The employee appeals the denial of payment for treatment after August 18, 2023, provided by or paid for by CentraCare St. Cloud Hospital, CentraCare Clinic, Blue Cross Blue Shield of Minnesota, St. Cloud Orthopedics, and Alliance Imaging.  We reverse.

Kathryn Berg, the employee, started working as an order selector for Spartan Nash Distribution Center, the employer, in 2021.  Her position required the employee to place items of varying weights, up to 50 pounds, on a pallet and to shrink-wrap the items for transport.  She also performed warehouse work for Walmart on a full-time basis from 2013 to 2021, and on a part-time basis since she started working for the employer and through the date of the work injury.  Prior to the work injury, the employee had no restrictions and had no difficulty in performing her job tasks.  The employee suffered no prior injuries and had full use of her right arm. 

On August 12, 2021, the employee suffered an admitted work injury when items fell on her upper right arm.  The employee experienced sharp pain from her right elbow to the side of her neck.  The employee finished her shift for the employer, but had right arm pain from her shoulder to her wrist.  She sought medical care the following morning as she could not lift her right arm beyond shoulder height and was experiencing significant pain.

The employee was initially diagnosed with a sprained wrist and a right shoulder rotator cuff tear.  The employee was taken off work and was prescribed a splint and anti-inflammatory pain medication.  Rest, elevation, and ice to the affected area were directed.  One week after the injury, the employee showed continued limitations in her range of motion, with swelling and tenderness in the right elbow and right shoulder area.  The employee’s diagnosis was modified to initial wrist sprain and right shoulder tendinopathy.  (Ex. I.)  She was released to light-duty work with restrictions, including lifting no more than five pounds.  In September 2021, the employee underwent a right shoulder MRI which showed no fractures and no rotator cuff tearing.  (Ex. K.)  On October 18, 2021, the employee began physical therapy, with initial goals of being able to perform a number of activities of daily living without limitations from pain.  The employee was assigned light-duty work with the employer until April 2022, when that work was no longer available.  Additionally, she was unable to work in her part-time position with Walmart due to her restrictions until February 2022.

Following the work injury, the employee continued to experience pain in her right shoulder and arm.  The employee also continued physical therapy to restore sufficient range of motion to enable her to resume working.  On September 9, 2022, the employee underwent a brachial plexus MRI seeking the source of the employee’s continuing symptoms.  The MRI showed no evidence of an inflammatory process or a discrete mass in the area.  (Ex. J.)

On March 21, 2023, the employee’s restrictions were eased to 10 pounds lifting with her right arm and 20 pounds overall.  On August 18, 2023, Sakshi Kaul, M.D., administered Synvisc-One injections to the employee which provided significant pain relief for five and one-half months.  The employee continued with physical therapy following the injections.  On January 31, 2024, the employee’s restrictions were further eased to 17.5 pounds with her right arm and 35 pounds overall.

The employee was scheduled for a repeat Synvisc-One injection on July 18, 2024.  This injection was approved by the insurer.  The procedure was rescheduled for November 2024, due to a scheduling conflict.  After the scheduling change, the insurer revoked approval for the procedure.  (Ex. N.)

In September 2024, the employee began a work conditioning program with St. Cloud Orthopedics, engaging in work-hardening activities one session per week.  The employee reported no improvement in pain, but moderate functional improvement.  (Ex. N.)

On October 29, 2024, Loren Vorlicky, M.D., conducted an independent medical examination (IME) of the employee on behalf of the employer.  Included in the records reviewed by Dr. Vorlicky was a prior IME report of Kristen Zeller, M.D., for an examination that was conducted in April 2023.  Dr. Vorlicky quoted some of Dr. Zeller’s conclusions, specifically that the employee was suffering from adhesive capsulitis, but the condition would likely reach maximum medical improvement (MMI) within a couple of months with the current treatment.  Dr. Vorlicky came to different conclusions from those of Dr. Zeller.  Dr. Vorlicky opined that the employee suffered a mild contusion to her right shoulder which resolved without permanent effects within three months of the date of injury.  Dr. Vorlicky offered no opinion regarding the need or reasonableness of the medical care received by the employee, regardless of causation.  (Ex. 1.)

On February 19, 2025, Dr. Kaul examined the employee, noting that the employee’s pain from the work injury was continuing.  Dr. Kaul adjusted the employee’s lifting restrictions to no more than 25 pounds (occasional) and 20 pounds (frequent) with the right arm and 45 pounds (occasional) and 40 pounds (frequent) with both arms.  (Ex. D.)

