BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         WILLIAM PICKRELL,
 
                                          File No.  626523
 
              Claimant,
 
                                            R E V I E W 
 
         VS.
 
                                         R E 0 P E N I N G 
 
         JOHN DEERE OTTUMWA WORKS,
 
                                          D E C I S I 0 N
 
              Employer,
 
              Self-Insured,
 
              Defendant.
 
         
 
                              STATEMENT OF THE CASE
 
         
 
              This is a proceeding in review-reopening brought by claimant 
 
         William Pickrell against defendant self-insured employer John 
 
         Deere Ottumwa Works as the result of injuries sustained on June 
 
         25 or July 3, 1979.  The matter came on for hearing before the 
 
         undersigned deputy industrial commissioner in Ottumwa, Iowa, on 
 
         February 28, 1989 and was considered fully submitted at the close 
 
         of hearing.  Both parties subsequently filed briefs.
 
         
 
              Claimant originally filed a petition in arbitration on 
 
         February 14, 1980.  Claimant voluntarily dismissed that petition 
 
         without prejudice on September 9, 1980.  Claimant subsequently 
 
         filed a petition in review-reopening on July 5, 1983.  An 
 
         application for approval of agreement for settlement (executed on 
 
         March 18, 1985 by claimant, his present counsel and defendant's 
 
         present counsel) was filed on March 27, 1985.  An order approving 
 
         the agreement for settlement was filed by Deputy Industrial 
 
         Commissioner Steven E. Ort on the same day.  Although the copy of 
 
         that order contained in the industrial commissioner's file bears 
 
         only the signature stamp of Deputy Ort, it is clear that the 
 
         parties have in all respects treated the agreement for settlement 
 
         as approved and binding.  The present petition in 
 
         review-reopening was subsequently filed on June 26, 1986.
 
         
 
              The record in this proceeding consists of joint exhibits 1 
 
         through 11 and the testimony of the following witnesses: 
 
         claimant, Bob McCall, Marilyn Pickrell and Craig Dalbey.
 
         
 
         
 
         
 
         PICKRELL v. JOHN DEERE OTTUMWA WORKS
 
         Page 2
 
         
 
         
 
                                      ISSUES
 
         
 
              Pursuant to the prehearing report submitted by the parties 
 
         and approved by the deputy at hearing, the following matters have 
 
         been stipulated:  that an employment relationship existed between 
 
         claimant and employer at the time of injury; that claimant 
 
         sustained an injury on June 25 and/or July 3, 1979 arising out of 
 
         and in the course of that employment (only one injury is at 
 
         issue, and the slight discrepancy as to the correct injury date 
 
         is of no real significance); that the injury caused both 
 

 
         
 
 
 
 
 
 
 
         temporary and permanent disability; that claimant sustained 
 
         permanent disability to the body as a whole; that the appropriate 
 
         rate of compensation is $264.39; that affirmative defenses are 
 
         waived; that claimant's entitlement to medical benefits is no 
 
         longer in dispute; that defendant is entitled to credit under 
 
         Iowa Code section 85.38(2); that defendant paid claimant 138 
 
         weeks, 1 day of compensation at the stipulated rate prior to 
 
         hearing.
 

 
         
 
 
 
 
 
         
 
              Issues presented for determination include: the extent of 
 
         claimant's entitlement to compensation for temporary total 
 
         disability/healing period and permanent disability, along with 
 
         the commencement date thereof; whether claimant's condition has 
 
         changed since the agreement for settlement; taxation of costs.
 
         
 
              Prior to the agreement for settlement, this matter was 
 
         scheduled for hearing on December 4, 1984.  The parties reached 
 
         agreement as to settlement on or shortly before that date.  
 
         However, as has been seen, settlement documents were not 
 
         submitted to this agency until March 27, 1985, approximately 
 
         three and one-half months later.  Claimant's counsel argued that 
 
         claimant sustained an exacerbation of his back problems in 
 
         February, 1985 and is of the view that any alleged change in 
 
         claimant's condition should be measured as of his condition on 
 
         December 4, 1984 rather than the date settlement documents were 
 
         filed and approved.  Defendant is of the view that any change in 
 
         claimant's condition should be measured as of the date the 
 
         agreement for settlement was filed and approved.
 
         
 
                              REVIEW OF THE EVIDENCE
 
         
 
              The application for approval of agreement for settlement 
 
         pursuant to Iowa Code section 86.13 stipulated that claimant 
 
         sustained an injury arising out of and in the course of his 
 
         employment on June 25 and/or July 3, 1979.  Further, that 
 
         claimant's injuries resulted in functional impairment to his 
 
         lower back, left hip and left leg.  Claimant underwent a 
 
         laminectomy and removal of a herniated
 
         
 
         
 
         
 
         PICKRELL v. JOHN DEERE OTTUMWA WORKS 
 
         Page 3
 
         
 
         
 
         disc at L2-L3 on August 10, 1979.  Thereafter, claimant continued 
 
         to have complaints and sought further treatment from various 
 
         physicians.  Physicians at the Mayo Clinic in Rochester, 
 
         Minnesota, rated claimant as having sustained a 15 percent 
 
         permanent partial functional impairment to the body as a whole in 
 
         March, 1982.  Neurosurgeon Thomas A. Carlstrom, M.D., evaluated 
 
         claimant on November 8, 1983 and subsequently opined that 
 
         claimant had sustained a functional impairment to the body as a 
 
         whole of 7-8 percent.  Claimant was evaluated by neurologist 
 
         Thomas B. Summers, M.D., on September 25, 1984.  Dr. Summers 
 
         subsequently opined that claimant had sustained a functional 
 
         impairment of 15-20 percent to the body as a whole.
 
         
 
              The parties further stipulated that claimant had been 
 
         employed with defendant since July, 1973 as an arc welder and was 
 
         paid on a piecework basis.  Following his injury claimant 
 
         returned to work in January, 1980 and was able to perform his 
 
         regular job, except that he took intermittent time off for 
 
         further treatment.  In February, 1982 claimant was assigned 
 
         physical restrictions that caused him to be transferred to a job 
 
         as a salvage welder at an hourly rate of pay; claimant was 
 
         physically able to perform that job, but was laid off for 
 
         economic reasons in September, 1984 and had not been recalled to 
 
         work as of the time the application was executed.
 

 
         
 
 
 
 
 
         
 
              Based on the foregoing, the parties agreed that claimant had 
 
         been paid all healing period benefits due him and had sustained a 
 
         permanent partial disability of 22 1/2 percent of the body as a 
 
         whole or 112 1/2 weeks which defendant "is paying" without 
 
         interest.
 
         
 
              The order approving the agreement for settlement, itself 
 
         approved as to form by claimant's attorney, found claimant 
 
         entitled to no healing period benefits, but 112 1/2 weeks of 
 
         permanent partial disability at the rate herein stipulated by 
 
         reason of a 22 1/2 percent permanent partial disability to the 
 
         body as a whole.  The agreement was subject to a review-reopening 
 
         proceeding under Iowa Code section 85.26.  No interest was 
 
         assessed and defendant was fully discharged from all liability 
 
         with respect to claimant's present condition.
 
         
 
              Claimant testified that he was 52 years of age at the time 
 
         of hearing, having been born on November 15, 1936.
 
         
 
              Claimant began work for defendant as an arc welder, having 
 
         previous experience as a welder.  This position included 
 
         responsibility for reading blueprints, measuring tolerances and 
 
         "setting up" incentive jobs.  This was a
 
         
 
         
 
         
 
         PICKRELL v. JOHN DEERE OTTUMWA WORKS 
 
         Page 4
 
         
 
         
 
         piecework.position and claimant was in the top 25-50 percent of 
 
         similarly situated workers, averaging approximately $15.00 per 
 
         hour.
 
         
 
              Claimant described his injury as occurring when he picked up 
 
         pipes weighing approximately 20 pounds from a skid and felt a 
 
         "pop" in the back.  He initially saw the company physician, 
 
         Walter Herrick, M.D., but his care was soon transferred to Donald 
 
         D. Berg, M.D.
 
         
 
              Claimant underwent surgery to his lumbar spine on August 10, 
 
         1979.  The surgery helped some, but claimant still had continuing 
 
         problems.  Nonetheless, he did return to work with some pain in 
 
         January, 1980.  Claimant returned to his regular job and 
 
         continued earning about the same as before his injury.  However, 
 
         he found himself easily tired so he returned to Dr. Berg.  Dr. 
 
         Berg subsequently referred claimant to the Mayo Clinic in 
 
         Rochester, Minnesota in approximately December, 1981 and March, 
 
         1982.
 
         
 
              Claimant testified that due to restrictions imposed (he was 
 
         unclear as to whether by Dr. Berg or physicians at Mayo) he was 
 
         transferred to a position as material handler and salvage welder, 
 
         not a piece rate job.  Claimant continued in this employment with 
 
         some intermittent layoffs until September, 1984.  At that time, 
 
         he was laid off due to lack of seniority.  Claimant does not 
 
         allege that this layoff was a subterfuge or caused in any respect 
 
         other than by general economic considerations. claimant expected 
 
         to be recalled from this layoff, but had not been as of the date 
 
         of hearing.
 

 
         
 
 
 
 
 
         
 
              Claimant testified that he settled his earlier proceeding on 
 
         December 4, 1984 in the Ottumwa courthouse, although the 
 
         settlement was not finalized until the next year.  He understood 
 
         that checks had been issued in December, 1984, but paperwork was 
 
         somehow misplaced and the checks needed to be reissued.
 
         
 
              Claimant testified that in February, 1985, his back 
 
         condition became much worse and he again saw Dr. Berg on February 
 
         25, 1985.  This visit was because of his lower back complaints 
 
         and not due to any cervical spine problems.
 
         
 
              Claimant indicated that Dr. Berg referred him to Marc Hines, 
 
         M.D., as of March 12, 1985, and that Dr. Hines has treated him 
 
         since that date.
 
         
 
              Claimant testified further that he first developed problems 
 
         in the cervical spine during approximately March or April, 1985.  
 
         Claimant eventually underwent an anterior
 
         
 
         
 
         
 
         PICKRELL v. JOHN DEERE OTTUMWA WORKS 
 
         Page 5
 
         
 
         
 
         fusion to the cervical spine in January, 1986.  That surgery 
 
         helped claimant with his symptoms of blurred vision, "snapping" 
 
         of the neck, weakness and pain in his elbows, and although he had 
 
         some headaches, he suffered no further neck pain for one year 
 
         after his fusion.
 
         
 
              Claimant eventually decided in mid-1987 that he would be 
 
         forever unable to return to his employment with Deere.  He stated 
 
         that the problems leading him to that conclusion included an 
 
         inability to remain in one position, inability or difficulty in 
 
         rising from bed, an inability to bend (this being much different 
 
         than December, 1984, when he could bend and could get up from a 
 
         squat without using his arms exclusively) and an inability to 
 
         walk any distance or with speed.  Claimant developed a foot drop 
 
         problem in summer, 1987 and now needs a cane and brace and is 
 
         unable to put weight on his left leg.
 
         
 
              Claimant reported that his salvage welding job required 
 
         light lifting, bending and twisting which is beyond his current 
 
         ability.  That job also involved working in the tool crib and 
 
         doing roving inventory counts.  In fact, claimant insisted that 
 
         there exists no job he knows of at Deere that he is able to 
 
         perform (although defendant has not offered to rehire him in any 
 
         event) because of his inability to cope with pain.  Claimant 
 
         stated that he could work only if he were allowed to sit or lie 
 
         down as needed to cope with his pain.
 
         
 
              Although claimant failed to finish eighth grade, he obtained 
 
         a GED in approximately 1975.  He has also had on-the-job training 
 
         in diesel and auto mechanics.  However, claimant indicated that 
 
         he has poor clerical skills and does not read or spell well.
 

 
         
 
 
 
 
 
         
 
              Claimant's work history includes farm work, restaurant dish 
 
         washing, a garbage route and odd jobs while in high school, and, 
 
         beginning in approximately 1960, five years as a mechanic for 
 
         Eagle Foods.  Claimant left that work as shop supervisor and 
 
         diesel mechanic.  Claimant next worked as a diesel mechanic in 
 
         Texas for approximately six months, then as a mechanic for a 
 
         business known as Union Carbide.  Thereafter, claimant operated a 
 
         self-service truck stop for a few months, worked as a welder for 
 
         approximately five months with Barker Poultry, and worked an 
 
         assembly job for approximately six months with Iowa Army 
 
         Ammunition Depot.  Next, claimant was employed as an auto 
 
         mechanic for P & W Automotive and took a position with John Deere 
 
         as an arc welder.  Subsequently, claimant worked for a short time 
 
         as a welder with a business known as L-John.  Claimant's most 
 
         remunerative position by history has been with defendant.
 
         
 
         
 
         
 
         PICKRELL v. JOHN DEERE OTTUMWA WORKS
 
         Page 6
 
         
 
         
 
              Claimant has sought vocational rehabilitation from the state 
 
         of Iowa, but apparently has not undergone a rehabilitation 
 
         program.
 
         
 
              Bob McCall testified that he is an electrician employed by 
 
         John Deere and that as union president since 1979, he has 
 
         responsibility for handling benefits problems.  He testified that 
 
         the hourly value of benefits paid in addition to wages is between 
 
         $11.00 and $13.00 per hour.  Benefits include vacation, personal 
 
         days, 11 or 12 holidays, medical insurance, grievance rights, a 
 
         pension based on years of service and a seniority system.  Mr. 
 
         McCall was of the belief that claimant would now be working if he 
 
         was physically able to be an arc welder, that he would now be 
 
         close to recall as a salvage welder based on his current 
 
         restrictions and that he would already have been recalled based 
 
         on McCall's understanding of claimant's 1984 physical 
 
         restrictions.  He stated that everyone laid off in September, 
 
         1984, except for individuals with medical problems, has now been 
 
         recalled.
 
         
 
              McCall indicated that salvage welders are now making 
 
         approximately $13.75 to $14.00 per hour.
 
         
 
              Marilyn Pickrell testified to being claimant's wife for 32 
 
         years prior to hearing.  She testified that prior to his injury 
 
         claimant was quite active in farming (both crops and livestock), 
 
         outdoor activities such as fishing and camping, bowling and 
 
         family life.  After the 1979 work injury claimant was unable to 
 
         bowl (inability to bend) or participate in outdoor activities.
 
         
 
              Ms. Pickrell indicated that since December, 1984, claimant's 
 
         ability to walk has greatly deteriorated.  While he did walk with 
 
         a limp before that time, he now walks with a cane and leg brace 
 
         (since 1988) and is unable to walk far.  He walks with a slow, 
 
         "sideways" gait.  When sleeping, claimant tosses and turns more 
 
         and sleeps less, if at all.  Claimant has both good and bad days 
 
         now, which was also true in 1984.  However, in 1984, claimant did 
 
         not take pain medications.  Bad days are more frequent now, 
 
         especially in cold weather.  Claimant is much less able to 
 
         perform chores around the home, although he tries.
 

 
         
 
 
 
 
 
 
 
              Craig Dalbey testified to being a salary administrator for 
 
         defendant.  He indicated that claimant would not have been 
 
         rehired based on his seniority after the September, 1984 layoff.
 
         
 
         
 
         
 
         PICKRELL v. JOHN DEERE OTTUMWA WORKS
 
         Page 7
 
         
 
         
 
              Thomas Summers, M.D., testified by deposition on November 
 
         20, 1984.  Dr. Summers is a board-certified neurologist.
 
         
 
              Dr. Summers indicated that he first saw claimant on 
 
         September 25, 1984 for evaluation.  His examination found that 
 
         claimant's problem basically was of pain and discomfort in the 
 
         back and the left lower extremity.  Claimant showed evidence of a 
 
         radicular syndrome.  Claimant was restricted in the movements of 
 
         the lower back, able to move forward through an angle of 30 
 
         degrees, but unable to bend backwards.  Claimant tended to limp 
 
         on the left side.  Vibratory sense was impaired on the left foot 
 
         and pain sensation was impaired on the inside of the left leg and 
 
         the inside of the left foot.
 
         
 
              Dr. Summers' clinical impression was of failed lumbar 
 
         laminectomy syndrome, that is, that claimant had undergone 
 
         surgical treatment for a ruptured disc without success.  It was 
 
         his view that claimant had a functional impairment of 
 
         approximately 15-20 percent of the body as a whole.
 
         
 
              With respect to physical limitations, Dr. Summers felt that 
 
         claimant should avoid stooping over and bending down and if 
 
         necessary, to first squat rather than bend.  He advised that 
 
         claimant not lift over 25 pounds, since items weighing more than 
 
         that cannot be lifted with just the arm and hands and require 
 
         strain to the lower back.  Likewise, claimant might find it 
 
         necessary to avoid standing or sitting for any length of time and 
 
         similarly situated people are much more comfortable if permitted 
 
         to change positions frequently.  Prolonged walking would be 
 
         contraindicated.  Dr. Summers did not feel that claimant was a 
 
         candidate for further surgical treatment.
 
         
 
              Dr. Summers was of the view that claimant's maximum 
 
         recuperation had probably been achieved around 18 months 
 
         following his lumbar surgery.
 
         
 
              Dr. Summers' report of September 25, 1984 reflected that 
 
         claimant started having pain again in the lower back and down the 
 
         left lower limb approximately one month after his lumbar surgery.  
 
         Claimant complained of constant pain in the lower back.  The pain 
 
         extended into the left hip and buttock and down the left leg into 
 
         the foot.  The left knee hurt badly and claimant experienced 
 
         sharp jabbing pain at times.  The left foot was described as 
 
         stinging.
 

 
         
 
 
 
         
 
              Thomas Carlstrom, M.D., testified by deposition on November 
 
         20, 1984.  Dr. Carlstrom is a board-certified neurosurgeon.  He 
 
         examined claimant on November 8, 1983 and
 
         
 
         
 
         
 
         PICKRELL v. JOHN DEERE OTTUMWA WORKS 
 
         Page 8
 
         
 
         
 
         performed.a general physical examination.  He found at that time 
 
         that claimant was able to forward bend 80 degrees, had a negative 
 
         straight leg raising exam while sitting and his neurological 
 
         examination was objectively normal.  However, there were some 
 
         subjective sensory findings in the left lower extremity.
 
         
 
              Dr. Carlstrom was of the view that claimant was continuing 
 
         to have symptoms of back and leg discomfort best described as a 
 
         failed back syndrome.  He felt that claimant had reached maximum 
 
         benefits of healing and had suffered a permanent partial 
 
         disability of about 7-8 percent of the body as a whole.  To a 
 
         reasonable medical certainty, Dr. Carlstrom believed that 
 
         claimant had reached maximum benefits of healing about six months 
 
         to a year postoperative, sometime in the middle part of 1980.  
 
