Court Opinion

ID: 9528535
Source: CourtListenerOpinion
Date Created: 2023-08-07 03:41:51.009827+00
Date Added: 2024-06-11T13:26:24.407811
License: Public Domain

SACKETT, Judge
(dissenting).
I dissent.
Respondent reported the fall and thought he had only skinned his leg. Two days later he began to notice numbness in his feet. He was unable to work on Monday, January 19, 1984. On the 19th, he consulted Dr. Mark O’Dell, complaining of back pain and numbness in his calf and left foot. Dr. O’Dell recommended bed rest for three days. Respondent returned to see O’Dell on January 25, 1984, and on January 27, 1984, O’Dell referred respondent to Dr. David C. Naden, a board certified orthopedic surgeon.
Dr. Naden examined respondent on January 26, 1984. He initially diagnosed a probable herniated nucleus pulposis at either the L4-5 or L5-S1 level with either a free fragment from the above level or a large free fragment at the L5-S1 level which compromised the first sacral nerve root on the left. A myelogram was performed on February 2, 1984. Dr. Richard Kundel, the physician who interpreted the myelogram, concluded respondent had a herniated inter-vertebral disc at the L4-5 level with a probable free fragment with nerve compression. Dr. Naden agreed with Dr. Kun-del’s diagnosis of a herniated disc at the L4-5 level with the free fragment just below the L4-5 level encroaching on the L5 nerve root. Dr. Naden suggested chemo-nucleolysis, but indicated surgery would probably be necessary. Prior to undergoing the injection, respondent obtained a second opinion from Dr. Harold J. Jersild, an orthopedic surgeon, who concurred with Dr. Naden’s diagnosis and recommendations.
Intradiscal chemonucleolysis was performed at the L4-5 level on February 21, 1984. There were no complications. On June 25, 1984, Dr. Naden reported that the free fragment which had been diagnosed was still present and that further surgery was indicated. On July 10, 1984, Dr. Na-den reported that respondent did not want to have the surgery and he was improving. Dr. Naden said as long as respondent felt he was improving that Dr. Naden would not recommend surgery and respondent would get along as well without the surgery as he would with it.
Dr. Jersild saw respondent again on June 6, 1984. He apparently agreed with Dr. Naden that if respondent felt he was improving he should continue under his present program of rehabilitation exercises rather than have surgery.
On October 26, 1984, respondent was examined by Dr. James A. Lehman and Dr. Tozzi at the University of Iowa Hospitals. The doctors reviewed radiographic studies and determined there was a myelographic defect at the L4-5 interspace bilaterally *69with amputation of the L5 nerve root bilaterally, with a large extradural defect on the left, ventrally, behind the body of L5. Dr. Lehman and Dr. Tozzi agreed with Dr. Naden, Dr. Kundel and Dr. Jersild respondent had a free fragment from the L4-5 disc which could be the cause of his complaints. Dr. Lehman and Dr. Tozzi also agreed with Dr. Naden and Dr. Jersild as long as respondent expressed gradual improvement he could forego surgery. They reported respondent’s healing period had ended. They assigned a twenty percent permanent impairment rating.
Dr. Naden reported respondent had reached maximum medical improvement on January 23, 1984, although he stated there would be minimal nonsignificant improvement. He gave respondent a fifteen percent permanent impairment of the whole body.
Respondent was examined by Dr. Raul E. Espinosa and Dr. Steven Stein at the Mayo Clinic on January 21, 1985. The doctors reported respondent’s neurological examination was normal except for subjective complaints of diffuse percussion tenderness in the low back, difficulty in lumbar flexion and pain with straight leg raising at seventy percent on the right and fifty percent on the left. The doctors interpreted respondent’s radiographic studies as showing a large lumbosacral disc protrusion and a midline disc protrusion at the L4 level.
Respondent returned to work on April 26, 1985. He saw Dr. Naden on May 28, 1985, and a myelogram was performed on June 4, 1985. Dr. Kundel interpreted the myelogram results as showing probable disc herniation on the left side at the L4-5 and L5-S1 level.
Respondent was hospitalized and a lami-nectomy was performed at the L4-5 and L5-S1 levels with extraction of the herniated disc and intradiseal material. The claimant’s recovery was uneventful. Dr. Naden released respondent for work on August 26, 1985, and respondent returned to work that day.
