Court Opinion

ID: 9734196
Source: CourtListenerOpinion
Date Created: 2023-08-26 17:27:37.074584+00
Date Added: 2024-06-11T18:26:46.068394
License: Public Domain

Smith, J,
(dissenting) — A considerable study of the record and briefs, even before the majority opinion was submitted, had *704led me to conclude the decision of the trial court, affirming the commissioner’s award, should on principle be reversed. Further study and reflection have strongly confirmed that conclusion in my mind.
The distinction between the relation of cause and effect of two events, and their mere adventitious sequence in time — the difference, that is, between causal and' casual — is peculiarly liable to be blurred, even in ordinary affairs. The danger of confusion multiplies when the layman assumes to determine the origin or cause of a rare human ailment with no precedent trauma or occurrence to indicate a probable cause and no medical expert opinion that such probability exists. Such attempt must be branded as speculative and unsound.
I. I have found no case, and neither claimant’s brief nor the majority opinion cites any, in which a jury or commissioner or a court acting in a fact-finding capacity has been permitted, or has assumed authority, to determine a causal relationship exists in such a case when the uncontradicted medical testimony is that the profession has been unable to discover even a probable cause of a given disease.
It is true, when the expert testimony is in conflict, the fact-finding official or body must resolve the conflict. It becomes a question of fact. But in the absence of any expert testimony based on the study of a sufficient number of clinical cases to justify even a tentative professional medical opinion of probable cause and effect, the matter is, in my opinion, too speculative and conjectural to warrant a judicial pronouncement.
The diagnosis of claimant’s ailment, as shown by the record, is conclusive and without conflict, that he was suffering from what the profession has identified and named sarcoidosis or “Boeek’s sarcoid.” I find in the record no reason for thinking that diagnosis was based on insufficient knowledge of claimant’s case history and symptoms to warrant the diagnosis. The doctors knew all that claimant and his lawyer revealed. Nothing material to the diagnosis seems to have been overlooked.
The three Waterloo doctors (assumed by the majority opinion to be “company doctors’ ’ — which certainly can make no difference in the case, even if true) were apparently puzzled. They *705(or someone, it is immaterial wlio) did the wise and proper thing by sending claimant to Oakdale Sanatorium since there was some suspicion of tuberculosis. The record does reveal indirectly that Doctor Miller, one of the three, considered Boeck’s sarcoid along with miliary tuberculosis and histoplasmosis.
Doctor Spear of Oakdale, speaking for himself and the Sanatorium staff, definitely eliminated tuberculosis, and left remaining “possible silicosis and possible Boeck’s sarcoid.” He made no final decision between those two. Presumably that was the purpose of sending him (claimant) to Iowa City.
The record does not reveal Avho then sent him. That too is immaterial. The search was still on for definite diagnosis. From IoAva City we have the only medical testimony in the case other than that of Doctor Spear.
Doctor O’Bannon is referred to by the majority as “a young intern of not too much experience with such cases. ” The record shows he had had four years of premedical and four years medical, six months general practice, a year rotating internship, and three years active duty in the United States Navy Medical Corps, before he came to the University Hospital as “a resident in a rotating general practice program.” As to the extent of his experience I only find this sentence (from his cross-examination) : “I have not had occasion to treat a large number of patients with silicosis. There is some similarity in the clinical picture between silicosis and Boeck’s sarcoid, but where we can definitely gain a diagnosis of Boeek’s sarcoid the existence of silicosis becomes less probable although it may be possible.” Doubtless he had access to whatever experience and thinking his profession had assembled on the subject.
Doctor Hardin, Doctor O’Bannon’s superior, also diagnosed claimant’s case as Boeck’s sarcoid. I am not sure the record bears out the majority statement that his diagnosis was “not from personal examination. ” The contrary seems to be true. He testifies that “when the house officer makes a diagnosis'# # * my confirmation * # * is based upon my personal knowledge of the patient * * With reference to claimant here he says:
“All the procedures tried on Mr. Burt Avere at my direction and supervision. I personally examined the X-rays, I have per*706sonally talked, with, him and have personally read his case history.
“My diagnosis * * * based upon X-rays, laboratory procedures, the case history, examination and study of the patient, and everything else was Boeck’s sarcoid.” (Emphasis supplied.)
It would be difficult to find a record more free from conflict and doubt as to diagnosis.
II. The exact nature of claimant’s disease being established the question of cause next arises. Again, the medical testimony is without conflict and the pronouncement undisputed. Doctor Spear expressed no opinion as to cause.