         But, claimant's return to work on January 3, 1980 was probable a 
 
         more accurate date in determining maximum benefits of healing.  
 
         Dr. Carlstrom felt that the preponderance of claimant's symptoms 
 
         were probably secondary to arachnoiditis.
 
         
 
              David W. Beck, M.D., an assistant professor of neurosurgery 
 
         at the University of Iowa Hospitals and Clinics, wrote to Dr. 
 
         Hines on April 30, 1985.  Dr. Beck related that he had seen 
 
         claimant on the day before for evaluation.  Claimant specifically 
 
         complained of pain in the low back, left hip, left leg, left knee 
 
         and left foot with numbness and weakness throughout the leg.  
 
         Claimant indicated that these problems had been rather static in 
 
         the last four years.  Claimant also complained of other symptoms, 
 
         including increased weakness in the upper extremities.
 
         
 
              Dr. Beck found that claimant had some mild stenosis in the 
 
         lower spine as seen on CT and myelogram.  The balance of Dr. 
 
         Beck's letter dealt primarily with claimant's cervical problems.
 
         
 
              Dr. Beck wrote again on July 16, 1985 that claimant had been 
 
         seen on the previous day for follow-up of low back pain and 
 
         weakness in the legs.  Claimant believed his legs were gradually 
 
         getting weaker.  For the first time, a left foot drop was 
 
         observed.  Dr. Beck agreed that.claimant's symptoms seemed to be 
 
         progressing.  Claimant's cervical problems had improved at this 
 
         point and Dr. Beck intended to focus again on the lumbar spine.
 
         
 
              Associate Professor of Neurosurgery Patrick W. Hitchon, 
 
         M.D., also of the University of Iowa Hospitals and Clinics, wrote 
 
         Dr. Beck on August 5, 1985 to recommend continued
 

 
 
 
 
 
         
 
         
 
         
 
         PICKRELL v. JOHN DEERE OTTUMWA WORKS 
 
         Page 9
 
         
 
         
 
         conservative treatment in the management of claimant's low back 
 
         pain.  Dr. Hitchon found no atrophy of the lower extremities, but 
 
         upon motor examination claimant displayed hesitation and 
 
         break-away weakness.  Straight leg raising was roughly 85 degrees 
 
         bilaterally, but was productive of low back pain on the left.  
 
         Claimant displayed diminished sensory perception in all 
 
         distributions on the left side compared to the right.
 
         
 
              Dr. Hitchon wrote Dr. Beck again on August 15, 1985 after 
 
         reviewing radiological studies.  He found the lumbar spine 
 
         myelogram to show evidence of a bulging disc at L4-5, but not of 
 
         a magnitude to warrant surgical intervention.
 
         
 
              Dr. Beck eventually performed a C5-6 anterior cervical 
 
         fusion on January 8, 1986.  Six weeks post-op Dr. Beck reported 
 
         on February 20, 1986 that claimant was doing much better with 
 
         respect to his upper extremity complaints.  However, he was at 
 
         that time "really complaining" about his low back pain radiating 
 
         to the left leg.  Dr. Beck suggested yet another (fifth) 
 
         myelogram.
 
         
 
              Dr. Beck reported to Dr. Hines on April 21, 1986 that 
 
         claimant underwent a lumbar myelogram on April 17.  Claimant 
 
         reported pain in the left lower extremity as the same as when he 
 
         ruptured a disc in 1979.  The pain was described as a chronic 
 
         ache which occasionally shoots down the left lower extremity; 
 
         claimant's foot feels "on fire."  Dr. Beck reported that claimant 
 
         could not lift the left lower extremity off the bed and that 
 
         there was 3/5 motor strength in all muscle groups in the left 
 
         lower extremity with fasciculation in the left inner thigh 
 
         musculature and left hip pain with a 45 degree right lower and 20 
 
         degree left lower extremity straight leg raising.  Dr. Beck 
 
         reported normal sensation to pinprick, light touch, vibration and 
 
         position sense throughout.
 
         
 
              Donald D. Berg, M.D., saw claimant from 1979 to 1985.  Dr. 
 
         Berg performed claimant's laminectomy in August, 1979.
 
         
 
              Dr. Berg reported in his chart notes that claimant visited 
 
         him on February 25, 1985 complaining of lower back pain and leg 
 
         discomfort and "now" is having problems with some numbness in the 
 
         left leg and sciatic pain along with problems with urination and 
 
         an inability to maintain an erection.  Physical examination 
 
         revealed diminished knee jerks and diminished ankle jerks; toe 
 
         extensors on the left were slightly weak compared to the right.  
 
         He found positive straight leg raising on the left.
 
         
 

 
 
 
 
 
         
 
         PICKRELL v. JOHN DEERE OTTUMWA WORKS
 
         Page 10
 
         
 
         
 
              E. W. McCarl, M.D., performed a CT scan at the request of 
 
         Dr. Berg on February 27, 1985.  There appeared to be some 
 
         moderate narrowing of the L2-L3 spaces, but this was only a scout 
 
         film and Dr. McCarl felt the patient should be rescanned at that 
 
         level if symptoms were localized there.  There was no evidence of 
 
         any herniated disc at L3 through Sl, but some asymmetry of the 
 
         posterior arches at L5-Sl, which had caused some sclerosis and 
 
         narrowing between the articular facets at L5 to Sl bilaterally, 
 
         indicating stress at that level.  Repeat scans on February 28, 
 
         1985 showed moderate disc space narrowing at L2-L3 with some 
 
         degenerative change of the anterior vertebral bodies along the 
 
         disc margin at that level.  There was some mild asymmetry or 
 
         narrowing of the inferior articular facet of L2 on the left, but 
 
         Dr. McCarl suspected it was congenital.
 
         
 
              Dr. Berg's chart notes of March 25, 1985 reflect that 
 
         claimant continued to complain of back and neck pain.  Dr. Berg 
 
         felt that claimant had degenerative disc disease and arthritis 
 
         with spurs in the neck.  A myelogram of claimant's back did not 
 
         show a great deal of significance.  Dr. Berg recommended no 
 
         further treatment for the back other than anti-inflammatory 
 
         medication and limitation of lifting.
 
         
 
              Dr. Berg reported further on June 17, 1985 that claimant was 
 
         essentially unchanged.  Claimant stated that his leg "gives out 
 
         occasionally" when walking, but did not feel this was work 
 
         related and was associated with degenerative disc disease and 
 
         degenerative osteoarthritis.  At that time Dr. Berg did not feel 
 
         claimant was able to work because of inflammation in the soft 
 
         tissues.
 
         
 
              Dr. Berg had imposed limitations prior to the agreement, for 
 
         settlement.  On February 18, 1983, Dr. Berg wrote Dr. Herrick to 
 
         note that claimant's work restrictions included no heavy lifting, 
 
         no bending or twisting of the back.  He specified that these 
 
         restrictions should be permanent.  Dr. Berg added an addendum on 
 
         March 4, 1983 to specify that claimant's weight restriction would 
 
         be 20 pounds and bending and twisting of 45 degrees should be 
 
         limited to no more than three times per hour.
 
         
 
              Dr. Carlstrom also testified by a deposition taken February 
 
         13, 1989.  In this deposition, Dr. Carlstrom noted that he had 
 
         seen claimant on November 8, 1983, April 2 and 23, 1987, and 
 
         January 1, 1989.  Dr. Carlstrom discussed claimant's neck and 
 
         lower back problems.  He specified that claimant's cervical 
 
         problems were not causally related to the work injury under 
 
         review.
 
         
 

 
 
 
 
 
 
 
         PICKRELL v. JOHN DEERE OTTUMWA WORKS
 
         Page 11
 
         
 
         
 
              With respect to the April, 1987 examinations, Dr. Carlstrom 
 
         noted that claimant had a diminished range of motion of the back, 
 
         not severe, and a normal neurologic examination.  While noting 
 
         that claimant's range of motion diminution suggested some 
 
         objective evidence for pain in the lower back, the normal 
 
         neurologic exam indicated that the pain was not causing any 
 
         significant impingement upon any neurological structures such as 
 
         nerve roots or the spinal cord.
 
         
 
              The 1987 x-rays did show the degenerative disease of 
 
         osteoarthritis in the lower spine, but Dr. Carlstrom did not find 
 
         anything indicating that this osteoarthritis was caused by the 
 
         work injury.  He was of the view that claimant's 1987 symptoms 
 
         may have been due in part to diminished activity following the 
 
         cervical fusion.
 
         
 
              Dr. Carlstrom testified:
 
              
 
              Q.  You go on to say, "Although he does seem to be a little 
 
              worse at the present, I do not think that this should be 
 
              considered related to his work activities, unless the neck 
 
              problem is likewise related."  What do you mean by that 
 
              statement?
 
              
 
              A.  Well, I think that he is-- He definitely got worse 
 
              between 1983 when I saw him first and 1989 when I saw him 
 
              last, especially in terms of findings related to his low 
 
              back.  In my opinion, part of that worsening relates to the 
 
              neck problem, to the neck surgery.  If the neck surgery is a 
 
              direct result of an injury--and I'm not aware of any injury 
 
              that could have caused that, so at least from my point of 
 
              view, I don't think it's related, but if it is, then I think 
 
              the worsening should be ascribed to the work injury--to a 
 
              work injury.
 
              
 
              Q.  But if there is no causal connection between the 
 
              back--the neck condition and work, what, then, would you 
 
              indicate?
 
              
 
              A.  Well, then I would think that the worsening probably has 
 
              no relationship to his work activity.
 
              
 
              Q.  So that we fully understand each other, between your 
 
              examination of 19--November of 1983 and your examinations of 
 
              April 2 and April 23 of 1987, if the neck condition was not 
 
              causally related to the 1979 incident, would there have been 
 
              any worsening in the condition of this
 
         
 
         
 

 
 
 
         PICKRELL V. JOHN DEERE OTTUMWA WORKS
 
         Page 12
 
         
 
         
 
              claimant from anything that occurred on June 25 of 1979?
 
              
 
              A.  I'm not sure I understand the question.  I might 
 
              rephrase it a little bit and say that if he had not had the 
 
              neck problem and/or the neck surgery, and had continued to 
 
              be as active as he had been throughout 1985 and 186, then I 
 
              don't think that he would be worse today.
 
              
 
              Q.  And would that be true as you saw him on January 31, 
 
              1989?
 
              
 
              A.  Yes.
 
         
 
         (Dr. Carlstrom deposition, page 14, line 20 through page 16, line 
 
         6)
 
         
 
              Dr. Carlstrom did, however, find objective changes between 
 
         April, 1987 and January, 1989 in that claimant had diminished 
 
         range of motion in the back.  He believed a "major portion" of 
 
         the worsening was related to claimant's cervical fusion.  
 
         Neurologic examination on January 31, 1989 also indicated normal 
 
         neurologic status with normal strength, sensation and 
 
         coordination of the legs.
 
         
 
              However, when asked specifically if he could tell on January 
 
         31, 1989 what portion of claimant's back symptoms were caused by 
 
         the cervical fusion, Dr. Carlstrom replied in the negative.  Dr. 
 
         Carlstom's report of February 1, 1989 indicated an impairment 
 
         rating of 12-13 percent of the body as a whole, but approximately 
 
         half of that rating was related to the cervical fusion.  The 
 
         doctor specified that perhaps 6 or 6 1/2 percent of the body as a 
 
         whole was impaired by reason of the lumbar area.
 
         
 
              With respect to claimant's physical restrictions, Dr. 
 
         Carlstrom testified:
 
         
 
              Q.  Discounting the neck condition, Doctor, of the cervical 
 
              fusion, talking only the lumbar area, what, if any, 
 
              restrictions would you place upon claimant?
 
              
 
              A.  Well, I think he would probable need to avoid heavy 
 
              lifting.  He would need to avoid prolonged sitting or 
 
              standing and cramped postures, such as forward bending or 
 
              stooping.
 
              
 
              Q.  Would he have had that condition from-- those 
 
              restrictions from the osteoarthritic condition?
 
         
 
         
 
         
 
         PICKRELL v. JOHN DEERE OTTUMWA WORKS 
 
         Page 13
 

 
         
 
 
 
         
 
         
 
              A.  Well, of course, that's possible, yes.
 
              
 
              Q.  Is he able to be employed today, in your opinion?
 
              
 
              A.  Yes.
 
              
 
              Q.  In what type of function?
 
              
 
              A.  Well, some type of function that lies within the 
 
              parameters I set forth earlier, something that is light duty 
 
              and allows him to be--to change positions, walk, sit, stand, 
 
              and so forth.
 
              
 
              Q.  Could he do light maintenance?
 
              
 
              A.  I think so.
 
              
 
              Q.  Clerical?
 
              
 
              A.  Probably.
 
              
 
              Q.  Guard duty?
 
              
 
              A.  Probably.
 
              
 
              Q.  What other type of activities?
 
              
 
              A.  Well, he could sell, he could be a salesman.  I would 
 
              imagine that he could do light maintenance repair work, like 
 
              for electronic things, and so forth.
 
         
 
         (Dr. Carlstrom deposition, page 24, line 25 through page 26, line 
 
         5)
 
         
 
              On cross-examination, Dr. Carlstrom admitted that traumatic 
 
         injuries can exacerbate or hasten the development of arthritic or 
 
         degenerative problems and that the work injury under review was 
 
         at least a substantial contributing and aggravating factor in the 
 
         overall disability to claimant's lower back.
 
         
 
              Marc E. Hines, M.D., wrote claimant's counsel on September 
 
         11, 1987.  He stated that claimant's MRI scan of March 11, 1987 
 
         revealed multiple levels of spondylosis in the cervical spine.  
 
         He noted that claimant had been followed since March, 1985 and 
 
         that he had been consulting with Dr. David Beck.  He stated that 
 
         claimant had reached his maximum degree of healing at the time of 
 
         his visits with Dr. Beck and himself in March and April, 1987, 
 
         and that no
 
         
 
         
 
         
 
         PICKRELL v. JOHN DEERE OTTUMWA WORKS 
 
         Page 14
 

 
 
 
         
 
         
 
         further substantial improvement would ensue.  He initially 
 
         indicated that claimant's cervical problems were related to his 
 
         lower back condition, specifically the inactivity caused by his 
 
         lower back complaints, but expressed a different view in his 
 
         deposition of September 14, 1988.
 
         
 
              In that deposition, Dr. Hines indicated that he had 
 
         continued to see claimant up through and including July 7, 1988, 
 
         and had plans to see him again in October.
 
         
 
              Dr. Hines distinguished between claimant's cervical and 
 
         lumbar problems.  He noted that claimant suffered arachnoiditis 
 
         in the lower back, which presumptively would be caused by 
 
         claimant's previous surgery.  In claimant's neck he showed a spur 
 
         formation, which is an osteoarthritic condition in which extra 
 
         bone is formed as a consequence of arthritis.  He testified:
 
         
 
              Q.  Doctor, what is your diagnosis -- What is your present 
 
              diagnosis of his condition?
 
              
 
              A.  I believe that Mr. Pickrell has lumbosacral 
 
              osteoarthritis with spinal arachnoiditis.  I believe as a 
 
              consequence of those two factors, he has lumbar 
 
              radiculopathy which means that the nerve roots are impinged 
 
              on and impaired in their function, and he has low back pain 
 
              as a consequence.  I believe he also has cervical 
 
              osteoarthritis and some neck pain because of that, and from 
 
              time to time has some mild cervical radiculopathy, as well.  
 
              I do not believe that the latter condition is as serious a 
 
              problem to him now as it was formerly.
 
         
 
         (Dr. Hines deposition, page 31, line 20 through page 32, line 8)
 
         
 
              As to causation of claimant's present condition, he 
 
         testified:
 
         
 
              A.  The problems in Mr. Pickrell's low back are secondary to 
 
              a combination of osteoarthritis, which is an arthritic 
 
              degenerative disease, and arachnoiditis, which is a scar 
 
              formation, which I believe is within a reasonable degree of 
 
              medical certainty presumptively due to his previous surgery.
 
              
 
              Q.  Do you have an opinion, assuming the facts in Exhibit 6 
 
              to be true as to it, why was the need or
 
         
 
         
 
         
 
         PICKRELL v. JOHN DEERE OTTUMWA WORKS 
 
         Page 15
 
         
 
         
 
              what was the cause of the first surgery in the low back?
 
              
 

 
 
 
 
 
              A.  As far as I can understand, not only from this record 
 
              but from Dr. Berg's records which I have, that Mr. Pickrell 
 
              bent over and felt a pop in his back while he was working at 
 
              John Deere, and probably it was at that time that he 
 
              herniated a disk in his low back and subsequently required 
 
              surgery for that because he did not respond to medical 
 
              management provided by Dr. Herrick and Dr. Berg.
 
         
 
         (Dr. Hines deposition, page 36, line 16 through page 37, line 9)
 
         
 
              As to causation relative the cervical spine, Dr. Hines 
 
         testified:
 
         
 
              Q.  Doctor, what, if any, causal relationship is there 
 
              between the problems he was having in the low back for which 
 
              you found and for which you've testified about, and those 
 
              problems that you found in his neck which you've testified 
 
              about?
 
              
 
              A.  Well, he has osteoarthritis in both places.  And 
 
              certainly having osteoarthritis in one place, it's not 
 
              surprising to find it in another.  I cannot relate the 
 
              injury to the problems in his neck in any direct manner 
 
              whatsoever.
 
              
 
              The injury, as far as I know, caused him a herniated disk in 
 
              the low back.  It is somewhat difficult to say as to whether 
 
              or not there is any further relationship.
 
              
 
              The presence of the problems in his neck perhaps could be 
 
              exacerbated by some forms of activity, but I don't know of 
 
              any clear-cut relationship in terms of another injury, for 
 
              instance, that he had, and the major difficulties that he 
 
              has that I can -- that I can demonstrate on myelogram, 
 
              x-ray, in any other further examination seem to be primarily 
 
              related to osteoarthritis.
 
              
 
              Q.  So that condition, you say perhaps, but you can't say 
 
              for sure -- you can't further say had anything to do with 
 
              the low back problems he was having?
 
         
 
         
 
         
 
         PICKRELL v. JOHN DEERE OTTUMWA WORKS 
 
         Page 16
 
         
 
         
 
              A.  I think it's more speculative than -- than anything 
 
              else, and there isn't a substantiating history in terms of 
 
              injury or other relationship to this previous injury or even 
 
              to the previous surgery that makes it clear.  Certainly the 
 
              two are connected by way of osteoarthritis, but this is a 
 
              naturally occurring degenerative disease.
 
