Page   1
 
            
 
            
 
            
 
            
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            ROGER G. BJORNSON,            :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File No.  730403
 
            CRST, INC.,                   :
 
                                          :  A R B I T R A T I O N
 
                 Employer,                :
 
                                          :      D E C I S I O N
 
            and                           :
 
                                          :
 
            CARRIERS INSURANCE COMPANY by,:
 
            IOWA INSURANCE GUARANTY ASSOC.:
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
                                   introduction
 
            
 
                 This is a proceeding in arbitration brought by Roger G. 
 
            Bjornson, claimant, against CRST, Inc., employer, and 
 
            Carriers Insurance Company, insurance carrier, by Iowa 
 
            Insurance Guaranty Association, for benefits as a result of 
 
            an alleged injury that occurred on April 6, 1983.  A hearing 
 
            was held in Des Moines, Iowa, on May 30, 1989, and the case 
 
            was fully submitted at the close of the hearing.  Claimant 
 
            was represented by W. Michael Murray.  Defendants were 
 
            represented by Brian L. Campbell.  The case was submitted on 
 
            the record and the record consists of claimant's exhibits 1 
 
            through 12 and defendants' exhibits 1 through 5.  No 
 
            witnesses appeared for either claimant or defendants.  At 
 
            the time of hearing, claimant presented a claimant's 
 
            contentions regarding issues and a bill for a spinal back 
 
            brace in the amount of $252 attached to the prehearing 
 
            report.  The deputy ordered a transcript of the hearing.  
 
            Both attorneys submitted excellent posthearing briefs.  
 
            
 
                               preliminary matters
 
            
 
                 Defendants submitted additional exhibits 5-21 and 5-22 
 
            along with their posthearing brief.  Defendants then wrote a 
 
            letter requesting that these exhibits not be considered 
 
            because defendants mistakenly failed to serve those letters 
 
            pursuant to rule 343 IAC 4.17.  These exhibits were not 
 
            considered in the determination of the issues in this case, 
 
            not only for the reason that they were not served pursuant 
 
            to rule 4.17 and were withdrawn by defendants; but they were 
 
            also not considered because no evidence shall be taken after 
 
            the hearing.  Rule 343 IAC 4.31.
 
            
 
                                   stipulations
 
            
 
                 The parties stipulated that claimant sustained an 
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            injury to his right leg on April 6, 1983, which arose out of 
 
            and in the course of employment with employer; that the 
 
            injury was the cause of temporary and permanent disability; 
 
            that claimant is entitled to 55 weeks of scheduled member 
 
            permanent partial disability benefits based upon a 25 
 
            percent permanent impairment of the right leg.
 
            
 
                                      issues
 
            
 
                 The parties submitted the following issues for 
 
            determination at the time of the hearing:
 
            
 
                 Whether claimant sustained an injury to his back on 
 
            April 6, 1983, which arose out of and in the course of 
 
            employment with employer; whether the back injury was the 
 
            cause of temporary or permanent disability; whether claimant 
 
            is entitled to temporary or permanent disability benefits 
 
            for a back injury; and whether claimant is entitled to the 
 
            medical expense for a spinal back brace in the amount of 
 
            $252.
 
            
 
                 Whether claimant is entitled to healing period benefits 
 
            for the right leg injury, and if so, the extent of benefits 
 
            to which he is entitled.
 
            
 
                 Whether the proper rate of compensation is $288.37 per 
 
            week or whether it is $221.61 per week.
 
            
 
                                 findings of fact
 
            
 
                                   back injury
 
            
 
                 It is determined that claimant did not sustain a back 
 
            injury on April 6, 1983, which arose out of and in the 
 
            course of employment with employer.
 
            
 
                 After claimant rolled his semi-tractor and trailer, he 
 
            was taken to St. Mary's Hospital in Reno, Nevada (joint 
 
            exhibit 3, pages 3-1 through 3-3).  Norman Young, M.D., 
 
            stated in the history and physical, "The patient denies pain 
 
            in the neck or spine, chest or abdomen." (jt. ex. 3-4).  
 
            Under the review of systems, Dr. Young reported, "Negative 
 
            except for severe pain in the right leg." (jt. ex. 3-4).  
 
            The doctor's physical examination for the thoracic and 
 
            lumbar spine recorded, "Negative to pain on palpation of 
 
            it's [sic] entire extent." (jt. ex. 3-4).  With respect to 
 
            the pelvis he recorded, "No tenderness on palpation or 
 
            evidence of instability." (jt. ex. 3-4).  Under the x-ray 
 
            section of his report, the doctor wrote, "AP and lateral of 
 
            the lumbar spine - negative, except for Grade I 
 
            spondylolisthesis of L5 on S1."  Dr. Young's impression was, 
 
            "Grade I spondylolisthesis of L5 on S1, difficult to 
 
            determine if this is acute or old." (jt. ex. 3-5).
 
            
 
                 Dr. Young's history and physical is dated April 6, 
 
            1983.  It is in conflict with the report of the radiologist, 
 
            Clifford D. Lader, M.D., who made a report on April 7, 1983.  
 
            Dr. Lader reported a normal pelvis.  With respect to the AP 
 
            and lateral lumbar spine he reported, "The bony elements of 
 
            the lumbar spine are intact.  There is no evidence of 
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            fracture or dislocation.  IMPRESSION:  1) NORMAL AP AND 
 
            LATERAL VIEWS OF THE LUMBAR SPINE." (jt. ex. 3-35).  Thus, 
 
            the radiologist, whose primary function is to interpret 
 
            x-rays, did not support Dr. Young's conclusion of a Grade I 
 
            spondylolisthesis of L5 on S1.
 
            
 
                 On the discharge summary, dated April 21, 1983, which 
 
            was also prepared by Dr. Young, it states, "X-rays revealed 
 
            a commin-uted fracture of the mid shaft of the tibia with 
 
            significant displacement.  Thorough examination of the rest 
 
            of the extremities, spine, chest and abdomen were negative." 
 
            (jt. ex. 3-27).  The discharge diagnosis was, "Grade II open 
 
            right tibia and fibula fractures."  (jt. ex. 3-28).  Dr. 
 
            Young did not mention any back complaints, any back injury 
 
            or any spondylolis-thesis comments of any kind on the 
 
            discharge summary (jt. ex. 3-28).
 
            
 
                 Claimant was discharged to David W. Grainger, M.D. and 
 
            Sacred Heart Medical Center, at claimant's place of 
 
            residence in Spokane, Washington.  Dr. Grainger, a board 
 
            certified orthopedic surgeon, treated claimant from April 
 
            21, 1983 through his final evaluation on August 1, 1988, a 
 
            period of five years and four months.  Dr. Grainger 
 
            testified that he searched his records and claimant did not 
 
            make any back complaints until May 30, 1984, which is over 
 
            one year after the initial accident (jt. ex. 2-9 & 2-10).  
 
            In response to claimant's back complaint, Dr. Grainger 
 
            ordered a CT scan which was normal (jt. ex. 2-10).  
 
            Claimant's x-rays demonstrated degenerative changes which 
 
            were compatible with a man of his age who had done hard work 
 
            all of this life (jt. ex. 2-10).  The records of Sacred 
 
            Heart Medical Center at Spokane, Washington, disclosed no 
 
            back complaints or treatment for any back complaints (jt. 
 
            ex. 4-1 through 4-17).  
 
            
 
                 The CT/MPR Lumbar Spine performed on June 6, 1984, of 
 
            L1 through S1, was reported as essentially normal by the 
 
            radiologist (jt. ex. 5-12).  
 
            
 
                 Dr. Grainger testified that (1) since there was no 
 
            evidence of a back injury at the time claimant was initially 
 
            treated at St. Mary's in Reno and (2) since claimant did not 
 
            make a complaint to him within a month or six weeks after 
 
            the accident, then claimant's back complaints were not 
 
            related to the accident (jt. ex. 2-18 & 2-19).  Furthermore, 
 
            if claimant had received a muscular strain, it would begin 
 
            improving in two weeks and usually would be gone anywhere 
 
            from one month to three months (jt. ex. 2-19 & 2-10).  
 
            Claimant testified that the pattern of his back pain is that 
 
            it is continually getting worse five years after the 
 
            accident (jt. ex. 1-72).  This would seem to indicate that 
 
            claimant's back problems stem more from degenerative disc 
 
            disease than the injury that occurred on April 6, 1983.  Dr. 
 
            Grainger examined the radiology report of Dr. Lader, dated 
 
            April 7, 1983, and the discharge summary of Dr. Young, dated 
 
            April 21, 1983, and testified that these reports would 
 
            indicate that claimant did not receive a back injury caused 
 
            by the motor vehicle accident of April 6, 1983 (jt. ex. 1-41 
 
            through 1-43).  He further testified that a lateral x-ray of 
 
            the lumbar spine, like the one taken by Dr. Lader on April 
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            7, 1983, should have disclosed a spondylolisthesis, but 
 
            failed to do so (jt. ex. 1-32, 1-34 & 1-45).  
 
            
 
                 Glenn G. Bonacum, M.D., states that he examined 
 
            claimant in his office on July 29, 1985; August 8, 1985 and 
 
            September 6, 1985 (jt. ex. 8-1) and he stated on May 28, 
 
            1986, "It is my opinion that the complaints of back pain are 
 
            not related to his injury.  Whether this has been accepted 
 
            or not, permanent partial disability would be 0% as related 
 
            to the lumbosacral spine." (jt. ex. 8-5).  
 
            
 
                 By contrast, no physician has stated that the injury of 
 
            April 6, 1983, was the cause of a back injury.  
 
            
 
                 An insurance adjuster reported on May 10, 1983, that 
 
            claimant reported to him that he suffered a fractured right 
 
            leg in approximately five places and a fractured disc in his 
 
            back (jt. ex. 10-1).  Claimant also testified, by 
 
            deposition, that he did mention his back to Dr. Young and 
 
            that Dr. Young mentioned it to him (jt. ex. 1-43).  Claimant 
 
            also testified that he told Dr. Grainger that he had pain in 
 
            his lower back at Sacred Heart Hospital in 1983 (jt. ex. 
 
            1-51 & 1-52).  Claimant maintained that both Dr. Young and 
 
            Dr. Grainger seemed to be more concerned about his leg (jt. 
 
            ex. 1-53).  
 
            
 
                 As an evidentiary matter, causal connection is 
 
            essentially within the domain of expert testimony.  Bradshaw 
 
            v. Iowa Methodist Hospital, 251 Iowa 375, 101 N.W.2nd 167 
 
            (1960).  Therefore, claimant's assertion to the insurance 
 
            adjuster that he fractured a disc in his back and his 
 
            testimony that he discussed his back complaints with both 
 
            Dr. Young and Dr. Grainger from the very beginning is out 
 
            weighed by the medical evidence summarized above.  
 
            
 
                 When claimant was admitted to St. Mary's Hospital in 
 
            Reno he denied any pain in his neck or spine.  A review of 
 
            all other systems was negative.  The physical examination of 
 
            the thoracic and lumbar spine was negative.  He had no 
 
            pelvic tenderness and the x-rays performed by Dr. Lader 
 
            demonstrated normal AP and lateral views of the lumbar 
 
            spine.  In the discharge summary, dictated by Dr. Young, the 
 
            discharge diagnosis was Grade II open right tibia and fibula 
 
            fractures and absolutely no mention was made of the lumbar 
 
            spine or spondylolisthesis.  In his deposition testimony, 
 
            Dr. Grainger said that the report from St. Mary's Hospital 
 
            and Dr. Young were inconsistent with a back injury.  
 
            Claimant did not complain of his back until May 30, 1984, 
 
            over one year after the accident (jt. ex. 5-22).  Claimant's 
 
            symptoms of continuing worsening symptoms over the five year 
 
            period after the injury is more indicative of degenerative 
 
            disc disease than a back injury caused by the accident of 
 
            April 6, 1983.
 
            
 
                 Consequently, it is determined that claimant did not 
 
            sustain an injury to his back on April 6, 1983, which arose 
 
            out of and in the course of employment with employer.  
 
            Therefore, the remaining issues of causal connection of the 
 
            back injury to temporary or permanent disability, 
 
            entitlement to temporary or permanent disability benefits, 
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
            and the issue of whether claimant is entitled to $252 for 
 
            the expense of a back brace are moot.
 
            
 
                      entitlement to healing period benefits
 
            
 
                 Claimant is entitled to healing period benefits from 
 
            April 6, 1983, the date of the injury, to September 6, 1985, 
 
            a period of 126.286 weeks.  
 
