Rosa Chavez v. MS Technology LLC and Westfield Insurance Company ( 2022 )


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  •                    IN THE SUPREME COURT OF IOWA
    No. 21–0777
    Submitted February 23, 2022—Filed April 1, 2022
    ROSA CHAVEZ,
    Appellant,
    vs.
    MS TECHNOLOGY LLC and WESTFIELD INSURANCE COMPANY,
    Appellees.
    Appeal from the Iowa District Court for Polk County, Sarah Crane, Judge.
    A workers’ compensation claimant challenges the commissioner’s
    treatment of her rotator cuff injury as a scheduled shoulder injury rather than
    an unscheduled whole body injury under Iowa Code section 85.34(2).
    AFFIRMED.
    Christensen, C.J., delivered the opinion of the court, in which all
    participating justices joined. Mansfield and McDermott, JJ., took no part in the
    consideration or decision of the case.
    Erin M. Tucker (argued) of Tucker Law Office, Des Moines, for appellant.
    2
    Lori N. Scardina Utsinger (argued) of Betty, Neuman & McMahon, P.L.C.,
    Davenport, for appellee.
    Jay M. Smith of Smith & McElwain Law Office, Sioux City, for amicus
    curiae Iowa Federation of Labor, AFL-CIO.
    Andrew W. Bribriesco, Bettendorf, for amicus curiae League of United
    Latin American Citizens of Iowa.
    Jason D. Neifert of Neifert, Byrne & Ozga, P.C., West Des Moines, for
    amicus curiae Workers’ Compensation Core Group of the Iowa Association for
    Justice.
    3
    CHRISTENSEN, Chief Justice.
    This case presents our first opportunity to interpret the legislature’s 2017
    amendment to Iowa Code section 85.34(2), which added “shoulder” to the list of
    scheduled member injuries for determining the award amount for permanent
    partial disability in a workers’ compensation proceeding. See 
    Iowa Code § 85.34
    (2)(n) (2018). In the course of her employment, the claimant sustained a
    “full thickness rotator cuff tear that has retracted to the level of the glenoid,
    severe AC arthrosis, tendonitis and tearing of the biceps tendon.” She sought
    permanent partial disability benefits for this injury, arguing her rotator cuff
    injury qualified as an unscheduled injury to the body as a whole, thereby
    entitling her to industrial disability benefits, instead of a scheduled injury to the
    shoulder.
    The workers’ compensation commissioner disagreed, concluding the
    claimant’s rotator cuff injury was a scheduled shoulder injury under Iowa Code
    section 85.34(2)(n), and the district court affirmed on judicial review. We retained
    the claimant’s appeal. For the reasons explained below, we affirm the district
    court decision that claimant’s rotator cuff injury is a scheduled shoulder injury
    under section 85.34(2)(n). We also affirm the district court decision that
    substantial evidence supports the commissioner’s finding that Chavez failed to
    prove her biceps tear resulted in a permanent disability to her arm under section
    85.34(2)(m).
    4
    I. Background Facts and Proceedings.
    On February 5, 2018, Rosa Chavez sustained a work injury in the course
    of her employment as a lab technician at MS Technology, LLC. Chavez performed
    a variety of tasks in this position, including mopping. At the time of her injury,
    Chavez was wringing out a mop by pushing it down in a mop bucket when she
    heard a pop and felt immediate pain in her right shoulder. She sought treatment
    for the pain on February 8, and her medical provider referred her to Dr. Todd
    Peterson, an orthopedic surgeon, for further evaluation.