Doctor O’Bannon testified: “It (Boeek’s sarcoid) is a disease, ailment or sickness that anybodjr can contract regardless of their occupation. * * * There is no cause or cure * *.” Again he says:
“The cause of Boeck’s sarcoid has not been established in the medical field and I don’t know if Boeck’s sarcoid could have been caused by Mr. Burt’s occupation.
“It is possible that an individual suffering from a general weakened condition would be more susceptible to Boeck’s sarcoid than the normal healthy individual.”
On a final re-cross-examination the doctor said: “In my opinion, the medical data that we have compiled in the case of Mr. Burt indicates that his employment contributed nothing to his condition.”
Doctor Hardin said: “Boeck’s sarcoid is a chronic disease; it is a long term infection. * * * No cause of Boeck’s sareoid is known. In a very rough sort of way it is analogous to the common cold — much more prolonged and unpleasant.” Later on cross-examination he testified: “Since the cause of Boeck’s sarcoid is unknown, I can’t say that it could have been caused as a result of his exposure to dust in his employment.” There is no showing that the “infection” could result from breathing dust.
III. I shall not cite the many cases that hold the burden of proof is on claimant to establish that his injury arose out of, as well as in the course of, his employment. They will be found *707under paragraph 101 in the annotations to Code section 85.61, in 5 Iowa Code Annotated, at pages 406, 407.
And while the commissioner’s finding may be based on circumstantial evidence and on the reasonable inferences that may be drawn from the evidence, “it cannot, however, be predicated upon conjecture, speculation, or mere surmise.” Sparks v. Consolidated Indiana Coal Co., 195 Iowa 334, 338, 190 N.W. 593, 594. The inference must be reasonable. Conjecture or guesswork will not suffice. Idem, citing Clapp’s Parking Station v. Industrial Acc. Com., 51 Cal. App. 624, 197 P. 369.
IV. The majority opinion assumes this is a case similar to Bocian v. Armour & Co., 244 Iowa 304, 56 N.W.2d 900, and others which emphasize the thought that the commissioner’s finding is conclusive if sustained by inference from the facts shown. In the Bocian case the expert opinion was in direct conflict upon the question of causality. The opinion pointed out that the difference in opinion created a factual dispute rather than a question of law.
It is not here a question of the right of the fact-finding authority to draw and rely on inferences where facts are in dispute but there is vast and important difference between legitimate inference and speculation. And for a layman to attempt to “infer” a causal connection in a technical matter where the experts are unable to draw it can only be branded as mere speculation. The record indicates that claimant’s first “symptoms” were reported by him after he had worked five or six years. There is no testimony of his habits and living conditions or history.
The majority here cites Black v. Creston Auto Co., 225 Iowa 671, 281 N.W. 189, to this sweeping generalization: “If claimant, under such exposure or conditions as were related, had taken pneumonia or bronchitis * * * or a common cold which disabled him, he would, we think, be entitled to have the question of fact as to the cause determined by the fact-finding authority.”
Of course that statement omits the very condition present here — the uncontradicted, unanimous medical testimony that the cause of a rare disease is still unknown, and the medical opinion that there was only a possibility that it might have arisen out of the employment.
*708Furthermore, I find no language in the Black case that warrants the statement above quoted. As I read it, the opinion in that case merely holds the commissioner erred in holding the lead poisoning suffered by claimant was an occupational disease (at that time not compensable) ; and in denying compensation because there was “no evidence of a specific injury at any fixed and certain date.”
The opinion in Nellis v. Quealy, 237 Iowa 507, 509, 21 N.W.2d 584, 585, is also cited. Its dissimilarity to the instant case is best shown by its own statement: “The medical testimony was to the effect that claimant’s loss of vision was caused by scar tissue resulting from ulcers, but Dr. Martin * * * and Dr. Chase * * * differed as to the probable cause of the ulcers.” (Emphasis supplied.)
So also as to the opinion in Hinrichs v. Davenport Locomotive Works, 203 Iowa 1395, 1397, 214 N.W. 585, 586, in which there was conflict of medical testimony, which says: “While there is disagreement in the testimony of the expert witnesses, it was peculiarly the province of the industrial commissioner to accept the testimony of such of these witnesses as seemed to him most consistent with all the testimony, and of the greater credibility. ’ ’
Almquist v. Shenandoah Nurseries, 218 Iowa 724, 254 N.W. 35, 94 A. L. R. 573, also cited, involved no allowance of compensation in face of uneontradicted expert testimony. Its importance is the holding that the personal injury, to be compensable, need not be the result of a physical accident or trauma. There is here no such contention.
I have said enough to make clear my disagreement with the majority. I respectfully dissent.
Wennerstrum, Thompson, and Peterson, JJ., join in this dissent.