         
 
         (Dr. Hines deposition, page 37, line 23 through page 39, line 5)
 

 
 
 
 
 
         
 
              With respect to claimant's lumbar spondylosis, Dr. Hines 
 
         testified:
 
         
 
              Q.  The lumbar spondylosis?
 
              
 
              A.  Okay. I think it would be reasonable to assume that any 
 
              lumbar spondylosis at L2-3 could be causally related to a 
 
              disk herniation and disc removal at L2-3.  I think to assume 
 
              that all of the remaining lumbar spondylosis which is 
 
              presently up and down the spine is related to that one disc 
 
              herniation would be unreasonable; and that, in fact, in the 
 
              presence of all of the cervical disease which is present, 
 
              without a prior injury as far as we know to that area, that 
 
              it is more reasonable to assume that the lumbar spondylosis 
 
              for the most part is due to the natural progression of an 
 
              osteoarthritic disease.
 
              
 
              Q.  And that's a condition which would have existed without 
 
              a June 25, 1979, injury?
 
              
 
              A.  Yes.  To some extent, it would have.
 
         
 
         (Dr. Hines deposition, page 62, line 10 through page 63, line 1)
 
         
 
              However, with respect to arachnoiditis of the lumbar spine, 
 
         he testified:
 
         
 
              Q.  All right.  Now, what about the situation where he 
 
              speaks of adhesive arachnoiditis in the lumbar spine?  Is 
 
              that a condition which could have developed without the 
 
              injury.and without the surgery?
 
              
 
              A  Probably not.
 
              
 
              Q.  What is that, Doctor?
 
         
 
         
 
         
 
         PICKRELL v. JOHN DEERE OTTUMWA WORKS 
 
         Page 17
 
         
 
         
 
              A.  That would be very rare to develop by itself.
 
              
 
              Q.  What is that?
 
              
 
              A.  That is a condition that usually comes on as a result of 
 
              some kind of manipulation inside the spinal canal.  Either a 
 
              myelogram, where we go in and stir things up, and 
 
              particularly if we get blood in the myelogram and then go 
 
              ahead and inject the dye, which everybody is careful not to 
 
              do because of that circumstance, or spinal surgery or 
 
              surgery of the lumbosacral area which can cause scar and 
 
              arachnoiditis.  But that condition is almost always due to 
 
              some type of traumatic event involving the area.
 

 
              
 
 
 
         
 
         (Dr. Hines deposition, page 63, line 2 through line 22)
 
         
 
              And further:
 
         
 
              A.  Okay. The spinal arachnoiditis causes a narrowing of the 
 
              canal and is contributed to also be the spondylosis.  They 
 
              both contribute.  You see, the spondylosis is in front of 
 
              the canal, pushing back in.  The arachnoiditis is around the 
 
              canal, causing a scar that constricts it and tightens it.
 
              
 
              Just like a scar on your body might cause a tight area of 
 
              skin, it can do the same thing in the covering of the spinal 
 
              cord, and in this case spinal nerve roots in the lumbar 
 
              area.
 
              
 
              And if it does so, then on the,myelogram, when we put the 
 
              dye inside, it will show up as an area where there is a 
 
              constricted or narrowed area, with the measurements usually 
 
              being less than 14 millimeters, oftentimes down to as low as 
 
              10 millimeters. and when they get that low in terms of their 
 
              width, they become significant in terms of there's not 
 
              enough room for the nerve roots, they become constricted, 
 
              don't get enough blood supply and develop pain and soon.
 
              
 
              Q.  Is that a condition which in this Claimant could have 
 
              developed outside of any injury?
 
              
 
              A.  I would say that the spinal -- What we're really talking 
 
              about is called spinal stenosis, by the way.
 
         
 
         
 
         
 
         PICKRELL v. JOHN DEERE OTTUMWA WORKS
 
         Page 18
 
         
 
         
 
              Q.  Yes.
 
              
 
              A.  Spinal stenosis and narrowing of the spinal canal would 
 
              be unlikely to occur at his age without the element of 
 
              surgery and arachnoiditis.  The spinal stenosis would be not 
 
              at all uncommon above the age of sixty in a gentleman like 
 
              Mr. Pickrell, with as much osteoarthritis as he has, but at 
 
              his age it would be a distinctly unusual thing.
 
         
 
         (Dr. Hines deposition, page 64, line 4 through page 65, line 12)
 
         
 
              As to whether there had been any change in claimant's 
 
         condition, Dr. Hines testified:
 
         
 
              Q. Now, I think we got to talking about a change of 
 
              condition.  I think you first saw him in March of 1985?
 
              
 
              A.  That's correct.
 

 
 
 
 
 
              
 
              Q.  And then has his -- Did his condition to the low back 
 
              worsen from that point to the time you last saw him in July 
 
              of 1988?
 
              
 
              A.  Yes, over that whole period of time, I would say that's 
 
              correct.
 
         
 
         (Dr. Hines deposition, page 75, line 2 through line 10)
 
         
 
              As to claimant's current limitations, Dr. Hines testified:
 
         
 
              Q.  With the disability he now has, what work limitations 
 
              would you -- Let me ask you this.  Could he return to the 
 
              type of work he was doing before?
 
              
 
              A.  Well, as far as I can understand it, what he was having 
 
              to do before, which would involve some -- some at least 
 
              limited even lifting and bending, stooping and so on, 
 
              standing for prolonged periods, I do not feel that he would 
 
              be able to return to that type of work.
 
         
 
         (Dr. Hines deposition, page 40, line 1 through line 10)
 
         
 
         
 
         
 
         PICKRELL v. JOHN DEERE OTTUMWA WORKS 
 
         Page 19
 
         
 
         
 
              And:
 
              
 
              Q. What kinds of jobs, if any, did you think he could 
 
              perform now, regardless of taking into consideration both 
 
              disabilities?
 
              
 
              A.  Frankly, I don't think that he's going to be able to do 
 
              much of anything.  In terms of really productive employment, 
 
              you know, one could perhaps creatively envision some type of 
 
              part-time work, but it would be something where he would 
 
              just be able to almost determine his own hours depending on 
 
              how he felt, and I don't know of any employers who really 
 
              are going to be able to allow that.
 
              
 
              Q.  How much of that do you attribute to the low back 
 
              problem, that opinion?
 
              
 
              A.  Well, right now, I think the majority of -Well, that may 
 
              be overstating it.  I think that a majority of that problem 
 
              is due to the low back, but I also think a significant 
 
              minority -- I would not want to discount the neck and arm 
 
              symptoms because if it weren't for that, he might be able to 
 
              do some type of sit-down work with rest, but the problem is 
 
              now he also has trouble with the flex posture of his neck.  
 
              He can't sit over a computer screen, papers, et cetera, and 
 
              so I think it's probably a significant contributor in terms 
 
              of the total disabling nature of the situation.
 

 
              
 
 
 
              
 
              Q.  If he were to find some employment and the employer were 
 
              to seek some consultation from you respecting the 
 
              limitations he might have to that portion of his injury to 
 
              do with the low back, what would your opinion be as to what 
 
              limitations held have for the low back portion of his 
 
              injury?
 
              
 
              A.  I think that he would -- I think that he would be 
 
              limited from continuous standing.  I think that he could sit 
 
              for one to two hours at a time.  He would need some rest 
 
              breaks in order to get up and move because of his back.  I 
 
              think that he would be unable to stoop, bend, lift, crawl, 
 
              that kind of operation.
 
              
 
              I don't think it would be reasonable to expect him to 
 
              operate foot controls repetitively or infrequently foot 
 
              controls that were heavy and hard to work like heavy 
 
              machinery.  I don't think he would be able to be involved in 
 
              an occupation
 
         
 
         
 
         
 
         PICKRELL v. JOHN DEERE OTTUMWA WORKS 
 
         Page 20
 
         
 
         
 
              that required repetitive jarring of the back, even if it was 
 
              mild.
 
              
 
              So I think we're really talking more about a sedentary type 
 
              of occupation, if we were even able to do that, if we were 
 
              able to create something very creative.
 
              
 
              Q.  Then you say that he also has a significant injury to 
 
              the upper portion which adds to the total problem?
 
              
 
              A.  Yeah.
 
         
 
         (Dr. Hines deposition, page 41, line 3 through page 43, line 5)
 
         
 
              With respect to periods of temporary total disability 
 
         related to the lumbar problems, Dr. Hines testified that claimant 
 
         was "clearly in active treatment" (defined at page 48 of the 
 
         deposition as "actually engaged in treatment as opposed to just 
 
         maintenance type of treatment") during 1985 and through January, 
 
         1986 when claimant underwent surgical treatment at the hands of 
 
         Dr. Berg.  Dr. Hines went on to state that "as we enter '87" they 
 
         were getting much more into a maintenance period and no question 
 
         that maintenance care was provided as 1988 was entered.  Dr. 
 
         Hines stated that "midway through" 1987 we were really in a 
 
         maintenance period and.not a lot of active treatment going on; 
 
         asked if that meant the physicians were doing things not 
 
         necessarily anticipating improvement, Dr. Hines answered 
 
         "Exactly."  As of the neighborhood of December, 1987, Dr. Hines 
 
         had basically been treating claimant for the low back.  Dr. Hines 
 
         testified further that claimant's back problem has worsened over 
 
         time, but has generally not been marked with sudden worsening or 
 
         increased difficulties other than claimant had had increased 
 
         problems with his left leg since approximately December, 1987 and 
 
         thereafter.  By "stabilization" he indicated that his testimony 
 
         dealt primarily with claimant's neck condition.
 

 
 
 
 
 
         
 
              In Dr. Hines' letter of May 17, 1985, he specified that 
 
         claimant had been disabled since when he had first been seen 
 
         through that date.  A review of that letter indicates that his 
 
         findings in that respect were based on both cervical and 
 
         lumbosacral radiculopathy and other problems.
 
         
 
              Dr. Hines saw claimant again on October 11, 1988, following 
 
         his deposition.  He noted that claimant had continued and 
 
         increasing difficulties with his low back, despite improvement in 
 
         the neck.  Claimant was currently
 
         
 
         
 
         
 
         PICKRELL v. JOHN DEERE OTTUMWA WORKS 
 
         Page 21
 
         
 
         
 
         having difficulties with urination, constipation and defecation.  
 
         His back pain was severe enough that he sits in a slightly turned 
 
         posture with decreased weight on the left hip and leg.  Dr. Hines 
 
         wrote:
 
         
 
              All normal living postures are effected (sic].  He has 
 
              difficulty with sleeping for more than a few hours at a 
 
              time, because of increased back pain, has more restless 
 
              nights than usual, and has to toss and turn, and often get 
 
              up and change positions.  Sitting for prolonged periods is 
 
              impossible without standing at intervals and walking about.  
 
              Standing for prolonged periods is difficult.  He is unable 
 
              to take long trips in the car without frequent breaks.  He 
 
              has significant difficulties with travel in this regard, in 
 
              any mode that requires prolonged sitting.  He has 
 
              difficulties with lifting and his non-specialized hand 
 
              activities, as previously stated.  He does have some 
 
              difficulties with his arms and hands as yet with regard to 
 
              fine coordination, but is able to perform grasping and 
 
              tactile discrimination tasks.  He has marked limitations in 
 
              lifting that were prescribed for him both by Dr. Beck and 
 
              myself.
 
              
 
              The patient is unable to get an erection at this time, which 
 
              we feel is due to the lumbar spinal stenosis and lumbar and 
 
              sacral nerve root involvement.  The patient, even if he were 
 
              able to get an erection, would have significant difficulties 
 
              with sexual function, due to his low back pain.  The 
 
              patient's sleep, as previously stated, is significantly 
 
              effected, [sic] and he does not obtain a restful nights 
 
              sleep because of the back pain.  His social and recreational 
 
              activities, naturally, have been markedly restricted due to 
 
              his low back paint including the ability to perform any type 
 
              of physical recreation.  He is now able to play cards on 
 
              occasion, but this is about the only recreational activity 
 
              that continues, other than occasional visits with family 
 
              members.
 

 
 
 
 
 
              
 
              On Neurological Examination, the patient had absent patellar 
 
              and achilles reflexes bilaterally, hyperasthesia in almost 
 
              the entire left lower extremity, with some hyperasthesia, 
 
              particularly in the L-5-S-1 dermatome in the left lower 
 
              extremity to pinprick, with additional hyperpathia to touch 
 
              on the bottom of the left foot and, also,
 
         
 
         
 
         
 
         PICKRELL v. JOHN DEERE OTTUMWA WORKS 
 
         Page 22
 
         
 
         
 
              hyperasthesia to touch as well in the entire left leg.  The 
 
              patient has straight leg raising at approximately 80 degrees 
 
              on the left.  No crossed straight leg raising is present up 
 
              to 90 degrees.  The patient has diffuse weakness in the left 
 
              lower extremity of 3/5 degree in the iliopsoas, quads, 
 
              hamstrings, plantar flexors of the foot, dorsal flexors are 
 
              4/5, evertor of the foot is 3/5, and invertor of the foot is 
 
              3/5.  In the right lower extremity there is some weakness, 
 
              however, in that the patient was able to be overcome with 
 
              regards to quadriceps in particular, and there was 4/5 
 
              weakness here and in the iliopsoas.  The remainder of the 
 
              musculature in the right lower extremity seemed to be 
 
              relatively spared.  Flexion of the back at the hips was 
 
              approximately 30 degrees.  Thoracolumbar lateral flexion was 
 
              approximately 10 degrees to the left and 20 degrees to the 
 
              right, and thoracolumbar rotation was approximately 10 
 
              degrees to either side.
 
              
 
              Using the guides to the Evaluation of Permanent Medical 
 
              Impairment, Second Edition, by the AMA, the patient's 
 
              thoracolumbar rotation gives a 4% impairment to the whole 
 
              person to each side using table 52 on page 57.  Using table 
 
              51, page 54-lateral flexion gives a 4% impairment to the 
 
              left and a 25 impairment to the right.  Again, using the AMA 
 
              Guides, table 50, page 52-abnormal flexion/extension-gives a 
 
              6% impairment to the whole person.  This gives an overall 
 
              20% impairment to the whole person for the limited motion of 
 
              the back.
 
              
 
              Using the AMA Guides nervous system section, the patient was 
 
              found, during examination, to have both sensory and motor 
 
              lumbar radiculopathy.  Using table 6, page 75-unilateral 
 
              spinal nerve root impairment-the patient has impairments in 
 
              all listed spinal nerve roots L-3 through S-1 on the left, 
 
              with limited impairment at L-3-4 on the right, of motor type 
 
              only.  Using table 5, page 74-grading scheme and procedure 
 
              for determining impairment of effected body part due to loss 
 
              of strength-the right lower extremity L-3-4 nerve root 
 
              impairment falls into category 2-complete range of motion 
 
              against gravity and some resistance, (sic] or reduced fine 
 
              movements and motor control-giving a grading of 20% for each 
 
              nerve root, giving a 4% and 6.8 impairment for L-3 and L-4 
 
              respectively, using the maximum percent
 

 
 
 
 
 
         
 
         PICKRELL v. JOHN DEERE OTTUMWA WORKS 
 
         Page 23
 
         
 
         
 
              loss of function due to loss of strength x the percentage 
 
              grade determined in table 5.  Using the same table 6, on 
 
              page 75, using table 5, page 74, for the left lower 
 
              extremities loss of strength, the patient falls under 
 
              category 3-complete range of motion against gravity, and 
 
              only without resistance [sic] -giving a 50% grading scheme.  
 
              This gives, for the respective nerves L-3 through S-1, 10%, 
 
              14%, 16.5% and 10% respectively for these nerve roots, with 
 
              regard to maximum percent loss of function due to sensory 
 
              deficit, pain, or discomfort, this is also derived from 
 
              table 6.  Using table 4, page 73, the grading scheme and 
 
              procedure for determining impairment of effected [sic] body 
 
              part due to pain, discomfort, or loss of sensation, the 
 
              patient falls under grading scheme #3-decreases sensation 
 
              with or without pain, which interferes [sic] with 
 
              activity-giving a 60% grade for the 5% impairments 
 
              respectively, from L-3 through S-1.  This gives a 3% 
 
              respective impairment for these nerve roots.
 
              
 
              This gives a motor impairment of 10.8% for the right lower 
 
              extremity, 2.5% for the left lower extremity, and a 
 
              functional loss due to sensory deficit, pain, or discomfort, 
 
              of 12% for the left lower extremity.  Using combined values 
 
              tables, pages 240-241 in the AMA Guides, the 12% and 50.5% 
 
              impairment gives a 54% impairment to the left lower 
 
              extremity.  Using table 15, page 82, the patient 54% 
 
              impairment to the left lower extremity gives a 22% 
 
              impairment to the whole person.  The patient's 10.8% 
 
              impairment to the lower extremity on the right gives a 4% 
 
              impairment to the whole person.
 
              
 
              Using the combined values tables again, the 20% impairment 
 
              from reduced motion, when combined with the 4% impairment 
 
              for right lower extremity motor loss, gives a 22% impairment 
 
              to the whole person.  The 22% impairment to the whole person 
 
              for left lower extremity dysfunction combined with the 22% 
 
              impairment to the whole person previously calculated, gives 
 
              a 32% impairment to the whole person.
 
         
 
                           APPLICABLE LAW AND ANALYSIS
 
         
 
              Pursuant to Iowa Code section 86.14(2), in a proceeding to 
 
         reopen an award for benefits, inquiry is to be made into whether 
 
         or not the condition of the employee warrants an end
 
         
 

 
 
 
         PICKRELL V. JOHN DEERE OTTUMWA WORKS
 
         Page 24
 
         
 
         
 
         to, diminishment of, or increase of compensation so awarded.  A 
 
         change in condition must be shown to justify changing the 
 
         original award.  Henderson v. Iles, 250 Iowa 787, 96 N.W.2d 321 
 
         (1959).  It is not proper to merely redetermine the condition of 
 
         the employee as adjudicated by the former award.  Stice v. 
 
         Consolidated Ind. Coal Co., 228 Iowa 1031, 291 N.W. 452 (1940).
 
