1804; 1108 Filed January 30, 1990 Deborah A. Dubik BEFORE THE IOWA INDUSTRIAL COMMISSIONER JAMES LEHRMAN, Claimant, VS. File No. 770825 MIDWEST SERVICE COMPANY, A R B I T R A T I O N Employer, D E C I S I O N and AMERICAN Mutual INSURANCE CO. Insurance Carrier, Defendants. 1804; 1108 Claimant was injured in collision with another semi that resulted in the death of the other driver. Claimant underwent cervical fusion and was hospitalized for one month with a permanent partial impairment due to his cervical problems of 20%. Claimant, since the injury, has had personality imbalances, psychiatric hospitalizations, psychogenic amnesia and suicidal ideations. Claimant has had ongoing psychological counseling and found.to have permanent partial impairment of 20% due to these problems. Claimant's psychological problems found casually connected to the injury. Claimant has been unable to secure any employment since his injury except for temporary employment at the behest of his sister-in-law. Claimant, although very bright, could not complete a retraining course due to his psychological problems. Claimant found to be permanent total. BEFORE THE IOWA INDUSTRIAL COMMISSIONER MARK E. DORPINGHAUS, Claimant, vs. File No. 771007 UNIVERSITY OF IOWA HOSPITALS A P P E A L AND CLINICS, D E C I S I O N Employer, and STATE OF IOWA, Insurance Carrier, Defendants. STATEMENT OF THE CASE Claimant appeals from an arbitration decision denying any benefits as a result of an injury on May 24, 1984. The record on appeal consists of the transcript of the arbitration hearing; joint exhibit l; and claimant's exhibits 2 and 3. Both parties filed briers on appeal. ISSUE The issue on appeal is wether there is a causal relationship between the alleged injury and the claimed disability. 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 in the arbitration decision are appropriate to the issues and evidence. ANALYSIS Claimant has the burden of proving that his alleged injury on May 24, 1984 is causally related to his claimed disability. Claimant argues on appeal that he has established sufficient evidence to establish the causal connection. The claimant DORPINGHAUS V. UNIVERSITY OF IOWA HOSPITALS AND CLINICS Page 2 relies upon the fact that claimant experienced pain shortly after the fall. However, claimant acknowledges that no medical personnel have causally related claimant's condition with the incident on May 24, 1984 (hereinafter sometimes referred to as the fall). After the fall claimant was examined by Edward A. Dykstra, M.D.; examined and treated by Michael M. Durkee, M.D.; and examined by James B. Worrell, M.D. None of these doctors indicated that the fall was the probable cause of any disability to claimant. Likewise, none of these doctors indicated that the fall aggravated claimant's prior shoulder problems. Not only is there no medical evidence to support a causal connection between the fall and claimant's alleged disability but, claimant's own statements and testimony indicate that his current condition is the result of shoulder problems that predated the fall by three years. Claimant testified that he had a recovery of 89-90 percent after the surgery in 1981. He did not deny that Dr. Durkee advised him that his limitation of motion was due to the prior surgeries. He also testified that he indicated to his supervisor that his limitation of motion was for a short period of time following the surgery after the fall. He returned to his same job. The office note of Dr. Durkee indicates that claimant told the doctor that he was 100 percent better than before his surgery following the fall. The statements made by the claimant do not demonstrate that his fall was the cause of any disability, either temporary or permanent. claimant has provided neither medical evidence nor any other evidence that shows that his fall was the cause of any disability. The chronological proximity between the fall and the onset of pain may be evidence of an injury but it is not evidence of a disability. Claimant has clearly not met cause of a disability, either temporary or permanent. FINDINGS OF FACT 1. Claimant was employed by the University of Iowa Hospitals and Clinics as a nursing assistant I, Department of Pediatrics, Division cf Development Disabilities on May 24, 1984. 2. Claimant's work shift began at 6:30 a.m. and ended at 3:30p.m. 3. Claimant was assigned a parking space in the University owned parking lot. 4. The main entrance of the Department of Pediatrics hospital school building was not open until 8:00 a.m. DORPINGHAUS V. UNIVERSITY OF IOWA HOSPITALS AND CLINICS Page 3 5. Claimant used a side entrance to the Department of Pediatrics hospital school building to enter to begin his work shift. 