Fairway Foods appeals the compensation judge’s finding that the employee did not sustain Gillette^[1] injuries to his low back and neck while working at United Parcel Service (UPS) and the judge’s award of reimbursement to intervenors and medical providers who did not appear at the hearing below.  We affirm.

On March 23, 1992, Thomas Aegerter, the employee, injured his low back while pulling a box as he worked as a warehouse laborer for Fairway Foods, which was self-insured for workers’ compensation liability and administered by Broadspire.  He was diagnosed with a disc herniation at L4-5 and underwent a L5-S1 laminectomy as well as a L4-5 laminectomy and excision in August 1993.  In September 1993, the employee underwent laminectomies at L4-5, L5-S1, and a discectomy at L4-5.  In 1994, he experienced a recurrent disc herniation at L5-S1, and underwent an L4-S1 anterior inter-body fusion.  The fusion was stable in March 1995 and the fusion hardware was removed in April 1996.

On July 7, 1996, the employee injured his neck while standing on an electric pallet jack.  He reported severe neck pain into his left arm and was diagnosed with a herniated disc by Dr. Sunny Kim.  The employee was later diagnosed with cervical strain, resolved, in November 1996, but he continued to treat for his low back and neck symptoms.  On June 30, 1998, the employee aggravated his low back condition while driving a forklift, and was treated for increased low back pain and received physical therapy.  In April 1999, the employee treated at the Physicians Neck & Back Clinic for low back and neck pain.  The employee was referred for physical therapy for his low back and neck, which he underwent through May 17, 1999.

In July 1999, the employee and Fairway Foods entered into a full, final, and complete settlement with medical expenses left open.  Fairway Foods admitted the employee’s 1992 low back injury, 1996 neck injury, and a 1998 low back injury.  The employee left Fairway Foods, which later went out of business.

In August 1999, the employee began working at UPS within his restrictions.  UPS was insured for workers’ compensation liability by Liberty Mutual Insurance Company and administered by Gallagher Bassett Services, Inc.  The employee worked as a package handler for about eight months and had intermittent neck and back problems resulting in absence from work.  He was treated with medication.  In April 2000, the employee began working as a network support technician, which required extensive travel throughout the state.  In August 2001, the employee again treated for low back pain.  On March 31, 2003, the employee treated for low back and neck pain.  A cervical spine MRI indicated a small right-sided disc herniation at C6-7, moderate central canal stenosis at C5-6, diffuse bulging at C3-4 and C4-5, and multi-level foraminal narrowing from C4 to C7.  In May 2003, the employee was referred to Dr. Ensor Transfeldt at Twin Cities Spine Center.  Dr. Transfeldt recommended conservative treatment and possible surgery.  On December 3, 2003, the employee underwent discectomy, decompression, foraminotomy, and an anterior cervical fusion at C5-C7, which was performed by Dr. Transfeldt.  In February 2004, he returned to full-time work for UPS in a help-desk position.

The employee was evaluated at Physicians Neck & Back Clinic for neck and upper back pain in April 2005, and participated in a rehabilitation program.  In September 2005, the employee was promoted to a management position as an automotive supervisor for UPS which required some travel.  The employee continued to treat for low back and cervical pain.  He reported increasing pain in March 2008.  A CT scan indicated no fusion at C6-7, a solid fusion at C5-6, and moderate arthritis at C3-4 and C4-5.  In January 2009, the employee reported persistent neck and arm pain as well as headaches.  A discogram indicated concordant pain at C2-C5.  The employee left his position with UPS in February 2009 due to worsening neck pain and headaches.  In April 2009, Dr. Francis Denis performed additional cervical spine surgery, including instrumentation removal, cervical discectomy, anterior fusion from C4 to C7, and spinal reconstruction from C4 to C7.  The employee was released for light duty work in July 2009.

On September 27, 2010, Dr. Wylie Zhu performed a posterior cervical laminectomy at C7-T1.  In November 2010, the employee had a surgical consultation with Dr. Zhu for his low back.  Dr. Zhu diagnosed spondylolisthesis, spinal stenosis, and lumbar facet arthropathy, and recommended surgery at L3-4.  On December 28, 2010, Dr. Zhu performed lumbar spine surgery, including a decompressive laminectomy, facetectomy, and posterior fusion at L3-4.  In May 2011, the employee treated at the United Pain Center, reporting chronic neck and headache pain which had grown progressively worse for 15 years.  He reported that his symptoms were due to a 1996 work injury and was treated with medication.