    Dr. Peterson evaluated Chavez on April 12, and Chavez reported
    experiencing pain on both the anterior and posterior aspect of her right shoulder
    and pain radiating down her right arm. Dr. Peterson ordered an MRI, which
    revealed “a large full thickness tear of the rotator cuff with retraction to around
    the level of the glenoid,” “[s]evere AC arthrosis,” “[b]iceps tendonitis and tearing,”
    “mild supraspinatus atrophy,” and “acromial spurring.” Her primary injury was
    a rotator cuff tear. Consequently, Dr. Peterson recommended Chavez undergo
    “shoulder arthroscopy with rotator cuff repair, biceps tenotomy, subacromial
    decompression, and distal claviculectomy.” He also modified Chavez’s work
    restrictions to include no overhead work or lifting over ten pounds. Chavez
    underwent the following procedures on July 11: “[r]ight shoulder arthroscopy
    with arthroscopic repair of the rotator cuff tendon of the supraspinatus,
    infraspinatus, and subscapularis tendons; extensive debridement of the labrum,
    biceps tendon, and subacromial space with biceps tenotomy, subacromial
    depression.”
    5
    On November 8, Dr. Peterson placed Chavez on maximum medical
    improvement, allowing her to continue working with no restrictions. He also
    concluded Chavez had a six percent partial permanent impairment to her right
    upper extremity. Chavez obtained an independent medical evaluation from
    Dr. Sunil Bansal on May 13, 2019. Dr. Bansal opined that Chavez “incurred an
    acute injury of her right shoulder” that “result[ed] in an acute injury to the
    labrum,    rotator   cuff   and   attached   muscles.”   Dr. Bansal   agreed   with
    Dr. Peterson’s identification of November 8, 2018, as the date of maximum
    medical improvement and placed Chavez at a ten percent upper extremity
    impairment, which he stated is equal to a six percent impairment of the body as
    a whole.
    Chavez filed a petition for arbitration before the Workers’ Compensation
    Commission on September 28, 2018, seeking workers’ compensation benefits for
    injuries to her “right shoulder, neck and right upper extremity.” The case went
    to hearing on October 1, 2019, where the parties primarily disputed whether
    Chavez’s injury resulted in an unscheduled industrial disability or a scheduled
    member injury to her shoulder in light of 2017 amendments to the Iowa Code
    that identify the “shoulder” as a scheduled member for workers’ compensation
    purposes. At the time of the hearing, Chavez continued to work for
    MS Technology, LLC, without restrictions and had received a raise since her
    injury.
    The deputy commissioner issued her arbitration decision on February 5,
    2020, concluding Chavez incurred an unscheduled injury to the body as a whole.
    6
    Nevertheless, the deputy commissioner limited Chavez’s recovery to a functional
    impairment rating because Chavez had returned to work for the same or greater
    pay. MS Technology, LLC, and its insurance carrier, Westfield Insurance
    Company, (hereinafter Appellees) appealed, and Chavez cross-appealed to the
    commissioner. On September 30, the commissioner issued a decision concluding
    Chavez’s injury was compensable as a scheduled shoulder injury rather than an
    unscheduled whole body injury and applied Dr. Bansal’s ten percent extremity
    impairment rating. Chavez petitioned for judicial review, and the district court
    issued a decision affirming the commissioner’s appeal decision that Chavez’s
    injury was compensable as a scheduled shoulder injury on April 29, 2021.
    Chavez filed a timely appeal, which we retained.
    II. Standard of Review.
    The standards set forth in Iowa Code chapter 17A guide “our judicial
    review of agency decision-making to determine whether our conclusion is the
    same as the district court.” Brewer-Strong v. HNI Corp., 
    913 N.W.2d 235
    , 242
    (Iowa 2018). Further, “we review the commissioner’s interpretation of Iowa Code
    chapter 85 for correction of errors at law instead of deferring to the agency’s
    interpretation” because the legislature has not clearly vested the commissioner
    with authority to interpret that chapter. 
    Id.
     Nevertheless, “[w]e accept the
    commissioner’s factual findings when supported by substantial evidence.”
    Gumm v. Easter Seal Soc. of Iowa, Inc., 
    943 N.W.2d 23
    , 28 (Iowa 2020) (quoting
    Bluml v. Dee Jay’s Inc., 
    920 N.W.2d 82
    , 84 (Iowa 2018)).
