The employer and insurer have appealed from the compensation judge’s determination that the employee’s medical care for his cervical spine and low back was reasonable, necessary, and related to his January 5, 1999, work injury.  We affirm.

The employee, John Reding, sustained an admitted work injury on January 5, 1999, while employed as a truck driver for Kraft Foods.  Mr. Reding slipped and fell from a plank spanning a ditch and injured his neck and low back.  He has treated for his work injury since that time, and his treating doctor for the work injury since February 2000 has been Dr. Todd Hess at United Pain Center.

In April 2004, the employee sustained a significant non-work injury while helping a neighbor build a backyard swing set.  Mr. Reding cut his left index finger with a circular saw and then fell to his knees.  The index finger was subsequently amputated, and Mr. Reding developed regional complex pain syndrome (RCPS) in his lower extremities as the result of injuring his knees.

In May 2010, the employee filed a claim petition that was heard by Compensation Judge Kathleen Behounek on January 13, 2011.  At issue in the hearing was the employee’s claim for permanent total disability benefits resulting from the 1999 work injury as well as claims for medical expenses.  The employer and insurer denied liability for the employee’s disability and ongoing medical care, alleging that the 2004 injury represented a superseding, intervening injury which relieved them of all liability.  In an unappealed decision, issued March 14, 2011, the compensation judge denied the employee’s claim for permanent total disability on the basis that the 2004 injury was a superseding, intervening cause of the employee’s disability.

The compensation judge also found that the employee continued to require “treatment and medication for his work related symptoms.”  The compensation judge determined that “treatment and medication provided for the employee’s low back and neck symptoms is reasonably necessary and causally related to the January 5, 1999 work injury.”  (Ex. I, findings 13, 14.)  The employer and insurer were ordered to pay medical expenses at issue that were related to cervical and low back symptoms.

The employee filed a medical request in May 2013, seeking payment of outstanding medical bills.  The employer and insurer refused payment, claiming that the compensation judge in her 2011 findings had held that the 2004 non-work injury was a “superseding intervening” injury which necessitated the employee’s treatment and that they had no liability for the employee’s medical care.

Ultimately, the employee’s medical request was the subject of a formal hearing before Compensation Judge Behounek on October 2, 2013.  Her findings and order was issued on January 3, 2014.  The compensation judge found that the employee had continued to treat with Dr. Hess at United Pain Center for “chronic low back and cervical pain related to his work related condition.  The treatment is reasonable and necessary to cure and relieve the effects of the employee’s January 5, 1999 work injury.”  (Finding 4).  The compensation judge awarded the employee his out-of-pocket medical expenses and ordered payment to the intervenors for medical expenses incurred by the employee.  The employer and insurer have appealed the compensation judge’s decision.

At hearing, the issue for the compensation judge was whether the medical treatment resulting in the claimed medical expenses was causally related to the 1999 work injury.

Support for the employee’s claim was provided by the treatment records of Dr. Todd Hess from 2000 through May 2013 and, in particular, a report dated September 19, 2012, from Dr. Hess.  In that report, Dr. Hess stated his treatment of Mr. Reding had been “exclusively related” to the 1999 work injury, and he set out the rationale for his continued care of Mr. Reding.

In response, the employer and insurer presented a report dated September 23, 2013, by Dr. Kristen Zeller-Hack, who had evaluated the employee at the request of the employer and insurer.  Her opinion was that the 1999 work injury was a sprain/strain, and she noted that “a sprain/train typically heals over a period of six to eight weeks.”  (Ex. 1.)  In the opinion of the IME, the 2004 injury was the cause of any need for continued medical care. Dr. Zeller-Hack also stated in her report that the employee’s treatment was reasonable and necessary.

In her decision, the compensation judge referred to the competing medical opinions in evidence and then stated that she relied on the opinion of Dr. Hess “in concluding that the employee’s treatment has been reasonable, necessary and causally related to the January 5, 1999, work injury.”  (Mem. at 4.)