            
 
                 Dr. Grainger stated on August 1, 1988, that claimant 
 
            was off work from the date of the accident, April 6, 1983 
 
            until sometime in the early fall of 1985 (jt. ex. 5-23).  
 
            
 
                 Dr. Bonacum last examined claimant on September 6, 
 
            1985, and stated that if claimant and the treating physician 
 
            decided against reconstruction of the right knee then the 
 
            case may be closed and that claimant may return to work as a 
 
            self-employed owner-operator of his tractor-trailer rig.  
 
            Dr. Bonacum stated, "If Mr. Bjornsen [sic] and his treating 
 
            physician decide that ligament reconstruction is not 
 
            desirable at this time, then the case may be closed." (jt. 
 
            ex. 8-4).  
 
            
 
                 Dr. Grainger had claimant examined by Walter F. 
 
            Krengel, Jr., M.D., an orthopedic knee specialist on October 
 
            24, 1983.  He also had claimant examined by Robert L. 
 
            Larson, M.D., another orthopedic knee specialist on November 
 
            7, 1984.  Neither one of these physicians recommended any 
 
            further surgery.  Dr. Grainger was opposed to further 
 
            surgery.  Claimant chose to follow the recommendations of 
 
            these physicians.  Therefore, claimant's first healing 
 
            period should only extend to September 6, 1986.
 
            
 
                 Claimant is entitled to healing period benefits for a 
 
            second period of time from January 13, 1988; the date that 
 
            Dr. Grainger performed surgery to remove the hardware from 
 
            his right leg; until June 15, 1988.  Dr. Grainger said 
 
            claimant could return to work light duty on April 15, 1988 
 
            (jt. ex. 5-23), "...but that heavy lifting and carrying and 
 
            climbing up and down stairs and up ladders should be 
 
            restricted for another two months until he gets his strength 
 
            back." (jt. ex. 5-19).  In his deposition, Dr. Grainger also 
 
            averred that he told claimant he could return to work on 
 
            April 15, 1988, but granted claimant another two months to 
 
            avoid heavy lifting, carrying, climbing up and down stairs 
 
            (jt. ex. 2-17).  Therefore, claimant is entitled to a second 
 
            healing period from January 13, 1988 until June 15, 1988; a 
 
            period of 22 weeks.  The total healing period then is 
 
            148.286 weeks (126.286 + 22).  
 
            
 
                                       rate
 
            
 
                 It is determined that claimant is entitled to a rate of 
 
            $283.90 as the proper rate of compensation for this injury.
 
            
 
                 At the hearing, claimant's counsel asserted that the 
 
            proper rate of compensation, based on gross earnings of 
 
            $461, was $288.37.  However, claimant's counsel erroneously 
 
            used the workers' compensation benefit schedule with rates 
 
            commencing on July 1, 1983.  This injury occurred on April 
 

 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
            6, 1983.  Therefore, the proper rate is taken from the 
 
            workers' compensation benefits schedule commencing on July 
 
            1, 1982.  The parties stipulated that claimant was married 
 
            and entitled to four exemptions.  
 
            
 
                 The proper rate for gross weekly wages of $461 for a 
 
            married person with four exemptions from the workers' 
 
            compensation benefits schedule commencing on July 1, 1982, 
 
            is $283.90 per week.
 
            
 
                 Claimant's answers to interrogatories show that 
 
            claimant's gross weekly earnings were $461 per week (jt. ex. 
 
            11-3).  A form 2, claim activity report, as of April 13, 
 
            1983, was prepared by the industrial commissioner's office 
 
            and showed gross weekly earnings of $461 which produced a 
 
            weekly rate of $283.90 per week.  Employer disputed this 
 
            rate and contended that the proper earnings were $345.98 
 
            based upon Iowa Code section 85.36(8) based on the usual 
 
            weekly earnings of similar services rendered by paid 
 
            employees because the employee had only worked four weeks 
 
            with employer prior to accident and defendants contended the 
 
            weekly amount will vary.
 
            
 
                 Subparagraph eight is used to calculate the rate if at 
 
            the time of the injury the hourly earnings have not been 
 
            fixed or cannot be ascertained.  Claimant contends that the 
 
            rate had been ascertained at the amount of $461 per week 
 
            (jt. ex. 11-3).  This evidence is not controverted by any 
 
            evidence on the part of defendants, other than the bare 
 
            contention on the form 2b that the weekly amounts will vary.  
 
            The form 2b is unsigned and undated.  Furthermore, if 
 
            subparagraph eight is to be used, it requires a showing of 
 
            the usual earnings for similar services where such services 
 
            were rendered by paid employees.  Defendants have made no 
 
            such showing.  Nor did defendants counsel address the rate 
 
            issue in his brief.
 
            
 
                 The proper basis for computation is Iowa Code section 
 
            85.36(7).  Where the duration of employment is less than 13 
 
            weeks and evidence of "work available to other employees" is 
 
            not presented, the gross weekly earnings are figured by 
 
            dividing the total amount earned by the number of weeks 
 
            actually worked.  Dagget v. Ace Lines, file number 818879 
 
            (Appeal Decision August 8, 1990); Anderson v. High Rise 
 
            Construction Specialist, Inc., file number 850096 (Appeal 
 
            Decision July 31, 1990); Barker v. City Wide Cartage, I Iowa 
 
            Industrial Commissioner Report, 12, 15 (Appeal Decision 
 
            1980).
 
            
 
                 The sole issue presented by the parties was whether the 
 
            rate should be determined by subparagraphs six and seven or 
 
            subparagraph eight.  It is determined that the rate should 
 
            be determined by subparagraphs six and seven.  Defendants 
 
            did not show why subparagraph eight would apply, nor did 
 
            they show the usual earnings for similar services paid to 
 
            other employees which would justify the use of subparagraph 
 
            eight.
 
            
 
                 In conclusion, it is determined that claimant is 
 
            entitled to a rate of $283.90 per week based upon gross 
 

 
            
 
            Page   7
 
            
 
            
 
            
 
            
 
            earnings of $461 for a married person with four exemptions 
 
            using the workers' compensation benefits schedule for July 
 
            1, 1982.
 
            
 
                                conclusions of law
 
            
 
                 Wherefore, based upon the foregoing and following 
 
            principles of law these conclusions of law are made:
 
            
 
                 That claimant did not sustain the burden of proof by a 
 
            preponderance of the evidence that he sustained an injury to 
 
            his back on April 6, 1983, which arose out of and in the 
 
            course of employment with employer.
 
            
 
                 That claimant is entitled to healing period benefits 
 
            (1) from April 6, 1983 to September 6, 1985; a period of 
 
            126.286 weeks and (2) from January 13, 1988 to June 15, 
 
            1988; a period of 22 weeks.  The combined healing period 
 
            benefits amount to 148.286 weeks of healing period benefits.  
 
            Iowa Code section 85.34(1).
 
            
 
                 That the proper rate of compensation is $283.90 per 
 
            week.  Iowa Code section 85.36(6)(7).
 
            
 
                 That defendants are entitled to a credit in the amount 
 
            of $37,452.06 as itemized in defendants posthearing brief 
 
            which was stipulated to by the parties (transcript pages 6 & 
 
            7).
 
            
 
                                      order
 
            
 
                 THEREFORE, IT IS ORDERED:
 
            
 
                 That defendants pay to claimant one hundred twenty-six 
 
            point two eight six (126.286) weeks of healing period 
 
            benefits at the rate of two hundred eighty-three and 90/100 
 
            dollars ($283.90) per week in the total amount of 
 
            thirty-five thousand eight hundred fifty-two and 60/100 
 
            dollars ($35,852.60) commencing on April 6, 1983, for the 
 
            period from April 6, 1983 to September 6, 1985.
 
            
 
                 That defendants pay to claimant fifty-five (55) weeks 
 
            of permanent partial disability benefits as stipulated to by 
 
            the parties at the rate of two hundred eighty-three and 
 
            90/100 dollars ($283.90) per week in the total amount of 
 
            fifteen thousand six hundred fourteen and 50/100 dollars 
 
            ($15,614.50) commencing on September 6, 1985.
 
            
 
                 That defendants pay claimant an additional twenty-two 
 
            (22) weeks of healing period benefits at the rate of two 
 
            hundred eighty-three and 90/100 dollars ($283.90) per week 
 
            in the total amount of six thousand two hundred forty-five 
 
            and 80/100 dollars ($6,245.80) commencing on January 13, 
 
            1988.
 
            
 
                 That defendants are entitled to a credit in the amount 
 
            of thirty-seven thousand four hundred fifty-two and 06/100 
 
            dollars ($37,452.06) as itemized in defendants' posthearing 
 
            brief and as stipulated to by the parties.
 
            
 

 
            
 
            Page   8
 
            
 
            
 
            
 
            
 
                 That all accrued benefits are to be paid in a lump sum.
 
            
 
                 That interest will accrue pursuant to Iowa Code section 
 
            85.30. 
 
            
 
                 That the costs of this action, including the cost of 
 
            the attendance of the court reporter at hearing and the cost 
 
            of the  transcript, are charged to defendants pursuant to 
 
            rule 343 IAC 4.33.
 
            
 
                 That defendants file any claim activity reports 
 
            requested by this agency pursuant to rule 343 IAC 3.1.
 
            
 
                 Signed and filed this ____ day of February, 1991.
 
            
 
            
 
            
 
            
 
                                          ______________________________
 
                                          WALTER R. McMANUS, JR.
 
                                          DEPUTY INDUSTRIAL COMMISSIONER    
 
            
 
            Copies to:
 
            
 
            Mr. W. Michael Murray
 
            Attorney at Law
 
            2323 Grand Ave.
 
            Des Moines, Iowa  50312
 
            
 
            Mr. Brian L. Campbell
 
            Attorney at Law
 
            1100 Des Moines Bldg.
 
            Des Moines, Iowa  50309-2464
 
            
 
 
         
 
         Page   1
 
         
 
                                       51100 1401 51401.20 51403.30 52902 
 
                                       51401.40 51802 52501 52601.10 52700 
 
                                       53001 53002 53003
 
                                       Filed February 22, 1991
 
                                       Walter R. McManus, Jr.
 
         
 
                           before the iowa industrial 
 
                                   commissioner
 
         ____________________________________________________________
 
                                       :
 
         ROGER G. BJORNSON,            :
 
                                       :
 
              Claimant,                :
 
                                       :
 
         vs.                           :
 
                                       :      File No.  730403
 
         CRST, INC.,                   :
 
                                       :  A R B I T R A T I O N
 
              Employer,                :
 
                                       :      D E C I S I O N
 
         and                           :
 
                                       :
 
         CARRIERS INSURANCE COMPANY by,:
 
         IOWA INSURANCE GUARANTY ASSOC.:
 
                                       :
 
              Insurance Carrier,       :
 
              Defendants.              :
 
         ___________________________________________________________
 
         
 
         51100 1401 51401.20 51401.30 52902
 
         Defendants admitted claimant received a knee injury when his semi 
 
         rolled over.  Claimant did not prove that he received a back 
 
         injury in this accident.  Medical evidence preferred over 
 
         claimant's testimony.
 
         
 
         51401.40 51802
 
         Claimant awarded healing period benefits for two periods, the 
 
         dates for which had to be dug out of the medical records.  
 
         Neither attorney provided any real assistance on the true time 
 
         off work for two healing periods.
 
         
 
         51401.40 51803
 
         Permanent partial disability was stipulated to for the right 
 
         knee.
 
         
 
         52501 52601.10 52700
 
         Claimant did not prove a back injury and was not awarded the 
 
         expense of a back brace.
 
         
 
         53001 53002 53003
 
         Claimant used the wrong year benefit schedule to calculate rate 
 
         which may or may not have been inadvertence.  Defendants' method 
 
         of calculating rate was either a gross error or a sharp claim 
 
         practice.  Defendants offered no evidence to support it and 
 
         defendants' attorney did not address rate in his brief.  The 
 
         correct rate was determined by section 85.36(6) and (7) and not 
 
         85.36(8).
 
         
 
 
        
 
 
 
 
 
                       BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
        
 
        
 
        CONNIE STREETER,
 
        
 
            Claimant,
 
        
 
        vs.
 
        
 
        IOWA MEAT PROCESSING CO.,        File Nos. 730461/809945
 
        
 
            Employer,                        A P P E A L
 
        
 
        and                                 D E C I S I O N
 
        
 
        CHUBB GROUP OF INSURANCE
 
        COMPANIES and ARGONAUT
 
        INSURANCE COMPANY,
 
        
 
            Insurance Carriers,
 
        
 
        and
 
        
 
        SECOND INJURY FUND OF IOWA,
 
        
 
            Defendants.
 