    7
    III. Analysis.
    Chavez argues the district court erred by finding her injury was a
    scheduled member injury to her shoulder rather than an unscheduled whole
    body injury under Iowa Code section 85.34(2). She also maintains that she is
    entitled to an industrial disability analysis if her injury is an unscheduled whole
    body injury. Alternatively, if we conclude that Chavez’s injury constitutes a
    scheduled shoulder injury, Chavez claims she is entitled to an industrial
    disability analysis because she incurred simultaneous injuries to her shoulder
    and arm. We address these claims in turn as necessary.
    A. Defining Shoulder Injuries Under Chapter 85. The dispositive issue
    in this case is the definition of “shoulder” under Iowa Code section 85.34(2)(n).
    Under section 85.34, the classification of a workers’ compensation claimant’s
    injury as either scheduled or unscheduled determines the extent of the
    claimant’s entitlement to permanent partial disability benefits. Floyd v. Quaker
    Oats, 
    646 N.W.2d 105
    , 109 (Iowa 2002). Paragraphs (a) through (u) of section
    85.34 govern permanent partial disability payments for injuries to specific
    members of the body and provide a schedule of benefits for injuries to those
    specific members. Second Inj. Fund of Iowa v. Nelson, 
    544 N.W.2d 258
    , 269 (Iowa
    1995); see also 
    Iowa Code § 85.34
    (2)(a)–(u). Disabilities resulting from injuries
    other than those listed in paragraphs (a) through (u) of section 85.34 are
    considered unscheduled injuries that allow for benefits based on the injury to
    the body as a whole and are evaluated according to the industrial method.
    Second Inj. Fund of Iowa, 544 N.W.2d at 269; see also 
    Iowa Code § 85.34
    (2)(v).
    8
    If an injury is classified as a scheduled member injury to her shoulder
    under Iowa Code section 85.34(2)(n), the claimant is eligible for a percentage of
    400 weeks of pay based on the impairment rating of the injury. In contrast, if an
    injury is classified as an unscheduled whole body injury under section
    85.34(2)(v), the claimant is eligible for payment for the functional impairment
    resulting from the injury on a 500-week schedule and additional compensation
    if the claimant did not return to work earning the same or greater wages as before
    the injury. Thus, claimants typically receive greater compensation for
    unscheduled whole body injuries than they would for scheduled member
    injuries. In 2017, the legislature amended section 85.34(2) to add “shoulder” to
    the list of scheduled injuries and set the benefits schedule for “the loss of a
    shoulder” to “weekly compensation during four hundred weeks,” but it did not
    define “shoulder.” 2017 Iowa Acts ch. 23, § 7 (codified at 
    Iowa Code § 85.34
    (2)(n)
    (2018)).
    The parties now dispute whether Chavez’s rotator cuff injury constitutes a
    scheduled member injury to her shoulder under section 85.34(2)(n) or an
    unscheduled whole body injury under section 85.34(2)(v). Chavez contends
    “shoulder,” under section 85.34(2)(n), is narrowly defined to only include injuries
    located within the glenohumeral (shoulder) joint, which is “a ball-and-socket
    synovial joint between the head of the humerus and the glenoid cavity of the
    scapula.” Glenohumeral joint, Stedmans Medical Dictionary 463600, Westlaw
    (database updated Nov. 2014). Under this definition, damage to the proximal
    side of the joint is considered an unscheduled whole body injury, damage to the
    9
    distal side of the joint is considered a scheduled arm injury, and damage within
    the glenohumeral joint is considered a scheduled shoulder injury. Appellees ask
    us to affirm the commissioner and district court rulings, which defined
    “shoulder,” under section 85.34(2)(n), more broadly to include Chavez’s injury
    by defining “shoulder” as the shoulder structure, including injuries to the
    tendons, ligaments, muscles, and articular surfaces connected to the
    glenohumeral joint.
