JONATHAN GROETSCH, Employee/Appellant, v. SUPERFAIR FOODS and ENSTAR, INC., Employer-Insurer/Respondents.

JUNE 6, 2022 
No. WC21-6446

MEDICAL TREATMENT & EXPENSE – REASONABLE & NECESSARY.  Substantial evidence, including medical records and expert medical opinion, supported the finding that the employee’s medical office visit of March 2, 2020, was not reasonable and necessary.

    Determined by:
  1. Patricia J. Milun, Chief Judge
  2. Deborah K. Sundquist, Judge
  3. Sean M. Quinn, Judge

Compensation Judge:  William J. Marshall

Attorneys: Deanna M. McCashin, McCashin Law Firm, Chtd., Alexandria, Minnesota, for the Appellant.  Stephanie K. Thiemann, Aafedt, Forde, Gray, Monson & Hager, P.A., Minneapolis, Minnesota, for the Respondents.




The employee appeals the finding that a medical office visit he attended on March 2, 2020, was not reasonable and necessary treatment for the employee’s work injury.  We affirm.


The employee, Jonathan Groetsch, was hired by the employer, Superfair Foods, in 1994 as a meat cutter following his graduation from a two-year vocational college course in meat cutting and management.  In this job, he sustained an admitted Gillette injury to both upper extremities which culminated on May 15, 1995.  The employee continued to work for the employer under restrictions until September 1995.  He began working as a night manager for another grocery store in 1997, but was laid off in December 1998.  In late 1999, the employee began working as a car salesman and has since continued to work in that capacity for more than 20 years.

The employee’s ongoing bilateral upper extremity symptoms were treated using a variety of medical modalities during the first 17 years following the work injury.  The employee’s EMG testing was negative, but he did exhibit some indications consistent with a possible carpal tunnel syndrome.  Some of his physicians made this diagnosis and others concluded he did not have carpal tunnel syndrome.  In 2012, Dr. Andrew W. Staiger recommended that the employee undergo a carpel tunnel release on the left and an injection into the carpel tunnel on the right to address the employee’s bilateral upper extremity symptoms.  The employer and its insurer denied the proposed surgery and injection based on the opinion of their medical expert, Dr. William Call.  Dr. Call did not agree with the diagnosis of carpal tunnel syndrome and found no objective evidence of carpal tunnel syndrome on either side.

A hearing was held before a compensation judge on April 18, 2013, to determine whether the proposed surgery was reasonable and necessary treatment.  Following the hearing, the compensation judge accepted the opinion of Dr. Staiger over that of Dr. Call and found that the employee’s 1995 Gillette injury included left carpal tunnel syndrome and remained a substantial contributing factor to the employee’s bilateral upper extremity symptoms.  The compensation judge also found that the proposed surgical treatment was reasonable and necessary.

The employee underwent the left carpal tunnel release procedure in January 2014, following which he initially experienced some relief.  He did not undergo the proposed right carpal tunnel injection.  He returned for a post-surgical follow-up evaluation with Dr. Staiger on February 16, 2014, reporting some snapping in the left wrist but no numbness or tingling.  He also reported numbness and tingling in the right wrist at night, but Dr. Staiger noted that an EMG on the right was negative for carpal tunnel.  Dr. Staiger released the employee to work without restrictions and recommended therapy to address scar tissue.  The employee was prescribed a splint for the right hand to wear at night.

The employee had eight occupational therapy sessions and then returned to Dr. Staiger for reevaluation on May 21, 2014.  He reported some ongoing pain along the hook of the hamate on the left wrist and a popping or clicking sensation with quick supination of his forearm.  Dr. Staiger recommended that the employee avoid quickly supinating his forearm.  The employee was told he could use his hand normally and that he need not return for further evaluation if he continued to improve.

In July of 2015, the employee returned to Dr. Staiger reporting mild intermittent discomfort in the left wrist.  Dr. Staiger noted that the employee’s current clinical findings were well within normal limits and considered a recurrent left carpal tunnel syndrome unlikely.  He wrote that the employee’s expectations appeared to be somewhat unrealistic with regard to the normal aging process.  The employee was released to work without restrictions and was advised that he need not return as long as he continued doing well.

The employee returned to see Dr. Staiger on April 13, 2016.  He reported vague numbness, tingling, and pain in his hands, particularly when writing.  Dr. Staiger’s diagnosis was bilateral wrist pain.  He told the employee that these symptoms were not something he could help him with at that time.  The employee was offered physical therapy for strengthening, but declined.

On March 29, 2017, the employee returned to Dr. Staiger for evaluation of ongoing bilateral wrist pain, worse in cold weather.  The employee denied persistent numbness and tingling.  Dr. Staiger again suggested physical therapy, but the employee declined.  Dr. Staiger continued the employee without restrictions and again noted that the employee did not need to return to the clinic if he showed improvement.

