The self-insured employer appeals from the compensation judge’s determination that the employee’s automobile accident on June 26, 2014, was in the course of his employment.  The employer also appeals the findings by the compensation judge that the employee sustained a Gillette injury in the nature of bilateral carpal tunnel syndrome.^[1]  We affirm.

Kevin Groetsch began working for Kemps at its Minneapolis Milk Plant in May 2004 as a “line picker” and he continued working in this position through May 2014.  The employee worked four 10 hour days each week: on Mondays and Tuesdays he worked on the Quart Line and on Fridays and Saturdays he worked on the Gallon Line.

On the Quart Line, the employee would scan orders and then fill the orders by taking product from shelves and placing them in boxes or cases.  Product would include juice, butter, and milk.  The employee testified at the hearing that he placed 10 items in each case and in a typical day filled 1,300 cases.  After filling the cases, he stacked them 3 or 4 high and maneuvered them onto a track.  On the Gallon Line, he placed four 1-gallon containers of milk into cases and then, using a hook, would drag up to six cases at a time.  The employee described both jobs as requiring repetitive grasping, pinching, lifting, and other constant use of his hands.  The employee was the only witness at the hearing.

The employee began experiencing sharp pain in his right forearm while at work on May 6, 2014.  The pain worsened during the day and he reported the symptoms to his employer that same day.  The employee also completed an incident report in which he identified “repeat picking of units on Quart Line” as the likely cause of his symptoms.  The employer admitted liability for a right forearm injury.

Mr. Groetsch first sought medical care for his right arm complaints when he saw Dr. David Feely at Golden Valley Family Physicians on June 20, 2014.  He reported to Dr. Feely that his arm pain was getting worse and he had decreased grip strength in his right hand.  Dr. Feely diagnosed “lateral epicondylitis, right,” recommended the use of Aleve and placed restrictions on the employee’s use of his right arm.  The employee was placed on light duty but testified that his symptoms continued to worsen.  He scheduled a follow-up appointment with Dr. Feely for June 26, 2014.

June 26, 2014, was a Wednesday, a day when Mr. Groetsch did not work.  The employee lived in Golden Valley near the intersection of Duluth Street and Highway 100.  He left his house and drove to the house of his ex-girlfriend’s parents in Edina, near the intersection of Highways 169 and 62, to drop off some boxes.  After dropping off the boxes, he drove north on Highway 169, exited on Highway 55, and proceeded east.  Dr. Feely’s office is located just off of Highway 55 less than a mile east of Highway 169, at the intersection of Highway 55 and Wisconsin Avenue.

The intersection to the west of the doctor’s office is at Highway 55 and Boone Avenue, an intersection controlled by a traffic light.  Mr. Groetsch stopped for a red light and after he did so, a truck rear-ended his vehicle.  The force of the impact pushed the employee’s pickup into the intersection.  The drivers drove into the parking lot where the Golden Valley Family Physicians clinic is located and exchanged insurance information.  Mr. Groetsch testified that the force of the impact bent his vehicle’s frame and resulted in damages to the vehicle of $11,000.00 to $13,000.00.

After the motor vehicle accident, the employee proceeded to his appointment at Golden Valley Family Physicians with Dr. Feely.  He reported no improvement in his right arm symptoms and worse discomfort with use of his right hand.  An assessment was made of lateral epicondylitis and he was given work restrictions and advised to use Aleve.  After he saw Dr. Feely for his arm symptoms, Mr. Groetsch saw another provider at Golden Valley Family Physicians for his symptoms resulting from the motor vehicle accident.  He reported mild neck stiffness and was assessed with mild cervical strain.  The following day he woke up with extreme pain in his neck, back, and shoulders.  The employee reported the motor vehicle accident to his supervisor.

The employee saw a chiropractor, Dr. Michael Shinder on July 2, 2014, for neck and upper back pain with no radicular symptoms into his arms or hands.  He also had low back pain with some radiation of pain into his left leg.  Dr. Shinder diagnosed strain/sprain affecting the cervical, thoracic and lumbar spine.  The employee received chiropractic care thereafter from Dr. Shinder on a frequent but intermittent basis with the last record of treatment before the hearing being on April 22, 2015.

