MOHAMMED S. IBRAHIM, Employee/Appellant, v. MAYO CLINIC, Self-Insured-Employer/Respondent, and UCARE and INJURED WORKERS PHARMACY, Intervenors.

The pro se employee appeals from the compensation judge’s denial of his claim for benefits for injuries on March 11 and June 17, 2013.  We affirm.

Prior to the injuries alleged in the current appeal, the employee, Mohammed Ibrahim, sustained a work injury to his low back and cervical spine on October 12, 2010, while employed as a microbiologist for a different employer, LabCorp, in North Carolina.  Following conservative treatment, the North Carolina Industrial Commission (Commission) issued an Opinion and Award on December 19, 2011, ordering LabCorp to pay for all medical expenses related to the employee’s low back and cervical spine injuries.  On June 11, 2013, the Commission ordered LabCorp to pay for additional medical treatment, including a proposed L5-S1 fusion surgery.^[1]

The employee began working for the self-insured employer, Mayo Clinic, as a clinical lab technologist on March 14, 2011.  The offer of employment, dated December 10, 2010, was contingent upon the employee’s successful completion of a background check and a preplacement evaluation to ensure that the employee met the physical requirements for the job which included lifting 50 pounds and sitting for several hours at a time using a microscope.

Shortly after his employment with the employer commenced, the employee began treating for low back and neck symptoms in Minnesota.  He attempted physical therapy, but it was discontinued as the employee’s symptoms were not reduced.  An EMG was conducted and read as normal.  Eventually, the employee was diagnosed with chronic back pain associated with isthmic spondylolisthesis at L5-S1 with mild left foraminal narrowing and pain behavior.  In February 2012, the employee began treating with Dr. Richard Newcomb at Mayo Clinic for upper and lower back pain.  The employee reported difficulty lifting his 15-pound child, sitting at a microscope, and bending forward for long periods of time.  The employee was given work restrictions of no lifting more than 10 pounds and no prolonged static positions such as working with his neck flexed.  The employee’s restrictions continued through June 2012.  Dr. Newcomb’s notes also chronicled the employee’s prior North Carolina work injury and associated lifting restrictions.  He noted that the employee’s job with the employer could be in jeopardy if the employee had failed to advise the employer of his prior work injury and restrictions.  Dr. Newcomb later noted that the employee’s preplacement forms did not reveal prior back problems, medication, symptom complaints, or treatment related to the North Carolina work injury prior to working for the employer.

The employee was involved in a motor vehicle accident unrelated to work on September 10, 2012, from which he suffered severe neck pain and low back pain.  An MRI showed uncinate spurring with mild to moderate foraminal narrowing at C5-6, and he was referred for physical therapy.  Physician Assistant (PA) Gladys Radke saw the employee for a cervical spine evaluation following the motor vehicle accident for ongoing lower neck and left upper extremity pain.

At a physical therapy appointment on October 25, 2012, the employee’s mobility in the cervical spine and shoulder was significantly limited.  The employee’s neck pain also affected his ability to manage heavy weights, work overhead, and look downward into a microscope.

During physical therapy on November 12, 2012, the employee experienced an episode of imbalance while rising from the treatment table and reported dizziness.  The employee was discharged from physical therapy on January 11, 2013, because it was not providing any benefit.  At the time of discharge, the employee’s neck disability was assessed as complete disability.

On December 18, 2012, the employee became dizzy, lost consciousness, and fell down a flight of stairs at home.  He was seen in the emergency department at Mayo Clinic.  He reported that the dizziness was chronic since his car accident several months earlier and he had complaints of neck and upper back pain and headaches.  He was seen in follow-up by PA Radke on January 4, 2013, at which time he complained of tingling in his hands and feet.  He was diagnosed with cervicothoracic junction pain with diffuse upper thoracic and interscapular tenderness following the motor vehicle accident and the recent fall.  An MRI scan revealed a superior endplate fracture at T3.  On January 29, 2013, the employee was evaluated by his primary care physician for continued complaints of dizziness, which he reported had been ongoing for two years.  He was diagnosed with orthostatic presyncope.

