Susan Ann Sullivan v. Cummins Filtration-Lake Mills, A/K/A Cummins, Inc., F/K/A Fleetguard, Inc., and Second Injury Fund of Iowa

IN THE COURT OF APPEALS OF IOWA
No. 3-1170 / 13-0658
Filed March 12, 2014
SUSAN ANN SULLIVAN,
Petitioner-Appellant,
vs.
CUMMINS FILTRATION-LAKE MILLS,
a/k/a CUMMINS, INC., f/k/a
FLEETGUARD, INC., and SECOND
INJURY FUND OF IOWA,
Respondents-Appellees.
________________________________________________________________
Appeal from the Iowa District Court for Winnebago County, Rustin
Davenport, Judge.
Susan Ann Sullivan appeals the district court ruling of her petition for
judicial review. AFFIRMED.
Mark S. Soldat of Soldat & Parrish-Sams, P.L.C., West Des Moines, for
appellant.
Richard G. Book of Huber, Book, Cortese & Lanz, P.L.L.C., West Des
Moines, for appellee Cummins Filtration-Lake Mills.
Thomas J. Miller, Attorney General, and Julie Burger and Jennifer York,
Assistant Attorneys General, Special Litigation, Des Moines, for appellee Second
Injury Fund of Iowa.
Heard by Potterfield, P.J., and Doyle and Bower, JJ.
2
BOWER, J.
Susan Ann Sullivan appeals the district court ruling of her petition for
judicial review. Sullivan claims the workers’ compensation commissioner
misapplied the Iowa successive-disability statute, and did not properly
summarize the evidence and explain the agency’s decision-making process.
Sullivan also claims the commissioner erred by denying her application for
alternative medical care. We find the successive-disability statute is inapplicable
as Sullivan failed to prove a permanent partial disability and as a result there is
no successive disability under the statute. We also find the commissioner’s
findings of fact and conclusions of law were sufficiently separated to allow us to
reconstruct the commissioner’s reasoning on appellate review. Because we find
there is no disability, an award of alternative medical care is not available. We
affirm.
I. Background Facts and Proceedings
Susan Ann Sullivan (Sullivan) is a former employee of Cummins Filtration1
(Cummins) where she worked on various production lines for several years.
During Sullivan’s employment with Cummins, she suffered a number of injuries
and physical ailments.2 Only the two petitions Sullivan filed with the workers’
1
Cummins Filtration, also known as Cummins, Inc., was formerly known as Fleetguard,
Inc.
2
Sullivan left Cummins for a brief period of time during which she worked at a Target
distribution center in Minnesota. With the exception of the time she was employed by
Target, she was employed at all material times by Cummins. Sullivan’s initial term of
employment with Cummins began on March 6, 1998. She was found to have no
significant medical impairment at that time.
3
compensation commissioner on June 11, 2009, are before us for review. A
discussion of Sullivan’s prior medical and injury history is necessary to fully
understand this dispute.
Sullivan sustained her first injury when she caught her right hand in a
crimping machine on January 14, 1999. She was treated by Dr. Ciota who
assessed a five percent permanent impairment to the whole body. Sullivan
entered into a settlement that was approved by the commissioner establishing a
twenty-two percent permanent partial disability in her right hand. Upon returning
to work, Sullivan was symptom free.
Sullivan began experiencing swelling and pain in her hands in late 2001.
The condition was reported to her supervisor on February 11, 2002. Sullivan
engaged in many treatments with several doctors but continued to have
symptoms. Sullivan and Cummins entered into a settlement regarding the
February 11, 2002, injury that was approved by the commissioner on October 27,
2005. The settlement states Sullivan suffered a 16.068 percent permanent
partial disability to her right arm.3 Following the settlement, Sullivan returned to
work with restrictions, which Cummins accommodated. 4
There are two stipulated injuries that are presented on appeal. The first
was reported to Cummins on August 17, 2007, after Sullivan noticed her hands
were sore, swollen, numb, and tingling after she finished working the previous
day. She was given additional restrictions and returned to appropriate work. One
3
Sullivan also complained of a right finger injury, compensability of which was disputed
by Cummins. Cummins paid Sullivan $1500 to settle the disputed claim.
