Opinion
No. 3-027 / 02-0643
Filed February 12, 2003
Appeal from the Iowa District Court for Woodbury County, Michael S. Walsh, Judge.
Petitioner appeals from the district court's decision on judicial review affirming the decision of the agency. AFFIRMED IN PART, REVERSED IN PART, AND REMANDED.
Robert Green, Sioux City, for appellant.
Matthew Grotnes of Hopkins Huebner, P.C., Des Moines, for appellee.
Thomas J. Miller, Attorney General, and Craig Kelinson, Assistant Attorney General, for appellee.
Considered by Sackett, C.J., and Zimmer and Vaitheswaran, JJ.
Petitioner-appellant, Judy Sands, appeals from the district court's decision on judicial review, which affirmed the decision of the agency. She claims (1) her work-related injury caused permanent and total disability, (2) Marian Health wrongfully denied benefits and medical treatment after Appellant refused the arteriogram, (3) the court should have allowed her to present additional evidence, and (4) the agency's findings are not supported by substantial evidence. We affirm in part, reverse in part, and remand.
Background facts and proceedings. In September 1992 appellant was injured at work when two fingers of her left hand were smashed between a cart she was pushing and a cart washer. About a week later, she awoke with severe pain and her fingers appeared black and purple. Her family doctor referred her to a neurologist at Marian Health, who referred her to doctors at the University of Nebraska Medical Center. They diagnosed her as having reflex sympathetic dystrophy (RSD). Treatment provided some relief.
In December 1993, Appellant saw a pain specialist. He noted a variety of tests had been run without conclusive showing of the etiology of her pain. The doctor noted the presence of dystrophic changes in the left hand and upper extremity with some mottling and coolness. Appellant also had a psychological evaluation, which revealed a major depression, possibly a reaction to her pain and the difficulty she had obtaining treatment for her injury. Appellant received treatment for the depression and began a series of nerve block injections beginning in February 1994.
In April 1994, Dr. Kanazi reported appellant was not able to perform her normal work duties. In October 1994, appellant completed a four-week program at a pain management center. The discharge summary indicates that she did well and learned to manage her pain without the use of medications. Dr. Willcockson, a psychologist, confirmed she was not yet ready to return to work on December 6, 1994; January 3, 1995; and January 27, 1995.
In June 1996, Marian Health requested an independent medical examination by Dr. Donovan. He indicated the history of injury could be consistent with several different conditions, including RSD or a vascular disorder. Dr. Donovan recommended a bone scan and a vascular examination including an arteriogram in order to assist in his diagnosis. The bone scan was performed. According to Dr. Donovan, the bone scan did not show good evidence of the existence of RSD on the left side. His exam also showed hypervascularity in the right wrist. Appellant was scheduled to have an arteriogram, but she declined to do so. Following appellant's refusal to submit to the arteriogram, Marian Health denied both healing period benefits and any further medical treatment.
In mid-1998, Sands underwent gallbladder surgery. Complications from that surgery resulted in a stroke. During that period of hospitalization, Appellant was diagnosed with anticardiolipin syndrome, a condition which makes her highly susceptible to developing blood clots. Based on this information, Dr. Donovan concluded she had a hypercoagulative condition which was the cause of her symptoms diagnosed as RSD by the University of Nebraska physicians.
Appellant's records were evaluated by Dr. Leth, a specialist in pain medicine. He concluded appellant's injury on September 26, 1992 caused a disturbance of blood flow into the ring and small fingers of the left hand which was caused by a pre-existing hypercoagulative condition. Dr. Leth indicated the injury was confined to the two fingers and did not involve any other portion of appellant's body.
The agency found appellant had experienced a fifty percent loss of use of the ring and little fingers of her left hand. The agency found no ratings of impairment and determined appellant had failed to prove her present disability was related to RSD rather than an aggravation of a pre-existing vascular condition. Therefore, the agency determined appellant's condition was a scheduled member disability of the ring and little fingers on her left hand. It ordered Marian Health to pay appellant healing period benefits to June 18, 1996, and twenty-two and one-half weeks of compensation for permanent partial disability beginning June 19, 1996.
