robin-lull-gumbusky-petitioner-appellantcross-appellee-v-great-plains ( 2015 )


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  •                        IN THE COURT OF APPEALS OF IOWA
    No. 13-1886
    Filed February 11, 2015
    ROBIN LULL-GUMBUSKY,
    Petitioner-Appellant/Cross-Appellee,
    vs.
    GREAT PLAINS COMMUNICATION, a/k/a
    GREAT PLAINS LOCATING SERVICES, INC.,
    n/k/a PROMARK CONSOLIDATED UTILITY
    LOCATORS, INC., a/k/a IOWA ONE CALL,
    EMPLOYERS MUTUAL CASUALTY, and
    COMMERCE AND INDUSTRY INSURANCE
    COMPANY,
    Respondents-Appellees/Cross-Appellants.
    ________________________________________________________________
    Appeal from the Iowa District Court for Polk County, Karen A. Romano,
    Judge.
    Robin Lull-Gumbusky appeals the district court order denying her petition
    for judicial review.    Promark cross-appeals the order requiring payment of
    ongoing medical expenses. AFFIRMED.
    Mark S. Soldat of Soldat, Parrish-Sams & Gustafson, P.L.C., West Des
    Moines, for appellant/cross-appellee.
    Aaron T. Oliver of Hansen, McClintock & Riley, Des Moines, for
    appellees/cross-appellants Promark.
    Jeffrey M. Margolin of Hopkins & Huebner, P.C., Des Moines, for appellee
    Great Plains.
    Heard by Danilson, C.J., and Doyle and Bower, JJ.
    2
    BOWER, J.
    In this appeal and cross-appeal we are to consider the district court’s
    affirmance of the ruling of the workers’ compensation commissioner concerning
    employee Robin Lull-Gumbusky (Robin). Robin claims (1) the district court erred
    by affirming the exclusion of the majority of her exhibits; and (2) the
    commissioner misapplied the review/reopening law, proximate cause laws, Iowa
    Code chapter 17A, Iowa Code section 85.34, and industrial disability principles.
    On cross-appeal, the employer, Promark Consolidated Utility Locators Inc., and
    Commerce and Industry Insurance Company (Promark), claim the district court
    erred in affirming the agency order to pay for Robin’s low-back medical
    expenses, provide ongoing low-back treatment for the 2007 injury, and increase
    Robin’s permanent partial disability (PPD) benefits by ten percent. We affirm.
    I.     BACKGROUND FACTS
    Robin began working for Great Plains Communication (Great Plains) in
    February 1999 as a utility locator. Her primary duty was to locate and mark
    buried utility lines.   This was a seasonal position, allowing her to collect
    unemployment during the winter months.
    On November 27, 2002, while working, Robin drove through a “T-
    intersection” and into a ditch. She sustained a serious spine fracture, requiring
    fusion surgery and the installation of extensive supportive hardware. Robin had
    a “smooth post-op course” and was discharged on December 11, 2002.
    On January 11, 2005, Robin entered into a settlement agreement with
    Great Plains for the 2002 injury. The settlement included approximately forty
    3
    weeks of temporary total disability/healing period (TTD/HP) benefits, thirty-five
    percent PPD benefits for 175 weeks, and an agreement for ongoing medical
    treatment. Robin continued to work as a utility locator from 2004 through part of
    2007. During this time she continued to experience problems associated with
    her injury.
    In March 2007, Great Plains’s name changed to Promark Consolidated
    Utility Locators, Inc., as did its insurance carrier. Robin was hired by Promark as
    a utility locator without an interruption in her normal work schedule. On August 2,
    2007, Robin sustained another work-related injury. While descending a ditch,
    she slipped and landed on her back before slipping again and landing on her
    “rump, where it pushed, jarred everything up.” A few months after this incident,
    Robin quit her job as a utility locator. Claiming her symptoms and pain increased
    due to the second injury, she filed a review-reopening petition against Great
    Plains and its insurance carrier Employer’s Mutual Casualty, and a workers’
    compensation claim against Promark and its insurance carrier Commerce &
    Industry Insurance Company.
