HAWA FLORKIAH, Pro Se Employee/Appellant, v. FIVE STAR SENIOR LIVING and BROADSPIRE, Employer-Insurer/Respondents, and HEALTHPARTNERS, INC., FAIRVIEW HEALTH SERVS. – ALL ENTITIES, and NYSTROM & ASSOCS., Intervenors.

The pro se employee appeals from the compensation judge’s denial of her workers’ compensation claim.  We affirm.

The employee, Hawa Florkiah, began working as a housekeeper for the employer, Five Star Senior Living, in June 2023.  The employee’s housekeeping duties required her to clean and vacuum rooms, bathrooms, and do laundry for long hours in a cold environment which she alleges caused specific or Gillette^[1] injuries to her bilateral knees, rheumatoid arthritis,^[2] osteoarthritis,^[3] and resulting depression culminating on January 20, 2024.

On March 16, 2016, Mary Figueroa, M.D., at M Health Fairview Clinic Edina, examined the employee for complaints of joint and musculoskeletal pain in the elbow, knee, shoulders, and mid back over the prior six months.  The employee reported the pain was sharp and that her bones wanted to break from morning stiffness.  Bilateral knee x-rays were negative.  (Ex. 3.)

On July 7, 2016, Jenikka Soyring, APRN CNP of M Health Fairview Clinic Edina, examined the employee for complaints of ongoing pain in her ankles, knees, elbows, shoulders, wrists, and hips.  There had been no change in the pain since the March 2016 visit.  The employee reported difficulty performing her daily activities because of her joint pain.  The employee was given a rheumatology referral for further evaluation of her symptoms.  (Ex. 4.)

Dr. Figueroa next saw the employee for complaints of whole-body joint pain on August 25, 2016.  (Ex. 5.)  The employee was assessed with unspecified anemia, vitamin D deficiency and multiple joint pain related to vitamin D deficiency, and low iron.

Nasima Soomar, M.D., of Fairview Clinics – Edina, completed a Certification of Health Care Provider for Employee’s Serious Health Condition under the Family Medical Leave Act (FMLA) dated September 16, 2022.  (Ex. L.)  When the document was prepared the employee was working as a housekeeper for M Health Fairview Services.  The medical conditions for which the employee sought FMLA leave were sickle cell trait, low potassium and iron, and joint pain.  These chronic conditions were deemed permanent and had started several years earlier.  The employee would require treatment for these chronic conditions at least twice per year and the conditions would recur over an extended period.  The completed FMLA form notes a chronic condition may be episodic rather than a continuous period of incapacity.

On January 30, 2024, Dr. Soomar examined the employee on complaints of left and right hand, elbow, and knee pain which interfered with her housekeeping job.  The employee was also being seen for ongoing depression and anxiety complaints.  By history provided by the employee, her joint pain had been occurring for many years and was worsened by cold weather.  The employee indicated that she stopped her weight loss medication and was awaiting surgery at a weight loss clinic.  Dr. Soomar observed that the employee’s left hand was slightly swollen.  At the employee’s request, she was taken off work for two days.  (Ex. 7.)

On January 31, 2024, Dr. Soomar informed the employee of results from tests performed during the previous day’s visit.  (Ex. 8.)  Those results showed the employee likely had rheumatoid arthritis (RA) because of a positive rheumatoid factor.  Dr. Soomar prescribed prednisone and recommended over-the-counter vitamin D.

On February 8, 2024, Nurse Practitioner (NP) Corinna Werner of M Health Fairview Clinic Maple Grove, saw the employee for a rheumatology visit.  On this visit, the employee indicated that she came to the United States in 2000 and noticed pain in her knees, feet, and elbows during the winter.  The joint pain worsened in cold environments such as the basement at her place of employment.  NP Werner did not observe any detectable joint swelling or deformity.  NP Werner’s assessment was palindromic onset of early RA^[4] with knee osteoarthritis (OA).  X- rays taken at this visit showed normal joint spacing of the employee’s hands and knees.  The right knee x-ray revealed a slight degenerative change in the right patellofemoral compartment. (Ex. 9.)