On July 8, 2014, Mr. Groetsch consulted with Dr. Steven Noran.  He reported neck pain into his right arm with some numbness.  He was found to have mild spasm in his neck and positive Tinel’s signs over the median nerve in both arms.  Dr. Noran recommended an MRI as well as EMGs.  The cervical MRI showed mild posterior disc bulging at C3-4 and a lumbar MRI showed a herniated disc at L3-4.  The EMGs demonstrated bilateral carpal tunnel.  Work restrictions were recommended.

In August 2014, the employee filed a claim petition for benefits arising out of the June 2014 motor vehicle accident as well as a Gillette injury of bilateral carpal tunnel syndrome.  The employer denied liability.

From May 6, 2014, to September 9, 2014, the employee was provided with light duty work by his employer, operating a fork lift and stocking.  The employee testified that this work still required repetitive use of his arms and hands and symptoms in his arms and hands continued to worsen.  On September 9, 2014, the employer advised Mr. Groetsch that they were no longer able to accommodate his work restrictions and the employee stopped working at that time.

On November 25, 2014, at Dr. Noran’s referral, the employee saw Dr. Jeffrey Husband for a consultation on his bilateral hand pain and numbness.  Dr. Husband reviewed the treatment options with the employee, including carpal tunnel release surgery.  Those surgeries were done in January and March 2015 and the employee had good results from the procedures.

Mr. Groetsch was evaluated for the employer and insurer by Dr. William Simonet on December 2, 2014.  It was Dr. Simonet’s opinion that the employee’s carpal tunnel syndrome was the result of his obesity and what Dr. Simonet described as “nonspecific right arm pain” had resolved.  Dr. Simonet also stated that the employee had not sustained any injury to his neck or low back as a result of the June 2014 motor vehicle accident.  No physical restrictions were necessary regardless of causation according to Dr. Simonet.

Because the employer had denied liability for the June 2014 motor vehicle accident, the employee’s medical expenses for care relating to that incident were paid by his no-fault insurer, State Farm Automobile Insurance.  State Farm had Mr. Groetsch evaluated by Dr. James Allen on December 16, 2014.  Dr. Allen concluded the employee had sustained temporary aggravations of his low back and upper back/neck conditions.  He also stated the employee had bilateral carpal tunnel syndrome which was “undoubtedly related to the very frequent, repetitive work.”

Dr. Noran prepared a narrative report on May 4, 2015, at the request of the employee’s attorney.  His opinion was that the employee sustained a permanent myoligamentous cervical injury and a permanent lumbar disc injury at L3-4 as a result of the June 2014 motor vehicle accident.  He also concluded the motor vehicle accident had worsened the employee’s carpal tunnel syndrome from blunt trauma to the wrist.

Dr. Husband also prepared a narrative report on May 4, 2015, in which he stated that “Based on Mr. Groetsch’s description of his work activities at Kemp’s Dairy, it is my opinion that these work activities were a substantial contributing factor with regard to his bilateral carpal tunnel syndrome.”

At the request of the employer, Dr. Simonet prepared a supplemental report after reviewing additional medical records and the July 2014 lumbar MRI scan.  Dr. Simonet noted that the employee had received chiropractic care for cervical and lumbar problems before 2014 that Dr. Simonet concluded were the same as his complaints after the motor vehicle accident.  He continued to opine that the employee had sustained no injury in the motor vehicle accident and the major factor for his carpal tunnel syndrome was his “morbid obesity not his work activities.”

The employee’s claim petition was heard by Compensation Judge Kirsten Tate on May 8, 2015, and her Findings and Order was issued on June 26, 2015.  Compensation Judge Tate determined that the employee was in the course of his employment at the time of the motor vehicle accident of June 26, 2014, and that he sustained injuries to his neck, upper back, and lower back. The compensation judge also found the employee sustained a Gillette injury in the nature of bilateral carpal tunnel syndrome culminating on or about July 8, 2014.  The employee was awarded temporary total disability benefits from September 9, 2014, through February 22, 2015, and temporary partial disability benefits from February 23, 2015, to the date of hearing and continuing.  The claims of intervening medical providers and State Farm Automobile Insurance were approved.  The employer has appealed.

On appeal, the employer argues that substantial evidence does not support the compensation judge’s finding that the employee sustained a Gillette injury.  The employer also contends that the compensation judge erred in finding that the June 26, 2014, motor vehicle accident was in the course of employment.  We consider each of these arguments in turn.

