Opinion
No. 1-1014 / 00-2066
Filed February 12, 2003
Appeal from the Iowa District Court for Polk County, Joel D. Novak, Judge.
David Wilson appeals from a district court order affirming an arbitration decision of the Iowa Workers' Compensation Commissioner. REVERSED AND REMANDED TO THE WORKERS' COMPENSATION COMMISSIONER.
William D. Scherle and Aaron T. Oliver of Hansen, McClintock Riley, Des Moines, for appellant.
David L. Jenkins of Bradshaw, Fowler, Proctor Fairgrave, P.C., Des Moines, for appellees.
Heard by Sackett, C.J., and Huitink and Hecht, JJ.
David Wilson appeals from a district court order affirming an arbitration decision of the Iowa Workers' Compensation Commissioner. We reverse and remand to the agency for further proceedings.
I. Factual Background.
Wilson was employed as the National Sales Trainer for Good Will Publishers, a company that markets religious tracts to businesses. He was the company's only trainer of sales representatives who were paid solely by commission. Wilson was kept very busy because Good Will's sales force experienced a high rate of turnover. He worked seventy-five to eighty hours per week, traveling across the country primarily by automobile. In 1993, he drove in excess of 51,000 miles in the course and scope of his employment, and in the following year, he logged almost 43,000 miles as he performed his training responsibilities.
The company's employee manual directed Wilson to give very high priority to his training mission:
ABOVE ALL . . . REMEMBER!
During your new reps first four (4) weeks of his training, he and his family must be the most important thing in your life.
You have a responsibility to this newest member of the Good Will Family. He and his entire family will be looking to you to teach and lead them to a successful future.
DON'T LET THEM DOWN!
The company provided Wilson with the names, addresses and starting dates of each new sales representative. Because Good Will's training was to be undertaken on weekdays, Wilson was typically required to travel to new training locations on the weekend.
On April 16, 1995 (Easter Sunday), Wilson departed from his home in Tabor, Iowa, to travel approximately six hundred miles to Dexter, Missouri, where he was scheduled to begin training a new Good Will representative the next day. At about 1:00 a.m. on April 17, Wilson stopped in Columbia, Missouri to rest at a motel for a few hours. While there, he noticed symptoms of indigestion. After resting and taking antacids for his discomfort, he continued driving so as to arrive in Dexter as scheduled by 8:00 a.m. The symptoms escalated as he drove, and when he arrived at his destination, he received a diagnosis of myocardial infarction.
Wilson made a claim for workers' compensation benefits. Good Will and its workers' compensation carrier denied liability.
II. The Agency Decision.
After a hearing, the presiding deputy issued an arbitration decision. In her discussion of medical causation, the deputy concluded:
Under the medical (factual) test, the doctors must say whether the exertion in fact caused the heart attack. . . While the medical evidence does establish that claimant had a preexisting heart condition and was at risk for a heart attack based in large part on his smoking history, the medical evidence fails to establish that claimant's heart attack was a result of the work he performed for defendant employer.
The deputy's arbitration decision also found that Wilson failed to meet his burden to establish legal causation by proving Good Will "required [him] to continue working after [he] first began to experience symptoms of chest discomfort."
Wilson sought intra-agency review. In its appeal decision of January 21, 2000, the agency "affirm[ed] and adopt[ed] as final agency action those portions of the proposed decision in this matter that relate[d] to issues properly raised on intra-agency appeal." Wilson sought judicial review in the district court.
III. Ruling on Petition for Judicial Review.
In its ruling, the district court concluded the commissioner erred in affirming the agency's determination that Wilson failed to establish legal causation. The court reasoned:
"the real test . . . is simply whether [Wilson's] continued exertions were required by his employment . . . As noted above, the Petitioner's position as national sales trainer required that he travel across the country training new associates. Since [Wilson] was traveling to meet and train a new sales associate on the day he suffered his heart attack, this Court finds that his driving on April 17, 1995, was required by his employment.
The district court nonetheless affirmed the agency's determination that Wilson had failed to meet his burden to establish medical causation. The court posited that
the applicable medical causation test is not whether the delay in receiving treatment caused additional heart damage, as the Petitioner contended, but is whether the continued exertions at work caused additional damage. . . While the Petitioner offered evidence that the delay in seeking treatment caused more damage to his heart, he offered no evidence that continuing to drive a modern automobile aggravated his condition. . . Given the Petitioner's failure to offer any evidence that his continued driving, rather than the mere passage of time, aggravated his heart condition, this Court agrees with the Deputy Commissioner and Chief Deputy Commissioner that the Petitioner has failed to establish medical causation.
