Opinion ID: 1573390
Heading Depth: 1
Heading Rank: 5

Heading: Entitlement to Industrial Disability.

Text: Under this assignment of error, Sherman raises two issues. The first issue is whether substantial record evidence supports the commissioner's finding that Sherman failed to prove she has thoracic outlet syndrome. The second issue is whether substantial record evidence supports the commissioner's finding that Sherman failed to prove the combination of her conditions resulted in disability of the body as a whole. Sherman contends there is a lack of substantial record evidence to support either finding. A. The thoracic outlet syndrome issue. Thoracic outlet syndrome is caused by compression of nerves and blood vessels, or both, at the base of the neck. 3 Robert K. Ausman & Dean E. Snyder, Medical Library § 4.8, at 45 (Lawyers ed.1989). Symptoms may occur anywhere from the shoulder to the fingers. Id. These symptoms include pain, numbness, swelling, loss of sensation and limb orientation (falling asleep), and weakness. Id. As to the thoracic outlet syndrome, we note that Kienker recorded in her medical notes the following symptoms Sherman described to her: She avoids [pulling] the skid full of parts, as pulling on it hurts her elbows, upper arms, shoulders and neck. She feels neck discomfort right away with pulling.... She said she feels worse now than she did prior to surgery. She is having searing elbow pain, particularly on the right, which she said she did not have prior to surgery. She has pain in the upper arms going into the shoulders and neck, which she did not have before.... She has a hot searing pain most of the time in the medial elbows.... She has discomfort going into her shoulders, across the upper deltoids and into the back of the right upper arm. She has occasional sharp shooting pains in the right forearm, front and back, mostly if she uses an air screwdriver.... Her right elbow is numb and feels tingly and prickly all the time.... Neff disagreed with Kienker's diagnosis that Sherman suffered from thoracic outlet syndrome because she based the diagnosis on Sherman's subjective complaints. To determine whether Sherman was suffering from thoracic outlet syndrome, Neff performed a noninvasive objective test known as Doppler screening. The test is used to verify the existence of intermittent claudication, a condition Kienker concluded supported her diagnosis of thoracic outlet syndrome. Neff described claudication as a diminished or reduced blood flow to part of the body. Neff noted that Sherman's Doppler screening studies were normal, ruling out intermittent claudication. He therefore concluded there was no objective support for a thoracic outlet syndrome diagnosis. In addition, Neff believed repetitive work activity such as Sherman was doing cannot cause thoracic outlet syndrome. Although Neff agreed that Sherman did exhibit some symptoms that were consistent with thoracic outlet syndrome, he ruled out that diagnosis because there was no objective proof of an abnormality, only symptoms. The commissioner gave greater weight to Neff's opinion because it was consistent with objective testing that showed the underlying condition of claudication was not present. In contrast, Kienker's opinion was based on merely subjective complaints. As the district court correctly observed, the commissioner as the fact finder has the responsibility for determining credibility of the witnesses, and we are bound by the commissioner's findings if supported by substantial evidence. Ultimately, the question is not whether the evidence might support a different finding, but whether the evidence supports the findings actually made. Kiesecker, 528 N.W.2d at 110. Although as fact finder, we might have found otherwise, we conclude there is substantial record evidence to support the commissioner's finding that Sherman failed to prove she suffered from thoracic outlet syndrome. B. Combination of conditions resulting in disability of the body as a whole. Sherman contends she suffered injury to scheduled members, her hands, and also to a part of her body not included in the schedule, her nervous system. For these reasons, she argues, she is entitled to compensation for industrial disability. This court has held that when an employee has an injury to a scheduled member and also to a part of the body not included in the schedule, the resultant permanent disability is compensable as an unscheduled injury. Barton v. Nevada Poultry Co., 253 Iowa 285, 291, 110 N.W.2d 660, 663 (1961). In Barton, the employee suffered an injury to the foot, a scheduled member. Id. at 287, 110 N.W.2d at 661. Because of the injury, causalgia affected the employee's entire nervous system. Id. This court held that because of the causalgia, the employee was entitled to compensation based on industrial disability. Id. at 292, 110 N.W.2d at 664. Our Workers' Compensation Act divides permanent partial disability into a scheduled or unscheduled loss. See Iowa Code § 85.34(2)(a)-(u). Section 85.34(2)(a)-(t) specifies the scheduled injuries, such as a loss of a hand, and sets forth the compensation payable for such injuries. Compensation for scheduled injuries is not related to earning capacity. Honeywell v. Allen Drilling Co., 506 N.W.2d 434, 437 (Iowa 1993). In