The employer and insurer appeal the compensation judge’s finding that the employee’s left knee injury arose out of and in the course of his employment and the judge’s corresponding award of temporary total disability benefits and medical expenses.  We affirm.

On March 26, 2012, Jose Villarreal, the employee, injured his left knee while employed by AAA Galvanizing, the employer, which was insured for workers’ compensation liability by Sentry Insurance Company.  On that day, the employee arrived at work 10 to 20 minutes before his assigned shift and parked in the employer’s parking lot adjacent to the employer’s business.  He exited his vehicle, placed his left foot on the parking lot surface, turned to the left, and felt a popping sensation and pain in his left knee.  The employee was able to work eight hours of his 10-hour shift, then left for medical treatment of his knee.  The employee treated for his injury on that day, and was taken off work through April 5, 2012.  An x-ray indicated no significant change from a previous x-ray showing very minimal patella-femoral compartment degenerative joint disease.^[1]

On April 2, 2012, the employee treated with Dr. John Tieban at Glencoe Regional Health Services.  The employee reported getting out of his vehicle, planting his left leg, pivoting, hearing a pop in his left knee, and experiencing pain and swelling.  Dr. Tieban recommended an MRI scan for a suspected medial meniscus tear.  The MRI scan indicated possible shallow chondromalacia on the top of the tibia bone.  A few days later, Dr. Robert Barrett, an orthopedic surgeon, treated the employee.  He read the MRI scan as showing a horizontal cleavage tear in the posterior portion of the medial meniscus, and recommended arthroscopic surgery to repair the meniscus tear.  The employee underwent the surgery on May 8, 2012.  During the surgery, Dr. Barnett found a superficial tear of the medial meniscus and removed a small part of the meniscus, but found no instability, flap tears, or cleavage tears of the medial meniscus.  After the surgery, the employee underwent physical therapy.  Dr. Barnett released the employee to his regular job as tolerated by June 18, 2012, and ordered continued physical therapy.

The employee returned to light-duty work with the employer on June 13, and continued working through July 22, 2012.  On July 23, the employee returned to Glencoe Regional Health Services.  He reported severe low back and knee pain and was taken off work.  The employee returned to Dr. Barnett on July 25, 2012, reporting increased left knee pain and difficulty walking, standing, and weight bearing, and was treated with an injection.  On August 9, 2012, the employee indicated he had only a small amount of knee pain and no low back pain.  Dr. Barnett found that the employee had reached maximum medical improvement and released him to return to light-duty work as of August 17, 2012, with restrictions of limited kneeling, squatting, stooping, and stair climbing, and no lifting over 25 to 30 pounds.  He also stated that he expected that the employee would be able to work without restrictions after an additional month.  The employee was able to return to light-duty work in August and has continued to work for the employer since that time.

In May 2012, the employee filed a claim petition for benefits including temporary total disability benefits, 2 percent permanent partial disability benefits, and medical expenses.  The employer and insurer denied primary liability.  In August 2012, the employee amended his claim petition to add temporary partial disability claims from May 18 through June 12 and from July 23 through August 12, 2012.  On December 28, 2012, the employee underwent an independent medical evaluation with Dr. Mark Friedland, an orthopedic surgeon.  He opined that the employee’s activity on the date of injury would not have produced any significant injuries or internal derangement of the left knee.  In February 2013, Dr. Barnett reported that the employee had sustained a work-related injury on March 26, 2012, and rated the employee for 2 percent permanent partial disability.  A hearing was held on February 18, 2013.  At the hearing, the parties stipulated that the employee’s medical treatment was reasonable and necessary.  The compensation judge found that the employee’s March 26, 2012, left knee injury arose out of and in the course of his employment and awarded temporary total disability benefits and medical expenses.  The employer and insurer 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.^[2]  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.^[3]  Fact findings are clearly erroneous if the reviewing court, looking at the entire evidence, is left with a definite and firm conviction that a mistake has been committed.^[4]  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 the evidence or not reasonably supported by the evidence as a whole.”^[5]  Questions of law may be considered by the Workers’ Compensation Court of Appeals de novo.^[6]

The employer and insurer appeal the compensation judge’s finding that the employee’s injury arose out of and in the course of his employment.  Employers are liable to pay compensation “in every case of personal injury . . . arising out of and in the course of employment.”^[7]  The employee must prove that the injury both “arose out of” and “in the course of” employment.^[8]  The “arising out of” and “in the course of” requirements “are elements of a single test of work-connection.”^[9]  The “proper analysis of compensability requires the balancing of both the ‘arising out of’ and ‘in the course of’ elements to determine whether, on the facts of each case, there is a sufficient ‘work-connection.’”^[10]  Determining whether the requisite causal connection exists is generally a question of fact for the compensation judge.^[11]

The judge found that the employee was in the course of his employment at the time and place of his injury.  The employer and insurer argue on appeal that the employee was not in the course of his employment, claiming that the circumstance of the injury occurring in the employer’s parking lot is not enough of a connection to render the injury compensable.  We disagree.  The phrase “in the course of” employment refers to the time, place, and circumstances of the incident causing the employee’s injury.^[12]  In most cases, an employee is covered by the workers’ compensation act “while engaged in, on, or about the premises where the employee’s services require the employee’s presence as a part of that service at the time of the injury . . . .”^[13]  In this case, the employee was injured in the employer’s parking lot adjacent to the employer’s business.  Parking lots owned or maintained by the employer are considered part of the employer's premises, and travel between the employer's parking lot and the main premises is considered be in the course of employment.^[14]  The judge did not err by finding that the employee was on the employer’s premises at the time of the injury.