        
 
        
 
                                 STATEMENT OF THE CASE
 
        
 
        Defendants Iowa Meat Processing Company and Chubb Insurance Group 
 
        appeal from an arbitration decision awarding permanent partial 
 
        disability benefits as the result of alleged injuries on March 
 
        28, 1983 and October 11, 1985.
 
        
 
        The record on appeal consists of the transcript of the 
 
        arbitration hearing and joint exhibits A through K. Iowa Meat 
 
        Processing Company and the Chubb Insurance Group, and Iowa Meat 
 
        Processing Company and Argonaut Insurance Companies filed briefs 
 
        on appeal.
 
        
 
                                      ISSUES
 
        
 
        Defendants Iowa Meat Processing Company and the Chubb Insurance 
 
        Group state the following issues on appeal:
 
        
 
        1. Did the deputy commissioner err in finding no medical evidence 
 
        or any other convincing evidence that the injury of March 28, 
 
        1983 was the cause of permanent functional impairment or 
 
        permanent disability?
 
        
 
        STREETER V. IOWA MEAT PROCESSING CO.
 
        Page 2
 
        
 
        
 
        2. Did the deputy commissioner err in finding a simultaneous 
 
        injury and in awarding benefits pursuant to Iowa Code  
 
        85.34(2)(s)?
 
        
 
        3. Did the deputy commissioner err in finding permanent 
 
        impairment to the upper extremities rather than to the hands?
 
        
 
        4. Did the deputy commissioner err in beginning permanency on 
 

 
        
 
 
 
 
 
        December 16, 1985?
 
        
 
                                 REVIEW OF THE EVIDENCE
 
        
 
        The arbitration decision adequately and accurately reflects the 
 
        pertinent evidence and it will not be set forth herein.
 
        
 
                                 APPLICABLE LAW
 
        
 
        Expert medical evidence must be considered with all other 
 
        evidence introduced bearing on the causal connection. Burt v. 
 
        John Deere Waterloo Tractor Works, 247 Iowa 691, 73 N.W.2d 732 
 
        (1955). The opinion of experts need not be couched in definite, 
 
        positive or unequivocal language. Sondag v. Ferris Hardware, 220 
 
        N.W.2d 903 (Iowa 1974). However, the expert opinion may be 
 
        accepted or rejected, in whole or in part, by the trier of fact. 
 
        Id. at 907. Further, the weight to be given to such an opinion is 
 
        for the finder of fact, and that may be affected by the 
 
        completeness of the premise given the expert and other 
 
        surrounding circumstances. Bodish, 257 Iowa 516, 133 N.W.2d 867. 
 
        See also Musselman v. Central Telephone Co., 261 Iowa 352, 154 
 
        N.W.2d 128 (1967).
 
        
 
        While a claimant is not entitled to compensation for the results 
 
        of a preexisting injury or disease, the mere existence at the 
 
        time of a subsequent injury is not a defense. Rose v. John Deere 
 
        Ottumwa Works, 247 Iowa 900, 908, 76 N.W.2d 756, 760-761 (1956). 
 
        If the claimant had a preexisting condition or disability that is 
 
        aggravated, accelerated, worsened or lighted up so that it 
 
        results in disability, claimant is entitled to recover. Nicks v 
 
        Davenport Produce Co., 254 Iowa 130, 115 N.W.2d 812, 815 (1962).
 
        
 
        Permanent partial disabilities are classified as either scheduled 
 
        or unscheduled. A specific scheduled disability is evaluated by 
 
        the functional method; the industrial method is used to evaluate 
 
        an unscheduled disability. Martin v. Skelly Oil Co., 252 Iowa 
 
        128, 133, 106 N.W.2d 95, 98 (1960); Graves v. Eagle Iron Works, 
 
        331 N.W.2d 116 (Iowa 1983); Simbro v. DeLong's Sportswear, 332 
 
        N.W.2d 886, 887 (Iowa 1983).
 
        
 
        An injury is the producing cause; the disability, however, is the 
 
        result, and it is the result which is compensated. Barton
 
        
 
        STREETER V. IOWA MEAT PROCESSING CO.
 
        Page 3
 
        
 
        
 
        v. Nevada Poultry Co., 253 Iowa 285, 110 N.W.2d 660 (1961); 
 
        Dailey v. Pooley Lumber Co., 233 Iowa 758, 10 N.W.2d 569 (1943).
 
        
 
        Iowa Code section 85.34(2)(s) states:
 
        
 
        The loss of both arms, or both hands, or both feet, or both legs, 
 
        or both eyes, or any two thereof, caused by a single accident, 
 
        shall equal five hundred weeks and shall be compensated as such, 
 
        however, if said employee is permanently and totally disabled the 
 
        employee may be entitled to benefits under subsection 3.
 
        
 
        
 
        Iowa Code section 85.34(1) states:
 
        
 
        If an employee has suffered a personal injury causing permanent 
 
        partial disability for which compensation is payable as provided 
 
        in subsection 2 of this section, the employer shall pay to the 
 
        employee compensation for a healing period, as provided in 
 
        section 85.37, beginning on the date of injury, and until the 
 

 
        
 
 
 
 
 
        employee has returned to work or it is medically indicated that 
 
        significant improvement from the injury is not anticipated or 
 
        until the employee is medically capable of returning to 
 
        employment substantially similar to the employment in which the 
 
        employee was engaged at the time of injury, whichever occurs 
 
        first.
 
        
 
        For purposes of the schedule contained in Iowa Code section 
 
        85.34(2)(1), an injury confined to the wrist is treated as an 
 
        injury to the hand. Elam v. Midland Mfg. Co., II Iowa Industrial 
 
        Comm'r Rep. 141 (Appeal Decision 1981).
 
        
 
                                      ANALYSIS
 
        
 
        Defendants Iowa Meat Processing and Chubb Insurance Group urge on 
 
        appeal that the deputy erred in finding that no permanent 
 
        disability resulted from claimant's injury of March 28, 1983. 
 
        Claimant was diagnosed as suffering from right carpal tunnel 
 
        syndrome on April 14, 1983. Claimant underwent release surgery in 
 
        May of 1983. Claimant returned to work without restrictions. 
 
        Claimant was later found to have right tendonitis, status post 
 
        carpal tunnel. Claimant did not receive any rating of permanency 
 
        or indication of permanency for her right hand or wrist until 
 
        after the second injury on October 11, 1985. Between May of 1983 
 
        and October of 1985, claimant did not miss work, and was able to 
 
        engage in educational course work, including a typing course. 
 
        Claimant did report pain extending up to her right elbow. 
 
        Claimant's ability to continue working at her job, completion of 
 
        a typing course, and the elapse of two years before her left hand 
 
        and wrist condition compelled her to seek
 
        
 
        STREETER V. IOWA MEAT PROCESSING CO.
 
        Page 4
 
        
 
        
 
        further medical attention indicates that claimant die not have 
 
        any permanent impairment of her right hand.or wrist following her 
 
        right carpal tunnel release surgery in May of 1983.
 
        
 
        The conclusion above assists in determining Chubb Insurance 
 
        Group's second issue on appeal. Since claimant did not suffer 
 
        permanent impairment as a result of the 1983 injury and surgery, 
 
        the record supports the conclusion that claimant's left and right 
 
        hand conditions found in 1985 were the result of a single 
 
        cumulative injury process. The permanent condition found in 1985 
 
        was the result of cumulative trauma occurring between 1983 and 
 
        October of 1985. In October of 1985, claimant was also found to 
 
        have left carpal tunnel syndrome. The record shows that this 
 
        condition was first noticed by claimant, and first noted by 
 
        medical personnel, subsequent to her right wrist surgery in 1983. 
 
        Thus, claimant developed both her permanent right hand and wrist 
 
        condition and her left carpal tunnel syndrome subsequent to her 
 
        1983 surgery. This cumulative injury compelled claimant to leave 
 
        work in October of 1985. Claimant has lost the use of both arms 
 
        or both hands as the result of a single accident, that is, 
 
        repetitive trauma to both wrists occurring between her surgery in 
 
        May 1983 and October 1985, and claimant is to be compensated 
 
        pursuant to Iowa Code section 85.34(2)(s).
 
        
 
        Chubb Insurance Group's third issue on appeal deals with whether 
 
        claimant's impairment is to the hand or to the arm. The mere fact 
 
        that claimant's carpal tunnel condition resulted in pain into her 
 
        right arm does not result in an impairment of the arm. The situs 
 
        of the injury in this case is in claimant's wrist. Claimant's 
 
        right epicondylitis, although producing pain, did not result in 
 
        any impairment or disability to the arm, and was not shown to be 
 

 
        
 
 
 
 
 
        permanent. Although the medical evidence rates claimant's 
 
        permanent impairment as 10 percent of the upper extremity, there 
 
        is no indication that the arms are impaired other than as the 
 
        site of pain.
 
        
 
        Claimant's surgery did not intrude into the arm. The pathology of 
 
        the injury is confined to the wrist. Claimant's impairment is to 
 
        the hand and does not extend into the arm.
 
        
 
        According to the AMA Guides to the Evaluation of Permanent 
 
        Impairment, Third Edition, 10 percent impairment of the upper 
 
        extremity converts to 11 percent impairment of the hand. Eleven 
 
        percent of the hand converts to six percent of the body as a 
 
        whole. Claimant has two impairments of the upper extremity, so 
 
        the combined values chart indicates claimant has a 12 percent 
 
        impairment of the body as a whole. Claimant is entitled to 60 
 
        weeks compensation.
 
        
 
        As a final issue, defendant Chubb Insurance Group urges rejection 
 
        of December 16, 1985 as the date when claimant's permanency began 
 
        in favor of May 9, 1986, the date on which
 
        
 
        STREETER V. IOWA MEAT PROCESSING CO.
 
        Page 5
 
        
 
        
 
        claimant's condition was given a permanent impairment rating. 
 
        Chubb offers no compelling argument in favor of this, however, 
 
        other than a reiteration of the earlier argument that the 
 
        impairment did not extend to the arm. The use of December 16, 
 
        1985, the date claimant returned to light duty work, is a proper 
 
        point in time under section 85.34(1) to establish the end of 
 
        claimant's healing period and the beginning of the permanency.
 
        
 
                                 FINDINGS OF FACT
 
        
 
        1. Claimant was an employee of defendant employer on March 28, 
 
        1983.
 
        
 
        2. On March 28, 1983, claimant received an injury arising out of 
 
        and in the course of her employment with defendant employer.
 
        
 
        3. Claimant's duties involved the use of both of her hands.
 
        
 
        4. Claimant began to experience pain in her right wrist in 
 
        January of 1983.
 
        
 
        5. Claimant underwent carpal tunnel release surgery on her right 
 
        hand in May of 1983.
 
        
 
        6. Subsequent to the release surgery, claimant was not given any 
 
        work restrictions, and did not miss work due to wrist pain again 
 
        until October of 1985.
 
        
 
        7. Between 1983 and 1985, claimant completed courses in typing 
 
        and accounting.
 
        
 
        8. Claimant continued to perform the same duties for employer 
 
        from 1983 to 1985 as she performed prior to her wrist surgery.
 
        
 
        9. In October of 1985, claimant was diagnosed as having left 
 
        carpal tunnel syndrome and right epicondylitis.
 
        
 
        10. Claimant received a medical release to return to work on 
 
        December 16, 1985.
 
        
 

 
        
 
 
 
 
 
        11. Claimant's carpal tunnel syndrome is confined to her left 
 
        wrist and hand. Claimant's epicondylitis is confined to her right 
 
        wrist and hand. Claimant has pain in her upper extremities but 
 
        claimant does not have impairment or disability in her upper 
 
        extremities.
 
        
 
        12. Claimant did not suffer any permanent disability or permanent 
 
        impairment as a result of her 1983 carpal tunnel release surgery.
 
        
 
        STREETER V. IOWA MEAT PROCESSING CO.
 
        Page 6
 
        
 
        
 
        13. Claimant developed her present right and left hand and wrist 
 
        conditions simultaneously subsequent to her 1983 carpal tunnel 
 
        release surgery.
 
        
 
                                 CONCLUSIONS OF LAW
 
        
 
        Claimant did not suffer any permanent disability or permanent 
 
        impairment as a result of her 1983 carpal tunnel release surgery.
 