6. The route from the assigned parking lot to the ancillary entrance which claimant normally used required a walk downhill through a grass-seeded area where construction was taking place. 7. It had rained throughout the night into the morning of May 24, 1984. 8. Claimant fell enroute to the hospital school building on the morning of May 24, 1984 approximately 50 yards from the hospital school building and approximately 100 yards from the entrance claimant customarily used. 9. Claimant had had numbness and tingling involving his hands and fingers as of May 27, 1981. 10. Claimant had fallen down stairs injuring his shoulders in approximately 1979. 11. On July 9, 1981 claimant had a Du Toit stapling of the right glenohumeral joint for recurrent anterior subluxation of the right humeral joint. 12. On October 1, 1981 claimant had a superior staple removed from the right glanoid. 13. Claimant had had limitation of right shoulder motion prior to May 24, 1984. 14. As of May 24, 1984 claimant had mild tenderness of shoulder with limitation of motion. 15. x-rays of May 24, 1984 showed no evidence of dislocation, but did reveal a staple extremely close to the anterior aspect of claimant's glenohumeral joint. 16. Right shoulder arthroscopy of June 22, 1984 revealed recurring dislocation and marked degenerative changes in he (glenohumeral) joint . 17. Bristow Repair of the shoulder and removal of the staple in the glenohumeral joint was performed on July 15, 1984. 18. Electromyographic studies of June 12, 1986 revealed no nerve conduction abnormalities. 19. Claimant's permanent partial impairment is five percent of the arm or approximately three percent of the body as a whole. DORPINGHAUS V. UNIVERSITY OF IOWA HOSPITALS AND CLINICS Page 4 20. Any industrial disability arising from claimant's injury, had such been found, would have been minimal. CONCLUSIONS OF LAW Claimant has established a work incident of May 24, 1984, which incident did arise out of and in the course of his employment. Claimant has not established that that incident resulted in an injury which was causally related to claimed disability. Claimant has not established any entitlement to healing period, temporary total disability or permanent partial disability benefits as a result of the incident of May 24, 1984. Claimant has not established medical costs which are compensable under section 85.27 as related to a compensable injury. 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 this proceeding including costs of transcription of the arbitration hearing. Signed and filed this 21st day of February, 1989. DAVID E. LINQUIST INDUSTRIAL COMMISSIONER BEFORE THE IOWA INDUSTRIAL COMMISSIONER MARK E. DORPINGHAUS, Claimant, File No. 771007 vs. A R B I T R A T I O N UNIVERSITY OF IOWA HOSPITALS D E C I S I O N AND CLINICS, Employer, F I L E D and JAN 20 1988 STATE OF IOWA, IOWA INDUSTRIAL COMMISSIONER Insurance Carrier, Defendants. INTRODUCTION This is a proceeding in arbitration brought by the claimant, Mark E. Dorpinghaus, against his employer, University of Iowa Hospitals and Clinics, and its insurance carrier, the State of Iowa, to recover benefits under the Iowa Workers' Compensation Act as a result of an injury allegedly sustained on May 24, 1984. This matter came on for hearing before the undersigned deputy industrial commissioner at Cedar Rapids, Iowa, on June 16, 1987. A first report of injury was filed August 23, 1984. No benefit payments have been made. The record in this case consists of the testimony of claimant as well as of joint exhibit 1 and claimant's exhibits 2 and 3. The parties specified relative to claimant's exhibit 2 that, of the 21 pages of medical costs submitted, only $202.29 had not been paid by the health insurer. Also, a statement in the amount of $150.00 from Medical Practitioners Neiman and Worrell was not received into evidence pursuant to defendants' objection that it was not timely served. ISSUES Pursuant to the prehearing report, the parties stipulated that claimant's rate of weekly compensation is $120.84. They further stipulated that claimant's time off work and period of benefits for healing period entitlement, if such is found, would be from May 25, 1984 through September 3, 1984. They stipulated that claimant's medical costs are fair and reasonable for the services