4
Sullivan also was self-employed part time during this period.
4
week later, she reported minor tingling and stated her hands were improving.
She was referred to Dr. Mixdorf who diagnosed bilateral carpal tunnel syndrome.
Dr. Mixdorf determined the carpal tunnel syndrome was probably work related.
Sullivan was later transferred to Dr. Ciota who performed carpel tunnel release
surgery on each arm. During a follow-up appointment shortly after the surgeries,
Dr. Ciota found Sullivan to be “doing really well” and agreed she could return to
work needing some restrictions for only two weeks. Dr. Ciota found Sullivan to
be at maximum medical improvement (MMI) as of May 19, 2008 with no
restrictions and no additional permanent partial disability.
Dr. Kuhnlein performed an independent medical evaluation on March 18,
2009, and related the carpal tunnel syndrome to Sullivan’s work. He assigned a
three percent permanent partial impairment to the right carpal tunnel, but found
no permanent impairment for the left carpal tunnel.
The second stipulated injury was reported to Cummins on July 1, 2008.
Sullivan was referred to Dr. Ciota with left wrist pain and diagnosed with left
trigger finger. On July 16, 2008, Dr. Ciota diagnosed Sullivan with trigger finger
from tenosynovitis and imposed work restrictions. The condition was found to be
work related. Over the following months, Sullivan participated in physical therapy
and continued to experience some trigger finger symptoms. Sullivan continued
to experience symptoms when seen by Dr. Ciota on September 24, 2008. He
diagnosed her with overuse repetitive tendonitis but separately stated she
continues to suffer from trigger finger which would require surgery. The surgery
was performed on October 15, 2008.
5
On October 29, 2008, Dr. Ciota examined Sullivan and found her to be
doing well, though the overuse symptoms remained unchanged. She was
released as to the trigger finger with no restrictions.
Sullivan was next referred to Dr. Mooney for evaluation.5 After testing, Dr.
Mooney opined that Sullivan’s “complaints did not meet her diagnoses” and
recommended a three-phase bone scan and prescribed an anti-inflammatory
medication. Sullivan declined both recommendations. Dr. Mooney later found
no impairment due to carpel tunnel and expressed his opinion that Sullivan had
no evidence of overuse syndrome, tendinitis, or a repetitive trauma injury. As a
result there could be no impairment. Finally, Dr. Mooney opined Sullivan’s hand
complaints did not fit within a diagnostic category and could be influenced by a
“psychological component.”
In his independent medical examination report, Dr. Kuhnlein related the
trigger finger condition to Sullivan’s employment, but was unable to relate the
bilateral hand pain from her overuse symptoms to her work. His opinion was
influenced, in part, by his conclusion that Sullivan’s complaints did not match the
findings of the medical examination. Dr. Kuhnlein found no impairment from the
trigger finger or the hand pain.
Sullivan filed her petitions with the workers’ compensation commissioner
on June 11, 2009. The petitions named Cummins and The Second Injury Fund
5
Sullivan self-servingly refers to Dr. Mooney as a “well-known defense doctor” on
multiple occasions throughout her brief despite no supporting evidence.
6
of Iowa (the Fund).6 A hearing was held before a deputy workers’ compensation
commissioner on April 5, 2010. The arbitration decision was filed on November
11, 2010. In it, the deputy found the August 16, 2007 work injury was not the
cause of any permanent disability. Sullivan filed an application for rehearing
which was denied. After an appeal to the commissioner,7 the case was
remanded so the deputy commissioner could rule on a number of outstanding
issues. Most relevant to this appeal, the deputy was asked to determine the
permanency claim for the July 1, 2008 stipulated injury. On remand, the deputy
found Sullivan had failed to prove a permanent disability as a result of the July 1,
2008 injury. On appeal, the commissioner adopted the deputy’s initial decision
as modified by the remand decision, with additional reasoning on several other
issues. An application for rehearing was denied, and the commissioner’s
decision was affirmed on judicial review.
