Cutler Law Firm, P.C.

The Commissioner Reduces Award for Distal Clavicle Excision

In 2017, the Iowa legislature amended the workers’ compensation statutes to provide that shoulder injuries are no longer injuries to the body as a whole, but are scheduled member injuries compensated on a percentage of 400 weeks. A separate amendment provided that when permanent impairment is based on the extent of the worker’s functional disability, the percentage of permanent impairment must be determined solely by using the Fifth Edition of the AMA Guides to the Evaluation of Permanent Impairment. As a result, workers’ compensation adjusters, attorneys, and physicians have increased their focus and attention on what exactly the Guides say about various injuries and medical conditions.

One area of focus has been on distal clavicle excisions. A distal clavicle excision (also known as a “Mumford procedure”) is a common procedure that is performed during a shoulder surgery where a small, projecting spur from the distal clavicle is removed or shaved off in order to decrease pain and improve shoulder function. For the most part, workers have argued that the AMA Guides require 10% upper extremity impairment to be added whenever the procedure is performed pursuant to Table 16-27 of the Guides, which awards 10% upper extremity impairment for a resection arthroplasty of the distal clavicle. Employers have countered that no impairment should be added because the procedure is not a true arthroplasty, the procedure decreases disability by improving function and decreasing pain, and because many orthopedic shoulder specialists in Iowa agree that adding 10% impairment for the procedure is not appropriate in all cases.

In a recent appeal decision, the Commissioner held that the plain language of the AMA Guides requires impairment to be added when a distal clavicle excision procedure is performed, but not at the full 10%. Jay v. Archer Skid Loader Services, LLC, File No. 19003586.01 (App. Dec. Aug. 23, 2022). Instead, a 25% multiplier is applied under Table 16-18 to result in an additional 2.5% impairment to the upper extremity. Then, the Combined Values Chart at page 604 of the Guides is used to determine the final rating by combining the 2.5% impairment with the worker’s base rating for loss of range of motion, decreased strength, etc. As a practical matter, then, a distal clavicle excision only increases upper extremity impairment by 2.5%, not 10%.

We wanted you to be aware of this decision as it will likely impact many present and future shoulder claims in Iowa. Of course, either party in the Jay decision may file a petition for judicial review and ask the Iowa appellate courts to review and perhaps reverse the decision, but unless or until that happens, the Jay decision will have to be followed by the deputy commissioners who preside over these cases.

As always, please feel free to contact any of our attorneys for questions regarding this or any other workers’ compensation issues.

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