BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         BURDETTA A. SIEFKEN,
 
         
 
              Claimant,
 
                                                   File No.  762694
 
         vs.
 
         
 
         ARCHER-DANIEL-MIDLAND CO.,                   A P P E A L
 
         
 
              Employer,                             D E C I S I 0 N
 
         
 
         and
 
         
 
         THE ILLINOIS INSURANCE
 
         GUARANTY FUND,
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
         
 
         
 
                              STATEMENT OF THE CASE
 
         
 
              Claimant appeals from,, an arbitration decision denying 
 
         temporary total disability benefits.
 
         
 
              The record on appeal consists of the transcript of the 
 
         arbitration proceeding; claimant's exhibits 1 through 6, 11 
 
         through 31, and 33 through 35; and defendantOs' exhibits A 
 
         through C.  Both parties tiled briefs on appeal.
 
         
 
                                      ISSUES
 
         
 
              Claimant states the following issues on appeal:
 
         
 
              I.  Did the Deputy industrial Commissioner err in concluding 
 
         that the Claimant has not established that a causal relationship 
 
         exists between her April 2, 1984, injury and the disability on 
 
         which she bases her claim?
 
         
 
             II.  Did the Deputy Industrial Commissioner err in concluding 
 
         that the Claimant has not established that she is entitled to 
 
         temporary total disability benefits from June 13, 1986, onward?
 
         
 
                              REVIEW OF THE EVIDENCE
 
         
 
              The arbitration decision adequately and accurately reflects 
 
         the pertinent evidence and it will not be set forth herein.
 
         
 
                                  APPLICABLE LAW
 
         
 
              The citations of law in the arbitration decision are 
 
         appropriate to the issues and the evidence.
 
         
 

 
         
 
         
 
         
 
         SIEFKEN V. ARCHER-DANIEL-MIDLAND CO.
 
         Page   2
 
         
 
                                    ANALYSIS
 
         
 
              The analysis of the evidence in conjunction with the law is 
 
         adopted.
 
         
 
                                 FINDINGS OF FACT
 
         
 
              1.  Claimant sustained an injury on April 2, 1984 when she 
 
         attempted to stabilize a full enzyme drum weighing between 300 
 
         and 350 pounds.
 
         
 
              2.  Claimant initially treated with Dr. Roberson, Dr. Myers, 
 
         and Dr. Rasmus.
 
         
 
              3.  Claimant last treated with Dr. Rasmus on October 22, 
 
         1984.
 
         
 
              4.  Claimant then was not responding to therapy, had been 
 
         tried on antidepressants, and Dr. Rasmus believed nothing further 
 
         could be done for her.
 
         
 
              5.  Claimant first saw Daniel Hoffman, M.D., a general 
 
         practitioner, on January 29, 1985.
 
         
 
              6.  Dr. Hoffman subsequently referred claimant to Om N. 
 
         Sureka, M.D., a physical medicine and rehabilitation specialist.
 
         
 
              7.  Both Dr. Hoffman and Dr. Sureka treated claimant for 
 
         diffuse complaints in her neck, shoulders, and sacrolumbar area.
 
         
 
              8.  Claimant had numerous other complaints relating to her 
 
         eyes, teeth, veins, and hemorrhoids, for which she saw other 
 
         medical practitioners.
 
         
 
              9.  Claimant had a diagnoses hiatus hernia and spastic 
 
         esophagitis for which John Erickson, M.D., an internist, treated 
 
         her.  The origin of the hiatus hernia is unknown.
 
         
 
             10.  Robert Martin, M.D., an occupational medicine 
 
         specialist, examined claimant on August 14, 1986.
 
         
 
             11.  Claimant had diffuse tenderness on examination, 
 
         inconsistencies on examination, few objective findings on 
 
         examination, and diffuse complaints pointing to a nonorganic 
 
         etiology for her complaints.
 
         
 
             12.  Claimant's demeanor at hearing was inconsistent with the 
 
         nature and severity of her purported complaints.
 
              13.  Claimant's complaints are of a nonorganic nature and do 
 
         not result from her work injury.
 
         
 
              14.  Claimant reached maximum healing of any work condition 
 
         as of October 22, 1984.
 
         
 
              15.  Claimant's medical costs for dental and eye care and 
 
         for treatment of her hemorrhoids, her veins, and her hiatus 
 
         hernia and spastic esophagitis are not related to any work 
 
         injury.
 
         
 
              16.  Claimant's medical costs incurred after October 22, 
 

 
         
 
         
 
         
 
         SIEFKEN V. ARCHER-DANIEL-MIDLAND CO.
 
         Page   3
 
         
 
         1984 are not related to a work-related condition.
 
         
 
              17. ClaimantOs housecleaning expenses and her husband's time 
 
         off  work to drive her to appointments do not relate to any 
 
         work-related condition.
 
         
 
              18.  Claimant incurred 1,180 miles for medical treatment of 
 
         her work condition on or before October 22, 1984.
 
         
 
              19.  Claimant incurred a prescription cost of $15.75 related 
 
         to her work condition.
 
         
 
              20.  Claimant incurred costs of treatment with Dr. Roberson 
 
         in April 1984 related to her work condition.
 
         
 
                                CONCLUSIONS OF LAW
 
         
 
              Claimant has not established that a causal relationship 
 
         exists between her April 2, 1984 injury and the disability on 
 
         which she bases her claim.
 
         
 
              Claimant has not established that she is entitled to 
 
         temporary total disability benefits from June 13, 1986 onward.
 
         
 
              Claimant is entitled to payment of costs with Dr. Roberson 
 
         totaling $55.00; to payment of costs from Fenn's Drug totaling 
 
         $15.75; and to payment of medical mileage totaling 1,180 miles at 
 
         the rate of $.24 per mile.
 
         
 
              Claimant is not entitled to other claimed medical and 
 
         miscellaneous expenses.
 
         
 
              WHEREFORE, the decision of the deputy is affirmed.
 
         
 
                                      ORDER
 
         
 
              THEREFORE, it is ordered:
 
         
 
              That defendants pay claimant medical costs as outlined in 
 
         the above conclusions of law.
 
         
 
              That claimant and defendants are to equally pay the costs of 
 
         the arbitration proceeding.  Claimant is to pay the costs of this 
 
         appeal including the cost of transcription of the arbitration 
 
         hearing.
 
         
 
              That defendants shall file claim activity reports as 
 
         required by this agency pursuant to Division of Industrial 
 
         Services Rule 343-3.1(1).
 
         
 
              Signed and filed this 24th day of June, 1988.
 
         
 
         
 
         
 
         
 
         
 
                                              DAVID E. LINQUIST
 
                                              INDUSTRIAL COMMISSIONER
 
         
 
         Copies To:
 

 
         
 
         
 
         
 
         SIEFKEN V. ARCHER-DANIEL-MIDLAND CO.
 
         Page   4
 
         
 
         
 
         Mr. Jack C. Vieley
 
         Attorney at Law
 
         1816 Savings Center Tower
 
         Peoria, Illinois 61602
 
         
 
         Mr. Christopher Klockan
 
         Attorney at Law
 
         1808 Third Avenue
 
         P.O. Box 1279
 
         Rock      sland, Illinois 61204
 
         
 
         Mr. Larry L. Shepler
 
         Mr. Bradford B. Ingram
 
         Attorneys at Law
 
         600 Union Arcade Bldg.
 
         111 East Third Street
 
         Davenport, Iowa 52801-1550
 
         
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                                  1108.50
 
                                                  Filed June 24, 1988
 
                                                  David E. Linquist
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         BURDETTA A. SIEFKEN,
 
         
 
              Claimant,
 
                                                    File No. 762694
 
         vs.
 
         
 
         ARCHER-DANIEL-MIDLAND CO.                    A P P E A L
 
         
 
              Employer,                             D E C I S I 0 N
 
         
 
         and
 
         
 
         THE ILLINOIS INSURANCE
 
         GUARANTY FUND,
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
         
 
         1108.50
 
         
 
              Affirmed deputy's decision that no causal connection was 
 
         shown between claimantOs condition and her injury.
 
 
 
         
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         _________________________________________________________________
 
         
 
         BURDETTA A. SIEFKEN,
 
         
 
             Claimant,
 
                                                 File No. 762694
 
         vs.
 
         
 
         ARCHER-DANIEL-MIDLAND CO.,
 
                                              A R B I T R A T I 0 N
 
             Employer,
 
                                                 D E C I S I 0 N
 
         and
 
         
 
         THE ILLINOIS INSURANCE
 
         GUARANTY FUND, 
 
         
 
             Insurance Carrier,
 
             Defendants.
 
         _________________________________________________________________
 
         
 
                                   INTRODUCTION
 
         
 
              This is a proceeding in arbitration brought by the claimant, 
 
         Burdetta A. Siefken, against her employer, Archer-Daniel-Midland 
 
         Co., and its insurance carrier, The Illinois Insurance Guaranty 
 
         Fund, to recover benefits under the Iowa Workers' Compensation 
 
         Act as a result of an injury sustained April 2, 1984.  This 
 
         matter came on for hearing before the undersigned deputy 
 
         industrial commissioner at the Bicentennial Building, in 
 
         Davenport, Iowa, on October 31, 1986.  The record was considered 
 
         fully submitted at close of hearing.  A first report of injury 
 
         was filed April 19, 1984.  Pursuant to the prehearing report, the 
 
         parties .stipulated that claimant has received temporary total or 
 
         healing period benefits from April 16, 1984 through June 13, 1986 
 
         at the stipulated rate of $273.35.
 
         
 
              The record in this case consists of the testimony of 
 
         claimant, and of Angela Gibson as well as of claimant's exhibits 
 
         1 through 6, 11 through 31, and 33 through 35, and of defendants' 
 
         exhibits A through C. Defendants' objections to claimant's 
 
         exhibits 7, 8, 9, and 32 are sustained.  Defendants' objection to 
 
         testimony' of claimant's additional witnesses are also sustained.  
 
         Claimant's exhibits 1 and 2 are the depositions of Daniel 
 
         Hoffman, M.D., and Om N. Sureka, M.D., respectively.  Claimant's 
 
         exhibits 3 and 4 are medical reports of Dr. Hoffman of September 
 
         26, 1986 and April 15, 1985, respectively.  Claimant's exhibit 5 
 
         is a medical report of Dr. Sureka of April 18, 1985.  Claimant's 
 
         exhibit 6 is a medical report of Stephen Rasmus, M.D. Claimant's 
 
         exhibits 10
 
         
 
         
 
         and 11 are medical notes of Dr. Hoffman.  Claimant's exhibit 12 
 
         is a medical report of John R. Erickson, M.D. Claimant's exhibits 
 
         13 through 15 are notes of Dr. Hoffman.  Claimant's exhibit 16 is 
 
         a medical report of Jeffrey W. Akeson, M.D. Claimant's exhibit 17 
 
         is design data as supplied by Harold P. Wendler and Associates, 
 

 
         Inc.  Claimant's exhibit 18 is claimant's summary of unpaid 
 
         temporary total disability payments she believes due her.  
 
         Claimant's exhibit 19 is a summary of claimant's expenses paid 
 
         through September 1986.  Claimant's exhibit 20 is doctor bills 
 
         and prescription bills claimant paid in 1984.  Claimant's exhibit 
 
         21 is doctor bills and prescription bills claimant paid in 1985.  
 
         Claimant's exhibit 22 is a list of miscellaneous expenses 
 
         claimant incurred in the years 1984, 1985, and 1986.  Claimant's 
 
         exhibit 23 is doctor bills and prescription bills claimant paid 
 
         in 1986.  Claimant's exhibits 24 through 31 are notes of Dr. 
 
         Hoffman.  Claimant's exhibit 33 is claimant's deposition.  
 
         Claimant's exhibit 34 and 35 are correspondence between counsel 
 
         and the insurance adjustor of May 1986.  Defendants' exhibit A is 
 
         a medical report of Robert I. Martin, M.D. Defendants' exhibits B 
 
         and C are items of correspondence between claimant and the 
 
         insurance adjustor.
 
         
 
                                  ISSUES
 
         
 
              Pursuant to the prehearing report, the parties stipulated 
 
         that claimant received an injury which arose out of and in the 
 
         course of her employment, and that she has been off work to the 
 
         present.  The issues remaining for resolution are:
 
         
 
              1)  Whether a causal relationship exists between claimant's 
 
         injury and her claimed disability;
 
         
 
              2)  Whether claimant is entitled to temporary total or 
 
         healing period benefits from June 13, 1986 onward; and:
 
         
 
              3)  Whether claimant is entitled to payment of certain 
 
         medical expenses as causally connected to her injury and 
 
         authorized by defendants.
 
         
 
                              REVIEW OF THE EVIDENCE
 
         
 
              Considerable evidence was presented not relevant to the 
 
         issues before us.  This review of the evidence will be confined 
 
         to evidence relevant to the issues of causal relationship, 
 
         temporary benefit entitlement, and medical payment.  All evidence 
 
         relevant to those issues was reviewed and considered in the 
 
         disposition of this matter even if such evidence is not expressly 
 
         set forth in the following review of the evidence.
 
         
 
              Fifty year old claimant testified that she began employment 
 
         with the predecessor of Archer-Daniel-Midland Co. in September 
 
         1979.  She was transferred to the enzyme department in February 
 
         1984.  Prior to that she had generally done light work as a
 
         laboratory technician.  In the course of the enzyme job, She was 
 
         required to fill 55 gallon drums with an enzyme product, roll the 
 
         drum onto a scale, weigh the full drum and roll it onto an 
 
         elevator.  Claimant estimated that the drums themselves weighed 
 
         between 42 and 45 pounds and that a loaded drum weighed between 
 
         300 and 325 pounds.  Claimant at a maximum dealt with 22 to 24 
 
         drums per day.  Claimant testified,that on April 2, 1984, while 
 
         she was trying to remove a drum from the scale, the product 
 
         shifted and as she attempted to control the drum, she felt a 
 
         burning, tearing sensation in her back.  Claimant worked 
 
         throughout her shift but reported she rested in bed over the next 
 
         two days and saw her family doctor, a Dr. Roberson, on April 4, 
 
         1984 and was referred to the company doctor, a Dr. Myers, on 
 
         April 6, 1984.  Pain medication and light duty work were 
 
         prescribed.  Claimant returned to regular work on April 8, 1984 
 
         and apparently attempted to try to work through April 26, 1984.  
 

 
         
 
         
 
         
 
         SIEFKEN V. ARCHER-DANIEL-MIDLAND CO.
 
         Page   3
 
         
 
         
 
         She has not worked since that day.  Claimant testified that she 
 
         has discussed a light duty work return with the employer, but has 
 
         not been offered that option.
 
         
 
              Claimant reported that she now continues to treat with 
 
         Daniel Hoffman, M.D., and Om Sureka, M.D. She denied having 
 
         refused treatment with Jeffrey W. Akeson, M.D., or Robert Martin, 
 
         M.D. Claimant stated that a Mr. Overmiller, safety director for 
 
         the employer, had told her that the company would be paying her 
 
         medical bills.  She identified the various exhibits outlining 
 
         medical and miscellaneous expenses.  She reported that she 
 
         requested reimbursement for days her husband took off work for 
 
         medical appointments which she felt was too distant for her to 
 
         drive to alone.  She reported that she had had to hire 
 
         housecleaning done after her injury, but agreed that she had had 
 
         housecleaning work done for her prior to the injury date as well.  
 
         Claimant started using a cane in late Summer or early Fall 1984 
 
         and reported she becomes very wobbly and clumsy without it.  
 
