Page 1 before the iowa industrial commissioner ____________________________________________________________ : PAMELA S. WILLER, : : Claimant, : : vs. : : File No. 732780 IOWA MEAT PROCESSING : COMPANY, : : A P P E A L Employer, : : D E C I S I O N and : : ARGONAUT INSURANCE COMPANIES, : : Insurance Carrier, : Defendants. : ___________________________________________________________ STATEMENT OF THE CASE Defendants appeal and claimant cross-appeals from an arbitration decision awarding healing period benefits and permanent partial disability benefits based upon an industrial disability of 55 percent. The record on appeal consists of the transcript of the arbitration hearing and joint exhibits A through H and J through R. Both parties filed briefs on appeal. issue The dispositive issue on appeal is whether there is a causal connection between claimant's injury and an alleged disability. review of the evidence The arbitration decision filed September 30, 1988 adequately and accurately reflects the pertinent evidence and it will not be reiterated herein. applicable law The citations of law in the arbitration decision are appropriate to the issues and evidence. analysis The claimant has the burden of proving by a preponderance of the evidence that the injury of May 5, 1983 is 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. O. Boggs, 236 Iowa 296, 18 N.W.2d 607 (1945). A possibility is insufficient; a Page 2 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). Claimant was examined by several physicians. The doctors at the University of Iowa Hospitals said the etiology of claimant's symptoms was unknown. (Exhibit A, page 3) Joel T. Cotton, M.D., indicated uncertain etiology. (Ex. C, p. 2) David G. Paulsrud, M.D., thought claimant's condition appeared to be congenital. (Ex. D) D. M. Nitz, M.D., a neurologist, indicated that claimant's symptoms were "most likely related to persistent posture from occupation." (Ex. F, p. 2) John N. Redwine, D.O., and Daniel M. Rhodes, M.D., two company physicians treated claimant on the basis that her condition was the result of employment activity but did not give an opinion as to causal connection. (Ex. G) Claimant was treated by Don Meylor, D.C., for about six months and he attributed claimant's condition to multiple factors including "work stress (primarily patient's work posture and work conditions), organic and/or functional physiological imbalances (demonstrated by lab results) and thoracic and cervical vertebrae misalignments." (Ex. K) Paul From, M.D., ruled out thoracic outlet syndrome but S. R. Winston, M.D., a neurosurgeon, refused to rule it out. (Ex. D, pp. 3-7 and 14-16). John Dougherty, M.D., an orthopedic surgeon, was claimant's principle treating physician. Although on cross-examination by claimant's counsel he stated that it was reasonable to assume that claimant's problems were work related, he frequently wrote "etiology (?)" in office notes. He indicated in his deposition that he was not sure why claimant's scapula rides up and he was unsure of the etiology. In summary, the medical evidence in this case is that the examining physicians who did offer an opinion of the cause of claimant's condition were not in agreement and were uncertain as to the cause. The conclusion that must be reached when all of Dr. Dougherty's deposition is read together is that he simply could not explain claimant's problems. When pressed, he agreed that it was reasonable to assume that claimant's problems were related to her work. His opinion falls short of saying that claimant's work Page 3 injury was the probable cause of her alleged disability. While claimant's problems may be frustrating to both her and the physicians dealing with her, she must prove by a preponderance of the evidence that a work injury caused those problems. Demonstrating that the problems might not be related to any other cause does not in this case meet claimant's burden of proof. Claimant has not met the burden of proving that the work injury on May 5, 1983 is the cause of her alleged disability. findings of fact 1. Claimant was employed by employer on May 5, 1983 in a job that required her to transfer packages of meat weighing from one pound to 35 pounds in a twisting movement by transferring the meat from a conveyor belt on her right to another conveyor belt behind her body. 2. On May 5, 1983 claimant experienced severe spasms in her right shoulder and other symptoms in her face, neck, back, arm, hand and rib cage and that her fingers turned purple. 3. Several possible neurological problems, which might have caused claimant's symptoms, were ruled out. 4. Two neurologists and a neurosurgeon could not find any pathological neurological reason for claimant's symptoms. 5. Claimant received treatment and evaluation on the basis that her problems were work related. 6. The cause of claimant's condition is unknown. conclusion of law Claimant has not proved that a work injury on May 5, 1983 was the cause of her alleged disability. WHEREFORE, the decision of the deputy is reversed. order THEREFORE, it is ordered: That claimant take nothing from these proceedings. That defendants pay the costs of this proceeding including the costs of transcription of the arbitration hearing. Signed and filed this ____ day of February, 1990. Page 4 ________________________________ DAVID E. LINQUIST INDUSTRIAL COMMISSIONER Copies To: Mr. David E. Vohs Attorney at Law 340 Insurance Centre 507 7th St. Sioux City, Iowa 51101 Mr. Harry W. Dahl Mr. Barry Moranville Attorneys at Law 974 73rd St., Suite 16 Des Moines, Iowa 50312 5-1402.40, 5-1803 Filed February 19, 1990 David E. Linquist before the iowa industrial commissioner ____________________________________________________________ : PAMELA S. WILLER, : : Claimant, : : vs. : : File No. 732780 IOWA MEAT PROCESSING : COMPANY, : : A P P E A L Employer, : : D E C I S I O N and : : ARGONAUT INSURANCE COMPANIES, : : Insurance Carrier, : Defendants. : ___________________________________________________________ 5-1402.40, 5-1803 Claimant's unusual and serious condition of the right shoulder manifested itself while claimant was performing her job. Her job involved performing repetitive work over a long period of time in an awkward position. Claimant was examined by several physicians who were not in agreement and were uncertain as to the cause of claimant's condition. Claimant's principle treating physician simply could not explain claimant's problems. It was held that claimant failed to prove a work injury was the cause of her alleged disability. Deputy reversed on appeal. BEFORE THE IOWA INDUSTRIAL COMMISSIONER PAMELA S. WILLER, Claimant, vs. File No. 732780 IOWA MEAT PROCESSING, A R B I T R A T I O N Employer, D E C I S I O N and ARGONAUT INSURANCE CO., Insurance Carrier, Defendants. INTRODUCTION This is a proceeding in arbitration brought by Pamela S. Willer, claimant, against Iowa Meat Processing Company, employer, and Argonaut Insurance Company, insurance carrier, defendants for benefits as the result of an injury that occurred on May 5, 1983. A hearing was held on September 24, 1987, at Sioux City, Iowa, and the case was fully submitted at the close of the hearing. The record consists of the testimony of Pamela S. Willer, claimant, Curtis Willer, claimant's husband, Denise Ruden, claimant's friend and neighbor, Linda Hall, employer's workers' compensation representative, Gail Leonhardt, defendants' vocational rehabilitation consultant and Joint Exhibits A through H and J through R. Defendants provided a transcript to the industrial commissioner's file. Both attorneys submitted excellent briefs. STIPULATIONS The parties stipulated to the following matters: That an employer-employee relationship existed between claimant and employer at the time of the injury. That claimant sustained an injury on May 5, 1983, which arose out of and in the course of employment with employer. That the injury was the cause of some temporary disability during a period of recovery. That the type of permanent disability, if the injury is found to be a cause of permanent disability, is industrial disability to the body as a whole. That the rate of compensation, in the event of an award, is $275.24 per weeks. That all requested medical benefits have been or will be paid. WILLER V. IOWA MEAT PROCESSING PAGE 2 That defendants do not seek credit for any benefits paid prior to hearing under an employee nonoccupational group health plan. That defendants are entitled to a credit for workers' compensation benefits paid prior to hearing in the amount of $275.24 per week for 160 3/7 weeks. That there are no bifurcated claims. ISSUES The parties submitted the following issues for determination at the time of the hearing. Whether the injury was the cause of permanent disability. Whether claimant is entitled to temporary or permanent disability benefits, and if so, the nature and extent of benefits. Whether claimant is an odd-lot employee. SUMMARY OF THE EVIDENCE All of the evidence was examined and considered. The following is a summary of the evidence most pertinent to this decision. Claimant was 27 years old at the time of the injury and 31 years old at the time of the hearing. She graduated from high school and has had no additional formal education or training. Claimant performed clerical tasks for a hospital for about six months and she also worked as a sales clerk in a retail store for approximately six months. Otherwise, from 1974 until this injury in 1983, a period of approximately nine years, she has been employed by various meat packing and processing plants in different parts of the country. Claimant has worked on the line doing knife jobs and she has also worked in quality control. At one time, she occupied a very important supervisory position in quality control. Everything that went out the plant had to be okayed by her at all times (Transcript pages 20 & 21). Claimant denied and there is no evidence of any serious injuries or illnesses prior to this injury. Claimant started to work for this employer, which is no longer in business, on January 5, 1981, on the production line using straight knives and Whizard knives. When claimant was five months pregnant with her first child, she bid on and received a job making boxes in the cry-o-vac department. However, rather than making boxes, she ended up at the end of the line inspecting final product and moving it from one conveyor belt to another. Claimant's first child was born on January 20, 1982. Prior to that she experienced fatigue on her right side and spasms in her right shoulder because she was constantly twisting to the right (Tr. p. 31). After the first child was born, claimant returned to work in March of 1982. She continued to do the same job when she returned to work. This job required her to pick up hams, tenderloins, tenders, pork butts and other meat products, which weighed anywhere from one pound to 30 pounds, and transfer them from a conveyor belt on her right to a conveyor belt that was WILLER V. IOWA MEAT PROCESSING PAGE 3 behind her. She