BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         _________________________________________________________________
 
         
 
         DENNIS RUNGE,
 
         
 
              Claimant,
 
                                                    FILE NO. 771016
 
         VS.
 
                                                 A R B I T R A T I 0 N 
 
         FRENCH & HECHT,
 
                                                    D E C I S I O N
 
              Employer,
 
              Self-Insured,
 
              Defendant.
 
         _________________________________________________________________
 
         _
 
         
 
                                   INTRODUCTION
 
         
 
              This is a proceeding in arbitration brought by Dennis Runge, 
 
         claimant, against French & Hecht, employer and self-insured 
 
         defendant for benefits as the result of an injury which occurred 
 
         on May 29, 1984.  A hearing was held on October 17, 1986 in 
 
         Davenport, Iowa and the case was fully submitted at the close of 
 
         the hearing.  The record consists of joint exhibits 1 through 23; 
 
         defendant's exhibit A; the testimony of Dennis Runge (claimant), 
 
         Bob Wayt, II (a co-employee), Gary Schlieper (a co-employee), and 
 
         Monica Walters (industrial nurse).
 
         
 
                                  STIPULATIONS
 
         
 
              The parties stipulated to the following matters in the 
 
         prehearing report:
 
         
 
              That an employer/employee relationship existed between the 
 
         claimant and the employer at the time of the alleged injury.
 
         
 
              That the claimant sustained an injury on May 29, 1984 which 
 
         arose out of and in the course of employment with the employer.
 
         
 
              That in the event of an award of temporary disability the 
 
         time off work for which the claimant seeks disability benefits is 
 
         from June 1, 1984 to July 9, 1984.
 
         
 
              That in the event of an award of permanent disability the 
 
         commencement date for benefits is July 9, 1984.
 
         
 
              That the rate of compensation in the event of an award is 
 
         $260.83 per week.
 
         
 
              That the employer is making no claim for credit for benefits 
 
         paid prior to the hearing.
 
         
 
              That the employer is making no claim for credit for sick pay 
 
         or medical benefits paid under an employee non-occupational group 
 
         plan, except that it is stipulated that if it is later determined 
 
         that any of the medical bills in claimant's exhibits 19 through 
 

 
         
 
         
 
         
 
         RUNGE V. FRENCH & HECHT
 
         Page   2
 
         
 
         
 
         22 have been paid by the group medical plan already, then the 
 
         employer will not be required to pay them again.
 
         
 
                                  ISSUES
 
         
 
              The issues presented by the parties for determination at the 
 
         time of the hearing are as follows:
 
         
 
              Whether the claimant is entitled to payment of certain 
 
         medical expenses.
 
         
 
              Whether the injury of May 29, 1984 was the cause of any 
 
         temporary or permanent disability.
 
         
 
              Whether the claimant is entitled to any temporary or 
 
         permanent disability benefits and, if so, the nature and extent 
 
         of such benefits.
 
         
 
              Whether the claimant is entitled to any compensation for 
 
         benefits during the period from May 30, 1984 to July 9, 1984 
 
         because a claimant allegedly refused suitable work consistent 
 
         with his disability offered by the employer.
 
         
 
              Paragraph 12 of the prehearing report specifies that there 
 
         is an issue about whether the claimant should be suspended from 
 
         benefits because of his alleged refusal to submit to a medical 
 
         examination pursuant to the specified on the hearing assignment 
 
         order and therefore, this issue cannot be determined by this 
 
         order and therefore, this issue cannot be determined by this 
 
         decision.  Furthermore, defendant did not mention this issue in 
 
         its opening statement, closing statement or post-hearing brief.  
 
         In addition, insufficient evidence was presented at the hearing 
 
         in order to make a determination if this were a viable issue.
 
         
 
                               PREHEARING MATTERS
 
         
 
              At the request of defense counsel all witnesses except 
 
         claimant and Monica Walters, industrial nurse, were sequestered.
 
         
 
              The claimant's original notice and petition, which was filed 
 
         pro se, alleged a claim for benefits against the Second Injury 
 
         Fund of Iowa in paragraph 19.  The claimant dismissed this 
 
         portion of his claim at the time of hearing and in addition it 
 
         was not specified in the hearing assignment order.
 
         
 
         
 
                          SUMMARY OF THE EVIDENCE
 
         
 
              All of the evidence presented at the hearing was examined 
 
         and considered in the decision in this case, however, only the 
 
         most pertinent evidence will be mentioned in this written 
 
         decision.
 
