The self-insured employer appeals from the finding that the employee sustained a Gillette injury^[1] culminating in April 2005; from the finding that the Gillette injury is a substantial contributing factor in the employee’s disability; and from the award of permanent total disability compensation.  We affirm.

Mary Regenscheid began working for the employer, Cedar Valley Services, in September 2001.  Cedar Valley Services provides light manufacturing and commercial services for various companies by employing developmentally disabled persons.  Ms. Regenscheid was hired to be a job coach, directing the work of employees in janitorial services.  She also assisted in the janitorial work and yard work to ensure that the tasks were performed.  In addition to the specific job duties of the departments, job coaches at times needed to help employees into and out of wheelchairs, buckle them into seats in vehicles, and from time to time assist with diapering.  There were no restrictions on the employee’s work activities when she started at Cedar Valley.  She testified at the hearing that she had never missed any time from work because of cervical spine problems and that she had always been able to function normally at work and at home.

Ms. Regenscheid had a history of pre-existing cervical problems before her employment at Cedar Valley.  In 1975, she had complaints of neck stiffness associated with her job at Land O’Lakes.  Radiologic studies of the cervical spine in 1978 were read as normal with the exception of “mild anterior hydrotropic spurring at the C5-6 level.”  The employee was also seen in November and December 1978 for neck and shoulder pain secondary to constant movement at work at Lake Center Industries.  In 1979, the employee was referred to the Mayo Clinic for evaluation of chronic neck discomfort.  It was noted at that time that her work involved prolonged sitting while assembling dome lights for automobiles.  A diagnosis was made of “tension myalgia” and Ms. Regenscheid was advised that further care at the Physical Medicine Department or a vascular consultation might be considered.  Ms. Regenscheid did not treat again at Mayo Clinic until mid-2001.

In 1989, because of neck and right shoulder complaints, x-rays were done and read as showing mild intervertebral disc space narrowing at the C4-5 and C5-6 levels, prominent anterior hypertrophic spurring at the C6-7 level, and mild neural foramina narrowing bilaterally at C4-5 due to spur formation.  After that time, Ms. Regenscheid received chiropractic care on an intermittent basis for her back and neck.

In 1999, Ms. Regenscheid was seen at Austin Medical Center for chronic neck pain and a tingling sensation in her left upper arm after falling and striking her head.  She was diagnosed with cervical spondylosis and referred for physical therapy.  An MRI of the cervical spine done in November 1999 showed degenerative disc disease at multiple levels with some encroachment but no significant effacement of the spinal cord or the nerve roots.  Ms. Regenscheid declined a referral for a neurosurgical consultation and continued with physical therapy.  She was later discharged from physical therapy with a diagnosis of severe degenerative disc disease and spinal osteoarthritis.  She returned to the Austin Medical Center in April 2001 with complaints of left-sided neck spasms and a headache and she was treated with physical therapy and pain medications.

Ms. Regenscheid was referred for a neurosurgical consultation at the Mayo Clinic in June 2001.  She reported chronic neck pain with radicular symptoms.  Examination showed stiffness in her upper back muscles, neck muscles, and trapezious muscles.  Ms. Regenscheid stated that her symptoms had worsened in early April and that physical therapy had not helped.  An MRI and an EMG were done and she met with a neurologist to discuss the test results.  Dr. J. D. Bartleson recommended continuation of conservative care, noting that the EMG showed only a moderate right carpal tunnel syndrome and no evidence of cervical radiculopathy.  He stated that the cervical MRI did show significant cervical spondylosis with some degree of cervical spinal canal stenosis and foraminal narrowing especially at C4-5.  At C5-6 and C6-7 there was less narrowing, both at the central canal and the exiting nerve root foramina.  Dr. Bartleson compared her cervical MRI with that done in November 1999.  He concluded that there was “not a lot of difference although the current study may show some increase in the stenosis at the C4-5 level.”  Ms. Regenscheid was prescribed medication and advised to return to her therapist in Austin for instructions in a home therapy program.  No activity restrictions were placed at that time.  This was Ms. Regenscheid’s last medical appointment for cervical complaints before she began working at Cedar Valley.