         Claimant is currently taking Parafon Forte and Tylenol #3 with 
 
         Codeine.  She indicated that she continues to be stiff and very 
 
         painful in her low back as well as in her neck and shoulder and 
 
         through the shoulderblades.  Claimant indicated that she drops 
 
         cigarettes and coffee cups, has difficulty riding in a boat and 
 
         pickup, and cannot vacuum, fish, hunt, camp, or mountain climb.  
 
         Claimant agreed that her no physician prescribed her cane and 
 
         that she drives in town.
 
         
 
              Claimant agreed that she saw a Dr. Germain, a dermatologist, 
 
         for her varicose and spider veins.  She denied having seen Dr. 
 
         Roberson for conditions other than her injury and denied that she 
 
         had had a Pap smear at his direction in 1986.  She agreed that 
 
         Dr. Bryant is a dentist and that Dr. McGee is an optomologist.  
 
         She reported that John R. Erickson, M.D., treated her for spastic 
 
         esophagus and hiatus hernia.  Dr. King is a podiatrist.  Claimant 
 
         claimed that all these medical visitations as well as 
 
         prescriptions generated from them were related to her original
 
         work condition.  Claimant agreed that a letter of Angela Gibson 
 
         of May 19, 1986 informed her that Drs. Hoffman and Sureca were no 
 
         longer her authorized physicians and stated that she continued to 
 
         treat with them after that event.  Claimant stated that she 
 
         understood that Dr. Martin had not wished to treat her on the day 
 
         of his examination and that she was made aware of Dr. Martin's 
 
         opinion that she needed no further medical treatment.  She 
 
         reported that she understood that Dr. Akeson was satisfied with 
 
         the treatment she was receiving from Drs.  Hoffman and Sureca.  
 
         Claimant denied having had problems with vericose or spider veins 
 
         prior to her injury.  She reported she first noticed this 
 
         condition in 1984 and that Dr. Hoffman told her to see a 
 
         specialist for examination.  Claimant related her hiatal hernia 
 
         to shortness of breath and pain that she had first noticed on the 
 
         job.
 
         
 
              Angela Gibson, an adjustor with Crawford and Company, 
 
         reported that the adjusting firm has handled claimant's claim 
 
         from mid-April 1984 with a suspension of its handling of the 
 
         claim at the time of Ideal Mutual's bankruptcy in 1985 and with 
 
         the resumption of claim handling in April 1985 for the Illinois 
 
         Guaranty Fund.  Gibson reported that claimant treated with Dr. 
 
         Roberson throughout 1984 and began treating with Drs. Hoffman and 
 

 
         
 
         
 
         
 
         SIEFKEN V. ARCHER-DANIEL-MIDLAND CO.
 
         Page   4
 
         
 
         
 
         Sureca in mid-1985.  She reported that Dr. Hoffman stated he was 
 
         not capable of outlining claimant's physical restrictions when 
 
         asked to do so, and that because Dr. Hoffman was not a 
 
         specialist, the claims adjustor, with defendants' attorney, began 
 
         to search for medical specialists who would undertake claimant's 
 
         care.  Gibson reported that Dr. Akeson examined claimant on April 
 
         14, 1986 and then reported to the adjustment company that 
 
         claimant refused treatment with him and that he wished to honor 
 
         her wishes.  Claimant was then scheduled to see Dr. Martin on May 
 
         9, 1986.  Gibson testified that on May 6, 1986, claimant's 
 
         counsel notified the adjustor that claimant would not be 
 
         attending that examination.  An Auxier letter was then sent 
 
         notifying claimant that her benefits would be terminated.  A 
 
         second examination with Dr. Martin was scheduled on August 14, 
 
         .1986.  Claimant attended that examination.  Her benefits were 
 
         terminated as of June 13, 1986 and benefits continued to be 
 
         denied following receipt of Dr. Martin's medical report.  Gibson 
 
         reported that nonpayment of benefits has been premised on the 
 
         contents of Dr. Martin's medical report following claimant's 
 
         August 1986 examination.  Gibson indicated that Dr. Martin 
 
         indicated claimant did not have an injury to treat and that 
 
         claimant had communicated through her counsel that she did not 
 
         wish to treat with Dr. Martin.  Gibson agreed that claimant's 
 
         exhibit 35 refers to examination and not examination and 
 
         treatment.  Defendants' exhibit C is a letter of claimant's 
 
         counsel of May 5, 1986 indicating that claimant would not appear 
 
         for "this examination."
 
         
 
              On referral from Dr. Myers, Stephen Rasmus, M.D., a 
 
         neurologist, saw claimant on May 7, 1984.  Claimant then 
 
         complained that she
 
         had pain around the lateral portion of her elbow when she gripped 
 
         with the right fist, generalized back pain some of which centered 
 
         around the midthoracic level and extended anteriorly around both 
 
         sides, and low back pain, central but radiating to both buttocks, 
 
         more on the right than the left.  Claimant then reported that her 
 
         lower back pain at times radiated down the right posterolateral 
 
         leg and occasionally even into the lateral ankle on the right.  
 
         The two middle toes at times were numb bilaterally.  On physical 
 
         examination, claimant could stand on her heels and toes and could 
 
         tandem walk well.  Strength in the upper extremity showed 
 
         decreased grip on the right but strength was otherwise normal.  
 
         Tenderness existed around the extensor carpi radialis insertion 
 
         at the elbow as well as less well localized tenderness in the 
 
         middle part of the arm.  Back range of motion was good.  Strength 
 
         in the lower extremities appeared normal.  Claimant could 
 
         straight leg raise to 90 degrees with some pain in the posterior 
 
         thigh bilaterally, equal.  DTR's were normoactive and symmetric 
 
         but for the left ankle jerk which might have been less compared 
 
         to the right.  Toes were downgoing and sensory examination was 
 
         inconsistent except in the middle finger and possibly the lateral 
 
         portion of the right foot.
 
         
 
              Dr. Rasmus then felt that claimant likely had extensor 
 
         tendonitis of the right elbow with a possible radiculopathy at 
 
         C7.  He reported that her back pain could be of L-5 or Sl 
 
         radicular origin, more on the right than the left, but that he 
 
         suspected that this was more a muscle strain and perhaps not disc 
 
         disease.  Dr. Rasmus prescribed Doxipen.  EMG's of the left upper 
 

 
         
 
         
 
         
 
         SIEFKEN V. ARCHER-DANIEL-MIDLAND CO.
 
         Page   5
 
         
 
         
 
         extremity and right lower extremity were performed May 21, 1984.  
 
         MCV and EMG of the right upper extremity was normal.  The doctor 
 
         then felt that claimant's symptoms were most likely secondary to 
 
         muscle strain, polar tendonitis.  An EMG of the right lower 
 
         extremity and right paraspinal muscles indicated radiculopathy at 
 
         the Sl and/or L5 level.  Dr. Rasmus again saw claimant on June 5, 
 
         1984 and July 17, 1984.  On July 17, 1984, Dr. Rasmus reported 
 
         that claimant was not doing much better and .that her affect was 
 
         not appropriate for the severity of her symptoms.  Her 
 
         examination remained normal and she was quite flexible and active 
 
         appearing.  Claimant was again seen on October 22, 1984 when Dr. 
 
         Rasmus reported that examination was unremarkable aside from 
 
         decreased left ankle jerk previously found and perhaps sensory 
 
         deficit widely distributed over the lower right leg.  He 
 
         indicated that claimant was not responding to therapy, that she 
 
         had been tried on antidepressants, and that. he could not see 
 
         anything else to do [for her].
 
         
 
              Daniel L. Hoffman, M.D., a general practitioner, first saw 
 
         claimant on January 29, 1985 with complaints of pain in the 
 
         shoulders with radiation to the neck and pain in the lumbar 
 
         sacral spine with radiation down the dorsal aspect of both legs 
 
         to the knees.  On initial examination, claimant had full range of 
 
         motion of the neck without muscle spasm, but muscle spasm
 
         
 
         with point tenderness of both supraspinatus muscles and full 
 
         range of motion of both arms.  Claimant had muscle spasms from L3 
 
         to Sl with point tenderness over the L4 to 5 and L5 to Sl 
 
         interspaces.  Straight leg raising on the right was positive at 
 
         75 degrees but negative on the left.  Reflexes were normal.  A CT 
 
         scan from L3 to Sl was negative.  Dr. Hoffman interpreted  the CT 
 
         scan as showing no disc herniation but as consistent with 
 
         degenerative disc disease at L5 to Sl which would have been 
 
         present before claimant's back injury.  Hoffman's impression was 
 
         that claimant sustained bilateral shoulder strains and lumbar 
 
         sacral strain as a result of a work-related injury of April 2, 
 
         1984.  He felt that her injury had probably somewhat aggravated 
 
         her preexisting degenerative disc disease, thereby prolonging her 
 
         recovery.
 
         
 
              Dr. Hoffman followed claimant on a regular basis through 
 
         September 20, 1986.  In a report of September 26, 1986, Dr. 
 
         Hoffman noted that as of September 20, 1986, claimant continued 
 
         to note pain in her cervical and lumbar sacral spine aggravated 
 
         by cold, damp weather.  He reported that on physical examination 
 
         claimant had muscle spasm of the cervical musculature and muscle 
 
         spasm of the right supraspinatus muscle, as well as muscle spasm 
 
         at L3 to Sl with forward flexion to 75 degrees, left and right 
 
         rotation to 75 degrees.  There was minimal tenderness over the L5 
 
         to Sl interspace.  Neurological examination and reflexes were 
 
         both normal.  The doctor then opined that claimant was not 
 
         capable of returning to a job which would require her to deal 
 
         with 50 to 300 pound weights.  He noted that claimant continued 
 
         under the care of his office receiving muscle relaxants and 
 
         analgesics with a recheck scheduled in three weeks.
 
         
 
              In his deposition taken January 30, 1986, Dr. Hoffman stated 
 
         that claimant would do better at a sit-down job where she could 
 
         get up and move about.  He indicated that she may have 
 

 
         
 
         
 
         
 
         SIEFKEN V. ARCHER-DANIEL-MIDLAND CO.
 
         Page   6
 
         
 
         
 
         intermittent low back problems throughout her life because her 
 
         degenerative joint disease may worsen over time even without 
 
         .trauma.  The doctor reported that claimant's restriction on 
 
         forward flexion may resolve with warmer weather as did a positive 
 
         straight leg raising test and positive knee jerks.
 
         
 
              Om N. Sureka, M.D., a board certified physical medicine and 
 
         rehabilitation specialist, first examined claimant on January 29, 
 
         1985.  His physical findings were consistent with those of Dr. 
 
         Hoffman.  On April 18, 1985, Dr. Sureka opined that claimant was 
 
         likely to have pain in the back of her neck and her back 
 
         intermittently in the future when doing strenuous work.  He 
 
         stated she was advised that when she returns to work, she should 
 
         do light duty work, preferably a desk job.  Dr. Sureka apparently 
 
         saw claimant again on or about August 20, 1985 when he reported 
 
         that straight leg raising test was positive at 90 degrees on both 
 
         sides.  He also apparently saw claimant on or about October 18, 
 
         1985-when he indicated that straight leg raising was positive on
 
         
 
         
 
         both sides at 50 degrees.  Other examination findings were 
 
         consistent with those of January 1985 on both later examinations.  
 
         In October 1985, Dr. Sureka initiated a program of physical 
 
         therapy consisting of hot packs for the back of the neck, 
 
         shoulders, upper and lower back, ultrasound for the back of the 
 
         neck and low back, light sedative massage for the above areas, 
 
         mobilizing exercises for the cervical spine and shoulder joints 
 
         and Williams' flexion exercises.  Dr. Sureka again saw claimant 
 
         on or about March 6, 1986.  On examination, movement of the 
 
         cervical spine was painful at 20 degrees and full reflexion, 
 
         extension, lateral rotation and at 30 degrees in lateral flexion 
 
         to both sides.  Movement of both shoulder joints was. painful at 
 
         140 degrees in abduction and flexion and 80 degrees in external 
 
         rotation.  Movement of lumbar spine was painful at 70 degrees and 
 
         forward flexion at 10 degrees in extension.  Straight leg raising 
 
         was positive at 70 degrees on both sides.  Claimant had muscle 
 
         spasm of the paraspinal muscles in the cervical and thoracolumbar 
 
         spine areas.  Muscle strength was normal in all four extremities.  
 
         Sensation, and deep tendon reflexes were normal and plantars 
 
         reflexor on both sides.  Claimant was asked to continue to use a 
 
         heating pad for the back of the neck, both shoulders, upper and 
 
         lower back and do mobilizing exercises for the cervical spine and 
 
         shoulder joints and Williams' exercises at home.  No recheck 
 
         appointment was initiated.
 
         
 
              In his deposition, Dr. Sureka characterized claimant's 
 
         cervical and lumbar sacral strain as causally related to her 
 
         accident and opined that claimant's condition is permanent in 
 
         that she will have neck and back pain intermittently in the 
 
         future on doing heavy work.  The doctor stated claimant's lifting 
 
         should be restricted to a 20 pound maximum with five to ten 
 
         pounds repetitively, and opined that she could not return to work 
 
         involving heavy lifting, but could do sedentary work.  The doctor 
 
         characterized claimant's range of motion findings as 
 
         significantly different from those normal for a 48 to 49 year old 
 
         obese woman.  The doctor reported that while it was possible 
 
         claimant had some degenerative arthritis prior to April 24, 1984, 
 
         trauma "more likely than not" can lead to early development of 
 
         degenerative arthritis and that claimant was a candidate for 
 

 
         
 
         
 
         
 
         SIEFKEN V. ARCHER-DANIEL-MIDLAND CO.
 
         Page   7
 
         
 
         
 
         development of that condition given her injury, her weight, and 
 
         her back and neck pain.  The doctor stated that varicose veins 
 
         are more common with an injury as claimant has had involving 
 
         heavy lifting.  He reported there is a clear relation between 
 
         varicose veins and heavy work and stated that such veins take six 
 
         months to a year or more to develop.
 
         
 
              John R. Erickson, M.D., who is board certified in internal 
 
         medicine, evaluated claimant on March 27, 1985 and ordered an 
 
         upper GI series which was performed on April 1, 1985.  The upper 
 
         GI series showed tertiary contractions of the esophagus with 
 
         intraesophageal reflex as well as a tiny sliding hiatus hernia 
 
         with gastroesophageal reflux.  On July 29, 1985, Dr. Erickson
 
         
 
         opined the cause of the sliding hiatus hernia was unknown and 
 
         that the condition is extremely uncommon with significance only 
 
         when symptoms of reflux esophagitis exists.  The doctor opined 
 
         that no restrictions on employment would be placed because of the 
 
         hernia.
 
         
 
              Jeffrey W. Akeson, M.D., an orthopedic specialist, examined 
 
         claimant on April 17, 1986.  In a report of that date, he noted 
 
         that claimant consented to his examining her and taking her 
 
         history but refused to permit him to take over her medical 
 
         treatment and stated he would like to honor her wishes in that 
 
         regard.  His impression was that claimant had muscle strain or 
 
         degenerative disc disease as the primary cause of her pain.  He 
 
         found no significant radiculopathy and no physical deformity.
 

 
         
 
         
 
         
 
         SIEFKEN V. ARCHER-DANIEL-MIDLAND CO.
 