    Before we engage in any statutory construction, we must determine
    whether the statutory language is ambiguous. Holstein Elec. v. Breyfogle, 
    756 N.W.2d 812
    , 815 (Iowa 2008). A statute is ambiguous when reasonable persons
    could disagree as to its meaning. Ramirez-Trujillo v. Quality Egg, L.L.C., 
    878 N.W.2d 759
    , 770 (Iowa 2016). Here, Iowa Code section 85.34(2)(n) is ambiguous
    because reasonable persons can—and do—disagree on the statutory meaning of
    “shoulder,” as the deputy commissioner applied Chavez’s proffered definition
    while the commissioner and district court applied Appellees’ proffered definition.
    See 43 Am. Jur. Proof of Facts 3d 201, § 2 (1997) (“The ‘shoulder’ therefore may
    be defined in at least three different ways.”). Consequently, we rely on our rules
    of statutory construction to guide our interpretation of “shoulder” under section
    85.34(2)(n). See Brewer-Strong, 913 N.W.2d at 251.
    Our goal in interpreting the statutory provisions contained in chapter 85
    of the Iowa Code “is to determine and effectuate the legislature’s intent.” Id. at
    249 (quoting Ramirez-Trujillo, 878 N.W.2d at 770). We do so “by looking at the
    legislature’s language rather than speculating about what the legislature might
    10
    have said.” Id. Further, “[w]e assess the statute in its entirety rather than isolated
    words or phrases to ensure our interpretation is harmonious with the statute as
    a whole.” Id. (quoting Ramirez-Trujillo, 878 N.W.2d at 770). “[L]egislative intent
    is expressed by omission as well as by inclusion . . . .” In re Guardianship of
    Radda, 
    955 N.W.2d 203
    , 209 (Iowa 2021) (alteration in original) (quoting Marcus
    v. Young, 
    538 N.W.2d 285
    , 289 (Iowa 1995)). Thus, when the legislature includes
    certain language in one section of a statute but omits it in another section of the
    same statute, we generally presume the omission is intentional. 
    Id.
    We also “look for ‘an interpretation that is reasonable, best achieves the
    statute’s purpose, and avoids absurd results.’ ” Holstein Elec., 
    756 N.W.2d at 815
     (quoting State v. Bower, 
    725 N.W.2d 435
    , 442 (Iowa 2006)). While Chavez
    “is correct that we interpret workers’ compensation statutes in favor of the
    worker, we still must interpret the provisions within the workers’ compensation
    statutory scheme ‘to ensure our interpretation is harmonious with the statute
    as a whole.’ ” Id. at 253 (quoting Ramirez-Trujillo, 878 N.W.2d at 770). These
    rules of statutory construction guide our conclusion that “shoulder” under
    section 85.34(2)(n) must be defined in the functional sense to include the
    glenohumeral joint as well as all of the muscles, tendons, and ligaments that are
    essential for the shoulder to function.
    Chavez’s treating physician, Dr. Peterson, diagnosed her injury as a “full
    thickness rotator cuff tear that has retracted to the level of the glenoid, severe
    AC arthrosis, tendonitis and tearing of the biceps tendon.” On appeal, Chavez
    concedes that “injuries like labral tears, glenoid tears, bicep tears and
    11
    glenohumeral joint instability” would be considered “shoulder” injuries under
    her proposed definition because they are injuries located within the
    glenohumeral joint. Her challenge is to the commissioner and district court
    rulings that her rotator cuff injury is a “shoulder” injury under section
    85.34(2)(n), which she maintains is incorrect “because every rotator cuff muscle
    attaches proximally-to the glenohumeral joint.”
    A rotator cuff is “the anterior, superior, and posterior aspects of the
    capsule of the shoulder joint reinforced by the tendons of insertion of the
    supraspinatus, infraspinatus, teres minor, and subscapularis (SITS) muscles.”