contrast, according to section 85.34(2)(u), unscheduled injuries are compensated by determining the employee's industrial disability. One arrives at industrial disability by determining the loss to the employee's earning capacity. Mortimer v. Fruehauf Corp., 502 N.W.2d 12, 14 (Iowa 1993). Measuring the employee's loss of earning capacity requires the commissioner to consider the employee's functional impairment, age, education, work experience, and adaptability to retraining, to the extent any of these factors affect the employee's prospects for relocation in the job market. Klein v. Furnas Elec. Co., 384 N.W.2d 370, 374 (Iowa 1986). When Sherman argues she has suffered injuries to her nervous system, an unscheduled member, we assume she is referring to the thoracic outlet syndrome, the myofascial neck pain, and the headaches. These, of course, are the injuries Kienker diagnosed. We have already determined there is substantial record evidence to support the commissioner's finding that Sherman failed to prove she suffers from thoracic outlet syndrome. In addition, the commissioner found that even if Sherman suffered from such a condition, she failed to prove a causal connection between that condition and her work. The commissioner similarly found Sherman failed to prove the myofascial neck pain and headaches were causally related to her work. For reasons that follow, we conclude there is substantial record evidence to support all of these non-work related findings. The employee must prove by a preponderance of the evidence that the injury is a proximate cause of the claimed disability. Musselman v. Central, 261 Iowa 352, 360, 154 N.W.2d 128, 132 (1967). A preponderance of the evidence exists when the causal connection is probable rather than merely possible. Blacksmith v. All-American, Inc., 290 N.W.2d 348, 354 (Iowa 1980). Generally, expert testimony is essential to establish causal connection. Bodish v. Fischer, Inc., 257 Iowa 516, 521, 133 N.W.2d 867, 870 (1965). The commissioner must consider the expert testimony together with all other evidence introduced bearing on the causal connection between the injury and the disability. Id. The commissioner, as the fact finder, determines the weight to be given to any expert testimony. Id. Such weight depends on the accuracy of the facts relied upon by the expert and other surrounding circumstances. Id.; see Sondag v. Ferris Hardware, 220 N.W.2d 903, 908 (Iowa 1974) (holding deputy commissioner disregarding uncontroverted expert testimony must state why). The commissioner may accept or reject the expert opinion in whole or in part. Sondag, 220 N.W.2d at 907. As mentioned, Kienker diagnosed Sherman with three conditions: thoracic outlet syndrome, myofascial neck pain, and headaches. The commissioner found that Kienker based her opinions on subjective complaints from Sherman and not on objective tests. In addition, the commissioner found that Kienker attributed the problems to both work and nonwork conditions and that it was unclear whether Kienker had an accurate history of Sherman's 13 year history of headaches. Sherman's work involved repetitive activity. According to Neff, repetitive activity cannot cause thoracic outlet syndrome and myofascial pain. Although he agreed that Sherman exhibited symptoms consistent with these two conditions, Neff opined Sherman had neither condition because there was no objective proof of an abnormality, only symptoms. Neff also refused to connect Sherman's headaches to her work activity, noting that she had a 13 year history of headaches. For all of these reasons, the commissioner found that Kienker's opinion did not rise to the level of a probable connection between Sherman's work and her alleged condition. Again, although as fact finder we might have found otherwise, we conclude substantial record evidence supports the commissioner's finding and we are bound by it. The commissioner explained why he accepted Neff's opinion that Sherman's conditions were not work-related rather than Kienker's opinion that they were: Dr. Neff's opinion is more consistent with the contemporaneous medical notes and reports as regards Sherman's symptomatology and treatment during her employment. They, therefore, are entitled to greater weight than the opinions of Dr. Kienker, whose opinions are inconsistent with objective medical notes and reports. Substantial record evidence also supports these findings. Given all of these findings, the commissioner concluded the record does not support a finding that [Sherman's] conditions other than her carpal tunnel and cubital tunnel are conditions causally related to her employment at Pella. Neither the cubital tunnel nor the carpal tunnel condition are conditions which would extend [Sherman's] impairment related to her employment at Pella into the body as a whole. [Sherman's] condition causally related to her employment with Pella is expressly found and concluded to be a scheduled member impairment. In short, because Sherman failed to prove the thoracic outlet syndrome, the myofascial neck pain, and headaches were work-related, she failed to prove the scheduled injuries affected her nervous system, an unscheduled member. She was therefore not entitled to a claim based upon a disability to the body as a whole.