Dr. Naden reported the L5-S1 level was normal at the time of the 1984 myelogram. He indicated respondent’s L4-5 disc problem was related to his work. Dr. Naden did not feel that there was a causal connection between the herniation of the L5-S1 level and the work injury. Dr. Naden reported during the laminectomy surgery he observed a difference in appearance between the disc at the L4-5 level and the L5-S1 level. This indicated to him the L4-5 injury had preceded the L5-S1 herniation. Dr. Naden said the existence of fibrosis and scarring found at the time of his surgery was the result of degradation of the free fragment he observed in the 1984 mye-logram.
Dr. Donald C. Young, a board certified radiologist who also specializes in nuclear medicine, evaluated respondent’s radio-graphic studies and also interpreted the 1984 myelogram as showing a bilateral L4-5 disc protrusion with a free fragment overlying the L5 intervertebral disc on the left which displaced the SI nerve root. This verified the findings of Dr. Kundel, Dr. Naden, Dr. Lehman and Dr. Tozzi. Dr. Young interpreted the subsequent 1985 myelogram as showing a defect at the L4-5 level which was less pronounced than the 1984 myelographic study. Dr. Young indicated there was asymmetry at the left side of the L5-S1 level, which he felt was possibly due to a free fragment. He reported no indication of a herniated disc but felt there could be a protruding disc.
Respondent’s attorney arranged to have respondent evaluated by Dr. David Beck, a neurosurgeon, on May 20, 1986. Dr. Beck evaluated respondent and determined respondent had injured both the L4-5 and L5-S1 discs on January 16, 1984. This diagnosis was not consistent with the diagnosis of the physicians who had examined respondent earlier or with the diagnosis of Dr. Naden, the physician who operated on respondent and observed the discs. Dr. Beck also disagreed with the examining physicians and Dr. Naden there was a free fragment resulting from the injury to the L4-5 intervertebral disc. Dr. Beck later testified he did not know if disc fragments disappear and he would not exclude the possibility of a free fragment. He also agreed Dr. Naden, the treating physician, *70was in a better position to observe respondent’s condition and make a diagnosis.
Dr. Beck gave respondent a thirty percent impairment based on his interpretation respondent had injured both the L4-5 and L5-S1 levels in the January 16, 1984 fall.
Respondent’s attorney also had Dr. Richard F. Neiman evaluate respondent. Dr. Neiman testified he felt respondent sustained damage to the L4-5 and L5-S1 discs at the time of the January 16, 1984 injury. Dr. Neiman further testified he felt respondent sustained a twenty-five percent permanent impairment. His rating was based on respondent having injured two discs on January 16, 1984.
The employer first contends it was error to find respondent sustained an injury to both the L4-5 and L5-S1 disc levels on January 16, 1984. The industrial commissioner found the assessment of respondent’s medical case as determined by Doctors Beck and Neiman as correct, as opposed to the assessments of the other physicians. No reasons were given for this finding. The trial court made substantially the same finding, also without reasons.
The employer acknowledges the doctors found respondent had injured two discs in the January 16, 1984 fall. It contends, however, it was erroneous to accept its assessment because it was contrary to the diagnosis of all the doctors who had treated the respondent over a period of time, and it was also contrary to the diagnosis of the surgeon who operated on respondent and was, therefore, in a superior position to observe the conditions.
We review to determine whether the agency decision is supported by substantial evidence when viewing the record as a whole. See Chauffeurs, Teamsters and Helpers, Local Union No. 238 v. Iowa Civil Rights Commission, 394 N.W.2d 375, 379 (Iowa 1986). The requirement that we take all record evidence in account in reviewing administrative findings does not detract from our duty to grant appropriate deference to the agency’s expertise. Cerro Gordo County Care Facility v. Iowa Civil Rights Commission, 401 N.W.2d 192, 195-96 (Iowa 1987). We give respect to the agency’s findings, but they must be set aside when the record clearly shows the agency decision was not justified. Id.
Evidence is substantial to support an agency decision if a reasonable person would find it adequate to reach the given conclusion. Mercy Health Center v. State Health Facilities, 360 N.W.2d 808, 809 (Iowa 1985). The agency finding is in accord with an opinion of two doctors who only evaluated claimant. The finding is contrary to the opinion of all of claimant’s treating physicians, including the surgeon who operated on claimant and visibly viewed the discs. I find under this record the decision of the commissioner should be modified to find that claimant only suffered a herniated disc at L4-5.
I would remand to the agency to reevaluate the industrial disability and healing period in accord with this finding.