The employee claimed he was sitting looking through a microscope when he became dizzy and hit his head, causing a cut on March 11, 2013.  He bandaged this wound and returned to his work duties.  The cut healed soon after without further treatment.  He later claimed this as a work injury with the employer.

The employee was diagnosed with major depressive disorder, single episode, on March 18, 2013, and was referred to Mayo Clinic’s depression care coordination program.  The employee reported that his depressive concerns had begun following the car accident in September 2012.  It was also observed that the employee’s back pain caused dizziness and numbness, which resulted in the December 2012 fall.  The employee participated in the depression care program until May 17, 2013.

The employee was seen by Dr. Aurelia Smith at the Mayo Clinic neurology department on March 21, 2013, to address his long history of back and neck pain which was causing intermittent dizzy spells.  The employee reported that the spells began back in 2010 and occurred approximately one to two times a month, each lasting for about a minute.  Following the September 2012 car accident, the dizzy spells had worsened.  He also reported headaches, hallucinations, and depression.  During the examination, the employee showed signs of pain behavior and significant functional overlay.  An examination of the scalp where the employee had been cut on March 11, 2013, showed no skin abnormality, nor erythema, scratches, scabs, ecchymosis, or evidence of trauma.  Dr. Smith determined the dizzy spells were nonneurologic in nature and of uncertain etiology.

On October 25, 2011, the employee received a formal notice of corrective action relating to his work performance from the employer.  A performance review took place on June 6, 2012, which reflected job areas where the employee required further development. A second formal written notice was given to the employee on March 6, 2013, with a final written warning issued on May 23, 2013.  A conference was conducted relating to the notices and the employee was given a two-day suspension without pay.  The employee appealed the written warnings, but they were upheld on June 12, 2013.  After his appeal was denied, he did not work from May 29 to June 12, 2013.

The employee asserted a second work injury occurred on June 17, 2013.  He maintained that he passed out, fell off a stool, and hit his head on the floor.  He was transported to St. Mary’s emergency department for evaluation.  The record from the evaluation noted that the employee had suffered multiple dizzy spells in the past with unknown etiology and the cause of this recent spell was undetermined.

Dr. Newcomb evaluated the employee for his dizzy spells and falls on July 19, 2013. Dr. Newcomb noted, “. . . [the employee] has been seeking medical restrictions to solve a problem that is actually administrative in nature related to a work environment that he finds stressful and anxiety provoking.”  (Ex. 5 at 442.)  Dr. Newcomb further noted that any restriction to keep him out of histology “is not based on a problem with his functionality related to his medical issues.”  Id.  After consulting with Dr. Newcomb, the employee agreed to be taken off work.

On July 31, 2013, the employee was terminated from his employment with the employer due to his failure to assist colleagues in answering the phone, inability to utilize and apply standard operating procedures, and attendance issues.

Dr. Vanda Niemi of Noran Neurological Clinic saw the employee for memory issues on February 19, 2014.  Dr. Niemi noted that the employee did not provide a coherent history and was not forthcoming with any information about his injuries or care.  During his neurological examination, the employee demonstrated significant generalized pain behavior and displayed normal muscle tone and strength in his upper and lower extremities.  No focal neurologic deficits were noted.

The employee sought a new job as a microbiologist.  He underwent a preemployment physical at the Olmsted Clinic on October 1, 1014.  His medical history indicated depression and chronic pain related to an L5 fracture in 2010 and a T3 fracture in 2012.  The physical showed no contraindication to the new job.  On July 10, 2017, the employee began the new job with Genesis Medical Center in Silvis, Illinois.