IV. Contentions on Appeal.
Wilson contends on appeal to this court that the agency and district court erred in applying incorrect legal standards on the medical and legal causation issues. He further claims the district court erred in failing, after finding the agency committed legal error on the legal causation issue, to remand this case to the agency for application of the correct legal standards. Finally, Wilson asserts the district court erred in concluding the agency's summary affirmance of the arbitration decision was sufficient to comply with Iowa Code section 17A.16(1) (1999).
Good Will cross-appeals, contending the district court erred by substituting its finding that Wilson continued to drive because he was "impelled to continue to work" for the agency's finding on the legal causation issue.
V. Scope and Standards of Review.
Our review of a final decision of the workers' compensation commissioner, like that of the district court, is for correction of errors of law. Second Injury Fund v. Shank, 516 N.W.2d 808, 812 (Iowa 1994). In determining whether the district court erred in exercising its power of judicial review, we apply the standards of Iowa Code section 17A.19(8) to the agency action. Williamson v. Wellman Fansteel, 595 N.W.2d 803, 806 (Iowa 1999); E.N.T. Assocs. v. Collentine, 525 N.W.2d 827, 829 (Iowa 1994). The agency's findings are akin to a jury verdict, and we broadly apply them to uphold the decision. Shank, 516 N.W.2d at 812.
We may reverse, modify, or remand to the commissioner for further proceedings if the agency's action was affected by an error of law, or if it is not supported by substantial evidence when the record is viewed as a whole . Quaker Oats Co. v. Ciha, 552 N.W.2d 143, 150 (Iowa 1996). Evidence is substantial if a reasonable mind would find it adequate to reach the same findings. Murillo v. Blackhawk Foundry, 571 N.W.2d 16, 17 (Iowa 1997). The commissioner's decision does not lack substantial evidential support merely because inconsistent conclusions could be drawn from the same evidence. Id. The ultimate question is not whether the evidence supports a different finding, but whether it supports the finding the commissioner actually made. Id.
VI. The Merits.
(a.) Medical Causation Issue. The agency's articulation of the medical causation issue required Wilson to produce doctors to testify "whether the exertion in fact caused the heart attack." Wilson did not claim, and Iowa law did not require him to prove, his work exertion "in fact caused the heart attack." The record includes substantial expert medical evidence tending to prove the damage to Wilson's heart was aggravated during the time he continued to work and consequently delayed medical treatment. The agency clearly erred in its determination such evidence was insufficient as a matter of law.
The district court likewise erred when it affirmed the agency's decision on the medical causation issue, reasoning Wilson failed to present expert medical evidence to prove that "continuing to drive a modern automobile aggravated his condition." We acknowledge that no expert opined that the physical exertion expended by Wilson while driving for several hours after the onset of heart attack symptoms was significantly greater than if he had merely sat in the hotel and waited for several hours before seeking treatment. As more fully explained below in our discussion of the applicable standard of legal causation, we conclude the district court erred in concluding that a claimant asserting a heart attack claim under the "aggravation theory" must prove through expert testimony that physical exertion while working and delaying medical treatment after onset of symptoms (1) was greater than exertion in nonemployment life and (2) caused aggravation of the resulting heart damage. Wilson's burden to prove medical causation required him only to present a preponderance of medical evidence tending to prove that, as a result of continuing to work in the course and scope of his employment and thereby delaying medical treatment after the onset of the symptoms of his heart attack, the resulting damage to his heart was aggravated. We therefore reverse the district court's ruling on judicial review and the agency's appeal decision to the extent that they applied an erroneous legal standard for proof of medical causation.
The testimony of Dr. Reiss suggests that, although the delay in seeking treatment for the heart attack did aggravate the extent of the resulting heart damage, the act of driving during the delay was not significant.
(b.) Legal Causation Issue. The legal causation issue requires us to focus our attention upon policy considerations distinguishing compensable injuries from those which are uncompensable. These considerations have led our supreme court to hold, for example, that mere proof a physical injury occurred during work hours is generally insufficient to prove it arose out of employment. See Miedema v. Dial Corp., 551 N.W.2d 309, 311 (Iowa 1996) (holding back injury sustained during work hours while attempting to flush a toilet not compensable).
