In 2017, the Iowa Legislature amended the Iowa Workers’ Compensation Act to make shoulder injuries part of the schedule. Previously, shoulder injuries were treated as body as a whole injuries and compensated using an industrial disability analysis. Now, under the 2017 amendments, shoulder injuries are to be compensated based on the functional impairment rating out of 400 weeks of benefits.
Confusion Abounds
Without any accompanying definition of “shoulder” in the 2017 amendments, employers and insurance companies were having difficulties in determining how to issue permanent partial disability benefits. Is the injury compensated industrially or as a scheduled member? For example, employers and insurance carriers conflict with claimants on what anatomical parts compose the shoulder (compensated under the schedule) versus extend to the body as a whole (compensated industrially). Claimant attorneys have been arguing rotator cuff injuries are not included in the statutory definition of “shoulder,” and are instead injuries to the body as a whole.
Another issue is whether permanent partial disability benefits should be paid based on the impairment rating to the upper extremity or to the body as a whole if the injury is in fact limited to the schedule. For example, the AMA Guides to the Evaluation of Permanent Impairment, 5th Edition does not give permanent impairment ratings for “shoulders,” as required under the statute, only for upper extremities and the body as a whole. Thus, there has been major ambiguity.
Commissioner’s Decisions Clarify Definition of “Shoulder”
Since the new 2017 amendments, by my count, there have been five arbitration decisions dealing with whether an injury to the shoulder joint and surrounding area is to the “shoulder” or to the body as a whole. The Commissioner has now weighed in on two of those arbitration decisions.
In Deng v. Farmland Foods, Inc., the Commissioner concluded that muscles making up the rotator cuff are injuries to the “shoulder.” The Commissioner gave a very thorough analysis of how he arrived at this conclusion, and those working in workers’ compensation are encouraged to read the decision in full. In summary, the Commissioner found that because the rotator cuff’s main function is to stabilize the shoulder joint (glenohumeral joint) and the rotator cuff muscles are so entwined with the glenohumeral joint, these muscles are included in the statutory definition of “shoulder” under the 2017 amendment to Iowa Code section 85.34(2)(n).
In his second appeal decision dealing with the shoulder amendment, Chavez v. MS Tech., LLC, the Commissioner incorporated his analysis and conclusions from Deng. Note, the Deng case involved an injury to the infraspinatus muscle, which was found to be part of the rotator cuff and shoulder. The Chavez case, on the other hand, involved tears to the supraspinatus, infraspinatus, and subscapularis muscles, tears to the biceps tendon, and tears to the labrum. As part of the surgery, a subacromial decompression was performed. All of these injuries were discussed in turn.
The Commissioner found that the supraspinatus and subscapularis muscle tears were like the infraspinatus injury in Deng. These muscles also make up the rotator cuff, so they are included in the statutory definition of “shoulder.” Likewise, the Commissioner concluded the that the “labrum is part of the cavity in which the joint sits” and because it is “closely connected both in location and function to the glenohumeral joint,” it is also included in the statutory definition of “shoulder.”
In concluding the subacromial decompression involved treatment to the shoulder, the Commissioner reasoned that a subacromial decompression is performed to relieve pressure on the rotator cuff muscles. Thus, because “claimant’s subacromial decompression impacted two anatomical parts that are essential to the functioning of the glenohumeral joint,” this treatment was to the “shoulder.”
In both Deng and Chavez, the Commissioner awarded benefits based on the impairment rating to the upper extremity, not the impairment rating to the body as a whole. The Commissioner looked at the AMA Guides to the Evaluation of Permanent Impairment, 5th Edition, which discusses injuries to shoulders in terms of the upper extremity. Further “for a single scheduled member injury, [the] agency has historically not utilized a whole person impairment rating.”
Further Definition of Shoulder Forthcoming
In summary, if a work injury is to the rotator cuff (including infraspinatus, supraspinatus, and subscapularis muscles), labrum, or involves a surgical subacromial decompression, these injuries will likely be considered a scheduled member shoulder injury. While other muscles, ligaments, bones, or articular surfaces may also eventually be included in the statutory definition of “shoulder,” this is yet to be seen. Other shoulder cases on appeal may eventually broaden this definition: Deleon v. Kingdom Cargo, LLC; Smidt v. JKB Restaurants, LC; and Rubalcava v. Siouxpreme Egg Prod., Inc. The Deng and Chavez cases provide a good starting point and excellent instruction, but they will likely be appealed. This blog will be updated in that regard.
The Big Picture
For employers and insurance carriers, if a worker has injured his/her shoulder and an impairment rating is given by the treating doctor, make sure to request the rating to the upper extremity. Some doctors will issue ratings to the body as a whole only, but it is important to know the rating to the upper extremity under the AMA Guides to the Evaluation of Permanent Impairment, 5th Edition in light of these decisions. The upper extremity rating is then multiplied by 400 weeks to ascertain the number of weeks of compensation.
Finally, it will continue to be important to get a detailed opinion from the treating doctor as to whether the work injury is to the shoulder versus the body as a whole. Consider asking the treating doctor to detail the specific injuries (i.e. what muscles, ligaments, bones, or articular surfaces were injured), as well as whether those parts are essential to the function of the shoulder joint.