In finding 26 of her findings and order, the compensation judge determined “[t]he employee sustained a Gillette injury in the nature of bilateral CTS culminating on or about July 8, 2014.”  In the footnote for that finding, the compensation judge referenced the evidence she relied upon to support her determination: the employee’s testimony as well as employee’s exhibits C, H, and E1.  Exhibit C is Dr. Husband’s May 4, 2015, report, Exhibit H are the treatment records from Noran Clinic from July 8, 2014, to March 18, 2015, and Exhibit E1 is Dr. Allen’s IME report from his evaluation of the employee on December 16, 2014.

The employer argues that the compensation judge erred in relying on the referenced medical opinions because those physicians lacked adequate foundation to render an opinion.  The argument is that these opinions were based on an inaccurate recitation of job duties by the employee.

A job description for the line picker position was prepared by the employer in 2005 and was introduced into evidence by the employee.  According to the job description, the line picker position requires “firm grasp for stacks, crates, single items, scrub brush, drive cover, and scanner” on a constant (67 to 100% of day) basis.  The employee’s testimony is consistent with the employer’s job description.  The employee was provided with light duty work after he reported his arm symptoms to his employer, but he testified that his new assignment still required lifting and grasping and his symptoms continued to worsen after that time.  There was no other evidence presented concerning the employee’s job duties or the effect of those duties on the employee’s symptoms.

The employee’s history to his doctors about his symptoms was consistent as well.  He described a burning sensation in his right forearm with decreased grip strength in his right hand.  While the initial diagnosis was lateral epicondylitis, subsequent diagnostic testing demonstrated bilateral carpal tunnel syndrome.  Dr. Husband had an accurate history of the nature of Mr. Groetsch’s job when the symptoms began and his opinion has adequate foundation.

Determination of a Gillette injury depends primarily on medical evidence.  Marose v. Maislin Transp., 413 N.W.2d 507, 512, 40 W.C.D. 175, 182 (Minn. 1987).  We have previously held that a medical opinion with adequate foundation will support a compensation judge’s finding as to the existence of a Gillette injury.  Kranz v. Coca Cola Enters., Inc., 73 W.C.D. 631 (W.C.C.A. 2013).  The information relied upon by Drs. Husband and Allen was sufficient to establish adequate foundation for their opinions.  See Scott v. Southview Chevrolet Co., 267 N.W.2d 185, 188, 30 W.C.D. 426, 430 (Minn. 1978); Smith v. Quebecor Printing, Inc., 63 W.C.D. 566 (W.C.C.A. 2003).

The compensation judge’s finding on this issue is affirmed.

The compensation judge found that the employee was traveling to a medical appointment for an admitted work injury at the time of his auto accident and was, as a result, in the course of his employment when injured.  The employer argues that the compensation judge erred in making this finding and the employee was not in the course of employment because he had deviated from the most direct route between his house and the site of his medical appointment.

A long-standing rule in Minnesota workers’ compensation law is that an employee is in the course of employment when traveling to a medical appointment to treat for a work injury. As a result, injuries sustained during the travel are compensable.  The courts, in considering this issue, have applied two approaches, special errands and dual purpose trips, depending on the facts of each case.

The first “special errand” case in Minnesota is Nehring v. Minnesota Mining & Manufacturing, 193 Minn. 169, 258 N.W. 307, 8 W.C.D. 321 (1935).  Mr. Nehring worked regular hours as an electrician for his employer and was called in to work on his usual day off to replace a fuse.  He was involved in a fatal motorcycle accident on his way home.  In concluding that the employee was in the course of his employment and that his death was compensable, the court took note of decisions from other states that had determined an employee in such a situation was performing a special service for the employer and was in the course of employment at the time of the injury. 

Nehring was followed by Fitzgibbons v. Clarke, 205 Minn. 235, 285 N.W. 528, 10 W.C.D. 475 (1939).  The employee in that case slipped on ice and fractured her shoulder as she was returning to her employer’s premises after seeing a doctor for an earlier work injury to her hand.  In its discussion, the court stated, “[t]he initial injury was in the course of the employment.  Obviously, medical attention was necessary to restore the use of her hand.  It was to the employer’s interest as much as to the employee’s to procure the necessary and proper treatment.”  205 Minn. at 236, 285 N.W. at 528, 10 W.C.D. at 476.  The court affirmed the industrial commission’s award of benefits.