         
 
              Claimant, age 32, began working for employer in 1979 and 
 
         performed several labor and heavy labor types of jobs (Exhibit 9, 
 
         page 4).  Even though claimant previously lost a part of his 
 
         right thumb in a bandsaw in 1973, bruised his right shoulder in a 
 
         car accident in 1981 (Ex. 15), and was hit in the right knuckle 
 
         and arm when he was beaten up with a baseball bat in 1981 (Ex. 11 
 

 
         
 
         
 
         
 
         RUNGE V. FRENCH & HECHT
 
         Page   3
 
         
 
         
 
         & 18), claimant testified that nevertheless he could perform his 
 
         job and regularly lifted rims and other items weighing from 40 
 
         pounds to 200 pounds at work.  Bob Wayt and Gary Schlieper, 
 
         co-employees, testified that claimant was very strong and 
 
         regularly lifted items weighing up to 200 pounds and even heavier 
 
         without difficulty prior to the instant injury.  They further 
 
         testified that this lifting required flexible movements of his 
 
         wrists and arms.  Claimant testified that none of these prior 
 
         incidents bothered him at the time of the instant injury and that 
 
         they had left him with no disability to perform his job at French 
 
         & Hecht.  Claimant's testimony was corroborated by the testimony 
 
         of Wayt and Schlieper.
 
         
 
              On May 29, 1984 at approximately 5:00 p.m., some rims got 
 
         jammed under a conveyor belt.  Claimant stepped out on a ledge to 
 
         unjam the rims.  He caught his foot on a bolt and fell to the 
 
         floor.  In this fall his right arm grazed an iron skid and he 
 
         landed on his right fingers, wrist and hand.  The fall abrased 
 
         his right forearm and hyperflexed his right wrist.  Claimant was 
 
         taken to the East Kimberly Urgent Care Center.  The nurse 
 
         recorded pain in his right wrist and hand.  Dr. O'Connor (full 
 
         name unknown) reported that claimant's sensation was intact but 
 
         claimant could not extend his fingers or wrists, but they could 
 
         be extended on stimulation.  An x-ray was taken, a futuro wrist 
 
         splint was applied, medicine prescribed, and claimant was 
 
         returned to work to do one handed work with his left hand.  Dr. 
 
         O'Connor diagnosed right wrist tenosynovitis and a strain (Ex. 
 
         1).
 
         
 
              Claimant did not return to work on May 30, 1984 or May 31, 
 
         1984. on June 1, 1984, he telephoned and asked Monica Walters, 
 
         plant nurse, for permission to see his own doctor.  Walters 
 
         testified that she declined to give him permission.  Furthermore, 
 
         she cautioned him that if he did see his own doctor it was at his 
 
         own expense.  In addition, she made it clear that if he needed 
 
         medical attention he could go back to the Urgent Care or to 
 
         contact Dr. Beckman (full name unknown) at his office.  This was 
 
         his employer's choice of physician.  Walters' testimony is 
 
         supported by her recorded notes (Ex.  A).
 
         
 
              Claimant saw John Skehan, his own personal physician, on 
 
         June 1, 1984 (Ex. 2).  Dr. Skehan referred the claimant to John 
 
         A. Baker, M.D., an orthopedic surgeon, who also saw him on June 
 
         1,,1984 (Ex. 3).  Dr. Baker found claimant could not extend his 
 
         right fingers or wrist.  The doctor took x-rays, applied a volar 
 
         wrist splint, and diagnosed right radial nerve palsy.  Dr. Baker 
 
         took claimant off work as of June 1, 1984 and released him to 
 
         return to work on light duty with no lifting with the right arm 
 
         effective July 9, 1984 (Ex. 3, p. 5).  Walters testified that she 
 
         explained to claimant that the company refused to accept Dr. 
 
         Baker's release from work because he was not the company's 
 
         authorized doctor and also because they had documentation from 
 
         their own doctor that the claimant could work except that he 
 
         could not use his right hand.  Walters testified that the company 
 
         offered claimant full time work within these limitations but the 
 
         claimant declined it.
 
         
 
              Dr. Baker treated claimant from June 1, 1984 to January 30, 
 
         1985.  In June of 1984, he ordered an EMG and physical therapy.  
 

 
         
 
         
 
         
 
         RUNGE V. FRENCH & HECHT
 
         Page   4
 
         
 
         
 
         Claimant maintained he could not extend his fingers and wrist, 
 
         but this was inconsistent with Dr. Baker's other medical findings 
 
         and Dr. Baker suspected a strong functional overlay (Ex. 3, pp. 
 