provided and that defendants would be entitled to credit under 85.38(2) as outlined in the prehearing report attachment which is incorporated into this decision by this reference. Issues remaining to be decided are: (1) whether claimant received an injury which arose out of and in the course of his employment; (2) whether a causal relationship exists between the alleged injury and the claimed disability; (3) whether claimant is entitled to benefits and the nature and extent of any benefit entitlement; and, (4) whether claimant is entitled to payment of certain medical costs pursuant to section 85.27. REVIEW OF THE EVIDENCE Claimant described himself as a 29-year-old high school graduate who has completed two years of a business education course at the University of Iowa and one year of a nursing program at Kirkwood Community College. He hopes to reenroll and complete the nursing program. Claimant has been employed at the University of Iowa for approximately ten years in clerical and nursing assistant positions. Claimant also has prior employment experience as a long-distance telecommunicator with American College Testing Services. Claimant is now employed as a nursing assistant I at the Department of Pediatrics, Division of Developmental Disabilities. He described his duties as lifting clients who range in age from infancy to approximately 30-35 years and in weight from approximately 13 to 150 pounds. He reported that he must do so without assistance and that he must also brace, walk and restrain mentally disabled clients. Claimant agreed that his general office skills from ACT as well as his understanding of medical terminology, his ability to document medical information and his ability to physically and psychologically restrain and work with clients are skills which are likely quite marketable in the medical community. He also agreed that he has received contract negotiated raises since his alleged injury. Claimant reported that on his injury date, which is variously described as May 24 or May 25, 1984, he was to work from 6:30 a.m. to 3:30 p.m. He reported that, on that morning, he parked his car in his assigned parking lot, which was owned by the University of Iowa, and walked downhill to the hospital school building in which he was employed. Claimant stated it had rained throughout the night and the surface was muddy as it was seeded for grass, but the grass had not yet begun to grow. He reported that construction was also underway in the area. Claimant fell approximately 50 yards from the hospital school building and approximately 100 yards from the entrance of the building which claimant generally used upon arriving at work. Claimant reported that the main entrance of the building did not open until 8:00 a.m. Claimant described his fall as occurring at a "dip in the hill" which claimant believed had been created for wheelchair access. Claimant testified that he physically fell backwards and caught himself with the palms of his hands extended outward. He indicated that he began work and informed the head nurse of his injury. He reported having a dull right shoulder pain with a red and blotchy area about the shoulder. He sought care at the Employee's Medical Clinic. X-rays were taken and claimant reported he was told there was no injury. Claimant described his arm as immobile, swollen and painful with numbness in the arm, palm and 4th and 5th fingers. Claimant subsequently took his x-rays to Mercy Hospital where he saw Edward A. Dykstra, M.D., an orthopaedic surgeon. Claimant's follow-up care, which will be described below, included Bristow Repair and shoulder reconstruction surgery. Claimant returned to work on September 4, 1984. Claimant reported he had a 50-pound lifting restriction upon his work return and was advised to use extreme caution in using his arm and in movements away from his torso. He agreed that such is no longer in effect. Claimant reported that shoulder pain occurs now at least twice weekly and that he has limited range of motion as well as limited ability to put his arm behind his back or his head without pain. He reported that he is unable to swim or play racquetball. He agreed that he can now lift 50 pounds, but stated that his ability to perform his job has not changed in the past three years. He reported that co-employees help him out on the job and that he often takes sick leave for reasons other than for his shoulder. Claimant opined that, if he would pursue a nurse's training course, such may require lifting and