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Angel Richards v. Creston Nursing & Rehabilitation Center

January 9, 2013


Appeal from the Iowa District Court for Polk County, Glenn E. Pille, Judge.

The opinion of the court was delivered by: Tabor, J.

Angel Richards appeals a district court order affirming the denial of her claim by the workers' compensation commissioner. AFFIRMED.

Considered by Potterfield, P.J., and Danilson and Tabor, JJ.

Angel Richards appeals a judicial review order affirming a decision from the workers' compensation commissioner that she did not sustain a permanent injury while working for the Creston Nursing and Rehabilitation Center in October 2006. She argues the commissioner's causation determination hinged on erroneous factual findings.

Like the district court, we conclude substantial evidence supports the agency's decision that Richards failed to meet her burden to prove by a preponderance of the evidence that her work injury caused permanent impairment or disability. The deputy commissioner cited Richards's inconsistent and incredible accounts of her back injury as the primary reason for denying benefits. In turn, the deputy discounted a medical opinion based on "a very suspect history" of the injury offered by Richards. The commissioner adopted these findings on intra-agency appeal. Because assigning credibility is a function we leave to the fact finder, we defer to the agency's determination.

I. Background Facts and Proceedings

Angel Richards, now thirty-three years old, worked for several employers leading up to and following the stipulated injury date. Her medical records show a history of back pain from 2002 through 2009. In September 2002 Richards saw a chiropractor for pain in her mid-to-low back and neck associated with falling backwards while she carried a sixty-pound child up bleachers. She returned in August and October 2003 with more low back symptoms, and again in July 2004 after falling on some stairs. In late 2004 Richards experienced pain radiating down her left leg after bending over to pick up a spoon.

Richards began working as a nursing assistant at Creston Nursing and Rehabilitation Center (CNRC) in October 2005. She obtained her certified nursing assistant (CNA) certificate, finished on-the-job training, and worked at the facility full time. She helped elderly residents with daily needs, transfers, lifts, and feeding.

Richards injured her back on February 13, 2006, while moving a patient. After seeking medical attention the night of the incident, she returned to light duty work four days later, and according to the attending physician, was fully recovered on February 27, 2006. The parties stipulated that on October 10, 2006, Richards injured her low back while assisting a resident out of bed. After the pain persisted for a week, Richards visited Dr. John Hoyt, who diagnosed her with acute low back pain. An MRI indicated "mild degenerative disc disease with a small central disc protrusion at L5-S1." Richards received two epidural steroid injections in November and continued on her pain medications, muscle relaxers, and physical therapy. Her conditions improved and she began working half days with no lifting, though she still experienced some radiating right leg pain.

Because Richards's radiating leg and low back pain had improved, in early December 2006 Dr. Hoyt authorized her to lift up to fifty pounds, but limited her to assisted transfers of patients. Later in December she aggravated her back while cleaning under tables at work.

Orthopedic surgeon Dr. Lynn Nelson saw Richards in January 2007 and ordered a second MRI, which revealed "a mild degree of disc desiccation at L4-5 and [L5-S1] with very small (noncompressive) degenerative disc bulges at both levels [and] [t]he thecal sac and nerve roots are without significant compression." Because these results confirmed Dr. Nelson's theory that Richards was not experiencing a "significant degree of impingement," he told her neither surgical treatment nor injections would be necessary, though he did restrict her to office work with no repetitive movements and a fifteen-pound lifting restriction.

Later in January 2007, Richards slipped on ice in CNRC's parking lot. She again sought treatment from Dr. Hoyt, who considered the second MRI to be "normal." Because her symptoms were improving, he switched her medication from Percocet to Vicoden. Richards told Dr. Hoyt that a CNRC administrator questioned her work restrictions and she asked Dr. Hoyt to provide a note to her employer.*fn1 On February 21, 2007, CNRC fired Richards for "excessive absenteeism" after she overslept and informed her boss she could not work her shift because of child care issues.

Dr. Hoyt discontinued Richards's Vicoden in March 2007 and discharged her from his care.*fn2 Richards worked as a telemarketer until June 2007, when she left that job to care for her father-in-law. Once his condition improved, Richards began working as a CNA at Crest Haven Care Center; she held that job from January to June of 2008. In her pre-employment physical with Dr. James Gerdes, Richards revealed her history of lower back issues but reported she was pain free at the date of examination. She testified her work duties at Crest Haven were similar to those at CNRC, but less lifting was required because the residents were more independent. She worked without restrictions and denied any back pain. Richards testified that conflict with co-workers, the needs of her father-in-law, and her desire to try a different line of work spurred her departure from Crest Haven.

In April 2008, Richards started working as a cashier for a Kum & Go convenience store. She testified the job involved less lifting, and although she experienced slight discomfort, it was not enough to interfere with her duties.*fn3

At 4:00 a.m. on August 1, 2008, Richards fell in the Kum & Go parking lot. Later that day, she visited Dr. Gerdes, complaining of severe tail bone and back pain. Dr. Gerdes diagnosed her with acute lower back spasm and prescribed pain medication and muscle relaxers. Richards returned to work a week later, but was restricted from lifting more than twenty pounds or making repetitive movements that would impact her spine. In follow-up ...

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