On March 7, 2018, the employee was seen for an initial occupational therapy evaluation at Northwest Industrial Rehabilitation Services.  He reported that his symptoms included tingling in both hands, worse with firm grasping and cold temperatures.  The employee reported that his hands seemed weak and had low endurance, particularly when lifting and when using long-handled tools.  From March 15 through June 28, 2018, the employee participated in 11 occupational therapy sessions.  He was discharged on June 28, 2018, on the basis that he had achieved maximum benefit from the therapy.  The employee was advised to continue drinking plenty of water, performing stretches, and wearing wrist splints at night, during driving, and as needed at work.

In March 2019, the employee again returned for an evaluation with Dr. Staiger, complaining of bilateral wrist pain with use, worse with cold temperatures.  He reported that his therapy in 2018 had helped and wondered if he could repeat it.  Dr. Staiger diagnosed mild bilateral median nerve irritability at the carpal tunnels and recommended therapy for bilateral myofascial techniques.  The employee was advised to return on an as-needed basis.

On March 2, 2020, the employee returned to Dr. Staiger’s clinic, where he was seen by a certified physician’s assistant (PAC), Emil Trutwin, for an evaluation of both wrists.  The employee reported that he had not seen much improvement in his symptoms in either hand.  He described both hands as “sleepy” and noted that he sometimes experienced dull aches and pains in the hands with occasional shooting pain into his forearms.  He stated that his symptoms had not gotten any better since 1995, reporting that although he had obtained a little bit of relief from certain therapy modalities, this relief had been very temporary.  PAC Trutwin noted that the employee appeared to have very mild recurrent symptoms, including “a lot of nonspecific symptoms.”  He suggested two options for the employee to consider: a repeat EMG of the bilateral upper extremities or diagnostic and therapeutic injections for a median nerve block.   The employee initially indicated he was not interested in the EMG, as he had found prior similar testing painful.  However, after further discussion, he wanted to leave that option open in case he decided to schedule it.  He stated he wished to proceed with the nerve block injections.

The employer and insurer denied payment for the March 2, 2020, office visit, alleging that it was not reasonable or necessary treatment to cure and relieve the employee’s work injury.  The employee filed a medical request on July 30, 2020.  The matter was initially considered at an administrative conference which resulted in a decision and order pursuant to Minn. Stat. § 176.106. The employer and insurer requested a formal hearing, resulting in the hearing at OAH.

The employer and insurer had the employee evaluated by Dr. Jeffrey Husband, who saw the employee on January 12, 2021.  Dr. Husband found no evidence of objective abnormalities when examining the employee’s bilateral upper extremities.  After reviewing prior records, he concluded that by history and examination, the employee had shown only subjective symptoms which were entirely unsupported by objective findings.  Dr. Husband opined that no objective evidence in the record or on examination supported a diagnosis of carpal tunnel syndrome, whether before or after the employee’s carpal tunnel surgery.  Accordingly, he noted in his report that he disagreed with the finding in the 2013 decision which found that the employee’s work injury had resulted in left carpal tunnel syndrome.

Dr. Husband further opined that, even if the 2013 decision had been correct in finding that the employee had carpal tunnel syndrome, the employee would have reached maximum medical improvement (MMI) for left carpal tunnel syndrome no more than four months following the left carpal tunnel release performed on January 8, 2014, and would have reached MMI for any right carpal tunnel syndrome as of May 8, 2014.  Dr. Husband agreed that, if he assumed the 2013 findings regarding carpal tunnel syndrome were correct, the left carpal tunnel release surgery in 2014 had been a reasonable form of treatment.  However, even under this assumption, it was his view that none of the treatment thereafter had been warranted and that yearly follow-up examinations since the surgery were not necessary or reasonable treatment for the employee’s subjective symptoms.  In his opinion, the employee’s symptoms would similarly not benefit from any further treatment.

On September 16, 2021, a hearing was held on the employee’s medical request.  The parties stipulated[1] that the 2013 Findings and Order was “the law of the case, at least to that point.” Following the hearing below, the compensation judge found that the employee had failed to show that the medical office visit on March 2, 2020, was reasonable and necessary.  The employee appeals. [2]


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(3).  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).


The sole issue below was the reasonableness and necessity of the March 2, 2020, office visit.  Medical care for a work injury is to “cure and relieve” the effects of the employee’s work injury.  Minn. Stat. § 176.135, subd. 1.  The fact that the medical care does not cure the injury does not mean that it was not reasonable or necessary.[3]  The reasonableness and necessity of medical treatment under Minn. Stat. § 176.135 is a question of fact for the compensation judge which will not be overturned unless it is clearly erroneous and unsupported by the record as a whole. [4]

A compensation judge may consider many factors when assessing whether certain medical treatment was reasonable and necessary, including the employee’s opinion as to relief obtained; the provision of services on a scheduled rather than an as-needed basis; the duration of relief from symptoms and whether symptoms recur; evidence as to a reasonable treatment plan; documentation of the details of treatment; whether the frequency of treatment is warranted; and the cost of treatment in light of the relief obtained.[5]  Not all factors apply in all cases and the weight to be attached to any given factor will vary from case to case.[6]

In his memorandum, the compensation judge noted that while the employee has continued to treat with Dr. Staiger at least yearly since his 2014 surgery, his diagnosis, clinical findings and symptoms, both as discussed in the medical records and by the employee’s own self-report, have remained consistent.  The judge further saw no indication that any of the treatment which the employee had received during that period provided any significant relief.  Although the PAC Trutwin offered some treatment options at the disputed office visit, the compensation judge further noted that nothing in the related chart notes indicated how the treatment recommendations might result in any improvement or relief.  In light of these considerations, the judge concluded that the employee had not shown that this office visit provided any reasonable and necessary treatment to cure and relieve the work injury.  These conclusions were supported in the medical record and constitute factors which provide substantial evidence for the compensation judge’s determination that the March 2, 2020, office visit was not proven to be reasonable and necessary.