At some point before October 2003, Ms. Regenscheid transferred to the employer’s food services department.  In this job, she helped employees prepare food items and then assisted in transporting the food to various locations.  The job frequently required lifting supplies and cooking equipment, as well as trays of food.  On October 28, 2003, Ms. Regenscheid was injured when she was getting supplies from a large two-door refrigerator and an employee tried to slam the refrigerator door closed.  The door struck her head and left side and the force of the impact threw her into the racks of the refrigerator where her upper back and neck struck the racks.  She felt dizziness and then experienced severe pain.

Ms. Regenscheid treated for this incident at Austin Medical Center and reported that she was experiencing increased neck pain with right upper extremity symptoms.  She was referred for physical therapy and traction.  Ms. Regenscheid told her physical therapist that lifting at work had triggered pain and tingling sensations in her right arm.  The therapist wrote restrictions of no lifting over twenty pounds effective from November 21, 2003, through December 29, 2003.  When she saw Dr. Shawn Nakamura at Austin Medical Center on January 14, 2004, she stated that her neck pain had returned to its usual level.  Dr. Nakamura noted that Ms. Regenscheid still had tingling and numbness throughout her right upper extremity, was now starting to have some tingling and numbness in the left upper extremity, and traction and therapy had not helped those symptoms.  However, because her neck pain had returned to its baseline level, Dr. Nakamura released Ms. Regenscheid to work without restrictions.

On January 27, 2004, Ms. Regenscheid returned to the Mayo Clinic for neck and arm weakness and persistent neck pain and stiffness.  She told the doctor that these symptoms were causing her difficulty at work and she was unsure if she would be able to continue to perform her job duties.  She was referred to the pain clinic and a repeat MRI scan was ordered.  The MRI scan, performed the next day, showed advanced degenerative changes but was unchanged from the prior scan in 2001.  Ms. Regenscheid was seen at the Mayo Pain Clinic two times in April 2004 and was treated with epidural steroid injections.

In June 2004, Ms. Regenscheid returned to Austin Medical Center for continuing neck pain.  She was given work restrictions limiting her lifting to ten pounds occasionally.  Her symptoms were not at that time considered to be work related.  During August 2004, she was seen again at the Mayo Clinic where she stated that she was having trouble following her work restrictions on the job.  She was also seen by her family physician, Dr. Carol Holtz, at Austin Medical Center, who continued her work restrictions until September 10, 2004.

On August 6, 2004, Ms. Regenscheid was seen again at Austin Medical Center for chronic neck pain.  She reported that she sometimes needed to lift heavy items at work which she found to be very painful and “nearly impossible.”  Ms. Regenscheid requested that a letter be sent to her employer about observing her restrictions.  Dr. Holtz took her off work, prescribed pain medication, and referred her to physical therapy.  When Ms. Regenscheid started physical therapy, she rated her pain symptoms as varying from seven to ten on a scale of one to ten.  She also stated that she was now unable to perform strenuous tasks such as sweeping, lifting, or carrying groceries, and had stopped gardening.  On October 15, 2004, the work restrictions were extended by Dr. Holtz through October 31, 2004.

Ms. Regenscheid attended a pain clinic at Mayo Clinic for a program of physical and occupational therapy and counseling from October 27, 2004, through November 16, 2004, during which time she was entirely off work.  Following her discharge from the pain clinic, she was advised she could return to work on November 22, 2004, working either four or six hours each day initially and increasing her schedule by two hours per day each week until she reached a full eight-hour work day.

Ms. Regenscheid returned to Cedar Valley on November 22, 2004, as a job coach assisting workers on a production line.  Packages of various Hormel products came down a production line, were put into plastic display containers, and then packaged onto trays or in carrying cases.  Cases then needed to be stacked on pallets.  Ms. Regenscheid testified that the job involved constant moving, lifting, bending, and stacking, and that she was continuously helping the workers and on occasion doing their production line duties.  She also helped other non-disabled workers with stacking the trays on pallets for shipment.  She further testified that her job duties frequently forced her to exceed her restrictions, both in performing repetitive lifting over ten pounds, and in assisting employees with wheelchairs, helping to buckle employees in vehicles, and diapering.  Ms. Regenscheid also testified that at one point she was placed in a different area of the production line with more special needs workers.  She had to diaper these workers which involved lifting them out of wheelchairs, placing them on a sheet to diaper them, and then lifting them back into the wheelchairs.  Ms. Regenscheid had increased symptoms of neck and back pain while doing the production line work and reported these problems to her supervisor.

