Shoulder Injuries Under Iowa Law

Shoulder injuries, and how they are compensated, have been a controversial issue in Iowa law since 2017. Before the 2017 changes to Chapter 85 of the Iowa Code, shoulder injuries were considered injuries to the body-as-a-whole, and compensable for up to 500 weeks under the industrial disability analysis. After the changes, however, shoulders were treated as scheduled injuries that were compensable for only 400 weeks. On its surface, this sounds like a straightforward change. The years since, however, have seen considerable debate regarding what the term “shoulder” even refers to and exactly how an injury to the region should be assessed and compensated.

Nowhere in the statute was the word “shoulder” defined. “Shoulder” was not defined in the AMA Guides, either, or used by doctors when assigning impairment ratings to the region. The term they used was “upper extremity,” which encompasses the entirety of the arm. Moreover, while authorities like Stedmans Medical Dictionary defined the shoulder joint narrowly as “a ball-and-socket synovial joint between the head of the humerus and the glenoid cavity of the scapula,” prior court rulings had decreed that the definition of shoulder also included the “tendons, ligaments, muscles, and articular surfaces connected to the glenohumeral joint.” Chavez v. MS Technology LLC, 972 N.W.2d 662, 667 (Iowa 2022).

The end result of this was an ambiguity about what an injury to the shoulder entailed—an ambiguity that claimant-side attorneys used to argue that injuries to the shoulder should be defined as injuries to the joint alone. In their decision in Chavez v. MS Technology LLC, the Supreme Court of Iowa resolved this ambiguity by deciding that the word “shoulder,” as used in Section 85.34(2)(n) “must be defined in the functional sense to include the glenohumeral joint as well as all of the muscles, tendons, and ligaments that are essential for the shoulder to function.” Id. at 668. This decision did a lot to clarify how cases involving shoulder claims would proceed in Iowa; however, some questions still remain.

Recently, plaintiff-side attorneys have begun arguing that upper extremity impairment ratings assigned to claimants with shoulder injuries should be multiplied by sixty percent in order to arrive at an impairment rating that applies exclusively to claimant’s shoulder. The rationale behind this theory is that it accounts for the shoulder joint’s involvement in the function of the upper extremity—which, according to the AMA Guides, is sixty percent. Whether or not this theory will prove successful in court remains to be seen. However, it has two significant hurdles to clear before it can become the law of the land: the fact that its rationale runs contrary to the Guides’ own directives for the issuance of impairment ratings, and the fact that this “weighting” has already been accounted for by the shoulder being worth 60% more than the upper extremity, as originally proposed in the 2017 amendments to the Iowa Workers’ Compensation Act.

Claims involving shoulder injuries are likely to remain sources of controversy, debate, and novel theories for years to come. Defendants should be careful to ensure that injuries to the shoulder are treated solely as scheduled injuries in accordance with 85.34(2)(n). Claimants, on the other hand, should be mindful to take advantage of any opportunities to expand shoulder claims into body-as-a-whole claims—all while remembering that injuries to the muscles, tendons, and ligaments attached to the glenohumeral joint will not be sufficient for this purpose.