         
 
              A mere difference of opinion of experts or competent 
 
         observers as to the degree of disability arising from the 
 
         original injury is insufficient to justify a different 
 
         determination on a petition for review-reopening; there must be 
 
         substantial evidence of a worsening of the condition not 
 
         contemplated at the time of the first award, Bousfield v. Sisters 
 
         of Mercy, 249 Iowa 64, 86 N.W.2d 109 (1957), or a change in 
 
         condition may be found where claimant has failed to improve to 
 
         the extent initially anticipated, Meyers v. Holiday Inn of Cedar 
 
         Falls, Iowa, 272 N.W.2d 24 (Iowa App. 1978).  Additionally, in 
 
         cases not involving scheduled members, a change in earning 
 
         capacity subsequent to the original award which is proximately 
 
         caused by the original injury may constitute a change in 
 
         condition.  Blacksmith v. All-American, Inc., 290 N.W.2d 348 
 
         (Iowa 1980).
 
         
 
              Thus, as a starting point, it is mandatory to review 
 
         claimant's condition as disclosed by the agreement for settlement 
 
         in determining whether claimant has established the requisite 
 
         change in condition.
 
         
 
              Physicians at the Mayo Clinic in Rochester, Minnesota rated 
 
         claimant as having sustained a 15 percent permanent partial 
 
         functional impairment to the body as a whole in March, 1982.  
 
         Thomas A. Carlstrom, M.D., found that claimant had sustained a 
 
         7-8 percent functional impairment to the body as a whole 
 
         following a November 8, 1983 evaluation.  Thomas B. Summers, 
 
         M.D., opined that claimant had sustained a functional impairment 
 
         of 15-20 percent of the body as a whole following an evaluation 
 
         of September 25, 1984.  Based on those evaluations, claimant's 
 
         medical history of laminectomy and excision of a disc at L2-L3 
 
         and employment history, the parties stipulated that claimant had 
 
         been paid all healing period benefits due him and had 'sustained 
 
         a permanent partial disability of 22 1/2 percent of the body as a 
 
         whole.
 
         
 
              However, the parties present an important issue as to 
 
         whether change should be measured from the date on which the 
 
         parties originally had a meeting of the minds or the date the 
 
         application for agreement for settlement was filed and approved.  
 
         A third possible date is the date upon which the parties executed 
 
         the agreement for settlement, March 18,
 
         
 

 
 
 
 
 
         PICKRELL v. JOHN DEERE OTTUMWA WORKS 
 
         Page 25
 
         
 
         
 
         1985.  The question is of importance in this case because 
 
         claimant's condition substantially changed between the date when 
 
         the parties reached a meeting of the minds as to settlement and 
 
         the date settlement papers were finally filed and approved, some 
 
         16 weeks later.  Claimant developed additional symptomatology 
 
         (numbness of the leg) in his relapse of February, 1985.
 
         
 
              Claimant's testimony that he "settled" the earlier 
 
         proceeding in the Ottumwa courthouse on December 4, 1984 is 
 
         unrefuted.  The case was scheduled to be heard on that date.  Had 
 
         claimant developed second thoughts and decided not to execute 
 
         formal settlement documents thereafter, defendants would have 
 
         been entitled to the equitable relief of specific performance 
 
         from the judicial system.  Dilton v. City of Davenport, 366 
 
         N.W.2d 918 (Iowa 1985) held that an oral settlement agreement not 
 
         yet approved by the agency is binding on the parties.
 
         
 
              A recent review-reopening decision issued by a deputy 
 
         industrial commissioner dealt with this identical question.  That 
 
         decision noted Dilton and pointed out that pegging claimant's 
 
         condition as disclosed in the agreement for settlement to the 
 
         date of oral settlement where there has been an intervening 
 
         change in condition promotes efficient administration of 
 
         contested cases by the agency.  The decision pointed out that 
 
         were the rule to be otherwise, claimants will regularly seek to 
 
         back out of settlements when there is an intervening change in 
 
         condition before settlement papers are actually approved by the 
 
         agency.  Grelk v. Dale Jones d/b/a Western Bar, file number 
 
         788371 (Review-reopening Decn. October 30, 1989).  The case 
 
         recognized that medical conditions are not static, but are 
 
         dynamic in nature and subject to dramatic change without notice.  
 
         It was further recognized that as a practical matter, it is not 
 
         uncommon for there to be a time gap for preparation of settlement 
 
         documents and final approval by the agency.
 
         
 
              On the other hand, the agreement for settlement approved in 
 
         March, 1985 was approved as to form by claimant's counsel and 
 
         related to claimant's "present" condition.  These documents were 
 
         executed by claimant and his attorney after he had visited Dr. 
 
         Berg on February 25, 1985 with serious additional symptomatology.  
 
         Executing without reservation settlement documents that do not 
 
         accurately depict claimant's condition on the date of execution 
 
         is a practice fraught with peril and not to be approved.  
 
         Particularly is this so when the proposed order approved as to 
 
         form makes note of claimant's "present
 
         
 
         
 

 
         PICKRELL V. JOHN DEERE OTTUMWA WORKS         
 
         PAGE 26
 
 
 
 
 
         
 
         condition," without in any way pegging that condition to the date 
 
         of verbal agreement.
 
         
 
              The question is close.  However, on balance, the undersigned 
 
         concludes that the appropriate date for measuring any change in 
 
         condition in this case is December 4, 1984.  This conclusion is 
 
         reached primarily because the deal struck by the parties on that 
 
         date is enforceable in equity and to a lesser degree for reasons 
 
         of administrative efficiency as set forth in the Grelk decision.
 
         
 
              The examination closest in time to December 4, 1984 was 
 
         performed by Dr. Summers on September 25 of that year.  Dr. 
 
         Summers' assessment of a 15-20 percent functional impairment was 
 
         the highest of the several medical opinions on that issue.  Dr. 
 
         Summers found that claimant had pain and discomfort in the back 
 
         and left lower extremity with evidence of a radicular syndrome.  
 
         Movements of the lower back were restricted, claimant able to 
 
         move forward 30 degrees, but unable to move backward.  Claimant 
 
         tended to limp on the left side.  Vibratory sense was impaired 
 
         and pain sensation was impaired.
 
         
 
              Claimant felt that his condition had become exacerbated when 
 
         he saw Dr. Berg on February 25, 1985. while continuing to have 
 
         lower back and sciatic pain, claimant had developed additional 
 
         symptomatology: numbness in the left leg, problems with urination 
 
         and initiation of urination, and inability to get an erection.  
 
         Clinically, his examination revealed diminished knee jerks and 
 
         ankle jerks.  A CT scan performed by Dr. McCarl at about that 
 
         time showed no herniated disc, but moderate disc space narrowing 
 
         at L2-L3 with some sclerosis, narrowing between articular facets 
 
         and degenerative change in the lumbar spine generally.
 
         
 
              Dr. Carlstrom noted osteoarthritic changes in the 1987 
 
         x-rays, but was of the view that these symptoms were not caused 
 
         by the work injury and may have been due to diminished activity 
 
         following claimant's cervical fusion.  His testimony was to the 
 
         effect that had claimant not had the neck problem and surgery and 
 
         had continued to be active, "then I don't think that he would be 
 
         worse today."  Dr. Carlstrom did find objective changes between 
 
         April, 1987 and January, 1989 in that claimant had diminished 
 
         range of motion in the back.  Thus, Dr. Carlstrom's testimony 
 
         appears to be internally inconsistent in that he believes that 
 
         claimant's lower back condition has changed for the worse 
 
         (although not finding a causal relationship to the work injury), 
 
         but of essentially the same or even less impairment rating (6 or 
 
         6 1/2 percent as of January 31, 1989 as opposed to 7-8 percent on 
 
         November 20, 1984).  Dr. Carlstrom
 
         
 
         
 

 
         PICKRELL V. JOHN DEERE OTTUMWA WORKS         
 
         PAGE 27
 
 
 
 
 
 
 
         believed that claimant would need to avoid heavy lifting, 
 
         prolonged sitting, standing and cramped postures such as forward 
 
         bending or stooping.  He believed that claimant was currently 
 
         employable, given his functions and restrictions, able to do a 
 
         job that was light-duty and allowed him to change positions, 
 
         walk, sit, stand and so forth.  He thought claimant could do 
 
         light maintenance, probably do guard duty or clerical work, and 
 
         could be a salesman or do light maintenance repair work such as 
 
         electronic devices.  Dr. Carlstrom did admit on cross-examination 
 
         that traumatic injuries can hasten the development of arthritic 
 
         or degenerative problems and that the work injury was at least a 
 
         substantial contributing and aggravating factor in the overall 
 
         disability to claimant's lower back.
 
         
 
              Dr. Beck saw claimant last on March 11, 1987.  He noted that 
 
         claimant had cervical and lumbar spondylosis as well as probable 
 
         adhesive arachnoiditis in his lumbar spine.  The diagnosis of 
 
         arachnoiditis is significant by reason of its confirmation of Dr. 
 
         Hines' views set forth below.  He noted that claimant would 
 
         continue to have neck and back problems if he engaged in activity 
 
         that "causes any flexion or extension or lateral bending of these 
 
         elements."  He found those problems could very well have been 
 
         exacerbated by previous work experience and environment.
 
         
 
              Dr. Hines followed claimant from March, 1985 through October 
 
         11, 1988.  He also did not conclude that claimant's cervical 
 
         problems were causally related to the work injury.  However, he 
 
         thought that claimant's lumbar spine problems were secondary to a 
 
         combination of osteoarthritis and arachnoiditis.  He agreed that 
 
         osteoarthritis is a naturally occurring degenerative disease 
 
         which for the most part was responsible for claimant's lumbar 
 
         spondylosis.  However, he had a different view as to the role of 
 
         arachnoiditis.  This is a condition that probably would not have 
 
         developed without the injury and subsequent surgery.  It is a 
 
         condition that he believed usually comes on as a result of some 
 
         kind of manipulation inside the spinal canal.  Dr. Hines 
 
         described claimant's spondylosis as in front of the spinal canal, 
 
         pushing back in, while the arachnoiditis was around the canal, 
 
         causing a scar that constricts it and tightens it.  Dr. Hines 
 
         believed that this spinal stenosis or narrowing of the spinal 
 
         canal would be unlikely to occur at claimant's age without the 
 
         element of surgery and arachnoiditis.
 
         
 
              As has been seen, Dr. Hines testified to a progressive 
 
         worsening of claimant's back condition between March, 1985 and 
 
         July, 1988 (as of his deposition).  On October 11, 1988, Dr. 
 
         Hines found further increasing difficulties in the lower
 
         
 
         
 
         
 
         PICKRELL V. JOHN DEERE OTTUMWA WORKS 
 
         Page 28
 
         
 
         
 
         back.  Claimant at that time was having difficulties with 
 
         urination, constipation and defecation.  Claimant sat in a 
 
         slightly turned posture with decreased weight on the left hip and 
 
         leg.  Sitting for prolonged periods was impossible without 
 
         standing and walking about at intervals.  Standing for long 
 
         periods was difficult.  Claimant was unable to take long trips in 
 
         the car without frequent breaks.  Claimant had marked limitations 
 
         in lifting prescribed by both Dr. Hines and Dr. Beck.  Claimant's 
 
         social and recreational activities had been markedly restricted 
 
         due to lumbar pain, including the ability to perform "any type of 
 
         physical recreation."  Other than occasional visits with family 
 
         members, claimant was able only to play cards for recreation.
 
 
 
 
 

 
 
 
 
 
         
 
              Asked what sort of work claimant might be able to perform as 
 
         of his deposition, Dr. Hines indicated that a majority of the 
 
         problems were due to the lower back and would keep claimant from 
 
         being able to do much of anything in terms of really productive 
 
         employment. one might creatively envision some type of part-time 
 
         work, but it would be something where claimant would be able to 
 
         almost determine his own hours.  Claimant would be limited from 
 
         continuous standing, could sit perhaps one to two hours at a 
 
         time, would be unable to stoop, bend, lift, or crawl, operate 
 
         foot controls repetitively or heavy foot controls infrequently, 
 
         or be involved in an occupation that required repetitive jarring 
 
         of the back.  In addition, claimant had significant cervical 
 
         problems.
 
         
 
              After the October 11, 1988 visit, Dr. Hines prepared a 
 
         detailed analysis of claimant's functional deficit.  Summarized, 
 
         he found a 20 percent impairment to the whole person based on 
 
         limited motion of the lumbar spine, a 22 percent impairment to 
 
         the whole person by reason of left lower extremity, and a 4 
 
         percent impairment to the whole person by reason of impairment to 
 
         the right lower extremity.  He found that claimant had sustained 
 
         a total 32 percent impairment of the whole person.  Dr. Hines 
 
         cited the AMA Guides to the Evaluation of Permanent Impairment 
 
         (2nd Ed.) in reaching this conclusion.  However, a review of the 
 
         combined values chart contained therein shows that body as a 
 
         whole impairments of 20 percent, 4 percent and 22 percent combine 
 
         to a 40 percent,impairment, not a 32 percent impairment.
 
         
 
              Dr. Carlstrom and Dr. Hines are in disagreement.  Dr. 
 
         Carlstrom finds that claimant has sustained a deterioration to 
 
         his lumbar spine, but attributes it to lack of activity forced by 
 
         the cervical condition which no physician causally connects to 
 
         the work injury.  However, he also agreed that traumatic injury 
 
         can hasten and exacerbate osteoarthritis.
 
         
 
         
 
         
 
         PICKRELL v. JOHN DEERE OTTUMWA WORKS 
 
         Page 29
 
         
 
         
 
         On the other hand, Dr. Hines finds that claimant's lumbar 
 
         condition is related both to osteoarthritis and to arachnoiditis.  
 
         While the osteoarthritis may be a naturally occurring condition, 
 
         he attributed the arachnoiditis to the work injury and subsequent 
 
         surgery.  On balance, this writer finds Dr. Hines' views to be 
 
         the more persuasive.  He has seen and treated claimant on 
 
         numerous occasions and followed him from March, 1985 through 
 
         April, 1988.  Dr. McCarl's CT scan in 1985 found sclerosis and 
 
         narrowing at L5-Sl bilaterally and at L2 and L2-L3.  Claimant has 
 
         developed additional symptomatology, including numbness to the 
 
         left leg, problems with urination and defecation and obtaining 
 
         erections, and reduced range of motion.  Claimant has developed 
 
         foot drop.  His ability to walk has deteriorated.
 

 
 
 
 
 
         
 
              It is held that claimant has sustained his burden of proof 
 
         in establishing a change in condition since December 4, 1984.  
 
         Claimant has also suffered further change of condition since 
 
         March 27, 1985 (developed foot drop and reduced range of motion).
 
         
 
              Functional impairment is an element to be considered in 
 
         determining industrial disability which is the reduction of 
 
         earning capacity, but consideration must also be given to the 
 
         injured employee's age, education, qualifications, experience and 
 
         inability to engage in employment for which he is fitted.  Olson 
 
         v. Goodyear Service Stores, 255 Iowa 1112, 125 N.W.2d 251 (1963).  
 
         Barton v. Nevada Poultry, 253 Iowa 285, 110 N.W.2d 660 (1961).
 
         
 
              A finding of impairment to the body as a whole found by a 
 
         medical evaluator does not equate to industrial disability.  This 
 
         is so as impairment and disability are not synonymous.  Degree of 
 
         industrial disability can in fact be much different than the 
 
         degree of impairment because in the first instance reference is 
 
         to loss of earning capacity and in the latter to anatomical or 
 
         functional abnormality or loss.  Although loss of function is to 
 
         be considered and disability can rarely be found without it, it 
 
         is not so that a degree of industrial disability is 
 
         proportionally related to a degree of impairment of bodily 
 
         function.
 
         
 
              Factors to be considered in determining industrial 
 
         disability include the employee's medical condition prior to the 
 
         injury, immediately after the injury, and presently; the situs of 
 
         the injury, its severity and the length of healing period; the 
 
         work experience of the employee prior to the injury, after the 
 
         injury and potential for rehabilitation; the employee's 
 
         qualifications intellectually, emotionally and physically; 
 
         earnings prior and subsequent to the injury; age; education; 
 
         motivation; functional impairment as a
 
         
 
         
 
         
 
         PICKRELL v. JOHN DEERE OTTUMWA WORKS 
 
         Page 30
 
         
 
         
 
         result of the injury; and inability because of the injury to 
 
         engage in employment for which the employee is fitted.  Loss of 
 
         earnings caused by a job transfer for reasons related to the 
 
         injury is also relevant.  These are matters which the finder of 
 
         fact considers collectively in arriving at the determination of 
 
         the degree of industrial disability.
 
         
 
              There are no weighting guidelines that indicate how each of 
 
         the factors are to be considered.  There are no guidelines which 
 
         give, for example, age a weighted value of ten percent of the 
 
         total value, education a value of fifteen percent of total, 
 
         motivation - five percent; work experience - thirty percent, etc.  
 
         Neither does a rating of functional impairment directly correlate 
 
         to a degree of industrial disability to the body as a whole.  In 
 
         other words, there are no formulae which can be applied and then 
 
         added up to determine the degree of industrial disability.  It 
 
         therefore becomes necessary for the deputy or commissioner to 
 
         draw upon prior experience, general and specialized knowledge to 
 
         make the finding with regard to degree of industrial disability.  
 
         See Haven Cafe, Inc., (Appeal Decision, February 28, 1985); 
 
         Christensen v. Hagen Inc., (Appeal Decision, March 26, 1985).
 

 
         
 
 
 
         
 
              Claimant's brief appropriately cites Diederich v. Tri-City 
 
         R. Co., 219 Iowa 587, 258 N.W. 899 (1935).  That claimant had 
 
         been a streetcar motorman for 30 years, was 59 years of age and 
 
         had suffered a compression fracture with fusion of several 
 
         vertebrae.  He had little education and was unable to find or 
 
         hold a position that would not require some manual labor.  From 
 
         the standpoint of his ability to go back to work to earn a living 
 
         for himself and his family, Diederich's disability was a total 
 
         disability, even though that disability was less than a 100 
 
         percent disability compared with a perfect man.
 
         
 
              Mr. Pickrell is 52 years of age and, although he has 
 
         obtained a GED, left school in the eighth grade and has poor 
 
         clerical skills and does not read or spell well.  His work 
 
         history includes farm work, dish washing, a garbage route, work 
 
         as a mechanic and work as a welder.  Given claimant's current 
 
         functional deficit and symptoms, it is hard to see how he could 
 
         realistically obtain work in any of those fields.  It is perhaps 
 
         even harder to see how he might obtain work in a clerical field 
 
         given his inability to sit for more than one or two hours and his 
 
         poor clerical skills.  The same problem militates against 
 
         successful retraining.  Based on a review of all the evidence, it 
 
         is held that claimant has become permanently and totally disabled 
 
         by reason of the work injury of June 25 or July 3, 1979.  This 
 
         conclusion does not take claimant's independent cervical
 
         
 
         
 
         
 
         PICKRELL v. JOHN DEERE OTTUMWA WORKS
 
         Page 31
 
         
 
         
 
         spine impairment into account because it has not been shown to be 
 
         causally related to the work injury.
 