    Rotator cuff of shoulder, Stedmans Medical Dictionary 217890, Westlaw
    (database updated Nov. 2014). The rotator cuff muscles “stabilize the
    glenohumeral joint.” Id.; see also 43 Am. Jur. Proof of Facts 3d 201, § 4. “When
    the complex of muscles and tendons which produce the joint’s stability are
    damaged or not functioning correctly, conditions known as the ‘unstable
    shoulder syndrome’, ‘rotator cuff disorder’, or ‘recurrent shoulder dislocations’
    occur.” 43 Am. Jur. Proof of Facts 3d 201, § 3.
    Viewing section 85.34(2) in its entirety, it is apparent that the legislature
    did not intend to limit the definition of “shoulder” solely to the glenohumeral
    joint. Notably, the legislature refers to the joints of certain body parts in other
    subsections, including the “shoulder joint,” yet it chose not to include the term
    “joint” when adding “shoulder” to the list of scheduled injuries. See In re
    Guardianship of Radda, 955 N.W.2d at 209. Compare 
    Iowa Code § 85.34
    (2)(n),
    with 
    id.
     § 85.34(2)(m). If the legislature only wanted to encompass the
    12
    glenohumeral joint under section 85.34(2)(n), it could have expressly stated so
    as it did when referring to joints in other subsections. Yet, it chose to list “the
    loss of a shoulder” as a scheduled injury under section 85.34(2)(n) instead.
    Moreover, we have previously explained that the “loss” referenced in
    section 85.34(2) includes the “loss of the use of a scheduled member.” Floyd, 
    646 N.W.2d at 109
    . In other words, the loss of function. “The functional shoulder is
    . . . not confined to the single anatomical joint known as the ‘shoulder’ or gleno-
    humeral joint, but is a system which in its entirety has the largest range of
    motion of any joint in the human body.” 43 Am. Jur. Proof of Facts 3d 201, § 4.
    Simply put, the shoulder cannot function to its fullest extent without the
    muscles that comprise the rotator cuff.
    Defining “shoulder” in the functional sense under section 85.34(2)(n) best
    achieves the statute’s purpose. Likewise, this functional definition aligns with
    the American Medical Association’s Guides to the Evaluation of Permanent
    Impairment, Fifth Edition, (AMA Guides) which is the guide “for determining the
    extent of loss or percentage of impairment for permanent partial disabilities”
    under section 85.34(2) in Iowa. 
    Iowa Admin. Code r. 876
    —2.4. The AMA Guides
    examine the shoulder’s active range of motion to evaluate impairment,
    measuring functions like flexion, extension, internal and external rotation,
    abduction, and adduction. See Cunningham v. Quad/Graphics, Inc., 
    522 S.W.3d 204
    , 205–07 (Ky. Ct. App. 2017) (explaining the evaluation process set forth in
    the AMA Guides to assess shoulder impairment). Consequently, it is impossible
    to evaluate shoulder impairment without some evaluation of the muscles,
    13
    tendons, etc. that make the shoulder function. Chavez’s own medical records
    support this conclusion, as the record is replete with references to Chavez’s
    injury as a “shoulder” issue.
    For example, when Chavez first sought medical attention for the pain she
    was experiencing from the mop incident, the medical notes documented,
    “[Chavez] returns to office with continued complaints regarding her right
    shoulder. She states that she feels like she injured her shoulder once again over
    the weekend.”1 (Emphasis added.) When she subsequently met with the
    orthopedic surgeon, she “present[ed] with complaints of right shoulder pain that
    started on 2/5/18 while mopping at work.” (Emphasis added.) She obtained a
    “Right Shoulder MRI” that led to the diagnosis of her “full thickness rotator cuff
    tear that has retracted to the level of the glenoid, severe AC arthrosis, tendonitis
    and tearing of the biceps tendon.” (Emphasis added.) The surgical procedure she
    received was “[r]ight shoulder arthroscopy with arthroscopic repair of the rotator
    cuff tendon of the supraspinatus, infraspinatus, and subscapularis tendons;
    extensive debridement of the labrum, biceps tendon, and subacromial space with
    biceps tenotomy, subacromial depression.” (Emphasis added.)