         Page   8
 
         
 
         
 
         
 
              Robert I. Martin, M.D., of Occupational Medical Services, 
 
         SC, examined claimant on August 14, 1986.  Following physical 
 
         examination with findings similar to those reported by claimant's 
 
         other physicians, Dr. Martin stated the following:
 
         
 
              There are some significant inconsistencies in the 
 
              examination findings today.  I [sic] particular, the 
 
              patient is able to stand and rock up and down on her 
 
              toes as well as heel walk and then having the diffuse 
 
              weakness in to [sic] flexors and dorsiflexors is 
 
              inconsistent.  The forward flexion to 45 degrees while 
 
              holding herself in an exaggerated lordosis is 
 
              indicative of a purely voluntary guarding of the back.  
 
              The dullness to pin prick sensation in the entire right 
 
              lower extremity and circumferentially about the right 
 
              forearm does not fit with any dermatome distribution.  
 
              Additionally, with the patient seated on the examining 
 
              table when I was checking sensation in her lower 
 
              extremities, I was kneeling down below her.  I would 
 
              look up and ask her whether there was any difference 
 
              between the right and left leg on testing various areas 
 
              with a Wartenberg Pinwheel.  She would look down and 
 
              meet my gaze which constituted flexing her neck over 30 
 
              degrees yet when I voluntarily asked her to flex it in 
 
              the initial part of the examination she could not go 
 
              beyond 20 degrees.
 
         
 
              Dr. Martin indicated that claimant's physical examination 
 
         findings did not objectively document her symptoms on the basis 
 
         of a post-traumatic problem and that he did not believe that her 
 
         varicose veins, her hernia, or her written complaints of 
 
         hemorrhoids were due to her injury.  The doctor opined that the 
 
         diffuse nature of claimant's complaints, her diffuse tenderness 
 
         on examination, the inconsistencies on examination, the lack of 
 
         objective findings on examination all pointed to nonorganic 
 
         etiology for claimant's complaints.  He did not feel that
 
         
 
         
 
         claimant had a post-traumatic problem which required further 
 
         treatment and did not believe she was incapacitated from work on 
 
         the basis of her April 2, 1984 injury.  He believed, however, 
 
         claimant believed she was having those difficulties and, 
 
         therefore, that psychological evaluation might be a benefit in 
 
         determining the etiology of her problems with treatment made 
 
         available for her nonoccupationally-related condition.
 
         
 
                           APPLICABLE LAW AND ANALYSIS
 
         
 
              Our first concern is whether a causal relationship exists 
 
         between claimant's injury and her claimed disabilities.
 
         
 
              The claimant has the burden of proving by a preponderance of 
 
         the evidence that the injury of April 2, 1984 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. 
 
         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 
 

 
         
 
         
 
         
 
         SIEFKEN V. ARCHER-DANIEL-MIDLAND CO.
 
         Page   9
 
         
 
         
 
         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).
 
         
 
              An expert's opinion based on an incomplete history is not 
 
         necessarily binding on the commissioner but must be weighed with 
 
         other facts and circumstances.  Musselman v. Central Tel. Co., 
 
         261 Iowa 352, 360, 154 N.W.2d 128, 133 (1967).
 
         
 
              A treating physician's testimony is not entitled to greater 
 
         weight as a matter of law than that of a physician who later 
 
         examines claimant in anticipation of litigation.  Weight to be 
 
         given testimony of physician is a fact issue to be decided by the 
 
         industrial commissioner in light of the record the parties 
 
         develop.  In this regard, both parties may develop facts as to 
 
         the physician's employment in connection with litigation, if so; 
 
         the physician's examination at a later date and not when the 
 
         injuries were fresh; the arrangement as to compensation; the 
 
         extent and nature of the physician's examination; the 
 
         physician's,
 
         
 
         education, experience, training, and practice; and all other 
 
         factors which bear upon the weight and value of the physician's 
 
         testimony may be considered.  Both parties may bring all this 
 
         information to the attention of the fact finder as either 
 
         supporting or weakening the physician's testimony and opinion.  
 
         All factors go to the value of the physician's testimony as a 
 
         matter of fact not as a matter of law.  Rockwell Graphic Systems, 
 
         Inc. v. Prince, 366 N.W.2d 187, 192 (Iowa 1985).
 
         
 
              The agency's experience, technical competence, and 
 
         specialized knowledge may be utilized in the evaluation of the 
 
         evidence.  Section 17A.14(5)
 
         
 
              Claimant claims myriad symptoms relate to her April 1984 
 
         work injury.  No support exists in this record for a finding of 
 
         causal relationship between claimant's injury and her need for a 
 
         Pap smear, her need to see a dentist, her need to see an 
 
         optomologist or her need to see a podiatrist.  Dr. Erickson who 
 
         treated claimant's hiatus hernia and spastic esophagus does not 
 
         attribute them to her work injury.  Only Dr. Sureka attributes 
 
         claimant's varicose veins to her work injury.  Dr. Sureka's 
 
         testimony suggests he believed claimant did heavy work over a six 
 
         month or more period, however, and that her varicose veins were 
 
         produced by such prolonged heavy work.  The record is to the 
 
         contrary, however, in that claimant did not begin heavy work with 
 

 
         
 
         
 
         
 
         SIEFKEN V. ARCHER-DANIEL-MIDLAND CO.
 
         Page  10
 
         
 
         
 
         defendants until two months before her work injury.  Hence, Dr. 
 
         Sureka's opinion, because not premised on the facts actually in 
 
         evidence, is not sufficient to establish any relationship between 
 
         claimant's claimed varicose and spider veins and her work injury.  
 
         Of course, medical care for treatment of any of the 
 
         aforementioned conditions is not,compensable as not related to 
 
         treatment of a compensable injury.
 
         
 
              Both Dr. Hoffman and Dr. Sureka have characterized 
 
         claimant's other complaints as cervical, shoulder, and lumbar 
 
         sacral strain and related those conditions to her April 1984 work 
 
         incident. .Dr.  Hoffman has stated claimant also has degenerative 
 
         disc disease.  Dr. Sureka has indicated claimant possibly had 
 
         degenerative arthritis prior to her injury but trauma "more 
 
         likely than not" can lead to early development of degenerative 
 
         arthritis.  Dr. Akeson believed claimant had muscle strain or 
 
         degenerative disc disease as the primary cause of her pain but 
 
         did not opine as to causation and felt she had no significant 
 
         radiculopathy or no physical deformity.  Dr. Martin felt that 
 
         claimant's physical examination findings did not objectively 
 
         document her symptoms on the basis of a post-traumatic problem.  
 
         He opined the diffuse nature of claimant's complaints, her 
 
         diffuse tenderness on examination, the inconsistencies on 
 
         examination, the lack of objective findings on examination, all 
 
         pointed to a nonorganic etiology for claimant's complaints.  He 
 
         characterized claimant's condition as nonoccupationally related 
 
         and felt claimant did not have a post-traumatic problem requiring 
 
         further treatment or incapacitating her from work.
 
         
 
              Dr. Hoffman is a general practitioner, Dr. Akeson, an 
 
         orthopedic specialist.  Both Dr. Sureka and Dr. Martin are 
 
         occupational medicine specialists.  Their greater degree of 
 
         specialization is a factor entitling their opinions to greater 
 
         weight.  While Dr. Sureka saw claimant on more occasions than Dr. 
 
         Martin, Dr. Martin apparently took great care in examining 
 
         claimant and appeared genuinely interested in discovering the 
 
         ultimate etiology of her diffuse complaints.  His belief that 
 
         claimant's problems are of a nonorganic origin and not related to 
 
         her work trauma are also consistent with claimant's demeanor at 
 
         hearing.  Other than her obvious use of her cane, claimant 
 
         maneuvered, sat, and stood without apparent difficulty through a 
 
         prolonged hearing process.  Her manner at all times was 
 
         inconsistent with that which this deputy commissioner has 
 
         generally observed in other claimants testifying as to complaints 
 
         as generalized and severe as those claimant purports to have.  
 
         Hence, we must agree with Dr. Martin that claimant's complaints, 
 
         if existent, have a nonorganic basis unrelated to her April 1984 
 
         injury.  Further, we believe this view is consistent with that of 
 
         Dr. Rasmus, the neurologist, who saw and treated claimant within 
 
         a month of her injury.  As of October 22, 1984, Dr. Rasmus 
 
         reported claimant's examination was unremarkable aside from 
 
         decreased left ankle jerk previously found and perhaps sensory 
 
         deficit widely distributed over the lower right leg.  He then 
 
         indicated claimant was not responding to therapy and that he 
 
         could see nothing else to do for her given that antidepressants 
 
         had been tried.  Dr. Rasmus' remarks suggest he also believed 
 
         claimant's complaints had a nonorganic basis and an unknown 
 
         etiology.  Because his treatment of claimant followed almost 
 

 
         
 
         
 
         
 
         SIEFKEN V. ARCHER-DANIEL-MIDLAND CO.
 
         Page  11
 
         
 
         
 
         immediately after her work injury, his remarks when coupled with 
 
         those of Dr. Martin seriously undermine claimant's claim of a 
 
         work injury relationship to her present diffuse cervical, 
 
         shoulder, and sacrolumbar complaints.  Claimant has not shown the 
 
         requisite causal relationship between her present complaints and 
 
         any work injury.  Without such a showing, claimant is not 
 
         entitled to either healing period or temporary total disability 
 
         benefits payments as sought in her petition.  We believe that any 
 
         temporary total disability period related to claimant's work 
 
         injury ceased as of October 22, 1984 when she last saw Dr. 
 
         Rasmus.  She apparently reached maximum objective healing as of 
 
         that date.
 
         
 
              Because we do not believe claimant had a condition causally 
 
         related to a compensable injury after October 22, 1984, claimed 
 
         medical and other expenses after that date are disallowed.  
 
         Claimant is entitled to payment for her April 1984 visits with 
 
         Dr. Roberson, totaling $55.00. Claimant is entitled to payment of 
 
         her Fenn's Drug prescription cost of April 1984 totaling  $15. 
 
         75. As noted, claimant is not entitled to payment of costs with 
 
         Dr. Germain, her dermatologist or Dr. Bryant, apparently her 
 
         dentist.  Claimant is entitled to payment for mileage incurred
 
         
 
         in 1984 totaling 1,180 miles to be reimbursed at the then 
 
         effective rate of $.24 per mile.  Claimant, of course, is not 
 
         entitled to lost wages for her husband nor for costs of 
 
         housecleaning.  The record simply does not support claimant's 
 
         claim that these were expenses made necessary because of any 
 
         compensable injury.  Claimant shall pay equally all costs allowed 
 
         under Division of Industrial Services Rule 343-4.33, formerly 
 
         Industrial Commissioner Rule 500-4.33. Costs not provided for in 
 
         the rule are, of course, disallowed.
 
         
 
                                 FINDINGS OF FACT
 
         
 
              WHEREFORE, IT IS FOUND:
 
         
 
              Claimant sustained an injury on April 2, 1984 when she 
 
         attempted to stabilize a full enzyme drum weighing between 300 
 
         and 350 pounds.
 
         
 
              Claimant initially treated with Dr. Roberson, her family
 
         doctor, the company doctor, Dr. Myers, and Dr. Rasmus, a 
 
         neurologist.
 
         
 
              Claimant last treated with Dr. Rasmus on October 22, 1984.
 
         
 
              Claimant then was not responding to therapy, had been tried 
 
         on antidepressants, and Dr. Rasmus believed nothing further could 
 
         be done for her.
 
         
 
              Claimant first saw Daniel Hoffman, M.D., a general 
 
         practitioner, on January 29, 1985.
 
         
 
              Dr. Hoffman subsequently referred claimant to Om N. Sureka, 
 
         M.D., a physical medicine and rehabilitation specialist.
 
         
 
              Both Dr. Hoffman and Dr. Sureka treated claimant for diffuse 
 
         complaints in her neck, shoulders, and sacrolumbar area.
 

 
         
 
         
 
         
 
         SIEFKEN V. ARCHER-DANIEL-MIDLAND CO.
 
         Page  12
 
         
 
         
 
         
 
              Claimant had numerous other complaints relating to her eyes, 
 
         teeth, veins, and hemorrhoids, for which she saw other medical 
 
         practitioners.
 
         
 
              Claimant had a diagnosed hiatus hernia and spastic 
 
         esophagitis for which John Erickson, M.D., an internist, treated 
 
         her.  The origin of the hiatus hernia is unknown.
 
         
 
              Robert Martin, M.D., an occupational medicine specialist, 
 
         examined claimant on August 14, 1986.
 
         
 
              Claimant had diffuse tenderness on examination, 
 
         inconsistencies on examination, few objective findings on 
 
         examination, and diffuse complaints pointing to a nonorganic 
 
         etiology for her complaints.
 
         
 
              Claimant's demeanor at hearing was inconsistent with the 
 
         nature and severity of her purported complaints.
 
         
 
              Claimant's complaints are of a nonorganic nature and do not 
 
         result from her work injury.
 
         
 
              Claimant reached maximum healing of any work condition as of 
 
         October 22, 1984.
 
         
 
              Claimant's medical costs for dental and eye care and for 
 
         treatment of her hemorrhoids, her veins, and her hiatus hernia 
 

 
         
 
         
 
         
 
         SIEFKEN V. ARCHER-DANIEL-MIDLAND CO.
 
         Page  13
 
         
 
         
 
         and spastic esophagitis are not related to any work injury.
 
         
 
              Claimant's medical costs incurred after October 22, 1984 are 
 
         not related to a work-related condition.
 
         
 
              Claimant's housecleaning expenses and her husband's time off 
 
         work to drive her to appointments do not relate to any work 
 
         related condition.
 
         
 
              Claimant incurred 1,180 miles for medical treatment of her 
 
         work condition on or before October 22, 1984.
 
         
 
              Claimant incurred a prescription cost of $15.75 related to 
 
         her work condition.
 
         
 
              Claimant incurred costs of treatment with Dr. Roberson in 
 
         April 1984 related to her work condition.
 
         
 
                              CONCLUSIONS OF LAW
 
         
 
              THEREFORE, IT IS CONCLUDED:
 
         
 
              Claimant has not established that a causal relationship 
 
         exists between her April 2, 1984 injury and the disability on 
 
         which she bases her claim.
 
         
 
              Claimant has not established that she is entitled to 
 
         temporary total disability benefits from June 13, 1986 onward.
 
         
 
              Claimant is entitled to payment of costs with Dr. Roberson 
 
         totaling $55.00; to payment of costs with Fenn's Drug totaling 
 
         $15.75; and to payment of medical mileage totaling 1,180 miles at 
 
         the rate of $.24 per mile.
 
         
 
              Claimant is not entitled to other claimed medical and 
 
         miscellaneous expenses.
 
         
 
                                   ORDER
 
         
 
              THEREFORE, IT IS ORDERED:
 
         
 
              Defendants pay claimant medical costs as outlined in  the
 
         above conclusions of law.
 
         
 
              Claimant and defendants pay costs equally pursuant to 
 
         Division of Industrial Services Rule 343-4.33, formerly 
 
         Industrial Commissioner Rule 500-4.33.
 
         
 
         
 
         
 
              Signed and filed this 31st day of December, 1986.
 
         
 
         
 
         
 
         
 
                                       HELEN JEAN WALLESER
 
                                       DEPUTY INDUSTRIAL COMMISSIONER
 
         
 
         Copies To:
 

 
         
 
         
 
         
 
         SIEFKEN V. ARCHER-DANIEL-MIDLAND CO.
 