stated his belief that he had not received a job for which he had applied in the intensive care unit because of his 50-pound lifting restriction. Claimant testified that he has applied for a position as a nursing unit clerk and as a clerk II in the hopes that taking such jobs would alleviate problems he has in doing physical work. Claimant agreed that he has had prior right shoulder surgery with Bruce L. Sprague, M.D., in 1981. He reported that such was for shoulder dislocation and staple repair. Claimant alleged that, after a six- to eight-week recovery period, he had no subsequent problems with the shoulder in his work or life activities. On cross-examination, he did not deny that he had limited shoulder range of motion prior to his May, 1984 injury. A May 27, 1981 note of B. L. Sprague, M.D., reports that he had seen claimant in his office that day and that claimant reported that, approximately two years earlier, he had fallen down some stairs injuring his shoulder. Claimant stated he had pain in the shoulder, particularly with abduction and external rotation which could be relieved "by forcing the shoulder down to A D duction [sic] and internal rotation." Claimant had radiation of pain down the medial aspect of the arm with numbness and tingling involving his hand and fingers. Some crepitus was noted on taking the shoulder from extension, external rotation to abduction, internal rotation. X-rays showed an old fracture off the anterior lip of the glenoid. Dr. Sprague's impression was that claimant had recurrent subluxations of the shoulder and would probably benefit from a shoulder capsular reattachment. A July 8, 1981 Mercy Hospital report of Ben Welch, M.D., reported that claimant had limitation of abduction of the right shoulder and was unable to get much over 85 degrees. He reportedly was otherwise able to internally rotate and externally rotate fully and extend fully, although there was some crepitus with abduction and extension in the shoulder joint. Neurosensory and motor functions in the arm were normal and intact. On July 9, 1981, claimant had a Du Toit stapling, right glenohumeral joint for recurrent anterior subluxation, right humeral joint. On July 29, 1981, Dr. Sprague reported that claimant had full flexion, 130 degrees of abduction, 40 degrees of internal rotation and external rotation to neutral. He characterized claimant as doing extremely well and gaining his full range of motion. On September 4, 1981, Dr. Sprague reported that claimant had much less motion in his right shoulder than a month earlier. Flexion was limited to 130 degrees, abduction to 90 degrees and internal rotation with external rotation of 20 degrees. Claimant reportedly stated that he had had a heavy door close against his hand and that this resulted in decreased shoulder motion. On September 16, 1981, claimant was reported as having less pain in the right shoulder, but not as good as two months earlier. Abduction was 130 degrees; flexion was 130 degrees; good external rotation; and, very limited internal rotation. Dr. Sprague suggested the exploration of the glenohumeral joint with removal of staples. On October 1, 1981, Dr. Sprague removed the superior staple from the right glenoid. On October 12, 1981, Dr. Sprague reported that claimant had 110 degrees of flexion, 90 degrees of abduction, 40 degrees of internal rotation and 20 degrees of external rotation. On October 26, 1981, claimant had 150 degrees of flexion, 150 degrees of abduction, 40 degrees of internal rotation and 20 degrees of external rotation. He had some pain on lifting with his arm and mild crepitus around the rotator cuff which Dr. Sprague characterized as perfectly normal at that time. An x-ray report of May 25, 1984 for the right shoulder reports that claimant is status post stapling of the right shoulder as a "Hill-Sachs deformity" but no fracture or dislocation at that time. Notes of E. A. Dykstra, M.D., of May 24, 1984 indicate that claimant was examined in the emergency room and had mild tenderness over his shoulder with limitation on range of motion and was placed in a shoulder immobilizer. The note further reports that x-rays including a stress axillary view show no evidence of dislocation, but that claimant has a strange shaped glenoid with a staple extremely close to the anterior aspect of the joint. Michael M. Durkee, M.D., on June 5, 1984, noted that x-rays revealed the staple appeared to be essentially in the anterior aspect of the joint. The doctor noted that, upon examination, claimant