JAKOB INGALLS, Employee/Appellant, v. ROSE ELEC. SYS., INC. and SELECTIVE INS. CO. OF AM., Employer-Insurer/Respondents, and BLUE CROSS BLUE SHIELD OF MINN. & BLUE PLUS, ASKEW REHAB. SERVS. and ANTHONY TODD NICHOLS, PH.D., L.P., Intervenors.

The employee appeals from the compensation judge’s finding that his consequential mental health injury had resolved as of July 22, 2021, and from the judge’s denial of payment for a rehabilitation consultation.  We affirm as modified in part, vacate in part, and remand for further findings consistent with this opinion.

The employee, Jakob Ingalls, worked as a traveling field engineer for the employer, Rose Electronic Systems, Inc., installing and maintaining high-voltage battery systems.  On April 20, 2021, while working on a battery system in Idaho, the employee connected a cable incorrectly, resulting in an arc flash and causing an electrical burn to the employee’s right hand.  He was seen at a local emergency department and was treated for a second-degree burn affecting three fingers on his right hand.  The employee completed the job in Idaho and returned home to Minnesota two days later.

Prior to the April 20, 2021, burn injury, the employee had a significant history of mental health treatment for recurrent depression and anxiety, as well as attention-deficit issues.  He had been hospitalized on more than one occasion for suicidal ideation and gestures.  He treated with a variety of medications and some counseling therapy.  The employee testified that his depression had improved through 2018 and 2019, and that he had discontinued therapy.

The parties stipulated that the employee’s burn injury to his right hand had resolved with no need for restrictions no later than May 12, 2021.  However, the employee testified that he experienced flashbacks, anxiousness, cold sweats, trouble sleeping, and twitching of his left hand in the weeks following the injury.  While working on a battery system job in North Carolina in May 2021, the employee testified that he felt panicky and was afraid of getting shocked.

On June 1, 2021, the employee self-referred to Dr. Todd Nichols, a psychologist at Family Attachment Clinic, for concerns related to the effects of his burn injury and for long-standing depression and anxiety.  Dr. Nichols diagnosed the employee with adjustment disorder with mixed anxiety and depression due to his workplace injury and with persistent depressive disorder.  Dr. Nichols issued a letter stating that the employee suffered from psychological consequences due to his work injury and that his symptoms interfered with his ability to safely perform his job duties.  The treatment notes indicate reports from the employee of electrocution nightmares and anxiety about mistakes while working.  The employee remained off work and continued to treat with Dr. Nichols for regular therapy sessions.

On July 22, 2021, the employee underwent a rehabilitation consultation with QRC Amy Christensen of Askew Rehabilitation Services.  QRC Christensen concluded that the employee was able to work so long as his job duties did not exacerbate his mental health condition.  She recommended that he not return to work for the employer.  The QRC determined that the employee was qualified for rehabilitation services, however, no services were provided.  The employee conducted a job search without the assistance of the QRC and started a position with a new employer at no wage loss in November 2021.

Later in the day on July 22, 2021, the employee was seen by Dr. Nichols for a therapy session in which the discussion centered around attention-deficit issues in social and job settings.  The employee continued therapy with Dr. Nichols on a regular basis.

On August 31, 2021, the employee had a therapy session with Dr. Nichols.  The employee continued to report issues with job interactions and social connections.  He also reported to Dr. Nichols that while falling asleep, he had experienced flashbacks of being electrocuted.  Dr. Nichols reviewed the protocols for the employee to follow when experiencing such flashbacks and how to prepare for sleep to avoid recurrence of the condition.  The treatment records show that the focus of subsequent therapy sessions moved away from the employee’s anxiety related to his work injury and job duties and focused instead on social and family interactions and management strategies to address stress and anxiety.

On November 15, 2021, Dr. John O’Neil conducted an independent psychological evaluation of the employee at the request of the employer and its insurer.  Dr. O’Neil opined that the employee did not sustain a consequential mental health injury from the April 20, 2021, burn injury, but rather, suffered from a continuation of the anxiety the employee had been experiencing prior to the work injury.  Dr. O’Neil believed the employee did not require work restrictions, but that the psychotherapy he had undergone was reasonable and necessary though not related to the burn injury.

Dr. Nichols reviewed the report of Dr. O’Neil and issued a narrative report dated February 14, 2022.  Dr. Nichols opined that while the employee suffered from attention-deficit, self-confidence, and self-esteem issues prior to the April 20, 2021, work injury, the incident aggravated his symptoms, resulting in an inability to safely perform his job duties.  Dr. Nichols noted that the employee’s emotional and behavioral symptoms had improved, and that the employee had reached maximum medical improvement from the effects of the work injury, though he continued to treat for symptoms that existed prior to the work injury.