         Page  14
 
         
 
         
 
         
 
         Mr. Jack C. Vieley
 
         Attorney at Law
 
         1816 Savings Center Tower
 
         Peoria, Illinois 61602
 
         
 
         Mr. Christopher Klockan 
 
         Attorney at Law 
 
         1808 Third Avenue
 
         P. 0. Box 1279
 
         Rock Island, Illinois  61204
 
         
 
         Mr. Larry L. Shepler
 
         Mr. Bradford B. Ingram
 
         Attorneys at Law
 
         600 Union Arcade Bldg.
 
         111 East Third Street
 
         Davenport, Iowa 52801-1550
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                                 1108.50
 
                                                 Filed 12-31-86
 
                                                 Helen Jean Walleser
 
         
 
                    BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         _________________________________________________________________
 
         
 
         BURDETTA A. SIEFKEN,
 
         
 
             Claimant,
 
                                                 File No. 762694
 
         VS.
 
         
 
         ARCHER-DANIEL-MIDLAND CO.,
 
                                               A R B I T R A T I 0 N
 
             Employer,
 
                                                 D E C I S I 0 N
 
         and
 
         
 
         THE ILLINOIS INSURANCE
 
         GUARANTY FUND,
 
         
 
             Insurance Carrier,
 
             Defendants.
 
         _________________________________________________________________
 
         
 
         1108.50
 
         
 
              Claimant failed to show that myriad continuing complaints of 
 
         cervical, thoracic, sacrolumbar discomfort, of varicose veins, 
 
         hiatus hernia, spastic esophagus, and dental and eye problems 
 
         related to a compensable injury.
 
 
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                 BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         CONNIE KAY MITCHELL,
 
         
 
              Claimant,                        File Nos. 762771/818960
 
         
 
         vs.                                         A P P E A L
 
         
 
         IOWA MEATS PROCESSING,                    D E C I S I O N
 
         
 
              Employer,                               F I L E D
 
         
 
         and                                         MAR 31 1989
 
         
 
         CHUBB GROUP OF INSURANCE            IOWA INDUSTRIAL COMMISSIONER
 
         COMPANIES,
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
                            STATEMENT OF THE CASE
 
         
 
              Claimant appeals from an arbitration decision denying 
 
         benefits from injuries alleged to have occurred March 22, 1984 
 
         and January 3, 1986.
 
         
 
              The record on appeal consists of the transcript of the 
 
         arbitration hearing and joint exhibits 1 through 101.  Neither 
 
         party filed a brief on appeal.
 
         
 
                                  ISSUE
 
         
 
              This matter will be considered generally without any 
 
         specified error.  The issue of whether claimant suffered injuries 
 
         that arose out of and in the course of her employment with 
 
         defendant employer is dispositive of this matter.
 
         
 
                           REVIEW OF THE EVIDENCE
 
         
 
              The arbitration decision adequately and accurately reflects 
 
         the pertinent evidence and it will not be reiterated herein.
 
         
 
                              APPLICABLE LAW
 
         
 
              The citations of law contained in the arbitration decision 
 
         are appropriate to the issues and evidence.
 
         
 
                                 ANALYSIS
 
         
 
              The analysis of the evidence in conjunction with the law in 
 
         the arbitration decision is adopted.
 
         
 
                             FINDINGS OF FACT
 
                                                
 
                                                         
 
         
 
              1.  Claimant began work for Iowa Meats in December 1980.
 
         
 
              2.  Claimant claims injury through repetitious use of her 
 
         arm and shoulder as well as complains of neck pain.
 
         
 
              3.  Claimant complained of burning of the left trapezius on 
 
         March 23, 1982.
 
         
 
              4.  Claimant was off work from May 3, 1982 through August 
 
         1982 on account of that complaint.
 
         
 
              5.  Claimant treated for like complaints in spring and 
 
         summer, 1984.
 
         
 
              6.  Claimant worked light-duty work during spring and 
 
         summer, 1984.
 
         
 
              7.  Claimant complained of right shoulder, thoracic back 
 
         pain while pulling a loin on January 3, 1986.
 
         
 
              8.  Claimant complained of neck and shoulder pain since 
 
         lifting 60-pound boxes on August 21, 1986.
 
         
 
              9.  Claimant was off work for her neck, shoulder and 
 
         extremity complaints from February 21, 1986 though April 13, 
 
         1986; from May 16, 1986 through May 20, 1986; and from July 9, 
 
         1986 through July 14, 1986.
 
         
 
              10.  Chubb provided Iowa Meats with insurance coverage from 
 
         December 1, 1983 through February 1, 1986.
 
         
 
              11.  John Morrell was the successor employer to Iowa Meats. 
 
         It is unclear when Iowa Meats was sold to John Morrell but it 
 
         appears the sale took place in February or March 1986.
 
         
 
              12.  Chubb did not provide insurance coverage for John 
 
         Morrell.
 
         
 
              13.  Claimant was terminated from employment with John 
 
         Morrell on September 29, 1986 for the stated reason that the 
 
         company could not provide claimant with work within restrictions 
 
         which Dr. Van Patten imposed.
 
         
 
              14.  Pain did not prevent claimant from continuing to work 
 
         at Iowa Meats during the period of coverage of the Chubb Group of 
 
         Insurance Companies.
 
         
 
              15.  It is unclear whether pain prevented claimant from 
 
         continuing to work during the time.she was employed by Iowa 
 
         Meats.
 
         
 
                             CONCLUSION OF LAW
 
         
 
              Claimant has not established an injury which arose out of 
 
                                                
 
                                                         
 
         and in the course of her employment with Iowa Meats during the 
 
         period of insurance coverage of the Chubb Group of Insurance 
 
         Companies.
 
         
 
              WHEREFORE, the decision of the deputy is affirmed.
 
         
 
                                      ORDER
 
         
 
              THEREFORE, it is ordered:
 
         
 
              That claimant take nothing from this proceeding.
 
         
 
              That claimant pay the costs of the appeal including costs of 
 
         transcription of the arbitration hearing.
 
         
 
              That claimant and defendants pay equally the costs of the 
 
         arbitration proceeding pursuant to Division of Industrial
 
         
 
         
 
              Signed and filed this 31st day of March, 1989.
 
         
 
         
 
         
 
         
 
         
 
         
 
                                               DAVID E. LINQUIST
 
                                            INDUSTRIAL COMMISSIONER
 
         
 
         Copies To:
 
         
 
         Mr. Harry H. Smith
 
         Attorney at Law
 
         P.O. Box 1194
 
         Sioux City, Iowa  51102
 
         
 
         Mr. Thomas M. Plaza
 
         Attorney at Law
 
         P.O. Box 3086
 
         Sioux City, Iowa  51102
 
         
 
         
 
                             
 
 
 
 
 
                                                
 
 
            
 
 
 
 
 
           
 
 
 
                                                 1100 - 2209
 
                                                 Filed March 31, 1989
 
                                                 DAVID E. LINQUIST
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         CONNIE KAY MITCHELL,
 
         
 
              Claimant,
 
         
 
         vs.                                   File Nos. 762771/818960
 
         
 
         IOWA MEATS PROCESSING,                     A P P E A L
 
         
 
              Employer,                           D E C I S I 0 N
 
         
 
         and
 
         
 
         CHUBB GROUP OF INSURANCE
 
         COMPANIES,
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
         1100 - 2209
 
         
 
              Claimant did not show an injury with defendant employer 
 
         where claimant did not leave work on account of the injury until 
 
         successor company was the employer and a defendant insurance 
 
         carrier was no longer the insurer.
 
         
 
         
 
         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                   BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         CONNIE KAY MITCHELL,
 
         
 
              Claimant,
 
         
 
         VS.
 
                                                    File Nos. 762771
 
         IOWA MEATS PROCESSING,                               818960
 
         
 
              Employer,                          A R B I T R A T I 0 N
 
         
 
         and                                        D E C I S I 0 N
 
         
 
         CHUBB GROUP OF INSURANCE
 
         COMPANIES,
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
         
 
         
 
                                   INTRODUCTION
 
         
 
              These are proceedings in arbitration brought by the 
 
         claimant, Connie Kay Mitchell, against her employer, Iowa Meats 
 
         Processing, and its insurance carrier, Chubb Group of Insurance 
 
         Companies, to recover benefits under the Iowa Workers' 
 
         Compensation Act as a result of alleged injuries of March 22, 
 
         1984 and January 3, 1986.  This matter came on for hearing before 
 
         the undersigned deputy industrial commissioner at Sioux City, 
 
         Iowa on February 5, 1988.  A first report of injury was filed on 
 
         March 24, 1986 relative to the alleges January 3, 1986 injury and 
 
         on April 24, 1984 relative to the alleged March 22, 1984 injury.  
 
         Defendants have paid claimant 9 3/7 weeks of temporary total 
 
         disability benefits.
 
         
 
              The record in this case consists of the testimony of 
 
         claimant and of Richard D. Sturgeon as well as of the deposition 
 
         testimony of Jolene Annette Loftin and of joint exhibits 1 
 
         through 101.
 
         
 
                                      ISSUES
 
         
 
              Pursuant to the pre-hearing report filed by the parties, the 
 
         parties stipulated that claimant's rate of weekly compensation 
 
         for the alleged 1964 injury is $196.39 and for the alleged 1986 
 
         injury $290.05. The parties further stipulated that the provider 
 
         of medical services would testify that costs for care other than 
 
         that of Dr. Horst Blume were reasonable and necessary.  The 
 
         issues remaining to be decided as regards both claims are:
 
         
 
              1.  Whether claimant received an injury which arose out of 
 
         and in the course of her employment;
 
         
 

 
         
 
         
 
         
 
         MITCHELL V. IOWA MEATS PROCESSING
 
         Page   2
 
         
 
              2.  Whether there is a causal relationship between the 
 
         alleged injury and the claimed disability;
 
         
 
              3.  Whether claimant is entitled to benefits and the 
 
         nature and extent of any benefit entitlement;
 
         
 
              4.  Whether claimant is entitled to payment of medical 
 
         costs as authorized by defendants and causally related to her 
 
         injury and also as reasonable and necessary costs for care as 
 
         regards medical care through Dr. Blume; and,
 
         
 
              5.  Whether an alleged oral settlement agreement is 
 
         binding on the parties.
 
         
 
         
 
                             REVIEW OF THE EVIDENCE
 
         
 
              Connie Kay Mitchell was born on June 2, 1953, has completed 
 
         10.5 grades of school and has obtained a GED.  She worked as a 
 
         production employee for Iowa Meats Processing from December, 1980 
 
         through December 1986.  Claimant had prior meat packing 
 
         experience with Iowa Beef Processors, Iowa Pork Industries and D 
 
         & L Processors.  Her beginning salary with Iowa Meats was $7.00 
 
         per hour.  Her previous employers also paid between $6.50 and 
 
         $7.00 per hour.  Claimant also worked for approximately five 
 
         months as a helper in a tax office.  There, she checked tax 
 
         return calculations, did debit and credit bookkeeping and 
 
         answered the telephone.
 
         
 
              For approximately four years while at Iowa Meats claimant 
 
         graded bellies.  She explained the procedure as involving pulling 
 
         the belly off the line, setting it on a scale, trimming the belly 
 
         and then throwing various trimmed parts into separate combos.  
 
         Bellies were reported as weighing from 12-50 pounds.  One grabbed 
 
         the belly with the left hand and then reached with the right 
 
         after trimming it.  The weighed belly was thrown into the 
 
         appropriate of four, weight-graded combos.  The throw could have 
 
         been backward or forward or to the side, depending upon which 
 
         combo the thrower needed to reach.  Four belly graders worked 
 
         with four scales with 800 units or 1,600 bellies processed per 
 
         hour.  Claimant's position was on the  farthest back of the 
 
         scales.  Claimant alleges she injured her left shoulder and arms 
 
         through repetitive use as a belly grader.  Claimant also worked 
 
         trimming cheeks, boning picnics, trimming butts and boning 
 
         loins.
 
         
 
              During 1982 while pregnant, claimant trimmed butts, which 
 
         she characterized as lighter work.  A. D. Blenderman, M.D., took 
 
         claimant off work at that time as she had developed shoulder, 
 
         neck and left arm pain.  Claimant states that her pain had 
 
         actually begun while grading bellies, but had continually 
 

 
         
 
         
 
         
 
         MITCHELL V. IOWA MEATS PROCESSING
 
         Page   3
 
         
 
         worsened.  Medical records, apparently of W. Jennings, M.D., 
 
         indicate that claimant complained of burning in the left shoulder 
 
         on March 23, 1982.  Myofascitis of the left trapezius was 
 
         diagnosed.  Dr. Blenderman, per medical reports, apparently took 
 
         claimant off work from May 3,1982 through August, 1982.  Claimant 
 
         was then off work from late September, 1982 through March, 1983 
 
         on account of the birth of her child on October 30, 1982.  She 
 
         returned to grading bellies.  Claimant reported she was off work 
 
         as of February 20, 1984 for left shoulder and neck pain for which 
 
         she again saw Dr. Jennings.  Claimant was then off work in 
 
         November and December, 1985 on account of cluster headaches.  In 
 
         1984, claimant apparently bid on loin pulling, but reported she 
 
         was unable to do that job on account of neck and shoulder pain 
 
         and was subsequently disqualified.  Claimant sought care from R. 
 
         Budensiek, D.O., initially in March, 1982 and then also in April, 
 
         1984 on account of right elbow and left arm complaints.  She also 
 
         saw John Dougherty, M.D., during that time.  He apparently 
 
         prescribed a shoulder brace.  Claimant performed light-duty work 
 
         in 1984, which she testified consisted of cleaning, picking up 
 
         and painting.  Claimant subsequently returned to belly grading.  
 
         She testified she had continuous problems and used Advil which 
 
         the plant nurse supplied.
 
         
 
              Claimant testified that, on February 13, 1986, stacked meat 
 
         fell upon her, striking her low back.  She reported that she fell 
 
         forward and was then jarred backwards with her legs forward and 
 
         the rest of her body in a backward position.  Claimant testified 
 
         that, subsequent to that incident, she had episodes of left leg 
 
         numbness which have since resolved.  Claimant testified that, in 
 
         Summer, 1986, she missed work intermittently over a period of six 
 
         weeks for which she was paid temporary total disability benefits.  
 
         Claimant again saw Dr. Dougherty during this period and, in 
 
         April, 1986, saw William P. Isgreen, M.D.  Claimant testified 
 
         that neither Dr. Dougherty nor Dr. Isgreen provided treatment 
 
         which gave her any relief.  On her return to work, claimant was 
 
         doing shoulder rolls.  Claimant reported that, in Spring and 
 
         Summer, 1986, she saw Joe M. Krigsten, M.D., and Milton D. 
 
         Grossman, M.D., as directed by Walter Graves, John Morrell's 
 
         safety director.  Claimant reported that, on September 26, 1986, 
 
         Mr. Graves advised her she would not be permitted to seek further 
 
         medical care and she subsequently saw her own physician, a Dr. 
 
         Van Patten.  Claimant testified that Dr. Van Patten placed her on 
 
         light-duty with restrictions on lifting and pushing and pulling 
 
         with the left arm.  She testified that she was subsequently laid 
 
         off on the basis that light-duty within those restrictions was 
 
         not available.  Claimant expressed her belief that light-duty was 
 
         available.  Claimant is not now working.  She testified that she 
 
         had sought employment subsequent to her layoff, but felt it was 
 
         not worth working for $3.50 per hour if one must pay a babysitter 
 
         $45.00 per week.  Claimant expresses an interest in returning to 
 
         work after her youngest child enters kindergarten in Fall, 1986.
 