continued to do this job from March of 1982 until the time of her injury on May 5, 1983 (Tr. pp. 32-35). About a month prior to the injury date, her right arm would become numb, tingly and go to sleep. Her right hand swelled up. She lost strength and mobility in her right arm. Her head would pull down to her right shoulder in a twisted position and she could not straighten it back up again. Claimant alleged she reported this to her foreman several times. Prior to May 5, 1983, her right scapula would ride up, but it would not pop out away from her body (Tr. pp. 41, 42, & 68). After May 5, 1983, the shoulder blade would pop out away from her body and rise up about three inches. Exhibit Q is a photograph which shows the protruding scapula. It also shows that her right shoulder is higher than her left shoulder (Tr. pp. 35-37). On May 5, 1983, claimant lifted a package of three full loins which weighed somewhere between 26 pounds and 30 pounds. This caused her to have spasms in her back and in her right shoulder blade (Tr. pp. 39 & 67). The spasms were so bad that she thought she was having a heart attack (Tr. p. 39). Her right arm became numb and her right palm and fingers turned purple like they were not receiving circulation (Tr. pp. 54 & 70) . Claimant maintained that this has happened several times since then. She further alleged that it happens several times a day and that when it occurs she cannot do anything with her arm (Tr. p. 54). These spasms might cause her to lie down for several hours or several days (Tr. p. 55). On May 5, 1983, the plant nurse sent claimant to see John Redwine, D.O. Dr. Redwine reported significant spasm and prominence of the right scapula. He noted that claimant was in a great deal of pain. On may 13, 1983, Dr. Redwine recorded that this was the worst case of severe spasm that he had ever seen. Daniel M. Rhodes, M.D., Dr. Redwine's associate, sent claimant to see John Dougherty, M.D., an orthopedic surgeon on May 20, 1983 (Ex. G). Claimant was treated by Dr. Dougherty from May 23, 1983 until November 13, 1985. Claimant was hospitalized for four or five days for tests and physical therapy and treatment with a TENS unit. The physical therapy and TENS unit were discontinued because they made it worse. Claimant related that she also saw a chiropractor, Don Meylor, D.C., in Le Mars, for about six months until the insurance company refused to pay his bills. Claimant testified that both Dr. Dougherty and Dr. Meylor were able to get the scapula down temporarily but it never stayed down. Claimant demonstrated that she could only raise her right arm approximately chest high. Her right arm is her dominant arm. Sitting in one position aggravates her condition. Claimant testified that Dr. Dougherty, nor did any other doctor, say that she could go back to work in the packing plant. Claimant testified that she could no longer do her old job. She also admitted that she had not tried to do any other kind of a job either. She testified that she inquired about some job descriptions for jobs that she saw advertised in the Le Mars newspaper, but that she did not find anything that she believed she was able to do. Claimant revealed she took a short course to learn to write children's stories but that she has not sold any. Claimant testified that she can only type one single spaced page until she has spasms and has to take a break. Spasms in her right shoulder are triggered by picking up her child, vacuuming the floor, reaching up in the cabinet to pick up a dish or WILLER V. IOWA MEAT PROCESSING PAGE 4 opening the refrigerator door. She said she cannot drive when she has spasms. She maintained that she has spasms two or three times a day at least. Gail Leonhardt, vocational rehabilitation consultant, tried to arrange for claimant to learn to work a computer and operate a computer business in her home. Claimant insisted that she could not work eight hours a day or even two hours a day (Tr. pp. 57 & 58). Claimant did not believe she could be a secretary for eight hours a day. Claimant asserted that she does not leave home very much because she never knows when she will suffer a spasm and that it will be necessary to find a place to lie down. Claimant testified that she was having spasms on the day of the hearing and demonstrated how the right scapula protrudes away from her body approximately three inches. Claimant stated that she has not improved since the date of the injury on May 5, 1983. She added that she has never had surgery for this condition (Tr. p. 68). Claimant further related that her second child was born on June 25, 1985. This child was born with a spinal condition known as spina bifida. Claimant asserted that this child required a great deal of extra care, especially when she was sleeping. The child was on a heart and lung monitor to prevent dying from crib death. Claimant testified that she had to be prepared to administer CPR if necessary. Claimant testified again that since her injury she has never made an application for employment anywhere (Tr. p. 77). Curtis Willer, claimant's husband, testified that he met claimant in October of 1982. He and claimant were married on February 26, 1983. He stated that claimant had no problem with her right arm and back at that time. His testimony corroborated claimant's testimony about the condition of the right shoulder and arm. Willer stated that claimant has not improved at all since May of 1983; he said that her situation has either remained the same or gotten worse. The witness described that claimant's shoulder blade will come clear up, her head will twist to the right until her right cheek is resting on her right shoulder, her eyes will droop, her mouth will twist, she has trouble keeping her balance if she tries to walk, and her speech is blurred. She appears to be in pain. He maintained that she cannot do normal housework and that she cannot vacuum (Tr. pp. 78-88). Denise Ruden testified that she is a friend of claimant and that she sees claimant and talks with her frequently. Two weeks ago, claimant was mixing a batter of zucchini bread when all of a sudden she dropped the spoon, her shoulder came up, her shoulder blade popped out, her head came to the right side, claimant began speaking very slowly and deliberately to form each word and she held her arm next to her side. Her palm and finger tips turned a little purple (Tr. pp. 88-98). Gail Leonhardt, defendants' vocational rehabilitation counselor, testified that he saw claimant four times on August 6, 1986, September 17, 1986, October 15, 1986, and November 23, 1986. He tried to arrange a situation where claimant could be trained to operate her own in-home computer service as a self-employed person, but claimant's husband opposed it because their youngest child had to be monitored and watched constantly during all of her waking hours. Claimant's husband felt that the child was the main priority and that claimant would not be able to work in the house or out of the house. At that point, WILLER V. IOWA MEAT PROCESSING PAGE 5 Leonhardt terminated contact with claimant. Leonhardt testified that he felt claimant could be trained on computers as well as in other areas. He said that claimant had a normal IQ with a numerical deficit but with an offsetting high verbal aptitude. He added that her appearance is good, she has a degree of sophistication and appears polished. He said she is people orientated and has a good personality. She has a high school diploma, clerical experience, sales experience, has studied children's literature and has quality control supervisory experience, all of which are transferable skills. He stated that her supervisory experience in quality control gives her good discriminating ability. After he terminated his contacts, neither claimant, nor claimant's attorney nor did the insurance carrier contact him after the second child no longer required constant care. He believed that if claimant requested it, that he could assist her in finding employment now (Tr. pp. 99-116). Leonhardt said that she met with Dr. Dougherty on September 11, 1986, for about an hour. Dr. Dougherty told Leonhardt that claimant had a peculiar situation that he (Dr. Dougherty) did not understand. He stated that Dr. Dougherty did not tell him how much claimant was able to work at that time, but focused his conversation on claimant's peculiar injury. Leonhardt stated the first that he knew that claimant could work eight hours a day was after he read Dr. Dougherty's deposition which was not given until February 19, 1987 (Ex. O). Leonhardt expressed the opinion that claimant was not employable but that she could be retrained to be employable. Leonhardt said he believed and accepted Dr. Dougherty's opinion that claimant could be employed eight hours a day even though Dr. Dougherty had not seen claimant after September 11, 1986, which was when he and Dr. Dougherty met and discussed claimant's condition. Leonhardt was forced to admit that he changed his testimony at the hearing from the testimony that he gave earlier in his deposition in a number of respects (Ex. N). Leonhardt concluded by saying that claimant does have the scapula problem which causes severe limitations but he thought that she could work around these limitations in data processing, telecommunications or teletechnology, feeding data into a keyboard, filing, some record keeping and making telephone calls. At the hearing, claimant took a position at a typewriter in the court room and demonstrated that she could not get her right arm up to the typewriter but was forced to insert the paper with her left hand. She maintained that she could not keep her right hand on the keyboard. Claimant gave a typing demonstration that demonstrated that she could not legibly type a simple sentence dictated to her by her counsel (Ex. R). Dr. Dougherty recorded that he first saw claimant on May 23, 1983, for constant pain in her right neck, shoulder and arms of one month duration allegedly due to continuous lifting at work. Her right shoulder was higher than her left shoulder. She had a prominent trapezius on the right and a high rising scapula on -he right. X-rays showed her right shoulder and right scapula were higher than her left shoulder and scapula. X-rays also showed scoliosis to the left in the cervical spine and to the right in the dorsal spine. The dorsal spine also showed minimal kyphosis. Dr. Dougherty gave this diagnosis: Pain in the neck and right upper thoracic cage, etiology (?), marked muscle spasms of the trapezius, marked elevation of the scapula on the right, with a WILLER V. IOWA MEAT PROCESSING PAGE 6 scoliosis to the right in the dorsal to the left in the cervical spine, must rule out a central nervous system lesion, with what appears to be a little drooping of the right eyelid. (Ex. E, p. 21) Dr. Dougherty wrote to Dr. Rhodes on May 23, 1983, that as near as he could tell, the high riding was of recent origin. She said she never had it before (Ex. E, p. 18). Dr. Dougherty wrote to Dr. Rhodes on May 24, 1983, that he had hospitalized claimant to rule out a central nervous system lesion (Ex. E, P. 19). The Marion Health Center admission history and physical examination on May 24, 1983, discloses complaints related to Dr. Dougherty which began about a month ago. Claimant described (1) tingling in the right side of her face; (2) right shoulder felt bruised and warm; (3) right hand discolored; (4) reduced strength in right hand; (5) knot over the right shoulder; (6) Charlie horse in her base of her neck and over the right shoulder; (7) drooping eyelid on the right; (8) headaches in the occipital area; (9) loss of balance while standing; and, (10) dizziness while changing position. Dr. Dougherty noted that claimant had been working in an awkward position and had been working up to ten hours a day when the onset occurred (Ex. E, pp. 27 & 28) . Dr. Dougherty called in D.M. Nitz, M.D., a neurologist, to examine claimant at the Marion Health Center on May 24, 1983, for WILLER V. IOWA MEAT PROCESSING PAGE 7 possible neurological causes for her complaints. He noted that claimant was working ten hours a day, six days a week, moving meat which weighed from 9 to 35 pounds from left to right in a bent over position when she developed spasms in the right trapezius area. X-rays of the right shoulder showed an elevated right scapula. Patient denied any previous similar problems. Dr. Nitz did not find a neurological problem. He concluded as follows: IMPRESSION: 1) Severe muscle spasm, right trapezius, with involvement of the sternocleidomsatoid-pectoralis muscle group--most likely related to persistent posture from occupation. 