The employee filed a claim petition seeking wage loss, medical, and vocational rehabilitation benefits as a result of his mental health condition consequential to the April 20, 2021, work injury.  His claims were heard by a compensation judge who issued a Findings and Order on March 22, 2022.  The judge found that the employee had sustained a consequential mental health condition but that the work injury was not a substantial contributing factor to that mental health condition after July 22, 2021.  Treatment after that date was found to be solely related to the employee’s preexisting mental health condition and was denied.  The employee’s claim for temporary total disability benefits was awarded, but only through July 22, 2021.  Finally, the judge denied payment for vocational rehabilitation services upon finding that those services were neither reasonable nor necessary.  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.”^[1]  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.”^[2]  Where evidence conflicts or more than one inference may reasonably be drawn from the evidence, the findings are to be affirmed.^[3]  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.”^[4]

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.^[5]

On appeal, the employee cites as error two “internal inconsistencies” within the findings of the compensation judge.

First, the employee argues that the judge’s finding that the employee’s work injury was no longer a substantial contributing factor to his mental health condition after July 22, 2021, is not supported by the evidence.  The compensation judge found that the employee suffered a consequential mental health injury in the nature of adjustment disorder and a temporary aggravation of his preexisting depression and anxiety as a result of the April 20, 2021, burn injury.  (Finding 38.)  The employee had been not working since June 1, 2021, when he first treated with Dr. Nichols, and was awarded wage loss and medical benefits.  (Finding 39; Orders 1-2.)  The judge concluded that the employee’s temporary aggravation resolved as of July 22, 2021, finding that this therapy session was the last at which the work injury was a significant concern.  (Finding 38.)  However, the judge also made a finding, consistent with the medical records in evidence, that in August 2021, the employee had told Dr. Nichols that while falling asleep, the employee had flashbacks of being electrocuted.  (Finding 32.)  The employee argues that these findings are internally inconsistent.  We agree.

On August 31, 2021, the employee attended a therapy session with Dr. Nichols.  The treatment record states that the employee “reported experiencing flashbacks (REM) over being electrocuted while falling asleep.”  (Ex. C.)  The treatment notes go on to state that a discussion was had regarding nightmare protocols and preparing the employee for a different resolution prior to sleep.  The August 31, 2021, therapy session treatment record does not support the judge’s finding that the employee’s temporary aggravation caused by his workplace injury had resolved by July 22, 2021.  This inconsistency contained in the findings cannot be reconciled and we therefore vacate Findings 38, 39 and 40.  We remand the matter to the compensation judge for determination of the nature and extent of the employee’s work injury and for adoption of findings consistent with that determination.

Second, the employee argues that the judge erred in denying payment for the July 22, 2021, rehabilitation consultation and for preparation of the rehabilitation plan.  Minn. Stat. § 176.102, subd. 4(a), states that a rehabilitation consultation must be provided upon an injured employee’s request.  If it is determined that an employee is a qualified employee for purposes of rehabilitation services, a QRC “shall . . . develop, record, and file a rehabilitation plan.”^[6]  In this case, QRC Christensen met with the employee for a rehabilitation consultation on July 22, 2021, determined he was a qualified employee, and prepared a rehabilitation plan.  The compensation judge found that the consultation occurred on July 22, 2021, prior to the therapy session with Dr. Nichols that same day.  (Findings 29-30.)  The judge found the employee was disabled from June 1, 2021, through July 22, 2021.  (Finding 39 (emphasis added).)  According to these findings, the employee was disabled from work and subject to work restrictions at the time of the rehabilitation consultation.^[7]  The judge, however, went on to find that the services provided by the QRC were not reasonable or necessary and denied the claim in its entirety.  (Finding 41; Order 3.)

We conclude that the judge’s finding that the employee remained disabled and subject to work restrictions through the date of the rehabilitation consultation, and her denial of the claim for vocational rehabilitation benefits which include that consultation, are inconsistent and unsupported.  We therefore modify Finding 41 to award the claim for rehabilitation benefits in the form of payment for the rehabilitation consultation.  To the extent that any additional rehabilitation services were performed, such services were determined to be neither reasonable nor necessary in light of the employee’s self-directed job search and lack of activity directed at returning the employee to work.  This determination regarding any remaining services is supported by substantial evidence and is affirmed.