The sometimes-difficult challenge of isolating work-related causal factors from others has led to the adoption of special legal causation standards which are applied in certain types of workers' compensation cases. For example, a claimant who asserts a mental-mental claim must prove the mental stress which caused the claimed injury was greater than that routinely experienced by other employees in the same or similar circumstances. Dunlavey v. Economy Fire Cas. Co., 526 N.W.2d 845, 853 (Iowa 1995). Our supreme court has concluded that, in the absence of such proof, the policy of the law will not support imposition of liability upon the employer because a sufficient causal nexus between the employment and the mental-mental injury has not been established. Id.
Courts and agencies also face challenging legal causation issues in heart attack cases. Many of these cases present a claimant with substantial pre-existing coronary artery disease or a history of genetic and life-style factors which create a predisposition to cardiac incidents. In an effort to distinguish work-related cardiac injuries from others, our supreme court has formulated a distinct set of legal causation rules for heart attack cases. In Sondag v. Ferris Hardware,
220 N.W.2d 903 (Iowa 1974), the court identified three scenarios in which the policy of the law will support imposition of workers' compensation liability upon employers in heart attack cases. Wilson relies upon only the third of these scenarios as he does not contend his heart attack was precipitated by customary or unusual work-related exertion. He contends his heart damage was aggravated because he felt impelled to continue, and did continue, driving to arrive as scheduled at his next training destination.
Claimants with pre-existing "circulatory or heart conditions" can recover workers' compensation benefits for a heart attack if they prove: (1) their work ordinarily requires heavy exertions which aggravates or accelerates the condition; or (2) their work required exertion greater than that of nonemployment life; or (3) they felt impelled to continue, and did continue, "exertions required by the employment after onset of the heart attack," thus aggravating their heart damage. Sondag, 220 N.W.2d at 905-06.
The workers' compensation commissioner concluded that Wilson failed to prove legal causation because he did not prove either "work stress . . . greater than he experienced in [his] non-employment life . . . [or] greater than normal work exertion." The agency thus failed to follow the legal causation standard prescribed by Sondag and advanced by Wilson, and its appeal decision determination of legal causation must therefore be reversed.
We note that the district court disagreed with the agency's ruling on legal causation, and expressly found Wilson felt impelled to continue driving after onset of his heart symptoms and that such driving "was required by [Wilson's] employment." Good Will cross-appeals from these findings, asserting that the fact-finding function is reserved to the agency as to issues upon which reasonable minds may differ. We agree. Judicial review of final agency action is not de novo review. Mortimer v. Fruehauf Corp., 502 N.W.2d 12, 13 (Iowa 1993). We accordingly reverse the district court's fact finding on this issue.
Because the agency must on remand again consider the issue of medical and legal causation, we shall further clarify the standard about which the parties strenuously disagree. Good Will contends a claimant fails to prove legal causation in a heart attack case unless he proves work-related exertions aggravated his heart damage while he continued to work after onset of the symptoms. In support of its position, Good Will notes that Sondag specifically recognized the compensability of claims for "damage caused by continued exertions required by the employment after the onset of a heart attack." Sondag, 220 N.W.2d at 906 (emphasis supplied). Moreover, Good Will notes that the record contains no medical evidence tending to prove that the exertion required of Wilson as he continued to drive an automobile for several hours after onset of heart attack symptoms aggravated Wilson's heart damage.
Wilson posits that claims such as his, brought under the third Sondag causation scenario, do not require proof of exertion greater than that required by the claimant's ordinary job activities during the time he continues to work and delays treatment after onset of heart attack symptoms. In essence, Wilson contends any work activity after onset of heart attack symptoms — even driving a modern automobile for several hours — can satisfy the exertion standard referenced in the third Sondag scenario. We agree. In its discussion of the legal causation standard controlling the compensability of heart injuries aggravated by continued work after onset of symptoms, our supreme has court observed:
The common knowledge that complete rest and immobilization are ordinarily prescribed for persons who are undergoing a heart attack has been judicially noticed. (citations omitted).
Sondag, 220 N.W.2d at 906. This language signals the court's understanding that any work activity requiring exertion more substantial than rest and immobilization after onset of heart attack symptoms may suffice to supply the legal causal nexus between the employment and the injury.