On February 13, 2024, the employee sent an email message to a representative of the employer reporting that she wanted to file a workers’ compensation claim.  (Ex. L.)  The employee claimed a work-related illness resulting from exposure to extreme cold weather that had occurred on January 20, 2024, with a diagnosis on January 30, 2024.

The employee prepared a Team Member Incident Report dated February 14, 2024.  (Ex. G.)  The employee claimed that on January 20, 2024, she was exposed to cold at work since the beginning of winter causing an illness or injuries.  The injuries identified were RA, OA, multiple joint pain, and major depressive disorder.  The employee reported that she worked eight hours a day and 40 hours per week.  The last day the employee worked for the employer was February 8, 2024.

Dr. Soomar prepared a letter dated February 21, 2024, stating the employee had a new diagnosis of RA and she was unable to work because of pain caused by the condition.  The employee reported that her pain worsened due to the cold environment at work.  Dr. Soomar commented that the medication prescribed to reduce the employee’s joint pain and stiffness would take several weeks or months to take effect.  (Ex. 10.)

On March 5, 2024, NP Werner prepared a letter “To Whom It May Concern” stating the employee had a diagnosis of RA.  NP Werner opined that the employee’s workload and environment were substantial contributing factors to the condition.  (Ex. E.)

On March 14, 2024, Dr. Soomar examined the employee, who was in the process of completing weight loss surgery.  At the employee’s request, Dr. Soomar took the employee off of work for three months at which time she would be reevaluated.  (Ex. 11.)

That same day, Nicholas G. Lebedoff, M.D., of Arthritis and Rheumatology Consultants, PA, evaluated the employee’s RA condition.  The employee complained of almost daily severe pain in both knees with migratory pain to her elbows and hands.  The pain prevented her from working.  Based upon his examination, Dr. Lebedoff started the employee on methotrexate.  (Ex. 12.)

On March 26, 2024, the employee attended a telehealth evaluation with Allina Health Weight Management for morbid obesity conducted by Dr. Charles Svendsen.  By history provided by the employee, she indicated she had been overweight for 18 years and for over five years she had been at her current weight of 229 pounds.  At the conclusion of the visit, the employee chose to have a robotic gastric bypass procedure to meet her weight loss goal.  (Ex. I.)

During a follow-up visit on March 27, 2024, NP Werner ordered physical therapy and a steroid injection for the employee’s right knee.  (Ex. 13).  On April 3, 2024, Sean Engel, M.D., of M Health Fairview Sports Medicine Clinic Maple Grove examined the employee for her right knee pain.  The employee reported the right knee pain started in November 2023 without an acute precipitating event.  Dr. Engel believed the right knee pain was due to a combination of RA and OA. During the visit the employee received a right knee steroid injection.  (Exs. 14 and D.)

On April 22, 2024, the employee attended a physical therapy evaluation for right knee pain at M Health Fairview Rehabilitation Services Maple Grove.  The chart note from that evaluation states the employee’s right knee pain was not the result of a specific injury or aggravating event.  The employee reported her pain level was 10/10 at rest or with use.  Eight physical therapy visits were recommended based on this evaluation.  (Exs. 15 and D.)

The employee returned to see Dr. Engel for left knee pain on May 1, 2024.  At this visit the employee received a left knee steroid injection.  (Exs. 16 and D.)  On May 20, 2024, NP Werner examined the employee, who reported the right knee injection helped some and there had been no improvement from the left knee injection.  (Exs. 17 and D.)

The employee attended a deposition on May 24, 2024, as part of this litigation.  The deposition was suspended after approximately 40 minutes as the court reporter could not understand the employee.  (Ex. F.)  Due to the communication problems at the employee’s deposition, she and her husband prepared Exhibit F, as a joint statement supporting the employee’s claim.  Exhibit F was filed with the Court of Administrative Hearings and served upon the employer, its insurer, Broadspire, and counsel for the employer and insurer.  Exhibit F was signed by the employee and her husband on June 5, 2024, and was notarized on June 6, 2024.  On August 2, 2024, the employee’s deposition resumed and was completed without an interpreter.  (Ex. J.)

