The pro se employee appeals from the compensation judge’s findings that the employee did not sustain a work-related head injury in October 2013 and that injuries sustained in November 2016 and March 2017 were temporary.  We affirm.

The employee, Fatuma Emam, was employed by the employer, Community Action Partnership of Ramsey, as a teachers’ aide and school bus monitor for more than fifteen years.  During her employment, the employee sustained a number of work-related and non-work-related injuries.

First, the employee claimed that on October 24, 2013, she was helping kids outside on a playground when she fell and hit her head, blacked out for a few minutes, and experienced blurred vision, dizziness, instability, depression, anxiety, and stress.  On December 24, 2013, the employee was seen at Allina Health complaining of headaches ongoing for two weeks.  She denied a history of head injury.  A CT scan of the sinuses showed no active sinus disease.  The medical notes indicated her symptoms were most likely from muscle tension issues and she was recommended for a neurological consultation.

On April 4, 2014, the employee was seen at Noran Neurological Clinic by Dr. Chad Evans for an evaluation of neck pain and headaches.  The medical notes referenced a motor vehicle collision in 2009 resulting in neck and thoracic pain which improved with physical therapy. Dr. Evans opined the employee’s current neck pain was due to underlying degenerative changes or a possibly herniated disc.  He noted that the 2009 motor vehicle collision could have led to some early degenerative changes or disc problems.  Dr. Evans ordered an MRI scan of the brain to determine if there was a secondary cause for her headaches and unilateral tinnitus.  She was referred to physical therapy and given a prescription for cyclobenzaprine.  On May 8, 2014, the employee underwent an MRI scan of the brain which was unremarkable.

Hearing exhibits show that on September 29, 2014, the employee was involved in a non-work-related motor vehicle collision.  She was assessed by medics onsite and was released with no visible injuries.  A letter from Dr. Steven Mouacheupao at Allina Health indicated the employee was seen on September 29, October 6, and November 25, 2014.  The employee had no significant deficit in her ability to walk or use her legs following the motor vehicle collision.

On November 1, 2016, the employee was again monitoring kids outside on the playground when a rock thrown by a child struck the employee’s head.  She sustained a bloody nose, reported the injury, and was seen at Allina Health that same day.

Finally, the employee claimed that on March 14, 2017, she tripped over a rug in a classroom and fell, resulting in injuries to her back, neck, shoulders, and right knee.  This was a reported injury and on August 18, 2017, the employee was seen again at Noran Neurological Clinic by Dr. Evans.  The medical records indicated the employee complained of headaches triggered by overexertion and neck pain which she associated with a recent work injury.

The employee filed a claim petition on February 5, 2019, claiming entitlement to various workers’ compensation benefits as a result of the October 24, 2013, November 1, 2016, and March 14, 2017, specific work-related injuries against the employer and its workers’ compensation liability insurer, SFM Mutual Insurance Company.

On April 4, 2019, the employee underwent an independent medical examination by Dr. Mark Engasser at the request of the employer and insurer.  Dr. Engasser found the employee sustained a temporary injury to her nose as a result of the November 1, 2016, work incident and had reached maximum medical improvement (MMI) on November 2, 2016, with no permanent partial disability and no work restrictions.  Dr. Engasser also found the employee sustained temporary contusions to her left knee and a strain of her right shoulder as a result of the March 14, 2017, work incident and that she had reached MMI no later than two months following the date of injury with no work restrictions.  Dr. Engasser found the medical treatment was reasonable and necessary due to her history of chronic neck and back issues, however, any treatment beyond May 14, 2017, was not related to the work injuries of November 1, 2016, or March 14, 2017.

On August 12, 2020, the employee completed a functional capacity examination at Courage Kenny to determine her functional abilities and limitations.  The employee showed limited test performance related to pain-focused behavior.  The therapist reported difficulty assessing the employee’s consistency in performance due to her pain-limited test performance.  The employee’s pain-focused behavior was noted to be a barrier to her return to work which needed to be addressed. Neuroscience pain education and/or counseling was recommended.

A hearing was held before a compensation judge on November 4, 2020.  The employee, who was not represented by an attorney at the hearing, tried to include the alleged 2009 and 2010 work injuries, which were not claimed in the pending claim petition.  The compensation judge gave the employee the opportunity to strike her current claims to allow her time to add any other alleged dates of injury against a prior insurer^[1] to be considered simultaneously, or to proceed with her current claims set forth in the claim petition.  The employee wished to proceed, and the hearing went forward.

In the Findings and Order served and filed January 5, 2021, the compensation judge determined that the employer and insurer were responsible for the employee’s medical expenses incurred on November 1 and November 2, 2016, for the temporary injury to her nose sustained on November 1, 2016, as well as medical expenses incurred between March 14 and May 14, 2017, for treatment of temporary injuries to her left knee and right shoulder sustained on March 14, 2017.  The compensation judge denied all other claims for medical treatment and found that the employee did not sustain a work-related injury on October 24, 2013.

The pro se employee appeals the decision of the compensation judge.

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).

In her filings with this court, the pro se employee seeks to add work injuries from 2009 and 2010 to her claim.  At the time of those injuries, the employer was covered by a different insurer for workers’ compensation liability which was not a party at the hearing before the compensation judge.  The issue of the other insurer was discussed at the hearing and the compensation judge advised the employee no decision would be made regarding these injuries because they had not been raised in the claim petition against the employer and its previous insurer, which did not have an opportunity to respond to the claims.^[2]

The Findings and Order from which the employee has appealed does not include any findings or related orders concerning the claimed injuries from 2009 or 2010.  An issue raised for the first time on appeal is beyond the scope of this court’s review.  See Barnett v. Pillsbury Co., 34 W.C.D. 581, 583 (W.C.C.A. 1982).  This court has authority to consider appeals from a compensation judge’s findings and order.  We do not address issues which were not decided by the compensation judge.  See Minn. Stat. § 176.421; Gollop v. Gollop, 389 N.W.2d 202, 203, 38 W.C.D. 757, 758 (Minn. 1986) (an appellate court may not consider matters not contained within the record before the compensation judge).  Accordingly, we will not consider the employee’s claims related to the alleged work injuries in 2009 or 2010.