         1-4).  Dr. Baker reported on April 8, 1985 that he had trouble 
 
         assessing the claimant's disability because the claimant's 
 
         symptoms seemed to be way above and beyond his objective 
 
         findings.  Furthermore, because of inconsistent results in the 
 
         Cybex test, Dr. Baker declined to give a percentage rating.  
 
         However, he said he doubted if there was any significant 
 
         disability.  Nevertheless, he did not want to evaluate the true 
 
         loss unequivocally without a repeat Cybex examination (Ex. 3, p. 
 
         7).  A repeat Cybex examination was never performed.
 
         
 
              The EMG/NCV tests for Dr. Baker were taken at the Franciscan 
 
         Medical Center on June 26, 1984.  Robert J. Chesser, M.D., 
 
         reported evidence of some denervation in the radial nerve 
 
         distribution, however, with good symmetrical nerve conduction 
 
         studies and the good progress patient had demonstrated to date he 
 
         expected a good prognosis (Ex. 5).  However, a later EMG/NCV test 
 
         performed for the employer's doctor, Dr. Kreiter (full name 
 
         unknown), by Daniel J. Johnson, M.D., much later on April 24, 
 
         1985, did indicate some impairment of the right radial nerve in 
 
         the following respect:
 
         
 
              EMG of the right arm is normal.
 
              NCV's of both radial nerves indicates a slowing of motor 
 
              conduction of the right radial nerve with normal distal 
 
              sensory latency.
 
         
 
              This is suggestive of an injury to the posterior interossius 
 
              branch of the right radial nerve in the forearm.
 
              (Ex. 6)
 
         
 
         
 
              Walters testified that she called the claimant on June  2, 
 
         1984 to come into work as it was indicated that he could do so by 
 
         Dr. O'Connor at Urgent Care.  She said that claimant could work 
 
         in the store room, file and sort for her, or do customer service 
 
         work.  She said claimant sounded confused on the telephone.  His 
 
         speech was slurred.  He had no interest in one handed work and he 
 
         thought he would take some vacation time (Ex.  A).  At the 
 
         hearing she described other one handed work which the claimant 
 
         could do as driving the sweeper, filing, record keeping and 
 
         janitor work.
 
         
 
              On June 11, 1984, claimant called Walters.  She told him 
 
         again that Dr. Baker's treatment was unauthorized and that Dr. 
 
         Baker's release from work was not being acknowledged.  She told 
 
         him to go back to Urgent Care and Dr. Beckman at his office.  
 
         Claimant did return to Urgent Care on June 13, 1984.  He was seen 
 
         by Dr. Koehler (full name unknown) who also said he could return 
 
         to work with no use of the right hand or wrist.  Dr. Koehler also 
 
         referred claimant to Dr. Kreiter, who was an orthopedic surgeon 
 
         and set up an appointment for July 6, 1984.  Claimant refused to 
 
         sign the work status determination of Dr. Koehler (Ex. 1, 
 
         pp.5-7).  Walters testified it was reported to her that claimant 
 
         became disorderly at Urgent Care on June 13, 1984 and this is 
 
         also recorded in her notes (Ex.  A).
 
         
 

 
         
 
         
 
         
 
         RUNGE V. FRENCH & HECHT
 
         Page   5
 
         
 
         
 
              Dr. Kreiter saw claimant on July 6, 1984 for an evaluation 
 
         before returning to work because claimant was taking a 
 
         considerable amount of medication, more specifically Tylenol 3 
 
         and Darvocet at the same time.  Dr. Kreiter reported claimant had 
 
         a cloudy sensorium possibly from the medication.  He found some 
 
         weakness of dorsiflexion and some radial numbness.  Dr. Kreiter 
 
         decreased claimant's analgesics and put him on anti-inflammatory 
 
         medications and stated that he could return to work on July 9, 
 
         1984.  Claimant returned to work on July 9, 1984 and did, in 
 
         fact, perform one handed work for Walters at that time.   Dr. 
 
         Kreiter saw claimant again on September 14, 1984.  At that time 
 
         he thought claimant was under the influence of either medication 
 
         or alcohol.  He said claimant had a good range of motion for his 
 
         right shoulder, elbow and digits.  His reflexes were intact and 
 
         his strength was improved.  However, claimant still had some 
 
         decreased sensation on the dorsum of the right hand.  His radial 
 
         nerve was otherwise functioning.  Dr. Kreiter felt like his 
 
         examination was inadequate because claimant was tremulous and 
 
         uncooperative    (Ex. 7).
 
