Opinion
No. 3-414 / 02-1689
Filed August 13, 2003
Appeal from the Iowa District Court for Polk County, Robert D. Wilson, Judge.
Petitioner appeals from the district court's ruling on judicial review reversing the workers' compensation commissioner's award. DISTRICT COURT REVERSED; WORKERS' COMPENSATION COMMISSIONER AFFIRMED.
J. Bryan Schulte and Toby Gordon of Schulte, Hahn Swanson, Burlington, for appellant.
James Peters and Elizabeth Croco of Simmons, Perrine, Albright Ellwood, P.L.C., Cedar Rapids, for appellee.
Considered by Zimmer, P.J., and Hecht and Eisenhauer, JJ.
Gary Aldridge appeals from the district court's ruling on judicial review reversing the workers' compensation commissioner's award of fifty-five percent (55%) industrial disability benefits under Iowa Code section 85.64 (1999), medical expenses, and fifty-percent (50%) penalty benefits under section 86.13. He contends the district court erred in concluding substantial evidence does not support the agency's finding of a causal relationship between the work injury and functional impairment, and between the work injury and industrial disability. He also contends the court erred in concluding substantial evidence does not support the finding for penalty benefits. We reverse the ruling of the district court and affirm the commissioner's award.
I. Background Facts and Proceedings. Gary Aldridge worked as a driver for Wal-Mart Distribution from 1994 until 1999. He has suffered chronic lower back pain most of his life, although prior to the incident at issue here he had never needed significant treatment, lost any work, or had any work restrictions. On Friday, September 10, 1999, Aldridge was climbing out of the semi-tractor when he lost his footing and slid down approximately four feet to the ground. He immediately felt pain in his back. That afternoon, Aldridge sought treatment from Dr. Ronald Keller. Aldridge complained of left S1 pain. Dr. Keller, an osteopath, performed a manipulation on Aldridge that helped to relieve some of the pain.
The following week, Aldridge returned to work. Due to increasing pain, Aldridge scheduled an appointment with his regular physician, Dr. Michael Duzan on September 20, 1999. Aldridge reported that he had been in pain since sliding out of the semi one week earlier. Dr. Duzan performed a manipulation and noted Aldridge had stooped posture and difficulty moving. The following day, Aldridge experienced a shooting pain in his right leg while getting off the bathroom stool. When Aldridge again sought treatment from Dr. Duzan that same day, he was referred to Dr. Dennis Abernathie, an orthopedic surgeon.
On September 28, 1999, Aldridge saw Dr. Abernathie. An MRI of Aldridge's lower back revealed a broad circumferential bulging of annulus with extruded disc material in the right lateral recess of L3 related to the L2-L3 disc. Further degenerative disc disease was found in the other levels from T12 through L5, with the most advanced level being at L4-L5. A diskogram performed in December 1999 showed systematic degenerative disease at L2-L3, L3-L4, and L5-S1 with the worst level being at L2-L3.
On January 17, 2000, Dr. Abernathie performed surgery, which consisted of a decompressive laminectomy at L2-L3 with a posterior lumbar interbody fusion at L2-L3 using interfixed cages and an autogenous bone graft. Aldridge's condition improved slightly, but on March 14, 2000, he returned to Dr. Abernathie complaining of pain. An additional surgery was performed on October 16, 2000, which consisted of a total decompression laminectomy and fusion from L3 to S1 and a posterolateral fusion from L4 to S1. Dr. Abernathie's post-operative diagnosis was lumbar instability and degenerative disc disease.
In a letter to Aldridge's attorney dated February 28, 2000, Dr. Abernathie noted Aldridge's prior episodes of low back pain, which were generally resolved without significant treatment. He added:
This all changed on September 10, 1999, when [Aldridge] got out of his truck, jumped to the ground and had an acute onset of back and right leg pain. I felt that at the time of that injury he tore some of the annular ligament allowing the disc to protrude posteriorly and inflamed the nerve root.
On June 1, 2001, Aldridge opined that Aldridge's present disability was forty percent of the body as a whole. Fifteen percent of the disability was a result of Aldridge's September 10 injury that led to the January 17, 2000 surgery, and the remaining twenty-five percent was the result of the additional discs that were treated by the second surgery, performed in October 2000.