had a great deal of grinding and catching in the shoulder and that the edge of the staple may be causing this. On June 22, 1984, Dr. Durkee reported that claimant had had a right shoulder arthroscopy and was felt to have recurring dislocation and marked degenerative changes in the joint. Claimant was reported as having lost a great deal of motion. On June 29, 1984, Dr. Durkee reported that he felt the staple may be giving claimant a little bit of trouble and would be removed. Bristow Repair of the shoulder, as well as removal of the staple, was performed July 15, 1984. On August 24, 1984, Dr. Durkee reported that claimant had abduction to about 70-80 degrees; forward flexion to 110 degrees; internal rotation to 90 degrees; and, almost no external rotation. On September 25, 1984, Dr. Durkee reported claimant had abduction to 90 degrees; forward flexion to 120 degrees; internal rotation to 85-90 degrees; and, external rotation of 10-15 degrees. He reported that claimant was able to get his hand behind his head with some difficulty, but was not quite able to get his hand behind the small of his back. Claimant was weight lifting at 25 pounds. On November 13, 1984, Dr. Durkee stated that claimant "was doing very well," had some limitation of motion and was unable to get his hand completely behind the small of his back. Abduction was reported as only to 90 degrees. Claimant was able to get his hand behind his head and had minimal amounts of pain and discomfort. Claimant was reported as stating the shoulder was "100% better than before surgery." On October 1, 1984, Dr. Durkee reported that, under the orthopaedic surgeon's guide, claimant's permanent physical impairment equals five percent of the arm. On May 8, 1986, James B. Worrell, M.D., pediatric and adult neurologist, reported that muscle strength over the shoulder girdle, including the rhomboids, spinatus and pectoral muscles was quite strong. Deltoid gave way a bit, but had no atrophy. Biceps, triceps, wrist extensors and extensors of the fingers were all reported as fairly strong with finger abduction a bit weaker on the right side, but not much. No atrophy was noted. Thumb flexion was strong, autonomic function seemed equal over the hands and reflexes were symmetrical. Claimant had "some decrease in sensory [sic] over the top of the right shoulder," mainly in the C5 distribution, but perhaps onto the C4. He was reported as having diminished sensation over the under aspect of the arm into the 4th and 5th fingers of the right hand which would be mainly T1 and C8, but other sensory areas seem fairly well spared. Dr. Worrell stated that, neurologically, claimant may have had injury to the brachial plexus with all these recurrent injuries. The doctor doubted that this would be a progressive problem. On June 12, 1986, Dr. Worrell reported that electromyographic studies revealed no nerve conduction abnormalities. He indicated there were some modest changes in the C5 muscle and C8 muscle, indicating some old injury perhaps to those nerve roots, but nothing acute. He suspected a previous stretch injury, perhaps to the plexus, now stable. Medical expenses, as could be gleaned from the submissions made, were as follows: Walgreens prescriptions $12.29 Steindler Ortho Clinic 5/24/84-8/24/84 2,066.00 Mercy Hospital IA CITY 5/25/84 72.50 Mercy Hospital IA CITY 6/13/84 1,225.60 Mercy Hospital IA CITY 7/18/84-7/20/84 2,297.34 M A Menezes M.D. 8/3/84 345.00 M A Menezes M.D. 7/2/84 299.00 University Hospitals 6/7/84 42.00 Towncrest X-ray Dept. 6/6/84 24.00 Bruce L. Sprague M.D. 5/27/84-10/26/84 1,274.00 APPLICABLE LAW AND ANALYSIS Of first concern is whether claimant received an injury which arose out of and in the course of his employment. Claimant has the burden of proving by a preponderance of the evidence that he received an injury on May 24, 1984 which arose out of and in the course of his 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(1). 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). "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." 