Opinion
No. 3-397 / 02-1389
Filed October 15, 2003
Appeal from the Iowa District Court for Linn County, Thomas M. Horan, Judge.
Gavin appeals the denial of her claim for workers' compensation benefits. AFFIRMED.
Cynthia Sueppel of Moyer Bergman, P.L.C., Cedar Rapids, for appellant.
Jack Paige of Elderkin Pirnie, P.L.C., Cedar Rapids, for appellees.
Considered by Mahan, P.J., and Miller and Vaitheswaran, JJ.
We must decide whether there is substantial evidence to support an agency finding that a claimant did not suffer from a latex allergy. We affirm.
I. Background Facts and Proceedings
Kathryn Gavin was exposed to latexwhile working as a nurse at Mercy Medical Center in Cedar Rapids. After nine years at the facility, she began experiencing tingling in her hands and mouth, numbness, tightness in her chest, wheezing, a raspy voice, throat congestion, and itching over her whole body. She left work for a period of time. On her return, she was placed in a different work environment, but her symptoms persisted. Eventually, Gavin gave up her nursing position.
Gavin sought workers' compensation benefits for a latex allergy and related anxiety. A deputy commissioner rejected her claim, concluding:
Claimant cannot establish that she is allergic to latex. Furthermore, claimant cannot establish that any mental disability from which she now suffers, including delusional disorder of a somatic type, is as a result of the work she performed for defendant employer. The most credible medical evidence indicates in the most recent testing that claimant is not allergic to latex. Notwithstanding her own sincerely held belief that she is allergic to latex, the medical evidence just does not support that conclusion. Claimant can prove neither a physical injury, nor an occupational disease.
The workers' compensation commissioner, through the chief deputy, affirmed the deputy commissioner's decision, as did the district court on judicial review.
On further judicial review, Gavin argues the agency's fact findings are not supported by substantial evidence. See Iowa Code § 17A.19(10)(f); Wal-Mart Stores, Inc. v. Caselman, 657 N.W.2d 493, 498 (Iowa 2003) (looking to date of final agency action rather than date claim filed in deciding whether amended judicial review standards apply). In evaluating this issue, we are required to consider evidence that "detracts from" as well as "supports" the agency findings. Iowa Code § 17A.19(10)(f)(3).
II. Latex Allergy
An allergic reaction may be an "injury" under chapter 85 of our workers' compensation scheme. St. Luke's Hosp. v. Gray, 604 N.W.2d 646, 652 (Iowa 2000). It also may be an occupational disease under Iowa Code chapter 85A. See Doerfer Div. of CCA v. Nicol, 359 N.W.2d 428,432 (Iowa 1984) (noting parties did not dispute that claimant's allergic contact dermatitis was an occupational disease). The key question here is whether there is substantial evidence to support the agency's finding that Gavin does not have a latex allergy. We believe there is.
The agency was not faced with, and did not decide, whether Gavin's allergic reactions, amounted to a compensable injury. See Gray, 604 N.W.2d at 651-52 (citing National Underground Storage v. Workmen's Comp. Appeal Bd., 658 A.2d 1389, 1392-93 (Pa.Cmmw.Ct. 1995)) (noting claimant's injury was not underlying allergy but allergic reaction). Therefore, we need not address this issue. See Meads v. Iowa Dep't of Social Servs., 366 N.W.2d 555, 559 (Iowa 1985).
Gavin underwent testing for a latex allergy shortly after experiencing the reactions described above. A latex skin test was negative at a lower concentration level but positiveat a higher level. Based on the positive reading, Dr. Barbara Muller initially diagnosed Gavin with "Type I IgE mediated latex hypersensitivity" and "Type IV contact latex hypersensitivity." However, colleague Miles Weinberger, M.D. viewed the positive skin test as "only mildly positive." He found "no objective evidence to support a diagnosis of latex allergy." Dr. Jordan Fink, who was also asked to evaluate Gavin, concurred with Dr. Weinberger's assessment. We believe the agency was free to accord greater weight to the opinions of Dr. Weinberger and Dr. Fink than to that of Dr. Muller concerning this first test. See Sondag v. Ferris Hardware, 220 N.W.2d 903, 907 (Iowa 1974) (stating Commissioner is free to accept or reject expert testimony in whole or in part).
This test uses a specific material diluted back to 1 to 1000 with subsequent increases in concentration to test for a positive response. A positive response shows IgE antibodies specific for latex.
This is particularly true in light of Dr. Muller's later equivocation concerning the test result. Two years after the first test, Dr. Muller retested Gavin and revised her initial diagnosis. She pointed out that Gavin's second skin test result was "negative to all concentrations. . ." and opined that it was "quite rare for a patient to `lose' clinical allergic sensitivity to a specific allergen over time." Dr. Muller ultimately concluded "the initial skin test may have been false positive."
Notably, a fourth allergy specialist, Dr. Loren Hunt, also revised his diagnosis of Gavin's condition. Although he initially found she suffered from a latex allergy, he eventually opined that Gavin's symptoms "do not appear to be associated with latex allergy in that her environment has been modified to reduce latex allergen exposure and her recent skin tests have been negative to latex."
Gavin claims this opinion supports her claim that she had a latex allergy at one time but minimized its effect through avoidance. However, Dr. Hunt was unwilling to definitively opine that the more recent negative test result was based on avoidance of latex.
Gavin's treating physician, Dr. Jolynn Glanzer, essentially deferred to the opinions of these allergy specialists concerning the latex allergy.
We are left with the opinion of Dr. Rick Larsen, a psychiatrist who reviewed the other physicians' medical records and Gavin's diary, and personally evaluated Gavin. He opined that Gavin merely had a delusion, or false belief, that she had a latex allergy. He stated he reached this conclusion only after determining that objective tests and findings concerning Gavin's physical discomfort had "ruled out other causes for that physical discomfort."
Dr. Larsen's opinion is consistent with Dr. Muller's final letter to defense counsel, stating Gavin suffers from "anxiety-related symptoms to exposures found in everyday life including irritants, odors, common household substances, and other chemicals." While it is inconsistent with Dr. Glanzer's testimony that Gavin never appeared to be delusional, Glanzer conceded she would typically defer to someone like Dr. Larsen for a psychiatric diagnosis.
On this record, we find substantial evidence to support the agency's finding that Gavin does not suffer from a latex allergy. Accordingly, we affirm the agency decision that Gavin failed to establish the existence of a physical injury under Iowa Code chapter 85 or an occupational disease under Iowa Code chapter 85A.
Gavin's remaining allegations are all premised on a finding of a latex allergy. As we have found substantial evidence to support the agency finding that this allergy did not exist, we also affirm the agency's rejection of these claims.
Gavin contends she sustained a mental impairment stemming from her claimed latex allergy, or a "physical-mental" injury. See Garrett v. Rochester Prods., 507 N.W.2d 190, 193 (Iowa Ct.App. 1993). She does not claim she suffered from a mental/mental injury, i.e. a mental injury compensable without an accompanying physical injury. See Humboldt Cmty. Schs. v. Fleming, 603 N.W.2d 759, 762 (Iowa 1999). Gavin also contends her latex allergy arose out of and in the course of her employment, and claims she should be entitled to healing period and permanent disability benefits.