The employee argues that the compensation judge’s decision was predicated on errors of fact and/or law.  He specifically disagrees with the judge’s conclusion that he had not experienced significant improvement or reduction in his symptoms as a result of the past several years of annual follow up appointments, pointing out that he did report some relief from occupational therapy in 2018.  He further argues that because this occupational therapy and a short period of physical therapy after his surgery are the only treatment modalities he has undergone during that period, it is not demonstrably the case that he might not benefit from additional treatment.[7]  He notes that there were other treatment recommendations that had been made which were denied by the insurer.  Finally, he argues that even where follow-up visits do not in themselves provide treatment, they are reasonable and necessary because they are needed for his physicians to assess his condition and then potentially make any appropriate treatment recommendations.

We are not persuaded by the employee’s argument, as it simply proposes a different set of inferences from the evidence, and does not show that the judge made any mistake of fact or law.  Where evidence is conflicting or more than one inference may reasonably be drawn from the evidence, the findings of the compensation judge are to be upheld.[8]

Additional evidence in the record supports the judge’s determination, notably the expert medical opinion of Dr. Husband, who opined that the employee had not required further treatment since the 2014 surgery and that no further treatment would be of assistance given the employee’s symptoms and clinical findings.

The employee points out that there was an unappealed finding at the 2013 hearing that the work injury resulted in carpal tunnel syndrome, and that the parties agreed that this finding is part of the law of the case.  Because portions of Dr. Husband’s report expressed disagreement with that finding, the employee contends that any reliance on the opinion of Dr. Husband would constitute an error of law.  We note that the compensation judge’s reasoning as set forth in his memorandum was not based on Dr. Husband’s opinion, and that the evidence the compensation judge did discuss is sufficient in and of itself to provide substantial support for the judge’s finding.  Further, despite expressing his disagreement with this 2013 finding, Dr. Husband predicated his overall opinion on a hypothetical acceptance of the finding and of a diagnosis of carpal tunnel syndrome.  Based on that hypothetical, he opined that the employee’s 2014 surgery would have been reasonable and necessary treatment, and it was only in that context that he offered the opinion that subsequent treatment was not reasonable and necessary.  Thus Dr. Husband’s expert opinion does constitute evidence on which the compensation judge would have been entitled to rely in resolving the issue before him.

Substantial evidence supports the compensation judge’s finding that the employee’s medical office visit of March 2, 2020, was not reasonable and necessary.  We therefore affirm.

[1] Stipulation 1, Findings & Order served and filed October 13, 2021.

[2] The appellant’s brief was due on January 28, 2022, but was not filed until January 31, 2022.  In their responsive brief, the employer and insurer requested that this court strike the appellant’s brief; in turn, the employee filed a motion requesting that the court accept the late brief, accompanied by an affidavit explaining why the brief was inadvertently filed late.  The employer and insurer responded opposing the motion.  Pursuant to Minn. R. 9800.0900, subp. 6, the failure of any party to timely file a brief “. . . may result in the striking of that party’s brief from consideration” (emphasis added).  After reviewing the submissions of the parties, and upon consideration of the facts and circumstances set forth therein, this court denies the request to strike the appellant’s brief.

[3] Pelowski v. K-Mart Corp. 627 N.W.2d 89, 61 W.C.D. 276 at n.1 (Minn. 2001), (citing Castle v. City of Stillwater, 235 Minn. 502, 51 N.W.2d 370, 17 W.C.D. 103 (1952)); Besic v. Wal-Mart Stores, 75 W.C.D. 519 (W.C.C.A. 2015).

[4] See Hopp v. Grist Mill, 499 N.W.2d 812, 48 W.C.D. 450 (Minn. 1993); Benson v. McQuay Int’l/AAF McQuay, Inc., 78 W.C.D. 303 (W.C.C.A. 2018).

[5] See Horst v. Perkins Rest., 45 W.C.D. 9 (W.C.C.A. 1991), summarily aff’d (Minn. July 10, 1991).  Additional factors a judge might consider were set forth by this court in Fuller v. Naegele/Shivers Trading, slip op. (W.C.C.A. Apr. 14, 1993).

[6] Olson v. Allina Health Sys., 59 W.C.D. 37, 43 (W.C.C.A. 1999).

[7] We agree that there was no evidence of a resolution of the employee’s injury, and note that the compensation judge made no finding to that effect.  Accordingly, we do not reach the question whether future medical care may be reasonable, necessary, and causally related to the work injury.

[8] Redgate v. Sroga’s Standard Serv., 421 N.W.2d 729, 734, 40 W.C.D. 948, 957 (Minn. 1988).