrist pain.  Dr. Peter Letourneau, a hand surgeon, also examined the employee and determined that no surgical intervention was required.  (Employee’s Ex. G.)  In April 2017, the employee sought further treatment with Dr. Letourneau.  An arthrogram was ordered which revealed low-grade partial tearing of the employee’s triangular fibrocartilage complex.  (Employee’s Ex. J.)   No surgery was indicated at that time.  Hand therapy was recommended in November 2017.

On August 30, 2017, the employee filed a medical request for treatment and out-of-pocket medical expenses as related to her August 2, 1993, work injury.  The employer and insurer filed a medical response, refusing to pay the claimed expenses.

The employee underwent an IME performed by Dr. Edward Szalapski at the request of the employer and insurer on September 10, 2020.  (Employer’s Ex. 1.)  Dr. Szalapski diagnosed the employee with a somatization or conversion disorder and opined that the employee had no objective findings and that there was no evidence of a wrist disorder or RSD.  He found that the employee’s treatment from 2011 to 2018 and the carpal tunnel condition diagnosed in 2015 were not causally related to her right wrist strain in August 1993.

On September 29, 2020, a hearing was held before a compensation judge on the employee’s medical request.  At the hearing, the employee testified that she struck her wrist on a piece of machinery on the date of injury.  By Findings and Order dated October 27, 2020, the judge denied the employee’s claims, finding that she did not sustain an ongoing injury to her right upper extremity as a result of her 1993 work injury and denying her claims for medical treatment and expenses incurred after her 1996 settlement.  The pro se employee appeals and also petitions to vacate the Award on Stipulation served and filed March 4, 1996.

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 pro se employee appeals from the compensation judge’s denial of her claim that she suffers ongoing disability from her 1993 work injury to her right wrist, arguing that the findings are not supported by substantial evidence in the record.  The employee further contends that the insurer has been conspiring to defraud her and obstructing her from receiving appropriate medical treatment for her wrist, and that this has resulted in her being unable to receive treatment for other conditions.

The employee has asserted that most of her medical providers have misdiagnosed her wrist injury since it occurred in 1993, and that a diagnosis of a torn ligament should have been discovered before the settlement.  She refers to Dr. Ryan’s suggestion in 1994 that an arthrogram might be needed and to a hand therapy note dated July 8, 1994, which stated that the therapist strongly suspected “ongoing ulnar collateral ligament component of TFCC injury with resultant radiocarpal tightness.”   (Employee’s Ex. J.)  The employee points to the MRI scan of her right wrist in 2016 as corroborating her conclusion.  That scan showed “[h]eterogeneity throughout the triangular fibrocartilage, with at least fraying of the foveal and ulnar styloid attachment” and also noted intrasubstance degeneration and fraying along the central disc and a possible full-thickness perforating defect in that area, but no discrete tendon tear.  (Employee’s Ex. I.)  A 2017 arthrogram also showed low-grade partial tearing of the employee’s triangular fibrocartilage complex.  (Employee’s Ex. J.)

We note, however, that Dr. Rizzo at the Mayo Clinic addressed the employee’s concern that a surgical treatment option had been missed when he evaluated the employee’s right wrist in 2016.  In a letter dated October 31, 2016, Dr. Rizzo explained his decision that surgery was not recommended.  Dr. Rizzo wrote that the ulnar area of the employee’s hand was evaluated with an ultrasound and there was no mass to surgically remove, pointing out that the April 22, 2016, MRI scan revealed no obvious mass in the areas and that the August 11, 2016, ultrasound showed no findings which would explain her right wrist pain.  The ultrasound was taken over the hook of the hamate and the ulnar region of the right wrist and indicated no obvious lesion in the volar aspect of her hand.  (Employee’s Ex. H; Employer’s Ex. 1 attachment.)  In addition, Dr. Letourneau, a hand surgeon, examined the employee and ordered an arthrogram in 2017, but did not indicate surgery was required.  Dr. Szalapski also noted that the employee’s evaluation at the Mayo Clinic did not discover any organic pathology in the employee’s right upper extremity and opined that the employee did not have an organic disorder of her right wrist or forearm or RSD, and that her treatment was not causally related to her right wrist strain in August 1993.  (Employer’s Ex. 1.)

While we understand the employee’s frustration with the lack of a clear diagnosis of her current right wrist condition or resolution of her symptoms, we note that the employee has been evaluated for this condition many times, including Dr. Rizzo’s evaluation at the Mayo Clinic.  Causation is a question of fact for the compensation judge to determine after considering the entire record.  It is not the role of this court to evaluate the credibility and probative value of witness testimony or to choose different inferences from the evidence than the compensation judge.  Krotzer v. Browning-Ferris/Woodlake Sanitation Serv., 459 N.W.2d 509, 513, 43 W.C.D. 254, 261 (Minn. 1990); Felton v. Anton Chevrolet, 513 N.W.2d 457, 50 W.C.D. 181 (Minn. 1994).

Under this limited standard of review, the issue for this court to determine is whether the findings made by the compensation judge have substantial support in the record, not whether the evidence might have provided substantial support for a contrary result.  See Redgate v. Sroga’s Standard Serv., 421 N.W.2d 729, 734, 40 W.C.D. 948, 957 (Minn. 1988) (whether an appellate court might have viewed the evidence differently is not the point, “but whether the findings of the compensation judge are supported by evidence that a reasonable mind might accept as adequate”); Minn. Stat. § 176.421, subd. 1.  Substantial evidence, including Dr. Rizzo’s and Dr. Szalapski’s expert medical opinions, supports the compensation judge’s finding that the employee has not sustained an ongoing injury or disability to her right upper extremity as a result of her August 2, 1993, work injury that required any medical treatment after the 1996 award on stipulation, and we affirm.

The employee also petitioned to vacate the Award on Stipulation served and filed March 4, 1996, asserting that her right wrist condition worsened after the settlement and that she has not been able to work since the settlement.^[2]   The employer and insurer argue that the employee has not shown grounds to vacate the settlement under Minn. Stat. § 176.461.

This court may set aside an award on stipulation “for cause,” which is limited to a mutual mistake of fact, newly discovered evidence, fraud, or a substantial change in medical condition since the time of the award that was clearly not anticipated and could not reasonably have been anticipated at the time of the award.  Minn. Stat. § 176.461(b).  When evaluating a petition to vacate an award on stipulation based upon an alleged substantial change in medical condition, this court may consider various factors, including whether there is a causal relationship between the injury covered by the settlement and the employee’s current worsened condition.  See Fodness v. Standard Café, 41 W.C.D. 1054, 1061 (W.C.C.A. 1989).  Given that we have affirmed the compensation judge’s finding that the employee has not shown that her ongoing disability and need for treatment were causally related to her work injury, there is no basis for this court to vacate the 1996 Award on Stipulation, and we deny the petition.