    In her review-reopening petition, Robin claimed the condition caused by
    the 2007 accident warranted an increase in compensation from the 2005
    settlement agreement. In her original notice and petition against Promark for the
    2007 injury, she also asked for a determination concerning the extent of the
    injury, plus credit/interest, Iowa Code section 85.27 expenses and benefits,
    penalties and costs.
    4
    II.   PREVIOUS PROCEEDINGS
    The deputy workers’ compensation commissioner (deputy) held contested
    arbitration proceedings on March 28, 2011. At the hearing the files for Great
    Plains and Promark were consolidated.        As a preliminary issue, the deputy
    commissioner noted Robin’s medical records in “Exhibit I” did not conform to the
    format required by the hearing assignment order. The records were organized in
    chronological order, rather than chronological order by provider. The deputy was
    aware Robin’s attorney, Mark Soldat, had been warned on multiple occasions
    about presenting exhibits in violation of the rule. The deputy told Soldat his
    noncompliance would lead to the exclusion of the exhibits. Soldat claimed the
    hearing assignment order “wasn’t adopted by a rule in any case,” and strict
    chronology provides a better understanding of medical treatment. The deputy
    rejected the argument and excluded Exhibit I. Though, the deputy did accept
    one report authored by Dr. John Kuhnlein, which was included in the exhibit.
    Robin’s husband Steve testified at the hearing.       He described Robin’s
    issues with ongoing pain since the 2002 accident. Her treating physician, Dr.
    Sufka-Boyd, recommended Robin see a chronic pain specialist; Kuhnlein made
    the same recommendation. Steve also described the issues Robin developed
    with anxiety while driving.   He said the 2007 injury magnified her pain and
    anxiety, and ultimately made it impossible for Robin to do her job.
    Robin also testified. She first described the enjoyment she had derived
    from her work. Then she described the 2002 injury and its lingering effects. The
    injury caused her to work slower to avoid re-injury. After her 2007 injury, Robin
    5
    noted her confidence decreased and her anxiety increased; she enjoyed her job
    but found driving to be scary. She now thought walking through ditches was
    dangerous, which she did not before the accident. After the 2007-2008 winter
    layoff, she worked in March and part of April before quitting. Robin felt she could
    no longer perform the job but managed to work several jobs following her utility
    locator position. She left those jobs for a variety of reasons. Robin testified she
    had not seen a psychiatrist since her first injury in 2002. After both injuries she
    continued to drive herself for work and worked normal hours. She testified the
    decision to quit was hers not a doctor’s, and she did not talk to anyone at Great
    Plains or Promark before deciding to quit.
    The deputy issued the review-reopening decision/arbitration decision on
    July 28, 2011. The deputy first noted Soldat failed to organize the exhibits, and
    since he had violated similar orders in the past, excluded those exhibits. The
    deputy found Robin sustained a work injury on November 27, 2002, and her
    claim for workers’ compensation was settled by agreement on January 11, 2005.
    Pursuant to the agreement, Robin was entitled to PPD benefits equal to thirty-five
    percent of the body as a whole.        The deputy also found Robin had been
    evaluated by Kuhnlein following the 2002 injury, and Kuhnlein assigned her a
    twenty-eight percent impairment of the whole person. Kuhnlein did not rate her
    mental health as it could not be quantified for an impairment rating.
    The deputy found Robin continued to have pain after the 2002 injury into
    2007 when she suffered the second accident. After Robin fell into the ditch, she
    worked the rest of her shift and reported to the emergency room. She took the
    6
    following day off (Friday), and returned to work on Monday. Robin sought no
    further medical treatment for the remainder of her seven weeks with Promark.
    She then underwent physical therapy and pain management assistance from a
    pain specialist. These treatments helped Robin’s symptoms improve.
    The deputy also found Robin saw Kuhnlein again in 2010. In his report,
    Kuhnlein opined her impairment rating, related to her 2002 injury, was the same
    as he found previously. The deputy found Kuhnlein attributed an additional three
    percent whole person impairment to Robin’s injuries from the 2007 accident.