        
 
        Claimant developed her present right and left wrist and hand 
 
        conditions simultaneously between her May 1983 carpal tunnel 
 
        release surgery and October 1985.
 
        
 
        Claimant's present left and right hand and wrist conditions do 
 
        not extend to the upper extremities.
 
        
 
        Claimant's healing period ended December 16, 1985.
 
        
 
        WHEREFORE, the decision of the deputy is affirmed in part and 
 
        reversed in part.
 
        
 
                                      ORDER
 
        
 
        THEREFORE, it is ordered:
 
        
 
        That defendants Iowa Meat Processing and Chubb Insurance Group 
 
        are to pay unto claimant healing period benefits from November 
 
        12, 1985 until December 16, 1985, at the rate of two hundred 
 
        fifty-one and 55/100 dollars ($251.55) per week.
 
        
 
        That defendants are to pay unto claimant sixty (60) weeks of 
 
        permanent partial disability benefits at a rate of two hundred 
 
        fifty-one and 55/100 dollars ($251.55) per week from December 17, 
 
        1985.
 
        
 
        That defendants shall pay accrued weekly benefits in a lump sum.
 
        
 
        That defendants shall pay interest on unpaid weekly benefits 
 
        awarded herein as set forth in Iowa Code section 85.30.
 
        
 
        That defendants are to be given credit for benefits previously 
 
        paid.
 
        
 
        That defendants are to pay the costs of this action.
 
        
 
        That defendants shall file claim activity reports as required by 
 
        this agency pursuant to Division of Industrial Services Rule 
 
        343-3.1(2).
 
        
 
        STREETER V. IOWA MEAT PROCESSING CO.
 
        Page 7
 
        
 
        
 

 
        
 
 
 
 
 
        Signed and filed this 31st day of March, 1989.
 
        
 
        
 
        
 
                                         DAVID E. LINQUIST
 
                                      INDUSTRIAL COMMISSIONER
 
        
 
        
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                    BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         CONNIE STREETER,
 
         
 
              Claimant,
 
         
 
         VS.
 
         
 
         IOWA MEAT PROCESSING CO.,             File Nos. 730461/809945
 
         
 
              Employer,                             A P P E A L
 
         
 
         and                                      D E C I S I 0 N
 
         
 
         CHUBB GROUP OF INSURANCE
 
         COMPANIES and ARGONAUT
 
         INSURANCE COMPANY,
 
         
 
              Insurance Carriers,
 
         
 
         and
 
         
 
         SECOND INJURY FUND OF IOWA,
 
         
 
              Defendants.
 
         
 
         
 
         
 
                              STATEMENT OF THE CASE
 
         
 
              Defendants Iowa Meat Processing Company and Chubb Insurance 
 
         Group appeal from an arbitration decision awarding permanent 
 
         partial disability benefits as the result of alleged injuries on 
 
         March 28, 1983 and October 11, 1985.
 
         
 
              The record on appeal consists of the transcript of the 
 
         arbitration hearing and joint exhibits A through K. Iowa Meat 
 
         Processing Company and the Chubb Insurance Group, and Iowa Meat 
 
         Processing Company and Argonaut Insurance Companies filed briefs 
 
         on appeal.
 
         
 
                                      ISSUES
 
         
 
              Defendants Iowa Meat Processing Company and the Chubb 
 
         Insurance Group state the following issues on appeal:
 
         
 
              1.  Did the deputy commissioner err in finding no medical 
 
         evidence or any other convincing evidence that the injury of 
 
         March 28, 1983 was the cause of permanent functional impairment 
 
         or permanent disability?
 
         
 
         STREETER V. IOWA MEAT PROCESSING CO.
 
         Page 2
 
         
 
                                                
 
                                                         
 
              2.  Did the deputy commissioner err in finding a 
 
         simultaneous injury and in awarding benefits pursuant to Iowa 
 
         Code SS 85.34(2)(s)?
 
         
 
              3.  Did the deputy commissioner err in finding permanent 
 
         impairment to the upper extremities rather than to the hands?
 
         
 
              4.  Did the deputy commissioner err in beginning permanency 
 
         on December 16, 1985?
 
         
 
                              REVIEW OF THE EVIDENCE
 
         
 
              The arbitration decision adequately and accurately reflects 
 
         the pertinent evidence and it will not be set forth herein.
 
         
 
                                  APPLICABLE LAW
 
         
 
              Expert medical evidence must be considered with all other 
 
         evidence introduced bearing on the causal connection.  Burt v. 
 
         John Deere Waterloo Tractor Works, 247 Iowa 691, 73 N.W.2d 732 
 
         (1955).  The opinion of experts need not be couched in definite, 
 
         positive or unequivocal language.  Sondag v. Ferris Hardware, 220 
 
         N.W.2d 903 (Iowa 1974).  However, the expert opinion may be 
 
         accepted or rejected, in whole or in part, by the trier of fact.  
 
         Id. at 907.  Further, the weight to be given to such an opinion 
 
         is for the finder of fact, and that may be affected by the 
 
         completeness of the premise given the expert and other 
 
         surrounding circumstances.  Bodish, 257 Iowa 516, 133 N.W.2d 867.  
 
         See also Musselman v. Central Telephone Co., 261 Iowa 352, 154 
 
         N.W.2d 128 (1967).
 
         
 
              While a claimant is not entitled to compensation for the 
 
         results of a preexisting injury or disease, the mere existence at 
 
         the time of a subsequent injury is not a defense.  Rose v. John 
 
         Deere Ottumwa Works, 247 Iowa 900, 908, 76 N.W.2d 756, 760-761 
 
         (1956).  If the claimant had a preexisting condition or 
 
         disability that is aggravated, accelerated, worsened or lighted 
 
         up so that it results in disability, claimant is entitled to 
 
         recover.  Nicks v Davenport Produce Co., 254 Iowa 130, 115 N.W.2d 
 
         812, 815 (1962).
 
         
 
              Permanent partial disabilities are classified as either 
 
         scheduled or unscheduled.  A specific scheduled disability is 
 
         evaluated by the functional method; the industrial method is used 
 
         to evaluate an unscheduled disability.  Martin v. Skelly Oil Co., 
 
         252 Iowa 128, 133, 106 N.W.2d 95, 98 (1960); Graves v. Eagle Iron 
 
         Works, 331 N.W.2d 116 (Iowa 1983); Simbro v. DeLong's Sportswear, 
 
         332 N.W.2d 886, 887 (Iowa 1983).
 
         
 
              An injury is the producing cause; the disability, however, 
 
         is the result, and it is the result which is compensated.  
 
         Barton
 
         STREETER V. IOWA MEAT PROCESSING CO.
 
         Page 3
 
         
 
                                                
 
                                                         
 
         
 
         v. Nevada Poultry Co., 253 Iowa 285, 110 N.W.2d 660  (1961);
 
         Dailey v. Pooley Lumber Co., 233 Iowa 758,.10 N.W.2d 569 (1943).
 
         
 
              Iowa Code section 85.34(2)(s) states:
 
         
 
              The loss of both arms, or both hands, or both feet, or both 
 
              legs, or both eyes, or any two thereof, caused by.a single 
 
              accident, shall equal five hundred weeks and shall be 
 
              compensated as such, however, if said employee is 
 
              permanently and totally disabled the employee may be 
 
              entitled to benefits under subsection 3.
 
         
 
              Iowa Code section 85.34(l) states:
 
         
 
              If an employee has suffered a personal injury causing 
 
              permanent partial disability for which compensation is 
 
              payable as provided in subsection 2 of this section, the 
 
              employer shall pay to the employee compensation for a 
 
              healing period, as provided in section 85.37, beginning on 
 
              the date of injury, and until the employee has returned to 
 
              work or it is medically indicated that significant 
 
              improvement from the injury is not anticipated or until the 
 
              employee is medically capable of returning to employment 
 
              substantially similar to the employment in which the 
 
              employee was engaged at the time of injury, whichever occurs 
 
              first.
 
         
 
         For purposes of the schedule contained in Iowa-Code section 
 
         85.34(2)(1), an injury confined to the wrist is treated as an 
 
         injury to the hand.  Elam v. Midland Mfg. Co., II Iowa Industrial 
 
         Comm'r Rep. 141 (Appeal Decision 1981).
 
         
 
                                     ANALYSIS
 
         
 
              Defendants Iowa Meat Processing and Chubb Insurance Group 
 
         urge on appeal that the deputy erred in finding that no permanent 
 
         disability resulted from claimant's injury of March 28, 1983.  
 
         Claimant was diagnosed as suffering from right carpal tunnel 
 
         syndrome on April 14, 1983.  Claimant underwent release surgery 
 
         in May of 1983.  Claimant returned to work without restrictions. 
 
          Claimant was later found to have right tendonitis, status post 
 
         carpal tunnel.  Claimant did not receive any rating of permanency 
 
         or indication of permanency for her right hand or wrist until 
 
         after the second injury on October 11, 1985.  Between May of 1983 
 
         and October of 1985, claimant did not miss work, and was able to 
 
         engage in educational course work, including a typing course.  
 
         Claimant did report pain extending up to her right elbow.  
 
         Claimant's ability to continue working at her job, completion of 
 
         a 
 
         
 
         STREETER V. IOWA MEAT PROCESSING CO.
 
         Page 4
 
         
 
         
 
                                                
 
                                                         
 
         typing course, and the elapse of two years before her left hand 
 
         and wrist condition compelled her to seek further medical 
 
         attention indicates that claimant die not have any permanent 
 
         impairment of her right hand or wrist following her right carpal 
 
         tunnel release surgery in May of 1983.
 
         
 
              The conclusion above assists in determining Chubb Insurance 
 
         Group's second issue on appeal.  Since claimant did not suffer 
 
         permanent impairment as a result of the 1983 injury and surgery, 
 
         the record supports the conclusion that claimant's left and right 
 
         hand conditions found in 1985 were the result of a single 
 
         cumulative injury process.  The permanent condition found in 1985 
 
         was the result of cumulative trauma occurring between 1983 and 
 
         October of 1985.  In October of 1985, claimant was also found to 
 
         have left carpal tunnel syndrome.  The record shows that this 
 
         condition was first noticed by claimant, and first noted by 
 
         medical personnel, subsequent to her right wrist surgery in 1983.  
 
         Thus, claimant developed both her permanent right hand and wrist 
 
         condition and her left carpal tunnel syndrome subsequent to her 
 
         1983 surgery.  This cumulative injury compelled claimant to leave 
 
         work in October of 1985.  Claimant has lost the use of both arms 
 
         or both hands as the result of a single accident, that is, 
 
         repetitive trauma to both wrists occurring between her surgery in 
 
         May 1983 and October 1985, and claimant is to be compensated 
 
         pursuant to Iowa Code section 85.34(2)(s).
 
                  
 
                                                
 
                                                         
 
         
 
              Chubb Insurance Group's third issue on appeal deals with 
 
         whether claimant's impairment is to the hand or to the arm.  The 
 
         mere fact that claimant's carpal tunnel condition resulted in 
 
         pain into her right arm does not result in an impairment of the 
 
         arm.  The situs of the injury in this case is in claimant's 
 
         wrist.  Claimant's right epicondylitis, although producing pain, 
 
         did not result in any impairment or disability to the arm, and 
 
         was not shown to be permanent.  Although the medical evidence 
 
         rates claimant's permanent impairment as 10 percent of the upper 
 
         extremity, there is no indication that the arms are impaired 
 
         other than as the site of pain.
 
         
 
              Claimant's surgery did not intrude into the arm.  The 
 
         pathology of the injury is confined to the wrist.  Claimant's 
 
         impairment is to the hand and does not extend into the arm.
 
         
 
              According to the AMA Guides to the Evaluation of Permanent 
 
         Impairment, Third Edition, 10 percent impairment of the upper 
 
         extremity converts to 11 percent impairment of the hand.  Eleven 
 
         percent of the hand converts to six percent of the body as a 
 
         whole.  Claimant has two impairments of the upper extremity, so 
 
         the combined values chart indicates claimant has a 12 percent 
 
         impairment of the body as a whole.  Claimant is entitled to 60 
 
         STREETER V. IOWA MEAT PROCESSING CO.
 
         Page 5
 
         
 
         
 
         weeks compensation.
 
         
 
              As a final issue, defendant Chubb Insurance Group urges 
 
         rejection of December 16, 1985 as the date when claimant's 
 
         permanency began in favor of May 9, 1986, the date on which 
 
         claimant's condition was given a permanent impairment rating.  
 