On June 17, 2024, Christopher Kissell, APRN CNP of M Health Fairview Urgent Care Brooklyn Park, examined the employee for bilateral knee pain.  The employee reported her right knee symptoms had started nine months before and her left knee pain started in April 2024.  The employee rated the pain in her right knee as 9/10 and in her left knee as 10/10.  CNP Kissell observed tenderness at the apex of the employee’s left patella.  The employee’s gait was normal with full range of active and passive motion of the bilateral knee joints.  The employee did not complain of tenderness in the medial or lateral joint lines of either knee.  The employee was given an injection of Toradol.  (Exs. 18 and D.)

On June 18, 2024, Asim Khan, M.D., conducted an independent medical examination (IME) of the employee on behalf of the employer and insurer.  Dr. Khan issued his IME report on June 26, 2024.  Dr. Khan diagnosed the employee with OA.  While the employee had a positive blood test for RA, Dr. Khan was not sure the physical examination supported an RA diagnosis.  Dr. Khan opined that the employee’s arthritic conditions were not caused by her work for the employer in only six to seven months of employment.  Rather, the employee’s arthritic conditions were caused by her pre-existing obesity and degenerative knee arthritis.  Dr. Khan concluded that a cold work environment did not cause the employee’s RA or OA because the conditions are autoimmune disorders affecting joints.  Dr. Khan acknowledged that the employee’s work in cold conditions could exacerbate the underlying arthritis by making the condition more sensitive.  Regardless of causation, Dr. Khan concluded that the employee did not require any permanent work restrictions for her OA or RA.  (Ex. 1.)

Dr. Soomar saw the employee on follow-up on June 24, 2024.  Dr. Soomar gave the employee a prescription of Celebrex for pain.  Dr. Soomar completed a medical leave letter for the employee, keeping her off work for four to six months due to the effects of her RA.  (Ex. 19.)

On July 15, 2024, Dr. Soomar issued a report addressed “To Whom it May Concern.” (Ex. E.)  The letter states that the employee was diagnosed with RA earlier in the year and has inflammatory arthritis^[5] and OA at multiple sites.  Dr. Soomar noted that the employee also suffers from chronic knee pain which has triggered the employee’s depression.  Dr. Soomar opined that the employee’s housekeeping job, which required repetitive activities like standing, walking, squatting, bending, kneeling, mopping, vacuuming, dusting, lifting, pushing and pulling furniture in a cold work environment, aggravated the employee’s joint pain.  Dr. Soomar opined that the employee would be unable to work for up to 12 months due to her ongoing fatigue, morning stiffness, and joint pain.

On July 17, 2024, NP Werner examined the employee on follow-up for early palindromic RA.  The employee described the pain in her knee as worse with use and cold weather.  The employee rated her pain as 10/10.  A left knee x-ray was normal.  NP Werner observed no joint swelling or deformity.  A left knee MRI scan was ordered as the employee’s pain was disproportionate to the examination findings.  (Ex. 20.)

On July 31, 2024, the employee underwent an MRI scan of her left knee at M Health Fairview Northland Imaging.  (Exs. 21 and K.)  The scan revealed a moderate to high-grade partial tear of the posterior medial meniscus root ligament, grade IV chondromalacia^[6] of the patellofemoral, lateral, and medical knee compartments, and joint effusion with synovitis.

At the employee’s request, Bradley Dreiss, MS, LPCC of Nystrom & Associates, prepared a letter on her workability dated August 1, 2024.  (Ex. H.)  Mr. Dreiss remarked that he first saw the employee for depressive symptoms on March 8, 2024, and that her depressive symptoms stem from the employee’s perception of chronic physical pain.  Mr. Dreiss opined that the employee was unable to work at present due to her depressive symptoms.