    After reviewing the evidence, the deputy found Robin’s neck pain was not related
    to her 2007 injury as there was little mention of the pain before her fall in 2009.
    The deputy also found the numbness in her hands could not be attributed to the
    2002 or 2007 injuries. Finally the deputy found Kuhnlein’s report persuasive, but
    found Robin lacked credibility due to false answers given under oath concerning
    her prior substance abuse.
    After reviewing Robin’s claim for PPD benefits, the deputy found there
    was no observable physical change relating to the second injury, and the
    impairment rating was based on a subjective report. The deputy denied Robin’s
    claim for PPD benefits relating to the 2007 incident. The deputy found there had
    been no impairment rating provided by an employer-retained physician, and
    denied Robin’s claim for reimbursement for Kuhnlein’s costs. Robin’s claim for
    rehabilitation benefits was also denied. The deputy found Robin was entitled to a
    lifetime of reasonable medical care for the 2002 injury.       Her ongoing care
    remained the responsibility of Great Plains. The deputy found care had been
    7
    abandoned, and Robin’s medical expenses for Sufka-Boyd should be paid or
    reimbursed by Great Plains.       The costs in both claims were taxed to Great
    Plains. Robin and Great Plains appealed to the commissioner.
    After conducting a de novo review of the record, the commissioner
    concluded the deputy did not abuse his discretion in excluding the evidence for
    being improperly submitted. The commissioner concluded, as no offer of proof
    was made regarding the evidence, Robin failed to preserve error on the
    exclusion of her exhibits. The commissioner struck all portions of Robin’s brief
    discussing evidence not contained in the record.
    The commissioner found Robin failed to carry her burden on the
    review/reopening petition. He also found Great Plains did not obtain a new Iowa
    Code section 85.39 evaluation of Robin, and Kuhnlein’s costs could not be taxed
    to Great Plains.    The commissioner affirmed the deputy’s denial of Robin’s
    rehabilitation benefits, ruling she did not establish the requisite inability to return
    to gainful employment.
    Relying on Kuhnlein’s report, the commissioner found, Robin had
    established a three percent permanent impairment to the body as a whole as a
    result of the 2007 injury. Relying on evidence of her increased medication use,
    Steve Gumbusky’s testimony, a medical opinion Robin could not continue
    working as a utility locator, and Kuhnlein’s report of an increased permanent
    impairment, the commissioner concluded Robin had shown by a preponderance
    of the evidence she sustained a permanent compensable work injury to her
    lumbar spine in August 2007. The commissioner found Robin was entitled to an
    8
    additional ten percent PPD benefits, attributable to Promark, and one day of
    healing period benefits. The commissioner determined Robin’s weekly rate for
    benefits, from the 2007 injury, was $463.10.
    The commissioner concluded no employee-retained physician offered an
    impairment rating of Robin’s injury, and denied her claim for reimbursement of
    Kuhnlein’s costs from the 2007 injury. The commissioner also denied her claim
    for rehabilitation as she returned to the same job after her injury.       The
    commissioner concluded Robin was entitled to lifetime reasonable medical care
    from Great Plains for pain in her ribcage plus any needed mental health
    treatment causally related to the 2002 incident.      The commissioner also
    concluded Robin was entitled to ongoing and future medical care relating to her
    lower back from Promark, as directed by Sufka-Boyd.
    Great Plains and Robin each requested rehearing. The commissioner
    clarified the taxing of costs against each defendant. The commissioner also
    noted the costs of Kuhnlein’s examinations and reports were not taxed to either
    defendant. He referred the parties to Iowa Code section 85.32 regarding the
    date for the commencement of benefits, and instructed the parties to work
    towards agreement on the amount of interest due. Finally, the commissioner
    explained which expenses were the responsibility of Great Plains and which were
    the responsibility of Promark.
    Robin petitioned and Promark cross-petitioned for judicial review. Great
    Plains did not file a cross-appeal.