2) Intermittent neurogenic claudication, brachial plexus right side. 3) Muscle contraction headaches. (Ex. F, pp. 1 & 2) Dr. Dougherty indicated that Dr. Nitz did rule out central nervous system problems. On June 3, 1983, Dr. Dougherty said that claimant was not significantly different. Claimant said that she felt something scraping under her scapula. For reasons of his own choosing, Dr. Dougherty chose to record that claimant has only been married to this present husband for three months, her mother-in-law is living with her and she has a 16 month old child by a previous marriage (Ex. E, p. 22) On June 13, 1983, Dr. Dougherty noted that it does improve. on June 23, 1983, he said that she was getting along better. He said that she was improving, but slowly (Ex. E, p. 22). On July 28, 1983, he noted that she is getting along better (Ex. E, p. 23). On July 29, 1983, the scapula was sticking up again and Dr. Dougherty said he did not know what to do with her, it just keeps recurring (Ex. E, p. 23). On August 16, 1983, Dr. Dougherty again stated he did not know what to do with this patient (Ex. E, p. 24). After the examination on August 16, 1983, Dr. Dougherty completed a Physicians Report for Argonaut Insurance Company. At item number six, he indicated that the injury was caused, aggravated or accelerated by patients alleged employment activity by putting three x's in the yes block. However, at item three, description of injury, he continued to say "etiology (?)", (Ex. E, p. 17). On September 6, 1983, she was not getting along any different. Dr. Dougherty ordered a second EMG. There was improvement in that the second EMG showed less muscle spasms than the previous EMG (Ex. E, p. 14). On September 19, 1983, claimant sought out Donald J. Meylor, D.C., for chiropractic care. Dr. Meylor's diagnosis is as follows: DIAGNOSIS: Conclusions drawn from examinations performed indicated a scapula humeralmyopathy (measured elevation of scapula from A-P full spine x-rays was approximately 2 inches) with attendant severe myospasm, severe myalgia and pronounced muscle weakness. Contributing factors appeared to be multiple and included: work stress (primarily patient's work posture and work conditions), organic and/or functional physiological imbalances (demonstrated by lab results) WILLER V. IOWA MEAT PROCESSING PAGE 8 and thoracic and cervical vertebrae misalignments. (Ex. K, p. 1) Claimant said she saw Dr. Meylor for about six months. His treatment brought temporary relief and he was able to bring the scapula down temporarily, but it never did stay down. Claimant saw Dr. Dougherty again on March 13, 1984. At this time he recorded that she either passed out or got light headed twice during his examination. The lady from the vocational rehabilitation company was present for the examination. Claimant still had a marked high riding scapula and a marked amount of spasm (Ex. E, pp. 25 & 26). In a letter dated April 10, 1984, Dr. Dougherty questioned whether the scoliosis conceivably contributed to the high riding scapula. He said that claimant's scapula will go down, but with the least amount of activity the muscles go into tremendous spasm and it pulls up again (Ex. E, p. 15). On July 5, 1984, Dr. Dougherty completed a Physical Capabilities Form on Iowa Meat Processing letterhead stationary. He said that he last saw claimant on March 13, 1984. At that time, she was not capable of returning to any type of work (Ex. E, p. 12). Claimant was next seen at the Medical Occupational Evaluation Center (MOEC) at Mercy Hospital in Des Moines on August 13, 14, and 15, 1984, by several doctors and other professionals. Paul From, M.D., reported that claimant had actually had distress for approximately one year prior to May 5, 1983. He took an extremely long and detailed history which revealed several complaints in many parts of her body with explicit details. Her physical examination disclosed decreased range of motion to the right. There was some increase in the trapezius, a high riding scapula and the trapezius was tight and tender. A peripheral arterial evaluation ruled out thoracic outlet syndrome (Ex. P, pp. 3-14). S.R. Winston, M.D., a neurosurgeon at the MOEC, said that claimant's problem was two and one-half years old or longer. He said her symptoms appeared while using a Whizard knife at work and they continued until the acute onset in May of 1983. He reported that the problem tends to get some better but then lifting or doing repetitive movements exacerbate her difficulty of cramping in the right shoulder and loss of feeling in the right upper extremity. By holding her right arm in a dependant resting position, and putting pressure on the top of the trapezius, causes the spasm and the elevation and the forward movement of the scapula to abate and gives her some relief from this difficulty. Dr. Winston's examination discloses marked limited motion of the right upper extremity and that she will irmmediately develop incredible muscle spasms in the trapezius, supraspinatus and all associated musculature around the scapula. He found that she had no pathologic neurologic signs, but he could not rule out thoracic outlet syndrome and for an intermediate diagnosis called it a neurogenic claudication. Dr. Winston thought she was limited to sedentary work and probably should be retrained (Ex. P, pp. 14-16). Todd J. Hines, Ph.D., saw claimant at the MOEC on August 15, 1984. She had a diary of her complaints. She did not see herself as completely disabled. His evaluation and tests WILLER V. IOWA MEAT PROCESSING PAGE 9 reflected a strong pattern of somatic conversion which very likely functions to exacerbate her experience of pain and distress. Her basic personality nature appears to contain many factors of a hysterical nature. Emotional factors intensify her impairment, but this is not evidence of malingering. Somatic conversion is not a conscious process. He stated she could successfully engage in rehabilitation training (Ex. P, pp. 17 & 18). Dr. Hines concluded as follows: In summary, Pamela Willer does present psychological variables which very likely cause her experience of pain, symptoms and disability to be worse than the physiological anomaly might suggest. This process is most accurately seen as an element of her characteristic psychological style and does not represent an emotional disorder caused or exacerbated by her injury. Psychological treatment in any form is not likely to be helpful and the most therapeutic course of action would be to return to work as quickly as possible in some vocational situation significantly different from that in which she experienced injury. (Ex. P, p. 18) Andrea Burt, L.P.T., a licensed physical therapist at the MOEC, extensively tested and measured claimant and determined that she has sustained a 22 percent permanent functional impairment based upon the American Medical Association's, Guide to the Evaluation of Permanent Impairment, second edition, based on limitation of range of motion. She too, understood that claimant first noticed trouble in 1982, but did not seek help until May 5, 1983. Burt carefully traced the development of the problem and the course of treatment for it from the beginning to the current date. Large deficits were found in the right shoulder flexion-extension and abduction and adduction (Ex. P, pp. 19-23). Burt made the following findings: Postural exam reveals a slight forward head. Her right scapula is abducted and rotated upward. The right shoulder and right hip are also high. A scoliosis exists at the T11 - L1 region which is concave to the left.. A leg length discrepancy was found with the right leg being about one-half inch longer than the left. She does use a lift in her shoe most of the time. (Ex. P, p. 20) James L. Blessman, M.D., saw claimant at the MOEC on August 15, 1984. He said that she had a fibromyalgia and fibrositis. He recommended pain management therapy and additional physical therapy. Robert A. Jones, B.S., and G. Patrick Weigel, M.A., two occupational therapists at the MOEC, examined claimant. They speculated that possibly she could return to her old job. Claimant expressed a desire to return to school and become a high school counselor or some other related professional. They said claimant has average intelligence and strong concern for other people. Her interest patterns are similar to child care, cosmetology, elementary school teaching, teacher's aid and WILLER V. IOWA MEAT PROCESSING PAGE 10 medically orientated blue collar occupations. Religion is an important element in her life. Claimant demonstrated excellent hand/eye/foot coordination and her upper extremity range of motion activities were far above other female patients. Her attitude was good. She demonstrated no physical problems and had no pain complaints during the entire performance of her work samples. They hoped that she could return to work for her old employer. If not, she should try to work in a day care center or an educational setting as a teacher's aid (Ex. P, pp. 28-32). Dr. From gave the final summary to conclude the MOEC report. He stated that claimant should return to gainful employment but preferably in an area different from that in which she sustained her injury. He said there was disagreement as to whether she had reached her maximum medical recuperation. He stated that she had some permanent functional impairment. He said claimant sustained an impairment of approximately 20 