On judicial review, the district court affirmed the agency. It also declined to hear additional evidence, in the form of records from a recent medical examination, determining appellant "has not shown that this additional evidence is material and has not given any good reasons why such evidence was not presented" to the agency.
Claims on appeal. On appeal, appellant claims (1) her work-related injury caused permanent and total disability, (2) Marian Medical wrongfully denied benefits and medical treatment after she refused the arteriogram, (3) the court should have allowed her to present additional evidence, and (4) the agency's findings are not supported by substantial evidence.
Scope and standard of review. Judicial review of agency action is governed by the Iowa Administrative Procedure Act, Iowa Code chapter 17A. City of Davenport v. Public Employment Relations Bd., 264 N.W.2d 307, 311 (Iowa 1978); Iowa Code § 17A.19. The district court acts in an appellate capacity to correct errors of law on the part of the agency. Dubuque Community Sch. Dist. v. Public Employment Relations Bd., 424 N.W.2d 427, 430 (Iowa 1988). In our review of the decision of the district court, we apply the standards of section 17A.19 to the agency action to determine whether our conclusions are the same as those of the district court. Houston v. Iowa Dept. of Revenue, 647 N.W.2d 470, 472 (Iowa Ct.App. 2002). Agency action must be supported by substantial evidence in the record. Koehler Elec. v. Wills, 608 N.W.2d 1, 3 (Iowa 2000). Evidence is substantial when a reasonable mind could accept it as adequate to reach a conclusion. Crane v. Meier, 332 N.W.2d 344, 346 (Iowa Ct.App. 1982). Substantial evidence need not rise to a preponderance, but a mere scintilla will not suffice. Herring v. Iowa Law Enforcement Agency, 341 N.W.2d 65, 66-69 (Iowa Ct.App. 1983). The question is not whether the evidence might support a different finding but whether the evidence supports the findings actually made. Henry v. Iowa Dep't of Job Serv., 391 N.W.2d 731, 734 (Iowa Ct.App. 1986). The possibility of drawing two inconsistent conclusions from the evidence does not mean the agency's decision is not supported by substantial evidence. Robbennolt v. Snap-On Tools Corp., 555 N.W.2d 229, 233 (Iowa 1996). Because "law issues are determinable by the judiciary alone," Iowa Malleable Iron Co. v. Iowa Employment Sec. Comm'n, 195 N.W.2d 714, 717 (Iowa 1972) (citation omitted), we owe the agency only limited deference on matters of law. Des Moines Indep. Cmty. Sch. Dist. v. Iowa Dep't of Job Serv., 376 N.W.2d 605, 609 (Iowa 1985).
Scheduled injury or industrial disability. The central issue in this appeal is whether appellant is totally and permanently disabled or whether she had an injury confined to two fingers of her left hand. If the injury is confined to her hand, she is entitled to be compensated only on a scheduled member basis and the agency decision is correct. SeeIowa Code § 85.34(2); Lauhoff Grain v. McIntosh, 395 N.W.2d 834, 837 (Iowa 1986). If the injury extends to the body as a whole, appellant is entitled to be compensated on the basis of an industrial disability. Id.; see Mortimer v. Fruehauf, 502 N.W.2d 12, 16 (Iowa 1993). Appellant basically claims the agency should have given more weight to the opinions and conclusions of the treating physicians at the University of Nebraska than to the opinions and conclusions of Drs. Donovan and Leth because the treating physicians only were interested in healing appellant, but Drs. Donovan and Leth were hired to give opinions beneficial to Marian Health.