         Chubb offers no compelling argument in favor of this, however, 
 
         other than a reiteration of the earlier argument that the 
 
         impairment did not extend to the arm.  The use of December 16, 
 
         1985, the date claimant returned to light duty work, is a proper 
 
         point in time under section 85.34(l) to establish the end of 
 
         claimant's healing period and the beginning of the permanency.
 
         
 
                                 FINDINGS OF FACT
 
         
 
              1.  Claimant was an employee of defendant employer on March 
 
         28, 1983.
 
         
 
              2.  On March 28, 1983, claimant received an injury arising 
 
         out of and in the course of her employment with defendant 
 
         employer.
 
         
 
              3.  Claimant's duties involved the use of both of her 
 
         hands.
 
         
 
              4.  Claimant began to experience pain in her right wrist in 
 
         January of 1983.
 
                                                
 
                                                         
 
         
 
              5.  Claimant underwent carpal tunnel release surgery on her 
 
         right hand in May of 1983.
 
         
 
              6.  Subsequent to the release surgery, claimant was not 
 
         given any work restrictions, and did not miss work due to wrist 
 
         pain again until October of 1985.
 
         
 
              7.  Between 1983 and 1985, claimant completed courses in 
 
         typing and accounting.
 
         
 
              8.  Claimant continued to perform the same duties for 
 
         employer from 1983 to 1985 as she performed prior to her wrist 
 
         surgery.
 
         
 
              9.  In October of 1985, claimant was diagnosed as having 
 
         left carpal tunnel syndrome and right epicondylitis.
 
         
 
              10.  Claimant received a medical release to return to work 
 
         on December 16, 1985.
 
         
 
              11.  Claimant's carpal tunnel syndrome is confined to her 
 
         STREETER V. IOWA MEAT PROCESSING CO.
 
         Page 6
 
         
 
         
 
         left wrist and hand.  Claimant's epicondylitis is confined to her 
 
         right wrist and hand.  Claimant has pain in her upper extremities 
 
         but claimant does not have impairment or disability in her upper 
 
         extremities.
 
         
 
              12.  Claimant did not suffer any permanent disability or 
 
         permanent impairment as a result of her 1983 carpal tunnel 
 
         release surgery.
 
         
 
              13.  Claimant developed her present right and left hand and 
 
         wrist conditions simultaneously subsequent to her 1983 carpal 
 
         tunnel release surgery.
 
         
 
                                CONCLUSIONS OF LAW
 
         
 
              Claimant did not suffer any permanent disability or 
 
         permanent impairment as a result of her 1983 carpal tunnel 
 
         release surgery.
 
         
 
              Claimant developed her present right and left wrist and hand 
 
         conditions simultaneously between her May 1983 carpal tunnel 
 
         release surgery and October 1985.
 
         
 
              Claimant's present left and right hand and wrist conditions 
 
         do not extend to the upper extremities.
 
         
 
              Claimant's healing period ended December 16, 1985.
 
         
 
              WHEREFORE, the decision of the deputy is affirmed in part 
 
                                                
 
                                                         
 
         and reversed in part.
 
         
 
                                      ORDER
 
         
 
              THEREFORE, it is ordered:
 
         
 
              That defendants Iowa Meat Processing and Chubb Insurance 
 
         Group are to pay unto claimant healing period benefits from 
 
         November 12, 1985 until December 16, 1985, at the rate of two 
 
         hundred fifty-one and 55/100 dollars ($251.55) per week.
 
         
 
              That defendants are to pay unto claimant sixty (60) weeks of 
 
         permanent partial disability benefits at a rate of two hundred 
 
         fifty-one and 55/100 dollars ($251.55) per week from December 17, 
 
         1985.
 
         
 
              That defendants shall pay accrued weekly benefits in a lump 
 
         sum.
 
         
 
              That defendants are to be given credit for benefits 
 
         previously paid.
 
         STREETER V. IOWA MEAT PROCESSING CO.
 
         Page 7
 
         
 
         
 
              That defendants are to pay the costs of this action.
 
         
 
              That defendants shall file claim activity reports as 
 
         required by this agency pursuant to Division of Industrial 
 
         Services Rule 343-3.1(2).
 
         
 
              Signed and filed this 31st day of March, 1989.
 
         
 
         
 
         
 
         
 
         
 
                                               DAVID LINQUIST
 
                                               INDUSTRIAL COMMISSIONER
 
         
 
         Copies To:
 
         
 
         Mr. Harry H. Smith
 
         Attorney at Law
 
         P.O. Box 1194
 
         Sioux City,  Iowa  51102
 
         
 
         Ms. Judith Ann Higgs
 
         Attorney at Law
 
         P.O. Box 3086
 
         Sioux City, Iowa  51102
 
         
 
         Mr. Barry Moranville
 
         Attorney at Law
 
         974 73rd St., Suite 16
 
                                                
 
                                                         
 
         Des Moines, Iowa  50312
 
         
 
         Ms. Shirley Ann Steffe
 
         Assistant Attorney General
 
         Tort Claims Division
 
         Hoover State Office Bldg.
 
         Des Moines, Iowa 50319
 
         
 
         
 
         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                                    1801.1 - 1803 - 1806
 
                                                    Filed March 31, 1989
 
                                                    DAVID E. LINQUIST
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         CONNIE STREETER,
 
         
 
              Claimant,
 
         
 
         VS.
 
         
 
         IOWA MEAT PROCESSING CO.,             File Nos. 730461/809945
 
         
 
              Employer,                              A P P E A L
 
         
 
         and                                       D E C I S I 0 N
 
         
 
         CHUBB GROUP OF INSURANCE
 
         COMPANIES and ARGONAUT
 
         INSURANCE COMPANY,
 
         
 
              Insurance Carriers,
 
         
 
         and
 
         
 
         SECOND INJURY FUND OF IOWA,
 
         
 
              Defendants.
 
         
 
         
 
         
 
         1803 - 1806
 
         
 
              Claimant had a carpal tunnel release on the right in 1983, 
 
         and later developed carpal tunnel on the left in 1985.  In 
 
         between, claimant returned to her same job, had no permanent 
 
         restrictions, and was able to complete a typing course.  Held 
 
         that the evidence did not show any permanency from the surgery, 
 
         and that all of claimant's present bilateral condition developed 
 
         during period of coverage of second insurance company.
 
         
 
         1803.1
 
         
 
              Determination of simultaneously developing bilateral 
 
         condition resulted in award under section 85.34(2)(s). Also held 
 
         that pain from carpal tunnel condition extending into the 
 
         forearm, without any evidence of disability or impairment to the 
 
         forearm, did not extend claimant's injury from the hand and wrist 
 
         to the arm.
 
         
 
         
 
 
 
                                                
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                  BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         CONNIE STREETER,
 
         
 
              Claimant,
 
         
 
         vs.
 
         
 
         IOWA MEAT PROCESSING CO.,
 
                                                     File No.  730461
 
              Employer,                                        809945
 
         
 
         and                                     A R B I T R A T I 0 N
 
         
 
         CHUBB GROUP OF INSURANCE                   D E C I S I 0 N
 
         COMPANIES and ARGONAUT
 
         INSURANCE COMPANY,
 
         
 
              Insurance Carriers,
 
         
 
         and
 
         
 
         SECOND INJURY FUND OF IOWA,
 
          
 
              Defendants.
 
         
 
         
 
         
 
         
 
                                   INTRODUCTION
 
         
 
              This is a proceeding in arbitration brought by Connie 
 
         Streeter, claimant, against (1) Iowa Meat Processing Company and 
 
         Argonaut Insurance Company for benefits as a result of an injury 
 
         which occurred on March 28, 1983 (file no. 730461); and (2) 
 
         against Iowa Meat Processing Company and Chubb Group of Insurance 
 
         Companies for benefits as a result of an injury which occurred on 
 
         October 11, 1985 (file no. 809945) and (3) against Second Injury 
 
         Fund of Iowa for benefits under Iowa Code section 85.64.  A 
 
         hearing was held in Sioux City, Iowa on January 28, 1988 and the 
 
         case was fully submitted as the close of the hearing.  The record 
 
         consists of the testimony of Connie Streeter (claimant), Theodore 
 
         Streeter (claimant's husband) and Joint Exhibits A through K.  A 
 
         transcript was ordered by all three defendants and the original 
 
         was supplied to the industrial commissioner's file.  All four 
 
         attorneys submitted excellent briefs.  All of the briefs were 
 
         very informative and helpful.
 
         
 
                                 STIPULATIONS
 
         
 
              All of the parties stipulated to the following matters:
 
              That an employer-employee relationship existed between 
 
         claimant and employer at the time of both of the injuries; and
 
         
 
              That the rate of compensation, in the event of an award, is 
 
         $248.78 per week for the injury of March 28, 1983 and $251.55 per 
 
         week for the injury of October 11, 1985.
 

 
         
 
         
 
         
 
         STREETER V. IOWA MEAT PROCESSING CO.
 
         Page   2
 
         
 
         
 
         
 
              Claimant, Iowa Meat, Argonaut and Chubb stipulated to the 
 
         following matters:
 
         
 
              That claimant sustained an injury on March 28, 1983 and 
 
         again on October 11, 1985 which arose out of an in the course of 
 
         employment with employer;
 
         
 
              That both injuries were the cause of temporary disability; 
 
         that claimant received temporary disability benefits after both 
 
         injuries; and that claimantOs entitlement to temporary disability 
 
         benefits is not an issue in dispute in this case at this time;
 
         
 
              That claimant's entitlement to medical benefits was no 
 
         longer in dispute;
 
         
 
              Claimant, Iowa Meat and Argonaut stipulated that the injury 
 
         of March 28, 1983 was a scheduled member disability to the right 
 
         arm or hand;
 
         
 
              It was stipulated that neither insurance carrier claimed a 
 
         credit under Iowa Code section 85.38(2) for benefits paid prior 
 
         to hearing under an employee nonoccupational group health plan;
 
         
 
              It was stipulates that Argonaut paid claimant 10 5/7 weeks 
 
         of workers' compensation benefits for the period from April 6, 
 
         1983 to June 19, 1983 prior to hearing and that Argonaut makes no 
 
         claim for credit for any permanent partial disability benefits 
 
         paid prior to hearing;
 
         
 
              It was stipulated that defendant, Chubb, paid claimant five 
 
         weeks of temporary disability benefits from November 12, 1985 to 
 
         December 16, 1985 and that no claim was made by Chubb for these 
 
         temporary disability benefits;
 
         
 
              It was further stipulated that Chubb paid claimant 19 weeks 
 
         of permanent partial disability benefits as workersO compensation 
 
         benefits prior to hearing and that Chubb is entitled to a credit 
 
         for 19 weeks of benefits at the rate of $251.55 per week; and
 
         
 
              It was stipulated that there are no bifurcated claims.
 
         
 
                                      ISSUES
 
         
 
              The parties submitted the following issues for determination 
 
         at the time of the hearing:
 
         
 
              Whether the injury of March 28, 1983 was the cause of any 
 
         permanent disability;
 
         
 
              Whether claimant is entitled to any permanent partial 
 
         disability benefits as a result of the injury of March 28, 1983;
 
         
 
              Whether the injury of October 11, 1985 was the cause of any 
 
         permanent disability;
 
         
 
              Whether claimant is entitled to any permanent partial 
 
         disability benefits as a result of the injury of October 11, 
 
         1985, and it so, the nature and extent of benefits; and
 

 
         
 
         
 
         
 
         STREETER V. IOWA MEAT PROCESSING CO.
 
         Page   3
 
         
 
         
 
         
 
              Whether claimant is entitled to any benefits from the Second 
 
         Injury Fund of Iowa, and if so, the amount of benefits to which 
 
         claimant is entitled.
 
         
 
                             SUMMARY OF THE EVIDENCE
 
         
 
              All of the evidence was examined and considered.  The 
 
         following is a summary of the pertinent evidence:
 
         
 
              Claimant was 37 years old at the time of the hearing, 
 
         married and the mother of four daughters.  She completed the 
 
         ninth grade of junior high school.  She did not attend high 
 
         school because she got married after completing the ninth grade 
 
         of junior high school (Exhibit I, page 8).
 
         
 
              Claimant took accounting classes and typing classes in adult 
 
         education and also took classes which resulted in obtaining her 
 
         G.E.D. in 1983 (Transcript page 57; Ex. I, p. 24).  Claimant has 
 
         three past employments; (1) she worked three weeks for Zenith 
 
         Soldering Parts; (2) she worked three weeks for Truck Haven as a 
 
         waitress and (3) she drove a truck and delivered automobile 
 
         repair parts for MOPAR for one and one-half years.  Claimant 
 
         started to work for employer on December 8, 1960 (Tran. pp. 
 