    Moreover, Dr. Bansal, who conducted Chavez’s independent medical
    evaluation, described Chavez’s injury as “an acute on chronic injury of her right
    shoulder.” (Emphasis added.) He explained,
    The shoulder is a ball and socket joint. However, the socket is very
    shallow, making it quite susceptible to injury. The shoulder itself
    1Chavez sought medical treatment for shoulder pain a few weeks before the injury at issue
    due to a slip and fall on ice.
    14
    has a relatively immobile scapula and clavicle and a mobile humeral
    head interface at the shoulder joint. Consequently, the humeral
    head may move suddenly in relation to the rest of the shoulder joint,
    especially from the forceful wringing of the mop, requiring her
    shoulder to be in an abducted and rotated position, resulting in an
    acute injury to the labrum, rotator cuff, and attached muscles.
    (Emphasis added.) In summary, Chavez’s medical records show that the
    physicians who treated or assessed Chavez’s injury considered it to be a shoulder
    injury.
    Chavez cites prior Iowa caselaw that looked to “the proximal point of the
    joint to classify an injury under the workers’ compensation statutes” to treat
    “shoulder” injuries as unscheduled whole body injuries, but that caselaw
    developed before the legislature amended the statutory scheme to add shoulder
    injuries to the list of scheduled member injuries under section 85.34(2). Holstein
    Elec., 
    756 N.W.2d at 816
    ; see Lauhoff Grain Co. v. McIntosh, 
    395 N.W.2d 834
    ,
    839–40 (Iowa 1986) (en banc); Second Inj. Fund, 544 N.W.2d at 269–70. Those
    cases only discussed the dividing line between the arm and the body as a whole
    because “shoulder” was not a scheduled injury at the time. See, e.g., Alm v.
    Morris Barick Cattle Co., 
    38 N.W.2d 161
    , 163 (Iowa 1949). It was inconsequential
    whether the injury was technically to the shoulder—all that mattered was
    whether the injury was to the scheduled member arm or extended beyond it.
    “Our rules of statutory construction hold that when the legislature amends a
    statute, a presumption exists that the legislature intended to change the law.”
    Colwell v. Iowa Dep’t of Hum. Servs., 
    923 N.W.2d 225
    , 235 (Iowa 2019). Thus,
    the pre-2017 amendment caselaw that Chavez cites is unpersuasive.
    15
    Finally, Chavez’s remaining arguments for defining the “shoulder” only to
    include the glenohumeral joint because it favors workers and reduces the need
    for litigation determining whether a claimant’s injury is a “shoulder” under
    section 85.34(2)(n) largely boil down to policy considerations that are best left for
    the legislature to consider. More litigation may be needed in the short term to
    develop the exact parameters of a scheduled shoulder injury under section
    85.34(2)(n), but that does not warrant ignoring our rules of statutory
    construction to interpret “shoulder” to be limited to the “shoulder joint.” In any
    event, Chavez acknowledged during oral argument that treating injuries like hers
    as whole body injuries would still require litigation in almost every case to
    determine the disability rating for compensation purposes. This negates her
    claim that her proffered definition is preferable because it favors the worker by
    reducing the need for litigation.
