Opinion ID: 1290227
Heading Depth: 2
Heading Rank: 2

Heading: Medical and Lay Testimony

Text: Terwilliger argues essentially that where credible lay testimony exists in addition to medical testimony, the commissioner is straitjacketed from rejecting the lay testimony if it contradicts the medical testimony. Terwilliger informs us that the commissioner should consider lay testimony in reaching an impairment determination and notes that an impairment determination may even stand where there is no medical testimony whatever. The law requires the commissioner to consider all evidence, both medical and nonmedical, in arriving at a disability determination. Miller, 525 N.W.2d at 420. We have held that lay witness testimony is relevant and material on the issue of cause and extent of an injury. Id. However, it is a basic tenet of law that it remains within the province of the industrial commissioner to weigh the facts presented to him and it is entirely within his right to reject any evidence he considers less reliable than other contradictory testimony. See Rockwell, 366 N.W.2d at 192; Lithcote Co. v. Ballenger, 471 N.W.2d 64, 66 (Iowa App.1994). The commissioner explicitly noted that he considered both the medical and lay evidence and considered the medical evidence more reliable because of the likelihood that Terwilliger magnified her symptoms. Substantial evidence supports the commissioner's concern regarding Terwilliger's symptom magnification. At least four of the doctors who have observed Terwilliger expressed a belief that emotional magnification or functional overlay served to increase the outward appearance of Terwilliger's discomfort. After reviewing the results of the MMPI test performed on Terwilliger, Dr. Dodd noted: This is a classic conversion. These individuals often present as being physically ill, pain being the chief complaint frequently. Pain tends to be localized in the extremities, head, neck or back. These individuals characteristically develop physical symptoms as reaction to mental or environmental stress.... The profile would suggest the diagnosis of hysterical neurosis, hysterical personality or psychophysiological reaction. We note that a conversion reaction is a mental defense mechanism whereby unconscious emotional conflict is transformed into physical disability. Redfern v. Sparks-Withington Co., 353 Mich. 286, 91 N.W.2d 516, 518 (1958) (quoting Blakiston's New Gould Medical Dictionary 280, 1012 (2d ed. 1956)). After reviewing the MMPI, Dr. Kitchell concluded that the MMPI was very abnormal, consistent with a conversion reaction. Dr. Kitchell also noted that the MMPI was performed due to his concern that Terwilliger had a large functional overlay to her symptoms. A functional overlay is an ailment in addition to an already existing condition which is not caused by a structural defect. Barrett v. Coast Range Plywood, 294 Or. 641, 661 P.2d 926, 928 (1983). A functional overlay could be described as a psychological or psychiatric condition which manifests itself in an over-reaction or over-response to pain. See id. Dr. Socarras, a neurologist, also expressed a concern regarding symptom magnification. After examining Terwilliger in 1988, he noted: It is my opinion that there is a great disproportion between patient's complaints and the lack of objective findings. I believe that there is a large functional element in this case.... I cannot explain the constellation of symptoms on the basis of a carpal tunnel syndrome. Dr. Crane testified that he based the impairment rating he assigned to Terwilliger's injury on objective factors, and did not base his decision on subjective factors. Although Terwilliger attacks Dr. Crane's methodology, his testimony demonstrates that he quite reasonably rejected subjective considerations because he did not feel they were consistent or reliable. The doctor testified that he believed the difference between objective evidence of Terwilliger's injury and her symptoms was a result of factors that [he] couldn't measure and were not part of [his] scope as a physician. Two of Terwilliger's treating physicians, Dr. Bergman and Dr. Crane, evaluated Terwilliger's injury and assigned her impairment ratings. Each doctor used recognized medical methods in arriving at their ratings. The industrial commissioner based his assessment of Terwilliger's impairment on the evaluations of these two doctors, and was especially convinced of the accuracy of his determination due to the fact that the two doctors arrived at very similar conclusions. The commissioner also considered the testimony of the six witnesses who stated that their observations of Terwilliger suggested the extent of her impairment was considerably higher than the assessment the two doctors gave. The commissioner's decision to base his impairment rating on the doctors' evaluations was based on his concern that Terwilliger may have magnified her symptoms in the presence of the lay witnesses. The commissioner based his decision on evidence which a reasonable mind would accept as adequate to reach that conclusion. See Suluki, 503 N.W.2d at 404. We find that substantial evidence supported the commissioner's decision.