percent but some of this may not be permanent but might improve. Claimant's emotional problems were not related to or aggravated by this injury (Ex. P, pp. 33-40). Dr. Dougherty's final examination was performed on November 19, 1985. He said that claimant had a difficult second pregnancy and that she had to stay in bed most of the time. She was hospitalized one or more times during this pregnancy. After the baby weighed ten pounds it was difficult to carry her. Claimant does vacuum but it bothers her. The scapula is about the same. Her whole arm and shoulder ache. She is right handed. She has gained 15 pounds. He had read the MOEC report and did not agree that there was a thoracic outlet syndrome and he did not agree that surgery would be of any benefit. Dr. Dougherty felt the right scapula was more rigid and persistent in riding high than it was a year and one-half ago when he last saw her on March 13, 1984. Dr. Dougherty commented that none of the medical examiners have been able to explain this problem and that it is difficult to explain why it has persisted based primarily on a so-called work injury. He speculated that the scoliosis might have some influence on the high riding scapula. He felt claimant was entitled to a 25 percent permanent functional impairment of the right upper extremity which converts to 15 percent of the body as a whole. Five percent should be added for disability to the spine. His total permanent functional impairment rating was 20 percent of the body as a whole. He thought that claimant was worse than she was when he last saw her on March 13, 1984, but that it was not bothering her as much. He did not feel that she could return to work in the packing house line of work. He added that she should not do heavy work and should not lift above her head. She should have the opportunity to get up and move around from a sitting job. He concluded by stating again that he did not truly understand her problem (Ex. E, pp. 7-9). Claimant was examined by David G. Paulsrud, M.D., an orthopedic surgeon, on April 8, 1986, at the request of her lawyer. She stated that she has had continuous pain in her neck, shoulder and intrascapular area without any real significant relief. Dr. Paulsrud stated that the elevation of the scapula appeared to be congenital, but she stated that she was not aware of it until her injury. He found that claimant had a full range of motion in her shoulder and neck, but she said the motion caused aching in her shoulder. He found that claimant's x-rays from 1983 to 1985 were unchanged. The 1983 tangential films WILLER V. IOWA MEAT PROCESSING PAGE 11 demonstrated deformity of the superior medial border of the scapula with a rather pronounced hook at this point. He added that her back demonstrated moderate scoliosis and a great deal of lumbar lordosis (Ex. D). Claimant was examined by Joel T. Cotton, M.D., a neurologist in Omaha, on June 30, 1986, at the request of defendants. He recorded that the chief complaint was continuous right shoulder spasm and inability to lift and hold heavy objects in her right hand for any length of time. His examination found the right shoulder more shrugged than the left with continuous spasm activity present in the right trapezius muscles superiorly. He concluded that her neurological examination was normal with these comments: Clinical Impression: This patient's neurological examination at this time is normal. She shows persistent elevation of the right shoulder which is of uncertain etiology. It is not in my opinion on a primary neurological basis. I can specifically demonstrate no evidence of damage to either the trapezius muscle itself nor to the nerve supply to the muscle, originating from either the spinal cord, cervical nerve roots, or peripheral nerves in the shoulder innervating it. Since this problem in my opinion does not originate on a primary neurological basis, I do not feel there is any neurological impairment in this individual and therefore find no WILLER V. IOWA MEAT PROCESSING PAGE 12 disability in this person from a neurological standpoint. She does not specifically in my opinion have either a "thoracic outlet syndrome" nor does this appear to represent a carpal tunnel syndrome. I furthermore do not feel it originates from a "pinched nerve" originating from the neck. In addition, it is not in my opinion a true "myosotis" as defined medically. I have no specific recommendations concerning treatment of this individual. According to the patient she has had no significant improvement in her symptoms in the last year. This would suggest to me a state of permanency. I am unable to state whether there will be any recovery of function in the future as again in my opinion, this problem is not a primary neurological abnormality involving either spinal cord, peripheral nerves, nerve roots, or the trapezius muscle itself. There is no reason from a neurological standpoint that I would restrict this individual's activity. (Ex. C, p. 2) Claimant was examined at the University of Iowa on June 16, 1987, and again on July 28, 1987, at the request of Dr. Dougherty. Claimant reported that the right scapula is all right when she is lying supine; but if she is erect for more than 30 minutes she experiences spasm and excruciating pain on the elevation of her right arm. Upon examination the doctors noted that intermittently during examination the muscles surrounding the scapula would go into spasm with marked elevation. Dr. Ruffin and Clark (full names unknown) concluded: "Impression: 1) scapular right parascapular muscle spasm with pain and disability, 2) workmen's comp. case related to #1. At this time we are unable to define the pathologic cause of this problem" (Ex. A, pp. 3 & 4). An MRI, EMG and NCV were ordered. On July 28, 1987, the MRI and the NCV were reported as normal. The EMG demonstrated spasms of the trapezius, romboids and cervical parasppinals muscles. Drs. Martin, Mysnyk and Clark (full names unknown) reported as follows: "Impression: The patient seems to be suffering from pain/spasm in her muscles/fascia, etiology is unknown at this time" (Ex. A, p. 3). They concluded by saying that their diagnostic studies were negative to date and that they had nothing further to offer to claimant. Dr. Dougherty gave a deposition on February 19, 1987 (Ex. O). He stated that he last saw claimant on November 19, 1985. He gave her a 20 percent permanent functional impairment at that time. He found that claimant was able to sit, walk and stand but that she should be able to move around a little bit. She can bend at the waist, twist and she could work at a keyboard. She can drive an automobile with provision for rest stops (Ex. O, pp. 12-14). He stated that she has spinal problems of scoliosis,kyphosis and lordosis. He felt that improved posture would decrease her discomfort (Ex. O, pp. 14 & 15). Dr. Dougherty testified that claimant could work eight hours a day (Ex. O, p. 16). He stated that he did not agree that the rising scapula was a congenital matter because it never happened to her before this injury and when he first started to treat her he could get it down again (Ex. O, p. 18). Dr. Dougherty said it was reasonable to assume that this WILLER V. IOWA MEAT PROCESSING PAGE 13 problem was caused by her work initially. He suspected central nervous system problems but they were ruled out. He stated that he was not saying that this injury was not related to her work. He said that his major problem was that he cannot explain why the scapula continues to pop out (Ex. O, pp. 20-23). APPLICABLE LAW AND ANALYSIS The claimant has the burden of proving by a preponderance of the evidence that the injury of May 5, 1983, is 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.O. 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). Claimant described in detail to her examining physicians and other professionals, as well as at the hearing, the precise repetitive physical movements of twisting her body to the right and behind her in a bent over position while transferring packages of meat weighing from one pound to 35 pounds. She described the gradual onset of symptoms in her right side--face, neck, shoulder, arm, hand, fingers, breast and rib cage. This evidence is not disputed, controverted or contradicted. There is a discrepancy as to whether symptoms first occurred one month prior to May 5, 1983, or one year or more prior to May 5, 1983. This discrepancy, however, is determined to be immaterial. It is entirely possible that some physicians interpreted the history that she gave differently than others. Dr. Redwine and Dr. Rhodes, two company physicians, accepted the description of a work related injury, treated her on that basis and did not suggest any other cause for her complaints (Ex. G). The same thing can be said with respect to Dr. Nitz, the neurologist selected by Dr. Dougherty. Furthermore, Dr. Nitz did say "most likely related to persistent posture from occupation" (Ex. F, p. 2). Dr. Meylor, the chiropractor, states that a contributing factor was "work stress (primarily patient's work posture and work condition)." Dr. From accepted the claimant's version of how the problem arose and stated that the peripheral artery evaluation ruled out thoracic outlet syndrome (Ex. P, pp. 3-14). Dr. Winston, a neurosurgeon, found no pathologic neurologic WILLER V. IOWA MEAT PROCESSING PAGE 14 signs. He speculated that the problem might be a neurogenic claudication. He refused to rule out thoracic outlet syndrome (Ex. P, pp. 14-16). Dr. Hines, the psychologist, seemed to accept claimant's version of a work-related injury. He added that emotional factors probably unknowingly intensify her impairment. Burt, the licensed physical therapist, Weigel and Jones, the occupational therapists, and Dr. Blessman appeared to accept claimant's version of how the injury occurred. In summary, none of the professionals at the MOEC disputed claimant's version of how the injury occurred. Dr. Paulsrud said that the elevated scapula appears to be congenital, but he did not state that claimant's spasms and other symptomatology were not caused as claimant described (Ex. D). Dr. Cotton, a neurologist, said that claimant did not have thoracic outlet syndrome. He said her problem was not a neurological problem. He did believe that her condition was permanent. Otherwise, he did not express his opinion on causal connection or the degree of impairment (Ex. C). The University of Iowa physicians confirmed claimant's symptomatology but could not define the cause for it. Dr. Dougherty, the principle treating physician, at all times stated that he could not explain claimant's problem, in particular, he stated that he could not explain why the scapula popped out. Frequently he wrote etiology (?). He never disputed that any of the other symptoms were caused by her work. He did not say the protruding scapula problem was not caused by work; he simply stated that he did not understand it. He proceeded to and continued to treat claimant on the history which she gave. Dr. Dougherty speculated