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.