On November 1, 2017, the employee was seen for neck and left arm pain which he related to a December 2012 work injury.^[2]  The employee reported that the pain radiated from his neck, left arm, and hand, and that standing or sitting aggravated the pain.  He also reported that his depression and anxiety were stable.  Examination of the employee’s cervical spine was within normal limits.  The employee was assessed with cervical region radiculopathy and evaluated by a neurologist.  Subsequently, the employee reported an improvement in his condition.

Dr. Eric Deal performed a medical examination of the employee on April 16, 2018, on behalf of the employer.  In his report dated May 10, 2018, Dr. Deal opined that the employee’s chronic neck and mid and low back pain complaints preexisted the claimed work injuries at the employer.  He also opined that the March 11, 2013, incident caused only a scalp abrasion and he further opined that the employee did not sustain any physical injury on June 17, 2013.  Dr. Deal viewed the employee’s syncopal episodes on March 11 and June 17, 2013, as unrelated to any cervical, thoracic, or lumbar condition.  He opined that the employee required no work restrictions for his alleged injuries and had reached maximum medical improvement one to two weeks after he cut his scalp on March 11, 2013.

On March 14, 2018, the employee reported a work injury after inhaling ethanol alcohol fumes while working at Genesis Medical Center.  On March 15 and May 15, 2018, the employee received written corrective action notices from his employer.  On October 15, 2018, the employee was seen by Dr. Brian Anderson regarding the exposure incident.  The employee became syncopal at this visit and was transported to the emergency department. At a follow-up visit October 23, 2018, the employee reported migraine headaches, diverticulitis, constipation, anxiety, and depression as the result of the alcohol fume exposure.  He also reported the aroma of alcohol triggered anxiety, depression, and headaches.  Dr. Anderson could not correlate the employee’s symptoms to the described exposure. 

On December 7, 2018, Dr. G. Narayana examined the employee, who complained of distress, anxiety, and nightmares as a result of physical and verbal abuse and harassment in the workplace.  Dr. Narayana diagnosed the employee with major depressive disorder, single episode, severe with psychotic features, and later post-traumatic stress disorder (PTSD).  On March 3, 2020, Dr. Narayana opined the employee was permanently and totally disabled.  The employee subsequently terminated his employment with Genesis Medical Center on July 23, 2020.

On September 28, 2020, the employee was evaluated for right-sided neck, shoulder, and trunk pain and was diagnosed with right-sided cervical radiculopathy.  Based upon the assessment, the employee was certified for eight weeks of physical therapy.

The employee underwent an evaluation at Ora Physical Therapy on February 21, 2021.  His physical complaints were low back pain with radiation down the left lower extremity as well as cervical and thoracic pain with radiation down the right arm.  The employee reported that these complaints were caused by a work injury in 2010 when a nitrogen tank fell on his low back, fracturing segments in his back, and as a result of falling from the second floor to the first floor on January 22, 2013, fracturing his thoracic spine.^[3]  Problems identified by the employee included difficulty working, walking, sleeping, ADL performance, standing greater than 10 minutes, sitting greater than 10 minutes, bending and twisting, and loss of motion and stiffness affecting mobility.

The employee’s claim petition filed on January 4, 2018, and amended claim petition filed on November 8, 2018, came on for hearing before a compensation judge on November 18, 2021.  The employee appeared pro se.  The compensation judge issued her Findings and Order on March 8, 2022.  The judge found the medical opinion of Dr. Deal to be persuasive.  She concluded that the employee had not sustained significant work-related injuries on March 11 or June 17, 2013. She also found that any lost time from work or medical treatment after March 11, 2013, was not substantially related to any work injury with the employer.  In her memorandum, the judge found the employee’s testimony to be not reliable or credible.  The employee has appealed.^[4]

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 issues before the compensation judge at hearing were whether the employee sustained work injuries on March 11 and June 17, 2013, and if so, the nature and extent of those injuries.  These issues raised questions of fact which were determined by the compensation judge based on a consideration of the evidence submitted by the parties.  Felton v. Anton Chevrolet, 513 N.W.2d 457, 50 W.C.D. 181 (Minn. 1994); Domarus v. Yule Transp., No. WC20-6387 (W.C.C.A. June 29, 2021).  The issue on appeal is whether substantial evidence supports the compensation judge’s decision.  In considering this issue, this court is to give due weight to the compensation judge’s assessment of witness credibility, which is “the unique function of the compensation judge.”  Even v. Kraft, 445 N.W.2d 831, 835, 42 W.C.D. 220, 225 (Minn. 1989).