         20-24; Ex. I, pp. 8 & 9).
 
         
 
              Claimant denied any prior health problems prior to this 
 
         employment except a neck injury when her vehicle was rear ended 
 
         while working for MOPAR (Tran. pp. 24-26, 28, 56; Ex. 1, pp. 10 & 
 
         11).  Claimant testified that her neck still gives her trouble.  
 
         Claimant also admitted that she injured her back once while 
 
         fishing (Ex. I, p. 11).  Claimant's other health problems are not 
 
         relevant to these particular injuries (Exs. C & H).
 
         
 
              Claimant worked on the liver table.  She picked livers from 
 
         a conveyor belt with her right hand and put them in front of her 
 
         to work on them.  She used her left hand to pull the gall off.  
 
         She used her right hand again to take the spots off, brand them 
 
         and throw them up above onto another belt (Ex. I, pp. 11 & 12, 
 
         20, 21 and 30).  Claimant and another employee completed 800 
 
         livers per hour (Tran. p. 55; Ex. I, p. 30).  The livers weighed 
 
         approximately three to five pounds.  Claimant worked 8 to 10 
 
         hours per day (Tran. pp. 26-28).  Claimant testified that her 
 
         right hand and arm are her dominant hand and arm (Tran. pp. 52, 
 
         55; Ex.  I, p. 6).
 
         
 
              In January of 1983, claimant began to experience pain in her 
 
         right wrist that would shoot up into her elbow and her shoulder 
 
         (Tran. p. 29).  The nurses taped her wrist at first and 
 
         eventually taped it up to the elbow (Tran. p. 30).  By March 28, 
 
         1983, claimant's right hand was completely numb.  She could not 
 
         feel anything in her hand.  Her arm was in pain up to her 
 
         shoulder (Tran. pp. 29 and 31).  Claimant testified that her 
 
         bones would crack when she moved her arm and send an electric 
 
         shock up into her arm (Ex. I, p. 12).
 
         
 
              The nurse sent claimant to see Dan M. Rhodes, M.D., the 
 
         company physician.  He examined her, gave her a brace and advised 
 
         her to take Tylenol (Tran. pp. 31 & 32).  She testified that he 
 

 
         
 
         
 
         
 
         STREETER V. IOWA MEAT PROCESSING CO.
 
         Page   4
 
         
 
         
 
         took her off work for approximately five weeks.  She said that 
 
         Dr. Rhodes sent her to see Dr. Eckman (full name unknown) who 
 
         performed surgery in May of 1983.  She stated that she was 
 
         released to return to work processing livers again in June of 
 
         1983 (Ex. 1, pp. 13 & 14).
 
         
 
              The medical records show that Dr. Rhodes first saw claimant 
 
         on April 5, 1983.  He found claimant had (1) tender right 
 
         trapezius; (2) tender right lateral humeral condyle and (3) 
 
         decreased pin prick in the first and third fingers on the right 
 
         hand.  He diagnosed (1) myositis right trapezius; (2) right 
 
         tennis elbow and (3) probable right carpal tunnel syndrome.  He 
 
         prescribed a wrist splint, Tolectin DS and hot packs (Ex. E, p. 
 
         7).  On April 8, 1983, he repeated this diagnosis and prescribed 
 
         (1) rest; (2) a sling; (3) heat and (4) medications (Ex. E, p. 
 
         6).  On April 11, 1983, he ordered Tandearil, carpal tunnel 
 
         studies and daily physical therapy (Ex. E., p. 5).  On April 14, 
 
         1983, claimant still had right wrist pain.  Dr. Rhodes found that 
 
         claimant's nerve conduction studies were consistent with carpal 
 
         tunnel syndrome on the right and claimant had a positive tinel's 
 
         sign.  Dr. Rhodes reduced his diagnosis to carpal tunnel 
 
         syndrome, right (Ex. E, p. 4).  On April 21, 1983, claimant had a 
 
         numb thumb, index and third finger.  Dr. Rhodes continued to 
 
         diagnose carpal tunnel syndrome, right. he referred claimant to 
 
         Dr. Kleider (full name unknown) (Ex. E, p. 3).  On June 15, 1983, 
 
         Dr. Rhodes reported that claimant had received surgery on May 3, 
 
         1983.  He stated that the tingling was better but that claimant 
 
         still had distal ulnar tenderness and pain. he diagnosed 
 
         tendonitis, status post-carpal tunnel.  He prescribed heat, soaks 
 
         and Indocin.  Dr.  Rhodes said that claimant could return to work 
 
         on June 20, 1983 (Ex. E, p. 2).  No restrictions or limitations 
 
         were imposed at that time.  On June 22, 1983, Dr. Rhodes said 
 
         that the right wrist was much better but that the left thumb 
 
         abductor was then tender and sore.  His diagnosis was (1) 
 
         tendonitis and status post-carpal tunnel, right and (2) resolving 
 
         mild left de Quervain disease (Ex. E, p. 1).  Dr. Rhodes did not 
 
         indicate whether there was or.was not any permanent impairment 
 
         and he did not give a permanent functional impairment rating.  
 
         The record does not disclose any medical evidence from the 
 
         surgeon, or from a Dr. Kleider or from a Dr. Eckman.  There was 
 
         some evidence that the surgeon left town or may have possibly 
 
         retired shortly after the surgery (Tran. p. 53).
 
         
 
              Claimant testified that after the surgery on the right, and 
 
         before she had problems on the left, she never did ask a doctor 
 
         if she had a permanent impairment to her right wrist (Tran. p. 
 
         52).  Nor did any doctor tell claimant that she had any permanent 
 
         disability to her wrist (Tran. p. 55).
 
         
 
              Claimant testified that she returned to work in June of 1983 
 
         at her regular job on the liver table.  She testified that her 
 
         left hand and arm were all right (Tran. pp. 33 & 46).  Her right 
 
         hand and arm continued to bother her off and on and her right 
 
         wrist was tender.  She said that she would keep it taped half way 
 
         up to her elbow (Tran. pp. 34, 35, 53, 54; Ex. I, p. 15).  
 
         Claimant did not recall how soon it was after she returned to 
 
         work that she started taping her right wrist and arm (Tran. p. 
 
         35; Ex. I, p. 15), but in her deposition she said it was right 
 
         after she returned to work following the surgery (Ex. I, p. 22). 
 

 
         
 
         
 
         
 
         STREETER V. IOWA MEAT PROCESSING CO.
 
         Page   5
 
         
 
         
 
          The nurse's notes show that claimant requested to have her right 
 
         wrist wrapped for support on June 4, 1984 (Ex. G, p. 2).  The 
 
         plant nurse also noted on September 14, 1984, that claimant had 
 
         bilateral pain in her hands and forearms on that date (Ex. G, p. 
 
         4).
 
         
 
              Over the objection of defendant, Chubb, claimant testified 
 
         that she thought her work on the liver table between 1983 and 
 
         1985 made her right hand and arm worse by using it over and over 
 
         in the same repetitious motions (Tran. pp. 46, 47, 49, 50, 51; 
 
         Ex. 1, p. 16).
 
         
 
              Claimant granted that from the time she returned to work in 
 
         June of 1983, until the second injury in October of 1985, that 
 
         she lost no time from work because of any problem that she was 
 
         having with her right hand and wrist (Ex. I, p. 17).  She 
 
         testified that she could perform the skills that were necessary 
 
         for the liver table job (Tran. p. 57).  She testified that she 
 
         could perform the job without any medically imposed limitations 
 
         or restrictions (Ex. 1, pp. 30 and 31).  Claimant also testified 
 
         that the typing, accounting and G.E.D. courses were completed in 
 
         1983 after the surgery on her right hand and wrist (Tran. pp. 57 
 
         & 58).
 
         
 
              Claimant testified that after the surgery and after she 
 
         returned to work, the pain in her right arm began moving up 
 
         toward her right elbow (Ex. I, p. 15).  She also testified that 
 
         she wore a right elbow brace (Ex. I, p. 23).
 
         
 
              Claimant testified that her left arm began to bother her in 
 
         October of 1985 (Tran. p. 34).; She saw the nurse first and 
 
         received analgesics and the nurse taped her arm.  The left arm 
 
         swelled up a lot more (Tran. pp. 35 & 36).  Claimant was sent to 
 
         see Michael A. Jennings, M.D., and John N. Redwine, D.O., at the 
 
         Morningside Clinic (Tran. pp. 35-37).  Claimant was taken off 
 
         work but the company made her come in anyway and sit on a bench 
 
         in the hallway for three weeks (Tran. pp. 37-39).  Eventually, 
 
         the Morningside Clinic sent tier to see David G. Paulsrud, M.D., 
 
         an orthopedic surgeon.  Claimant contended that he told her that 
 
         she should not be working in the packing house due to the 
 
         condition of her wrist (Tran. pp. 39 & 40).
 
         
 
              The medical records show that Dr. Jennings recorded that he 
 
         saw claimant on October 11, 1985 for bilateral wrist pain.  
 
         Claimant reported pain and tingling in both wrists, the left more 
 
         than the right.  He found that she had a positive tinel's sign 
 
         and positive Phalen's sign on the left.  He diagnosed tendonitis 
 
         of the right extensor tendon and left flexor tendons of the wrist 
 
         and hands.  He prescribed medications and a wrist splint (Ex. D, 
 
         p. 8).  Followup examinations were performed on October 18, 1985 
 
         and October 22, 1985 with a diagnosis of carpal tunnel syndrome 
 
         of the left wrist and right and left tendonitis (Ex. D, pp. 6 & 
 
         7).  Right lateral epicondylitis was added to the diagnosis on 
 
         October 25, 1985, October 29, 1985 and November 11, 1985 (Ex. D, 
 
         pp. 3-5).  A nerve conduction velocity test performed by Dennis 
 
         Nitz, M.D., on October 31, 1985, showed that the left median 
 
         nerve conduction velocity was normal and that there was no 
 
         evidence of carpal tunnel syndrome on the left at that time (Ex. 
 
         F).  On November 5, 1985, and November 8, 1965, the diagnosis 
 

 
         
 
         
 
         
 
         STREETER V. IOWA MEAT PROCESSING CO.
 
         Page   6
 
         
 
         
 
         continued to be (1) carpal tunnel syndrome left hand and wrist 
 
         and (2) right lateral epicondylitis.  Claimant was referred again 
 
         to Dr. Paulsrud (Ex. D, pp. 1 & 2).
 
         
 
              Dr. Redwine made an office note on November 8, 1985, that 
 
         claimant had pain in the left wrist and a positive tinel's sign 
 
         and PhalenOs sign of the left hand. her right forearm was 
 
         slightly swollen and the strength in that arm was slightly 
 
         reduced.  He diagnosed carpal tunnel syndrome of the left wrist 
 
         and right lateral epicondylitis (Ex. A).
 
         
 
              The medical records show that Dr. Paulsrud saw claimant on 
 
         November 12, 1985 for pain in the right arm to her right 
 
         epicondyl area and numbness and tingling in her left hand and 
 
         wrist.  He continued to keep her off work.  His diagnosis was 
 
         diffuse traumatic synovitis involving both upper extremities (Ex. 
 
         B, pp. 5 & 6).  He returned claimant to work on light duty on 
 
         December 16, 1985 (Ex. B, pp. 3 & 4).  On May 9, 1986, Dr. 
 
         Paulsrud reported to the insurance carrier as follows:
 
         
 
              As you know, Connie Streeter has been treated through 
 
              this office for diffuse traumatic synovitis involving 
 
              both of her upper extremities.  She was seen November 
 
              12 and December 12, 1985 for this condition.
 
         
 
              She is in really an impossible situation because of the 
 
              continued heavy, repetitive [sic] use of her hands in a 
 
              cold environment.  This will cause problems.  I do not 
 
     
 
         
 
         
 
         
 
         
 
         STREETER V. IOWA MEAT PROCESSING CO.
 
         Page   7
 
         
 
         
 
              have a lot to offer her other than anti-inflammatories 
 
              which are a problem for her to take.  She was told to 
 
              remain at rest until December, 1986 and then was 
 
              released to return to light work December 16, 1985, 
 
              progressing to full duties after one month, but 
 
              preventing repetitive [sic] use of her hands.
 
         
 
              I would rate her permanency at 10% of each upper 
 
              extremity.
 