on intracerebral lesion, thoracic outlet syndrome and some central nervous symptom problem. These possibilities were ruled out by Dr. Nitz, Dr. Cotton and the University of Iowa doctors. Eventually, in his deposition on February 19, 1987, Dr. Dougherty said it was reasonable to assume that her work caused this injury. He said that he had ruled out the neurological problems that he was concerned about. He stated that he was not saying that it was not caused by her work. On the Physicians Report to Argonaut, on August 16, 1983, Dr. Dougherty checked the block to indicate that the injury was caused by work even if he did put a question mark after the word etiology to show that he did not know the exact mechanism or cause and effect relationship between the job and the injury (Ex. E, p. 17). Defendants indicated in their brief that they proceeded to pay claimant several weeks of benefits under the impression that Dr. Dougherty thought this was a work-related injury. They first learned that he questioned the causal connection at the time of his deposition on February 19, 1987. From the foregoing, it is determined that the injury of May 5, 1983, was the cause of both temporary and permanent disability. It is entirely possible that Dr. Paulsrud is correct in his WILLER V. IOWA MEAT PROCESSING PAGE 15 belief that the protruding scapula is congenital. Claimant does have a number of bodily deformities--cervical and dorsal scoliosis, dorsal kyphosis, lumbar lordosis and one leg is longer than the other. Nevertheless, the employer takes the employee as is and therefore takes her subject to any active or dormant health problems. Lawyer & Higgs, Iowa Workers' Compensation--Law & Practice, section 4-2, page 21. Claimant's problem developed while working on the job doing repetitive work in an awkward bent over position. The weight of the evidence is that the job caused the injury. A number of other causes were explored and all of them were rejected. No other cause has been proven. Claimant's account of how the injury occurred was not disputed, controverted or contradicted. Iowa Code section 85.34(l) provides that claimant is entitled to healing period benefits until (1) she returns to work; (2) is capable of performing substantially similar employment; or (3) it is medically indicated that medical improvement is no longer anticipated. In this case, claimant is entitled to healing period benefits from May 5, 1983, to March 13, 1984. Dr. Dougherty noted on June 13 that claimant was improving (Ex. E, p. 22). On July 8, 1983, she was getting along better (Ex. E, p. 23). On September 7, 1983, Dr. Dougherty said the second EMG showed less muscle spasm than the previous one (Ex. E, p. 14). It wasn't until March 13, 1984, that Dr. Dougherty failed to record any impairment whatsoever (Ex. E, pp. 15, 25 & 26). Therefore, it is determined that claimant achieved maximum medical improvement on March 13, 1984. As claimant has an impairment to the body as a whole, an industrial disability has been sustained. Industrial disability was defined in Diederich v. Tri-City Railway Co., 219 Iowa 587, 593, 258 N.W. 899, 902 (1935) as follows: "It is therefore plain that the legislature intended the term 'disability' to mean 'industrial disability' or loss of earning capacity and not a mere 'functional disability' to be computed in the terms of percentages of the total physical and mental ability of a normal man." Functional disability is an element to be considered in determining industrial disability which is the reduction of earning capacity, but consideration must also be given to the injured employee's age, education, qualifications, experience and inability to engage in employment for which he is fitted. Olson v. Goodyear Service Stores, 255 Iowa 1112, 1121 125 N.W.2d 251, 257 (1963). Dr. Dougherty awarded claimant a permanent functional impairment rating of 20 percent of the body as a whole. The MOEC awarded a permanent functional impairment rating of 22 percent, which Dr. From rounded down to 20 percent. Dr. Dougherty and other physicians and professionals indicated that claimant could not return to her former employment. At age 31, claimant is young enough to be retrained. Conrad v. Marquette School, Inc., IV Iowa Industrial Commissioner Report 74, 78 (1984). Leonhardt testified that claimant could be retrained. Claimant is intelligent and presents a good appearance. Leonhardt described her as sophisticated and polished. Claimant has clerical, sales, supervisory, and discriminating transferable skills. Claimant can write and is WILLER V. IOWA MEAT PROCESSING PAGE 16 good with words and is good with people. She is a person of good moral character and her religious beliefs are important in her life. Her work record is excellent. The first nine years of her employment history was devoted to the meat packing industry. She worked for this employer for approximately three years prior to her injury. She can no longer do this kind of work. Therefore, many of the highest paying and easiest to obtain jobs are now foreclosed to claimant. Michael v. Harrison County, Thirty-fourth Biennial Report of the Industrial Commissioner 218, 219 (1979); Rohrberg v. Griffin Pipe Products Co., I Iowa Industrial Commissioner Report 282 (1981). Leonhardt, defendants' vocational rehabilitation consultant, testified that claimant is not employable, but that she can be retrained. Retraining is an expensive matter. Claimant did not sustain the burden of proof by a preponderance of the evidence that she is permanently totally disabled either under general principles of workers' compensation law or as an odd-lot employee. First of all, claimant told Dr. Hines that she did not feel that she was completely disabled back in August of 1984. Second, claimant admitted twice that she has never actually sought or made any attempt to be employed since the injury. She contacted no employers; she completed no job applications. Since claimant has made no showing of an effort to find other employment; there is no showing of what claimant can do within the boundaries of her disability and restrictions. Schofield v. Iowa Beef Processors, Inc., II Iowa Industrial Commissioner Report 334, 336 (1981). WILLER V. IOWA MEAT PROCESSING PAGE 17 In addition, claimant introduced no evidence of an attempt to be gainfully employed either with or without the help of the vocational rehabilitation service that was provided to her by defendants. Since claimant has not demonstrated a bona fide effort to return to gainful employment in the area of residence, she has failed to make a prime facia case of permanent total disability under the odd-lot doctrine. Guyton v. Irving Jensen Co., 373 N.W.2d 101 (Iowa 1985); Emshoff v. Petroleum Transportation Services, Inc., file no. 753723, appeal decision March 31, 1987. The evidence reveals a number of disincentives or reasons why claimant might not be motivated to return to gainful employment. First of all, at the time of the injury claimant's first child, by her first husband, was only approximately one year old. Second, claimant had only been married for three months to her present husband when the injury occurred. Third, she became pregnant with her second child sometime in the fall of 1984. Dr. Dougherty said that claimant was sick in bed most of the time and was even hospitalized some of the time during this pregnancy. Fourth, when the second child was born on June 25, 1985, it was a spina bifida child and required claimant's constant care. Fifth, claimant told Leonhardt that her husband said that he did not want her to work either inside or outside of the home either one. Sixth, the evidence clearly shows what Dr. Hines pointed out. Claimant does present psychological variables which cause her to experience pain, symptoms and disability worse than the physiological anomaly might suggest (Ex. P, p. 18). Jones and Weigel, occupational therapists at the MOEC, felt that claimant could work back on August 15, 1984. Regarding her performance on the Work Samples, we note that Pam turned in some very good scores when compared to our other female patients. She demonstrated excellent hand/eye/foot coordination and her upper extremity range of motion activities were far above average when compared to our other female patients. She demonstrated good work habits and motivation and she had a good, competitive spirit. She appeared to be quite enthused in her performance of the Work Samples. Although she was very physically active throughout her performance of the Work Samples, she demonstrated no physical problems and had no pain complaints during her entire performance of the Work Samples. (Ex. P, pp. 31 & 32) Claimant has been performing the tasks of wife, mother of two small children and homemaker since the injury occurred. These are three of the most difficult tasks to perform under any conditions in the employment world. Claimant actually ceased to obtain active medical treatment after she saw Dr. Dougherty on March 13, 1984, and Dr. Meylor a short time after that. Therefore, based upon the foregoing considerations and all of the factors that go into a determination of industrial disability, it is determined that claimant has sustained an industrial disability of 55 percent to the body as a whole. FINDINGS OF FACT Wherefore, based upon the foregoing evidence the following WILLER V. IOWA MEAT PROCESSING PAGE 18 findings of fact are made. That claimant was employed by employer on May 5, 1983, in a job that required her to transfer packages of meat weighing from one pound to 35 pounds in a twisting movement by transferring the meat from a conveyor belt on her right to another conveyor belt behind her body. That on May 5, 1983, claimant experienced severe spasms in her right shoulder and other symptoms in her face, neck, back, arm, hand and rib cage and that her fingers turned purple. That claimant gave this work history for the acute onset of her problem to numerous physicians. That none of these many doctors ever disputed claimant's history as the cause of the injury. That several possible neurological problems, which might have caused claimant's symptoms, were ruled out. That two neurologists and a neurosurgeon could not find any pathological neurological reason for claimant's symptoms. That Dr. Redwine, Dr. Rhodes and Dr. Dougherty all treated claimant on the basis of the history of the work injury which she described to them. That Dr..Nitz, said that the injury was most likely related to the persistent posture of her occupation. That Dr. Dougherty completed a Physicians Report for the insurance company and checked a block which indicated that claimant's problem was work related. That Dr. Dougherty gave a deposition that he initially assumed that claimant's symptoms were work related even though he could not explain why her scapula protruded. That Dr. Dougherty stated that he was not stating that her injury was not work related. That all of the physicians and other professionals at the MOEC proceeded on the history which claimant gave that described