         
 
              Claimant testified that she continues to have problems with 
 
         her neck and shoulder if she is required to do scooping, bending 
 
         or scrubbing.  She reported that she has difficulty sleeping and 
 
         needs to change her position frequently if she is to be 
 
         comfortable.  She reported that she has been able to cook, clean 
 
         and do family laundry, but has had trouble with lifting, bending, 
 
         reaching, vacuuming and moving furniture.  Claimant no longer 
 
         bowls, lifts weights or plays softball.
 

 
         
 
         
 
         
 
         MITCHELL V. IOWA MEATS PROCESSING
 
         Page   4
 
         
 
         
 
              Claimant saw Dr. Blume for examination related to her neck 
 
         and shoulder in May, 1987.  She characterized the examination as 
 
         of several hours' duration and as including grip strength testing 
 
         and x-rays.  She reported that Dr. Blume has suggested a nerve 
 
         block, but that she does not wish to undergo that procedure.
 
         
 
              Claimant agreed she had had incidents at work on April 14, 
 
         1986 when her left wrist was caught in a door; on July 22, 1986 
 
         when she fell and hurt her back; on August 21, 1986 when she 
 
         complained of neck and shoulder pain after she had lifted 
 
         60-pound boxes.  Nursing notes in evidence confirm the alleged 
 
         incidents.  A nursing note relative to the April 14, 1986 
 
         incident indicates that a guard who witnessed the accident stated 
 
         claimant had intentionally slammed the door on her wrist.  The 
 
         guard stated that claimant opened the door, put her wrist behind 
 
         the door and then let the door shut on her wrist.  The report for 
 
         August 21, 1986 indicates that claimant is complaining of neck 
 
         and shoulder pains since lifting 60-pound boxes.  A note of 
 
         January 3, 1986 indicates that claimant complained of right 
 
         shoulder, thoracic back pain while pulling on a loin.  BenGay was 
 
         prescribed.  Progress notes dated from February 20, 1986 through 
 
         July 8, 1986 and with the initials "MAJ" indicate that, as of 
 
         March 11, 1986, claimant stated she had had gradual onset of pain 
 
         in the neck, especially on the left side, since three weeks 
 
         earlier.  Objectively, claimant had limited range of motion of 
 
         the neck, especially on rotation to the right.  Forward bending, 
 
         side bending, flexion and extension were normal.  There was some 
 
         tenderness on the right paravertebral musculature.  The 
 
         assessment was of cervical myositis.
 
         
 
              On April 9, 1986, Dr. Dougherty indicated that claimant 
 
         could stand, walk or sit for five to eight hours; could 
 
         occasionally lift up to ten pounds; could bend, climb, carry and 
 
         kneel occasionally; and, was able to work an eight-hour day, but 
 
         was unable to reach above shoulder level.
 
         
 
              On April 23, 1986, Dr. Isgreen opined that his best 
 
         assessment of claimant's neurological problems was involvement of 
 
         the suprascapular nerve on the left below the trapezius and along 
 
         the supraspinatus muscle area.  He reported that, after four 
 
         years of difficulty, he was pessimistic about doing anything to 
 
         help claimant and felt he would simply declare that the chronic 
 
         discomfort and the suggestion of irritation of the suprascapular 
 
         nerve precludes working in situations requiring repetitive 
 
         movement such as pulling and twisting of the shoulders and arms.  
 
         The doctor opined that, under the 1984 AMA guidebook, permanent 
 
         partial impairment of up to five percent was allowed for problems 
 
         of the suprascapular nerve due to discomfort with three to five 
 
         percent being "probably ... a more realistic number."  He opined 
 
         that, after four years of discomfort, claimant had reached a 
 
         plateau and that he would not anticipate further improvement.
 
         
 
              William M. Krigsten, M.D., reported on June 9, 1986 that, 
 
         when he first saw claimant on May 15, 1986, she had pain in the 
 
         left side of her neck with a 25% loss of neck motion and 
 
         tenderness in the left trapezius with some tenderness over the 
 
         radial head. he reported that an EMG of May 16, 1986 was 
 
         consistent with carpal tunnel syndrome, although clinically "this 
 
         doesn't fit into the picture."  He thought her trouble stemmed 
 

 
         
 
         
 
         
 
         MITCHELL V. IOWA MEATS PROCESSING
 
         Page   5
 
         
 
         from the neck.  On May 29, 1986, claimant had normal but painful 
 
         neck motion.  A Phalens test was negative on May 15, 1986, but as 
 
         of May 29, 1986, made all fingers numb and tingle.  Cervical 
 
         spine stretchings were prescribed.  Claimant did not believe such 
 
         were helpful.  On June 27, 1986, Dr. Krigsten opined that, given 
 
         claimant' EMG evidence of carpal tunnel syndrome, he would give 
 
         her a 1% impairment of the left arm.
 
         
 
              John J. Dougherty, M.D., reexamined claimant on July 11, 
 
         1986.  In a report of July 16, 1986, he stated that claimant's 
 
         disability was strictly based on her complaints and that she, at 
 
         best, would be entitled to 1%-2% of the left upper extremity.  He 
 
         felt that her ongoing complaints were associated with somewhat 
 
         poor posture, her mild scoliosis and probably either an 
 
         irritation to the suprascapula nerve or possibly a subscapula 
 
         bursitis or periscapular syndrome. he saw no reason why claimant 
 
         could not continue to work, but reported that she had been off 
 
         work repeatedly in the past and continued to have a problem.  He 
 
         then opined that it appeared to him the only answer to her 
 
         problem would be to quit work and to live with it.  He opined 
 
         that the possibility of a carpal tunnel syndrome should be 
 
         discussed with claimant "although with the tongue in cheek."  He 
 
         thought her problem might possibly be myositis or fibrositis in 
 
         the periscapular area and left shoulder which possibly could 
 
         benefit from, prolonged physiotherapy and deep heat.  On October 
 
         7, 1987, G. L. Tapper, D.C., diagnosed claimantOs condition as 
 
         subluxation of the lower cervical, upper thoracic spine stating 
 
         that, in layman's terms, such represented a minute misalignment 
 
         of two vertebral segments in relationship to one another.  He 
 
         reported the condition can directly or indirectly resuit in 
 
         subsequent irritation to the nerve or muscular tissues of the 
 
         spinal column.  Dr. Tapper felt that claimant's condition 
 
         resulted from, repetitive spinal stress over time.  Dr. Tapper 
 
         first saw claimant on August 26, 1986 per the request of John 
 
         Morrell & Company.  He reported the claimant stated that the 
 
         previous week she had been lifting boxes weighing approximately 
 
         60 pounds for two days and then began to experience pain in the 
 
         lower neck and upper back.  The doctor indicated that this 
 
         incident was the closest to a specific traumatic event which 
 
         claimant related in her initial consultation.
 
         
 
              Dr. Dougherty again examined claimant on October 19, 1987.  
 
         He reported he was not terribly impressed with the amount of pain 
 
         or discomfort she was having and he did not think she was having 
 
         that much trouble.  He was unsure as to what else to suggest in 
 
         regards to treatment, but stated that an MMPI might be 
 
         considered.  He did not believe that a myelogram was indicated.  
 
         He states:  "It appears to me as near as I can tell her 
 
         complaints were just a gradual onset, probably associated with 
 
         work.
 
         
 
              Dr. Blume initially saw claimant on May 11, 1987.  He 
 
         concluded that claimant had sustained an injury to the cervical 
 
         spine of the facet joints and paraspinal muscle mainly on the 
 
         right side and mid upper cervical spine responsible for the 
 
         cervical and occipital myalgia on the right side.  He thought 
 
         that both the neck and back conditions were related to years of 
 
         working at the packing house where she did lifting, turning, 
 
         twisting, reaching and throwing of pork bellies on a repetitive, 
 
         daily and yearly basis.  He felt claimant had a similar condition 
 

 
         
 
         
 
         
 
         MITCHELL V. IOWA MEATS PROCESSING
 
         Page   6
 
         
 
         with some irritation of the facet joints and paraspinal muscles 
 
         in the low back, but without evidence of lower cervical or 
 
         lumbosacral nerve root irritation or compression signs.  He 
 
         reported that he would "basically agree with Dr. Isgreen, that 
 
         the patient has a permanent partial impairment for the neck and 
 
         back condition to the body as a whole of 5%."
 
         
 
              The following medical expenses were entered into evidence 
 
         through exhibits 2, 3, 4, 56, 62, 67, 70, 99, 100 and 101:
 
         
 
              Dr. Krigsten -- 4/30/86-6/6/86           $    225.00
 
              Dr. Tapper -- 8/26/86-9/8/86                  220.00
 
              Dr. Van Patten -- 9/26/86-10/8/87             500.00
 
              Dr. McGowan -- 8/18/80                         32.50
 
              Dr. McGowan -- 8/25/80                         12.00
 
              Dr. McGowan -- 8/27/86                         12.00
 
              Morningside Family Practice -- 7/8/86          20.00
 
              Dr. Dougherty -- 7/31/86                      400.00
 
         
 
              Richard D. Sturgeon identified himself as a self-employed 
 
         paralegal-legal assistant with claimant's counsel's firm.  He 
 
         reported that he had been involved in work on claimant's file and 
 
         had communicated with the insurer and the employer regarding 
 
         claimant's claim.  Mr. Sturgeon expressed his belief that Iowa 
 
         Meat Processing had changed its name to John Morrell & Company on 
 
         March 15, 1986 and that Chubb had ceased to be Iowa Meat's 
 
         insurer as of February 1, 1986.  He reported that, in Spring, 
 
         1986, claimant had asked assistance with getting medical care as 
 
         a result of a dispute between John Morrell and Chubb.  Such had 
 
         not been resolved as of October, 1986.  Mr. Sturgeon described 
 
         himself as actively participating in settlement negotiations with 
 
         Chubb as 
 
         
 
         those were carried out by Jolene Annette Loftin, a claims 
 
         adjustor for Chubb.  He reported that Ms. Loftin offered $6,000 
 
         on a special case settlement where an allegation of subsequent 
 
         injury would be made.  Sturgeon testified that he advised Loftin 
 
         he was investigating the subsequent alleged injury and, if found, 
 
         would file a new petition against John Morrell and its insurance 
 
         carrier.  Sturgeon reported that John Morrell subsequent denied 
 
         that a new injury with John Morrell had occurred.  He later 
 
         stated that any new injury was not to the upper body, but, if any 
 
         existed, was to the left lower back and left leg.  He expressed 
 
         his belief that that did not result in a McKeever situation and 
 
         that, therefore, the parties were unable to settle under the 
 
         proffered section 85.35 settlement.
 
         
 
              Jolene Annette Loftin testified that Chubb had been Iowa 
 
         Meats' insurer from December 1, 1983 through February 1, 1986.  
 
         She indicated that Iowa Meats was sold to John Morrell & Company 
 
         and that Chubb had never insured John Morrell.  Ms. Loftin 
 
         testified that claimant was paid medical benefits and temporary 
 
         total benefits by Chubb through the following dates:  February 
 
         21, 1986 through April 13, 1986; May 16, 1986 through May 20, 
 
         1986; and, July 9, 1986 through July 14, 1986.  She expressed her 
 
         belief that Chubb would not have paid such benefits had it been 
 
         aware of the holdings in the McKeever decision.  Ms. Loftin 
 
         indicated that claimant was last given medical treatment by Chubb 
 
         under section 85.27 in September, 1986.  She indicated that Chubb 
 
         had authorized claimant to see Dr. Jennings who had subsequently 
 

 
         
 
         
 
         
 
         MITCHELL V. IOWA MEATS PROCESSING
 
         Page   7
 
         
 
         referred her to Dr. Dougherty.  She indicated that Chubb also had 
 
         permitted claimant to see Dr. Isgreen when claimant sought a 
 
         second opinion.  Ms. Loftin stated that Walt Graves had permitted 
 
         claimant to seek treatment with Dr. Krigsten and Dr. Grossman 
 
         without the insurer's knowledge.
 
         
 
              Ms. Loftin indicated that, on approximately August 5, 1986, 
 
         she had a phone conversation with Mr. Sturgeon in which she 
 
         offered $6,000 to settle the claim on the basis of section 85.35. 
 
         She reported that, on September 16, 1986, during a phone 
 
         conversation, Sturgeon informed her that claimant had had an 
 
         injury of February 13, 1986 and that, if Chubb was off coverage 
 
         for such injury, the $6,000 was probably acceptable.  
 
         Subsequently a letter was received reporting that claimant's 
 
         counsel felt there was new information suggesting Chubb's 
 
         coverage was through February 15, 1986 and that, if such were 
 
         true, the offer would probably be rejected, but is such were not 
 
         true, the offer would probably be accepted.  Ms. Loftin indicated 
 
         that she checked the coverage period and reestablished that the 
 
         coverage ended as of February 1, 1986.  She stated she therefore 
 
         sent information to her counsel for processing of section 85.35 
 
         settlement papers.  She reported that, by way of a phone 
 
         conversation of September 29, 1986, Mr. Sturgeon advised her that 
 
         the deal had fallen through.
 
         
 
         
 
                           APPLICABLE LAW AND ANALYSIS
 
         
 
         
 
              Our first concern is whether claimant receives an injury 
 
         which arose out of and in the course of her employment with the 
 
         alleged employer.
 
         
 
              Claimant has the burden of proving by a preponderance of the 
 
         evidence that she received injuries on March 22, 1984 and January 
 
         3, 1986 which arose out of and in the course of her employment.  
 
         McDowell v. Town of Clarksville, 241 N.W.2d 904 (Iowa 1976); 
 
         Musselman v. Central Telephone Co., 261 Iowa 352, 154 N.W.2d 128 
 
         (1967).
 
         
 
              An employee is entitled to compensation for any and all 
 
         personal injuries which arise out of and in the course of the 
 
         employment.  Section 85.3(l).
 
         
 
              The injury must both arise out of and be in the course of 
 
         the employment.  Crowe v. DeSoto Consol. Sch. Dist., 246 Iowa 
 
         402, 68 N.W.2d 63 (1955) and cases cited at pp.405-406 of the 
 
         Iowa Report.  See also Sister Mary Benedict v. St. Mary's Corp., 
 
         255 Iowa 847, 124 N.W.2d 548 (1963) and Hansen v. State of Iowa, 
 
         249 Iowa 1147, 91 N.W.2d 555 (1958).
 
         
 
              The words "out of" refer to the cause or source of the 
 
         injury.  Crowe v. DeSoto Consol. Sch. Dist., 246 Iowa 402, 68 
 
         N.W.2d 63 (1955).
 
         
 
              The words "in the course of" refer to the time and place and 
 
         circumstances of the injury.  McClure v. Union et al.  Counties, 
 
         188 N.W.2d 283 (Iowa 1971); Crowe v. DeSoto Consol. Sch. Dist., 
 
         246 Iowa 402, 68 N.W.2d 63 (1955).
 
         
 

 
         
 
         
 
         
 
         MITCHELL V. IOWA MEATS PROCESSING
 
         Page   8
 
         
 
              "An injury occurs in the course of the employment when it is 
 
         within the period of employment at a place the employee may 
 
         reasonably be, and while he is doing his work or something 
 
         incidental to it.O  Cedar Rapids Comm. Sch. Dist. v. Cady, 278 
 
         N.W.2d 298 (Iowa 1979), McClure v. Union et al. Counties, 188 
 
         N.W.2d 283 (Iowa 1971), Musselman v. Central Telephone Co., 261 
 
         Iowa 352, 154 N.W.2d 128 (1967).
 