On April 11, 2005, Ms. Regenscheid returned to the Austin Medical Center and saw Dr. Holtz for neck and back pain.  She stated that she had been doing well until the past week when she started to notice an acute exacerbation of her symptoms.  She attributed this to being forced to do tasks at work that exceeded her restrictions, including lifting more than ten pounds “constantly throughout the day,” moving patients in bed, and generally doing a lot of bending and lifting.  Dr. Holtz took her off work and instructed her to return in one week.  He diagnosed “spondylotic myelopathy with chronic pain, with acute worsening due to activities at work.”

On April 19, 2005, Ms. Regenscheid returned to Dr. Holtz, who noted that her pain symptoms had not been eased by being off of work for the past week.  He stated that the employee was a “good candidate for disability.”  Ms. Regenscheid returned to Cedar Valley and was told to apply for long-term disability.  She was later determined to be totally disabled by the Social Security Administration as of May 7, 2005.

As part of the long term disability insurance application, Ms. Regenscheid had a functional capacities evaluation [FCE] early in 2006.  The FCE lasted about three hours and Ms. Regenscheid was not able to complete all of the tasks.  The evaluator concluded that she could perform light duty work with lifting restrictions of no more than twenty-five pounds and with no repetitive lifting over ten pounds.  Ms. Regenscheid testified that she was unable to perform any significant tasks due to pain the day after this FCE.

Ms. Regenscheid was referred to the Institute for Low Back and Neck Care for assessment of her pain and saw Dr. Steven R. Sabers on March 24, 2006.  Dr. Sabers did not recommend surgery due to the potential for an adverse outcome, including paralysis, and the limited potential for pain relief.  Subsequent x-rays and an MRI showed severe degenerative changes and cervical spinal stenosis at the C4-5, C5-6, and C6-7 levels.

Dr. Sabers also referred Ms. Regenscheid for a two-day FCE at Abbott Northwestern Hospital, which he believed would give a more accurate assessment of the employee’s abilities in light of her pain after the limited FCE conducted by the disability insurer.  The new FCE was conducted at Abbott Northwestern Hospital on May 23 and 24, 2006.  The evaluator concluded that Ms. Regenscheid’s job classification and exertional level was “below sedentary work level.”  After reviewing the FCE results, Dr. Sabers concluded in his chart notes of June 29, 2006, that Ms. Regenscheid’s physical capacities fell below the level required for sedentary work and that she was incapable of performing competitive employment.

Ms. Regenscheid filed a claim petition in September 2007 against Cedar Valley seeking workers’ compensation benefits arising out of injuries she alleged to have sustained from the refrigerator door incident on October 28, 2003, a Gillette injury on or about October 1, 2004, that resulted in the care and wage loss in October and November 2004, and a Gillette injury culminating on April 5, 2005, that had resulted in continuing total disability.

Ms. Regenscheid was seen by Dr. Joel Gedan at the request of the employer on December 5, 2007.  Dr. Gedan concluded that there were no lasting injuries from either of the incidents on October 28, 2003, and October 1, 2004.  He agreed that she suffered a Gillette-type injury, culminating on April 5, 2005, but stated that this injury “would best be described as a temporary, subjective, exacerbation of longstanding complaints of neck pain.”  Dr. Gedan attributed Ms. Regenscheid’s need for restrictions solely to her longstanding chronic neck pain and degenerative changes in the cervical spine and not to any work-related injury or activity.  He opined that she should limit lifting to twenty-five pounds occasionally and up to ten pounds on a frequent basis.  She should also limit frequent repetitive lifting, frequent repetitive overhead work and static neck postures.  He believed Ms. Regenscheid was capable of full-time work within these restrictions.