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). As a general rule, absent special circumstances, employees are not entitled to compensation for injuries occurring off the employer's premises on the way to or from work. However, an injury arising out of and in the course of employment may be found where: (1) the site of injury was so closely related in time, location and employee usage to the work premises as to bring the claimant within the zone of protection of the workers' compensation law, or (2) the employer had exercised its control over the abutting area as to make it an extension of the business premises. Frost v. S. S. Kresge Co., 299 N.W.2d 646, 648 (Iowa 1980). In the instant case, claimant fell approximately 50 yards from the hospital school building and approximately 100 yards from the entrance to the building which claimant normally used to enter his work premises. While the record is silent as to whether any other entrances were available to claimant, the record discloses that the building's main entrance was not open until 8:00 a.m. Claimant was expected to arrive at work at or before 6:30 a.m. Thus, it could be expected that claimant would be in the vicinity of this or another ancillary entrance while traveling to work. The record is also silent as to whether claimant might have chosen a less-hazardous route into the building. Claimant appears to have been taking the most direct route from his assigned parking lot to his work premises, however. Hence, it appears that the employer acquiesced in claimant's use of such route to enter the building from one of, if not the only, entrance available at the time his work shift began. The record is silent as to ownership of the area where claimant fell. Claimant was traveling from an assigned employer-owned parking lot to the employer's premises at the time of his fall, however. As noted, the main entrance to the employer's premises was not available to claimant when his fall occurred. As further noted, the employer apparently acquiesced in the use of the route from the parking lot to the employer's premises on which the injury occurred. Such would suggest that the employer had some degree of control over the area, if not through ownership, then through an informal and consented-to arrangement permitting its employees entrance by that route. Given the foregoing, it can be said that the site of claimant's fall was so closely related in time, location and employee usage to the work premises as to bring claimant within the zone of protection of the workers' compensation law and that the employer had exercised such control over the route on which the fall occurred as to make the route an extension of the employer's business premises. Thus, claimant has established a work incident arising out of and in the course of his employment on May 24 or 25, 1984. It remains for claimant to establish that his work incident resulted in a work injury which is causally related to his claimed disability. The claimant has the burden of proving by a preponderance of the evidence that the injury of May 24, 1984 is causally related to the disability on which he now bases his claim. Bodish v. Fischer, Inc., 257 Iowa 516, 133 N.W.2d 867 (1965). Lindahl v. L. O. Boggs, 236 Iowa 296, 18 N.W.2d 607 (1945). A possibility is insufficient; a probability is necessary. Burt v. John Deere Waterloo Tractor Works, 247 Iowa 691, 73 N.W.2d 732 (1955). The question of causal connection is essentially within the domain of expert testimony. Bradshaw v. Iowa Methodist Hospital, 251 Iowa 375, 101 N.W.2d 167 (1960). However, expert medical evidence must be considered with all other evidence introduced bearing on the causal connection. Burt, 247 Iowa 691, 73 N.W.2d 732. The opinion of experts need not be couched in definite, positive or unequivocal language. Sondag v. Ferris Hardware, 220 N.W.2d 903 (Iowa 1974). However, the expert opinion may be accepted or rejected, in whole or in part, by the trier of fact. Id. at 907. Further, the weight to be given to such an opinion is for the finder of fact, and that may be affected by the completeness of the premise given the expert and other surrounding circumstances. Bodish, 257 Iowa 516, 133 N.W.2d 867. See also Musselman v. Central Telephone Co., 261 Iowa 352, 154 N.W.2d 128 (1967). While a claimant is not entitled to compensation for the results of a preexisting injury or disease, the mere existence at the time of a subsequent injury is not a defense. Rose v. John Deere Ottumwa Works, 247 Iowa 900, 908, 76 N.W.2d 756, 760-761 (1956). If the claimant had a preexisting condition or disability that is aggravated, accelerated, worsened or lighted up so that it results in disability, claimant is entitled to recover. Nicks v. Davenport Produce Co., 254 Iowa 130, 115 N.w.2d 812, 815 (1962). The Iowa Supreme Court cites, apparently with approval, the C.J.S. statement that the aggravation should be material if it is to be compensable. Yeager