a work-related injury from repetitive motions at work in an awkward position over a long period of time. That there is no evidence of any other cause of the injury other than the description related by claimant. That claimant was unable to work after the injury on May 5, 1983. That claimant reached maximum medical improvement on March 13, 1984. That Dr. Dougherty awarded a 20 percent permanent functional impairment of the body as a whole and Burt, the licensed physical therapist at the MOEC, awarded claimant a 22 percent impairment. That claimant cannot return to her former employment in the packing house. WILLER V. IOWA MEAT PROCESSING PAGE 19 That claimant is limited to sedentary work. That claimant will probably need to be retrained in order to obtain further employment. That claimant has not endeavored to find any employment since the injury on May 5, 1983, and has completed no job applications and contacted no prospective employers. That claimant has not seriously explored vocational rehabilitation or applied for vocational rehabilitation benefits under the workers' compensation law. That no medical professional has indicated or suggested that claimant is permanently totally disabled. That Dr. Hines found that claimant's psychological nature intensified claimant's pain, symptoms and impairment. That claimant is married and has two small children at home. That claimant has sustained an industrial disability of 55 percent of the body as a whole. CONCLUSIONS OF LAW WHEREFORE, based upon the evidence presented and the foregoing principles of law, the following conclusions of law are made. That the injury of May 5, 1983, was the cause of both temporary and permanent disability. That claimant is entitled to 44.714 weeks of healing period benefits from May 5, 1983 to March 13, 1984. That claimant is entitled to 275 weeks of permanent partial disability based upon an industrial disability of 55 percent of the body as a whole, commencing on March 13, 1984. That claimant is not permanently totally disabled either is an odd-lot employee or otherwise under the workers' compensation law. ORDER THEREFORE, IT IS ORDERED: That defendants pay to claimant forty-four point seven one four (44.714) weeks of healing period benefits at the rate of two hundred seventy-five and 24/100 dollars ($275.24) per week in the total amount of twelve thousand three hundred seven and 08/100 dollars ($12,307.08) for the period from May 5, 1983 to March 13, 1984. That defendants pay to claimant two hundred seventy-five (275) weeks of permanent partial disability at the rate of two hundred seventy-five and 24/100 dollars ($275.24) per week in the total amount of seventy-five thousand six hundred ninety-one dollars ($75,691) commencing on March 13, 1984. WILLER V. IOWA MEAT PROCESSING PAGE 20 That all accrued benefits are to be paid in a lump sum. That interest will accrue pursuant to Iowa Code section 85.30. That defendants are entitled to a credit for one hundred sixty point four two nine (160.429) weeks of workers' compensation benefits paid prior to hearing at the rate of two hundred seventy- five and 24/100 dollars ($275.24) per week in the total amount of forty-four thousand one hundred fifty-six and 48/100 dollars ($44,156.48). That defendants pay the costs of this proceeding pursuant to Division of Industrial Services Rule 343-4.33. That defendants file claim activity reports as requested by this agency pursuant to Division of Industrial Services Rule 343-3.1. Signed and filed this 30th day of September, 1988. WALTER R. McMANUS, JR. DEPUTY INDUSTRIAL COMMISSIONER Copies to: Mr. David Vohs Attorney-at-Law STE 340 Insurance Ctr 507 7th St Sioux City, Iowa 51101 Mr. Harry Dahl Attorney-at-Law 974 73rd St., STE 16 Des Moines, Iowa 50312 1402.40; 1802; 1803; 2209; 4100 Filed September 30, 1988 WALTER R. McMANUS, JR. BEFORE THE IOWA INDUSTRIAL COMMISSIONER PAMELA S. WILLER, Claimant, vs. File No. 732780 IOWA MEAT PROCESSING, A R B I T R A T I O N Employer, D E C I S I O N and ARGONAUT INSURANCE CO., Insurance Carrier, Defendants. 1402.40; 1802; 1803; 2209 Claimant sustained a serious injury to her right shoulder from performing repetitive work over a long period of time in an awkward position. She was awarded approximately ten months of healing period benefits from the date of injury to a point when it was determined from doctors notes that she had attained maximum medical improvement. Claimant was awarded 55 percent industrial disability. Permanent functional impairment ratings were 20 and 22 percent. Claimant was foreclosed from production line work in the future and restricted to sedentary work. Defendants' vocational consultant said claimant was unemployable at the time of the hearing but that she could be retrained. 4100 Claimant had a number of disincentives to work of a personal nature and had not made any attempt of any kind to find employment or to cooperate with the vocational rehabilitation assistance offered by defendants. BEFORE THE IOWA DIVISION OF INDUSTRIAL SERVICES MARIETTA COYLE, Claimant, File Nos. 733550/727272 830411 vs A P P E A L SHELLER-GLOBE CORPORATION, R U L I N G Self-Insured, Employer, F I L E D and JAN 20 1988 SECOND INJURY FUND OF IOWA, IOWA INDUSTRIAL COMMISSIONER Defendants. Division of industrial Services Rule 343-4.27 states in part: No appeal shall be separately taken under this or 4.25 (17A, 86) from an interlocutory decision, order or ruling of a deputy industrial commissioner. A decision, order or ruling is interlocutory if it does not dispose of the contested case, unless the sole issue remaining for determination is claimant's entitlement to additional compensation for unreasonable denial or delay of payment pursuant to Iowa Code section 86.13. The ruling filed December 16, 1987, which is the subject matter of this appeal, is not dispositive of the contested case and therefore interlocutory. THEREFORE, the appeal filed December 24, 1987 is hereby dismissed. Signed and filed this 20th day of January, 1988. DAVID E. LINQUIST INDUSTRIAL COMMISSIONER Copies To: Mr. Arthur C. Hedberg, Jr. Attorney at Law 840 Fifth Avenue Des Moines, Iowa 50309 Mr. Harry W. Dahl Attorney at Law 974 73rd St., Suite 16 Des Moines, Iowa 50312 Mr. Craig Kelinson Assistant Attorney General Tort Claims Division Hoover State Office Bldg. Des Moines, Iowa 50319 BEFORE THE IOWA INDUSTRIAL COMMISSIONER LOIS HERRING, File No. 733671 Claimant, A P P E A L vs. D E C I S I O N ARMOUR DIAL, INC., F I L E D Employer, MAR 28 1988 Self-Insured, Defendant. IOWA INDUSTRIAL COMMISSIONER STATEMENT OF THE CASE Claimant appeals from a review-reopening decision awarding benefits based on a 25 percent impairment of claimant's left upper extremity. The deputy denied benefits for industrial disability holding that claimant did not establish that she sustained a disability to the body as a whole. The record on appeal consists of the transcript of the review-reopening hearing and joint exhibits 1 through 11. The deputy took official notice of the exhibits received into evidence at the arbitration hearing in this matter on August 27, 1984. Only claimant-appellant has filed a brief on appeal. ISSUES Claimant states the following issue on appeal: "The deputy's finding that the claimant's impairment and disability are limited to the arm and the scheduled portion of the Code as opposed to the body as a whole and unscheduled part of the Code is error." REVIEW OF THE EVIDENCE The review-reopening decision reflects the pertinent evidence and it will not be totally reiterated herein. The deputy made the following findings of fact in the arbitration decision filed in this matter: Claimant sustained an injury arising out of and in the course of her employment when she strained herself while separating two cartons of canned meat which were glued together. Claimant's injury resulted in a reflex sympathetic dystrophy with an underlying carpal tunnel syndrome. Claimant had a carpal tunnel release performed June 3, 1983. The release did not relieve claimant's symptoms. Claimant had a series of ganglion blocks in February 1984. These resulted in some improvement in her symptoms. Claimant will require at least a second series of ganglion blocks to return to her preinjury status. Claimant has not recovered to the extent that she can return to work substantially similar to that in which she was engaged when injured. Claimant has not yet returned to work for defendant. Claimant has incurred medical expenses related to her April 28, 1983 injury. These include medical mileage of the 1270 miles in 1983 and of 840 miles in 1984, and costs for a series of ganglion. (Arbitration Decision, page 13) Claimant's injury occurred on April 28, 1983. Since the arbitration hearing, claimant underwent a second series of ganglion blocks on December 5, 1984. The ganglion blocks were of little benefit to claimant. See joint exhibit 5. D. K. Nelson, M.D., claimant's treating physician, states his impression of claimant's condition in his January 8, 1985 notes: "Impression: She has clinical evidence of ulnar neuropathy or C8 radiculopathy also improved condition of reflex sympathetic dystrophy." (Joint Exhibit 5) Dr. Nelson referred claimant to a Dr. Blair for a second opinion. Dr. Blair examined and treated claimant on three occasions from March 12, 1985 through April 23, 1985. In his March 12, 1985 clinical notes, Dr. Blair states: EXAM: Exam reveals the left upper extremity appears the same in size, color and texture to the right upper extremity. The forearm measured 18 cm proximal to the radial styloid, is 1 cm less in diameter than the right. The left upper extremity is slightly cooler than the left throughout. Color is the same. The skin on the left hand is slightly dryer than the right. She has full ROM of the shoulder, elbow, wrist and fingers. No swelling, no particular tenderness to touch except the posterior arm. Neck has full ROM without reproduction of symptoms. IMP: The patient was seen and examined with Dr. Blair. We feel she is in a late stage of an almost completely recovered reflex sympathetic dystrophy now with persistent dysesthesias, cold intolerance. (Jt. Ex. 7) In his April 23, 1985 clinical notes, Dr. Blair states: PHYSICAL EXAM: Exam shows the skin to be apparently dryer than on the other side and slightly shiny. Strength in her deltoid, triceps, wrist flexion and extension on the left is all 4+/5 compared with the right and strength in her biceps is 5- compared with 5 on the right. IMP: The patient was seen with Dr. Blair and it was felt that she has received some relief from the TENS unit and that the headaches that she described could be due to improper placement of the pads. She was therefore sent down to PT for review of the proper use of the TENS unit and will return in 2 months for f/u. When she does return AP and lateral flexion extension views of her spine will be obtained to rule out any pathology here causing her symptoms. (Jt. Ex. 8) On May 13, 1985, Dr. Nelson performed surgery on claimant for left ulnar neuropathy. See joint exhibit 7, page 