On August 31, 2011, the employee was examined by Dr. Paul Wicklund at Fairway Food’s request.  Dr. Wicklund opined that the employee’s low back condition should be apportioned as 80 percent to the employee’s work at Fairway Foods and 20 percent to his work at UPS.  He also opined that the employee was at maximum medical improvement (MMI) for his low back and did not need further low back treatment.  Dr. Wicklund assigned 22.5 percent permanent partial disability to the employee’s low back condition attributable to the employee’s work at Fairway Foods, and an additional 5 percent permanent partial disability attributable to his work at UPS which was based on his lack of problems at L3-4 until he worked at UPS.

Dr. Wicklund further opined that the employee had sustained a temporary cervical strain in July 1996 that had resolved by November 1996.  He stated that the employee was at MMI for his neck and did not need further medical treatment, and assigned 15 percent permanent partial disability for the neck condition.  In a September 2012 supplemental report, Dr. Wicklund concluded that the employee had sustained a Gillette injury to his cervical spine while working for UPS and that there was no basis to apportion any liability for the employee’s neck condition to his work at Fairway Foods.

On March 19, 2012, and September 9, 2013, the employee was examined by Dr. John Dowdle pursuant to the requests of UPS and Liberty Mutual.  Dr. Dowdle noted that the employee did not need low back treatment or additional low back surgery until about eighteen months after leaving UPS employment.  He also noted that the employee reported that his work at UPS did not aggravate, accelerate, or increase his symptoms or pain.  Dr. Dowdle opined that the employee’s work activities for UPS were not a substantial contributing factor to his low back condition or his cervical spine condition, that the employee was at MMI for both conditions, and that the employee did not need any further medical treatment for either condition.

The employee was also examined by Dr. Robert Wengler at the employee’s attorney’s request on May 6, 2011.  He reviewed additional records and issued a supplemental report on April 14, 2014.  Dr. Wengler opined that the employee’s low back and neck conditions were attributable to his work injury at Fairway Foods and that the employee did not sustain any Gillette injuries at UPS and that he did not aggravate his neck or low back conditions as a result of his work activities at UPS.  He stated that the employee’s need for additional fusion surgery at L3-4 was related to the previous fusions and, therefore, was related to the admitted work-related low back injury.  Dr. Wengler also opined that the employee’s cervical spine problems were related to the 1996 injury, which was likely an annular tear.  He concluded that the employee’s later problems and need for treatment were a natural progression of his previous work injuries.

The employee filed a claim petition on May 28, 2013, against Fairway Foods for payment of medical expenses for his low back and neck conditions for admitted injuries sustained with that employer in 1992 (low back), 1996 (neck), and 1998 (low back).  On June 11, 2013, Fairway Foods moved to join UPS.  Fairway Foods claimed that that the 1996 neck injury was temporary and that the employee had sustained Gillette injuries to his low back and neck while working at UPS.  After a hearing on April 29, 2014, the compensation judge found that the employee had not sustained Gillette injuries while working for UPS and that the employee’s 1992 low back injury and his 1996 neck injury while working for Fairway Foods were substantial contributing causes of the medical treatment and expenses claimed.  The judge ordered Fairway Foods to pay the employee’s medical expenses, including those from intervenors who did not appear at the hearing.  Fairway Foods 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.  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).  Where evidence conflicts or more than one inference may reasonably be drawn from the evidence, the findings are to be affirmed.  Id. at 60, 37 W.C.D. at 240.  Similarly, 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).

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).

Fairway Foods argues that the record does not support the compensation judge’s finding that the employee did not sustain Gillette neck or low back injuries while working for UPS.  After reviewing the record, we determine there is substantial evidence to support the findings of the compensation judge.

The opinions of Drs. Wengler and Dowdle support the compensation judge’s decision.  Dr. Wengler opined that the employee did not sustain any Gillette injuries at UPS and that he did not aggravate his neck or low back conditions as a result of his work activities at UPS.  Dr. Wengler also opined that the employee’s cervical spine problems were related to the 1996 injury and that the employee’s later problems and need for treatment for both conditions were the natural progression of his previous admitted work injuries.  Dr. Dowdle opined that the employee’s work activities for UPS were not a substantial contributing factor to his low back or his cervical spine conditions.