         
 
              Because claimant is found to be permanently and totally 
 
         disabled, there is no healing period to determine.
 
         
 
              Commencement of permanent disability benefits is difficult 
 
         because of the current posture of this cause.  The agreement for 
 
         settlement approved March 27, 1985 did not deal with the extent 
 
         of claimant's healing period, as it was merely found that this 
 
         was not an issue at that time.  Nor did it determine the 
 
         commencement date of permanent partial disability, as it had 
 
         apparently all accrued.  It was merely awarded without interest 
 
         and without any specific date.
 
         
 
              Claimant's condition has deteriorated in stages since 
 
         December, 1984.  The first exacerbation was in February, 1985, 
 
         but he has clearly traveled a downhill path since then.  Claimant 
 
         had certainly developed at least some additional partial 
 
         disability, and perhaps total disability, as of March 27, 1985.  
 
         It would be entirely arbitrary to find several stages of 
 
         increasing permanent disability and then some one date 
 
         constituting the deterioration to permanent total disability.  It 
 
         is held that the commencement date for permanent total disability 
 
         is March 28, 1985.
 

 
 
 
 
 
         
 
              As stipulated, defendant has continued to pay claimant 
 
         benefits in accordance with the collective bargaining agreement 
 
         and benefit agreement.  Defendant is entitled to credit for those 
 
         benefits under Iowa Code section 85.38(2). It has been held that 
 
         an employer may unilaterally establish the amount of the credit 
 
         due under Iowa Code section 85.38(2).  Bakalar v. Woodward State 
 
         Hospital School, file number 756871 (App. Decn. June 16, 1989).  
 
         If claimant disputes the accuracy of the amount of the credit 
 
         taken, his proper remedy is to file a new petition for a 
 
         determination by the commissioner of the reasonableness of the 
 
         credit.  This agency retains jurisdiction at all stages to 
 
         determine a proper credit under Iowa Code section 85.38(2).
 
         
 
                                 FINDINGS OF FACT
 
         
 
              THEREFORE, based on the evidence presented, the following 
 
         ultimate facts are found:
 
         
 
              1. As stipulated, claimant sustained an injury arising out 
 
         of and in the course of his employment with defendant on June 25 
 
         or July 3, 1979.
 
         
 
         
 
         
 
         PICKRELL v. JOHN DEERE OTTUMWA WORKS
 
         Page 32
 
         
 
         
 
              2. As stipulated, the appropriate rate of weekly 
 
         compensation is $264.39.
 
         
 
              3. As stipulated, defendant is entitled to credit under Iowa 
 
         Code section 85.38(2) for sick pay/disability income of 
 
         $12,418.00 at the time of hearing and increasing thereafter.
 
         
 
              4. The parties herein entered into an agreement for 
 
         settlement which was verbally agreed to on December 4, 1984, 
 
         executed on March 18, 1985 and submitted and approved on March 
 
         27, 1985.
 
         
 
              5. The agreement for settlement was based on impairment 
 
         ratings by Mayo Clinic physicians of 15 percent of the body as a 
 
         whole, Dr. Summers' rating of 15-20 percent of the body as a 
 
         whole, Dr. Carlstrom's rating of 7-8 percent of the body as a 
 
         whole, a medical history of an excised disc and found that 
 
         claimant had sustained an industrial disability based on his 
 
         "current condition" of 22 1/2 percent of the body as a whole.
 
         
 
              6. The medical examination closest in time to December 4, 
 
         1984 was performed by Dr. Summers on September 25, 1984.  
 
         Claimant's symptomatology at that time included pain and 
 
         discomfort in the back and left lower extremity with evidence of 
 
         a radicular syndrome, movements of the lower back were 
 
         restricted, claimant tended to limp on the left side, and 
 
         vibratory sense and pain sensation were impaired.
 

 
         
 
 
 
         
 
              7. Claimant's condition became exacerbated and he saw Dr. 
 
         Berg on February 25, 1985.  Continuing to have lower back and 
 
         sciatic pain, claimant had developed additional symptomatology: 
 
         numbness in the left leg, problems with urination and initiation 
 
         of urination, and inability to obtain an erection.  Claimant's 
 
         examination revealed diminished knee jerks and ankle jerks.
 
         
 
              8. Although Dr. Carlstrom did not believe that claimant's 
 
         admittedly exacerbated back condition was causally related to the 
 
         work injury as opposed to a separate cervical condition, he 
 
         believed that claimant would need to avoid heavy lifting, 
 
         prolonged sitting, standing and cramped postures such as forward 
 
         bending or stooping, but believed that claimant was employable.
 
         
 
              9. Dr. Hines found that claimant suffered a progressive 
 
         worsening of his back condition between March, 1985 and July, 
 
         1988, and again on October 11, 1988.  He felt that sitting for 
 
         prolonged periods was impossible without standing and walking 
 
         about at intervals as was standing for
 
         
 
         
 
         
 
         PICKRELL v. JOHN DEERE OTTUMWA WORKS 
 
         Page 33
 
         
 
         
 
         long periods.  Claimant had marked limitations in lifting and was 
 
         essentially unable in his view to do much of anything in terms of 
 
         productive employment.  Specifically, claimant was limited from 
 
         continuous standing, could sit perhaps one to two hours at a 
 
         time, would be unable to stoop, bend, lift or crawl, operate foot 
 
         controls repetitively or heavy foot controls infrequently, or be 
 
         involved in an occupation requiring repetitive jarring of the 
 
         back.
 
         
 
              10. Dr. Hines found that claimant's impairment rating under 
 
         American Medical Association Guides to the Evaluation of 
 
         Permanent Impairment was to the extent of 32 percent of the body 
 
         as a whole.  However, his evaluation appears to have inaccurately 
 
         made use of the combined values chart of the AMA guides, which 
 
         indicate a 40 percent body as a whole impairment based upon 
 
         separate evaluations of the back and lower extremities.
 
         
 
              11. Claimant has established a change in condition to his 
 
         lower back causally related to his work injury since December 4, 
 
         1984.
 
         
 
              12. Claimant is currently and for the foreseeable future 
 
         disabled from any meaningful employment in any recognized and 
 
         regular field of endeavor.
 
         
 
                                CONCLUSIONS OF LAW
 
         
 
              WHEREFORE, based on the principles of law previously cited, 
 
         the following conclusions of law are made:
 

 
 
 
 
 
         
 
              1. Claimant has met his burden of proof in establishing a 
 
         change in condition to his lumbar spine since December 4, 1984, 
 
         the date upon which the parties reached an enforceable settlement 
 
         later approved by this office on March 27, 1985.
 
         
 
              2. Claimant is permanently and totally disabled by reason of 
 
         his work injury and without regard to independent cervical spine 
 
         problems.
 
         
 
                                      ORDER
 
         
 
              THEREFORE, IT IS ORDERED:
 
         
 
              Defendant is to pay unto claimant two hundred sixty-four and 
 
         39/100 dollars ($264.39) per week as permanent total disability 
 
         compensation during such time as claimant remains totally 
 
         disabled.
 
         
 
         
 
         
 
         PICKRELL v. JOHN DEERE OTTUMWA WORKS
 
         Page 34
 
         
 
         
 
              Defendant shall be entitled to credit at its discretion 
 
         under Iowa Code section 85.38(2) for disability/sick pay benefits 
 
         paid pursuant to the collective bargaining agreement and benefit 
 
         agreement.  This agency retains jurisdiction to review the amount 
 
         of that credit.
 
         
 
              All benefits which have accrued as of the date of this 
 
         decision shall be paid in a lump sum together with statutory 
 
         interest pursuant to Iowa Code section 85.30.
 
         
 
              The costs of this action shall be assessed to defendant 
 
         pursuant to Division of Industrial Services Rule 343-4.33.
 
         
 
              Defendant shall file claim activity reports as requested by 
 
         this agency pursuant to Division of Industrial Services Rule 
 
         343-3.1.
 
         
 
              Signed and filed this 27th day of February, 1990.
 
         
 
         
 
         
 
         
 
                                         DAVID RASEY
 
                                         DEPUTY INDUSTRIAL COMMISSIONER
 
         
 
         
 
         
 
         Copies To:
 
         
 
         Mr. Arthur C. Hedberg, Jr.
 

 
 
 
 
 
         Attorney at Law
 
         840 Fifth Avenue
 
         Des Moines, Iowa 50309
 
         
 
         Mr. Walter F. Johnson 
 
         Attorney at Law 
 
         111 West Second Street 
 
         P.O. Box 716 
 
         Ottumwa, Iowa 52501
 
         
 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
 
         
 
 
 
 
 
 
 
 
 
 
 
                                         1804, 2904, 3301
 
                                         Filed February 27, 1990
 
                                         DAVID RASEY
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         WILLIAM PICKRELL,
 
                                          File No. 626523
 
              Claimant,
 
                                         R E V I E W 
 
         VS.
 
                                         R E 0 P E N I N G 
 
         JOHN DEERE OTTUMWA WORKS,
 
                                         D E C I S I 0 N
 
              Employer,
 
              Self-Insured,
 
              Defendant.
 
         
 
         
 
         3301, 2904
 
         
 
              Although agreement for settlement was approved only by 
 
         deputy's stamped name, it was held valid.
 
         
 
              Where parties verbally agreed to settlement on scheduled 
 
         date of hearing in December, but did not execute and file 
 
         settlement documents until following March, the December date was 
 
         used to measure change of condition in subsequent 
 
         review-reopening.  Claimant had suffered an exacerbation of 
 
         symptoms during the interim.
 
         
 
         1804
 
         
 
              Fifty-two-year-old claimant with eighth grade education and 
 
         poor clerical and reading skills (but with GED), work history of 
 
         manual labor and welding, restrictions against continuous 
 
         standing or sitting and stooping, lifting, bending, crawling, 
 
         operating foot controls or being subject to repetitive jarring 
 
         and 40 percent impairment rating was found permanently and 
 
         totally disabled.
 
         
 
         
 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
 
            
 
     
 
 
 
           
 
                                          
 
         
 
                    BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         LOUELLA BROWN,
 
         
 
              Claimant,
 
                                                File Nos. 627617/498456
 
         VS.
 
                                                       A P P E A L
 
         JOHN DEERE WATERLOO
 
         TRACTOR WORKS,
 
                                                     D E C I S I 0 N
 
              Employer,
 
              Self-Insured,
 
              Defendant
 
         
 
         
 
         
 
         
 
                              STATEMENT OF THE CASE
 
         
 
              Claimant appeals from a consolidated review-reopening 
 
         decision denying all compensation because claimant had not 
 
         established a change of condition.
 
         
 
              The record on appeal consists of the transcript of the 
 
         review-reopening proceeding; joint exhibits A through J; and the 
 
         transcript and exhibits of the prior review-reopening proceeding 
 
         on June 15, 1983.  Both parties filed briefs on appeal.
 
         
 
                                      ISSUES
 
         
 
              Claimant states the issues on appeal as:
 
         
 
              (1)  Are the claimant's present physical problems causally 
 
              [sic] related to the worker's [sic] compensation injuries 
 
              she received at the John Deere Waterloo Tractor Works on 
 
              January 11, 1978 and February 6, 1980?
 
         
 
              (2)  Is Deputy Commissioner Helmut Mueller's Decision of 
 
              January 26, 1984 that claimant had undergone a change of 
 
              condition subsequent to the settlement of October 14, 1980 
 
              res judicata on that issue in the present hearing?
 
         
 
              (3)  Is the claimant entitled to medical benefits, healing 
 
              period benefits and permanent total disability benefits, or 
 
              in the alternative, additional permanent partial disability 
 
              benefits?
 
         
 
                             REVIEW OF THE EVIDENCE
 
         
 
              The review-reopening decision adequately and accurately 
 
         reflects the pertinent evidence and it will not be reiterated 
 
         herein.
 
         
 
              Briefly stated, claimant sustained an injury to her low back 
 

 
         
 
         
 
         
 
         BROWN V. JOHN DEERE WATERLOO TRACTOR WORKS
 
         Page   2
 
         
 
         
 
         while moving a ladder at work on January 11, 1978.  On February 
 
         6, 1980 claimant sustained an injury to her head and neck when 
 
         she was struck by parts which fell when a truck or parts carrier 
 
         passed by her work station.  Claimant entered into a settlement 
 
         agreement with John Deere Waterloo Tractor Works (hereinafter 
 
         John Deere) based on her condition as of October 14, 1980.  
 
         Paragraph 7 of the settlement agreement states the following 
 
         concerning claimant's work restrictions:
 
         
 
                   7.  That the Claimant presently has the following work 
 
              restrictions at her employment with Employer: (1) 20 pound 
 
              weight lifting restriction; (2) no continuous or repetitive 
 
              bending or twisting; (3) no prolonged standing.  By this, 
 
              the parties mean that Claimant should be able to sit 50% of 
 
              the working time; (4) a maximum of a forty hour work week.
 
         
 
         (Commissioner's Exhibit 8; review-reopening 6-15-83)
 
         
 
              Paragraph 8 of the settlement agreement states the following 
 
         concerning claimant's permanent disability:
 
         
 
                   8.  That based upon all of the foregoing, Claimant has 
 
              suffered and is entitled to compensation for a 15% permanent 
 
              industrial disability to her body as a whole from her 
 
              January 11, 1978 injury and a 5% permanent industrial 
 
              disability to her body as a whole for the February 6, 1980 
 
              injury.  That based thereon, Employer shall pay Claimant 
 
              weekly benefits as follows:
 
         
 
              15% x 500 weeks = 75 weeks @ $203.21 per week =  $15,240.75
 
               5% x 500 weeks = 25 weeks @ $198.69 per week =  $ 4,967.25
 
                                               TOTAL:          $20,208.00
 
         
 
         (Commissioner's Exhibit 8; review-reopening 6-15-83)
 
         
 
              Claimant underwent a cervical fusion at the C5 and C6 level 
 
         on April 17, 1983.  This procedure was performed by John R. 
 
         Walker, M.D.  Following this surgery on June 15, 1983 a 
 
         review-reopening hearing was held and in the review-reopening 
 
         decision filed thereafter the following findings of fact and 
 
         order were made:
 
         
 
              1.  That this agency has jurisdiction of the persons 
 
         and the subject matter.
 
         
 
              2.  That on January 8, 1981 the parties entered into an 
 
         agreement for settlement concerning claimant's two admitted 
 
         industrial injuries.
 
         
 
              3.  That on December 7, 1981, claimant produced medical 
 
         evidence that she was unable to perform acts of gainful 
 
         employment due to neck pain.
 
         
 
              4.  That on April 18, 1983 medical evidence was 
 
         produced, following cervical surgery, that claimant had 
 
         indeed undergone a change of condition.
 
         
 
              5.  That claimant has been unable to work from December 
 
         7, 1981 to June 15, 1983.
 

 
         
 
         
 
         
 
         BROWN V. JOHN DEERE WATERLOO TRACTOR WORKS
 
         Page   3
 
         
 
         
 
         
 
              6.  That the rate of weekly entitlement is $198.69.
 
         
 
              7.  That claimant's hospital and doctor bills incurred 
 
         as a result of the recent surgery are payable by the 
 
         defendant.
 
         
 
              THEREFORE, IT IS ORDERED that defendant pay the 
 
         claimant a seventy-nine (79) week period of temporary total 
 
         disability at one hundred ninety-eight and 69/100 dollars 
 
         ($198.69) per week together with interest from the date 
 
         due.
 
         
 
         (Review-reopening decision filed 1-26-84)
 
         
 
              No appeal was taken from this decision.
 
         
 
              On September 8, 1983 claimant underwent chymopapain 
 
         injections at L4 and L5.  These injections were performed by Dr. 
 
         Walker.  Claimant apparently got some temporary relief from these 
 
         injections; however, she started having muscle spasms in her back 
 
         and had to be hospitalized on October 25, 1983 as a result of 
 
         complications of the chymopapain injections.  She was discharged 
 
         on November 10, 1983.
 
         
 
              Dr. Walker states the following in a letter dated October 
 
         12, 1984 concerning claimant's current permanent disability:
 
         
 
                 At the present time, as far as her cervical spine injury 
 
              is concerned, I feel that she has a 10% permanent, partial 
 
              impairment of the body as a whole.  As far as the low back 
 
              is concerned, I would add another 12% permanent, partial 
 
              impairment of the body as a whole.  This would bring it to a 
 
              22% permanent, partial impairment of the body as a whole.
 
         
 
         (Joint Ex.C; review-reopening 8-29-85)
 
         
 
              Finally Dr. Walker opines that if claimant would undergo 
 
         further surgery on her back her permanent disability would be 30 
 
         percent.  However, he stated he is "somewhat loathe" to do any 
 
         further surgery on claimant as she has not gotten the anticipated 
 
         results from her previous surgery.
 
         
 
              Charles R. Buck, M.D., examined claimant on March 12, 1985 
 
         and states the following:
 
         
 
                 On examining her today, she demonstrates exaggerated 
 
              tenderness in the S/I joint and lateral hip area.  She 
 
              has markedly limited range of motion to a few degrees 
 
              in all planes, complaining of pain.  No spasm was 
 
              noted.  SLR on the left was negative.  SLR on the right 
 
              was positive was positive [sic] for back and right leg 
 
              pain at 20 degrees; however there was tensing of her 
 
              hip flexors throughout the exam which I believe 
 
              exaggerated her pain.  We also observed sitting SLR on 
 
              the right was negative for nerve root irritation.
 
         
 
                 ....
 
         
 

 
         
 
         
 
         
 
         BROWN V. JOHN DEERE WATERLOO TRACTOR WORKS
 
         Page   4
 
         
 
         
 
                 From the record, and with her history today, 
 
              Louella's overall condition is the same as it has been 
 
              for several years, except for the three or four months 
 
              following chymopapain when she experienced the local 
 
              spasms.  Since that point, she has been back to her 
 
              baseline symptomatology and thus achieved no benefit 
 
              from the chymopapain treatment.
 
         
 
         (Jt  Ex. F; review-reopening 8-29-85)
 
         
 
              Richard N. Stauffer, M.D., examined claimant on November 21, 
 
         1984.  He opines that there is no good evidence of radiculopathy 
 
         and that he does not think a laminectomy would be a good idea.
 