    9
    The district court affirmed the commissioner’s ruling in all respects other
    than a modification to the parties’ future medical obligations. The district court
    modified the commissioner’s ruling:
    In the Appeal Decision, the Commissioner discussed the
    applicable law regarding medical benefits as provided in Iowa Code
    section 85.27. The Commissioner discussed the law regarding an
    award of alternate medical care. As the Commissioner discussed
    law regarding an award of alternate medical care, and awarded
    Robin medical care controlled by Dr. Sufka-Boyd, the court
    concludes the Commissioner intended to award alternate medical
    care to Robin to ensure her continued treatment. The court
    therefore modifies the Appeal Decision to explicitly provide
    alternate medical care for her August 2007 injury from
    Promark/Commerce & Industry. See Iowa Code § 17A 19(10)
    (providing “The court may affirm the agency action or remand to the
    agency for further proceedings. The court shall reverse, modify, or
    grant other appropriate relief from agency action, equitable or legal
    and including declaratory relief if it determines that substantial
    rights of the person seeking judicial relief have been
    prejudiced . . . .”). The court otherwise finds that the Commissioner
    committed no error in ordering Promark/Commerce & Industry
    responsible for ongoing and future medical care for Robin’s low
    back symptoms and injury, and affirms the Appeal Decision on this
    issue.
    Regarding the Commissioner’s order pertaining to ongoing
    and future medical care of Robin’s issues originally addressed in
    the settlement following the 2002 injury, the court finds the
    Commissioner erred in limiting Robin’s ongoing and future medical
    care provided by Great Plains/EMC to only Robin’s rib cage and
    mental health. The court finds that the settlement agreement
    covered all of Robin’s ongoing and future medical care causally
    related to the 2002 accident, and the Commissioner unnecessarily
    limited care relating to the 2002 injury in the Appeal Decision.
    Therefore, the court modifies the Appeal Decision. See Iowa Code
    §17A19(10). Great Plains/EMC shall be responsible for all of
    Robin’s ongoing and future medical care causally related to the
    2002 accident, except that the ongoing and future medical care for
    Robin’s low back injury and increased low back pain relating to the
    2007 injury shall be the responsibility of Promark/Commerce &
    Industry.
    10
    From this ruling, Robin appeals, Promark cross-appeals, and Great Plains
    does not appeal.
    III.   STANDARDS OF REVIEW
    Our review is governed by Iowa Code chapter 17A (2013). See Mike
    Brooks, Inc. v. House, 
    843 N.W.2d 885
    , 888 (Iowa 2014). Under chapter 17A,
    the district court acts in an appellate capacity to correct errors of law. 
    Id.
     In
    reviewing the district court’s decision, we apply the standards of chapter 17A to
    determine whether we reach the same conclusions as the district court. 
    Id. at 889
    . If we do, we affirm; if not, we reverse. 
    Id.
     In reviewing agency action, the
    district court may only reverse or modify if the agency’s decision is erroneous
    under one of the provisions set forth in Iowa Code section 17A.19(10) and a
    party’s substantial rights have been prejudiced. Gits Mfg. v. Frank, 
    855 N.W.2d 195
    , 197 (Iowa 2014).
    We may reverse, modify, affirm, or remand the case to the commissioner
    for further proceedings if we conclude the agency’s action is affected by an error
    at law or if it is not supported by substantial evidence. Iowa Code § 17A.19(10);
    Gits Mfg. Co., 855 N.W.2d at 197. “‘Substantial evidence’ means the quantity
    and quality of evidence that would be deemed sufficient by a neutral, detached,
    and reasonable person, to establish the fact at issue when the consequences
    resulting from the establishment of that fact are understood to be serious and of
    great importance.” Iowa Code § 17A.19(10)(f)(1). Substantial evidence supports
    an agency’s decision even if the interpretation of the evidence may be open to a
    fair difference of opinion. Arndt v. City of Le Claire, 
    728 N.W.2d 389
    , 393 (Iowa
    11
    2007). Accordingly, the district court and the appellate court should not consider
    the evidence insubstantial merely because the court may draw different
    conclusions from the record. 
    Id.
    Robin’s claims on appeal concern whether the commissioner correctly
    applied the law to the facts, and whether the commissioner correctly excluded
    evidence (questions of law and fact). Promark’s claims on cross-appeal concern
    whether the commissioner ignored factual evidence and the language of the
    settlement, and whether the commissioner’s decision was supported by
    substantial evidence (questions of fact).