The pro se employee contends that he was injured at work on March 13 and June 27, 2013.  He maintains that his problems since that time, both physical and psychological, have been the result of those injuries.  The self-insured employer disputes that the employee’s injuries were related to his work activities.  Instead, the employer contends that the employee’s physical complaints were caused by preexisting health issues or conditions personal to him.  The employer also disputes the nature and extent of the employee’s alleged injuries.

A compensation judge may base her conclusions on all reliable evidence in the record.  Reimer v. Minnit Tool/M.I.T. Tool Corp., 520 N.W.2d 397, 51 W.C.D. 153 (Minn. 1994).  It is the obligation of a compensation judge to carefully consider all the evidence presented at the hearing and to weigh the conflicting medical opinions.  The employee argues that the judge’s findings were not based upon a thorough review of the evidence submitted by the parties for consideration nor based upon substantial evidence including the employee’s medical records, hearing testimony, and exhibits.  We are not persuaded.

The employee’s testimony offered relatively little information for the judge’s consideration.  The employee could not recall much of his medical history and instead relied upon and deferred to the medical records.  In this case, the judge’s findings and order identified the evidence she considered including the testimony of the employee and stated her conclusions.  In her memorandum, she explained her decision.  The employee presented no medical opinions in support of his physical or mental health claims.  In contrast, the employer provided the report of Dr. Deal, which the compensation judge found persuasive.

In weighing medical evidence, a compensation judge has the discretion as the trier of fact to choose between competing and conflicting medical experts’ reports and opinions.  Gianotti v. Indep. Sch. Dist. No. 152, 889 N.W.2d 796, 803, 77 W.C.D. 117, 126 (Minn. 2017).  This assessment of the weight to be given to the conflicting opinions is upheld on appeal, absent an abuse of discretion.  Mattick v. HyVee Food Stores, 898 N.W.2d 616, 77 W.C.D. 617 (Minn. 2017).  As the facts assumed by Dr. Deal are supported by the evidence, the compensation judge’s choice is therefore upheld.  Nord v. City of Cook, 360 N.W.2d 337, 342-43, 37 W.C.D. 364, 372-73 (Minn. 1985).

As to the employee’s claims of work-related stress, we note that the general rule is that mental injury or disability resulting from work-related stress is not compensable under the Minnesota Workers’ Compensation Act.  Lockwood v. Indep. Sch. Dist. No. 877, 312 N.W.2d 924, 34 W.C.D. 305 (Minn. 1981); see also Schuette v. City of Hutchinson, 843 N.W.2d 233, 74 W.C.D. 169 (Minn. 2014).  While an exception is made for PTSD, specific criteria must be met to establish compensability for that condition.  See Minn. Stat. § 176.011, subds. 15 and 16.  The employee asserted that his treatment by the employer during his employment resulted in PTSD, but that claim was properly denied by the compensation judge because no evidence was offered that any of the statutory criteria had been met.