    Ultimately, “[d]octors have been drawing these lines for years, deciding
    whether an injury is a whole body injury or a scheduled injury under the Act,”
    and “[t]here is no reason doctors cannot continue to do so under this new
    amendment.” Injured Workers of Kan. v. Franklin, 
    942 P.2d 591
    , 608 (Kan. 1997)
    (rejecting challenges to an amendment that added shoulders to the list of
    scheduled injuries for workers’ compensation purposes). For these reasons,
    “shoulder” is not limited to the glenohumeral joint. Chavez does not alternatively
    argue that her particular injury should be considered anything other than an
    unscheduled whole body injury, such as an arm. As we described above, it is
    clear from Chavez’s medical records that her rotator cuff injury is a “shoulder”
    16
    injury. Therefore, we affirm the commissioner and district court rulings that
    Chavez suffered a scheduled injury to her shoulder under section 85.34(2)(n).
    B. Whether Chavez is Entitled to Industrial Disability Benefits. Chavez
    maintains that should we conclude her shoulder injury is a scheduled injury,
    she is entitled to industrial disability benefits because she injured two scheduled
    members: her right shoulder and right arm. Section 85.34(2)(t) provides:
    The loss of both arms, or both hands, or both feet, or both legs, or
    both eyes, or any two thereof, caused by a single accident, shall
    equal five hundred weeks and shall be compensated as such;
    however, if said employee is permanently and totally disabled the
    employee may be entitled to benefits under subsection 3.
    
    Iowa Code § 85.34
    (2)(t). Chavez acknowledges this section does not apply
    because it does not mention shoulder injuries, so she argues instead that an
    injury to her right arm and right shoulder falls under the catch-all provision in
    section 85.34(2)(v). The relevant language in this section provides:
    In all cases of permanent partial disability other than those
    described or referred to in paragraphs “a” through “u”, the
    compensation shall be paid during the number of weeks in relation
    to five hundred weeks as the reduction in the employee’s earning
    capacity caused by the disability bears in relation to the earning
    capacity that the employee possessed when the injury occurred.
    
    Id.
     § 85.34(2)(v).
    We need not address this statutory interpretation argument because
    substantial evidence supports the commissioner’s finding that Chavez “failed to
    carry her burden to prove her biceps tear results in any permanent disability to
    her arm.” See Gumm, 943 N.W.2d at 28 (“[W]e accept the commissioner’s factual
    findings when supported by substantial evidence.” (alteration in original)
    (quoting Bluml, 920 N.W.2d at 84)). As the injured employee, Chavez had the
    17
    burden to prove by a preponderance of the evidence that she sustained a
    permanent partial disability to her arm under section 85.34(2)(m). See Xenia
    Rural Water Dist. v. Vegors, 
    786 N.W.2d 250
    , 254 (Iowa 2010). Dr. Peterson
    diagnosed Chavez with “[b]iceps tendonitis and tearing,” and Chavez underwent
    a biceps tenotomy as part of her surgery. However, nothing in the record
    indicates Chavez suffered a permanent impairment to her right arm apart from
    the shoulder injury.
    As the district court aptly summarized in affirming the commissioner’s
    determination that Chavez did not prove a permanent partial disability to her
    arm under section 85.34(2)(m),
    Chavez did not present a separate permanent impairment rating for
    her arm from either Dr. Peterson or her expert Dr. Bansal.
    Dr. Bansal’s report is expressly limited to Chavez’s right shoulder:
    “This examination should focus on her right shoulder.” Dr. Bansal’s
    physical examination noted a 40% loss of abduction and 20% flexion
    strength loss in Chavez’s right shoulder as compared to the left
    shoulder. The only assessment that seems to reference the arms is
    “upper extremity reflexes,” which notes the same result for right and
    left of +2.
    (Citations     omitted.)   Accordingly,   substantial    evidence   supports     the
    commissioner’s finding that Chavez failed to meet her burden to prove her biceps
    tear resulted in a permanent disability to her arm under section 85.34(2)(m).
    IV. Conclusion.
    For the aforementioned reasons, we affirm the judgment of the district
    court.
    AFFIRMED.
    18
    All justices concur except Mansfield and McDermott, JJ., who take no
    part.