         
 
              The supreme court of Iowa in Almquist v. Shenandoah 
 
         Nurseries, 218 Iowa 724, 731-32, 254 N.W. 35, 36 (1934), 
 
         discussed the definition of personal injury in workers' 
 
         compensation cases as follows:
 
         
 
              While a personal injury does not include an 
 
              occupational disease under the Workmen's Compensation 
 
              Act, yet an injury to the health may be a personal 
 
              injury. [Citations omitted.]  Likewise a personal 
 
              injury includes a disease resulting from an injury .... 
 
              The result of changes in the human body incident to the 
 
              general processes of nature do not amount to a personal 
 
              injury.  This must follow, even though such natural 
 
              change may come about because the life has been devoted 
 
              to labor and hard work.  Such result of those natural 
 
              changes does not constitute a personal injury even 
 
              though the same brings about impairment of health or 
 
              the total or partial incapacity of the functions of the 
 
              human body.
 
         
 
                 ....
 
         
 

 
         
 
         
 
         
 
         MITCHELL V. IOWA MEATS PROCESSING
 
         Page   9
 
         
 
              A personal injury, contemplated by the Workmen's 
 
              Compensation Law, obviously means an injury to the 
 
              body, the impairment of health, or a disease, not 
 
              excluded by the act, which comes about, not through the 
 
              natural building up and tearing down of the human body, 
 
              but because of a traumatic or other hurt or damage to 
 
              the health or body of an employee. [Citations omitted.]  
 
              The injury to the human body here contemplated must be 
 
              something, whether an accident or not, that acts 
 
              extraneously to the natural processes of nature, and 
 
              thereby impairs the health, overcomes, injures, 
 
              interrupts, or destroys some function of the body, or 
 
              otherwise damages or injures a part or all of the 
 
              body.
 
         
 
              In McKeever Custom Cabinets v. Smith, 379 N.W.2d 368 (Iowa 
 
         1985), the Iowa Supreme Court upheld this agency's adaption of 
 
         the cumulative injury rule for application in factually 
 
         appropriate cases.  The McKeever Court cited Larsen's Workmen's 
 
         Compensation Law, section 39.50 at 11-350.28 for two general 
 
         rules as to when the injury occurs for time limitation purposes 
 
         in cumulative trauma cases.  Under Larsen, the injury may occur 
 
         when pain prevents the employee from, continuing to work or when 
 
         pain occasions the need for medical treatment.  The Court adopted 
 
         the view that the injury occurs when pain prevents the employee 
 
         from continuing work reasoning that "clearly the employee is 
 
         disabled and injures when, because of pain or physical disability 
 
         he can no longer work.O  McKeever at 374.  The McKeever Court 
 
         then adopted what is commonly called the "last injurious exposure 
 
         rule" for successive trauma cases, thereby placing full liability 
 
         upon the carrier covering the risk at the time of the most recent 
 
         trauma bearing a causal relationship to any disability.  
 
         McKeever at 376.
 
         
 
              Claimant alleges a cumulative trauma brought about through 
 
         repetitious use of her arm and shoulder.  In her petition, she 
 
         cites two specific injury dates, that is, March 22, 1984 and 
 
         January 3, 1986.  The first reference in the record to complaints 
 
         regarding claimant's upper extremity and shoulder area occur in 
 
         what apparently is a note of Dr. Jennings of March 23, 1982 
 
         wherein he recites that claimant complains of burning in the left 
 
         trapezious area.  Claimant was off work from May 3, 1982 through 
 
         August, 1982, apparently on account of that complaint.  Claimant 
 
         has not alleged a specific injury date in 1982, however.  Nor 
 
         does the record made suggest that the claimant did not recover 
 
         sufficiently from her condition at that time such that she could 
 
         not return to and continue working.  Indeed, the record indicates 
 
         that claimant's next treatment for like conditions was in spring 
 
         and summer, 1984.  She saw Drs. Budensiek and Dougherty over that 
 
         period, but apparently continued to perform light-duty work.  
 
         Claimant alleges an aggravation of her condition on January :3, 
 
         1986, but presented little evidence regarding such.  Claimant was 
 
         then intermittently off work from February 21, 1986 through April 
 
         13, 1986; from May 16, 1986 through May 20, 1986; and, from July 
 
         9, 1986 through July 14, 1986.  Chubb Group of Insurance 
 
         Companies, the alleged insurance carrier in this action, insured 
 
         Iowa Meats from December 1, 1983 through February 1, 1966.  
 
         Apparently, Iowa Meats was sold to John Morrell & Company during 
 
         1986.  Chubb has never insured John Morrell.  Claimant continued 
 
         to work at the Iowa Meats/John Morrell plant until she was 
 

 
         
 
         
 
         
 
         MITCHELL V. IOWA MEATS PROCESSING
 
         Page  10
 
         
 
         terminated from John Morrell's employment on September 29, 1986.  
 
         Claimant's termination resulted from her inability to work in the 
 
         plant, given the restrictions that her personal physician, Dr. 
 
         Van Patten, had imposed.  Claimant had several incidents 
 
         involving neck and shoulder pain after February 1, 1986.  We 
 
         exclude from, those incidents the alleged injury of February 13, 
 
         1986 as findings indicate that that primarily involved the lower 
 
         back and left lower extremity.  Claimant did catch her left wrist 
 
         in a door on April 14, 1986; she fell and hurt her back on July 
 
         22, 1986; and, she complained of neck and shoulder pain after 
 
         lifting 60-pound boxes on or about August 21, 1986.  On January 
 
         3, 1986, claimant had complained of right shoulder, thoracic back 
 
         pain while pulling a loin.  All of the above suggest that, while 
 
         claimant may have had cumulative trauma which culminated in an 
 
         injury under the McKeever doctrine, any such injury did not occur 
 
         during ChubbOs period of insurance coverage.  Hence, under the 
 
         McKeever doctrine, Chubb would not be liable for payment of 
 
         workers' compensation benefits to claimant.  Any injury would 
 
         have occurred when claimant left work as pain prevented her from 
 
         continuing to work.  After 1982, a period for which claimant does 
 
         not claim injury in this action, claimant did not leave work 
 
         again until February 21, 1986.  She did not ultimately leave, 
 
         that is, she was not terminated on account of her restrictions 
 
         and thereby unable to continue working, until September 29, 1986. 
 
          Both those events were outside the period of Chubb's insurance 
 
         coverage.  Both events were also, apparently, beyond the times 
 
         when Iowa Meats employed claimant.  Hence, we do not find an 
 
         injury arising out of and in the course of claimant's employment 
 
         with Iowa Meats. [We expressly do not find as well that claimant 
 
         sustained an injury arising out of and in the course of her 
 
         employment with John Morrell.  That question is not before us in 
 
         this action.  Any issue regarding whether claimant received an 
 
         injury during her John Morrell employment would need to be 
 
         addressed in a claim against that employer.]
 
         
 
              As claimant has not prevailed on the threshold issue of  
 
         whether she received an injury which arose out of and in the 
 
         course of her employment with this employer, we need not reach 
 
         the remaining issues.
 
         
 
         
 
                                 FINDINGS OF FACT
 
         
 
              WHEREFORE, IT IS FOUND:
 
         
 
              Claimant claims injury through repetitious use of her arm 
 
         and shoulder as well as complains of neck pain.
 
         
 
              Claimant complained of burning of the left trapezious on 
 
         March 23, 1982.
 
         
 
              Claimant was off work from May 3, 1982 through August, 1982 
 
         on account of that complaint.
 
         
 
              Claimant treated for like complaints in Spring and Summer, 
 
         1984.
 
         
 
              Claimant worked light-duty work during Spring and Summer, 
 
         1984.
 
         
 

 
         
 
         
 
         
 
         MITCHELL V. IOWA MEATS PROCESSING
 
         Page  11
 
         
 
              Claimant complained of right shoulder, thoracic back pain 
 
         while pulling a loin on January 3, 1986.
 
         
 
              Claimant complained of neck and shoulder pain since lifting 
 
         60-pound boxes on August 21, 1986.
 
         
 
              Claimant was off work for her neck, shoulder and extremity 
 
         complaints from February 21, 1986 through April 13, 1986; from 
 
         May l6, 1986 through May 20, 1986; and, from July 9, 1986 through 
 
         July 14, 1986.
 
         
 
              Chubb provided Iowa Meats with insurance coverage from 
 
         December 1, 1983 through February 1, 1986.
 
         
 
              John Morrell was the successor employer to Iowa Meats.
 
         
 
              Chubb did not provide insurance coverage for John Morrell.
 
         
 
              Claimant was terminated from employment with John Morrell on 
 
         September 29, 1986 for the stated reason that the company could 
 
         not provide claimant with work within restrictions which Dr. Van 
 
         Patten imposed.
 
         
 
              Pain did not prevent claimant from continuing to work at 
 
         Iowa Meats during the period of coverage of the Chubb Group of 
 
         Insurance Companies.
 
         
 
         
 
                                CONCLUSIONS OF LAW
 
         
 
         
 
              THEREFORE, IT IS CONCLUDED:
 
         
 
              Claimant has not established an injury which arose out of 
 
         and in the course of her employment with Iowa Meats during the 
 
         period of insurance coverage of the Chubb Group of insurance 
 
         Companies.
 
         
 
         
 
                                      ORDER
 
         
 
              THEREFORE, IT IS ORDERED:
 
         
 
              Claimant take nothing from this proceeding.
 
         
 
              Claimant and defendants pay equally the costs of this 
 
         proceeding pursuant to Division of Industrial Services Rule 
 
         343-4.33.
 
         
 
         
 
              Signed and filed this 24th day of June, 1988.
 
         
 
         
 
         
 
         
 
         
 
         
 
         
 
                                         HELEN JEAN WALLESER
 
                                         DEPUTY INDUSTRIAL COMMISSIONER
 

 
         
 
         
 
         
 
         MITCHELL V. IOWA MEATS PROCESSING
 
         Page  12
 
         
 
         
 
         Copies To:
 
         
 
         Mr. Harry H. Smith
 
         Attorney at Law
 
         632-640 Badgerow Building
 
         P.O. Box 1194
 
         Sioux City, Iowa 51102
 
         
 
         Mr. Thomas M. Plaza
 
         Attorney at Law
 
         200 Home Federal Building
 
         P.O. Box 3086
 
         Sioux City, Iowa 51102
 
         
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                                   1100, 2209
 
                                                   Filed June 24, 1988
 
                                                   HELENJEAN WALLESER
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         CONNIE KAY MITCHELL,
 
         
 
              Claimant,
 
         
 
         VS.
 
                                                      File Nos. 762771
 
         IOWA MEATS PROCESSING,                                 818960
 
         
 
              Employer,                            A R B I T R A T I 0 N
 
         
 
         and                                          D E C I S I 0 N
 
         
 
         CHUBB GROUP OF INSURANCE
 
         COMPANIES,
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
         
 
         1100, 2209
 
         
 
              Claimant did not show an injury with prior employer where 
 
         claimant did not leave work on account of the injury until 
 
         subsequent employer and subsequent insurer were on the risk.
 
 
 
         
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         RITA M. HUTTIG,
 
         
 
              Claimant,
 
                                                 File No. 762852
 
         VS.
 
         
 
         YOUNKERS,                             A R B I T R A T I 0 N
 
         
 
              Employer,
 
                                                  D E C I S I 0 N
 
         and
 
         
 
         AETNA CASUALTY,
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
                                        
 
                                   INTRODUCTION
 
         
 
              This is a proceeding in arbitration brought by the claimant, 
 
         Rita M. Huttig, against her employer, Younkers, and its insurance 
 
         carrier, Aetna Casualty, to recover benefits under the Iowa 
 
         Workers' Compensation Act as a result of an injury sustained 
 
         April 13, 1984.  This proceeding was held before the undersigned 
 
         Deputy Iowa Industrial Commissioner at Davenport, Iowa, on May 
 
         22, 1987.  A first report of injury was filed April 23, 1984.  
 
         Claimant has been paid 6/7 weeks of temporary total disability 
 
         benefits.  The record was considered fully submitted at the close 
 
         of hearing.
 
         
 
              The record consists of the testimony of claimant as well as 
 
         of joint exhibits A through P and claimant's exhibits 1 through 9 
 
         as identified on the exhibit lists which are a part of the 
 
         official file in this matter.
 
         
 
                                      ISSUES
 
         
 
              Pursuant to the pre-hearing report filed by the parties, the 
 
         parties stipulated that claimant's rate of weekly compensation is 
 
         $121.42; that claimant was off work on account of her injury from 
 
         April 14, 1984 to April 22, 1984 with temporary total disability 
 
         or healing period benefits through that period; and, that 
 
         claimant received an injury arising out of and in the course of 
 
         her employment on April 13, 1984.  The issues remaining for 
 
         resolution are:
 
         
 
              1.  Whether there is a causal relationship between the
 
         injury and claimant's claimed disability; and,
 
         
 

 
         
 
         
 
         
 
         HUTTIG V. YOUNKERS
 
         Page   2
 
         
 
         
 
              2.  Whether claimant is entitled to permanent partial 
 
         disability benefits.
 
         
 
                          REVIEW OF THE EVIDENCE
 
         
 
              Claimant is 56 years old and has had one year of college.  
 
         She was injured on April 13, 1984 when, while acting as head of 
 
         the accessory sales department at Younkers, she caught her shoe 
 
         toe in a marble square in the department and fell face-forward 
 
         hitting the left side of her face and both knees.  Claimant was 
 
         taken to St. Lukes Hospital emergency room where her facial cut 
 
         was sutured and an ace bandage was applied to the left knee.  
 
         Claimant reported that the left knee would not "unlock."  
 
         Claimant returned to work on April 23, 1984 and worked until 
 
         December, 1984 when she left her Younkers employment for reasons 
 
         not related to the injury.  Claimant testified that she has had 
 
         trouble with her knees on squatting and on descending stairs with 
 
         more problems with the left knee than with the right.  She 
 
         reported she has pain and swelling in the evenings and after 
 
         activities and stiffness upon waking.  She indicated that humid 
 
         weather increases her difficulty.  She stated she no longer bowls 
 
         or plays tennis, walks only in moderation, and takes aspirin as 
 
         needed for knee pain.
 
         
 
              Claimant saw John Sinning, M.D., an orthopaedic surgeon, on 
 
         February 19, 1985.  Dr. Sinning prescribed physical therapy 
 
         consisting primarily of extremity strengthening and stretching 
 
         exercises.  Claimant reported she does prescribed exercises.  
 
         Claimant denied having told Dr. Sinning, when she again saw him 
 
         on May 19, 1985 for an evaluation the insurer requested, that she 
 
         no longer had knee pain.  She denied knowing that Dr. Sinning had 
 
         stated her gait problem was unrelated to her work injury.
 
         
 
              Vijay Verma, M.D., evaluated claimant on September 12, 1986. 
 
          She did not know why she had not told Dr. Verma she had a 
 
         problem descending stairs.  Claimant agreed that she had had two 
 
         prior right knee injuries when her knee had either given out or 
 
         she had fallen in 1973 and 1977 and that she had seen Dr. Sinning 
 
         for those problems.  She testified she had had no problems with 
 
         her left knee prior to April 13, 1984 and stated that no surgery 
 
         or other medical treatment was scheduled for the left knee.
 
         
 
              An emergency room report of April 13, 1984 stated that the 
 
         right leg is negative and that the left leg has swelling, 
 
         tenderness, and discoloration over the medial aspect of the left 
 
         knee with the left knee being very painful with attempted range 
 
         of motion.  A surgeon's report of April 30, 1984 diagnoses 
 
         claimant's condition as a left lid laceration and as left knee 
 
         bursitis.
 