         
 
         (Ex. B, p. 1)
 
         
 
              Claimant testified that at the time of her deposition on 
 
         September 22, 1986, that her claim for both the right side and 
 
         the left side was for her hands and wrists and not for her arms 
 
         (Ex. I, pp. 25-27).  She testified that in her left wrist and 
 
         hand there is pain, cracking and a light tingle.  It was not 
 
         completely dead (Ex. I, p. 27).  On the right side it was not 
 
         much different except that the surgery did remove the numbness 
 
         (Ex. I, p. 27).
 
         
 
              Claimant further testified that she can no longer bowl, is 
 
         limited on how much she can lift and has trouble opening things. 
 
         She has pain in her wrist up to her elbow continuously.  She 
 
         needs help to do her housework (Tran. pp, 44 & 45; Ex. I, pp. 6 & 
 
         30) .
 
         
 
              Theodore Streeter, claimant's husband, testified that his 
 
         wife is limited in her cooking, lifting and housework.  He and 
 
         the children help with the cooking, laundry and vacuuming (Tran. 
 
         pp. 56-61).
 
         
 
                           APPLICABLE LAW AND ANALYSIS
 
         
 
              The claimant has the burden of proving by a preponderance of 
 
         the evidence that the injuries of March 28, 1983 and October 11, 
 
         1985 are causally related to the disability on which she now 
 
         bases her claim.  Bodish v. Fischer, Inc., 257 Iowa 516, 133 
 
         N.W.2d 867 (1965).  Lindahl v. L. 0. Boggs, 236 Iowa 296, 18 
 
         N.W.2d 607 (1945).  A possibility is insufficient; a probability 
 
         is necessary.  Burt v. John Deere  Waterloo Tractor Works, 247 
 
         Iowa 691, 73 N.W.2d. 732 (1955).  The question of causal 
 
         connection is essentially within the domain of expert testimony.  
 
         Bradshaw v. Iowa Methodist Hospital, 251 Iowa 375, 101 N.W.2d 167 
 
         (1960).
 
         
 
              However, expert medical evidence must be considered with all 
 
         other evidence introduced bearing on the causal connection.  
 
         Burt, 247 Iowa 691, 73 N.W.2d 732.  The opinion of experts need 
 
         not be couched in definite, positive or unequivocal language.  
 
         Sondag v. Ferris Hardware, 220 N.W.2d 903 (Iowa 1974).  However, 
 
         the expert opinion may be accepted or rejected, in whole or in 
 
         part, by the trier of fact.  Id. at 907.  Further, the weight to 
 
         be given to such an opinion is for the finder of fact, and that 
 
         may be affected by the completeness of the premise given the 
 
         expert and other surrounding circumstances.  Bodish, 257 Iowa 
 
         516, 133 N.W.2d 867.  See also Musselman v. Central Telephone 
 
         Co., 261 Iowa 352, 154 N.W.2d 128 (1967).
 
         
 

 
         
 
         
 
         
 
         STREETER V. IOWA MEAT PROCESSING CO.
 
         Page   8
 
         
 
         
 
              While a claimant is not entitled to compensation for the 
 
         results of a preexisting injury or disease, the mere existence at 
 
         the time of a subsequent injury is not a defense.  Rose v. John 
 
         Deere Ottumwa Works, 247 Iowa 900, 908, 76 N.W.2d 756, 760-761 
 
         (1956).  If the claimant had a preexisting condition or 
 
         disability that is aggravated, accelerated, worsened or lighted 
 
         up so that it results in disability, claimant is entitled to 
 
         recover.  Nicks v. Davenport Produce Co., 254 Iowa 130, 115 
 
         N.W.2d 812, 815 (1962).
 
         
 
              The right of a worker to receive compensation for injuries 
 
         sustained which arose out of and in the course of employment is 
 
         statutory.  The statute conferring this right can also fix the 
 
         amount of compensation to be paid for different specific 
 
         injuries, and the employee is not entitled to compensation except 
 
         as provided by the statute.  Soukup v. Shores Co., 222 Iowa 272, 
 
         268 N.W. 598 (1936).
 
         
 
              Permanent partial disabilities are classified as either 
 
         scheduled or unscheduled.  A specific scheduled disability is 
 
         evaluated by the functional method; the industrial method is used 
 
         to evaluate an unscheduled disability.  Martin v. Skelly Oil Co., 
 
         252 Iowa 128, 133, 106 N.W.2d 95, 98 (1960); Graves v. Eagle Iron 
 
         Works, 331 N.W.2d 116 (Iowa 1983); Simbro v. DeLong's Sportswear, 
 
         332 N.W.2d 886, 887 (Iowa 1983).
 
         
 
              Claimant did not sustain the burden of proof by a 
 
         preponderance of the evidence that the injury stipulated to have 
 
         occurred on March 28, 1983 was the cause of any permanent 
 
         disability.  It is true that claimant received surgery on the 
 
         right hand for carpal tunnel syndrome; however, there is no 
 
         medical report from the operating surgeon.  The company 
 
         physician, Dr. Rhodes, did not give an impairment rating or even 
 
         say anything to slightly suggest that claimant sustained a 
 
         permanent injury or was entitled to an impairment rating.  Dr. 
 
         Rhodes released claimant to return to work without restrictions 
 
         or limitations.  Claimant returned to the same job.  She 
 
         testified that she could and did perform the job without any 
 
         limitations from June of 1983 to October of 1985.  She testified 
 
         that she lost no time from work due to this injury from, June of 
 
         1983 to October of 1985.  She also testified that sometime after 
 
         the surgery in 1983, she attended adult education classes and 
 
         took typing, accounting and the courses necessary to obtain her 
 
         G.E.D.  Claimant's right hand is her dominant hand.  Being a 
 
         student entails writing with your dominant hand to take notes, do 
 
         homework, take tests and to perform other student tasks.  
 
         Claimant indicated that she taped her right wrist and arm after 
 
         she returned to work but she did it primarily as a precautionary 
 
         or preventative measure at first.  She did encounter problems 
 
         with her right hand again sometime after she returned to work 
 
         "off and on" but she could not recall when the right hand 
 
         problems recurred.  The nurse's notes show that claimant's right 
 
         wrist was wrapped on June 4, 1984 and that she reported bilateral 
 
         pain in her hands on September 14, 1984.  There is no other 
 
         medical evidence in the record to show that claimant received any 
 
         other treatment for the right carpal tunnel syndrome until the 
 
         second injury which is stipulated to have occurred on October 11, 
 
         1985.  The nurse's notes of June 4, 1984 and September 14, 1984 
 
         are the first hand evidence of a recurrence of additional trouble 
 

 
         
 
         
 
         
 
         STREETER V. IOWA MEAT PROCESSING CO.
 
         Page   9
 
         
 
         
 
         with the right side.  These dates are approximately one year 
 
         after the initial injury of March 28, 1983 and the surgery on May 
 
         3, 1983.
 
         
 
              Defendant, Chubb, contends that certain evidence proves that 
 
         claimant sustained a permanent injury as a result of the injury 
 
         that occurred on March 28, 1983.  First, Chubb points out that 
 
         claimant had complaints of pain off and on after she returned to 
 
         work after the surgery of May 3, 1983; however, she did not 
 
         require any medical attention from a doctor for these complaints, 
 
         only went to the nurse's office twice and her complaints, 
 
         according to the nurse's notes, would appear to be minor.  Chubb 
 
         points out that claimant quit bowling prior to the surgery and it 
 
         became necessary for her husband and daughters to assist her with 
 
         the housework prior to the surgery on the right hand.  Chubb also 
 
         contends that the surgery itself is some evidence of permanent 
 
         impairment.  All of these evidential points are relevant and 
 
         material as to whether claimant sustained a permanent injury as a 
 
         result of the injury on March 28, 1983.  However, these 
 
         evidential points are not persuasive or conclusive in the absence 
 
         of medical evidence of impairment.  There is no report from the 
 
         operating surgeon or from any other physician rating impairment 
 
         from the 1983 injury.  The treating physician did not assess any 
 
         impairment or disability.  He imposed no restrictions or 
 
         limitations on claimantOs return to work.  No evidence was 
 
         introduced from an independent medical examiner to establish that 
 
         the injury of March 28, 1983 was the cause of any permanent 
 
         impairment.  Therefore, it is determined that claimant did not 
 
         sustain the burden of proof by a preponderance of the evidence 
 
         that she sustained a permanent injury as a result of the injury 
 
         that was stipulated to have occurred on March 28, 1983.  
 
         Accordingly, claimant is not entitled to any permanent disability 
 
         benefits for the injury of March 28, 1983.
 
         
 
              Consequently, claimant is not entitled to benefits from the 
 
         Second Injury Fund of Iowa.  Iowa Code section 85.64 requires (1) 
 
         the loss of loss of use of one hand, one arm, one foot, one leg 
 
         or one eye; (2) the loss or loss of use of another such member or 
 
         organ and (3) some degree of permanent disability resulting from 
 
         the first and second injury.  Anderson v. Second Injury Fund, 262 
 
         N.W.2d 789 (Iowa 1978) ; Lawyer & Higgs, Iowa Workers' 
 
         Compensation--Law & Practice, section 17.5 page 143.
 
         
 
              Counsel for the Second Injury Fund in her brief accurately 
 
         and succinctly summarized why claimant is not entitled to Second 
 
         Injury Fund benefits in this case.
 
         
 
                 No limitations or restrictions were imposed by 
 
              Claimant's physician subsequent to her May 1983 surgery 
 
              and in connection with her return to work.  Jt. Ex. E, 
 
              pp. 1-2.  The record is devoid of any medical evidence 
 
              as to any residual functional impairment resulting from 
 
              her March 28, 1983, injury.  Furthermore, the evidence 
 
              shows that Claimant functioned quite well subsequent to 
 
              her May 1983 surgery performing the same duties at Iowa 
 
              Meats as before her surgery until problems (bilateral 
 
              in nature) developed in October of 1985.  Tr. pp. 33, 
 
              57.
 
         
 

 
         
 
         
 
         
 
         STREETER V. IOWA MEAT PROCESSING CO.
 
         Page  10
 
         
 
         
 
                 In sum, Claimant's position that her first claimed 
 
              injury to her right upper extremity was sufficient to 
 
              invoke SS85.64 must be summarily rejected as Claimant's 
 
              first injury was not permanent and did not act as any 
 
              hindrance to ClaimantOs ability to obtain or retain 
 
              gainful employment.  Claimant has not met the entry 
 
              level requirement of SS85.64; Anderson, 262 N.W.2d at 
 
              791.  See also Allen v. Second Injury Fund, 34 Iowa 
 
              Indus. CommOr Biennial Rep. 273 (1979).1
 
         
 
              The case of Allen v. Second Injury Fund, is actually found 
 
         at Thirty-fourth Biennial Report of the Industrial Commissioner 
 
         page 15, and not page 273 as cited above.
 
         
 
              No Second Injury Fund benefits were awarded to a claimant 
 
         who failed to show a permanent disability existed as a result of 
 
         the first injury and prior to the second injury.  Ross v. Service 
 
         Master-Story Co., Inc., Thirty-fourth Biennial Report of the 
 
         Industrial Commissioner 273 (1979).
 
         
 
              None of Dr. PaulsrudOs impairment rating can be attributed 
 
         to the first injury because (1) he did not examine claimant after 
 
         the first injury; (2) he first examined claimant after the second 
 
         injury; (3) it appears that he rated claimant's condition as it 
 
         existed when he examined her, and (4) he does not attribute any 
 
         part of the impairment to the 1983 injury.  There is no 
 
         information in any of Dr. Paulsrud's data that even slightly 
 
         suggests that he intended to rate the first injury of March 28, 
 
         1983 (Ex. B, pp. 1-6).  Consequently, claimant is not entitled to 
 
         Second Injury Fund benefits because she did not sustain the 
 
         burden of proof by a preponderance of the evidence that the first 
 
         injury resulted in any permanent disability.
 
         
 
              Claimant is entitled to permanent disability benefits as a 
 
         result of the injury which the parties stipulated occurred on 
 
         October 11, 1985.  The records of the Morningside Clinic clearly 
 
         show that the various doctors there treated claimant for 
 
         bilateral upper extremity problems which were narrowed down to 
 
         carpal tunnel syndrome of the left hand and wrist and right 
 
         lateral epicondylitis (Ex. D, pp. 1-7).  These problems were 
 
         reported simultaneously by both the Morningside Clinic and also 
 
         Dr. Paulsrud.  From the narrow view, Dr. Paulsrud treated pain in 
 
         the right arm up to the epicondyle and numbness and tingling in 
 
         the left hand and wrist.  From a wider view, his diagnosis was 
 
         diffuse traumatic synovitis involving both upper extremities (Ex. 
 