On August 2, 2024, James Lorge, D.O., at M Health Fairview Clinic Princeton, conducted an orthopedic examination of the employee’s left knee.  The employee described her left knee pain as beginning in October 2023 without any specific injury or trauma, had worsened over time, and had been consistent over the last few months.  The employee’s worsening pain prevented her from attending her physical therapy sessions.  Dr. Lorge’s examination of the employee’s left knee revealed no gross deformity, soft tissue or bursal swelling, no erythema, no induration with 0-115 degrees of active motion, no increased warmth, and no gross instability to varus and valgus testing.  Dr. Lorge noted some tenderness on the lateral joint line.  Dr. Lorge’s impression was left knee primary OA (grade IV chondromalacia) and degenerative posterior horn medical meniscus.  The left knee was aspirated, and the fluid was sent to be cultured.  The employee was directed to return in two weeks.

The employee underwent a gastric bypass procedure on August 5, 2024.  (Ex. D.)

On October 7. 2024, the employee was seen by Alex Michael Basara, M.D., at M Health Fairview Northland Emergency Department because she had run out of Tylenol for pain in her right elbow and both knees.  (Exs. 23 and D.)  On examination, there was no reproducible tenderness in any of the employee’s joints, including the right elbow and both knees.  The employee’s range of motion was normal and there was no redness or warmth to touch.  The employee was prescribed Tylenol.

On October 10, 2024, the employee returned to see Dr. Lorge with complaints about continuing left knee pain.  During this visit, the employee received a left knee steroid injection.  (Ex. D.)

Mark Friedland, M.D., saw the employee for an independent medical examination on November 21, 2024.  By history, the employee had worked as a housekeeper since 2000.  She denied seeking treatment for knee pain before June 2023.  The employee further reported that she had no work injuries for any prior employer before January 2024, and that one week after beginning work for the employer in June 2023 she noticed bilateral knee, hand, and elbow pain.  Per the employee, she sustained no specific injuries while working for the employer.  Based upon his examination including a digital copy of a July 31, 2024, left knee MRI scan, Dr. Friedland opined that the employee’s diagnoses of rheumatoid arthritis and osteoarthritis are inherent degenerative and inflammatory conditions that are atraumatic and unrelated to her work activities at the employer.  It was Dr. Friedland’s further opinion that there was no objective medical evidence to substantiate the employee’s claim of injury to her elbows, wrists, hands, knees, or other joints causally attributable to her housekeeping and laundry work for the employer.  Instead, it was Dr. Friedland’s opinion that the employee’s joint pain in her upper and lower extremities was a manifestation of her chronic, pre-existing, longstanding atraumatic inflammatory arthritis and secondary osteoarthritis.  The employee did not require any physical or hourly work restrictions based upon normal joint and neurologic function found on examination by Dr. Friedland.  (Ex. 2.)

The employee filed a claim petition on April 2, 2024, seeking temporary total disability, medical, and rehabilitation benefits.  The claim petition was amended on September 13, 2024, with a second amended claim petition filed on October 16, 2024.  The claim came on for hearing before a compensation judge on June 3, 2025, and June 20, 2025.  The employee declined to testify at hearing, and relied on her deposition testimony, admitted to the record as exhibit J, and written statements of the employee and her husband were also received as evidence.  (Exs. F and O.)  In findings and order dated August 22, 2025, the compensation judge denied the employee’s claim, determining the employee did not sustain a work injury on January 20, 2024, either as a direct result of a specific injury or a Gillette-type injury.  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.”  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).  When the findings are supported by substantial evidence, the Workers’ Compensation Court of Appeals must defer to the compensation judge. Lagasse v. Horton, 982 N.W.2d 189, 202 (Minn. 2022).  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); see also Smith v. Carver Cnty., 931 N.W. 2d 390, 79 W.C.D. 495 (Minn. 2019).

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); see also Busch v. Advanced Maint., 659 N.W.2d 772, 778-79 (Minn. 2003).