On March 20, 2025, the employee began working seasonally half time at a school cafeteria.  In March 2025, the employee’s restrictions were eased to 25 pounds for her right arm and 45 pounds overall.  The employee’s vocational goal throughout her recovery has been to return to work for the employer with no restrictions.  This goal is reflected in the employee’s rehabilitation plan.  (Ex. N.)

On March 25, 2025, Dr. Kaul provided a narrative opinion regarding the employee’s condition and need for ongoing care.  Dr. Kaul opined that the August 12, 2021, work injury was a substantial contributing cause of the employee’s continuing symptoms, and that the employee required ongoing care to reach MMI.

The parties filed various petitions disputing entitlement to indemnity benefits and medical treatment.  On July 17, 2025, the matter came on for hearing before a compensation judge.  The hearing was limited to whether the treatment provided by or paid for by CentraCare St. Cloud Hospital, CentraCare Clinic, Blue Cross Blue Shield of Minnesota, St. Cloud Orthopedics, and Alliance Imaging was reasonable, necessary, and causally related to the August 12, 2021, work injury.^[1]  The compensation judge stated on the record that the issue of approval or denial of another Synvisc-One injection was not a justiciable issue before the court.  (T. 75-78.)  Counsel for the employee further clarified on the record that there was no claim for a specific injury to the elbow, wrist, neck, or thoracic spine.  (T. 80.)  The question for the compensation judge was whether the diagnostic tests and other medical care, through the date of hearing, to treat the symptoms in the elbow, wrist, neck, and thoracic spine were reasonable, necessary and causally related to the admitted shoulder injury.

Both the employee and the employer and insurer introduced evidence, including medical opinions from Drs. Kaul and Vorlicky.  Neither party entered Dr. Zeller’s report into evidence.  The compensation judge explicitly found the employee’s testimony, that she experienced five and one-half months of pain relief from the injection, to be credible.  The judge expressly rejected the opinions of Drs. Kaul and Vorlicky.  Relying on the opinion of Dr. Zeller, solely as quoted in the IME report of Dr. Vorlicky, the judge awarded treatment through August 18, 2023, and denied payment for treatment after that date.  The employee appeals the denial of payment for treatment after August 18, 2023.

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 contends that the compensation judge’s denial of medical care as not reasonable and necessary is unsupported by substantial evidence in the record.  In particular, the employee asserts that the compensation judge erred by relying on the conclusions of Dr. Zeller because her report was not put into evidence and therefore lacks foundation.  The employee asserts that the compensation judge’s determination was not supported by a well-founded medical opinion and is contrary to substantial evidence in the record.  In response, the employer and insurer note that there was no objection made to the foundation of Dr. Vorlicky’s IME report.  The employer and insurer maintain that the compensation judge could rely on the quoted language contained in that report in support of her decision.

At the hearing before the compensation judge, the employer and insurer objected to the employee’s claimed medical care as being not reasonable and necessary to cure and relieve the employee from the effects of the work injury.  With few exceptions, this defense generally follows one of two paths.  On one path, an employer asserts that the care is not treating the effects of the work injury, because the work injury had resolved or a superseding intervening cause had broken the chain of causation.  On the other path, an employer asserts that something regarding the particular care provided is unreasonable or not necessary in the employee’s particular circumstance.  In this case, the employer and insurer chose to defend against the employee’s claim along the first path, relying on Dr. Vorlicky’s opinion to assert that the employee’s work injury had resolved and therefore none of the employee’s medical care at issue was provided to treat the effects of the work injury.  The compensation judge rejected this defense and awarded the medical care provided through the date of the Synvisc-One injection, August 18, 2023.  The award of medical care through August 18, 2023, is supported by the record and no party appealed that award.

In denying the medical care provided to the employee after August 18, 2023, the compensation judge appears to be following the second path, concluding that something about the medical care provided after that date was not needed or not reasonable to treat the effects of the August 12, 2021, work injury.  But the employer and insurer offered no affirmative medical evidence in support of this contention.  Dr. Vorlicky does not specifically identify any questionable treatment received by the employee, instead contending that the employee’s injury was temporary and had resolved no later than three months after the date of injury and without any comment regarding care provided after that time.

Despite the lack of any medical opinion criticizing the particular care received, the employer and insurer argued that the overall nature of the care received was in some unspecified fashion inappropriate. (T. 20-22, 24, 27.)  None of these arguments are supported by medical opinion.  Arguments of counsel are not a substitute for well-founded medical opinion or facts in the record.  See Devos v. Rhino Contracting, Inc., 78 W.C.D. 9 (W.C.C.A. 2018); Thao v. Synovis Life Techs., Inc., 76 W.C.D. 607 (W.C.C.A. 2016).