    If the claim of error lies with the agency’s findings of fact, the proper
    question on review is whether substantial evidence supports those
    findings of fact. If the findings of fact are not challenged, but the
    claim of error lies with the agency’s interpretation of the law, the
    question on review is whether the agency’s interpretation was
    erroneous, and we may substitute our interpretation for the
    agency’s. Clark [v. Vicorp Restaurants, Inc.], 696 N.W.2d [596,]
    604 [(Iowa 2005)] (citing Iowa Code § 17A.19 (10)(c), (11)(b));
    Mycogen Seeds [v. Sands], 686 N.W.2d [457,] 464 [(Iowa 2004)].
    Still, if there is no challenge to the agency’s findings of fact or
    interpretation of the law, but the claim of error lies with the ultimate
    conclusion reached, then the challenge is to the agency’s
    application of the law to the facts, and the question on review is
    whether the agency abused its discretion by, for example,
    employing wholly irrational reasoning or ignoring important and
    relevant evidence. See Iowa Code § 17A.19 (10)(i), (j). In sum,
    when an agency decision on appeal involves mixed questions of
    law and fact, care must be taken to articulate the proper inquiry for
    review instead of lumping the fact, law, and application questions
    together within the umbrella of a substantial-evidence issue.
    Meyer v. IBP, Inc., 
    710 N.W.2d 213
    , 219 (Iowa 2006).
    12
    IV.    ANALYSIS
    A.     Exclusion of Exhibit I
    Robin claims the court erred by affirming the agency’s exclusion of her
    Exhibit I due to her violation of the hearing assignment order.1 We note the
    record shows the deputy commissioner had admonished Robin’s attorney at
    several prior proceedings for submitting evidence in a manner the agency found
    “unhelpful and unwanted.” On review, the commissioner stated: “[t]he division
    and its professional staff have a workflow and internal practices which make the
    presentation of exhibits in a uniform manner a necessity. The counsel’s plea to
    do it his way due to his desire to ‘build a better mousetrap’ . . . is rejected.” The
    district court agreed with the commissioner’s assessment.
    We review the exclusion of Exhibit I for an abuse of discretion. See
    Schoenfeld v. FDL Foods, Inc., 
    560 N.W.2d 595
    , 598 (Iowa 1997) (“The
    imposition of sanctions by administrative agencies is discretionary.”). This court
    shall reverse or grant other appropriate relief from agency action when that
    action is an abuse of discretion.      Iowa Code § 17A.19(10)(n).        An abuse of
    discretion occurs when the agency exercises its discretion on untenable grounds
    or its exercise of discretion was clearly erroneous. See IBP Inc., v. Al–Gharib,
    
    604 N.W.2d 621
    , 630 (Iowa 2000). The agency has broad discretion in oversight
    and determinations about the admissibility of evidence. See Marovec v. PMX
    Industries, 
    693 N.W.2d 779
    , 786 (Iowa 2005).
    1
    Promark and Great Plains claim Robin did not preserve error on the exclusion of her
    exhibits. For the purposes of this appeal, we will assume Robin preserved error for this
    issue.
    13
    Iowa Administrative rule 876-4.36 permits the commissioner to sanction a
    party for noncompliance with a rule or order:
    If any party to a contested case or an attorney representing such
    party shall fail to comply with these rules or any order of a deputy
    commissioner or the workers’ compensation commissioner, the
    deputy commissioner or workers’ compensation commissioner may
    impose sanctions which may include dismissing the action without
    prejudice, excluding or limiting evidence, assessing costs or
    expenses, and closing the record in whole or in part to further
    activity by the party.
    As stated by our supreme court, “It is of no concern to a court reviewing
    an administrative sanction whether a different sanction would be more
    appropriate or whether a less extensive sanction would have sufficed; such
    matters are the province of the agency.” Marovec, 
    693 N.W.2d at 786
    . We
    agree and find the exclusion of Robin’s Exhibit I was not an abuse of discretion
    by the agency. Consequently, we shall not consider the materials excluded by
    the commissioner, even though Robin extensively cites the excluded material in
    her brief.