On appeal, the employee asserts that the compensation judge committed errors of law requiring reversal by not adopting the evidence she introduced at hearing, failing to find that she suffered a specific or Gillette injury on January 20, 2024, by not using the work-connection balancing analysis set out in Bohlin v. St. Louis Cnty./Nopeming Nursing Home, 61 W.C.D. 69 (W.C.C.A. 2000), aff’d without opinion, 621 N.W.2d 459 (Minn. 2001),^[7] by incorrectly admitting the evidence of the employer, and by accepting the employer’s medical opinions over those submitted by the employee.  We are not persuaded.

Under the Minnesota Workers’ Compensation Act, it is the burden of the employee to prove entitlement to benefits by a preponderance of the evidence.  Minn. Stat. § 176.021, subds. 1 and 1a.  At hearing, the employee bore the obligation to prove by a preponderance of the evidence that she sustained a specific or Gillette work injury on January 20, 2024, and that she was entitled to workers’ compensation benefits.  See, e.g., Fischer v. Saga Corp., 463 N.W.2d 501, 501, 43 W.C.D. 559, 560 (Minn. 1990).

The pro se employee did not file an appeal brief.  Based on our review of the employee’s notice of appeal and letter waiving oral argument, she asserts the compensation judge failed to apply the work-connection balancing test used in Bohlin, which was overruled by the supreme court in Dykhoff v. Xcel Energy, 840 N.W.2d 821, 73 W.C.D. 865 (Minn. 2013).

Under Minnesota workers’ compensation law, to be compensable an injury must arise out of and in the course of employment.  Minn. Stat. § 176.021, subd. 1.  The “arising out of” requirement of the statute means a causal connection and the “in the course of” requirement refers to the time, place, and circumstances of the incident causing the injury.  Gibberd v. Control Data Corp., 424 N.W.2d 776, 780, 40 W.C.D. 1040, 1047 (Minn. 1988).  Each requirement must be proven for an injury to be compensable.  See, e.g., Dykhoff, 840 N.W.2d 821, 73 W.C.D. 865; Roller-Dick v. CentraCare Health Sys., 916 N.W.2d 373, 78 W.C.D. 483 (Minn. 2018).

In Dykhoff, our supreme court held that an employee must show that an injury both arose out of and in the course of the employment, striking down the balancing test set out in Bohlin.  With respect to the “arising out of” requirement, the court in Dykhoff stated:

The employee argues that the compensation judge erred in not applying the overturned Bohlin balancing test to her claim, as opposed to the compensation judge’s use of the increased risk test adopted by the supreme court in Dykoff.  The compensation judge applied the correct standard in the decision, which we affirm.

The employee asserts that the compensation judge’s decision was not based on the facts and evidence presented at hearing.  We disagree.  A pre-trial conference was held on June 3, 2025, during which exhibits from both parties were identified.  The issues relating to the employee’s claim were also discussed and agreed upon by the parties during the pre-trial with the compensation judge.  (Findings and Order, footnote 5.)  At hearing both parties introduced exhibits which were admitted into evidence by the compensation judge.  Our examination of the record shows that the exhibits offered by the employee were received into evidence.  This includes exhibits F, J, and O, which were received over the objection of the employer’s counsel.  We also reviewed the verified record received from CAH which shows the employee’s second amended claim petition and all attachments were part of the record available for the compensation judge’s examination.  (Ex. 26.) Based upon this court’s assessment of the record, the compensation judge’s decision was based on a thorough evaluation of the issues, testimony, and exhibits received at hearing, including those of the employee.

