Opinion
No. 3-855 / 03-0173.
Filed December 10, 2003.
Appeal from the Iowa District Court for Polk County, Richard G. Blane, II, Judge.
Conlin, Edgewel Electric, Inc., and EMC Insurance Co. appeal the district court's workers' compensation decision. REVERSED ON APPEAL; AFFIRMED ON CROSS-APPEAL.
Stephen Lombardi of Lombardi Law Firm, West Des Moines, for appellant.
Michael Mock of Bradshaw, Fowler, Proctor Fairgrave, P.C., Des Moines, for appellees.
Considered by Vogel, P.J., Hecht and Vaitheswaran, JJ.
Quint Conlin worked for Edgewel Electric as an electrical contractor. He injured his right shoulder when a drill he was using did not shut off.
Conlin sought workers' compensation benefits. Following a hearing, a deputy workers' compensation commissioner determined that he sustained industrial disability of twenty-five percent. The interim commissioner affirmed that decision.
Edgewel and its insurer sought judicial review. The district court declined to overturn the agency determination of industrial disability but found a lack of substantial evidence to support a finding on the extent of disability. All parties sought further judicial review.
The district court reversed the agency decision after finding flaws in a medical opinion on which the agency relied. The employee claims this was error. The employer claims the district court did not go far enough and should have concluded that the claimant sustained no industrial disability as a matter of law. Finding substantial evidence to support the agency decision in its entirety, we partially reverse the district court.
I. Medical Opinions
Conlin was seen by various physicians, including Dr. Kary R. Schulte, an orthopedic surgeon, and Dr. Marc Hines, a neurologist. Dr. Schulte initially restricted Conlin to work requiring no use of his right arm but eventually removed this restriction. Dr. Hines, who examined Conlin after Dr. Schulte removed the restriction, found that Conlin had a "significant restriction with regard to repetitive use of his shoulder." He determined the restriction was permanent.
In assessing these divergent medical opinions, the deputy commissioner recognized that Dr. Schulte had consistently found a full range of motion in Conlin's shoulder. The deputy also found that, in rendering a contrary opinion, Dr. Hines was not operating within his area of expertise. The deputy nevertheless found that Conlin "sustained some minimal measure of permanent disability." The interim commissioner seconded this opinion, stating, "Dr. Schulte's assessment is entitled to greater weight than the assessment from Dr. Hines but that does not mean the assessment from Dr. Hines is to be totally disregarded. The most accurate assessment is located between those two. . . ."
The district court disagreed with the weight assigned to Dr. Hines's opinion, noting that he failed to consider two notes from Dr. Schulte's office reflecting the removal of Conlin's work restrictions. The court stated, "Dr. Hines could not possibly have come to an informed medical conclusion without reviewing these two evaluations." On further judicial review, Conlin maintains that the district court impermissibly substituted its judgment concerning Dr. Hines's opinion for that of the agency.
The key question is whether the agency decision is supported by substantial evidence. Iowa Code § 17A.19(10)(f)(1) (2001). Evidence supporting an agency finding "must be judged in light of all the relevant evidence in the record cited by any party that detracts from that finding as well as all of the relevant evidence in the record cited by any party that supports it. . . ." Iowa Code § 17A.19(10)(f)(3). "[E]vidence is not insubstantial merely because it would have supported contrary inferences." Wal-Mart Stores, Inc. v. Caselman, 657 N.W.2d 493, 499 (Iowa 2003).
Judging the record in this light, we conclude the agency determination of twenty-five percent industrial disability is supported by substantial evidence. The agency was faced with two contrary medical opinions. While the commissioner could have decided to accord no weight to Dr. Hines's opinion based on his lack of expertise in orthopedics and his failure to consider two of Dr. Schulte's evaluations, he was not required to do so. See IBP, Inc. v. Al-Gharib, 604 N.W.2d 621, 631 (Iowa 2000) (stating commissioner, as fact finder, determines weight to be given to expert testimony and its decision concerning weight "depends on the accuracy of the facts relied upon by the expert and other surrounding circumstances."). Notably, Dr. Hines did not merely review Conlin's past medical history but conducted his own physical examination which revealed "a popping type of crepitus" and "exquisite tenderness in the distal clavicular area. . . ." This is consistent with Dr. Schulte's finding that Conlin's shoulder was tender to palpation, a finding contained in one of the medical notes not reviewed by Dr. Hines. While Dr. Schulte found "no crepitus", neither this difference nor Dr. Hines's apparent failure to review this diagnosis mandates rejection of Dr. Hines's opinion. See Poula v. Siouxland Wall Ceiling, Inc., 516 N.W.2d 910, 911 (Iowa Ct.App. 1994) (stating if medical expert's opinion is based on incomplete history, commissioner may give it less weight or reject it) (emphasis added). The agency's decision to accord weight to Dr. Hines's opinion fell within its range of discretion. See Trade Professionals, Inc. v. Shriver, 661 N.W.2d 119, 123 (Iowa 2003).
Crepitation is "[a] clicking or crackling sound often heard in movements of joints. . . ." Taber's Cyclopedic Medical Dictionary 460 (18th ed. 1997).
II. Industrial Disability
The employer contends the agency should have found that "[c]laimant sustained no industrial disability as a matter of law." The district court thoroughly and cogently analyzed the evidence supporting and detracting from the agency determination of industrial disability. Finding no error, we affirm that portion of the decision.
III. Disposition
We affirm that portion of the district court's opinion upholding the commissioner's determination of industrial disability. We reverse the portion of the opinion rejecting the agency's determination of the extent of industrial disability. Costs are taxed to the employer and insurer.