On October 9, 2009, Ms. Regenscheid was seen at the Institute for Low Back and Neck Care for neck pain, right arm pain, low back pain, and right leg pain, although her primary concern was her neck pain and right arm weakness.  Lumbar and cervical MRI scans, as well as an EMG, were recommended.  The scans showed multilevel disc degenerative changes and narrowing at the C4-5 level.

Ms. Regenscheid was evaluated by Dr. Robert A. Wengler on November 1, 2010, at the request of her attorney.  In his report, Dr. Wengler noted that Ms. Regenscheid had been able to work for many years despite pre-existing cervical spine degeneration and associated pain.  He concluded that the work activities at Cedar Valley had resulted in a substantial permanent aggravation to her underlying cervical problems which culminated in an inability to work in April 2005.  He agreed with Ms. Regenscheid’s treating physicians that surgery was not likely to substantially improve her condition.  In his opinion, Ms. Regenscheid was incapable of further employment, with her cervical condition being a substantial contributing factor in her disability.  He rated a 22% whole body disability pursuant to Minn. R. 5223.0370, subps. 4.E.(1) and 4.E.(4).  He apportioned this permanency 75% to the pre-injury condition and 25% to the effects of the work activities performed for the employer.

Ms. Regenscheid was seen on March 11, 2011, by qualified rehabilitation consultant [QRC] John E. Peterson for a vocational evaluation at the request of her attorney.  Mr. Peterson reviewed her medical records, Dr. Wengler’s report, and the results of the 2006 FCE.  Mr. Peterson concluded that the employee was “unable to work, 100% disabled,” basing his conclusions on the FCE showing an inability to work at even a sedentary level, in combination with her age, declining health and outdated skill set.  He did not think there would be any employer in her labor market that would be willing to accommodate her restrictions.

Maureen Ziezulewicz, a QRC, saw Ms. Regenscheid for a vocational evaluation on behalf of the employer.  In her report dated April 11, 2011, and in her testimony Ms. Ziezulewicz stated that based instead on Dr. Gedan’s restrictions, she felt that Ms. Regenscheid would be employable in the Albert Lea or Austin labor markets for work in office and customer service occupations, as well as in some cashier and retail positions in a $9.00 to $12.00 hourly range.

In a report dated April 18, 2011, Dr. Sabers diagnosed Ms. Regenscheid with axial and radicular pain secondary to “fairly severe underlying disc and facet joint degeneration with resultant foraminal and central stenosis.”  He also stated that it was “highly likely that the patient’s work-related activities brought about an exacerbation of her underlying condition that eventually resulted in her ceasing work activities in April of 2005.”  Based upon Ms. Regenscheid’s demonstrated level of function, Dr. Sabers considered the exacerbation to be permanent.  He did not believe that surgery would be of benefit and thought her condition was unlikely to improve.  He considered Ms. Regenscheid disabled from any future employment.  In his view, she should observe restrictions of no lifting over five pounds, no repetitive upper extremity activity, and no static postures over twenty minutes, no overhead activities, and no activities requiring repetitive neck extension or rotation.

The employee’s claims were heard by Compensation Judge Harold Schultz, II, on April 20, 2011.  Ms. Regenscheid claimed entitlement to temporary total disability benefits from October 6 to 13, 2004, and October 27 to November 18, 2004, as the result of work injuries of October 28, 2003, and October 1, 2004.  Those claims were denied by the compensation judge.  The employee also claimed a Gillette injury culminating on or about April 5, 2005, to her cervical spine, permanent partial disability, and permanent total disability from April 11, 2005, and continuing.  In his Findings and Order issued July 29, 2011, the compensation judge concluded Ms. Regenscheid had a Gillette injury to her cervical spine on April 11, 2011, found she was permanently totally disabled from April 11, 2011, in substantial part as the result of the injury, and awarded her 25% of the permanent partial disability rated by Dr. Wengler.  The employer appeals.

In concluding that Ms. Regenscheid had sustained a Gillette injury and that the injury was a substantial cause of her disability, the compensation judge relied on the medical records, on the expert medical opinions of Dr. Wengler and Dr. Sabers, on Ms. Regenscheid’s testimony as to the job duties she performed, the progression of her symptoms, and her inability to work.

