Court of Appeals Affirms Commissioner's Rating of Distal Clavicle Excision Which Used a 25% Modifier

 Koeller v. Cardinal Logistics Management Corp., No. 25-0172 (Iowa App. Dec. 3, 2025)

Claimant suffered an injury to his shoulder and was found to need a shoulder surgery, which included a distal clavicle excision.  Dr. Bollier, the physician who performed the surgery, provided a 6% permanent impairment rating based on loss of range of motion. No rating was provided for the distal clavicle excision, as Dr. Bollier did not believe this was related to the work injury. Dr. Taylor, claimant's IME physician, provided a 19% upper extremity impairment rating, which included a 10% rating for the distal clavicle excision.  In making this rating, Dr. Taylor indicated he did not use the 10% modifier from Table 16-18 of the AMA Guides because he believed that Table 16-27 was inadvertently listed as one of the tables to which the modifier should be applied.  Dr. Crites performed a record review and also found that the modifier did not apply and gave the full 10% impairment rating.  Dr. Crites ultimate rating, which also included range of motion and ratings for a biceps tenotomy, amount to 12% of the whole person.

The deputy adopted Dr. Taylor's ratings for the most part.  Dr. Crites' rating was rejected because he had only provided a file review and not an examination of claimant. The deputy, however, applied the 25% modifier to the distal clavicle excision and found a 13% impairment of the upper extremity. The commissioner affirmed on appeal and the district court affirmed the commissioner.

On appeal to the Court, claimant argues that Dr. Taylor's 19% impairment rating was the proper rating, while defendants argued that the 6% rating of Dr. Bollier was appropriate. The Court notes that section 85.34(2) requires the use of the AMA Guides and that 85.34(2)(x) requires that lay testimony or agency expertise shall not be used in determining the degree of permanent impairment. With respect to the issue of the modifier, the Court concludes that although Dr. Taylor was entitled to disagree with the AMA Guides, he "cannot ignore them for the purpose of a workers' compensation claim." The Court viewed Dr. Taylor's opinion as disregarding the plain language of the AMA Guides. The Court rejects defendants' argument that Dr. Bollier's rating was appropriate, finding that the decision of the agency was supported by substantial evidence. The Court also rejected defendants' argument that alternate medical care was inappropriate on substantial evidence grounds.

Judge Langholz dissented, finding that Dr. Taylor's opinion to eschew use of the 25% modifier was correct. He would conclude that focusing on only one general instruction rather than on the whole text, gives an incomplete and inaccurate understanding of the Guides. Although the Guides have a specific provision given the percentage of upper extremity impairment, the Commissioner applied a general provision to reduce the award, "thus improperly reducing the upper-extremity-impairment rating directed by the specific provision." The Judge finds that Table 16-27 gives impairment ratings for the upper extremity and since the "impairment rating is already for the upper extremity, the 25% modifier ... has no applicability." The Judge also concludes that the interpretation of the meaning of the AMA Guides is a question of law which is to be reviewed without giving deference to the commissioner. "Bottom line, the workers' compensation commission erroneously interpreted the AMA Guidelines to require use of a modifier from table 16-18 to reduce an upper-extremityimpairment rating given by table 16-26."  The dissent potentially sets up a request for further review by the Supreme Court.