         
 
              A medical report of Dr. Sinning dated April 4, 1986 
 
         reported, as regards a February, 1985 examination that claimant 
 
         walked with a normal gait, had stable ligaments, but was 
 
         consistently quite tender at the insertion of the patellar 
 
         tendon.  The report also stated that claimant had patellofemoral 
 
         crepitus in the terminal 200 of extension, but that 
 
         patellofemoral compression was not painful.  Rotary testing was 
 
         considered unremarkable.  X-rays were entirely normal with no 
 
         evidence of degenerative changes when compared with x-rays taken 
 

 
         
 
         
 
         
 
         HUTTIG V. YOUNKERS
 
         Page   3
 
         
 
         
 
         in 1977.  The doctor's impression was of chronic patellar 
 
         tendonitis with some chondromalacia of the patella which may 
 
         contribute.  He reports that there does not appear to be any 
 
         significant permanent impairment.
 
         
 
              Dr. Sinning reported on May 19, 1986 that there was no 
 
         indication of any gait problem related to claimant's work injury 
 
         and that claimant appeared to have reached maximum recovery from 
 
         her work injury.  He reported there was full range of motion of 
 
         both knees with good strength and without the complaints of pain 
 
         which claimant had had previously.  He recommended no further 
 
         treatment.
 
         
 
              A note of Dr. Sinning of September 12, 1973 reported that 
 
         claimant has had a right knee giving way at home upon getting out 
 
         of bed and that the diagnosis is an internal derangement of the 
 
         right knee, type unknown.  An arthrogram of the knee performed at 
 
         that time was normal.  A note of Dr. Sinning, apparently of 
 
         September 16, 1977, reported that claimant's right knee is 
 
         swollen and painful after a fall at home, but that the knee is 
 
         stable without ligamentous instability.  X-rays taken were 
 
         normal.
 
         
 
              A report of Dr. Verma dated September 12, 1986 stated that 
 
         no symptoms of chondromalacia of the patella are found, but that 
 
         claimant has moderate crepitations palpable during knee range of 
 
         motion.  He reported that there are no restrictions and no 
 
         locking of the knee.  Claimant's gait is reported as adequate, 
 
         but with complaints of weakness of the left lower extremity after 
 
         walking.  Range of motion is normal on the right and normal on 
 
         the left as far as the hip and knee, but dorsiflexion of the left 
 
         ankle is barely to 50.  The doctor's impression then was of light 
 
         lower extremity chronic mild weakness and inconsistent pain.  He 
 
         stated that claimant's permanent partial "disability" was 10% and 
 
         as a result of the medical history and the information obtained 
 
         from claimant, the disability could "possibly" be related to the 
 
         April 13, 1984 fall.
 
         
 
              In a report of October 20, 1986, Dr. Verma stated that the 
 
         permanent partial "disability" related to the whole person.  He 
 
         characterized the word "possibly" as "a typographical error" and 
 
         restated that claimant's condition was "probably" related to the 
 
         fall of April 13, 1984.
 
         
 
              In a November 26, 1986 report, Dr. Verma stated that 
 
         claimant is left lower extremity impairment under the AMA guides 
 
         would be 35% of the left lower extremity as a result of chronic 
 
         mild weakness of the left lower extremity and restricted ankle 
 
         range of motion on dorsiflexion.
 
         
 
                           APPLICABLE LAW AND ANALYSIS
 
         
 
              Of first concern is the causal relationship question.
 
         
 
              The claimant has the burden of proving by a preponderance of 
 
         the evidence that the injury of April 13, 1984 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. 0. Boggs, 236 Iowa 296, 18 N.W.2d 607 (1945).  A 
 

 
         
 
         
 
         
 
         HUTTIG V. YOUNKERS
 
         Page   4
 
         
 
         
 
         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).
 
         
 
              A treating physician's testimony is not entitled to greater 
 
         weight as a matter of law than that of a physician who later 
 
         examines claimant in anticipation of litigation.  Weight to be 
 
         given testimony of physician is a fact issue to be decided by the 
 
         industrial commissioner in light of the record the parties 
 
         develop.  In this regard, both parties may develop facts as to 
 
         the physician's employment in connection with litigation, if so; 
 
         the physician's examination at a later date and not when the 
 
         injuries were fresh; the arrangement as to compensation; the 
 
         extent and nature of the physician's examination; the physician's 
 
         education, experience, training, and practice; and all other 
 
         factors which bear upon the weight and value of the physician's 
 
         testimony may be considered.  Both parties may bring all this 
 
         information to the attention of the factfinder as either 
 
         supporting or weakening the physician's testimony and opinion.  
 
         All factors go to the value of the physician's testimony as a 
 
         matter of fact not as a matter of law.  Rockwell Graphic Systems, 
 
         Inc. v. Prince, 366 N.W.2d 187, 192 (Iowa 1985).
 
         
 
              The only practitioner's opinion relating claimant's current 
 
         complaints to her fall at work is that of Dr. Verma who saw 
 
         claimant only once on September 12, 1986.  He relies upon 
 
         claimant's medical history and information claimant gave him to 
 
         relate her lower extremity complaints and the objective finding 
 
         of restricted ankle range of motion on dorsiflexion to the April 
 
         13, 1984 fall.  He appears to have had great difficulty 
 
         determining whether claimant's condition is possibly or probably 
 
         related to the fall.  He does report that claimant has no 
 
         restrictions during knee range of motion as well as no locking of 
 
         the knee and an adequate gait.  Those findings are consistent 
 
         with findings of Dr. Sinning who saw claimant and prescribed 
 
         physical therapy in February, 1985 and who reexamined claimant in 
 
         May, 1986.  In April, 1986, Dr. Sinning reported that, when 
 
         examined in 1985, claimant did not appear to have significant 
 
         permanent impairment.  After reexamining claimant in May, 1986, 
 
         he reported that claimant then had full range of motion of the 
 
         knees with good strength and without the pain complaints she had 
 
         had previously.  Dr. Sinning's diagnosis of claimant's condition 
 
         as chronic patellar tendonitis is consistent with the surgeon's 
 
         report diagnosis of left knee bursitis of April 30, 1984.  We 
 

 
         
 
         
 
         
 
         HUTTIG V. YOUNKERS
 
         Page   5
 
         
 
         
 
         accept Dr. Sinning's evaluation of claimant and his statement 
 
         made in April, 1986 that there does not appear to be significant 
 
         permanent impairment over claimant's self-described complaints 
 
         and over Dr. VermaOs opinions.  The statement of Dr. Sinning 
 
         appears to have been arrived at more objectively.  We note that 
 
         the medical evidence does not reveal any left ankle injury in 
 
         claimant's fall.  We do not find that claimant has established a 
 
         causal relationship between her April, 1984 work incident and the 
 
         claimed disability to her left knee.  We also do not find that 
 
         claimant has shown a causal connection between her injury and her 
 
         right knee complaints.  The evidence does not indicate that 
 
         claimant's right knee was ever considered or diagnosed as injured 
 
         in the April 13, 1984 incident.  Further, the evidence clearly 
 
         shows that claimant had had prior long existing problems with the 
 
         right knee.
 
         
 
              As we have not found the requisite causal relationship 
 
         between claimant's claimed disability and her injury, we need not 
 
         reach the benefit entitlement question.
 
         
 
                                 FINDINGS OF FACT
 
         
 
              WHEREFORE, IT IS FOUND:
 
         
 
              1.  Claimant fell at work on April 13, 1984 and was then 
 
         medically treated for a left-sided facial laceration and for 
 
         swelling, tenderness and discoloration over the medial aspect of 
 
         the left knee.
 
         
 
              2.  Claimant's right leg was negative for evidence of injury 
 
         on April 13, 1984.
 
              
 
              3.  Claimant's right knee had given out and she had fallen 
 
         with the right knee in non-work incidents in 1973 and 1977.
 
         
 
              4.  Claimant's gait problem does not relate to her work 
 
         injury.
 
         
 
              5.  Claimant had bursitis of the left knee on April 30, 
 
         1984.
 
         
 
              6.  Claimant had chronic patellar tendonitis with some 
 
         chondromalacia of the patella when examined in February, 1985.
 
         
 
              7.  As of May 19, 1986, claimant had full range of motion of 
 
         both knees, good strength and no longer had complaints of pain.
 
         
 
              8.  Claimant did not injure her left ankle in her fall at 
 
         work.
 
         
 
                                CONCLUSIONS OF LAW
 
         
 
              THEREFORE, IT IS CONCLUDED:
 
         
 
              Claimant has not established a causal relationship between 
 
         her injury of April 13, 1984 and her claimed disability.
 
         
 
                                      ORDER
 
         
 
              THEREFORE, IT IS ORDERED:
 

 
         
 
         
 
         
 
         HUTTIG V. YOUNKERS
 
         Page   6
 
         
 
         
 
         
 
              Claimant take nothing from this proceeding.
 
         
 
              Claimant pay the costs of this proceeding.
 
         
 
              Signed and filed this 31st day of July, 1987.
 
         
 
         
 
         
 
                                             HELEN JEAN WALLESER
 
                                             DEPUTY INDUSTRIAL COMMISSIONER
 
         
 
         Copies to:
 
         
 
         Mr. John H. Westensee
 
         Attorney at Law
 
         1703 Second Avenue
 
         Rock Island, Illinois 61201
 
         
 
         Mr. Larry L. Shepler
 
         Attorney at Law
 
         600 Union Arcade Building
 
         111 East Third Street
 
         Davenport, Iowa 52801-1550
 
 
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                                    1108.50
 
                                                    Filed July 31, 1987
 
                                                    HELEN JEAN WALLESER
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         RITA M. HUTTIG,
 
         
 
              Claimant,
 
                                                    File No. 762852
 
         VS.
 
         
 
         YOUNKERS,                              A R B I T R A T I 0 N
 
         
 
              Employer,
 
                                                   D E C I S I 0 N
 
         and
 
         
 
         AETNA CASUALTY,
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
         
 
         
 
         1108.50
 
         
 
             Claimant's knee complaints are found not related to a fall
 
         at work.
 
 
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                    BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         
 
         
 
         STEVEN McDONOUGH,
 
         
 
              Claimant,
 
                                                  File No. 762853
 
         VS.
 
         
 
         DAHLEN TRANSPORTATION,                      A P P E A L
 
         
 
              Employer,                            D E C I S I 0 N
 
         
 
         and
 
         
 
         IDEAL MUTUAL INSURANCE
 
         COMPANY,
 
         
 
              Insurance Carrier,
 
              Defendants
 
         
 
         
 
         
 
         
 
                              STATEMENT OF THE CASE
 
         
 
              Defendants appeal from an arbitration decision awarding 
 
         permanent partial disability benefits for impairment to 
 
         claimant's left arm and for hearing loss in claimant's left ear.
 
         
 
              The record on appeal consists of the transcript of the 
 
         arbitration hearing and joint exhibits 1 through 34.  Both 
 
         parties have filed briefs on appeal.
 
         
 
                                      ISSUES
 
         
 
              Defendants state the following issues on appeal:
 
         
 
              1.  The hearing officer erred in finding that Claimant 
 
              developed a hearing loss in his left ear subsequent to 
 
              his injury on March 21, 1984.
 
         
 
              2.  The hearing officer erred in finding that 
 
              Claimant's permanent hearing loss in the left ear 
 
              resulted from trauma to his head in his March 21, 1984 
 
              injury.
 
         
 
              3.  The hearing officer erred in finding the Claimant's 
 
              costs with Dr. Zimmer relate to his compensable hearing 
 
              loss.
 
         
 
                             REVIEW OF THE EVIDENCE
 
         
 
              The arbitration decision adequately and accurately reflects 
 
         the pertinent evidence and it will not be totally reiterated 
 
         herein.
 

 
         
 
         
 
         
 
         McDONOUGH V. DAHLEN TRANSPORTATION
 
         Page   2
 
         
 
         
 
         
 
              Claimant sustained injuries on March 31, 1984 when the truck 
 
         in which he was riding left the roadway, went through a 
 
         guardrail, and came to rest in a bunch of trees.  Claimant was 
 
         part of a two-man driving team for defendant employer and at the 
 
         time of the accident, claimant was sleeping in the sleeper area 
 
         of the truck.  Claimant stated that during the accident he struck 
 
         the left side of his head and shoulder against a corner inside 
 
         the truck.  Claimant indicated that as a result of the accident 
 
         he sustained a broken arm, but did not recall whether he 
 
         sustained any bruises or abrasions to his head.
 
         
 
              Claimant related that about one and one-half months after 
 
         the injury he began experiencing a humming in his head which 
 
         claimant described as "like somebody was blowing a horn in your 
 
         ear, your left ear all the time." (Transcript, page 36)  Claimant 
 
         stated that he went to his family doctor to have the wax cleaned 
 
         out of his ear and that shortly after the wax was removed he lost 
 
         all hearing in the left ear.  Claimant testified that he had had 
 
         wax problems which affected his hearing before the injury, but 
 
         that his hearing always returned to normal when the wax was 
 
         removed.
 
         
 
              Claimant testified that he went to Albert Zimmer, M.D., for 
 
         treatment of his hearing loss.  In a December 10, 1985 letter, 
 
         Dr. Zimmer opined:
 
         
 
                 I have seen Mr. Steven McDonough several times.  He 
 
              was first seen in November of 1984.  At that time he 
 
              was complaining of hearing loss in the left ear, of 
 
              sudden onset, following trauma to his head.  Audiograms 
 
              taken using masking of 60 decibels, revealed a hearing 
 
              level of 20 decibels in the right ear, and about 70 
 
              decibels in the left ear.  Auditory evoked brainstem 
 
              response was unremarkable.  Middle ear tomograms 
 
              revealed clouding of the left tympanic cavity, but no 
 
              destruction of bone.
 
         
 
                 He continues to complain of some tinnitus, and 
 
              occasional vertigo. he has a sensorineural hearing loss 
 
              in the left ear, most probably related to trauma to the 
 
              head.  He also has a conductive hearing loss related 
 
              probably to trauma to the head, producing infection.
 
         
 
                 While some of his hearing loss is probably related 
 
              to noise exposure that anyone faces, the bulk of it is 
 
              directly related to the head trauma.  He will probably 
 
              continue to have some problem for the remainder of his 
 
              life.
 
         
 
         (Joint Exhibit 7)
 
         
 
              In his February 18, 1986 deposition, page 12, Dr. Zimmer 
 
         opines with a reasonable degree of medical certainty that 
 
         claimant suffers a 100 percent impairment to the left ear as a 
 
         result of the March 21, 1984 injury.
 
         
 
              Joint exhibit 27 is a physical examination form completed by 
 
         Dr. R. Rosen and dated January 16, 1980, and under the general 
 

 
         
 
         
 
         
 
         McDONOUGH V. DAHLEN TRANSPORTATION
 
         Page   3
 
         
 
         
 
         comments it reveals some hearing loss left ear but perceives 
 
         whisper and voice with good ear adequately.  Claimant did not 
 
         recall Dr. Rosen indicating anything about a hearing loss or 
 
         performing an audiogram.  Joint exhibits 24, 25 and 26 are 
 
         physical examination forms for examinations performed on February 
 
         18, 1985, July 26, 1983, and September 16, 1981, respectively.  
 
         These examinations reveal no hearing problems.  However, claimant 
 
         revealed that those examinations did not involve audiometric 
 
         tests.
 
