IN THE COURT OF APPEALS OF IOWA
No. 17-1525
Filed September 12, 2018
CHRISTINE KEERAN,
Plaintiff-Appellant,
vs.
QUAKER OATS COMPANY, INDEMNITY INSURANCE COMPANY OF NORTH
AMERICA and SECOND INJURY FUND OF IOWA,
Defendants-Appellees.
________________________________________________________________
Appeal from the Iowa District Court for Polk County, Lawrence P. McClellan,
Judge.
Claimant seeks appellate review of an order affirming final agency action.
AFFIRMED.
Robert R. Rush and Christoph P. Rupprecht of Rush & Nicholson, PLC,
Cedar Rapids, for appellant.
Kent M. Smith of Scheldrup Blades Schrock Smith, PC, West Des Moines,
for appellees Quaker Oats Company and Indemnity Insurance Company of North
America.
Thomas J. Miller, Attorney General, and Amanda R. Rutherford, Assistant
Attorney General, for appellee Second Injury Fund of Iowa.
Considered by Potterfield, P.J., and Bower and McDonald, JJ.
2
MCDONALD, Judge.
Christine Keeran challenges the workers’ compensation commissioner’s
denial of her claim for workers’ compensation benefits. The agency record shows
Keeran sought workers’ compensation benefits for cumulative injuries to her knees
allegedly sustained during the course of her employment with Quaker Oats. The
deputy commissioner found Keeran failed to prove her knee injuries arose out of
and in the course of her employment with Quaker Oats and denied her claim for
benefits. Because the deputy commissioner found Keeran failed to meet her
burden of proof on the issues of causation and compensability, the deputy
commissioner concluded the remaining issues presented were moot. Keeran
sought intra-agency review of the deputy’s decision. The commissioner affirmed
the deputy’s decision in its entirety and adopted as final the relevant portions of
the deputy’s decision. The district court affirmed the commissioner’s denial of
Keeran’s claim. Keeran timely filed this appeal.
I.
Our review is governed by the Iowa Administrative Procedure Act, Iowa
Code chapter 17A. See Lakeside Casino v. Blue, 743 N.W.2d 169, 172 (Iowa
2007). The standard of review differs depending on the error alleged. See
Jacobson Transp. Co. v. Harris, 778 N.W.2d 192, 196 (Iowa 2010). Factual
challenges are reviewed for substantial evidence. See id. “Evidence is substantial
if a reasonable mind would find it adequate to reach a conclusion.” Quaker Oats
Co. v. Ciha, 552 N.W.2d 143, 150 (Iowa 1996). “If the error is one of interpretation
of law, we will determine whether the commissioner’s interpretation is erroneous
3
and substitute our judgment for that of the commissioner.” Jacobson Transp. Co.,
778 N.W.2d at 196.
II.
In her first claim of error, Keeran contends the agency applied the wrong
legal standard to determine whether Keeran’s injury and disability arose out of her
employment with Quaker Oats. “When the agency exercises its discretion based
on an erroneous interpretation of the law, we are not bound by those ‘legal
conclusions but may correct misapplications of the law.’” Meyer v. IBP, Inc., 710
N.W.2d 213, 219 (Iowa 2006) (quoting Stroup v. Reno, 530 N.W.2d 441, 443 (Iowa
1995)).
“Our workers’ compensation statute provides coverage for ‘all personal
injuries sustained by an employee arising out of and in the course of the
employment.’” Id. at 220 (Iowa 2006) (quoting Iowa Code § 85.3(1) (2001)). “This
statutory coverage formula gives rise to four basic requirements: (1) the claimant
suffered a personal injury, (2) the claimant and the respondent had an employer-
employee relationship, (3) the injury arose out of the employment, and (4) the injury
arose in the course of the employment.” Id. “The failure of any one requirement
results in a denial of a claim for benefits.” Id. To prove an injury arose out of
employment, the claimant must establish a “causal connection exists between the
employment and the injury.” Id. at 222. In addition to showing a causal connection
between her employment and the injury, the claimant must prove her work-related
injury is the proximate cause of her disability. See Ayers v. D & N Fence Co., 731
N.W.2d 11, 17 (Iowa 2007). “In order for a cause to be proximate, it must be a
substantial factor.” Id. (citation omitted). If the alleged injury resulted from the
4
worsening, aggravation, or acceleration of a preexisting condition or injury, a
claimant may recover so long as she can show a causal connection between the
working conditions and her injury. See Musselman v. Cent. Tel. Co., 154 N.W.2d
128, 132 (Iowa 1967). “In other words, the injury must not have coincidentally
occurred while at work, but must in some way be caused by or related to the
working environment or the conditions of [her] employment.” Miedema v. Dial
Corp., 551 N.W.2d 309, 311 (Iowa 1996).
We conclude the agency applied the correct legal standard to the question
of causation. Here, the agency stated Keeran needed only to “show that those
natural degenerative processes were accelerated, speeded up or aggravated by
her work activities.” This is a correct statement of the law. See Musselman, 154
N.W.2d at 132. In addition, the agency also stated Keeran was required to
establish any injury was a proximate cause of her resulting disability. See Ayers,
731 N.W.2d at 17. This too was a correct statement of the law. We find no error
in the agency’s statement of the relevant legal principles.
III.
In her second claim of error, Keeran contends the agency’s findings
regarding medical causation were not supported by substantial evidence.