         
 
              Claimant was laid off from John Deere in December 1981.  
 
         Richard Mayer, supervisor of wage and employment benefits at John 
 
         Deere, stated at the June 15, 1983 review-reopening hearing that 
 
         claimant was laid off because she was a junior employee.
 
         
 
                                  APPLICABLE LAW
 
         
 
              The citations of law in the review-reopening decision are 
 
         appropriate to the issues and the evidence presented.
 
         
 
                                     ANALYSIS
 
         
 
              The first issue claimant raises concerns the causal 
 
         connection between claimant's current disability and her work 
 
         injuries of January 11, 1978 and February 6, 1980.  Defendant 
 
         makes the following reply in its appeal brief to claimant's 
 
         argument concerning this issue:  "Employer does not believe that 
 
         the above issue is really involved in this case.  The Employer 
 
         long ago conceded that Claimant had industrial injuries on 
 
         January 11, 1978, and February 6, 1980.  For many years, the only 
 
         battle has been over the extent of her entitlement to benefits.O
 
         
 
              The prehearing order filed January 11, 1985 does not 
 
         indicate causal connection as an issue in this case.  The record 
 
         as a whole indicates that defendant has not contested the causal 
 
         connection between claimant's injuries and her disability.  In 
 
         any event, the record amply supports a finding of causal 
 
         connection.  Thus, the major dispute in this case concerns the 
 
         nature and extent of claimant's current disability as a result of 
 
         the injuries.
 
         
 
              Before claimant can be entitled to additional benefits for 
 
         permanent disability in these review-reopening proceedings she 
 
         must establish by a preponderance of the evidence a change of 
 
         condition since her previous award.  However, claimant argues 
 
         here that the review-reopening decision filed on January 26, 1984 
 
         is res judicata on the issue of change of condition.  Since that 
 
         decision was never appealed, it became the final agency decision 
 
         and is necessarily res judicata on the issues it adjudicated.  
 
         However, the issue that the January 26, 1984 review-reopening 
 
         decision considered was further temporary total disability as a 
 
         result of the February 6, 1980 injury.  The January 1984 decision 
 
         is not res judicata as to further permanent disability.
 
         
 
              Therefore, claimant must show a permanent change of 
 

 
         
 
         
 
         
 
         BROWN V. JOHN DEERE WATERLOO TRACTOR WORKS
 
         Page   5
 
         
 
         
 
         condition since October 14, 1980 to recover additional benefits 
 
         for permanent disability.  On this issue claimant does not 
 
         preponderate.  The record shows that claimant's problems have 
 
         essentially remained the same or have gotten better.  Although 
 
         Dr. Walker indicates that claimant's current disability rating is 
 
         22 percent, his opinion is not supported by the other examining 
 
         physicians.  The analysis of this issue contained in 
 
         review-reopening decision is adequate and accurate and is adopted 
 
         herein.
 
         
 
              Claimant argues that she is entitled to temporary total 
 
         disability or healing period benefits from June 15, 1983 to 
 
         October 14, 1984 when Dr. Walker opines that claimant has reached 
 
         maximum medical improvement unless she has further back surgery.  
 
         Claimant is only entitled to a further award of temporary total 
 
         disability for those surgeries which resulted in a temporary 
 
         worsening of claimant's condition beyond that anticipated in her 
 
         earlier award of permanent disability.
 
         
 
              The record here indicates that claimant underwent chemo- 
 
         nucleolysis for her low back problems on September 8, 1983.  The 
 
         subsequent discharge summary on September 10, 1983 indicates that 
 
         the procedure was very successful.  However, on October 25, 1983 
 
         claimant had to be readmitted to the hospital for muscle spasms 
 
         secondary to the chemonucleolysis.  Dr. Walker, who performed the 
 
         chemonucleolysis and treated claimant's subsequent complications, 
 
         outlines the following history in his hospital report:
 
         
 
              HISTORY:
 
              This patient had a Chymopapain injection September 8th. 
 
              was doing fine.  Had no problems with the legs or back 
 
              and did just beautifully but, at any rate, last 
 
              Thursday which was about five days ago she began to get 
 
              severe back spasms and pain and this bothered her 
 
              walking.  She fell a couple of times because of the 
 
              severe pain in her back.  She does not have weak legs 
 
              but what happens is that when she moves her legs or 
 
              raises them she has extreme pain in the back and, 
 
              therefore, cannot walk or get around well.  She called 
 
              Friday and we gave her analgesic drugs and told her to 
 
              lay on the heating pad at home but she is much worse 
 
              and is unable to hardly get around now at all.  She has 
 
              extreme muscle spasm.  This is a complication that I 
 
              have noticed on one particular patient before with a 
 
              Chymopapain and one other that wasn't as bad but this 
 
              is one of the more severe ones.  This will take 
 
              approximately three weeks for this patient to get over 
 
              this.  This is what happened at least on the last 
 
              patient that I had.  This is one of the complications 
 
              of Chymodactin [sic] injections and probably she will 
 
              do well in the end.
 
         
 
         (Jt. Ex  B)
 
         
 
              Claimant was discharged on November 10, 1983.  She testified 
 
         on direct examination at the August 29, 1985 hearing that 
 
         chemonucleolysis improved her back condition for about a month 
 
         but then she developed muscle spasms and had to be readmitted to 
 
         the hospital.  She also testified on direct examination that the 
 

 
         
 
         
 
         
 
         BROWN V. JOHN DEERE WATERLOO TRACTOR WORKS
 
         Page   6
 
         
 
         
 
         muscle spasms went away gradually, but her pain remained.  On 
 
         cross-examination she testified that her back condition returned 
 
         to the same condition that she suffered before the 
 
         chemonucleolysis.
 
         
 
              It appears from the preceding evidence that claimant 
 
         experienced temporary relief from her back condition for about 
 
         one month and then experienced a subsequent worsening of her back 
 
         condition for three weeks due to muscle spasms secondary to her 
 
         chemonucleolysis.  After that three week period her back 
 
         condition returned to normal or to a condition similar to that 
 
         before the chemonucleolysis.  It is for the three week period 
 
         that claimant's back condition worsened that she is entitled to 
 
         temporary total disability benefits.  As that temporary 
 
         disability was related to the back injury claimant suffered 
 
         January 11, 1978, the appropriate rate for the three weeks of 
 
         temporary disability is $203.21.  This is the rate that the 
 
         parties have stipulated is correct for any award of disability as 
 
         a result of the January 11, 1978 injury.
 
         
 
              As the deputy correctly indicated in the review-reopening 
 
         decision filed November 20, 1985 claimant is entitled to medical 
 
         expenses for continuing medical care if related to her 
 
         compensable injury.  No evidence expressly relating to that issue 
 
         was presented; however, the parties are encouraged to work 
 
         amicably and equitably toward that result.
 
         
 
                                 FINDINGS OF FACT
 

 
         
 
         
 
         
 
         BROWN V. JOHN DEERE WATERLOO TRACTOR WORKS
 
         Page   7
 
         
 
         
 
         
 
              1.  Claimant received an injury to her low back on January 
 
         11, 1978 while lifting a ladder in the course of her employment 
 
         for John Deere.
 
         
 
              2.  Claimant received an injury to her cervical area on 
 
         February 6, 1980 when she was hit by falling parts while in the 
 
         course of her employment for John Deere.
 
         
 
              3.  Claimant and her employer entered into a settlement 
 
         agreement on January 8, 1981 based on claimant's condition as of 
 
         October 14, 1980.
 
         
 
              4.  Under the terms of the settlement agreement, claimant 
 
         received benefits reflecting an industrial disability of 20 
 
         percent of the body as a whole.
 
         
 
              5.  Claimant reported experiencing sensation of a rock in 
 
         the lower part of her back on July 14, 1978.
 
         
 
              6.  Dr. Walker performed a cervical fusion for claimant on 
 
         April 17, 1983.  Claimant indicated that her cervical condition 
 
         was improved following that surgery.
 
         
 
              7.  Dr. Walker performed chemonucleolysis at both the L4 and 
 
         L5 interspaces on September 9, 1983.
 
         
 
              8.  Claimant reported that that procedure only temporarily 
 
         improved her low back condition.
 
         
 
              9.  Claimant suffered a temporary worsening of her back 
 
         condition for three weeks due to muscle spasms secondary to the 
 
         chemonucleolysis.
 
         
 
             10. Claimant's back condition returned to normal or to a 
 
         condition similar to that before the chemonucleolysis.
 
         
 
             11.  The temporary worsening of claimant's back condition is 
 
         causally related to her injury of January 11, 1978.
 
         
 
             12.  Claimant is entitled to temporary total disability 
 
         benefits for a three week period from October 25, 1983 through 
 
         November 14, 1983 at the rate of $203.21 per week.
 
         
 
             13.  On objective examination, claimant's physical condition 
 
         is substantially that of October 14, 1980.
 
         
 
             14.  Claimant's physical restrictions are substantially those 
 
         of October 14, 1980.
 
         
 
             15.  Claimant was laid off at John Deere in December 1981 on 
 
         account of a lack of seniority in her work classification and not 
 
         on account of either work injury.
 
         
 
             16.  Claimant has not sought other employment and has not 
 
         shown that her failure to seek or receive other employment is due 
 
         to her work injuries.
 
         
 
             17.  The objective physical findings and the restrictions 
 

 
         
 
         
 
         
 
         BROWN V. JOHN DEERE WATERLOO TRACTOR WORKS
 
         Page   8
 
         
 
         
 
         imposed on claimant do not support either Dr. Walker's 22 percent 
 
         permanent partial impairment for the body as a whole increased 
 
         rating or his 30 percent permanent partial impairment to the body 
 
         as a whole increased ratings of claimant's physical impairment.
 
         
 
             18.  Claimant's condition has not worsened and remains 
 
         substantially that of October 14, 1980.
 
         
 
         
 
                                CONCLUSIONS OF LAW
 
         
 
              Claimant has not established by a preponderance of the 
 
         evidence a right to permanent partial disability benefits in 
 
         addition to those awarded in the prior settlement of January 8, 
 
         1981.
 
         
 
              Claimant has established a temporary worsening of her back 
 
         condition from October 25, 1983 through November 14, 1983 which 
 
         is causally related to her compensable work injury of January 11, 
 
         1978.
 
         
 
              WHEREFORE, the review-reopening decision of the deputy is 
 
         affirmed as to file no. 627617 and affirmed and modified as to 
 
         file no. 498456.
 
         
 
                                      ORDER
 
         
 
              THEREFORE, it is ordered:
 
         
 
              That defendants pay to claimant three (3) weeks of temporary 
 
         total disability at the rate of two hundred three and 21/100 
 
         dollars ($203.21) per week.
 
         
 
         
 
              That defendants pay any medical expenses for continuing 
 
         medical care related to her compensable injuries.
 
         
 
              That defendants pay the costs of the review-reopening 
 
         proceeding and claimant is to pay the costs of the appeal 
 
         including the transcription of the hearing proceedings.
 
         
 
         
 
              Signed and filed this 16th day of February, 1987.
 
         
 
         
 
         
 
         
 
         
 
         
 
                                               ROBERT C. LANDESS
 
                                               INDUSTRIAL COMMISSIONER
 
         
 
         
 
         Copies To:
 
         
 
         Mr. Gary Papenheim
 
         Attorney at Law
 
         234 Third Street
 
         Parkersburg, Iowa 50665
 

 
         
 
         
 
         
 
         BROWN V. JOHN DEERE WATERLOO TRACTOR WORKS
 
         Page   9
 
         
 
         
 
         
 
         Mr. John W. Rathert
 
         Attorney at Law
 
         620 Lafayette Street
 
         P.O. Box 178
 
         Waterloo, Iowa 50704
 
         
 
         
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                                  1302.10-1801-1803
 
                                                  Filed February 16, 1987
 
                                                  ROBERT C. LANDESS
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         LOUELLA BROWN,
 
         
 
              Claimant,
 
                                               File Nos. 627617/498456
 
         VS.
 
                                                      A P P E A L
 
         JOHN DEERE WATERLOO
 
         TRACTOR WORKS,                             D E C I S I 0 N
 
         
 
              Employer,
 
              Self-Insured,
 
              Defendant.
 
         
 
         
 
         1302.10 - 1801 - 1803
 
         
 
              Claimant sought permanent partial disability benefits in 
 
         addition to that which she received in an earlier settlement 
 
         agreement.  Further benefits, permanent partial disability, 
 
         denied as she had not established a change of condition since the 
 
         settlement agreement proximately related to his work injuries.  
 
         Claimant awarded further benefits for temporary total disability 
 
         for that period in which her condition temporarily worsened 
 
         beyond that anticipated in her earlier award of permanent 
 
         disability.  Affirmed as to file No. 627617 and modified as to 
 
         file No. 498456.
 
 
 
         
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            GARY SIMMONS,                 :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :
 
            CLOW CORPORATION,             :
 
                                          :      File No. 628314
 
                 Employer,                :
 
                                          :        A P P E A L
 
            and                           :
 
                                          :      D E C I S I O N
 
            ROYAL INSURANCE,              :
 
                                          :
 
                 Insurance Carrier,       :
 
                                          :
 
            and                           :
 
                                          :
 
            SECOND INJURY FUND OF IOWA,   :
 
                                          :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
            
 
            The record, including the transcript of the hearing before 
 
            the deputy and all exhibits admitted into the record, has 
 
            been reviewed de novo on appeal.  The decision of the deputy 
 
            is affirmed and is adopted as the final agency action in 
 
            this case.
 
            Signed and filed this ____ day of April, 1990.
 
            
 
            
 
            
 
            
 
                      ________________________________
 
                             DAVID E. LINQUIST
 
                          INDUSTRIAL COMMISSIONER
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            
 
            Copies To:
 
            
 
            Mr. Fredd J. Haas
 
            Attorney at Law
 
            5001 SW 9th St
 
            Des Moines, Iowa 50315
 
            
 
            Mr. Charles S. Lavorato
 
            Assistant Attorney General
 
            Tort Claims
 
            Hoover Building
 
            Des Moines, Iowa 50319
 
            
 
            
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                          5-9998
 
                                          Filed April 16, 1990
 
                                          DAVID E. LINQUIST
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            GARY SIMMONS,                 :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File No. 628314
 
            CLOW CORPORATION,             :
 
                                          :        A P P E A L
 
                 Employer,                :
 
                                          :      D E C I S I O N
 
            and                           :
 
                                          :
 
            ROYAL INSURANCE,              :
 
                                          :
 
                 Insurance Carrier,       :
 
                                          :
 
            and                           :
 
                                          :
 
            SECOND INJURY FUND OF IOWA,   :
 
                                          :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
            5-9998
 
            
 
            Deputy's decision summarily affirmed on appeal.
 
            
 
 
         
 
 
 
 
 
 
 
 
 
 
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         GARY SIMMONS,
 
         
 
              Claimant,                               File No. 628314
 
         
 
         VS.
 
                                                   A R B I T R A T I 0 N
 
         CLOW CORPORATION,
 
                                                      D E C I S I 0 N
 
              Employer,
 
         
 
         and                                             F I L E D
 
         
 
         ROYAL INSURANCE,                               AUG 23 1989
 
         
 
              Insurance Carrier,               IOWA INDUSTRIAL 
 
         COMMISSIONER
 
         
 
         and
 
         
 
         SECOND INJURY FUND OF IOWA,
 
         
 
              Defendants.
 
         
 
         
 
                                   INTRODUCTION
 
         
 
              This is a proceeding in arbitration brought by the claimant, 
 
         Gary Simmons, against Clow Corporation, employer, and Royal 
 
         Insurance, insurance carrier, and Second Injury Fund of Iowa, 
 
         defendants, to recover benefits as a result of an alleged injury 
 
         sustained on February 22, 1979.  This matter came on for hearing 
 
         before the deputy industrial commissioner on May 19, 1989, in 
 
         Ottumwa, Iowa.  The record consists of the testimony of claimant 
 
         and joint exhibits 1 through 9.
 
         
 
              In taking official notice of the agency's records, the 
 
         undersigned determined that there is a possibility that both 
 
         parties were proceeding under a misunderstanding and a mutual 
 
         mistake of fact.  It is believed that the parties thought there 
 
         was a memorandum of agreement on file with this agency, since 
 
         this was a pre-July 1982 injury.  The agency records show there 
 
         was never a memorandum of agreement on file in this case.  The 
 
         undersigned set up a conference call with the attorneys for the 
 
         parties involved.in the hearing; namely, Fredd Haas on behalf of 
 
         claimant and Charles Lavorato on behalf of the Second Injury Fund 
 
         of Iowa.  The other defendants, the employer and insurance 
 
         carrier, had settled with claimant prior to the hearing.  The 
 
         undersigned gave claimant and Second Injury Fund an opportunity 
 
         to present more evidence and witnesses, or further stipulate if 
 
         the present status of the prehearing record was different than 
 
         what they had understood.  The attorneys for the parties 
 
         indicated that they desired to proceed based on the record, the 
 
         evidence and stipulations presented to the undersigned on May 19, 
 
         1989, and waived presenting any further evidence, witnesses or 
 
         stipulations.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
                                      ISSUES
 
         
 
              The issue for resolution is the nature and extent of the 
 
         Second Injury Fund's liability to claimant for permanent 
 
         disability benefits, if any.
 
         
 
                              REVIEW OF THE EVIDENCE
 
         
 
              This 40-year-old claimant testified that he has worked at 
 
         manual labor jobs since he finished the eleventh grade at age 17 
 
         up to his employment with defendant employer on December 5, 1972. 
 
         Claimant described the various manufacturing jobs he held with 
 
         defendant employer.  The employer made fire hydrants and valves.
 
         
 
              Claimant stated he injured his right index finger at work in 
 
         1972 resulting in the amputation of his right index finger and 
 
         joint above it.  Claimant was off work approximately one year. 
 
         Claimant indicated he eventually returned to work after his first 
 
         injury and operated defendant employer's fork lift for six 
 
         months. Claimant stated that after this period, he got back his 
 
         former Pangborn job he had at the time of his first injury.
 