At the hearing, the issues before the compensation judge included primary liability for the injuries that the employee claimed happened at work on October 24, 2013, November 1, 2016, and March 14, 2017, as well as the nature and extent of those injuries.  The employer and insurer did not deny that these incidents may have happened on the claimed dates of injury, however, they argued that any injuries sustained were, at most, temporary and did not result in entitlement to workers’ compensation benefits.  The compensation judge found that the employee had failed to establish by a preponderance of the evidence that she had sustained a work-related head injury on October 24, 2013, or a work-related neck injury, and denied her claims related to those injuries.  The judge also found that the employee had sustained temporary work-related injuries to her nose on November 1, 2016, and to her left knee and her right shoulder on March 14, 2017.  In considering those injuries and the employee’s claims, the compensation judge listened to the employee’s testimony and her arguments in support of her claims and reviewed the medical records she presented.  He also considered the arguments made by the attorney for the employer and insurer as well as the report by Dr. Engasser, who had examined the employee at their request.

The employee asserts that Dr. Engasser’s expert medical opinion is not credible because he was not her treating physician and he had provided a report at the request of the employer and insurer.  An expert medical opinion regarding causation of a medical condition or symptoms generally requires special education and training that a doctor or similar health care provider has learned.  In workers’ compensation cases involving medical issues, as in this case, the employer and its workers’ compensation insurer are allowed to have the employee examined by a doctor of their choice.  Minn. Stat. § 176.155.  Such an examination is called an adverse or independent medical examination.  This doctor, or examiner, is not allowed to provide medical care or advice to the employee.  The task of the examiner is to provide a medical opinion to the employer and insurer based on the examination of the employee, a review of the medical records, and the doctor’s experience and training.  This level of knowledge is sufficient to establish a doctor’s competence to render an expert opinion.  See Grunst v. Immanuel-St. Joseph Hosp., 424 N.W.2d 66, 68, 40 W.C.D. 1130, 1132-33 (Minn. 1988).

In this case, Dr. Engasser performed this task as requested by the employer and insurer, and it was within the discretion of the compensation judge to find this opinion to be more persuasive than the evidence presented by the employee.  The compensation judge was not required to accept the treating doctors’ diagnoses and impressions over the opinion of the employer and insurer’s medical expert.  How to weigh conflicting medical evidence is a decision generally left to the discretion of the compensation judge, and if the opinion relied upon by the compensation judge has adequate factual support, this court will not reverse the compensation judge on that issue.  See Nord v. City of Cook, 360 N.W.2d 337, 342-43, 37 W.C.D. 364, 372-73 (Minn. 1985); Smith v. Quebecor Printing, Inc., 63 W.C.D. 566, 573 (W.C.C.A. 2003), summarily aff’d (Minn. Aug. 15, 2003).  Dr. Engasser’s medical opinion was based on adequate information and provided substantial evidence for the compensation judge’s decision in this case.  See Carda v. State of Minn./Dep’t of Human Servs., 79 W.C.D. 649, 655 (W.C.C.A. 2019).

The employee also argues there is evidence in the record to support findings that she had sustained work-related head and neck injuries as claimed and that her other injuries were not temporary.  Causation is a question of fact for the compensation judge to determine.  Felton v. Anton Chevrolet, 513 N.W.2d 457, 459, 50 W.C.D. 181, 184 (Minn. 1994).  When there is a factual dispute in a workers’ compensation case, the compensation judge decides the issue by a preponderance of the evidence, meaning “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 this case, because the employee filed the claim which initiated the hearing, she had the obligation to present evidence in support of her claim that was more persuasive than the evidence presented by the employer and insurer.  See Minn. Stat. § 176.021, subd. 1.

In deciding this case, the compensation judge noted the employee had a medically complicated case, and that there was an absence of a medical opinion establishing a connection between the injuries and her need for treatment.^[3]  The judge accepted Dr. Engasser’s opinion that the November 2016 and March 2017 injuries were temporary.  He also weighed the evidence presented and considered that the employee had a history of significant work-related and non-work-related injuries and accidents in determining that the employee “failed to establish by a preponderance of the evidence that she sustained injuries to her head on October 24, 2013.”  (Finding 22.)   The employee asserts that her medical records include references to a head injury in October 2013.  Those records, however, document what the providers were told by the employee six months after the incident.  The providers were not expressing medical opinions in those records that would adequately support the employee’s claim.  There is also no medical evidence or medical opinion that the injury on November 1, 2016, was anything other than a bloody nose which resolved in less than a day.  In the same way, the employee presented no medical evidence that the work injuries in March 2017 were not temporary.

On appeal, the issue for this court is whether the decision of the compensation judge is supported by substantial evidence when considering the entire record.  It is not this court’s function to assess whether substantial evidence might support a conclusion contrary to that reached by the compensation judge, but solely to assess whether substantial evidence exists to support the conclusion actually reached by the judge.  See Redgate v. Sroga’s Standard Serv., 421 N.W.2d 729, 734, 40 W.C.D. 948, 957 (Minn. 1988) (substantial evidence is evidence that a reasonable mind might accept as adequate).  For the reasons we have set forth above, we find substantial evidence supports the decision in this case.  The decision of the compensation judge is affirmed.