Opinion
No. 5-395 / 04-1350
Filed August 17, 2005
Appeal from the Iowa District Court for Polk County, Glenn Pille, Judge.
Greg Jones seeks further review of a workers' compensation decision denying his claim for payment of medical expenses. AFFIRMED.
Thomas Wertz, Wertz Law Firm, P.C., Cedar Rapids, for appellant.
James Peters, Simmons, Perrine, Albright Ellwood, P.L.C., Cedar Rapids, for appellees.
Considered by Sackett, C.J. and Huitink and Vaitheswaran, JJ.
Greg Jones seeks further judicial review of a workers' compensation decision denying his claim for payment of medical expenses. We affirm.
I. Background Facts and Proceedings
In 1990, Jones injured his back while working for Tie Yard of Omaha. He applied for workers' compensation benefits. In 1992, Jones underwent back surgery, performed by Dr. James LaMorgese. A deputy workers' compensation commissioner concluded that Jones showed "a causal relationship between [his] injury and [his] permanent partial disability as manifested on June 21, 1990," but did not show a causal relationship between his injury and the 1992 surgery. The agency awarded permanent partial disability benefits and denied medical benefits for the 1992 surgery.
In 1999, Jones underwent a second back surgery, performed by Dr. Michael Chapman. He sought reimbursement for the medical expenses associated with that surgery. A deputy workers' compensation commissioner concluded the 1990 work injury "was at least a substantial factor in the need for the 1999 surgery and subsequent treatment and medications." The deputy ordered Tie Yard to pay Jones's medical expenses.
On intra-agency appeal, the workers' compensation commissioner reversed, concluding Jones failed to establish that the work injury was a proximate cause of the 1999 surgery.
Jones sought judicial review. The district court concluded the commissioner applied the correct legal standard and his findings were supported by substantial evidence. This appeal followed.
II. Further Judicial Review
The parties agree the sole issue before the agency was whether the 1999 surgery was proximately caused by the 1990 work injury. They also agree that the commissioner cited the correct causation standard, as follows:
The claimant has the burden of proving by a preponderance of the evidence that the injury is a proximate cause of the disability on which the claim is based. A cause is proximate if it is a substantial factor in bringing about the result; it need not be the only cause. . . .
They part ways on whether the commissioner correctly applied the law to the facts, with Jones contending he did not. This contention triggers review under Iowa Code section 17A.19(10)(m) (2005) (reviewing agency action based upon "irrational, illogical, or wholly unjustifiable application of law to fact that has clearly been vested by a provision of law in the discretion of the agency"); P.D.S.I. v. Peterson, 685 N.W.2d 627, 633 (Iowa 2004) (statingapplication of law to fact in workers' compensation cases is "vested by a provision of law in the discretion of the agency," permitting reversal only if application was "irrational, illogical, or wholly unjustifiable").
The commissioner's application of law to fact was as follows. He first noted that the evidence supported several causes for Jones's 1999 surgery. He stated:
First, the work injury itself may have contributed to his present condition. Second, scarring from the 1992 surgery was observed by Dr. Chapman in the 1999 surgery and may be causing part of the problem. Third, the claimant had a slip and fall on ice prior to the 1999 surgery that may have precipitated the surgery. Fourth, the claimant has degenerative changes that may also be a factor producing his present condition.
The commissioner then summarized the medical causation opinions of Drs. LaMorgese and Chapman. He noted that Dr. LaMorgese, who performed the 1992 surgery, "consistently attributed the 1990 injury to all of [Jones's] surgeries and back problems." He explained that Dr. Chapman proffered three opinions. The first concluded the 1990 injury did not lead to the 1999 surgery. The second found a causal connection between the injury and the 1999 surgery. The third found the 1999 surgery "more related to natural degeneration of this segment and probably not significantly related to the original work injury. . . ." With some reservation, the commissioner found Dr. Chapman's third opinion "to be his best and final expression of opinion."
The commissioner's reservation was based on Dr. Chapman's reliance on the first agency decision finding no causal relationship between the 1992 surgery and the work injury. The commissioner stated Dr. Chapman should have relied on his own medical expertise to render an opinion "regardless of legal conclusions reached in the arbitration decision."