10. On subsequent visits, Dr. Nelson's notes reflect that claimant was experiencing shoulder and neck pain, but claimant retained full range of motion in her shoulders. See joint exhibits 8-10. On May 7, 1986, Dr. Nelson examined claimant for the purpose of evaluating claimant's impairment: I saw Mrs. Herring on May 7, 1986. At that time I felt that her healing had plateaued and at that time I ended her healing period. I estimated her permanent physical impairment to be 25% of the upper extremity, this equates to a 15% whole man extremity. Her symptoms and disability are the result of her injury at work on May 1, 1983. I feel that her condition is permanent and have no other recommendations for treatment. (Jt. Ex. 11) In the arbitration decision, the deputy states the following concerning claimant's prior medical history: Claimant recited that repetitive raising of her left arm remains a problem. Claimant reported that she had injured a tendon in her upper left arm at work in 1979 and that she had missed "quite a bit" of work when hospitalized for stomach problems prior to the April 28, 1983 incident. On cross examination, claimant elaborated concerning her 1979 injury. She stated she ruptured a tendon while lifting cases of chili from a pallet. She testified that the muscle in her upper left arm "caved in." Claimant was off work because of this injury from January 10, 1979 through April 1, 1980. She reported a Dr. Browning treating her condition and performed surgery about 1.5 inches above her wrist on her forearm. She stated the doctor described such as "clearing out a tunnel" but "didn't call it a carpal tunnel." Claimant stated returning to her regular job following her injury was "quite an adjustment." She reported that she experienced a dull ache in her wrist following this injury. Claimant disclosed that she was hospitalized in 1982 for severe headaches. She recited that tests at that time revealed a pinched nerve. Claimant admitted she had experienced pain at the base of her skull before 1983 and that such radiated into both shoulders. Claimant relayed that in May 1983 she displaced a rib while loading meat into her home freezer. (Arb Dec. p. 3) APPLICABLE LAW The citations of law are appropriate to the issues and evidence. ANALYSIS Contrary to claimant's argument, the greater weight of evidence supports the deputy's finding that claimant's disability is limited to the left upper extremity. Claimant states that she experiences pain in her left shoulder, but Dr. Nelson's clinical notes reveal that claimant retains full range of motion in the left shoulder. The arbitration decision discloses that claimant experienced pain problems in the neck and both shoulders before the injury of April 28, 1983. This fact weakens the causal connection between claimant's neck and shoulder complaints and her April 28, 1983 work injury. The evidence claimant presented just failed to meet her burden. FINDINGS OF FACT 1. Claimant reached maximum medical improvement on May 7, 1986. 2. As a result of claimant's April 28, 1983 work injury, claimant suffers a 25 percent impairment of the left upper extremity. CONCLUSIONS OF LAW Claimant is entitled to healing period benefits from April 28, 1983 through May 7, 1986. Claimant is entitled to permanent partial disability benefits based upon a 25 percent impairment of the left upper extremity. WHEREFORE, the decision of the deputy is affirmed. ORDER THEREFORE, it is ordered: That defendant pay claimant healing period benefits for the period from April 28, 1983 through May 7, 1986 at the rate of two hundred sixty-eight and 08/100 dollars ($268.08) per week. That defendant pay claimant sixty-two point five (62.5) weeks of permanent partial disability benefits at the rate of two hundred sixty-eight and 08/100 dollars ($268.08) per week commencing May 8, 1986. That defendant shall pay accrued amounts in a lump sum together with interest pursuant to Iowa Code section 85.30. That defendant shall receive credit for all benefits already paid. That claimant shall pay the costs of this appeal in accordance with Division of Industrial Services Rule 343-3.1. Signed and filed this 28th day of March, 1988. DAVID E. LINQUIST INDUSTRIAL COMMISSIONER Copies To: Mr. Robert W. Pratt Attorney at Law 1913 Ingersoll Ave. Des Moines, Iowa 50309 Mr. Larry Shepler Attorney at Law 600 Union Arcade Bldg. Davenport, Iowa 52801-1550 1402.40 - 1803.1 Filed March 28, 1988 DAVID E. LINQUIST BEFORE THE IOWA INDUSTRIAL COMMISSIONER LOIS HERRING, Claimant, File No. 733671 vs. A P P E A L ARMOUR DIAL, INC., D E C I S I 0 N Employer, Self-Insured, Defendant. 1402.40 - 1803.1 Claimant failed to establish an injury to the body as a whole. Although claimant experienced pain in her neck and shoulder she retained full range of motion in her left shoulder. Claimant had similar neck and shoulder pain before her work injury. Page 1 before the iowa industrial commissioner ____________________________________________________________ : SANDRA CORBIN, : : Claimant, : : vs. : : File No. 733687 MERCY HOSPITAL MEDICAL CENTER, : : A R B I T R A T I O N Employer, : : D E C I S I O N and : : AETNA CASUALTY & SURETY COMPANY,: : Insurance Carrier, : Defendants. : ___________________________________________________________ statement of the case This is a proceeding in arbitration brought by Sandra Corbin, claimant, against Mercy Hospital Medical Center, employer (hereinafter referred to as Mercy), and Aetna Casualty & Surety Company, insurance carrier, defendants, for workers' compensation benefits as a result of an alleged injury on May 17, 1983. On April 2, 1990, a hearing was held on claimant's petition and the matter was considered fully submitted at the close of this hearing. The parties have submitted a prehearing report of con tested issues and stipulations which was approved and accepted as a part of the record of this case at the time of hearing. Oral testimony and written exhibits were received during the hearing from the parties. The exhibits offered into the evidence are listed in the prehearing report. According to the prehearing report, the parties have stipulated to the following matters: 1. On May 17, 1983, claimant received an injury which arose out of and in the course of his employment with Mercy. 2. Claimant is seeking temporary total disability or healing period benefits for the times off work listed in the prehearing report and defendants agree that she was not working during those times. 3. If the injury is found to have caused permanent disability, the type of disability is an industrial disabil ity to the body as a whole. 4. Claimant's rate of weekly compensation in the event of an award of weekly benefits from this proceeding shall be $177.16. Page 2 5. With reference to the medical expenses requested by claimant, it was agreed that the providers would testify that they are fair and reasonable and defendants are not offering contrary evidence. It was agreed that these expenses are causally connected to the left shoulder condi tion upon which a portion of the claim herein is based but that the issue of the causal connection of the left shoulder condition to the work injury remained at issue. issues The parties submitted the following issues for determi nation in this proceeding: I. Whether claimant received an injury to the left shoulder arising out of and in the course of employment. It was urged by defendants that the left shoulder injury or a cumulative trauma issue was not before this deputy commissioner. However, on July 3, 1988, claimant filed an amended petition alleging a fall on May 17, 1983 as well as an injury from "daily stresses and strains of employment." This condition was labeled in this petition as bilateral impingement syndrome to the arms, shoulders and neck. It is rather clear that a cumulative trauma along with the fall incident has been alleged. Also, there has been no bifurcation of any issue raised in the petition. II. Whether the left shoulder injury claim is barred as not asserted within two years of the last payment of ben efits under Iowa Code section 85.26 or barred for failure to provide 90 day notice to Mercy under Iowa Code section 85.23. III. The extent of claimant's entitlement to disabil ity benefits for her right and left shoulder conditions. IV. The extent of claimant's entitlement to medical benefits for the left shoulder condition. findings of fact Having heard the testimony and considered all the evidence, this deputy industrial commissioner finds as follows: A credibility finding is necessary to this decision as defendants placed claimant's credibility at issue during cross-examination as to the nature and extent of the injury and disability. From her demeanor while testifying, claimant is found credible. Claimant has worked for Mercy since March 1975 and con tinues to do so at the present time. Her duties for the most part involve housekeeping and cleaning work. At the time of the alleged work injury, claimant was an instrument technician. Claimant had been performing this job for a number of years prior to the injury. In this job she cleaned and prepared surgical instruments for reuse in the operating rooms. As a part of this job, claimant was to Page 3 pick up the instruments from the operating rooms and trans port them on carts to the cleaning area. The four wheeled carts used by claimant were five feet high and two feet square containing three or four shelves. Claimant would place the instruments into trays which weighed from 15 to 20 pounds each and placed these trays on to shelves in the carts. The carts would contain two to ten trays at a time. Claimant would then push or pull the carts to the cleaning area. The trays containing the instruments were then placed by claimant into various vats for cleaning and steriliza tion. For the last year claimant has been assigned to wash ing dishes which does not violate the current work restric tions imposed in 1989 against repetitive lifting and lifting over 20 pounds. On or about May 17, 1983, claimant fell in the Mercy parking lot injuring her right shoulder, arm and neck. Claimant suffered no bone fractures but began to experience chronic pain in the right shoulder and neck radiating down to the right arm. She also experienced numbness of the right arm, hand and fingers. Claimant was initially treated with medication and physical therapy and returned to work on June 19, 1983. However, claimant continued to experience chronic pain and was eventually sent to an orthopedic surgeon, William Boulden, M.D., in September of 1983. Dr. Boulden diagnosed right shoulder A/C joint separation and treated claimant for this condition. This treatment included steroid injections, physical therapy, installation of a nerve stimulation device and cervical traction. When claimant appeared to improve from the traction, Dr. Boulden released claimant to return to work on October 10, 1983. In November 1983, Dr. Boulden stated that claimant would have no permanent partial impair ment from the injury stating that a home traction unit