The record reflects the following. Keeran worked for Quaker Oats for thirty-
nine years. She held various hourly positions during her employment, including:
sweeper, packer, baghandler, machine tender, and package line operator. These
positions required manual labor and repeated physical activity, including crawling,
squatting, lifting and pulling heavy items, climbing ladders, kneeling, and standing.
5
Over the course of her employment, Keeran experienced pain in both of her
knees. Keeran first met with Dr. Hugh MacMenamin in 2004. At that time, she
indicated she had experienced knee pain for several years. Dr. MacMenamin
diagnosed Keeran with arthrosis—a degenerative joint condition—in both knees.
She sought treatment again in 2009 when her primary-care physician
referred her to Dr. Fred Pilcher. Dr. Pilcher noted Keeran did not suffer from a
specific knee injury but recommended corrective surgery to treat her pain. Keeran
did not undergo corrective surgery at that time. Keeran returned to Dr. Pilcher in
mid-2010. Dr. Pilcher diagnosed Keeran with degenerative meniscus disease and
degenerative arthritis in her left knee and meniscus tears and loose body in her
right knee. In August of the same year, Dr. Pilcher removed Keeran from work
due to her advanced knee pain although he did not attribute her knee condition to
Keeran’s work conditions. Later the same month, Dr. Pilcher performed
arthroscopic surgery on Keeran’s knees and removed a loose body from her right
knee. Keeran returned to work in November without any restrictions. However,
she continued to experience pain.
Keeran visited another physician, Dr. David Tearse, in September 2011.
Dr. Tearse suspected Keeran’s symptoms would not improve with additional
surgery and recommended pool therapy instead. Keeran again visited her
primary-care doctor in November and complained of her ongoing pain. The doctor
referred Keeran to University of Iowa Hospitals and Clinics, Department of
Orthopedics (UIHC) for another opinion.
Keeran treated with Dr. John Callaghan at UIHC in April 2012. Dr.
Callaghan noted Keeran reported knee pain for the past three years. Dr.
6
Callaghan recommended knee-replacement surgery. In May, Keeran visited
rheumatologist, Dr. Michael Brooks, who recommended knee-replacement
surgery and noted:
She would certainly improve in terms of knee symptoms were she to
quit her present work and I would expect it if she gets [knee
replacements] that they would last longer if she were not stressing
them at her present type of work. I would encourage her to avoid
overuse of the knees in terms of climbing, squatting, kneeling or even
walking and standing more than she needs to for everyday function.
In June 2012, Dr. Sandeep Munjal began treating Keeran’s knee pain, and
Keeran agreed to a left knee replacement. Keeran’s last day of work was
September 25, 2012. She underwent knee-replacement surgery without
complications in October. However, she received limited improvement and
underwent two rounds of surgical manipulation of her left knee. Keeran’s range of
motion remained limited, and, in June 2013, Dr. Munjal recommended physical
therapy and advised against “ladders or lifting heavy weights.”
In October 2013, Keeran underwent an independent medical exam (IME)
with Dr. Stanley Mathew. When presented with the question, “Has Christine
sustained a cumulative injury to her knees arising out of and in the course of her
physically demanding work at Quaker Oats over 39 years?” Dr. Mathew
concluded, “I do believe Christine had sustained a cumulative injury to her knees
arising out of course of physically demanding work at Quaker Oats for over 30
years.” Keeran shared Dr. Mathew’s IME report, as well as job descriptions from
Quaker Oats, with Dr. Munjal. Dr. Munjal signed a letter confirming he considered
the physical demands of Keeran’s work to be a contributing factor to her knee
injuries.
7
In June of 2014, Keeran underwent a second IME, at Quaker Oats’ request,
with Dr. Thomas Gorsche. Dr. Gorsche concluded, “while it is possible that work
duties of going up and down ladders continuously could aggravate and contribute
to developing arthritis, I believe in this situation it would be a minor contribution at
best.” He went on to state:
In my opinion, since there is no specific injury that brought on her
symptoms that they are more than likely related to her systematic
risk factors such as her age, gender, ethnicity, genetic factors, and
possibly dietary factors. It is medically possible that physical activity
at work could have played a role in this, but in my medical opinion,
that is unlikely. If it did play a role, in my opinion, it would be very
minor.
Our resolution of Keeran’s claim is controlled by the standard of review.
“Medical causation ‘is essentially within the domain of expert testimony.’” Cedar
Rapids Cmty. Sch. Dist. v. Pease, 807 N.W.2d 839, 845 (Iowa 2011) (citation
omitted). “Medical causation presents a question of fact that is vested in the
discretion of the workers’ compensation commission.” Id. at 844. The
commissioner’s findings may only be disturbed if they are not supported by
substantial evidence. Id. at 845.
Here, the agency credited Dr. Gorsche’s medical opinion over the other
medical opinions. The commissioner concluded Dr. Gorsche presented the most
thorough opinion accounting for all of the medical evidence presented. Although
this court does “not simply rubber stamp the agency finding of fact,” this court also
does not declare evidence insubstantial “because different conclusions may be
drawn from the evidence.” See id. We will not reverse an agency decision where
“the evidence supports a different finding than the finding made by the
commissioner, but . . . the evidence [also] ‘supports the findings actually made.’”
8
Meyer, 710 N.W.2d at 218 (quoting St. Luke’s Hosp. v. Gray, 604 N.W.2d 646, 649
(Iowa 2000)). Here, the evidence supports the findings actually made. The agency
did not commit reversible error.
IV.
The agency applied the correct law, and its findings of fact are supported
by substantial evidence. We affirm the judgment of the district court.
AFFIRMED.