On review of the assertions in the employee’s notice of appeal, she contends the compensation judge may not have given the same weight to her evidence and witness statements as those offered by the employer.  Underlying this contention is the assertion that the employee’s case did not receive the same unbiased, fair, and impartial review as that of counsel for the employer by the compensation judge.  This court’s examination of the record demonstrates the compensation judge provided the employee not only the opportunity to offer documentary evidence, but also with the opportunity to express and argue her position on the claims at issue.  The transcript shows the employee was treated with dignity and courtesy during the hearing by the compensation judge.  Our review of the decision of the compensation judge leads us to conclude that he applied the workers’ compensation statute fairly, without bias, impartially, and consistently to all parties.  The employee is asking this court for a reevaluation of the evidence which we cannot provide.  “Whether the evidence is documentary or oral, it is not the function of a reviewing court to try the facts anew.”  Courtney by Higdem v. City of Orono, 463 N.W.2d 514, 517 n. 2, 43 W.C.D. 571, 575 n. 2 (Minn. 1990).

The compensation judge based his conclusions on substantial evidence contained 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 responsibility of a judge to carefully consider all the evidence presented at the hearing and to weigh the conflicting evidence.  The employee argues that the judge’s findings were not based upon a thorough review of the evidence submitted by the parties, or upon substantial evidence including the hearing testimony.  We do not agree.  The record in this matter is extensive.  The compensation judge’s decision included 40 factual findings on the issues identified by the parties for decision.  His factual findings are supported by numerous references to the evidentiary record.  The findings and order incorporate a memorandum further explaining the basis for the compensation judge’s decision.  The fact that the judge did not reference all the evidence favoring the employee’s position in his findings and order does not establish that that evidence was ignored.  See Rothwell v. Minn. Dep’t of Nat’l Resources, slip op. (W.C.C.A. Dec. 6, 1993).  A compensation judge is not required to relate or discuss every piece of evidence introduced at the hearing.  Braun v. St. John’s Univ., slip op. (W.C.C.A. July 20, 1992).

It is also the compensation judge’s responsibility, as trier of fact, to resolve conflicts in expert testimony.  Nord v. City of Cook, 360 N.W.2d 337, 342-43, 37 W.C.D. 364, 372-73 (Minn. 1985).  In the present case, the issue of primary liability involved the judge’s resolution of differences in the medical records and physician opinions.  We reiterate that it is not this court’s function to assess whether substantial evidence might support a conclusion contrary to that reached by the compensation judge; our function on review is only to assess whether substantial evidence exists to support the conclusion 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) (“The point is not whether [the appellate courts] might have viewed the evidence differently, but whether the findings of the compensation judge are supported by evidence that a reasonable mind might accept as adequate”).

 The employee did not object at hearing to the reports of Dr. Khan or Dr. Friedland.  A compensation judge’s decision to adopt the opinion of an expert must be upheld if the opinion has adequate foundation, absent an abuse of discretion.  Mattick v. Hy-Vee Foods Stores, 898 N.W.2d 616, 621, 77 W.C.D. 617, 624 (Minn. 2017).  “An expert opinion lacks adequate foundation when the opinion does not include the facts upon which the expert is relying in forming the opinion, there is no explanation of the basis for the opinion, or the facts assumed by the expert are not supported by the evidence.”  Erickson v. Grand Itasca Clinic & Hosp., No. WC21-6413 (W.C.C.A. Nov. 16, 2021) (citing Hudson v. Trillium Staffing, 896 N.W.2d 536, 540, 77 W.C.D. 437, 442 (Minn. 2017)).

Here, the compensation judge found the expert medical opinions of Dr. Khan and Dr. Friedland more credible and persuasive in determining that the employee did not sustain a work injury on January 20, 2024.  This conclusion made by the compensation judge was based upon the recommendation for the employee to seek a rheumatology evaluation in 2016, reported weight issues since 2019, and 2022 diagnosis of joint pain with work restrictions made in 2022. (Memo. p. 11.)  The medical opinions accepted by the compensation judge have adequate foundation and the findings are supported by substantial evidence in the record, therefore we affirm.

We find no basis to conclude that the compensation judge erred in accepting the opinions of Dr. Khan and Dr. Friedland and denying the employee’s claim based upon the record before us.  As the compensation judge’s decision is supported by substantial evidence, that decision is affirmed in its entirety.  See Nord, 360 N.W.2d 337, 37 W.C.D. 364.