OCLA BELLAMY, Employee/Appellant, v. MIDWEST SPECIAL SERVS., INC., NONPROFIT INSURANCE TRUST, ADMIN’D BY NPIA, INC., Employer-Insurer/Respondents, and OCCUPATIONAL INJ. CONSULTANTS, NORAN NEUROLOGICAL CLINIC, P.A., N. MEM’L HEALTH CARE, UCARE, MEDICA HEALTH PLANS, and FAIRVIEW HEALTH SERVS. - ALL ENTITIES, Intervenors.

The employee appeals the compensation judge’s findings that she did not contract an occupational disease in her right eye and that she did not sustain a specific work-related personal injury in the nature of an infection in her right eye.  We affirm.

Midwest Specialty Services has employed Ocla Bellamy, the employee, since 2020 as a direct support professional administering basic personal care for clients with disabilities.  The employee worked in close contact with clients, including diapering and toileting residents and clients, some of whom were non-ambulatory and required a Hoyer lift for repositioning. 

As a child, the employee injured her right eye in a BB gun accident.  She underwent surgery for an eye implant in 2007 and had two revision surgeries in 2009.  In 2012, she underwent an orbital reconstruction and a conformer^[1] was placed in her right eye socket.  Over the course of 13 years, the employee had one recorded eye infection for which she received treatment in 2017. 

On or around April 18, 2023, the employee developed a foul-smelling discharge in her right eye.  The employee sought treatment with her primary care physician, Jason Ricco, M.D., who is board certified in family medicine.  Dr. Ricco diagnosed a bacterial infection and prescribed an antibiotic, but her symptoms continued to worsen.  Due to the severity of the infection, the employee sought treatment at North Memorial Emergency Department on April 21, 2023, and was diagnosed with periorbital cellulitis.  She was prescribed antibiotic ointment and drops, and transferred to M Health Fairview where she was admitted for additional treatment.  A culture of her right eye tested positive for E. coli, a bacteria associated with fecal matter, as well as streptococcus and staphylococcus. 

On April 26, 2023, an oculoplastic specialist, Andrew Harrison, M.D., performed a right orbital implant removal, dermis fat graft, secondary orbital implant, and temporary tarsorrhaphy.  Dr. Harrison stated in his postoperative report that the employee had presented with extruding right orbital implant “that was causing chronic infections in the eye socket.”  (Ex. AA.)  Dr. Harrison’s records do not reference the employee’s work duties or contact with fecal matter while at work.  On April 27, 2023, she was discharged from the hospital.  Dr. Harrison released her to return to work with positional restrictions on May 8, 2023, and released her to work without restrictions on June 1, 2023.

Dr. Ricco had also restricted the employee from work on May 11, 2023, due to her hospitalization for a life-threatening infection and her ongoing medical issues.  On May 23, 2023, he stated it was “highly likely” that the source of her eye infection was her exposure to a “sick client at work” and restricted her from working within close proximity of clients or colleagues who showed symptoms of an infection.  (Ex. Q.)  In a June 23, 2023, note, Dr. Ricco stated that if that restriction was not possible, she should remain off work.  At a deposition, Dr. Ricco testified that the fact that the employee did not have an eye infection between 2018 and 2023 was evidence that she practiced regular hand hygiene.  While Dr. Ricco did not know the incubation period for E. coli, he testified that E. coli was “potentially” transmitted to the employee while helping toilet and clean clients.  (Ex. 1 at 20.)  He noted that she possibly could have been exposed by a client who had no active E. coli infection or symptoms.  

Dr. Harrison referred the employee to Midwest Eye Laboratories for a new right eye prosthesis, which was fitted on August 23, 2023.  

The employer and its insurer denied that the employee had developed a work-related eye infection and retained ophthalmologist Gunnar Erickson, M.D., for an independent medical opinion.  Dr. Erickson reviewed multiple records, took a medical history from the employee, and conducted an examination.  In his December 11, 2023, narrative report, he referenced the employee’s long medical history of orbital problems, which began with a poorly fitted implant and continued as she wore a conformer on and off for many years.  He noted that conformers should only be used temporarily because they make proper blinking difficult, thereby retaining mucus and discharge, which leads to rubbing and tissue breakdown.  He concluded that the employee’s eye problems were not caused by an occupational disease, but were related to the care of the eye orbit, hygiene issues, and the use of an ill-fitting conformer that collected discharge around her eye and led to the breakdown.  He agreed with Dr. Harrison’s conclusions and his release of the employee from work restrictions as of June 1, 2023. 

The matter went to hearing on September 12, 2025.  The employee argued that her eye condition was an occupational disease or a specific personal injury attributable to her work.  The parties offered conflicting expert medical opinions.  While the employee made no foundational objection at hearing, she questioned Dr. Erickson’s foundation for his opinion in her written post-hearing closing argument.  In his findings and order, the compensation judge adopted Dr. Erickson’s opinion in finding that the employee had not met her burden of proof that the eye infection was a direct and proximate cause of her work environment as an occupational disease or as a personal injury arising out of her employment, and denied compensation.  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.”  N. 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 argues that the compensation judge erred in adopting the causation opinion of Dr. Erickson because he lacked the necessary foundation on which to base his opinion.  She also argues that the compensation judge erred in finding that she had failed to prove that her work was a direct and proximate cause of an occupational disease of her right eye or that she suffered a specific personal injury to her right eye arising out of her employment.  We are not persuaded.