Fairway Foods argues that Dr. Wengler and Dr. Dowdle were not provided with all of the details of the employee’s job duties at UPS and, therefore, those doctors did not have adequate foundation for their opinions.  An expert medical opinion must be based on adequate foundation to be of evidentiary value.  See Welton v. Fireside Foster Inn, 426 N.W.2d 883, 41 W.C.D. 109 (Minn. 1988); Bode v. River Valley Truck Ctr., No. WC09-132 (W.C.C.A. Sept. 29, 2009).  The question of foundation goes to the competency of the witness to render an expert opinion, which depends upon both the degree of the witness’s scientific knowledge and the extent of the witness’s practical experience with the matter at issue.  Reinhardt v. Colton, 337 N.W.2d 88, 93 (Minn. 1983).  Foundation may be established by personal knowledge, a hypothetical question, or testimony at the hearing.  Scott v. Southview Chevrolet Co., 267 N.W.2d 185, 188, 30 W.C.D. 426, 430 (Minn. 1978).

Dr. Wengler and Dr. Dowdle both examined the employee, reviewed his medical records, and took a medical history from the employee.  As a general rule, this level of knowledge establishes a doctor’s competence to render an expert opinion.  See Grunst v. Immanuel-St. Joseph Hosp., 424 N.W.2d 66, 40 W.C.D. 1130 (Minn. 1988); Suess v. St. Jude Med., Inc., 69 W.C.D. 470, 473 (W.C.C.A. 2009).  There was sufficient foundation for Dr. Wengler’s and Dr. Dowdle’s medical opinions.  The compensation judge did not err by relying on their opinions.

Fairway Foods also points to evidence in the record which supports its argument regarding the employee’s neck condition, including Dr. Wicklund’s opinion and the employee’s medical records from November 1996 where the employee’s neck condition was described as “cervical strain, resolved.”  They further argue that the employee did not seek treatment for his neck condition until April 1999 when he participated in a neck rehabilitation program through May 17, 1999, and not again until March 2003.  The employee, however, testified that he had neck and shoulder symptoms and took pain medication from November 1996 through April 1999.  In many of his documented medical histories, the employee related his conditions to his work injuries at Fairway Foods.  Conversely, at the hearing, the employee testified that his work activities at UPS did not cause any permanent injury to his back or neck.  The compensation judge considered the employee’s work activities at UPS and determined that those activities caused intermittent manifestations of the employee’s pre-existing conditions.  The compensation judge relied on the medical records, the medical opinions, and the employee’s work activities in concluding that the employee did not sustain work-related Gillette injuries at UPS.  Substantial evidence supports this determination, and we affirm.

Fairway Foods also argues that the judge erred as a matter of law by awarding reimbursement of medical expenses to intervenors and medical providers who did not personally appear at the hearing, citing Minn. Stat. § 176.361, Minn. R. 1415.1100, and Minn. R. 1415.1250, and Sumner v. Jim Lupient Infinity, No. WC13-5639 (W.C.C.A. Apr. 3, 2014) (heard on appeal at the Minnesota Supreme Court on Sept. 30, 2014).  In Sumner, this court stated that the “statutes and rules set forth as a general requirement that an intervenor must personally attend all scheduled administrative conferences and hearings in the matter unless the intervenor’s interests are ‘otherwise established.’”^[2]  Sumner, slip op. at 8-9.  The court also noted that Minn. Stat. § 176.361 allows “limited exceptions to the personal attendance requirement, most notably giving the compensation judge discretion to waive personal attendance by an intervenor at a proceeding.”  Id. at 9; see also Minn. Stat. § 176.361, subd. 6.  The compensation judge has the discretion to waive the personal attendance requirement since the judge can assess “whether an intervenor’s presence at the hearing is necessary for the full and fair litigation of the issues” based on the status of the issues and the positions of the parties.  Sumner, slip op at 10.  In this case, several of the intervenors appeared at the hearing.  The compensation judge noted that the employee had initiated the claim for payment of medical expenses and the employee’s claim was presented whether the potential intervenors or intervenors made a formal intervention or appeared or attended in any capacity, citing Adams v. DSR Sales, Inc., 64 W.C.D. 396 (W.C.C.A. 2004).  The compensation judge awarded the intervenors’ claims and the claims for medical expenses made by the employee alone, except for psychological treatment claims which were withdrawn and reserved.  While Fairway Foods objected to the interventions, it did not specify any issues with the claims or any prejudice by the non-appearance of the intervenors or potential intervenors.  The compensation judge has the discretion to waive the attendance requirement, if in the judge’s judgment, the intervenors’ right to reimbursement has otherwise been established.  The judge did not err by awarding the intervenors’ interests in this case.