The employer argues that this evidence was not adequate to sustain the findings.  The employer contends that the findings were based on an erroneous view of the facts and that Ms. Regenscheid’s testimony was inaccurate and misleading to such an extent that the compensation judge erred as a matter of law in relying on it in whole or in part.  The appellant also contends that because Dr. Wengler and Dr. Sabers relied on the employee’s history in forming their expert opinions, the foundation for their opinions was inadequate.

In arguing that Ms. Regenscheid’s testimony was not credible, the employer points out that she testified that she considered her cervical problems before her job to be insignificant, giving her “no problems,” and that her “problems” essentially began after she started work at Cedar Valley Services.  The employer contends that this testimony is clearly false since it is directly contradicted by the medical records which show treatment for Ms. Regenscheid’s cervical pain going back for several decades.  We note, however, that her testimony taken as a whole reasonably bears the interpretation that she used the term “problems” not to refer to her ongoing pain symptoms, but to difficulties in performing work duties or in doing routine tasks at home.  The medical records do not contradict this testimony since they do not show that Ms. Regenscheid’s pre-existing cervical condition, regardless how extensive or protracted, had resulted in ongoing work restrictions or any significant loss of time from work before she started working for Cedar Valley.

The employer also argues that Ms. Regenscheid’s testimony deliberately minimized the medical treatment she received before she started with the employer.  By way of example, the appellant points to Ms. Regenscheid’s failure to recall having a cervical MRI scan before that date, to her testimony that she was not treating for her cervical condition at the time she started working for the employer, and to her testimony that she did not recall having any prior symptoms of tingling in her upper arms.  While Ms. Regenscheid was in fact mistaken with respect to the MRI and it is true that she did briefly report some upper extremity symptoms a few times prior to 2003, the compensation judge could reasonably have attributed these errors to minor lapses in her memory over some of the events or symptoms which had occurred almost a decade before.  And, while it is also true that Ms. Regenscheid had treated for her cervical condition only a month prior to beginning work at Cedar Valley, that treatment had apparently ended by the time she was hired there, with recommendations only that she follow a home exercise program.  The question of the employee’s pre-existing condition and its role in Ms. Regenscheid’s ongoing condition was the key defense raised by the employer at the hearing and the arguments made here were considered by the compensation judge.

The employer also complains of purported misrepresentations by Ms. Regenscheid about her job duties and the extent to which any of those duties might have exceeded her restrictions.  In particular, the employer points to testimony that she had to perform repetitive lifting beyond the ten-pound weight limitation imposed by her physicians.  The employer contends that Ms. Regenscheid’s testimony is contradicted by employment and medical records and that she offered contradictory weight estimates of products being packed during deposition testimony, so that her estimates were “inconsistent.”

We note, however, that the employer did not offer into evidence any employment records listing product weights to contradict Ms. Regenscheid’s testimony, and did not offer any testimony of job duties or the weight of trays of any of the products she worked with.  The employer has not cited to any specific medical records that allegedly would clearly contradict the employee’s testimony.  The employer, instead, only points to testimony about repetitive lifting of trays of Hormel products packed twelve to a tray which Ms. Regenscheid stated weighed about twelve pounds in total.  The employer argues in its brief that a can of Spam contains only twelve ounces of the product, so that twelve containers would weigh less than ten pounds and would be within her ten pound lifting limit.

Ms. Regenscheid testified that the production line processed not just Spam but “Spam, sausage, whatever was . . . . being shipped out,” and that she stated she was using Spam as an example of the process in her testimony.  Even were we to accept, for the sake of argument, the appellant’s claim as to the weight of a can of Spam,^[2] a question about which no evidence was introduced at the hearing, we are not willing to conclude that continuous lifting of nine pound cases and stacking those cases on pallets with only a thirty minute lunch break and an additional fifteen minute break in a work day was significantly at variance with her testimony.