The employee argues that his anxiety and depression were consequences of the physical injury when he cut his head and constituted compensable conditions on that basis.  A claimed mental injury or disability which is the result of a physical injury may be compensable.  See Hartman v. Cold Spring Granite Co., 243 Minn. 264, 271, 67 N.W.2d 656, 660, 18 W.C.D. 206, 212 (1954); Dotolo v. FMC Corp., 375 N.W.2d 25, 38 W.C.D. 205 (Minn. 1985).  However, in this case we note that the employee testified that his scalp laceration had healed.  (T. 100.)  “Where healed injuries have not impaired an employee's ability to work and other possible causes of the mental injury are present, medical opinion that establishes a causal connection between the physical injury and the mental injury or disability is required before the mental injury can be found compensable. . . . ” Bell v. Indep. Sch. Dist. No. 625, 65 W.C.D. 465, 469 (W.C.C.A. 2005); Rindahl v. Brighton Wood Farm, 382 N.W.2d 855, 38 W.C.D. 473 (Minn. 1986); Greer v. Minn. Vikings Football Club, No. WC14-5693 (W.C.C.A. Sept. 30, 2014); Phan v. Radisson Hotel, 70 W.C.D. 358 (W.C.C.A. 2009), summarily aff’d (Minn. Aug. 26, 2009).  Here, the employee failed to provide medical evidence sufficient to connect a physical injury to his asserted mental health claims.

The employee also claimed his preexisting physical and mental health conditions were aggravated by repetitive work at the employer, constituting a Gillette injury.  A Gillette injury is a result of repeated trauma or aggravation of a preexisting condition which results in a compensable injury when the cumulative effect is sufficiently serious to disable the employee from further work.  Gillette v. Harold, Inc., 101 N.W.2d 200, 206, 21 W.C.D. 105, 115 (Minn. 1960).  The employee testified that his work duties included working in a laboratory setting where he sat for several hours leaning forward to look through a microscope, bending his back and neck.  He also lifted trays of glass bottles weighing up to 50 pounds from cabinets and racks at heights from above his head to floor level.

We recognize that a preexisting physical condition does not disqualify a claim of a work injury arising out of employment where the employment aggravated, accelerated, or combined with the preexisting condition to produce a disability for which compensation is sought.  See Gillette, 101 N.W.2d at 207, 21 W.C.D. at 115.  The employee has the burden to show a causal connection between the work activities and the ensuing disability.  Proof of a Gillette injury principally depends on medical evidence, and the employee’s testimony alone is generally not sufficient to establish this connection.  See, e.g., Gunderson v. McNeilus Cos., 73 W.C.D. 401, 409 (W.C.C.A. 2013).  In the case before us, there is no medical evidence in the record addressing a possible Gillette injury.  While the employee’s testimony can be a factor, the compensation judge determined the employee’s testimony alone, in this case, was not enough to establish a connection under the Gillette injury theory.  Substantial evidence supports the compensation judge’s finding that the employee did not suffer a Gillette injury.

In his brief, the employee indicated that the compensation judge erred in not awarding permanent partial disability (PPD) benefits.  No medical evidence or doctor’s report was offered into evidence regarding PPD and no PPD issue was identified for resolution at the hearing.  A compensation judge may decide only those issues that are raised at the hearing.  Minn. Stat. § 176.371; see Dexter v. Hubbard Cnty. Dev. Achievement Ctr., 79 W.C.D. 547, 551 (W.C.C.A. 2019) (citing Kulenkamp v. Timesavers, Inc., 420 N.W.2d 891, 40 W.C.D. 869 (Minn. 1988)).  Because no claim of entitlement to PPD benefits for the employee’s claimed injuries was presented at the hearing, the compensation judge did not err by not addressing PPD.  

When this court considers an appeal involving factual findings, we do not retry the case.  Our function is to decide whether the compensation judge’s decision is based on substantial evidence.  Our supreme court has defined substantial evidence as evidence that “a reasonable mind might accept as adequate.”  Hengemuhle, 358 N.W.2d at 59, 37 W.C.D. at 239.  A medical opinion based on adequate information may constitute substantial evidence that a compensation judge may rely on in deciding a case.  Carda v. State of Minn./Dep’t of Human Servs., 79 W.C.D. 649 (W.C.C.A. 2019).  After due consideration, we conclude there was no error on the part of the compensation judge and her decision was based on substantial evidence.  The decision is affirmed.