which he prescribed would eventually correct the problem. Claimant returned to Dr. Boulden in January 1984 with con tinuing complaints. Dr. Boulden then said that he was going to try a "neuroprobe" and that if that treatment did not work, claimant would have to consider a change of duties. There is no other further reports in the record from Dr. Boulden. Claimant continued to experience right shoulder pain and she was referred to another orthopedic surgeon, Marshall Flapan, M.D., in February 1985. Dr. Flapan diagnosed a rotator cuff tear in the right shoulder and following unsuc cessful conservative treatment, Dr. Flapan surgically cor rected the tear in July 1985. Claimant was off work from March 14, 1985 through March 15, 1985 and from July 3, 1985 through October 20, 1985. Dr. Flapan restricted claimant to light duty work with a 25 pound lifting restriction when claimant returned to work. Dr. Flapan also advised against the pushing and pulling of carts and against repetitive lifting. Claimant, however, continued to work in her instrument cleaning job. In March 1985, claimant began to complain to Dr. Flapan of left shoulder pain. Claimant reported this condition to an insurance claims representative at approximately the same Page 4 time. The employer's insurance carrier received reports from Dr. Flapan of this condition soon after they were prepared. In April 1987, claimant began treating with another orthopedic surgeon, Paul K. Ho, M.D., for her now bilateral shoulder, neck and arm pain. Dr. Ho diagnosed impingement syndrome of the right shoulder, A/C joint arthritis and myofascial pain syndrome. Dr. Ho treated claimant with physical therapy and medication but claimant remained on the instrument job at Mercy. In February 1988, claimant was evaluated by James Nepola, M.D., an Assistant Professor in the Orthopedics Department of the University of Iowa Hospitals and Clinics. Dr. Nepola diagnosed bilateral shoulder impingement with right rotator cuff tear and recommended surgery on the right shoulder. This surgery was performed and claimant was off work as a result from May 13, 1988 through June 23, 1989. When he released claimant to return to work, Dr. Nepola imposed a restriction against repetitive lifting with the right upper extremity due to the right shoulder problem. As a result of her fall at work on May 17, 1983, claimant has a six percent permanent partial impairment to the body as a whole. This finding is based upon the views of Dr. Nepola who was the most recent treating physician. Dr. Nepola also opined that the right shoulder impingement was causally connection to the original fall injury of May 17, 1983. Dr. Boulden's contrary opinion concerning perma nent partial impairment was rendered long ago and was based upon the assumption that claimant's continuing problems would be corrected by the cervical traction device he pre scribed. This did not occur. Claimant also suffers from a five percent permanent partial impairment to the body as a whole from her left shoulder problem. However, claimant did not establish that this condition was due to the fall at work in 1983 or due to repetitive trauma. Claimant is basing her claim of repeti tive trauma on the report dated June 29, 1989, by Robert McLain, D.O., who was apparently acting for Dr. Nepola. Dr. McLain stated in this report that claimant's discomfort at the time was due to "daily stresses and strains of employ ment." However, in the same report Dr. McLain had discussed that claimant would be suffering occasional discomfort when she used her right arm above shoulder level. It appears from a reading of the entire report that Dr. McLain was not causally connecting all of claimant's problems to her work. He appears to be simply explaining the cause of her current discomfort while performing her current job. Therefore, absent a supportive opinion from a physician, a finding could not be made that the left shoulder condition, occur ring almost three years after the injury, was causally related to that injury. The lack of a finding that the left shoulder condition is work related does not affect the award of temporary total disability benefits in this case as it does not appear that any of these times off work were due to the left shoulder problems but due primarily to the right shoulder problems. Page 5 As a result of the work injury of May 17, 1983, claimant has suffered only a ten percent loss of earning capacity. Claimant's work restrictions against lifting over 20 pounds and against repetitive lifting is due primarily to the right shoulder condition. Although claimant has some disability due to the left shoulder problems, this is minor compared to the right shoulder problems. Claimant is 50 years of age and has only a formal eleventh grade education. However, claimant has earned her GED. Claimant's past employment has been as a waitress, cook and as a salesclerk in addition to her duties at Mercy. Claimant is physically capable of returning to much of the type of work she per formed prior to her employment at Mercy. Claimant has changed jobs as a result of the right shoulder problems but this has not resulted in a loss of income. Mercy is accom modating satisfactorily for claimant's disability. Claimant appears to have low potential for vocational rehabilitation but such rehabilitation is unnecessary at this time as claimant's employment appears suitable and stable. conclusions of law I. Claimant has the burden of proving by a prepon derance of the evidence that claimant received an injury which arose out of and in the course of employment. The words "out of" refer to the cause or source of the injury. The words "in the course of" refer to the time and place and circumstances of the injury. See Cedar Rapids Community Sch. v. Cady, 278 N.W.2d 298 (Iowa 1979); Crowe v. DeSoto Consol. Sch. Dist., 246 Iowa 402, 68 N.W.2d 63 (1955). An employer takes an employee subject to any active or dormant health impairments, and a work connected injury which more than slightly aggravates the condition is considered to be a personal injury. Ziegler v. United States Gypsum Co., 252 Iowa 613, 620, 106 N.W.2d 591 (1960) and cases cited therein. In the case sub judice, claimant failed to show by a preponderance of the evidence that the left shoulder prob lems arose out of and in the course of her employment at Mercy. II. The affirmative defenses of untimeliness and lack of notice involves the alleged left shoulder injury. As claimant failed to show that the left shoulder problems were work related, these affirmative defensives are moot. III. Claimant must establish by a preponderance of the evidence the extent of weekly benefits for permanent dis ability to which claimant is entitled. As the claimant has shown that the work injury was a cause of a permanent physi cal impairment or limitation upon activity involving the body as a whole, the degree of permanent disability must be measured pursuant to Iowa Code section 85.34(2)(u). However, unlike scheduled member disabilities, the degree of disability under this provision is not measured solely by the extent of a functional impairment or loss of use of a body member. A disability to the body as a whole or an "industrial disability" is a loss of earning capacity Page 6 resulting from the work injury. Diederich v. Tri-City Railway Co., 219 Iowa 587, 593, 258 N.W. 899 (1935). A physical impairment or restriction on work activity may or may not result in such a loss of earning capacity. The extent to which a work injury and a resulting medical condi tion has resulted in an industrial disability is determined from examination of several factors. These factors include the employee's medical condition prior to the injury, imme diately after the injury and presently; the situs of the injury, its severity and the length of healing period; the work experience of the employee prior to the injury, after the injury and potential for rehabilitation; the employee's qualifications intellectually, emotionally and physically; earnings prior and subsequent to the injury; age; education; motivation; functional impairment as a result of the injury; and inability because of the injury to engage in employment for which the employee is fitted. Loss of earnings caused by a job transfer for reasons related to the injury is also relevant. Olson v. Goodyear Service Stores, 255 Iowa 1112, 1121, 125 N.W.2d 251, 257 (1963). See Peterson v. Truck Haven Cafe, Inc., (Appeal Decision, February 28, l985). In the case sub judice, it was found that claimant has suffered a ten percent loss of earning capacity as a result of the work injury. Based upon such a finding, claimant is entitled as a matter of law to 50 weeks of permanent partial disability benefits under Iowa Code section 85.34(2)(u) which is ten percent of 500 weeks, the maximum allowable for an injury to the body as a whole in that subsection. Under Iowa Code section 85.34(l), claimant is entitled to healing period benefits from the time she was off work as set forth in the prehearing report. This totals 80 2/7 weeks and such will be awarded. Claimant's healing period ended when she returned to work on June 24, 1990. IV. The requested medical expenses involve treatment for the left shoulder. As this was not found work related, the expense cannot be awarded. order 1. Defendants shall pay to claimant fifty (50) weeks of permanent partial disability benefits at the rate of one hundred seventy-seven and 16/l00 dollars ($177.16) per week from June 24, 1989. 2. Defendants shall pay to claimant healing period benefits at the rate of one hundred seventy-seven and 16/l00 dollars ($177.16) per week for the time period set forth in the prehearing report which totals eighty and two-sevenths (80 2/7) weeks. 3. Defendants shall pay accrued weekly benefits in a lump sum and shall receive credit against this award for weekly benefits previously paid. 4. Defendants shall pay the interest on weekly bene fits awarded herein as set forth in Iowa Code section 85.30. Page 7 5. Defendants shall pay the cost of this action pur suant to Division of Industrial Services Rule 343-4.33. 6. Defendants shall file activity reports on the pay ment of this award as requested by this agency pursuant to Division of Industrial Services Rule 343-3.1. Signed and filed this ____ day of August, 1990. ______________________________ LARRY P. WALSHIRE DEPUTY INDUSTRIAL COMMISSIONER Copies To: Mr. Kenneth B. Thomson Attorney at Law 1000 - 73rd St Suite 10 Westgate Plaza Des Moines IA 50311 Mr. Glenn Goodwin Attorney at Law 4th Flr Equitable Bldg Des Moines IA 50309 5-1803 Filed August 2, 1990 LARRY P. WALSHIRE before the iowa industrial commissioner ____________________________________________________________ : SANDRA CORBIN, : : Claimant, : : vs. : : File No. 733687 MERCY HOSPITAL MEDICAL CENTER, : : A R B I T R A T I O N Employer, : : D E C I S I O N and : : AETNA CASUALTY & SURETY COMPANY,: : Insurance Carrier, : Defendants. : ___________________________________________________________ 5-1803 - Extent of disability benefits.