The employer and insurer assert on appeal that the compensation judge erred in relying on the opinion of Dr. Hess because his opinion lacks foundation.  Specifically, the appellants contend that the statement by Dr. Hess in his September 2012 report that his treatment was “exclusively” related to the work injury was incorrect when, in fact, he “repeatedly” treated the employee for his RCPS and that as a result his opinion was without foundation.  We are not convinced.

The primary difficulty with the appellants’ assertion is that this is not a foundation issue.  The competence of a witness to render expert medical testimony depends on both the degree of the witness’s scientific knowledge and the extent of a 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, 267 N.W.2d 185, 188, 30 W.C.D. 426, 430 (Minn. 1978); Kelsey v. Lovegreen Indus. Servs., No. WC07-159 (W.C.C.A. Dec. 12, 2007).

Dr. Hess began treating the employee for his work injury in February 2000.  As a result, he was well aware of the employee’s condition, symptoms, and need for treatment both before and after the April 2004 injury.  Dr. Hess was uniquely qualified to speak to causation and reasonableness, and his opinion has more than adequate foundation.

We have carefully reviewed the record and cannot conclude that Dr. Hess “repeatedly” treated the employee for his non-work condition.  Mr. Reding was unfortunate enough to have sustained two significant injuries.  It is understandable that Mr. Reding would discuss his complete medical situation with a doctor who has treated him for many years.  The record is clear that Dr. Hess has continued to treat the employee for his work injury since February 2000 and that his treatment has been primarily for the work injury.

The appellants argue here, as they did at the hearing and at the 2011 hearing, that the 2004 injury is a superseding, intervening injury that excuses them from any liability for the work injury.  The question in the instance of a subsequent injury is whether the subsequent injury has broken the causal connection between the work injury and the consequent condition.  Buford v. Ford Motor Co., 52 W.C.D. 723 (W.C.C.A. 1995), summarily aff’d (Minn. June 30, 1995).  Medical expenses are payable if the work injury remains a substantial contributing factor in the need for medical treatment.  Keane v. Critical Care Servs., Inc., 72 W.C.D. 709 (W.C.C.A. 2012).  In her 2011 decision, the compensation judge found the employee’s need for care for his low back and cervical pain continued to be the result of his 1999 work injury.  Her decision on the same point in 2014 is supported by substantial evidence.

The compensation judge adopted the opinions of Dr. Hess over those of Dr. Zeller-Hack.  It is the role of the compensation judge to consider competing medical opinions and a decision based upon a medical opinion with adequate foundation will generally be affirmed by this court.  Nord v. City of Cook, 360 N.W.2d 337, 37 W.C.D. 363 (Minn. 1985); Nitz v. Abbott Northwestern Hosp., 64 W.C.D. 191 (W.C.C.A. 2004); Koppen v. Knowlan’s Supermarket, 71 W.C.D. 99 (W.C.C.A. 2011).  We do so here.

The employer and insurer also appeal from the compensation judge’s award to the intervenors and claim that this award is not supported by substantial evidence.  We note here that, at the hearing, the employer and insurer did not argue that the treatment of the employee was not reasonable and necessary treatment.  Indeed, the IME, Dr. Zeller-Hack agreed the treatment at issue was appropriate.  The argument made by the appellants was that the treatment for the cervical and low back condition was not due to the 1999 work injury.  The compensation judge found a causal relationship between the work injury and the treatment for the cervical and low back conditions.  The intervention claims clearly indicate that the reimbursement sought was for cervical and low back treatment.  Accordingly, we conclude substantial evidence supports the compensation judge’s award.

Finally, we address the question of attorney fees.  This court has the authority to raise the issue of attorney fees on its own motion.  Minn. Stat. § 176.1081, subd. 3.  The attorney for the employee may file a petition for fees with this court requesting Roraff fees^[1] for legal services provided on appeal.