In determining that the employee had not suffered a compensable occupational disease or a specific injury, the compensation judge adopted the opinion of the employer and insurer’s medical expert, Dr. Erickson, over the opinion of the employee’s primary care physician, Dr. Ricco.  The employee argues that the judge erred in adopting Dr. Erickson’s opinion because it lacked foundation.  While the employee touched on the issue of foundation in closing arguments submitted after the hearing, the employee did not object to Dr. Erickson’s report at the hearing and did not raise the issue in the notice of appeal to this court.  An objection to an expert medical opinion must be made upon admission of the testimony or report.  See Willy v. Nw. Airlines Corp., 77 W.C.D. 349, 355 (W.C.C.A. 2016) (citing Weis v. Clinton Elec. Co., slip op. (W.C.C.A. Oct. 10, 1997)), summarily aff’d (Minn. May 10, 2017).  We conclude that a specific foundation objection to Dr. Erickson’s opinion was not raised as an issue at the hearing and will not be addressed on appeal.  See id.

Where there was no objection to an expert medical opinion at the hearing, any alleged defects go to the weight of the opinion.  Dehn v. Honeywell, Inc., slip op. (W.C.C.A. May 25, 2006); Burke v. Precision Eng’g, slip op. (W.C.C.A. Aug. 21, 1997).  Given the employee’s acknowledgement that Dr. Erickson reviewed the employee’s records and saw the employee during an independent medical examination, her argument that Dr. Erickson’s lack of familiarity with the employee’s medical history in forming his opinion goes to the persuasiveness and weight of the opinion, as also argued in her written closing argument submitted after the hearing.  Dr. Erickson reviewed multiple medical records from before and after the 2023 eye infection, took a medical history from the employee, and examined the employee’s eye.  He explained the basis of his opinion, and noted his agreement with Dr. Harrison, the oculoplastic specialist, who also indicated that the problem was the ill-fitting conformer.  Dr. Erickson’s opinion was based on “enough facts to form a reasonable opinion that [was] not based on speculation or conjecture.”  See Gianotti v. Indep. Sch. Dist. 152, 889 N.W.2d 796, 802, 77 W.C.D. 117, 124 (Minn. 2017); see also Drews v. Kohl’s, 55 W.C.D. 33 (W.C.C.A. 1996), summarily aff’d (Minn. July 11, 1996); Grunst v. Immanuel-St. Joseph Hosp., 424 N.W.2d 66, 68, 40 W.C.D. 1130, 1132-33 (Minn. 1988).   The compensation judge did not abuse his discretion by accepting and relying on the adequately founded opinion of Dr. Erickson in determining whether the employee’s eye condition was causally related to her work.

The employee also argues that the compensation judge erred in finding that she had failed to prove that her work was a direct and proximate cause of an occupational disease of her right eye or that she suffered a specific personal injury to her right eye arising out of her employment.  We disagree.  The employee bears the burden of proving, by a fair preponderance of the evidence, the compensability of her claim.  See Swanson v. Fairway Foods, 439 N.W.2d 722, 723, 41 W.C.D. 1010, 1013 (Minn. 1989).  An occupational disease requires a causal connection to work that is direct and proximate.  Minn. Stat. § 176.011, subd. 15(a).  To prove a specific personal injury is compensable, an employee must show that the employment is a substantial contributing cause of the injury.  Salmon v. Wheelabrator Frye, 409 N.W.2d 496, 497-98, 40 W.C.D. 117, 122 (Minn. 1987). Conflicts in expert opinions and other evidence regarding the causal connection between an employee’s work and a claimed work injury are resolved by the compensation judge.  Ruether v. State of Minn., 455 N.W.2d 475, 478, 42 W.C.D. 1118, 1123 (Minn. 1990).   

In this case, the parties submitted conflicting expert medical opinions.  Dr. Erickson opined that the employee’s eye problems were not caused by an occupational disease, but were related to the care of the eye orbit, hygiene issues, and the use of an ill-fitting conformer that collected discharge around her eye and led to the breakdown.  As an ophthalmologist, he was qualified to consider the information necessary to establish whether the employee’s condition had a work connection.  The compensation judge was also presented with Dr. Ricco’s opinion that the infection potentially could have been transmitted to the employee at work.  The judge did not accept this opinion, reasoning that Dr. Ricco was not an expert in infectious diseases, did not know the incubation period for E. coli, and was not aware of steps taken to determine exactly where the employee was exposed to the bacteria.  Relying on the testimony of the employer’s representative that no one else who worked for the employer had developed E. coli, the judge determined that the condition was not peculiar to her work activities.  He concluded that the evidence did not establish a causal connection as an occupational disease or a specific injury.

In analyzing whether the compensation judge erred in his findings, we look to the record as a whole and if the record supports the judge’s findings, we must affirm.  Lagasse v. Horton, 982 N.W.2d 189, 202 (Minn. 2022).  The compensation judge determined there was insufficient evidence on the issue of causation for an occupational disease or for a specific personal injury. Substantial evidence, including the opinions of Drs. Erickson and Harrison, supports the compensation judge’s findings that the employee did not contract an occupational disease in her right eye and that she did not sustain a specific work-related personal injury in the nature of an infection in her right eye, and we affirm.