         
 
              A Pangborn machine cleans the metal castings with small shot 
 
         pellets.  Claimant stated that his job was to place the castings 
 
         into the Pangborn machine and blast the castings.  Claimant 
 
         testified he received his second injury on February 22, 1979, 
 
         when he attempted to step on the Pangborn machine platform, which 
 
         was not secured to the machine.  Claimant indicated the platform 
 
         moved and he began to fall.  Claimant said that he grabbed a mesh 
 
         while falling and caught and snapped back his left thumb in the 
 
         mesh. Claimant testified he felt he had fully recovered from his 
 
         right hand injury and was not restricted in his Pangborn job up 
 
         to the time of his second injury.  Claimant testified that due to 
 
         his first injury to his right hand, he is unable to firmly grasp 
 
         anything hard, unable to pick up certain weights, and unable to 
 
         use a hammer.  Claimant also indicated it is hard for him to 
 
         drive and his right hand goes numb and stiff.  Claimant stated 
 
         because of his left hand second injury, he is unable to grasp and 
 
         pick up objects with his left hand without discomfort.  Claimant 
 
         indicated he has pain in his left wrist, the upper part of his 
 
         left hand, and his remaining left thumb.  Claimant said that 
 
         although he drove to the hearing, if a trip is over one hour, 
 
         both hands go numb.  Claimant indicated he can't put his left 
 
         hand on the steering wheel because of the vibration and pain.  
 
         Claimant testified that his left thumb continually aches and 
 
         gives him a burning sensation.  Claimant stated his left thumb is 
 
         like a boil; you can't touch anything with it.  Claimant stated 
 
         that the cold weather affects his left hand causing him to wear 
 
         snowmobile gloves.  Claimant emphasized that due to poor 
 
         circulation, his left hand could freeze without realizing it.  
 
         Claimant said he can't be outside in the cold, otherwise, his 
 
         hand turns blue, burns and stings.
 
         
 
              Claimant indicated he was off work after his February 22, 
 
         1979 second injury until 1985.  Claimant testified that he then 
 
         went back to defendant employer as a fork lift operator, but was 
 
         unable to do this job.  Claimant indicated that this position was 
 
         arranged for him through his union's vocational rehabilitation 
 
         personnel.  Claimant said defendant employer then moved him into 
 
         a position known as a B and P operator (mold maker).  Claimant 
 
         said he worked ten hours a day at this job and "it was killing 
 
         him to do it."  Claimant stated this B and P machine kicks out 
 
         two molds every minute and an operator needs two good hands.  
 
         Claimant indicated he was getting close to getting fired or 
 
         removed from this job.  Claimant testified he held this job until 
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         his last day of employment with defendant employer in May 1986.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              Claimant indicated he had surgery in May 1986 and has not 
 
         worked since.  Claimant acknowledged that there was a strike at 
 
         defendant employer which lasted approximately one year in 1986 to 
 
         1987.  Claimant stated the last surgery on his left hand was in 
 
         August 1987.  Claimant said that Ronald S. Bergman, M.D., 
 
         released him to go back to work on November 19, 1987.  Claimant 
 
         emphasized that at the time of his release, there was no way in 
 
         which he could do the required work at defendant employer.
 
         
 
              Claimant indicated that he never attempted to go back to 
 
         work for defendant employer as they hired all new people and 
 
         busted the union.  Claimant said he was a union member and would 
 
         not cross the picket line.  Claimant said he applied for two 
 
         jobs, one at Pepsi and one at an egg.producer. Claimant indicated 
 
         that both jobs required a lot of lifting and that he could not do 
 
         them even if he had been hired.  Claimant indicated that jobs are 
 
         hard to find.
 
         
 
              The medical evidence indicates that claimant's right index 
 
         finger was amputated on April 14, 1977 as a result of a 
 
         work-related injury on March 11, 1976.  J. W. Brindley, M.D., 
 
         described this surgery in his April 14, 1977 operative report as 
 
         follows:
 
         
 
              The right hand was prepped to the elbow.  The skin incision 
 
              was made using flaps, and going from the second web space 
 
              dorsally, over the base of the second metacarpal, and then 
 
              up distally over the volar side of the finger and back down 
 
              the radius side of the finger, joining the other dorsal 
 
              incision. this carried down the dorsal vein, then cut 
 
              clamped and coagulated.  The radial dorsal nerve to the 
 
              index finger was cut.  The one to the long finger was 
 
              preserved.
 
         
 
              The extensor tendons were then cut, and the proximal 
 
              portions were let retract.  The dorsal interosseous and 
 
              volar interosseous were then dissected away from the bone.  
 
              The transverse metacarpal ligament was cut.
 
         
 
         (Joint Exhibit 1)
 
         
 
              Bruce L. Sprague, M.D., in his report of November 11, 1982, 
 
         indicated that claimant "eventually ended with a Ray amputation 
 
         from this injury."  Dr. Sprague was referring to claimant's right 
 
         hand index finger when he made this notation.  The International 
 
         Dictionary of Medical Biology described a Ray amputation as:  An 
 
         amputation of a single digital bony unit including its 
 
         metacarpal, if in the hand, or its metatarsal if in the foot."
 
         
 
              Claimant incurred his first operation to his left thumb on 
 
         December 11, 1979, which involved a fusion at the MP joint.  A 
 
         cartilage was removed and a V-shaped depression was made in the 
 
         distal end of the metacarpal and an arrow-shaped portion was made 
 
         in the distal end of the phalanx to fit this V-shaped depression. 
 
         This operation was the result of his injury at work on February 
 
         22, 1979.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              The medical records reflect, in part, the following surgical 
 
         procedures that involve claimant's left thumb:
 
         
 
              In July 16, 1980 letter from Jack W. Brindley, M.D., to 
 
         Royal Globe Insurance Company, the doctor wrote:
 
         
 
              The patient.was taken to surgery again on June, 24, 1980 and 
 
              had a bone graft from his left iliac crest to the left 
 
              thumb. This patient now is again in a thumb spica cast.
 
         
 
              In a December 23, 1980 letter to Royal Globe, Dr. Brindley 
 
         wrote:
 
         
 
              We took him to surgery on 12-16-80 and we did an onlay bone 
 
              graft from his left iliac crest to his left thumb and also 
 
              used three-holed plate across the MP joint of the thumb.  
 
              The patient was placed in a plaster cast after his surgery. 
 
              Hopefully his thumb will go ahead and fuse this time."
 
         
 
              In a November 1, 1982 letter to Royal Globe, Dr. Brindley 
 
         wrote:
 
         
 
              The patient was taken to surgery on 10-28-82 and the plate 
 
              and three screws were removed.  The patient was found to 
 
              have a pseudoarthrosis and two cross K-wires were put across 
 
              the fusion site and these were cut off at the bone.  The 
 
              patient was placed in a thumb spica cast following surgery.
 
         
 
         (Jt. Ex. 6)
 
         
 
              On November 1, 1982, Dr. Brindley's notes at St. Joseph 
 
         Hospital indicated:
 
         
 
              The patient has undergone several fusion attempts of the MP 
 
              joint.  He initially had a fusion on 12-12-79 and this was 
 
              done with K-wires and this failed and on 12-16-80 he 
 
              underwent an onlay bone grafting from the iliac crest and 
 
              had a 3 hold plate across the pseudoarthrosis.  This seemed 
 
              to go ahead and fuse and the patient was taken out of the 
 
              cast, but shortly after he was taken out of the cast the 
 
              patient's house caught on fire and in trying to break out of 
 
              the burning house the patient injured his thumb and there 
 
              was some displacement at the fusion site.  He was again 
 
              casted and did not seem to be fusing well, so external 
 
              electrical stimulator was used from the EBI System and the 
 
              thumb went ahead and seemed to fuse.  It appeared to be 
 
              fused on x-ray. Cast was removed and the patient was started 
 
              on physical therapy.  Further x-rays after this, however, 
 
              showed that the patient probably had a pseudoarthrosis.  The 
 
              patient was sent to a hand surgeon in Iowa City, Dr. Bruce 
 
              Sprague, who agreed that there was probably a 
 
              pseudoarthrosis, although he thought that it did appear at 
 
              one time to be fused.  Dr. Sprague advised taking out the 
 
              plate, putting in two K-wires and pinning them off the bone 
 
              and leaving them and then probably starting to use the 
 
              external stimulator again hoping that this would use [sic].
 

 
              
 
 
 
 
 
 
 
 
 
 
 
         
 
                   The patient had his surgery performed by taking out the 
 
              plate and putting in the K-wires on 10-28-82.
 
         
 
         (Jt. Ex. 1)
 
         
 
              On May 23, 1983, claimant's Northwest Community Hospital 
 
         records indicate:  "He has been treated by numerous orthopedic 
 
         surgeons with numerous reconstructive procedures, none of which 
 
         have helped thus far."  (Jt. Ex. 2)  Basically, claimant had 
 
         another reconstruction of his left thumb.
 
         
 
              On September 13, 1983, claimant had another surgery 
 
         performed, namely:
 
         
 
                   At this time decompression and neurolysis of the 
 
              digital nerve on the radial aspect of the left thumb under 
 
              3.5 power magnification was performed as well as 
 
              preservation of the digital artery and vein on the radial 
 
              aspect of the left thumb under 3.5 power magnification.  
 
              Decompression and neurolysis of the digital nerve on the 
 
              ulnar aspect of the left thumb under 3.5 power magnification 
 
              was also performed. Preservation of the digital artery and 
 
              vein on the ulnar aspect of the left thumb under 3.5 power 
 
              magnification was also accomplished.  At this time, 
 
              harvesting of the iliac bone graft of the right iliac crest 
 
              was performed with the use of osteotomes.
 
         
 
         (Jt. Ex. 2)
 
         
 
              The October 31, 1983 pre-operative diagnosis notes of 
 
         Northwest Community Hospital reflect:  "Status/Post extensive 
 
         reconstruction of the left thumb, infected left thumb, 
 
         status/post meticulous debridment [sic], exploration and packing 
 
         of the left thumb."  On August 10, 1984, claimant again had a 
 
         reconstruction of the thumb.  On November 19, 1984, claimant's 
 
         left thumb was operated again.  The operation involved:
 
         
 
                   Exploration of interphalangeal joint of left thumb 
 
              under 3.5 power magnification; Removal of prior pin through 
 
              interphalangeal joint; Contouring of the proximal segment of 
 
              the distal phalanx of the left thumb; Contouring of the 
 
              distal segment of the proximal phalanx of left thumb; 
 
              Harvesting of a bone graft from right iliac crest: Insertion 
 
              of bone graft to the interphalangeal joint of the left 
 
              thumb.
 
         
 
         (Jt. Ex. 6)
 
         
 
              Although there is no operative report, R. S. Bergman, M.D., 
 
         wrote on May 15, 1986:  "In order to expedite his healing process 
 
         and get.him back to work as soon as possible, I did agree to do 
 
         an amputation of the thumb at the interphalangeal joint level."  
 
         (Jt. Ex. 6)  On July 11, 1986, claimant had an operation:  
 
         "Removal of Swanson prosthesis at the MP joint, left thumb; 
 
         harvesting of an iliac bone graft from the right iliac crest.  
 
         Reconstruction of the left thumb with iliac bone graft."  (Jt. 
 
         Ex. 6)  On September 22, 1986, claimant had surgery to remove the 
 
         pin in his left thumb.  On August 17, 1987, Dr. Bergman's notes 
 
         reflect that claimant again had surgery involving reconstruction 
 
         of the left thumb via iliac bone graft.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              On March 3, 1989, claimant had an orthopedic evaluation, an 
 
         occupational therapy evaluation and a vocational evaluation. 
 
         Sinesio Misol, M.D., who performed an orthopedic evaluation March 
 
         8, 1989, wrote:
 
         
 
              IMPRESSION.
 
         
 
                   In summary, I believe this patient has reached a state 
 
              of maximum recuperation and I do not believe there is need 
 
              for any further surgery unless the dorsal plate begins to 
 
              protrude more through the skin; in which case it could be 
 
              removed, together with the screws.
 
         
 
                   I think this man has a permanent partial functional 
 
              impairment that amounts essentially to an amputation of the 
 
              left thumb; that is, he has lost 40% of the use of his left 
 
              hand.
 
         
 
                   I further think if this man is going to be retrained, 
 
              it would have to be pretty much for a job that he can do 
 
              right handed as his left hand is mostly going to be used in 
 
              assisting the right.  I do not believe he should be employed 
 
              in any job where dexterity is required.
 
         
 
         (Jt. Ex. 7)
 
         
 
              Janet S. Darling, OTR/L, who performed claimant's 
 
         occupational therapy evaluation on March 8, 1989, wrote:
 
         
 
                   Gary's hand function bilaterally has been altered due 
 
              to his injuries, which have resulted in amputations and 
 
              decreased sensation.  His dysfunction due to amputation is 
 
              obvious, bu [sic] the sensation changes are probably a 
 
              culmination of the injury and numerous surgeries and are 
 
              never the less important to consider.  In the 9-Hole Peg 
 
              Test, the right hand was able to compensate for the loss of 
 
              the index finger, although speed was reduced, dropping one 
 
              peg.  Gary was able to complete the 9-Hold Test using the 
 
              index and long fingers on the left hand, but again speed was 
 
              decreased and he dropped the pegs on several occasions. 
 
              Cylindrical grasping on the left was unsafe.  Gary reports 
 
              that his hands react to the cold weather quickly, left 
 
              greater than right, and this would be important to consider 
 
              in job placement.
 
         
 
         (Jt. Ex. 7)
 
         
 
              Claimant's vocational evaluation involved completing:
 
         
 
              General Aptitude Test Battery (GATB) vocational aptitude 
 
              testing, the Career Assessment Inventory (CAI) vocational 
 
              interest assessment, VALPAR Component Work Samples #11, 
 
              Eye-Hand-Foot Coordination, and portions of Work Samples #1 
 
              and 4, Small Tools Usage and Upper Extremity Range of Motion 
 
              respectively, the Wide Range Achievement Test (WRAT) Level 1 
 
              Word Pronunciation sheet, the Tests of Adult Basic Education 
 
              (TABE) Level M (medium) Reading Test, and the Bennett 
 
              Mechanical Comprehension Test, as well as an intensive 
 
              in-depth interview.
 

 
              
 
 
 
 
 
 
 
 
 
 
 
         
 
         (Jt. Ex. 7)
 
         
 
              Robert W. Jones, B.S., who performed claimant's vocational 
 
         evaluation on March 8, 1989, indicated that the claimant had 
 
         taken the above tests during his vocational evaluation.  In his 
 
         summary, Jones wrote:
 
         
 
              SUMMARY AND CONCLUSIONS:
 
         
 
                   On the basis of the current vocational and medical 
 
              evaluations, it would appear it is going to be quite 
 
              difficult and challenging to find alternative employment for 
 
              the patient.  He is not a high school graduate, demonstrates 
 
              generally weak academic abilities and vocational aptitudes, 
 
              has a work history of unskilled employment, and is now 
 
              basically a one-handed worker who does not demonstrate very 
 
              good manual dexterities or finger manipulation skills in 
 
              this right, dominant, hand.  If he could upgrade his current 
 
              academic abilities and obtain his GED certificate this would 
 
              be expected to improve his ultimate vocational potential, 
 
              but it is not clear he has the ability to upgrade these 
 
              skills, especially if he was indeed in special education in 
 
              school. While one would think there is surely some kind of 
 
              job which this gentleman could perform such as pizza 
 
              deliverer, telephone sales and canvassing, etc., the 
 
              Department of Labor's Dictionary of Occupational Titles, 
 
              which is the best reference guide available to 
 
              rehabilitation professionals, does not readily identify any 
 
              such alternative vocational possibilities for the patient.  
 
              As a result, it would be this evaluator's recommendation 
 
              that the patient's ability to upgrade his math and reading 
 
              skills first be determined and that he then be provided with 
 
              the assistance of a professional job placement specialist 
 
              with the additional expectation that he may also require the 
 
              assistance of an ergonomist/adaptive equipment specialist in 
 
              order to be able to return to work.
 
         
 
         (Jt. Ex. 7)
 
         
 
                                 LAW AND ANALYSIS
 
         
 
              Iowa Code section 85.64 provides:
 
         
 
                   If an employee who has previously lost, or lost the use 
 
              of, one hand, one arm, one foot, one leg, or one eye, 
 
              becomes permanently disabled by a compensable injury which 
 
              has resulted in the loss of or loss of use of another such 
 
              member or organ, the employer shall be liable only for the 
 
              degree of disability which would have resulted from the 
 
              latter injury if there had been no preexisting disability.  
 
              In addition to such compensation, and after the expiration 
 
              of the full period provided by law for the payments thereof 
 
              by the employer, the employee shall be paid out of the 
 
              "Second Injury Fund" created by this division the remainder 
 
              of such compensation as would be payable for the degree of 
 
              permanent disability involved after first deducting from 
 
              such remainder the compensable value of the previously lost 
 
              member or organ.
 

 
              
 
 
 
 
 
 
 
 
 
 
 
         
 
                   Any benefits received by any such employee, or to which 
 
              he may be entitled, by reason of such increased disability 
 
              from any state or federal fund or agency, to which said 
 
              employee has not directly contributed, shall be regarded as 
 
              a credit to any award made against said second injury fund 
 
              as aforesaid.
 
         
 
              Industrial disability was defined in Diederich v. Tri-City. 
 
         Railway Co., 219 Iowa 587, 593, 258 N.W. 899, 902 (1935) as 
 
         follows:  "It is therefore plain that the legislature intended 
 
         the term 'disability' to mean 'industrial disability' or loss of 
 
         earning capacity and not a mere 'functional disability' to be 
 
         computed in the terms of percentages of the total physical and 
 
         mental ability of a normal man."
 
         
 
              The opinion of the supreme court in Olson v. Goodyear 
 
         Service Stores, 255 Iowa 1112, 125 N.W.2d 251 (1963) at 1121, 
 
         cited with approval a decision of the industrial commissioner for 
 
         the following proposition:
 
         
 
              Disability * * * as defined by the Compensation Act means 
 
              industrial disability, although functional disability is an 
 
              element to be considered . . . In determining industrial 
 
              disability, consideration may be given to the injured 
 
              employee's age, education, qualifications, experience and 
 
              his inability, because of the injury, to engage in 
 
              employment for which he is fitted.
 
         
 
              Before the second injury fund is triggered three 
 
         requirements must be met.  First, the employee must have lost or 
 
         lost the use of a hand, foot, leg or eye.  Second, the employee 
 
         must sustain another loss or loss of use of another member or 
 
         organ through a compensable injury.  Third, permanent disability 
 
         must exist as to both the initial injury and second injury.  See 
 
         Allen v. The Second Injury Fund, State of Iowa, Thirty-fourth 
 
         Biennial Report, Iowa Industrial Commissioner 15 (1980); Ross v. 
 
         Service Master-Story Co., Inc., Thirty-fourth Biennial Rep., Iowa 
 
         Indus. Comm'r 273 (1979).
 