II. Scope and Standard of Review
We review workers’ compensation commissioner cases under the Iowa
Administrative Procedure Act, Iowa Code chapter 17A (2011). Meyer v. IBP,
Inc., 710 N.W.2d 213, 218 (Iowa 2006). “Under the Act, we may only interfere
with the commissioners decision if it is erroneous under one of the grounds
enumerated in the statute, and a party's substantial rights have been prejudiced.”
Id. The grounds are enumerated in section 17A.19. See Iowa Code § 17A.19.
6
The Second Injury Fund is a named party to this appeal. Because we affirm on appeal,
all issues impact the Fund and Cummins identically, and we do not consider the Fund
separately.
7
The commissioner delegated authority to a deputy who acted in the place of the
commissioner. Throughout this opinion, we refer to the decisions of the deputy acting on
delegated authority as “the commissioner.”
7
We give deference to findings of fact made by the commissioner. Meads v. Iowa
Dep’t of Soc. Servs., 366 N.W.2d 555, 561 (Iowa 1985).
III. Discussion
Sullivan raises three separate issues on appeal. First, she claims the
commissioner misapplied the successive-disability statute found in section
85.34(7). She also claims factual findings and decisions regarding material
evidence were not properly explained by the commissioner. Finally, she claims
the commissioner erred by denying alternate medical care and prematurely
determined permanent disability issues.
A. Permanency and successive disabilities
Sullivan claims the commissioner erred by denying application of the
successive-disability statute. She contends the stipulated injuries should have
been considered successive injuries compensable under the statute.
Section 85.34(7) governs an employer’s liability for successive workplace
injuries suffered while working for the same employer. The section holds when
an employee has a preexisting disability from the same employment
compensable under the same subsection and paragraph of the statute, the
employer is responsible for the combined disability resulting from the injuries as
compared to the employee’s condition prior to the first injury. See id.Sullivan contends the commissioner was also required to consider not a
singular disability, but the effect of the stipulated injuries when combined with her
prior disabilities. She also claims the commissioner should have entered findings
of fact regarding whether her prior injuries were compensable under the same
8
subsection and paragraph of the statute, a threshold inquiry before the
successive-disability statute can be triggered. However, Sullivan skips the first
step in any successive-disability analysis. Before the commissioner can combine
two disabilities to a compensable whole, there must be two disabilities available
to be combined.
The statute does speak of combining a preexisting disability with “the
employee’s present injury.” Iowa Code § 85.34(7)(b)(1). If the second injury,
however, adds no additional disability, there is nothing to combine the original
disability with. The statute makes this clear. Employers are responsible for
compensating disabilities under section 85.34; a present disability is required
before the statute is applicable. Additionally, the prior disability must have been
“compensable under the same paragraph of subsection 2 as the employee’s
present injury . . . .” Id. § 85.34(7)(a). The clear requirement of the language is
the present injury must be compensable. Only disabilities are compensable
under the statute. As a result, the present injury must itself be compensable as a
permanent disability before it can be combined into a successive whole.
The commissioner, recognizing this, correctly considered whether the
present stipulated injuries were compensable permanent disabilities under the
statute and found they were not. Though expert evidence is normally necessary
to establish permanency, some injuries may by their very nature require a finding
of permanency. See Daniels v. Bloomquist, 138 N.W.2d 868, 873 (Iowa 1965).
As with other expert testimony, the commissioner must consider the expert’s
opinion along with all other evidence. Sherman v. Pella Corp., 576 N.W.2d 312,
9
321 (Iowa 1998). It is then the commissioner’s duty to weigh all the evidence
and the commissioner may accept or reject the expert opinion in whole or in part.
Id.Though Sullivan does not explicitly claim her injuries are such that
permanency is implied in her present condition, this is the essence of her claim.
We find the commissioner was justified in relying upon the qualified medical
opinions of multiple doctors in concluding Sullivan has recovered from the
stipulated injuries and they have caused no permanent disability. Doctors have
uniformly found the carpal tunnel symptoms have resulted in no permanency,
and the evidence is overwhelming the trigger finger issues were completely
resolved by surgery.
Without a compensable disability, the successive-disability statute is
inapplicable and the commissioner committed no error.
B. Form of the commissioner’s ruling
Sullivan claims the commissioner’s ruling is in error because it fails to
separately state findings of fact and conclusions of law, as required by statute.