In Varied Enterprises, Inc. v. Sumner, 353 N.W.2d 407 (Iowa 1984), our supreme court affirmed the commissioner's determination that Sumner's continued truck driving after onset of heart attack symptoms caused a compensable aggravation of his myocardial damage. Sumner, 353 N.W.2d at 411. We acknowledge that in that case an expert opined Sumner's heart damage was aggravated while he continued, after onset of symptoms, to drive a semi-truck which was not equipped with power steering. Id, at 410. Although Sumner's post-onset driving thus arguably required greater exertion than Wilson's, we do not believe Sumner stands for the proposition that exertion greater than that required by the claimant's ordinary job duties is required to establish legal causation under the third Sondag legal causation standard. Although the work performed by Sondag after onset of his cardiac symptoms did involve substantial exertion, Sondag, 220 N.W.2d at 904, we do not believe heavy or unusual exertion must be shown where claimant asserts aggravation of cardiac damage resulting from continued work and a resultant delay of medical treatment after onset of symptoms. We conclude the third Sondag legal causation alternative merely requires proof of some work activity following onset of symptoms and aggravation of the heart damage as a consequence of the resulting delay in obtaining medical treatment. The causal nexus between the employment and the injury in such cases is supplied by proof that the employee (1) reasonably believed he was impelled to continue working in the service of the employer after the onset of symptoms; (2) continued work after onset of symptoms resulting in delay of medical treatment; and (3) sustained aggravation of the heart damage.
We must also clarify one other aspect of the legal causation issue essential to the agency's remand decision. The commissioner concluded Wilson "failed to establish that [Good Will] required [him] to continue working" after the onset of symptoms. This language suggests the agency interpreted the applicable legal causation standard to require Wilson to prove he was expressly directed to continue working after onset of his heart attack symptoms. Wilson has no such burden. The author of a leading workers' compensation treatise has observed:
The most obvious relevance of this element [continuing exertion after symptoms] is in showing causal connection between the obligations of the employment and the final injury; for if the workman, for some reason, feels impelled to continue with his duties, when, but for these duties, he could and would have gone somewhere to lie down at once, the causal contribution of the employment to the aggravation of the condition is clear.
1A Larson, The Law of Workman's Compensation § 38.64(c), at. 7-145 (1972). Although proof of an employer's express directive requiring an employee to continue working after onset of heart attack symptoms would clearly suffice to establish legal causation, such evidence is not required. The agency should consider all of the circumstances surrounding the employee's motivation to continue working after onset of symptoms.
These include, but are not limited to whether the claimant was motivated by express or implied message from the employer to the employee suggesting (a) urgency of, or a schedule for, completion of a work-related task or objective, or (b) the employer's expectation that job duties be completed without interruption or delay. See Varied Enterprises, Inc. v. Sumner, 353 N.W.2d 407, 409 (Iowa 1984) (finding sufficient employee's belief that his probationary job status was "shaky").
Although a claimant carries no burden to prove an express order to continue working, we must clarify the standard to be applied by the agency when determining whether Wilson reasonably believed he was impelled to continue working after onset of the cardiac symptoms. See M. Carmoney , When Are Heart Attacks Compensable Injuries Under Iowa Workers' Compensation Law? 49 Drake L. Rev. 621, 635 (2001) ("Under present Iowa law, it is clear that this is not to be an objective determination, but rather requires an examination into the subjective mindset of the employee."). Although it is true that our supreme court in Varied Enterprises, Inc. v. Sumner, 353 N.W.2d 407, 409 (Iowa 1984) affirmed the commissioner's finding that the claimant felt impelled to continue driving because of the rather shaky nature of his probationary status with his employer, the court decided only the sufficiency of the evidence to support the agency's finding as to the claimant's motive for continuing to work after the onset of symptoms. The court did not expressly decide whether this element of legal causation should be judged by an objective or subjective standard.
We conclude an objective standard should be applied in this context. This standard balances the competing policy interests implicated here. A reasonableness standard is not onerous to the claimant because we do not anticipate that most employees will continue working and intentionally delay procurement of treatment after onset of cardiac symptoms unless they reasonably believe they are impelled to continue working. Moreover, an objective standard provides reasonable assurances to employers that claimants will be unable to convert uncompensable heart attack claims into compensable claims by merely continuing to work and delaying medical treatment after onset of symptoms.
VII. Conclusion.
Having decided that legal errors were committed by the agency and the district court affecting the issues of medical and legal causation, we reverse and remand this proceeding to the workers' compensation commissioner for further proceedings consistent with our opinion. Costs of this appeal are taxed one-half
to the appellant and one-half to the appellees.
REVERSED ON APPEAL; REVERSED ON CROSS-APPEAL; REMANDED TO THE WORKERS' COMPENSATION COMMISSIONER.
Huitink, J. concurs; Sackett, C.J., dissents.
I would affirm without opinion.