NATEIGA CAMERON, Claimant,
v.
PACIFICA HEALTH SERVICES, Employer,
and,
SFM MUTUAL INSURANCE,, Insurance Carrier, Defendants.
No. 5063931
Iowa Workers Compensation
Before the Iowa Workers’ Compensation Commissioner
January 21, 2021
Head
Note Nos.: 1402.40, 1801, 1802, 2500, 2700, 2907
APPEAL
DECISION
STEPHANIE J. COPLEY DEPUTY WORKERS' COMPENSATION
COMMISSIONER
Claimant
Nateiga Cameron appeals from an arbitration decision filed on
May 5, 2020. Defendants Pacifica Health Services, employer,
and SFM Mutual insurance, insurer, respond to the appeal. The
hearing was held on July 9, 2019 and reconvened on October 9,
2019 before Deputy Workers' Compensation Commissioner
Michelle A. McGovem. The case was considered fully submitted
in front of Deputy Commissioner McGovern on November 6, 2019.
Due to Deputy Commissioner McGovern's retirement,
however, the case was delegated to Deputy Commissioner
Jennifer S. Gerrish-Lampe, who issued the arbitration
decision, along with a ruling on motion for rehearing on June
10,2020.
On
December 30, 2020, the Iowa Workers' Compensation
Commissioner delegated authority to the undersigned to enter
a final agency decision in this matter. Therefore, this
appeal decision is entered as final agency action pursuant to
Iowa Code section 17A.15(3) and Iowa Code section 86.24.
In the
arbitration decision, the deputy commissioner found
claimant's October 22, 2017 injury was not the cause of
her symptoms that led to her surgery in October of 2018.
Instead, the deputy commissioner found claimant sustained a
new aggravation in September of 2018 that "may or may
not be caused by work" but was "not the subject
matter of [the arbitration] hearing." Thus, for the
October 22, 2017 date of injury, the deputy commissioner
found claimant should take nothing.
On June
10, 2020, the deputy commissioner issued a ruling on motion
for rehearing that ordered defendants to pay for the entirety
of claimant's IME with John Kuhnlein, M.D.
On
appeal, claimant asserts the deputy commissioner erred in
finding claimant's ongoing symptoms are not causally
related to her October 22, 2017 work injury. Claimant argues
she is not at maximum medical improvement (MMI) for her work
injury and is entitled to a running award of temporary
benefits. Claimant also seeks reimbursement for medical
expenses and mileage. In the alternative, should it be found
on appeal that claimant has reached MMI, claimant asserts she
is entitled to permanent partial disability (PPD) benefits
for her industrial disability. Claimant asserts her correct
rate is $378.31. Claimant also seeks an order forcing
defendants to authorize care with Nicholas Wetjen, M.D.
Lastly, claimant seeks a reimbursement for her costs.
Those
portions of the proposed agency decisions pertaining to
issues not raised on appeal are adopted as a part of this
appeal decision.
I
performed a de novo review of the evidentiary record and the
detailed arguments of the parties. Pursuant to Iowa Code
sections 86.24 and 17A.15, the arbitration decision filed on
May 5, 2020 is respectfully reversed.
The
deputy commissioner found claimant's October 22, 2017
work injury was not the cause of her October 2018 surgery or
her ongoing symptoms; instead, the deputy commissioner found
claimant experienced a new aggravation in September of 2018.
However, none of the experts in this case opined that
claimant sustained a new aggravation of her symptoms in
September of 2018. While it is true that Dr. Kuhnlein
indicated claimant began experiencing "true
radiculopathy" in September of 2018, he did not go so
far as to say this was due to a new incident or new
aggravation; in fact, he indicated she had "equivocal
radicular features" leading up to this point.
(Claimant's Exhibit 1, p. 10)
Furthermore,
though the notes from claimant's emergency room (ER)
visit in September of 2018 indicate back pain from the last
week to 10 days, her complaints were very much a continuation
of the complaints she had been experiencing since October of
2017. The loss of bowel control was a new symptom, but the
remainder of her complaints, including numbness and tingling
down her right leg, were noted in numerous medical records
prior to the ER visit. (See Joint Ex. 1, pp. 13, 15,
17, 20, 22; JE 3, pp. 16, 25; JE 6, pp. 6, 15; JE 7, p. 3)
Her imaging had likewise not drastically changed.
(See JE 3, p. 32) As claimant explained at hearing,
there was no "new incident'" that preceded her
ER visit; it was a worsening after an increased workload at
her job. (Hearing Transcript, p. 35)
The
greater weight of the evidence supports a finding not that
claimant sustained a new aggravation or injury in September
of 2018 but instead that her work-related symptoms continued
after she was placed at MMI by Kurt Smith, D.O., in June of
2017.
The
only physician in the record to opine against causation in
this case is Trevor Schmitz, M.D., but his opinion is
problematic for several reasons. First, Dr. Schmitz initially
opined in December of 2017 that claimant had a work injury on
October 22, 2017 and that this work injury was causing her
symptoms. (CI. Ex. 3, p. 1) Roughly a year later, in October
of 2018, he indicated that surgery was "warranted"
for claimant, though he did not believe it was likely to
"drastically improve her symptoms." (JE 3, p. 32)
It was not until June of 2019, in response to a letter from
defense counsel, that Dr. Schmitz offered a different opinion
regarding the source of claimant's symptoms. (JE 3, p.
33-38)
While
it is not unheard of for a physician to change his or her
mind regarding causation, Dr. Schmitz went a step beyond
opining against causation; Dr. Schmitz indicated he did
"not feel as though [claimant] sustained any injury to
her back as a result of her October 22, 2017 incident."
(JE 3, p. 35 (emphasis added)) Later in the letter Dr.
Schmitz again stated he did not believe claimant
"sustained an injury as a result of her October 22, 2017
incident." (JE 3, p. 35)
Importantly,
this is contrary to defendants' stipulation in this case
that claimant sustained a work-related injury on October 22,
2017. It is also contrary to the opinions of Dr. Kuhnlein,
Dr. Wetjen, and William Boulden, M.D.
Dr.
Kuhnlein, claimant's IME physician, opined that claimant
sustained a work-related low back injury with radiating low
back pain on October 22, 2017, for which surgery was
eventually required. (CI. Ex. 1, p. 10) This is consistent
with the opinions of Dr. Boulden, who offered a second
opinion at defendants' request in April of 2018. Dr.
Boulden opined that claimant's October 22, 2017 work
injury "caused her problem or aggravated it to a point
where she is quite symptomatic from the herniated disc"
and that "most likely she is going to need surgical
intervention." (CI. Ex. 4, p. 4) Dr. Wetjen, who
performed claimant's surgeries, indicated claimant would
require surgery for her back pain that radiated into her
right leg. (JE 8, p. 2) Prior to hearing Dr. Wetjen also
stated he believed claimant has what appears to be permanent
nerve damage from her work injury. (CI. Ex. 5, p. 4)
Given
defendants' stipulation in this case that claimant
sustained an injury on October 22, 2017, the opinions of Drs.
Kuhnlein, Boulden and Wetjen, and the original opinions of
Dr. Schmitz, I simply do not find Dr. Schmitz's opinions
from June of 2019 to be credible. Instead, the greater weight
of the evidence supports a finding that claimant's
ongoing symptoms, including her need for surgery, are related
to the stipulated October 2, 2017 work injury. The deputy
commissioner's finding is therefore reversed.
...