    B.     Review/Reopening
    Robin claims the district court erred by affirming the commissioner’s failure
    to award PPD.        Her claim focuses on her perception the commissioner
    misapplied the law to the facts. Courts will not reverse that application unless it
    is “irrational, illogical, or wholly unjustifiable.” See Neal v. Annett Holdings, Inc.,
    814 N .W.2d 512, 518 (Iowa 2012). Robin’s claim appears to focus on error’s
    made in the agency’s findings of fact. We review an agency’s fact finding to
    determine if substantial evidence supports the decision. Meyer, 
    710 N.W.2d at 219
    . “‘Substantial evidence’ means the quantity and quality of evidence that
    14
    would be deemed sufficient by a neutral, detached, and reasonable person, to
    establish the fact at issue when the consequences resulting from the
    establishment of that fact are understood to be serious and of great importance.”
    Iowa Code § 17A.19(10)(f)(l).
    For a compensable review-reopening claim, Robin has the burden, by a
    preponderance of the evidence, to prove her current condition is “proximately
    caused by the original injury.” Kohlhaas v. Hog Slat, Inc., 
    777 N.W.2d 387
    , 392
    (Iowa 2009) (citation omitted).     “The commissioner must then evaluate ‘the
    condition of the employee, which is found to exist subsequent to the date of the
    award being reviewed.’ The commissioner is not supposed to ‘re-determine the
    condition of the employee which was adjudicated by the former award.’” 
    Id. at 391
     (citations omitted).     The change may be either economic or physical.
    Blacksmith v. All-American Inc., 
    290 N.W.2d 348
     (lowa 1980); Henderson v. Iies,
    
    96 N.W.2d 321
     (Iowa 1959). The commissioner may adjust awards pursuant to
    Iowa Code section 86.14(2) by determining the employee’s condition “warrants
    an end to, diminishment of, or increase of compensation so awarded or agreed
    upon.”
    Robin claims she has an increased industrial disability due to worsening
    symptoms attributable to one or both incidents. The commissioner relied on
    Kuhnlein’s findings to note she had no additional impairment related to the 2002
    injury.    Kuhnlein also noted Robin’s mental health status had not changed
    substantially since he saw her in 2004. The commissioner stated Robin had not
    proved any economic or other related change resulting from the 2002 injury. The
    15
    commissioner found Robin failed to carry her burden of proof to establish a
    change in condition or entitlement to additional permanent partial disability
    benefits for the November 27, 2002 date of injury. The district court agreed. We
    find substantial evidence supports the commissioner’s decision and affirm.
    C.     Promark’s Obligation to pay Low-back Expenses and Ongoing
    Treatment for the 2007 Injury; and Ten Percent PPD Award
    (Cross Appeal Issues I and II)
    Promark claims the commissioner and district court ignored the factual
    evidence and controlling language from the settlement agreement by ordering
    Promark to pay for Robin’s ongoing low-back treatment. Promark also claims the
    commissioner and district court erred in ordering Promark to pay ten percent
    PPD benefits. In its decision, the commissioner reasoned:
    Claimant asserts various medical difficulties subsequent to
    her work injury of August 2, 2007.
    ....
    As to claimant’s prior medical complaints, Dr. Kuhnlein is in
    the unique position of having evaluated claimant both before and
    after her 2007 injury.         As noted by the presiding deputy
    commissioner, his even-handed and measured evaluation is highly
    persuasive.       Dr. Kuhnlein specifically identified that claimant
    sustained a three percent whole person functional impairment
    rating as a result of the 2007 work injury. Defendants’ authorized
    surgeon, David Beck, M.D., similarly found that claimant sustained
    a permanent impairment and loss of function of one percent of the
    body as a whole as a result of the August 2, 2007 work injury. It is
    therefore concluded that claimant has established that she
    sustained additional permanent impairment as a direct and
    proximate result of her August 2, 2007 injury.