In its brief, the employer has cited other special errand cases to support its position that an employee on a special errand must not deviate at all from the most direct route necessary to complete the errand.  However, in one of those cited cases, Pedersen v. Maple Island Inc., 256 Minn. 21, 97 N.W.2d 285, 20 W.C.D. 434 (1959), the court in noting that the employee had taken a direct route from the employer’s premises to his doctor’s appointment and then home, stated, “[i]f he had, in fact, taken an indirect route or made any unnecessary stopovers for purely personal business, we would have to take those factors into consideration.”  256 Minn. at 23, 97 N.W.2d at 287, 20 W.C.D. at 436.  The court did not state, however, that those facts would have eliminated the business purpose of the special errand.

Since the special errand cases generally involve trips that have the employer’s premises as one of the points of the journey, we question whether the special errand rule applies here, given the facts of this case.  Mr. Groetsch did not begin or end his travel on June 26, 2014, at the employer’s plant in northeast Minneapolis.  He was not working that day and he began and ended his trip at his home.  Accordingly, we consider instead whether the application of the dual purpose trip rule is more appropriate.  That rule provides that:

Minnesota has long followed this rule.  In a case cited by the employer, Kayser v. Carson Pirie Scott & Company, 203 Minn. 578, 282 N.W. 801, 10 W.C.D. 301 (1938), the employee claimed his injuries from an automobile accident were compensable because he intended to call on a customer after driving his daughter to an appointment in another town.  The court held that the employee was not in the course of his employment because the employee’s personal errand, not his claimed business purpose, necessitated the travel.  A contrary result was reached, applying the same test, in Lindell v. Minnesota American Legion Pub. Co., 208 Minn. 415, 294 N.W. 416, 11 W.C.D. 350 (1940) where the court affirmed an award of compensation where the evidence demonstrated that the main purpose of the trip was for the employee to serve the interest of the employer despite a personal purpose as well.

In Rau v. Crest Fiberglass Industries, 275 Minn. 483, 148 N.W.2d 149, 24 W.C.D. 103 (1967), the employee left her house, where she was employed as bookkeeper and treasurer for the family business, to deliver a sales contract to a local bank.  She did not drive directly to the bank; but, rather, stopped at a café for lunch and a liquor store to pick up a bottle of brandy.  Both of those stops were not on the direct route between her home and the bank.  She then dropped off the contract at the bank and on her way to pick up hamburgers for her children she was in a motor vehicle accident and injured.  The court affirmed the award of benefits and stated, “[a]pplying the dual purpose test we must agree that the evidence adequately supports a reasonable inference that the employee’s work and the need to promptly deliver the contract to the bank created the necessity for the trip, which would have had to be made even if that had not coincided with her stopping for lunch, purchasing a bottle of brandy, and getting hamburgers for the children.  The business purpose of the trip, although not the sole cause, was at least a concurrent cause and not a mere incident to her personal activities.”  275 Minn. at 486, 148 N.W.2d at 152, 24 W.C.D. at 107.

We conclude that, based on the evidence in this case, it is appropriate to apply the “dual purpose trip” analysis.  The evidence adequately supports the compensation judge’s determination that seeking medical care for the admitted work injury was the primary purpose to Mr. Groetsch’s trip even though there was also a personal purpose as well.

The employer argues the finding that the employee’s injury to be compensable in this case means that any deviation, even driving to Chicago, would be ignored as long as the employee ended up at his doctor’s office.  Clearly, an extreme deviation by the employee would raise the question of whether there was, in fact, a concurrent business purpose for the journey.  On the other hand, under the employer and insurer’s argument, any deviation would mean that the injury would not be compensable.  This result would be contrary to the holding in Rau.

We believe that whether or not a deviation is so substantial as to obviate the business purpose of a trip is for a compensation judge to determine.  Here the compensation judge noted that the motor vehicle accident on June 26, 2014, was just minutes before the employee’s scheduled medical appointment.  The location of the accident was so close to the location of the medical appointment that the employee and the truck driver exchanged insurance information post-accident in the clinic parking lot.  The compensation judge’s conclusion that the employee was in the course of employment when injured on June 26, 2014, is in accord with the case law and the evidence in this matter.

The compensation judge’s decision is affirmed.