Opinion ID: 1703375
Heading Depth: 1
Heading Rank: 4

Heading: Benefits After Maximum Medical Improvement.

Text: As noted earlier, the court of appeals reversed the district court decision affirming the commissioner's determination that Schutjer was not entitled to benefits after February 28, 2003, the date Dr. Palit concluded she had reached maximum medical improvement. To be entitled to benefits following this date, Schutjer had to satisfy her burden of proving that her medical treatment subsequent to February 28, as well as any temporary or permanent disability, was causally related to the December 2, 2002 injury. Schutjer argues the commissioner's finding that her medical problems after February 28, 2003, were not causally related to her December 2002 injury is not supported by substantial evidence. She contends the commissioner failed to explain the basis for his rejection of the evidence supporting a causal connection, particularly the testimony of Dr. Beck. The court of appeals concluded the district court erred in holding that the commissioner found the opinions of Dr. Palit and Dr. Kuhnlein, along with the testimony of [Schutjer], to support the finding that [Schutjer's] continuing back problems were not caused by the December 2, 2002 incident at Algona Manor. The court of appeals believed the agency based its causation ruling solely on its determination that Schutjer lacked credibility and that the agency failed to explain the weight given to the varied medical opinions or explain how it resolved the conflicts in the medical evidence. 1. Applicable legal principles. A claimant must prove by a preponderance of the evidence that the injury is a proximate cause of the claimed disability. Grundmeyer v. Weyerhaeuser Co., 649 N.W.2d 744, 752 (Iowa 2002). Ordinarily, expert testimony is necessary to establish the causal connection between the injury and the disability for which benefits are claimed. Id. With regard to expert testimony, [t]he commissioner must consider [such] testimony together with all other evidence introduced bearing on the causal connection between the injury and the disability. The commissioner, as the fact finder, determines the weight to be given to any expert testimony. Such weight depends on the accuracy of the facts relied upon by the expert and other surrounding circumstances. The commissioner may accept or reject the expert opinion in whole or in part. Id. (quoting Sherman v. Pella Corp., 576 N.W.2d 312, 321 (Iowa 1998) (citations omitted)); accord Sanchez v. Blue Bird Midwest, 554 N.W.2d 283, 285 (Iowa Ct. App.1996) (Expert opinion testimony, even if uncontroverted, may be accepted or rejected in whole or in part by the trier of fact.). With respect to the commissioner's written decision, Iowa Code section 17A.16(1) provides: The [agency] decision shall include an explanation of why the relevant evidence in the record supports each material finding of fact.... Each conclusion of law shall be supported by cited authority or by a reasoned opinion. This duty on the part of the agency is intended to allow a reviewing court to ascertain effectively whether or not the presiding officer actually did seriously consider the evidence contrary to a finding, and exactly why that officer deemed the contrary evidence insufficient to overcome the evidence in the record supporting that finding. Arthur E. Bonfield, Amendments to Iowa Administrative Procedure Act, Report on Selected Provisions to Iowa State Bar Association and Iowa State Government 42 rptr. cmt. (1998) [hereinafter Bonfield]; accord Catalfo v. Firestone Tire & Rubber Co., 213 N.W.2d 506, 510 (Iowa 1973) ([The commissioner's] decision must be sufficiently detailed to show the path he has taken through conflicting evidence. When he disregards uncontroverted expert medical evidence he must say why he has done so.); see also Tussing v. George A. Hormel & Co., 417 N.W.2d 457, 458 (Iowa 1988) (finding commissioner's failure to state any reasons for rejecting overwhelming evidence, including medical evidence, that work-related injury occurred on date in question required reversal). The requirement that the commissioner explain his decision is not intended to be onerous: [T]he commissioner's decision must be sufficiently detailed to show the path he has taken through conflicting evidence, [but] the law does not require the commissioner to discuss each and every fact in the record and explain why or why not he has rejected it. Such a requirement would be unnecessary and burdensome. Terwilliger, 529 N.W.2d at 274 (quoting Catalfo, 213 N.W.2d at 510); accord Bonfield at 42 reporter cmt. (stating the requirement of a brief explanation will not be burdensome); see also Bridgestone/Firestone v. Accordino, 561 N.W.2d 60, 62 (Iowa 1997) (stating commissioner's duty to furnish a reasoned opinion is satisfied if `it is possible to work backward ... and to deduce what must have been [the agency's] legal conclusions and [its] findings of fact' (quoting Norland v. Iowa Dep't of Job Serv., 412 N.W.2d 904, 909 (Iowa 1987))). 