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IN THE COURT OF APPEALS OF IOWA No. 2-1095 / 12-0999 Filed February 27, 2013 ALICE TALTON, Petitioner-Appellant, vs. FLEUR DELIS MOTOR INNS, INC. and CAMBRIDGE INTEGRATED SERVICES GROUP, INC., Respondent-Appellee. ________________________________________________________________ Appeal from the Iowa District Court for Polk County, Eliza J. Ovrom, Judge.

An injured employee appeals from the district court's decision affirming the agency's denial of workers' compensation benefits. AFFIRMED.

Nicholas W. Platt of Hopkins & Huebner, P.C., Des Moines, for appellant. Charles A. Blades of Scheldrup, Blades, Schrock, Smith & Aranza, P.C., Cedar Rapids, for appellee.

Considered by Doyle, P.J., and Mullins and Bower, JJ.

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MULLINS, J. We consider whether there is substantial evidence to support the workers' compensation commissioner's (commissioner) conclusion that employee Alice Talton's work injury did not cause her arthritis or the pain in her knee and back, that she was not entitled to alternate medical care, and that she was not entitled to additional temporary disability or healing period benefits. The district court affirmed the commissioner's ruling and so do we. I. Background Facts On April 17, 2007, Talton sustained a stipulated work-related injury when a seven-pound can of tomatoes fell about six feet onto her left foot. Talton's primary care physician referred her to podiatrist Dr. Robert Eells. Dr. Eells evaluated her foot and x-rays, and diagnosed an injury to the first metatarsal head. Talton saw Dr. Eells periodically for about three months. On July 18, 2007, Dr. Eells referred Talton to Dr. Eric Barp, a foot surgeon, for possible removal of a fractured sesamoid. Talton met with Dr. Barp on July 19, 2007. He diagnosed a fractured fibular sesamoid on her left foot that he believed would heal with conservative treatment. He noted her back and hip pain "should subside once we get her out of the CAM boot. We will get her out of the CAM boot." Dr. Barp's assessment was sesamoiditis and arthritis in her big toe joint. In a November 20 letter to the nurse case manager, Dr. Barp stated he told Talton to stop using the CAM boot that day. The letter indicated he believed she had reached maximum medical improvement and that her left big toe arthritis was unrelated to her work injury.

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On January 11, 2008, Talton sought treatment on her own initiative from Dr. Vincent Mandracchia, a podiatrist at Broadlawns Medical Center. Dr.

Mandracchia assessed her condition as degenerative joint disease with hallux limitus first metatarsal phalangeal joint, left. Dr. Denise Mandi, a foot surgeon at Broadlawns Medical Center, performed an exostectomy on January 31. Talton had follow-up appointments with Dr. Mandi on February 26 and March 25, 2008. Talton was recovering well from surgery, but reported that her pain was "about the same." replace the left big toe joint. Talton saw other doctors throughout 2008 to treat pain in her right knee and lower back. Dr. David Wadle and Dr. Dana Simon of the Mercy Pain Dr. Mandi suggested hemi-implant surgery to

Medicine Center treated her for back pain. Dr. Simon indicated Talton's back pain was "probably secondary to the antalgic gait abnormality, maybe somewhat contributory." Dr. Wadle similarly stated that Talton's altered weight bearing

activities seem to have aggravated a pre-existing condition in her lower back. On March 26, 2008, Talton saw Dr. Timothy Kenney from the Iowa Orthopaedic Center for her knee pain. Dr. Kenney believed Talton's altered

weight bearing aggravated a pre-existing condition in her arthritic right knee but that this was a temporary condition caused by her altered gait while wearing the CAM boot. On July 8, 2009, Dr. Mandracchia wrote a letter explaining that he believed the joint disease and cartilage damage in Talton's left big toe directly

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resulted from her April 2007 work injury and that joint replacement was a better option than conservative treatment. II. Prior Proceedings On January 16, 2009, Talton filed a workers' compensation petition. The parties stipulated she sustained a left foot injury arising out of and in the course of her employment on April 17, 2007. Talton claimed she also experienced right knee and low back problems resulting from the injury. On August 19, 2010, the deputy workers' compensation commissioner (deputy) ruled in Talton's favor, finding her left foot injury altered her gait and thereby caused her right knee and low back problems. The deputy awarded continuing temporary partial disability benefits and alternate medical care. The deputy found Talton had not yet

reached maximum medical improvement, and therefore permanent partial disability issues were not ripe. On intra-agency appeal from the arbitration decision, the final agency decision1 found Talton's stipulated injury had healed and the ongoing problems with her left foot, right knee, and low back were unrelated. The commissioner awarded temporary disability benefits only through November 20, 2007, the date the commissioner found Talton reached maximum medical improvement. The commissioner denied Talton's requests for alternate medical care and penalty benefits.

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A deputy workers' compensation commissioner issued a final agency decision pursuant to a delegation of authority from the commissioner.

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Talton filed a petition for judicial review in district court. The district court affirmed the commissioner's decision. III. Standard of Review Iowa Code chapter 17A governs judicial review of the decisions of the workers' compensation commissioner. Iowa Code

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