         13, p. 6).  It would appear from the reports of the Morningside 
 
         Clinic and Dr. Paulsrud that both of these conditions developed 
 
         simultaneously.  Claimant did use both hands in her work.  There 
 
         was no evidence that either the right side or the left side 
 
         developed separately.  Actually, bilateral problems had 
 
         manifested themselves as early as June 22, 1983, when claimant 
 
         saw Dr. Rhodes for the last time after the right carpal tunnel 
 
         surgery.  At that time he noted that claimant also had mild left 
 
         de Quervain disease in addition to being status post-carpal 
 
         tunnel surgery on the right (Ex. E, p. 1).  According to the 
 
         nurse's notes claimant had trouble with the right side on June 4, 
 
         1984 (Ex. G, p. 2) and trouble on both sides on September 14, 
 
         1984 (Ex. G, p. 4).  The nurse's note for October 11, 1985, 
 
         indicates that claimant had bilateral wrist pain with a gradual 
 

 
         
 
         
 
         
 
         STREETER V. IOWA MEAT PROCESSING CO.
 
         Page  11
 
         
 
         
 
         onset (Ex. G, p. 6). Therefore, it would appear that claimant 
 
         actually had already encountered bilateral problems by June 22, 
 
         1983.  From that time forward it would appear that she aggravated 
 
         this preexisting condition and that this aggravation took place 
 
         during the period of coverage for Chubb Insurance which was 
 
         between December 1, 1983 and February 1, 1986.
 
         
 
              The Iowa Supreme Court case of Simbro 332 N.W.2d 886 held 
 
         that permanent partial disability of two members caused by a 
 
         single incident is a scheduled injury and that the degree of 
 
         impairment for a partial loss must be computed on the basis of a 
 
         functional, rather than industrial disability pursuant to Iowa 
 
         Code section 85.34(2)(s).
 
         
 
              Iowa Code section 85.34(2)(s) provides as follows:
 
         
 
                 The loss of both arms, or both hands, or both feet, 
 
              or both legs, or both eyes, or any two thereof, caused 
 
              by a single accident, shall equal five hundred weeks 
 
              and shall be compensated as such, however, if said 
 
              employee is permanently and totally disabled he may be 
 
              entitled to benefits under subsection 3.
 
         
 
              Dr. Paulsrud rated claimant's permanency at ten percent of 
 
         each upper extremity (Ex. B, p. 1).  Narrowly speaking, 
 
         claimantOs bilateral injury was (1) to the left wrist and hand 
 
         and (2) to the right arm.  However, claimant testified that she 
 
         also had problems up into both arms.  She testified that her 
 

 
         
 
         
 
         
 
         STREETER V. IOWA MEAT PROCESSING CO.
 
         Page  12
 
         
 
         
 
         right arm required a brace at the elbow.  Claimant testified and 
 
         the doctors verified that her left arm was swollen.  Dr. 
 
         Paulsrud's overall diagnosis covered a wider area.  He stated 
 
         that claimant had diffuse traumatic synovitis involving both of 
 
         her upper extremities.  The only medical evidence relative to 
 
         impairment is that claimant sustained a ten percent impairment to 
 
         each upper extremity.  This evidence is not controverted by any 
 
         other medical evidence introduced by defendants.  If Dr. Paulsrud 
 
         rated each upper extremity at ten percent, then that is what he 
 
         means in the absence of any contrary evidence.  This is 
 
         consistent with his diagnosis of diffuse traumatic synovitis in 
 
         both of the upper extremities.  Dr. Paulsrud was aware of the 
 
         fact that these percentages would be used in computing workers' 
 
         compensation benefits.  There is no competing or conflicting 
 
         opinion or rating front any other doctor as the result of an 
 
         independent medical examination.  Therefore, claimant is awarded 
 
         benefits based upon a ten percent permanent functional impairment 
 
         to each upper extremity.
 
         
 
              The fact,that Dr. Paulsrud made his evaluation in a letter 
 
         dated May 9, 1966, which was after Chubb's coverage expired on 
 
         February 1, 1986, is not material.   Dr. Paulsrud saw claimant on 
 
         two occasions--November 12, 1985 and December 12, 1985.  His 
 
         evaluation could only be based upon the observations he made at 
 
         the time he saw claimant and this was during a period of time 
 
         when Chubb did have coverage.
 
         
 
              Using the Guides to the Evaluation of Permanent Impairment, 
 
         second edition, published by the American Medical Association, 
 
         table 26 on page 23, it shows that ten percent of the right upper 
 
         extremity converts to six percent of the whole person.  Likewise, 
 
         ten percent of the left upper extremity converts to six percent 
 
         of the whole person.  The combined values chart on page 240, then 
 
         illustrates that the combined value of six percent and six 
 
         percent is twelve percent of the whole person.  Twelve percent of 
 
         500 weeks is equal to 60 weeks of permanent partial disability 
 
         benefits.  Therefore, it is determined that the injury of October 
 
         11, 1985 was the cause of permanent partial disability to both 
 
         the right upper extremity and left upper extremity simultaneously 
 
         and that claimant is entities to 60 weeks of permanent partial 
 
         disability benefits pursuant to Iowa Code section 85.34(2)(s) 
 
         from Iowa Meat and Chubb Insurance.
 
         
 
                                 FINDINGS OF FACT
 
         
 
              Therefore, based upon the evidence presented the following 
 
         findings of fact are made:
 
         
 
              That there was no medical evidence or any other convincing 
 
         evidence that the injury that occurred on March 28, 1983 was the 
 
         cause of any permanent functional impairment or permanent 
 
         disability;
 
         
 
              That the doctors at the Morningside Clinic treated bilateral 
 
         upper extremity problems as a result of the injury that occurred 
 
         on October 11, 1985;
 
         
 
              That Dr. Paulsrud, the only medical practitioner to testify 
 
         on the subject of impairment, treated a bilateral problem 
 

 
         
 
         
 
         
 
         STREETER V. IOWA MEAT PROCESSING CO.
 
         Page  13
 
         
 
         
 
         simultaneously;
 
         
 
              That Dr. Paulsrud diagnosed claimant as having diffuse 
 
         traumatic synovitis of both upper extremities as a result of the 
 
         injury that occurred on October 11, 1985;
 
         
 
              That Dr. Paulsrud's assessment is accepted as being 
 
         correct;
 
         
 
              That Dr. Paulsrud awarded a ten percent permanent functional 
 
         impairment of each upper extremity and his ratings are accepted 
 
         as correct; and
 
         
 
              That the ratings of Dr. Paulsrud convert and combine to 
 
         equal a twelve percent permanent functional impairment of the 
 
         whole person.
 
         
 
                                CONCLUSIONS OF LAW
 
         
 
              WHEREFORE, based upon the evidence presented and the 
 
         principles of law previously discussed the following conclusions 
 
         of law are made:
 
         
 
              That claimant did not sustain the burden of proof by a 
 
         preponderance of the evidence that the injury of March 28, 1983 
 
         was the cause of any permanent functional impairment or permanent 
 
         disability;
 
         
 
              That claimant is not entitled to any permanent disability 
 
         benefits as a result of the injury of March 28, 1983;
 
         
 
              That claimant did sustain the burden of proof by a 
 
         preponderance of the evidence that the injury of October 11, 1985 
 
         was the cause of bilateral permanent impairment of both upper 
 
         extremities which occurred simultaneously;.
 
         
 
              That claimant is entitled to 60 weeks of permanent partial 
 
         disability benefits from Iowa Meat and Chubb Insurance pursuant 
 
         to Iowa Code section 85.34(2)(s) for the injury that occurred on 
 
         October 11, 1985;
 
         
 
              That defendants, Iowa Meat and Chubb insurance, are entitled 
 
         to a credit for 19 weeks of permanent partial disability paid 
 
         prior to hearing at the rate of $251.55 per week; and
 
         
 
              That the Second Injury Fund of Iowa is not liable for the 
 
         payment of any benefits pursuant to Iowa Code section 85.64.
 
         
 
                                      ORDER
 
         
 
              THEREFORE, IT IS ORDERED:
 
         
 
              That defendants, Iowa Meat and Chubb Insurance, pay to 
 
         claimant sixty (60) weeks of permanent partial disability 
 
         benefits at the rate of two hundred fifty-one and 55/100 dollars 
 
         ($251.55) per week in the total amount of fifteen thousand 
 
         ninety-three and 00/100 dollars ($15,093.00) commencing on 
 
         December 16, 1985;
 
         
 

 
         
 
         
 
         
 
         STREETER V. IOWA MEAT PROCESSING CO.
 
         Page  14
 
         
 
         
 
              That these defendants are entitled to a credit for nineteen 
 
         (19) weeks of permanent partial disability benefits paid prior to 
 
         hearing at the rate of two hundred fifty-one and 55/100 dollars 
 
         ($251.55) per week in the total amount of four thousand seven 
 
         hundred seventy-nine and 45/100 dollars ($4,779.45);
 
         
 
              That these benefits are to be paid in a lump sum;
 
         
 
              That interest will accrue pursuant to Iowa Code section 
 
         85.30 ;
 
         
 
              That the costs of this action are assessed to defendants, 
 
         Iowa Meat and Chubb Insurance, pursuant to Division of Industrial 
 
         Services Rule 343-4.33; and
 
         
 
              That ail defendants are to file claim activity reports as 
 
         requested by this agency pursuant to Division of industrial 
 
         Services Rule 343-3.1.
 
         
 
         
 
              Signed and filed this 24th day of June, 1988.
 
         
 
         
 
         
 
         
 
         
 
                                          WALTER R. McMANUS, JR.
 
                                          DEPUTY INDUSTRIAL COMMISSIONER
 
         
 
         Copies To:
 
         
 
         Mr. Harry Smith
 
         Attorney at Law
 
         PO Box 1194
 
         Sioux City, Iowa 51102
 
         
 
         Mr. Barry Moranville
 
         Attorney at  Law
 
         974-73rd St, STE 16
 
         Des Moines, Iowa 50312
 
         
 
         Ms. Judith Ann Higgs
 
         Attorney at Law
 
         PO Box 3086
 
         Sioux City, Iowa 51102
 
         
 
         Ms. Shirley Ann Steffe
 
         Assistant Attorney General
 
         Hoover State Office Bldg
 
         Des Moines, Iowa 50319
 
         
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                                    1402.40; 1803; 3203
 
                                                    Filed June 24, 1988
 
                                                    WALTER R. McMANUS, JR.
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         CONNIE STREETER,
 
         
 
              Claimant,
 
         
 
         vs.
 
         
 
         IOWA MEAT PROCESSING CO.,
 
                                                        File No.  730461
 
              Employer,                                           809945
 
         
 
         and                                          A R B I T R A T I 0 
 
         N
 
         
 
         CHUBB GROUP OF INSURANCE                        D E C I S I 0 N
 
         COMPANIES and ARGONAUT
 
         INSURANCE COMPANY,
 
          
 
              Insurance Carriers,
 
         
 
         and
 
         
 
         SECOND INJURY FUND OF IOWA,
 
         
 
              Defendants.
 
         
 
         
 
         
 
         1402.40
 
         
 
              Claimant did not sustain the burden of proof by a 
 
         preponderance of the evidence that the injury of March 28, 1983 
 
         was the cause of any permanent disability despite the fact that 
 
         claimant had surgery for right carpal tunnel syndrome.  There was 
 
         no report from the operating surgeon.  There was no rating from 
 
         any other doctor and claimant returned to work and performed her 
 
         old job without loss of time.
 
         
 
         1803
 
         
 
              Claimant did sustain the burden of proof by a 
 
         preponderance of the evidence that the injury of October 11, 
 
         1985 was the cause of an Iowa Code section 65.34(2)(s) injury 
 
         to both upper extremities and was awarded 60 weeks of permanent 
 

 
         
 
         
 
         
 
         STREETER V. IOWA MEAT PROCESSING CO.
 
         Page   2
 
         
 
         
 
         partial disability pursuant to the impairment rating given by 
 
         the operating surgeon.
 
         
 
         
 
         
 
         3203
 
         
 
              Claimant was not entitled to Second Injury Fund benefits 
 
         because she did not prove that the injury of March 28, 1983 was 
 
         the cause of any permanent disability.