The commissioner next framed the legal issue in light of the evidence, stating Jones had to prove that "the 1999 surgery was proximately caused by the 1990 injury independently from the 1992 surgery and its consequences." After framing the issue in this fashion, the commissioner compared Dr. Chapman's third opinion with Dr. LaMorgese's opinion. He stated "both doctors attribute the need for the 1999 surgery to the 1992 surgery and degeneration. Neither opines that the 1999 surgery would have been required because of the 1990 injury if the intervening 1992 surgery had not occurred." The commissioner concluded:
I accept the most recent opinion from Dr. Chapman because the greater weight of the evidence attributes the 1999 surgery to the 1992 surgery, an intervening event that was previously adjudicated to have not been work-related. It is concluded that the record fails to prove that it is probable that the 1990 injury was a substantial factor in bringing about the need for the 1999 surgery. The 1992 surgery was a significant event that broke the chain of causation. Defendants are not liable for the expenses claimed by claimant.
Jones takes issue with the commissioner's (1) selection of Dr. Chapman's third opinion over his second, (2) characterization of Dr. LaMorgese's opinion, and (3) imposition of a requirement that he prove the 1999 surgery was proximately caused "independently" from the 1992 surgery.
1.
With respect to Dr. Chapman's opinions, we note that his third and final letter is consistent with his original opinion stating "Mr. Jones' progressive degeneration of his low back and subsequent need for surgery in 1999 were unrelated to his fall in 1990." Additionally, the circumstances triggering the second and third opinions, discussed extensively by both parties, go to the weight of the evidence, and the determination of weight is peculiarly within the province of the agency. Dunlavey v. Economy Fire Cas. Co., 526 N.W.2d 845, 853 (Iowa 1995) (stating determination of weight "may be affected by the completeness of the premise given the expert and other surrounding circumstances").
We recognize the commissioner was not the fact-finder and his decision to accord greater weight to Dr. Chapman's third opinion rather than his second was contrary to the deputy commissioner's decision on this question. However, the deputy did not personally assess Dr. Chapman's demeanor, relying instead solely on the contents of his letters. Therefore, the commissioner was free to reweigh the evidence. See Iowa Code §§ 17A.15(2) (stating fact findings may be prepared by someone other than person who presided at reception of evidence "unless demeanor of witnesses is a substantial factor"); 17A.15(3) (stating agency "has all the power which it would have in initially making the final decision except as it may limit the issues on notice to the parties or by rule"); 17A.19(10)(f)(3) (defining "record as a whole" as "including any determinations of veracity by the presiding officer who personally observed the demeanor of the witnesses"); Trade Professionals, Inc. v. Shriver, 661 N.W.2d 119, 125 (Iowa 2003) ("The only time final findings of fact must be prepared by the person who heard the case originally is in cases in which `demeanor of witnesses is a substantial factor.'").
The commissioner's decision to accord greater weight to Dr. Chapman's third opinion was permissible even though that opinion did not use the "substantial factor" language contained in our opinions on proximate cause. We are bound by reasonable inferences that may be fairly drawn from disputed evidence. Midwest Automotive v. Iowa Dep't of Transp., 646 N.W.2d 417, 428 (Iowa 2002). The commissioner was free to infer from the language used by Dr. Chapman that he did not find the work injury a substantial factor in bringing about the 1999 surgery.
2.
Turning to the commissioner's characterization of Dr. LaMorgese's opinion, we agree with Jones that Dr. LaMorgese did not simply attribute the 1999 surgery to the 1992 surgery and degeneration, as the commissioner ultimately concluded. Dr. LaMorgese also stated, "the low back surgery subsequently performed by Dr. Chapman in November of 1999 was needed as a result of the original work injury of January 31, 1990." This additional uncited language does not mandate reversal because it is axiomatic that an agency may choose between competing medical opinions. Grundmeyer v. Weyerhaeuser Co., 649 N.W.2d 744, 752 (Iowa 2002) ("The commissioner may accept or reject the expert opinion in whole or in part."). Here, even if Dr. LaMorgese's opinion did not coincide with Dr. Chapman's, the commissioner was free to reject it in its entirety.
3.
Finally, we are not persuaded that the commissioner's use of the term "independently" evinced a misapplication of the proximate cause standard. The commissioner merely sought to determine whether the work injury was a substantial factor in the need for the 1999 surgery or whether the 1992 surgery was an "intervening cause" of the 1999 surgery, as he ultimately found.
We cannot conclude the commissioner's application of law to fact was "irrational, illogical, or wholly unjustifiable."
AFFIRMED.