Ms. Regenscheid also testified about other aspects of her job duties for the employer which exceeded her restrictions, including assisting wheelchair-bound clients, strapping clients in vehicles, and diapering.  The employer did not offer any testimony or other evidence which contradicted her testimony with respect to these duties.  Overall, we cannot conclude that the judge erred in accepting Ms. Regenscheid’s testimony that her job tasks at times were in excess of her restrictions.  The compensation judge’s decision to accept the testimony on this issue was, in the final analysis, a matter of witness credibility, a matter uniquely committed to the compensation judge, and we must affirm.  Even v. Kraft, Inc., 445 N.W.2d 831, 834, 42 W.C.D. 220, 225 (Minn. 1989); Shoemaker v. Route 52 Truck & Car Wash, No. WC10-5133 (W.C.C.A. Feb. 9, 2011).  The compensation judge’s acceptance of Ms. Regenschied’s testimony also answers the employer’s argument that Dr. Wengler’s and Dr. Sabers’ opinions, both of which relied in substantial part on her statements to them, lacked foundation.  The compensation judge did not err in relying on those opinions.

We find substantial evidence that supports the compensation judge’s determination that Ms. Regenscheid sustained a Gillette injury on April 11, 2005, and that this injury is a substantial contributing factor in the employee’s current disability.  We affirm his finding on this point.

The compensation judge found Ms. Regenscheid has been permanently totally disabled since April 11, 2005, and is entitled to permanent total disability benefits as of that date.  The compensation judge accepted Dr. Sabers’ opinion that Ms. Regenscheid was limited to lifting no more than five pounds, was not to engage in repetitive upper extremity activity, static postures over twenty minutes, overhead activity, or activity requiring repetitive neck extension or rotation.  Dr. Sabers’ restrictions were supported by the results of the FCE performed on May 23 and 24, 2006, which indicated that the employee’s physical capabilities fell below those classified as sedentary work.  The compensation judge also accepted the vocational expert opinion of John E. Peterson, who concluded that the employee was totally disabled from work by virtue of her age, limited and outdated occupational skills, and physical inability to work at even a sedentary level.

The employer first argues that, regardless of the employee’s disability status, it should not be held responsible for permanent total disability benefits because Ms. Regenscheid’s disability is not causally related to a work injury but is instead due solely to her pre-existing condition..  We have already discussed this issue and have affirmed the compensation judge’s determination to the contrary and need not consider this argument further.

The appellant next argues that the compensation judge’s findings that Ms. Regenscheid is permanently totally disabled and that a job search would be futile are unsupported by substantial evidence.  Specifically, the appellant contends that the vocational and medical evidence and opinions relied on by the compensation judge lack foundation.  This argument is based in large part on the same objections to the credibility of Ms. Regenscheid’s testimony that were raised on the issue of the causation and we have already accepted the compensation judge’s conclusions on credibility.

In addition, however, the employer argues that Mr. Peterson’s vocational opinion lacked foundation.  Specifically, the employer points out Dr. Sabers’ report of April 18, 2011, which the compensation judge adopted, was issued after Mr. Peterson’s vocational evaluation and therefore did not constitute part of the foundation for that opinion.  We note, however, first, that Dr. Sabers’ conclusion as to employability as set out in that report was identical to the opinion as to employability that he expressed on June 29, 2006, after reviewing the FCE.  He stated in his chart note of that date, “Patient underwent a two-day FCE.  Conclusions of the examiner are delineated in her report.  Patient was not able to complete the testing.  She was deemed not appropriate for competitive job placement.  I would agree with this estimation.  Given the degree of stenosis in the patient’s cervical spine and her current pain, I do not believe that she is competitive for gainful employment.”

The employer further contends that Mr. Peterson’s opinion was “baseless” because he did not conduct vocational or IQ testing or a labor market survey.  Accordingly, it is argued, the compensation judge should have instead accepted the opinion of their vocation expert, Maureen Ziezulewicz.  Mr. Peterson’s opinion, however, did not rest on possible results of such testing.  Further, Ms. Ziezulewicz did not perform any vocational or IQ testing and her labor market survey consisted of a telephone call to one potential employer, who had no job openings.  Given this testimony, the lack of testing is simply not relevant.

We conclude substantial evidence supports the compensation judge’s finding of permanent total disability and his decision is affirmed.