In addition to the lack of evidence criticizing the care provided to the employee, the compensation judge expressly relied on the opinion of Dr. Zeller in both awarding benefits through August 18, 2023, and denying medical care thereafter.  Dr. Zeller, as quoted by Dr. Vorlicky, opined that “. . . if [the employee] just follows the treatment plan over the next couple of months, she will reach Maximum Medical Improvement . . .  and with appropriate treatment I do think she will reach Maximum Medical Improvement and there would be no rating for this.”  (Ex. 1.)

The quoted portion of Dr. Zeller’s opinion indicates that the employee’s condition was improving from the care that she was receiving.  This impliedly indicates that Dr. Zeller considered the care being provided to be reasonable and necessary to address the effects of the work injury.  Dr. Zeller did not opine that the treatment would resolve the work injury, but rather that the employee would reach MMI.  Achieving MMI is important to wage replacement benefits and the determination of permanency benefits.  Junker v. B.F.I., Inc., slip op. (W.C.C.A. Feb. 5, 1997).  However, reaching MMI does not preclude an employee from receiving further reasonable and necessary medical care.  Hopp v. Grist Mill, 499 N.W.2d 812, 814 n.3, 48 W.C.D. 450, 452 n.3 (Minn. 1993); Romano v. Timberline/Northstar Personnel, slip op. (W.C.C.A. Aug. 20, 1993); Heikkila v. Allied Staffing, LLC, No. WC22-6447 (W.C.C.A. July 18, 2022).

Dr. Zeller’s conclusion regarding MMI does not indicate whether any care received by the employee after her examination in April 2023, was or was not reasonable or necessary to cure and relieve the employee of the effects of the work injury.^[2]  In relying on Dr. Zeller’s April 2023 conclusion that the employee might soon be at MMI as the basis to deny the payment of medical care after August 18, 2023, as not reasonable and necessary, the compensation judge committed plain error.^[3]

While a determination of reasonable and necessary care is not required to be supported by a medical opinion, the determination must be supported by substantial evidence in the record.  Tuomela v. Reserve Mining Co., 299 Minn. 203, 204, 216 N.W.2d 638, 639, 27 W.C.D. 312, 313 (1974).  In such a case, a compensation judge may arrive at a determination regarding the reasonableness and need of medical care over an otherwise unopposed medical opinion where a contrary conclusion is supported by the employee’s medical record.  See Ruether v. State, Mankato State Univ., 455 N.W.2d 475, 478, 42 W.C.D. 1118, 1123 (Minn. 1990); Leuthard v. Craig’s Tree Serv., 76 W.C.D. 735, 741-42 (W.C.C.A. 2016) (denial of medical referral as not reasonable or necessary supported by poor outcomes in medical record); Stans v. Long Prairie Mem’l Hosp., 72 W.C.D. 255 (W.C.C.A. 2012) (medical record supported award of medical care over unopposed medical opinion)..  In this case, the record is clear.  The employee’s overall physical condition continued to improve after the effects of the Synvisc-One injection waned.  The employee was able to engage in work conditioning, reported improved results from physical therapy, obtained half-time work, and had her lifting restrictions progressively reduced.

The only inference available from the employee’s medical record and her credible testimony regarding the effects of the Synvisc-One injection is that the medical care the employee continued to receive after August 18, 2023, was reasonable and necessary to cure and relieve her of the effects of the August 12, 2021, work injury.  There was no competent evidence entered into the record to counter this conclusion.  The other evidence remaining included: (1) the opinions of Drs. Vorlicky and Kaul, both found to be unpersuasive by the compensation judge, and (2) the opinion, to the extent quoted by Dr. Vorlicky, of Dr. Zeller, who examined the employee in April 2023 and opined that the care to date had been reasonable, necessary, and causally related to the work injury, surmised that the employee would need some unspecified future care, and offered no opinion regarding care occurring after August 2023.  As no other evidence was offered to dispute that the medical care was something other than reasonable and necessary, and as the only remaining evidence supports that conclusion, the employee carried her burden to demonstrate that she was entitled to the award of payment for that care.^[4]

For the foregoing reasons, we reverse the compensation judge’s denial of payment for medical treatment after August 18, 2023, because substantial evidence in the record does not support the determination and conclusion.  The employer and insurer shall pay the compensable costs of treatment provided by or paid for by CentraCare St. Cloud Hospital, CentraCare Clinic, Blue Cross Blue Shield of Minnesota, St. Cloud Orthopedics, and Alliance Imaging.