The agency is not compelled to accept the opinion of any medical expert. Hurley v. Sheller-Globe Corp., 512 N.W.2d 796, 798 (Iowa Ct.App. 1993). We do "not reassess the weight to be accorded various items of evidence. Weight of evidence remains within the agency's exclusive domain." Titan Tire Corp. v. Employment Appeal Bd., 641 N.W.2d 752, 755 (Iowa 2002) (quoting Burns v. Bd. of Nursing, 495 N.W.2d 698, 699 (Iowa 1993)). The agency gave more weight to the opinions of Drs. Donovan and Leth which, although not from treatment of appellant, were based on more recent information than those of the doctors at the University of Nebraska. Our review is to determine if substantial evidence supports the agency's findings. Henry, 391 N.W.2d at 734. "Evidence is substantial if a reasonable person would find it adequate for reaching a conclusion, even though a reviewing court might reach a contrary inference." Oscar Mayer Foods Corp. v. Tasler, 483 N.W.2d 824, 830 (Iowa 1992). The agency's findings are conclusive when facts are in dispute or when reasonable minds may differ on the inferences to be drawn from the evidence. Harlan v. Iowa Dep't of Job Serv., 350 N.W.2d 192, 193 (Iowa 1984). The opinions of Drs. Donovan and Leth constitute substantial evidence supporting the decision of the agency that appellant's disability is confined to her left hand.
Termination of healing period benefits and medical treatment. Appellant claims Marian Medical improperly terminated her healing period benefits and medical treatment in June 1996 based on her refusal to undergo an arteriogram. She argues she had not reached maximum medical recovery. See Iowa Code § 85.34(1). Healing period benefits end when the worker returns to work, is capable of returning to substantially similar employment, or has reached maximum medical recovery. Id. Maximum medical recovery is determined by when care providers indicate no further improvement is expected, not by looking back to find the point when the care provided ceased causing improvement. See Armstrong Tire Rubber Co. v. Kubli, 312 N.W.2d 60, 65 (Iowa Ct.App. 1981).
The agency determined Dr. Donovan's report established appellant had not reached maximum medical improvement at the time he requested she undergo certain tests to aid his determination when that point would be reached. The agency concluded appellant's refusal to undergo the arteriogram marked the end of her healing period because it was the point at which she "declined further attempts to improve her condition." It noted benefits can be suspended during the period of a worker's refusal to submit to an independent examination required under section 85.39. The agency found appellant's refusal to undergo the arteriogram was not unreasonable. It concluded "[t]here was no basis for suspending her benefits as a result of the refusal to undergo the arteriogram test. Doing so was unreasonable and contrary to law." In addition to terminating her healing period benefits, Marian Health also refused to authorize any future medical care for the injury. We cannot agree appellant's refusal to have the arteriogram constituted a refusal of further attempts to improve her condition. Appellant submitted to the examination requested under section 85.39. She did not decline any offered medical care. The agency's determination appellant's healing period ended when she refused the test is not supported by substantial evidence. We therefore reverse only that portion of the agency decision and remand for a determination of when appellant met one of the criteria for the end of her healing period set forth in section 85.34(1) and computation of any healing period benefits due up to that date.
Additional evidence. Appellant requested that the district court allow her the opportunity to have a current medical examination and to consider the results of that examination as additional evidence under section 17A.19(7). Marian Health resisted on the grounds appellant did not state the additional evidence was material, she did not show any good reason for failure to present such evidence in the contested case proceeding, and the agency itself ruled appellant did not timely raise the section 85.39 medical exam issue. The district court denied the request because appellant "has not shown that this additional evidence is material and has not given any good reasons why such evidence was not presented" to the agency. Our conclusions are the same as those of the district court.
Summary. We, like the district court, affirm the agency's determination appellant's injury is limited to her left hand and, therefore, is compensable as a scheduled member injury under section 85.34(2). We conclude substantial evidence does not support the agency's determination appellant's healing period ended when she "declined further attempts to improve her condition" by refusing to undergo an arteriogram as part of a medical examination. We affirm the district court's refusal to allow additional evidence.