v. Firestone Tire & Rubber Co., 253 Iowa 369, 112 N.W.2d 299 (1961); 100 C.J.S. Workmen's Compensation 555(17)a. Initially, we note that no medical personnel has causally related claimant's condition to his work incident of May 24, 1984. Likewise, no physician has indicated that the work incident aggravated claimant's prior shoulder problems. Claimant was not thought to have evidence of a dislocation when examined on May 24, 1984. A staple extremely close to the anterior aspect of the (glenohumeral) joint was disclosed on x-rays of that date, however. As of June 22, 1984, Dr. Durkee opined that claimant had recurring dislocation of the right shoulder with marked degenerative changes in the joint. He felt, as of June 29, 1984, that the staple (remaining from claimant's July 9, 1981 Du Toit stapling of the right glenohumeral joint) "may be giving" claimant "a little bit of trouble" and advised its removal. Bristow Repair of the shoulder was also advised. At no point does either Dr. Durkee or Dr. Dykstra, or any other medical practitioner, indicate that the repair and staple removal were required on account of claimant's May 24, 1984 fall or that either the marked degenerative changes found in the joint, the recurring dislocation, or the problems with the staple were conditions aggravated by that fall. Likewise, Dr. Sprague noted, on May 27, 1981, that claimant had radiation of pain down the medial aspects of his arm and numbness and tingling involving his hands and fingers. Claimant attributed those problems to his May 24, 1984 fall. Their existence from three years prior to that incident undercuts claimant's credibility as a reporter of his own pre- and post-incident physical condition and symptomatology. Dr. Worrell confirmed claimant's numbness and tingling upon physical examination of May 8, 1986. Nevertheless, Dr. Worrell only stated that claimant may have had injury to the brachial plexus from all his recurrent injuries. He did not expressly attribute the problems to the May 24, 1984 incident. The presence of the symptoms prior to the 1984 incident, as noted, further indicates that they should not be so attributed. Furthermore, Dr. Worrell reported, on June 12, 1986, that electromyographic studies revealed no nerve conduction abnormalities. All of the above demonstrate that claimant has not established the requisite causal connection between his May 24, 1984 incident and any subsequent problems. That such a connection is not possible is not disputed. The law, however, requires a probability and such is not shown in this record. As claimant has not prevailed on the causal connection issue, we need not address the remaining issues of benefit and medical payment entitlement. We note, however, that any permanency due claimant would likely have been small. Claimant's assigned impairment is five percent of the arm. Under the AMA guides to impairment, such would translate to three percent of the whole person. (We note that the impairment of five percent of the arm was obtained under the orthopaedic guides and not under the AMA guides. Further, no distinction was made as to what percentage, if any, of that impairment related to claimant's pre-May 24, 1984 condition.) Claimant is not now under a lifting restriction. Dr. Durkee's November 13, 1984 medical report belies claimant's contention that he is unable to get his hand behind his head. The doctor does state that claimant is not able to get his hand completely behind the small of his back, however, indicating that claimant may not have altogether exaggerated that complaint. However, that restriction does not appear to unduly impair claimant in performing other work duties. Likewise, as claimant attested to, he has a considerable number of marketable clerical and medical skills. He is also a bright individual who has completed a number of years of college and associate college work. He is a younger worker who could well proceed with his plans to obtain a nursing degree. For those reasons, it is doubtful that claimant could have shown any industrial disability resulting from the May 24, 1984 incident. FINDINGS OF FACT WHEREFORE, IT IS FOUND: Claimant was employed by the University of Iowa Hospitals and Clinics as a nursing assistant I, Department of Pediatrics, Division of Developmental Disabilities on May 24, 1984. Claimant's work shift began at 6:30 a.m. and ended at 3:30 p.m. Claimant was assigned a parking space in the University-owned parking lot. The main entrance of the Department of Pediatrics hospital