2. Analysis. The commissioner's opinion does not express the step-by-step reasoning process that led him to the conclusion that Schutjer failed to show the December 2002 injury caused continued disability after February 28, 2003. Nevertheless, we conclude on this specific issuethe connection between the December 2, 2002 injury and the subsequent treatments after February 28, 2003, and resulting impairmentit is possible to determine from the commissioner's opinion what evidence he considered and why he credited some of this evidence over other, conflicting evidence. As noted by the court of appeals, the agency did summarize the medical opinions contained in the evidence. The commissioner observed that Dr. Palit stated Schutjer had reached maximum medical improvement on February 28, 2003, and Dr. Palit found no permanent impairment. The commissioner noted that Dr. Palit further opined that, based upon his evaluation of Schutjer in January and February 2003, Schutjer's surgery was not causally related to her work injury and was not medically necessary. On the other hand, the commissioner mentioned that Dr. Beck, who initially saw Schutjer in June 2003 and eventually performed a laminectomy on her, opined Schutjer's December 2, 2002 injury was a substantial factor in causing her back pain and that under the guidelines she had a twelve percent whole body impairment as a result of that injury. Finally, the commissioner discussed the opinion of the independent medical expert, Dr. Kuhnlein. Dr. Kuhnlein, as noted previously, opined that he could not objectively relate Schutjer's December 2, 2002 injury to her June 2003 back pain as Schutjer did not have a straight record of symptoms from her December injury to her July surgery. The commissioner also took note of Dr. Kuhnlein's observation that, while Schutjer maintained she had remained on nonsteroidal anti-inflammatory medication after her release from Dr. Palit, the medical records did not support this. In addition to reviewing these medical opinions, the commissioner summarized the various medical providers from whom Schutjer sought care during the period between February 28, 2003, and June of 2003, specifically finding that she did not mention any back or leg symptoms to her primary care physician or her psychiatrist when she saw them on five separate occasions in April and May 2003. At the end of his review of the medical evidence, the commissioner stated the following conclusion: Claimant does not carry her burden of demonstrating that her December 2, 2002 work injury was a substantial factor in precipitating her June 2003 complaints, her July 2003 surgery, and her continuing low back and bilateral leg symptoms. The record clearly demonstrates that claimant has never been averse to seeking medical care. It also clearly demonstrates that claimant tends to complain profusely to her care providers about any medical conditions for which she is seeking care. Given those circumstances, claimant's statements, both to medical providers from June 4, 2003 onward and at hearing, that she had continuing low back and leg symptoms from December 2, 2002 lack credibility. (Emphasis added.) It is apparent from the commissioner's discussion that he believed Schutjer would have complained of back and leg pain between February 2003 and June 2003 if she had continued to experience such pain during that time. The commissioner had previously noted, however, that the record did not indicate such complaints had been made. Accordingly, the commissioner concluded Schutjer's assertions of continuing symptoms between February and June lacked credibility. This conclusion confirmed Dr. Kuhnlein's opinion that, in the absence of a straight record of symptoms from the December 2002 injury to the July 2003 surgery, it could not be said that the December 2002 injury was causally linked to the later surgery and permanent impairment. Thus, when the commissioner's conclusion that Schutjer's testimony of continuing symptoms was not credible is considered in the context of the commissioner's review of the medical evidence, it is evident that the commissioner chose to rely on the opinions of Dr. Palit and Dr. Kuhnlein because those opinions were more consistent with the factual findings made by the commissioner with respect to the symptoms Schutjer experienced between February and June. Thus, it is possible to identify from the commissioner's causation discussion the evidentiary basis of his conclusion and why he gave preference to the opinion testimony of Dr. Palit and Dr. Kuhnlein. We conclude, therefore, that the commissioner's decision was sufficiently detailed to permit us to ascertain that he seriously considered the evidence for and against his finding with respect to causation, as well as why he concluded the evidence against causation was more credible. In addition, the commissioner's decision on causation is supported by substantial evidence in the form of the expert opinions of Dr. Palit and Dr. Kuhnlein. Therefore, we vacate the decision of the court of appeals and affirm the decision of the district court affirming the commissioner's ruling that Schutjer was not entitled to benefits for the medical expenses and disability she sustained after February 28, 2003.