She also contends the commissioner did not state reasons for rejecting
uncontroverted evidence.
Section 17A.16 requires the commissioner include “findings of fact and
conclusions of law, separately stated.” Iowa Code § 17A.16(1). The purpose of
the rule is to allow the reviewing court to determine when the commissioner is
making a determination of fact and when the commissioner is engaging in the
application or interpretation of law, so that we may properly review the relevant
10
portion of the decision. See Dodd v. Fleetguard, Inc., 759 N.W.2d 133, 137
(Iowa Ct. App. 2008) (finding format proper where court is able to clearly
determine where findings of fact end and conclusions of law begin despite lack of
individual headings). Our review in this case is complicated by the number of
decisions made during the agency process. Unlike the usual case, the record
contains four separate rulings by the deputy or commissioner. The
commissioner’s final decision adopts the original arbitration decision as the final
agency decision, as modified by the remand decision. The commissioner then
adds additional reasoning. The conclusions, reasoning, and decision of the
commissioner are spread across three separate documents. Sullivan is correct,
the decision is not neatly broken down into a single set of findings of fact and a
single set of conclusions of law.
Our supreme court has refrained from imposing “unnecessary and
burdensome requirements into the statute.” Bridgestone/Firestone, Pacific
Emp’rs Ins. v. Cathy Accordino, 561 N.W.2d 60, 62 (Iowa 1997). Provided we
can deduce the commissioner’s decision making process, there is no
requirement the commissioner duplicate previous agency efforts to provide a
decision in an unnecessarily precise format. Id. Though the decision of the
commissioner is complicated and spread across a number of documents, we are
able to follow the commissioner’s decision-making process for purposes of
review. We are able to determine when the commissioner is engaging in fact
finding and are provided with a path to follow so that we may review those factual
conclusions.
11
Sullivan also claims the commissioner is required to go through each fact
in the record and discuss its applicability to the final decision. This is not
required. Id. The commissioner clearly explained the evidence relied upon.
Sullivan asked the commissioner to reconsider the various restrictions she
believes proved a permanent partial disability. The commissioner’s decision
discussed restrictions, but clearly finds the medical opinions of various doctors
more persuasive.
C. Alternative medical care
Sullivan claims the commissioner erred in denying her request for
alternative medical care, or alternatively erred by prematurely determining there
had been no permanent disability.
Section 85.27(4) provides an opportunity for the commissioner to order
alternative medical care when the employee is dissatisfied with the care provided
and it can be shown the care provided was unreasonable. See Iowa Code
§ 85.27(4); Bell Bros. Heating and Air Conditioning v. Gwinn, 779 N.W.2d 193,
204 (Iowa 2010). The injury, however, must be compensable. Iowa Code
§ 85.27(1). A causal connection is an essential element of compensability.
The commissioner found the two stipulated injuries had reached MMI and
were not the cause of a permanent disability. We have affirmed those
conclusions. Alternative care is no longer needed for those injuries because no
further care is necessary. Sullivan claims, however, an award of alternative
medical care is required for her additional symptoms that have been attributed to
overuse. The commissioner determined she had failed to prove a causal
12
connection between these symptoms and her work. We agree. As the
commissioner points out, Dr. Ciota considered these complaints and found them
unrelated to the stipulated, work related, injuries. No doctor has offered an
opinion connecting the overuse symptoms to her employment. Dr. Kuhnlein
discussed Sullivan’s overuse symptoms and expressed doubt as to the accuracy
of the complaints, finding a “strong psychological component” to her symptoms
and noting Sullivan ceased any display of her symptoms when she was
distracted during her examinations.
Expert testimony is generally required to establish a causal connection.
See Sherman, 576 N.W.2d at 321. Sullivan offers no expert testimony to support
a causal connection between her overuse symptoms and her work. Rather, she
attempts to paint the overuse symptoms as a natural and unmistakable result of
her history of hand and limb problems while working for Cummins. We agree
with the commissioner that no such connection is compelled by the evidence.
Based upon the evidence in the record, we find the commissioner’s conclusion
that the overuse symptoms were not causally connected to Sullivan’s
employment was supported by substantial evidence.
AFFIRMED.