school building was not open until 8:00 a.m. Claimant used a side entrance to the Department of Pediatrics hospital school building to enter to begin his work shift. The route from the assigned parking lot to the ancillary entrance which claimant normally used required a walk downhill through a grass-seeded area where construction was taking place. It had rained throughout the night into the morning of May 24, 1984. Claimant fell enroute to the hospital school building on the morning of May 24, 1984 approximately 50 yards from the hospital school building and approximately 100 yards from the entrance claimant customarily used. Claimant had had numbness and tingling involving his hands and fingers as of May 27, 1981. Claimant had fallen down stairs injuring his shoulders in approximately 1979. On July 9, 1981, claimant had a Du Toit stapling of the right glenohumeral joint for recurrent anterior subluxation of the right humeral joint. On October 1, 1981, claimant had a superior staple removed from the right glenoid. Claimant had had limitation of right shoulder motion prior to May 24, 1984. As of May 24, 1984, claimant had mild tenderness of the shoulder with limitation of motion. X-rays of May 24, 1984 showed no evidence of dislocation, but did reveal a staple extremely close to the anterior aspect of claimant's glenohumeral joint. Right shoulder arthroscopy of June 22, 1984 revealed recurring dislocation and marked degenerative changes in the (glenohumeral) joint. Bristow Repair of the shoulder and removal of the staple in the glenohumeral joint was performed on July 15, 1984. Electromyographic studies of June 12, 1986 revealed no nerve conduction abnormalities. Claimant's permanent partial impairment is five percent of the arm or approximately three percent of the body as a whole. Claimant is a younger worker. Claimant has marketable skills in the medical field as well as in the clerical field. Claimant has completed three years of coursework at either the university or the associate college level. Claimant no longer has medically-imposed lifting limitations. Claimant's continuing inability to put his arm behind his back does not appear to affect his ability to perform work. Claimant would be a good candidate to complete a degree in nursing, as he desires. Any industrial disability arising from claimant's injury, had such been found, would have been minimal. CONCLUSIONS OF LAW THEREFORE, IT IS CONCLUDED: Claimant has established a work incident of May 24, 1984, which incident did arise out of and in the course of his employment. Claimant has not established that that incident resulted in an injury which was causally related to claimed disability. Claimant has not established any entitlement to healing period, temporary total disability or permanent partial disability benefits as a result of the incident of May 24, 1984. Claimant has not established medical costs which are compensable under section 85.27 as related to a compensable injury. ORDER THEREFORE, IT IS ORDERED: Claimant take nothing from this proceeding. Claimant pay costs of this proceeding. Signed and filed this 20th day of January, 1988. HELEN JEAN WALLESER DEPUTY INDUSTRIAL COMMISSIONER Copies To: Ms. Janice M. Becker Attorney at Law 528 South Clinton P.O. Box 106 Iowa City, Iowa 52240 Ms. Shirley A. Steffe Assistant Attorney General Tort Claims Division Hoover State Office Building Des Moines, Iowa 50319 1100, 1104, 1107, 1108 Filed January 20, 1988 HELEN JEAN WALLESER MARK E. DORPINGHAUS, Claimant, vs. File No. 771007 UNIVERSITY OF IOWA HOSPITALS AND CLINICS, A R B I T R A T I 0 N Employer, and D E C I S I 0 N STATE OF IOWA, Insurance Carrier, Defendants. 1100, 1104, 1107, 1108 Claimant, who slipped on wet ground while walking from employer assigned parking lot to side entrance of his building, had established an injury arising out of and in the course of his employment where the main entrance was not available to claimant at the hour at which he needed to arrive to work and where the employer apparently acquiesced in the use of the side entrance and the route claimant used from the lot to the side entrance. Claimant did not establish that the work incident was causally related to the claimed disability where claimant had had prior shoulder injury with recurrent dislocations and surgeries and where claimant's post work incident surgery consisted of repair of remarked degenerative changes in the glenohumeral joint and removal of a staple present in the joint as a result of prior surgery.