Dr. Abernathie indicated it was his understanding that Aldridge reported he had a sudden onset of both lower back and right leg pain when he landed on the ground after exiting the truck. Dr. Abernathie found it unusual that Aldridge did not report right leg or buttock pain to Dr. Duzan on September 20, 1999. He assumed Aldridge had right leg symptoms a few days after the September 10, 1999 injury. Dr. Abernathie agreed that in the normal course of events, referred pain down the leg to the foot would come within two to three days after a significant injury. However, Dr. Abernathie testified that the amount of time between the traumatic injury and the onset of leg pain symptoms can vary widely and could take as much as a few weeks to fully manifest. In fact, Aldridge did not complain of right leg pain until September 21, 1999.
Dr. Abernathie acknowledged it was his understanding of Aldridge's history that led to his conclusion that the January 17, 2000 surgery was due to the September 10, 1999 incident. Dr. Abernathie agreed that, based on the condition of Aldridge's back, the L2-L3 compromise could have occurred while Aldridge was using the toilet on September 21, 1999.
Wal-Mart requested Dr. Stanley Bigos, an orthopedic surgeon and a professor of orthopedics at the University of Washington School of Medicine, to review Aldridge's medical records and offer an opinion as to the causation of his symptoms. In his February 13, 2001 report, Dr. Bigos responded that it was impossible for him to tie the onset of Aldridge's problems to any one event with a reasonable degree of medical certainty. Dr. Bigos opined that the surgery at L2-L3 was due to the aging process rather than a specific traumatic episode. Dr. Bigos acknowledged the time between injury and onset of referred pain can be varied.
Following an arbitration hearing, the deputy workers' compensation commissioner found Aldridge failed to establish his injury was the proximate cause of his resulting disability. On appeal, the chief deputy workers' compensation commissioner found Aldridge's January 17, 2000 surgery was casually connected to the September 10, 1999 work injury and awarded Aldridge fifty-five percent industrial disability, as well as fifty percent penalty benefits. On judicial review, the district court reversed the commissioner's decision and affirmed the arbitration decision.
II. Standard of Review. We review a district court's review of agency action for correction of errors of law. IBP, Inc. v. Harpole, 621 N.W.2d 410, 414 (Iowa 2001). Our review is limited to whether the district court correctly applied the law in exercising its judicial review function. Id. We are bound by the workers' compensation commissioner's factual findings if they are supported by substantial evidence in the record. Id. Evidence is substantial if a reasonable mind would accept it as adequate to reach the same conclusion. St. Luke's Hosp. v. Gray, 604 N.W.2d 646, 649 (Iowa 2000).
III. Causal Connection. The workers' compensation commissioner found a causal relationship exists between Aldridge's work injury and functional impairment, and between his work injury and industrial disability. The district court concluded that the commissioner's finding of a causal relationship lacked substantial evidence because Dr. Abernathie initially believed Aldridge complained of right leg pain at the onset of the injury. Aldridge contends the district court improperly exceeded its scope of review in rejecting Dr. Abernathie's opinion regarding causal connection of the September 10, 1999 injury and the January 2000 surgery.
In reviewing the commissioner's findings of fact, the question is not whether the evidence might support a different finding, but whether it supports the findings actually made. Id. The commissioner weighs the evidence, and we should broadly and liberally apply those findings in order to uphold, rather than defeat, the commissioner's decision. Id. We are not free to interfere with a commissioner's decision just because inconsistent conclusions may be drawn from the same evidence. Quaker Oats v. Ciha, 552 N.W.2d 143, 150 (Iowa 1996).
[E]vidence is not insubstantial merely because it would have supported contrary inferences. Nor is evidence insubstantial because of the possibility of drawing two inconsistent conclusions from it. The ultimate question is not whether the evidence supports a different finding but whether the evidence supports the findings actually made.
City of Hampton v. Iowa Civil Rights Comm'n, 554 N.W.2d 532, 536 (Iowa 1996).
In its order, the district court noted Dr. Abernathie "clearly misunderstood Aldridge's right-sided symptoms and, therefore, the Court rejects his opinion regarding causal connection of the injury to the subsequent surgery." The court then concluded "there is insufficient evidence to support a finding of causal connection between Aldridge's September 10, 1999 injury and his subsequent January 17, 2000 surgery." We conclude the district court, in so finding, impermissibly substituted its judgment for that of the commissioner. In choosing to accept the opinion of Dr. Abernathie, the commissioner reasoned:
Dr. Bigos never actually saw the claimant; he only reviewed medical records. Dr. Abernathie, on the other hand, was claimant's treating physician. Dr. Abernathie saw claimant numerous times. Dr. Abernathie performed surgery on claimant's back. Dr. Abernathie had the opportunity to view claimant's back condition internally during surgery, where he noted there was no scarring or thickening, indicating a recent injury.