    It is further noted that Dr. Beck’s impairment rating lacks any
    specificity as to how it was reached or under what provision of the
    AMA Guides it was assigned. Dr. Kuhnlein’s assessment of a three
    percent permanent impairment rating attributable to the August 2,
    2007 injury was delineated as being under the AMA Guides and the
    specific section of the Guides from which the rating could be
    derived was identified by Dr. Kuhnlein. It is therefore further
    concluded that Dr. Kuhnlein’s assessment of an additional three
    16
    percent impairment to the body as a whole is accurate and the
    basis for further permanent partial disability.
    Due to the conclusion that the medical evidence supports an
    award of permanent partial disability, the finding of the presiding
    deputy that claimant is not a credible witness must be considered.
    Even if claimant’s self-interested account of ongoing pain levels is
    unreliable, this by no means implies that she has no pain or is not
    still entitled to medical care for alleviation of that pain. Indeed, her
    prescription usage increased significantly after the August 2, 2007
    date of injury. I defer to the observations and credibility findings of
    the presiding deputy and concur that claimant’s testimony is likely
    exaggerated as to the extent of her symptoms and residual abilities.
    Nevertheless, I find objective documentation of increased pain
    medication usage, namely Dr. Kuhnlein’s persuasive opinion
    explaining claimant’s increased medication usage and how she is
    now taking the maximum allowable dosage of Vicodin. It is
    concluded that this evidence, coupled with the testimony of
    claimant’s husband, Steve Gumbusky, establishes that there has
    been a permanent increase in claimant’s back symptoms as a
    direct result of the August 2, 2007 date of injury.
    Having concluded that claimant has established an
    increased level of permanent functional impairment, it must also be
    determined whether this permanent impairment has resulted in
    further permanent disability. It is concluded that claimant quit her
    job at Great Plains at least partially as a result of her increased
    symptoms and anxiety about further injury. Although no physician
    has imposed specific permanent work restrictions upon claimant
    since the August 2, 2007 work injury, it must be noted that at least
    one treating physician has concluded claimant cannot continue to
    perform her work as a locator for Great Plains. Specifically, Joseph
    A. Brunkhorst, M.D., opined in a December 18, 2008 letter to the
    Social Security Administration that “I think it would be hard for her
    to continue that type of work.” While recognizing the presiding
    deputy’s concerns as to claimant’s testimony and her potential
    exaggeration of her symptoms, the following conclusions are
    provided. It is concluded that claimant has not proven a substantial
    change of condition, or that she sustained any additional loss of
    future earning capacity as a result of the November 27, 2002 date
    of injury. However, given the increased permanent impairment, Dr.
    Kuhnlein’s opinions about increased medication usage, and the
    opinions of Dr. Brunkhorst about claimant’s ability to continue to
    work as a locator for the employer, it is also concluded that
    claimant has proven by a preponderance of the evidence that she
    sustained a compensable, permanent work injury as a result of the
    August 2, 2007 work injury. It is further concluded that claimant’s
    injury resulting from the August 2, 2007 date of injury is limited to
    17
    her lumbar spine. Dr. Kuhnlein’s opinions are accepted with
    respect to causation issues for any alleged injuries to the neck,
    shoulders or arms (carpal tunnel). Having considered numerous
    factors of industrial disability it is concluded that claimant presently
    has a permanent loss of earning capacity equal to forty-five percent
    as a result of the August 2, 2007 work injury.
    While other conclusions could be drawn from the evidence in the record,
    we find the commissioner relied on substantial evidence in finding Robin was
    entitled to ongoing treatment for the 2007 injury. See Arndt, 
    728 N.W.2d at 393
    (“Substantial evidence supports an agency’s decision even if the interpretation of
    the evidence may be open to a fair difference of opinion.”).
    V.    CONCLUSION
    For the foregoing reasons, we find the commissioner did not abuse his
    discretion excluding Robin’s improperly submitted exhibits. We find substantial
    evidence supports the commissioner’s denial of Robin’s review/reopening claim.
    We also find substantial evidence supports the commissioner’s finding of an
    additional ten percent PPD and Promark’s obligation for ongoing low-back
    expenses and treatment. Thus, we affirm the judgment of the district court.
    AFFIRMED.