         
 
              Claimant's wife, Cheryl McDonough, testified that she has 
 
         known claimant since 1980 and that she did not notice that 
 
         claimant was having difficulty hearing until about two months 
 
         after the March 21, 1987 injury.
 
         
 
              Carl Fanger testified that he team drove with claimant for 
 
         about a year before the March 21, 1984 injury and that during 
 
         that time he did not notice that claimant was having any 
 
         difficulty hearing with his left ear.
 
         
 
              John Orey.testified that he is pastor of the church that 
 
         claimant attends and that he is a personal friend of claimant.  
 
         Orey stated that he knew claimant prior to March 21, 1984 and 
 
         that he did not notice that claimant was having difficulty 
 
         hearing until after the March 21, 1984 injury.
 
         
 
              Claimant is 40 years old with a GED and no other formal 
 
         training.  His work experience consists of driving a truck for 
 
         the last 22 years except for one year in which he worked as a 
 
         dispatcher.  Claimant currently works for defendant employer as a 
 
         local truck driver because he does not like to work as a team 
 
         driver which would require him to sleep while his partner drives.  
 
         He stated that his current job does not require him to unload 
 
         cartons or boxes.  Claimant related that the local truck driving 
 
         job pays less than the team driving job he had at the time he was 
 
         injured.
 
         
 
              Claimant suffers a 14 percent impairment to the left upper 
 
         extremity but has no restrictions on the use of his left arm.  He 
 
         opined that he has some difficulty picking up a gas hose with his 
 
         left arm.  Claimant stated that he is right-handed.
 
         
 
                                  APPLICABLE LAW
 
         
 
              Iowa Code section 85.34(2)(u) (1983) states:
 
         
 
                 In all cases of permanent partial disability other 
 
              than those hereinabove described or referred to in 
 
              paragraphs "aO through "t" hereof, the compensation 
 
              shall be paid during the number of weeks in relation to 
 
              five hundred weeks as the disability bears to the body 
 
              of the injured employee as a whole.
 
         
 
                 If it is determined that an injury has produced a 
 
              disability less than that specifically described in 
 
              said schedule, compensation shall be paid during the 
 
              lesser number of weeks of disability determined, as 
 
              will not exceed a total of said scheduled maximum 
 
              compensation.
 

 
         
 
         
 
         
 
         McDONOUGH V. DAHLEN TRANSPORTATION
 
         Page   4
 
         
 
         
 
         
 
              When an injury results in impairment outside of a scheduled 
 
         member, a claimant is entitled to have his disability rated 
 
         industrially.  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, 125 
 
         N.W.2d 251 (1963).  Barton v. Nevada Poultry, 253 Iowa 285, 110 
 
         N.W.2d 660 (1961).
 
         
 
              A finding of impairment to the body as a whole found by a 
 
         medical evaluator does not equate to industrial disability.  This 
 
         is so as impairment and disability are not synonymous.  Degree of 
 
         industrial disability can in fact be much different than the 
 
         degree of impairment because in the first instance reference is 
 
         to loss of earning capacity and in the later to anatomical or 
 
         functional abnormality or loss.  Although loss of function is to 
 
         be considered and disability can rarely be found without it, it 
 
         is not so that a degree of industrial disability is 
 
         proportionally related to a degree of impairment of bodily 
 
         function.
 
         
 
              Factors to be considered in determining industrial 
 
         disability include the employee's medical condition prior to the 
 
         injury, immediately after the injury, and presently; the situs of 
 
         the injury, its severity and the length of healing period; the 
 
         work experience of the employee prior to the injury, after the 
 
         injury and potential for rehabilitation; the employee's 
 
         qualifications intellectually, emotionally and physically; 
 
         earnings prior and subsequent to the injury; age; education; 
 
         motivation; functional impairment as a result of the injury; and 
 
         inability because of the injury to engage in employment for which 
 
         the employee is fitted.  Loss of earnings caused by a job 
 
         transfer for reasons related to the injury is also relevant.  
 
         These are matters which the finder of fact considers collectively 
 
         in arriving at the determination of the degree of industrial 
 
         disability.
 
         
 
              There are no weighting guidelines that indicate how each of 
 
         the factors are to be considered.  There are no guidelines which 
 
         give, for example, age a weighted value of ten percent of the 
 
         total value, education a value of fifteen percent of total, 
 
         motivation - five percent; work experience - thirty percent, etc.  
 
         Neither does a rating of functional impairment directly correlate 
 
         to a degree of industrial disability to the body as a whole.  In 
 
         other words, there are no formulae which can be applied and then 
 
         added up to determine the degree of industrial disability.  It 
 
         therefore becomes necessary for the deputy or commissioner to 
 
         draw upon prior experience, general and specialized knowledge to 
 
         make the finding with regard to degree of industrial disability.  
 
         See Peterson v. Truck Haven Cafe, Inc., (Appeal Decision, 
 
         February 28, 1985); .Christensen v. Hagen, Inc., (Appeal 
 
         Decision, March 26, 1985).
 
         
 
         
 
                                     ANALYSIS
 
         
 

 
         
 
         
 
         
 
         McDONOUGH V. DAHLEN TRANSPORTATION
 
         Page   5
 
         
 
         
 
              Defendants argue that claimant's hearing loss in the left 
 
         ear is not related to the March 21, 1984 injury.  Defendants' 
 
         argument relies upon the January 16, 1980 examination report 
 
         which notes a left ear hearing problem.  The deputy adequately 
 
         and accurately analyzes this argument in the arbitration 
 
         decision:
 
         
 
                 We accept Dr. Zimmer's ultimate opinion that 
 
              claimant's left ear hearing loss results primarily from 
 
              trauma related to his vehicle accident.  The only 
 
              evidence substantially contradicting Dr. Zimmer's 
 
              opinion is the exhibit 27 report of Dr. Rosen stating 
 
              claimant had ear hearing loss on January 16, 1980 
 
              examination.  While claimant refers to a 1980 audiogram 
 
              in his brief, no such audiogram was offered into 
 
              evidence.  In any event, claimant had physical 
 
              examination in 1981 and 1983 where left side hearing 
 
              loss was not noted.  Those facts suggest any hearing 
 
              loss claimant had at those times was not so substantial 
 
              as to require extensive personal concern or medical 
 
              attention.  Further, claimant himself testified he had 
 
              had wax buildup in his ears with a return to normal 
 
              hearing after its removal.  He last had wax removed 
 
              prior to his injury while living in Des Moines at a 
 
              time contemporaneous with examination by Dr. Rosen.  
 
              Hence, wax buildup could well account for claimant's 
 
              1980 examination results.  Significant after claimant's 
 
              injury are the facts that wax removal did not change 
 
              the hearing loss and that the loss was apparent to 
 
              other persons.  Those facts as well as Dr. Zimmer's 
 
              deposition testimony regarding claimant's auditory 
 
              brain stem response results are significant factors 
 
              supporting the conclusion that claimant's injury was a 
 
              proximate cause of his hearing loss.
 
         
 
         (Arbitration Decision, page 8)
 
         
 
              The greater weight of evidence supports the deputy's finding 
 
         that the March 21, 1984 injury was the cause of claimant's left 
 
         ear hearing loss and claimant's medical treatment with Dr. 
 
         Zimmer.
 
         
 
              Defendants also contend that claimant's hearing loss should 
 
         be apportioned between the work injury and preexisting hearing 
 
         loss.  Apportionment is only proper where "a prior injury or 
 
         illness, unrelated to the employment, independently produces some 
 
         ascertainable portion of the ultimate industrial disability .... 
 
         " Varied Enterprises v. Sumner, 353 N.W.2d 407, 411 (Iowa 1984).
 
         
 
              The extent of claimant's prior hearing loss, if any, cannot 
 
         be ascertained from the record; therefore, in this case 
 
         apportionment would not be appropriate.
 
         
 
              Although claimant tailed to establish that the disability 
 
         resulting from his arm injury extends to his body as a whole, he 
 
         is still entitled to benefits for industrial disability under 
 
         section 85.34(2)(u).  Claimant sustained a loss of his hearing 
 
         and of his left arm in a single accident.  Loss of hearing and of 
 
         the arm in a single accident is not described in paragraphs (a) 
 

 
         
 
         
 
         
 
         McDONOUGH V. DAHLEN TRANSPORTATION
 
         Page   6
 
         
 
         
 
         through (t) of section 85.34(2).  Therefore, claimant is entitled 
 
         to industrial disability benefits under section 85.34(2)(u).
 
         
 
              The factors for evaluating industrial disability are set out 
 
         in the preceding citations of law.  Claimant's education is 
 
         limited to a GED.  He is 40 years old.  Claimant now suffers a 
 
         hearing loss in the left ear and suffers a 14 percent impairment 
 
         to the left upper extremity.  Although claimant opines that he 
 
         has difficulty picking up a gas hose with his left arm, no work 
 
         restrictions have been placed on him by his doctors.  
 
         Furthermore, claimant is right-handed.  Claimant's prior work 
 
         experience consists of truck driving for 22 years.  He is 
 
         currently a local truck driver because he dislikes team truck 
 
         driving after the accident, but claimant presents no medical 
 
         testimony that he is physically or psychologically precluded from 
 
         team truck driving.  Without that testimony claimant cannot 
 
         establish that his reduced earnings on the local truck driving 
 
         job are related to his work injury.  The greater weight of 
 
         evidence establishes that claimant suffers a 15 percent 
 
         industrial disability.
 
         
 
         
 
                                 FINDINGS OF FACT
 
         
 
              1.  Claimant was injured on March 21, 1984 when his left 
 
         side and head were thrown against the side of the sleeper 
 
         compartment of the semi-tractor that his partner was driving when 
 
         the semi-tractor was involved in a motor vehicular accident.
 

 
         
 
         
 
         
 
         McDONOUGH V. DAHLEN TRANSPORTATION
 
         Page   7
 
         
 
         
 
         
 
              2.  Claimant received a displaced transverse comminuted 
 
         fracture of the middle third of the left humerus.
 
         
 
              3.  Claimant was treated with open reduction and internal 
 
         fixation with compression plate on March 22, 1984.  
 
         
 
              4.  Claimant's fracture did not heal and on July 3, 1985 an 
 
         open reduction repeat internal fixation and bone grafting of the 
 
         fracture was performed.
 
         
 
              5.  Claimant developed restriction of shoulder motion from 
 
         an impingement syndrome and adhesive capulitis.
 
         
 
              6.  Claimant underwent extensive physical therapy for his 
 
         condition.
 
         
 
              7.  An arthrogram of the left shoulder of November 1984 was 
 
         negative.
 
         
 
              8.  Claimant has normal shoulder range of motion and can 
 
         carry on activities of daily living without restriction.
 
         
 
              9.  Claimant's chiropractic care with Dr. Hill was not 
 
         authorized.
 
         
 
             10.  Claimant developed hearing loss in his left ear 
 
         subsequent to his injury.
 
         
 
             11.  Claimant had had hearing loss at other times but such 
 
         loss resolved following removal of wax from claimant's ear.
 
         
 
             12.  Claimant's post-injury hearing loss did not resolve 
 
         following wax removal.
 
         
 
             13.  Claimant's brain stem auditory evoked responses for 
 
         November 1984 and August 1985 are abnormal on the left.
 
         
 
             14.  Claimant's permanent hearing loss in the left ear 
 
         resulted from trauma to his head in his March 21, 1984 injury.
 
         
 
             15.  Claimant's costs with Dr. Zimmer relate to his 
 
         compensable hearing loss.
 
         
 
             16.  Claimant is 40 years old and has a GED.
 
         
 
             17.  Claimant has worked (except for one year as a 
 
         dispatcher) the last 22 years as a truck driver.
 
         
 
             18.  Claimant currently works as a local truck driver for 
 
         defendant employer.
 
         
 
             19.  Claimant suffers a 15 percent industrial disability.
 
         
 
         
 
                                CONCLUSIONS OF LAW
 
         
 
              Claimant has established that his March 21, 1984 injury is 
 
         the cause of permanent partial disability to his left ear and 
 

 
         
 
         
 
         
 
         McDONOUGH V. DAHLEN TRANSPORTATION
 
         Page   8
 
         
 
         
 
         left arm.
 
         
 
              Claimant is entitled to permanent partial disability 
 
         benefits based on a 15 percent industrial disability.
 
         
 
              Claimant is entitled to payment of costs with Dr. Zimmer.
 
         
 
              Claimant is not entitled to payment of costs with Dr. Hill.
 
         
 
              WHEREFORE, the decision of the deputy is affirmed and 
 
         modified.
 
         
 
                                      ORDER
 
         
 
              THEREFORE, it is ordered:
 
         
 
              That defendants pay claimant seventy-five (75) weeks of 
 
         permanent partial disability benefits at the rate of three 
 
         hundred nine and 49/100 dollars ($309.49) per week.
 
         
 
              That defendants pay claimant the costs of medical treatment 
 
         with Dr. Zimmer in the amount of one hundred forty-four dollars 
 
         ($144.00).
 
         
 
              That defendants pay accrued amounts in a lump sum.
 
         
 
              That defendants pay interest pursuant to Iowa Code section 
 
         85.30.
 
         
 
              That defendants pay costs pursuant to Division of Industrial 
 
         Services Rule 343-4.33.
 
         
 
              That defendants file claim activity reports as required by 
 
         the agency.
 
         
 
         
 
         
 
         
 
         
 
              Signed and filed this 21st day of June, 1988.
 
         
 
         
 
         
 
         
 
         
 
         
 
         
 
         
 
                                                  DAVID E LINQUIST
 
                                                  INDUSTRIAL COMMISSIONER
 
         
 
         
 
         Copies to:
 
         
 
         Mr. James H. Hood
 
         Attorney at Law
 
         302 Union Arcade Building
 
         Davenport, Iowa 52801
 
         
 

 
         
 
         
 
         
 
         McDONOUGH V. DAHLEN TRANSPORTATION
 
         Page   9
 
         
 
         
 
         Mr. David H. Sivright, Jr.
 
         Attorney at Law
 
         408 South Second Street
 
         Clinton, Iowa 52732
 
         
 
         Mr. William L. Dawe
 
         Attorney at Law
 
         1100 Des Moines Building
 
         Des Moines, Iowa 50309
 
         
 
         
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                                 1402.20; 1802; 1803.1;
 
                                                 1402.40
 
                                                 Filed June 21, 1988
 
                                                 David E. Linquist
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         STEVEN McDONOUGH,
 
         
 
              Claimant,
 
                                                   File No. 762853
 
         VS.
 
         
 
         DAHLEN TRANSPORTATION,                       A P P E A L
 
         
 
              Employer,                            D E C I S I 0 N
 
         
 
         and
 
         
 
         IDEAL MUTUAL INSURANCE
 
         COMPANY,
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
         1402.20
 
         
 
              Claimant established that he sustained an injury to his 
 
         hearing in his left ear when his left side and head were thrown 
 
         against the side of the sleeper compartment of the semi-tractor 
 
         that his partner was driving when the semi-tractor was involved 
 
         in a motor vehicular accident
 
         
 
         1803; 1803.1
 
         
 
              As claimant sustained a loss of hearing and of his left arm 
 
         in a single accident he is entitled to benefits for industrial 
 
         disability under Iowa Code section 85.34(s)(u).
 
         
 
         1402.4
 
         
 
              Although claimant opined that he dislikes working as a team 
 
         driver since the accident, he presented no medical testimony that 
 
         he is physically or psychologically precluded from doing so.  
 
         Without this testimony claimant cannot establish that his 
 
         reduction in earnings is related to his work injury.