When all is said and done, the record contains two medical opinions on causation. Dr. Abernathie states that the delay between the traumatic injury and the onset of leg pain can vary widely, and that in his opinion, claimant's leg pain is the result of his September 10, 1999 injury. Dr. Bigos states that it is impossible to determine with certainty the cause of claimant's leg and back pain. No medical opinion exists in the record that says his leg pain and L2-L3 back condition was caused by any trauma involved in using the toilet on September 21, 1999. And, no medical opinion exists in the record that says his leg pain and L2-L3 condition was caused by the leg massage his wife gave him on September 21, 1999. No medical opinion exists in the record that states that the work injury of September 10, 1999, was not the cause of his leg pain and L2-L3 back condition. We are left then with the opinion of Dr. Abernathie, the doctor most familiar with the claimant's condition, that his leg pain and L2-L3 back condition was caused by the work injury on September 10, 1999.
Based on all the evidence, the greater weight will be given to the opinion of Dr. Abernathie. It is found that the claimant has carried the burden of proof to show that his L2-L3 back condition, resulting leg pain, and surgery were substantially caused by the work injury of September 10, 1999.
We conclude substantial evidence supports the commissioner's finding of a causal connection between Aldridge's September 10, 1999 injury and his functional impairment. Dr. Abernathie's apparent misunderstanding as to the onset of leg pain did not change his ultimate conclusion that the fall caused the injury.
Based on its conclusion that Aldridge's September 10, 1999 injury is not causally connected to his functional impairment, the district court further concluded the injury is not causally connected to Aldridge's industrial disability. Having found a causal connection between the injury and functional impairment, we likewise conclude substantial evidence supports the commissioner's finding of a causal connection between the injury and Aldridge's industrial disability.
Wal-mart argues substantial evidence does not support the finding that the injury is causally related to the January 2000 surgery because (1) Dr. Abernathie testified that he would have given Aldridge work restrictions based solely on the degenerated condition of his lower back and (2) Dr. Abernathie concluded the symptoms of Aldridge's L2-L3 conditions were alleviated by the January 2000 surgery. However, it is undisputed that Aldridge did not suffer any loss of earning capacity prior to his September 10, 1999 work injury. When industrial disability precipitates disability from a latent condition, the entire disability is compensable. Bearce v. FMC Corp., 465 N.W.2d 531, 535 (Iowa 1991).
IV. Penalty Benefits. Finally, Aldridge contends the district court erred in reversing the commissioner's award of penalty benefits. He argues the district court erred in concluding his workers' compensation claim was fairly debatable.
Iowa Code section 86.13 provides in pertinent part:
If a delay in commencement or termination of benefits occurs without reasonable or probable cause or excuse, the workers' compensation commissioner shall award benefits in addition to those benefits payable under this chapter, or chapter 85, 85A, or 85B, up to fifty percent of the amount of benefits that were unreasonably delayed or denied.
An employer and insurance carrier have a duty to act reasonably in paying benefits absent specific direction by the commissioner. Davidson v. Bruce, 594 N.W.2d 833, 838 (Iowa Ct.App. 1999). If there has been a delay in the payment of workers' compensation benefits, an employee is entitled to receive penalty benefits unless the employer proves it had a reasonable cause or excuse to delay payment. Id. A reasonable cause or excuse exists if either (1) the delay was necessary for the insurer to investigate the claim or (2) the employer had a reasonable basis to contest the employee's entitlement to benefits. Id. Penalties are not only available for willful or reckless acts, but also for negligent conduct. Boylan v. American Motorists Ins. Co., 489 N.W.2d 742, 744 (Iowa 1992).
In awarding penalty benefits, the commissioner considered that although Dr. Abernathie stated in his reports throughout the case that Aldridge's back condition was caused by work injury, Wal-mart did not obtain a doctor's opinion stating the work injury was not the cause until February 13, 2001. Even then, Dr. Bigos opinion only stated it was impossible to pinpoint an exact cause. The commissioner also considered Wal-mart's history of having penalty benefits imposed against it. See Robbennolt v. Snap-On Tools, Corp., 555 N.W.2d 229, 238 (Iowa 1996) ("In determining the amount of the penalty, the commissioner shall consider such factors as the length of the delay, the number of the delays, the information available to the employer regarding the employee's injuries and wages, and the prior penalties imposed against the employer under section 86.13.") Based on these factors, substantial evidence supports the commissioner's award of penalty benefits.
Accordingly, we reverse the district court's order and reaffirm the decision of the workers' compensation commissioner.