         
 
              The fund is responsible for the difference between total 
 
         disability and disability for which the employer at the time of 
 
         the second injury is responsible.  Section 85.64.  Second Injury 
 
         Fund v. Mich. Coal Company, 274 N.W.2d 300 (Iowa 1970), Second 
 
         Injury Fund v.;John Deere Component Works, Iowa Supreme Court 
 
         Case No. 88-399,filed February 22, 1989.
 
         
 
              This 40-year-old claimant has a very limited education. 
 
         Claimant was an orphan for many years and at age 12 was taken in 
 
         by foster parents.  Claimant was in special education classes for 
 
         a period of time up to his completing the eleventh grade, at 
 
         which time he got married.  Claimant indicated he received low 
 
         D's.
 
         
 
              Over the years, claimant has had basically manual labor-type 
 
         jobs.  He has no special skills transferable to other types of 
 
         work other than working with his hands and operating machines, if 
 
         physically able to do this type of work.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              Robert Jones, who performed the vocational evaluation, 
 
         indicated that it would be quite difficult and challenging to 
 
         find alternative employment for this claimant.  He indicated 
 
         claimant exhibits weak academic abilities and vocational 
 
         aptitudes and has a work history of unskilled labor.  Jones 
 
         indicated claimant is basically a one-handed worker who does not 
 
         demonstrate very good manual dexterity or finger manipulation 
 
         skills in his right dominant hand.  Jones questioned claimant's 
 
         ability to upgrade his skills by obtaining a GED.
 
         
 
              Claimant's educational orientation score was a very low 4 
 
         with a score of 30 and below, indicating a dislike for or 
 
         indifference toward school course work and academic-related 
 
         activities.  Claimant scored low in the basic interest scales.  
 
         In work samples, it was obvious to the tester that claimant was 
 
         very slow in performing any type of job using his hands.  Not 
 
         only was his dexterity bad, particularly his left hand, but 
 
         claimant was not able to use the pressure and force that would be 
 
         required in the work place.  If by chance claimant bumped his 
 
         left,hand thumb stump, he would exhibit extreme pain.  On the 
 
         WRAT, Level 1 Pronunciation Sheet, claimant performed at the 
 
         fourth grade level. On the TABE reading test, claimant was at a 
 
         67 reading vocabulary and a 63 on reading comprehension.  On the 
 
         Bennett Mechanical Comprehension Test, claimant scored at the 
 
         10th percentile for skilled trade job applicants and demonstrated 
 
         poor mechanical comprehensive skills.  There were other tests 
 
         that claimant performed and it is obvious claimant is very 
 
         limited in his educational skills and his ability to perform 
 
         manual labor jobs where use of his hands is a requirement.
 
         
 
              Janet Darling, an occupational therapist, performed an 
 
         occupational therapy test and indicated that claimant's function 
 
         bilaterally has been altered due to his injuries.
 
         
 
              Claimant injured his right hand in 1976 which resulted in 
 
         the amputation of his right index finger.  The doctor referred to 
 
         a Ray amputation.  A Ray amputation extends beyond the finger and 
 
         into the hand.  This was obvious to the deputy on personal 
 
         observation at the hearing.  Claimant was apparently paid, as 
 
         indicated by him and the Second Injury Fund's stipulation, on the 
 
         basis of a 20 percent impairment of the right upper extremity (30 
 
         weeks of permanent partial disability).  The right hand is not 
 
         considered the right upper extremity.  The manner in which 
 
         permanent partial disability was figured is erroneous as the 
 
         parties used the conversion charts.  For a 20 percent upper 
 
         extremity impairment in the manner in which the parties 
 
         stipulated would indicate that claimant had a 22 percent 
 
         impairment to his hand as a result of his first injury.  Since a 
 
         hand is worth 190 weeks, claimant would have been entitled to 
 
         41.8 weeks of permanent partial disability benefits.
 
         
 
              The greater weight of medical evidence indicates that 
 
         claimant's second injury of February 22, 1979, which has been 
 
         alluded to as a left thumb injury, in fact, extends into the left 
 
         hand.  Claimant has had numerous surgeries on his left thumb and 
 
         some of the surgeries involve the metacarpal bone.  The 
 
         undersigned deputy find that the second injury is an injury to 
 
         claimant's left hand.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              The parties stipulated that there is a 36 percent impairment 
 
         of the left upper extremity resulting from the second injury on 
 
         February 22, 1979, and that claimant received 60 weeks of 
 
         permanent partial disability for this injury.  It appears the 
 
         parties used the same or similar procedure as it did in computing 
 
         the first injury.  Sixty weeks of permanent partial disability is 
 
         equivalent to a 100 percent loss of the thumb.  Neither the thumb 
 
         nor the hand is an upper extremity for purposes of the law.  The 
 
         parties are in error in the manner in which they figured 
 
         permanent injury to claimant's left hand as a result of his 
 
         second injury on February 22, 1979.
 
         
 
              The evidence indicates that claimant has little dexterity in 
 
         his left hand.  Claimant cannot handle items using his small 
 
         thumb stub as it is very tender and is like touching a boil.  
 
         Claimant has had numerous surgeries to the thumb and several 
 
         reconstructions.  Nothing seems to have satisfactorily solved the 
 
         problem.  Claimant testified that he has had approximately 27 
 
         surgeries on his thumb or hand.  There is a statement by Dr. 
 
         Brindley on November 1, 1982, in which he indicated:
 
         
 
              The patient has undergone several fusion attempts of the MP 
 
              joint.  He initially had a fusion on 12-12-79 and this was 
 
              done with K-wires and this failed and on 12-16-80 he 
 
              underwent an onlay bone grafting from the iliac crest and 
 
              had a 3 hold plate across the pseudoarthrosis.  This seemed 
 
              to go ahead and fuse and the patient was taken out of the 
 
              cast, but shortly after he was taken out of the cast the 
 
              patient's house caught on fire and in trying to break out of 
 
              the burning house the patient injured his thumb and there 
 
              was some displacement at the fusion site.  He was again 
 
              casted and did not seem to be fusing well, so external 
 
              electrical stimulator was used from the EBI System and the 
 
              thumb went ahead and seemed to fuse.
 
         
 
         (Jt. Ex. 1)
 
         
 
              All the above would indicate that claimant incurred another 
 
         injury that may be the cause of claimant's subsequent problems 
 
         and surgeries.  The undersigned finds that the injury of February 
 
         22, 1979 is the the cause of claimant's present disability and 
 
         was the cause of claimant's permanent impairment to his left 
 
         hand.  The claimant's medical history since his February 22, 1979 
 
         injury has many notations where the doctors thought there was 
 
         fusion and, in fact, there was pseudoarthrosis, a false joint 
 
         arising at the site of an ununited fracture.  The undersigned 
 
         finds that the house fire instance in 1981 is not a contributing 
 
         factor to any of claimant's impairments to his left hand or any 
 
         disability.
 
         
 
              Claimant was satisfactorily performing his job with 
 
         defendant employer prior to the time of his second injury on 
 
         February 22, 1979.  There is no evidence in the record which 
 
         indicates claimant would now be able to perform the types of 
 
         manual labor he was performing prior to his second injury.  
 
         Claimant's work record indicates that any job claimant has had, 
 
         he has had to have the use of two hands.  If claimant were to 
 
         find work he could perform based on his present skills most would 
 
         require some use of his hands.  Claimant is very deficient in 
 
         mental skills and abilities.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              Dr. Misol opined:
 
         
 
                   I think this man has a permanent partial functional 
 
              impairment that amounts essentially to an amputation of the 
 
              left thumb; that is, he has lost 40 percent of the use of 
 
              his left hand.
 
         
 
                   I further think if this man is going to be retrained, 
 
              it would have to be pretty much for a job that he can do 
 
              right handed as his left hand is mostly going to be used in 
 
              assisting the right.  I do not believe he should be employed 
 
              in any job where dexterity is required.
 
         
 
         (Jt. Ex. 7)
 
         
 
              The undersigned finds that claimant has a 40 percent 
 
         permanent functional impairment of the use of his left hand.  
 
         Under Iowa Code section 85.34(2)(1), this would amount to 76 
 
         weeks (190 x 40% = 76).
 
         
 
              Claimant indicated he has applied for only two jobs and was 
 
         not hired.  He also indicated that if he had been hired, he would 
 
         not have been able to do the work.  Claimant did not produce 
 
         evidence of any extensive search for a job.  This does not 
 
         surprise the undersigned.  Claimant testified he has had 
 
         approximately 27 operations.  A Dr. Boulden indicated that 
 
         claimant's history reflected 32 surgeries.  From the evidence 
 
         presented, claimant has had numerous surgeries involving his left 
 
         thumb/hand, beginning with his injury of February 22, 1979 up to 
 
         August 1987.  It would have been futile for claimant to seek a 
 
         job when he had no hope of obtaining work commensurate with 
 
         claimant's skills and education, if claimant were honest with 
 
         employer as to his medical condition.  Claimant's healing period 
 
         involved several years.
 
         
 
              Taking into consideration claimant's medical condition prior 
 
         to the injury and after the injury, present medical condition, 
 
         location of the injury in reference to his body, the severity of 
 
         the injury, the length of healing, the work experience prior to 
 
         the injury, the work experience after the injury, his potential 
 
         for rehabilitation, his qualifications intellectually and 
 
         emotionally, his qualifications physically, his earnings prior to 
 
         and after the injury, age, education, motivation, functional 
 
         impairment is a result of the injury, and functional impairment 
 
         and inability because of the injury to engage in employment for 
 
         which he is fitted, the undersigned finds claimant permanently, 
 
         totally disabled.
 
         
 
              The three requirements before the Second Injury Fund is 
 
         triggered have been met as applied to this case under 
 
         consideration, namely:  (1) claimant has lost the use of a hand 
 
         in the first injury, (2) claimant has sustained another loss of 
 
         the use of a hand through a compensable injury, and (3) permanent 
 
         disability as found to exist both as to the initial injury and 
 
         the second injury.  The Fund therefore is responsible for the 
 
         difference between the total disability and the disability for 
 
         which the employer at the time of the second injury is 
 
         responsible.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              Because permanent total disability benefits are payable for 
 
         life, there is no way to give credit for the compensable value of 
 
         the previously lost member without deducting its compensable 
 
         value on the beginning period in which the Second Injury Fund 
 
         payments are to be made.  The undersigned finds that the 
 
         compensable value of the first injury in 1976 was 41.8 weeks.  
 
         The compensable value of the second injury of February 22, 1979 
 
         is 76 weeks.  This totals 117.8 weeks.  It is this 117.8 weeks 
 
         that is used as a credit to the Second Injury Fund and not the 30 
 
         weeks plus 60 weeks equals 90 weeks to which the parties had 
 
         erroneously stipulated based on the misapplication of the statute 
 
         and law. Defendant insurance carrier and employer were not 
 
         involved in this hearing as they settled prior to hearing.  It is 
 
         not what the employer or insurance carrier paid but what claimant 
 
         was entitled to.  In this particular case, under these particular 
 
         circumstances, it is immaterial that claimant has not received an 
 
         additional approximately 27.8 weeks of compensation to which he 
 
         was entitled from the employer.
 
         
 
              The parties stipulated to a January 17, 1988 commencement 
 
         date for permanent partial disability benefits in the event such 
 
         benefits are awarded.  The stipulation is obviously contrary to 
 
         law and will not be adopted by the undersigned.  Healing period 
 
         benefits were paid up to and including January 16, 1988, as 
 
         claimant had reached maximum healing on that date.  Since the 
 
         undersigned has found permanent total disability, the Second 
 
         Injury Fund is entitled to credit for the 117.8 weeks, commencing 
 
         January 17, 1988.  The Second Injury Fund will commence paying 
 
         their payments of $219.10 per week on April 23, 1990.
 
         
 
                                 FINDINGS OF FACT
 
         
 
              1.  Claimant received a work-related injury to his right 
 
         hand on November 24, 1976, resulting in a 22 percent permanent 
 
         partial disability.
 
         
 
              2.  Claimant was paid 30 weeks of permanent partial 
 
         disability benefits for his November 24, 1976 injury, but the 
 
         compensable value is in fact 41.8 weeks (190 x 22% = 41.8).
 
              
 
              3.  Claimant received a work-related injury to his left hand 
 
         on February 22, 1979, which resulted in a 40 percent permanent 
 
         partial disability.
 
              
 
              4.  Claimant was paid 60 weeks permanent partial disability 
 
         benefits for his February 22, 1979 injury, but the compensable 
 
         value is in fact 76 weeks (190 x 40% = 76).
 
              
 
              5.  The present condition of claimant as a result of the 
 
         combined permanent partial disabilities to the right and left 
 
         hands resulted in a permanent total disability of the body as a 
 
         whole.
 
         
 
              6.  Claimant stipulated the healing period ended January 16, 
 
         1988.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
                                CONCLUSIONS OF LAW
 
         
 
              The compensable value of the permanent partial injury to 
 
         claimant's right hand is 41.8 weeks.  The compensable value of 
 
         the permanent injury to claimant's left hand is 76 weeks.
 
         
 
              The overall industrial disability as a result of the 
 
         combined effects of both permanent injuries is total permanent 
 
         disability.
 
         
 
              The obligation of the Second Injury Fund is for the period 
 
         of claimant's disability commencing April 23, 1990, at the weekly 
 
         rate of $219.10.
 
         
 
                                      ORDER
 
         
 
              THEREFORE, it is ordered:
 
         
 
              That the Second Injury Fund of Iowa pay compensation for 
 
         permanent total disability benefits commencing April 23, 1990 for 
 
         the period of claimant's disability, at the weekly rate of two 
 
         hundred nineteen and 10/100 dollars ($219.10).
 
         
 
              That credit be given for any benefits previously paid by the 
 
         Fund.
 
         
 
              That the Second Injury Fund pay the costs of this action.
 
         
 
              That the Second Injury Fund file a claim activity report as 
 
         requested by Division of Industrial Commissioner Rule 343-3.1(2).
 
         
 
              Signed and filed this 23rd day of August, 1989.
 
         
 
         
 
         
 
         
 
         
 
         
 
                                            BERNARD J. O'MALLEY
 
                                            DEPUTY INDUSTRIAL COMMISSIONER
 
         
 
         Copies to:
 
         
 
         Mr. Fredd J. Haas
 
         Attorney at Law
 
         5001 SW 9th St
 
         Des Moines, IA  50315
 
         
 
         Mr. Charles S. Lavorato
 
         Assistant Attorney General
 
         Tort Claims
 
         Hoover Building
 
         Des Moines, IA  50319
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
         
 
 
                                            
 
 
 
 
 
 
 
 
 
 
 
                                            3200; 1804
 
                                            Filed August 23, 1989
 
                                            Bernard J. O'Malley
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         GARY SIMMONS,
 
         
 
              Claimant,                              File No. 628314
 
         
 
         vs.
 
                                                 A R B I T R A T I 0 N
 
         CLOW CORPORATION,
 
                                                     D E C I S I 0 N
 
              Employer,
 
         
 
         
 
         and
 
         
 
         ROYAL INSURANCE,
 
         
 
              Insurance Carrier,
 
         
 
         and
 
         
 
         SECOND INJURY FUND OF IOWA,
 
         
 
              Defendants.
 
         
 
         
 
         3200
 
         
 
              Claimant's first injury resulted in a 22 percent permanent 
 
         partial disability to claimant's right hand.
 
         
 
         3200
 
         
 
              Claimant's second injury resulted in a 40 percent permanent 
 
         partial disability to claimant's left hand.
 
         
 
         1804
 
         
 
              Defendant employer and defendant insurance carrier settled 
 
         prior to hearing.  Although claimant and Second Injury Fund 
 
         stipulated to 20 percent permanent partial disability benefits to 
 
         the right upper extremity and 30 weeks of permanent partial 
 
         disability benefits paid and 36 percent permanent partial 
 
         disability benefits to the left upper extremity and 60 weeks of 
 
         permanent partial disability benefits paid (based on 100 percent 
 
         loss of left thumb), deputy disregarded stipulation as it was 
 
         based on erroneous application of law and use of combined 
 
         impairment charts.  Deputy found 22 percent permanent partial 
 
         disability to right hand and 40 percent permanent partial 
 
         disability to left hand which resulted in a combined permanent 
 
         total disability.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
         3200
 
         
 
              Second Injury Fund given 41.8 weeks credit instead of the 
 
         stipulated 30 weeks credits for the compensable value of the 
 
         first injury (right hand) and 76 weeks credit for the compensable 
 
         value of the second injury (left hand) instead of 60 weeks.  The 
 
         117.8 weeks of credit begins after the end of the healing period.  
 
         The parties stipulated that any permanent partial disability 
 
         benefits would begin January 17, 1988.  Second Injury Fund found 
 
         liable for weekly benefits for the period of claimant's 
 
         disability beginning April 23, 1990.
 
         
 
              Note of interest:  Parties took left thumb and right index 
 
         finger/hand and referred to them as left and right upper 
 
         extremities, respectively, and used combined impairment charts to 
 
         reach impairment to body as a whole.
 
         
 
              Employer paid 100 percent loss of thumb.  If, in fact, the 
 
         left thumb was only member involved in second injury, we would 
 
         not have a Second Injury Fund case as a thumb is not a scheduled 
 
         member under 85.64.  Deputy found injury involved metacarpal 
 
         bone, which is into the hand.
 
         
 
              Claimant lost 27.8 weeks of weekly benefits for which he 
 
         will not get paid due to the settling parties' actions, but these 
 
         27.8 weeks are still credited to the Second Injury Fund to 
 
         determine its liability.
 
         
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                      2904
 
                      Filed April 11, 1991
 
                      PATRICIA J. LANTZ
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
                      :
 
            VINCENT M. KOBLISKA,     :
 
                      :
 
                 Claimant, :
 
                      :
 
            vs.       :
 
                      :      File Nos. 629402
 
            SHEPHERD COMPONENTS, INC.,    :                491816
 
                      :
 
                 Employer, :       R E V I E W -
 
                      :
 
            and       :     R E O P E N I N G
 
                      :
 
            IOWA INSURANCE GUARANTY  :      D E C I S I O N
 
            ASSOCIATION on behalf of :
 
            IOWA NATIONAL MUTUAL     :
 
            INSURANCE COMPANY,  :
 
                      :
 
                 Insurance Carrier,  :
 
                 Defendants.    :
 
            ___________________________________________________________
 
            
 
            2904
 
            Review-reopening proceeding, where evidence showed 
 
            claimant's surgery was causally related to a work-related 
 
            injury; claimant awarded medical benefits and temporary 
 
            total disability.  No showing of increased industrial 
 
            disability.