The employer and insurer also argue that the employee was clearly not involved in a work activity when exiting his vehicle, and therefore, that the employee was not in the course of his employment at the time of the injury.  We are not persuaded by this argument.  The employee need not be directly involved in a work activity at the time of an injury in order for the injury to be compensable since “[a]n activity is ‘in the course of employment’ if it occurs while the employee is fulfilling work duties or is engaged in activities reasonably incidental to his or her particular employment.”^[15]  Moreover, the protection of the workers' compensation act extends to a reasonable period beyond an employee’s actual working hours if an employee is engaging in activity reasonably incidental to employment.^[16]  For example, in Starrett v. Pier Foundry, the employee was injured when he tripped getting out of a vehicle and fell in the employer's parking lot before work.^[17]  In those circumstances, the Minnesota Supreme Court determined that the employee was injured while on the employer's premises and engaged in an activity reasonably incidental to his employment, and concluded that the injury arose out of and in the course of employment.^[18]

In this case, the compensation judge noted that the employee need not be performing actual work tasks in order for an injury to be in the course of employment, and specifically found that the employee’s activity of leaving his car to enter the employer’s building 10 to 20 minutes before reporting for his work shift was reasonably incidental to his employment.  Based on this finding, the judge determined that the employee’s injury occurred in the course of his employment.  We agree.  Substantial evidence supports the judge’s finding on this issue, and we affirm.  We also agree with the compensation judge, contrary to the employer and insurer’s assertions, that the “in the course of” component of the work-connection test is strong in this case.

The employer and insurer also contend that the employee’s injury did not arise out of his employment.  For an injury to “arise out of” employment, there must be a causal connection between the employment and the injury.^[19]  The requisite causal connection “exists if the employment, by reason of its nature, obligations or incidents may reasonably be found to be the source of the injury-producing hazard.”^[20]  The employer and insurer argue that the employee’s injury did not arise out of his employment since the activity he was engaged in at the time of the injury was not unique to his employment.  We disagree.  There is no requirement that a work injury must occur as a result of an activity unique to his employment.  Injuries which occur as a result of actions which could have occurred just as easily elsewhere may be compensable.^[21]  The employer and insurer also argue, quoting Gibberd v. Control Data Corp., that there is “nothing but the most attenuated nexus between the [incident] and the employment.”^[22]  In Gibberd, however, the supreme court discussed the special hazard exception, which was found to be inapplicable, and held that the employee’s death from being assaulted off the employer’s premises with no other work connection involved, was not compensable.^[23]  Neither situation is applicable to this case.

The judge found that the “arising out of” component of the work-connection test in this case was neither very weak nor very strong, but was of average strength.  The judge emphasized that the employee had not sustained an unexplained idiopathic injury, but had developed left knee pain after pivoting on his left foot as he turned from his car to enter the employer’s building.  Since the employee’s need to turn had its origin in the location of the employer’s parking spaces in relation to the employer’s building, the judge determined that the injury was caused by the employee’s ordinary bodily movement which was incidental to employment.  The judge concluded that the employee’s acute injury was “caused by the manner in which the employee moved as he was starting to walk from the employer’s parking lot into the employer’s building,”^[24] and the injury aggravated the employee’s mild underlying degenerative condition.  Based on this analysis, the judge found that the employee’s injury arose out of his employment.  Substantial evidence supports this finding, and we affirm.

Considering the “arising out of” and “in the course of” elements, the judge balanced both elements and concluded there was a sufficient work-connection between the employee’s injury and his employment for the injury to be compensable.  As previously noted, the determination of whether the requisite causal connection exists is a question of fact for the compensation judge.^[25]  Substantial evidence supports the compensation judge’s finding that the employee’s injury arose out of and in the course of his employment, and we affirm.

The employer and insurer also argue that the employee’s temporary total disability from July 23 to August 12, 2012, is not causally related to his work injury, but is the result of a nonwork-related low back condition.  The employee’s medical records indicate that he returned to Glencoe Regional Health Services on July 23, 2012, reporting severe low back and left knee pain, and was taken off work.  On July 25, 2012, the employee treated with Dr. Barnett for increased left knee pain and difficulty walking, standing, and weight bearing.  When the employee returned to Dr. Barnett on August 9, 2012, he reported a small amount of knee pain and no low back pain.  The doctor released him to return to light-duty work as of August 17, 2012.  While the employee was reporting low back pain during that time, he was also reporting left knee pain from his work injury.  The work injury need not be the sole cause of the disability, only a substantial contributing cause.^[26]  In this case, the employee was taken off work for both a nonwork-related condition and a work-related condition.  There is no medical evidence in the record to support the employer and insurer’s assertion that the employee’s disability from July 23 to August 12, 2012, was solely due to his low back condition.  We therefore affirm the compensation judge’s award of temporary total disability benefits for that time period.

The parties stipulated that the employee’s medical treatment was reasonable and necessary.  The employer and insurer argue on appeal that the award of medical expenses should have been denied on the basis that the employee’s injury did not arise out of or in the course of his employment.  Since we have affirmed the compensation judge’s finding that the employee’s injury arose out of and in the course of his employment, we also affirm the corresponding award of medical expenses.