         
 
              Claimant was examined for the employer by Bruce L. Sprague, 
 
         M.D., on April 16, 1985.  Dr. Sprague commented that claimant 
 
         appeared to have been drinking and his sensorium was not very 
 
         clear.  The results of his examination based on several clinical 
 
         tests was essentially normal, except claimant resisted active 
 
         dorsiflexion of the right wrist, but he still had full passive 
 
         dorsiflexion.  Dr. Sprague noted that Dr. Baker's EMG showed some 
 
         denervation of the extensor muscles of the right forearm.  On May 
 
         6, 1985, Dr. Sprague noted that Dr. Kreiter's EMG report showed 
 
         decreased conductivity and changes in the extensor digiti 
 
         communis muscle of the right forearm conducive with a 
 
         postinterosseous nerve syndrome.  Dr. Sprague ended this report 
 
         as follows:
 
         
 
              Because of the patient's attitude, one is reluctant to 
 
              operate on him because the complications from this type 
 
              of surgery can be significant, and the eventual 
 
              improvement may be minimal.  Therefore, I feel it would 
 
              be most efficacious to give him an impairment rating of 
 
              10% of the upper extremity due to weakness of the 
 
              extensor comramunis [sic] muscle, as well as the indius 
 
              proprius instead of trying to undertake the surgical 
 
              correction.
 
              (Ex. 8).
 
         
 
              Claimant was seen for the last time by Dr. Sprague on 
 
         January 20, 1986 for continued right wrist pain.  Basically, 
 
         there was no change from the claimant's previous condition.  
 
         However, Dr. Sprague did comment in this report that the claimant 
 
         had denied any previous injuries other than the one at work (Ex. 
 
         8).
 
         
 
              Much of the claimant's past medical history was introduced 
 
         into evidence.  It demonstrated a number of accidents and 
 
         illnesses for which the claimant's personal physician had ordered 
 
         prescription drugs (Ex. 10-18).
 
         
 
              Claimant presented unpaid medical bills as follows: (Ex. 19 
 
         through 22)
 

 
         
 
         
 
         
 
         RUNGE V. FRENCH & HECHT
 
         Page   6
 
         
 
         
 
         
 
         Dr. John Skehan                              $  26.00
 
                    Dr. John A. Baker                   276.00
 
                    Rock Valley Physical Therapy        158.00
 
                    Franciscan Medical Center           190.00
 
                                 Total                $ 650.00
 
         
 
              Walters testified that claimant could have and would have 
 
         been given the same treatment by the employer's doctors that he 
 
         received from Dr. Baker if claimant would have gone back to 
 
         Urgent Care and given them a chance.  She also testified that the 
 
         employer's doctors had been to the plant and that they knew the 
 
         plant.  Also the company doctors knew it was the employer's 
 
         Policy to return injured workers to work in some capacity as soon 
 
         as possible and that the employer's doctors agreed with this 
 
         policy and tried to implement it.  She further testified that Dr. 
 
         Baker had not been to the plant and was not familiar with the 
 
         employer's policy.
 
         
 
         
 
         
 
              Claimant testified that his current condition is that he 
 
         suffers weakness in his fingers, hand and wrist on the right hand 
 
         and that he cannot dorsiflex his right wrist.
 
         
 
                          APPLICABLE LAW AND ANALYSIS
 
         
 
              Iowa Code section 85.27 provides that the employer shall 
 

 
         
 
         
 
         
 
         RUNGE V. FRENCH & HECHT
 
         Page   7
 
         
 
         
 
         furnish reasonable medical care, but also provides that the 
 
         employer has the right to chose the care.  The employer did 
 
         provide emergency care at the time of the injury.  Walters 
 
         testified that additional care could have been and would have 
 
         been provided if claimant would have returned to Urgent Care or 
 
         Dr. Beckman as she directed him to do.  Claimant did not return 
 
         to Urgent Care or Dr. Beckman.  Instead claimant chose to see his 
 
         own personal physician for reasons of his choosing.  Walters 
 
         informed claimant that if he chose his own.care the payment for 
 
         it would be his own expense.  Claimant did talk to his union 
 
         representative and they verified that the employer could chose 
 
         the care.  Claimant testified his own physician was closer to him 
 
         and more convenient and that he was not happy with the treatment 
 
         he received at Urgent Care.  Walters testified that claimant 
 
         wanted to go to his own doctors so he could get stronger pain 
 
         pills.  In any event, claimant chose to see his own physicians 
 
         knowing full well that the employer had the right to choose the 
 
         care and that if he chose the care he would be expected to pay 
 
         for them himself.  The union representative told claimant that 
 
         the non-occupational group medical plan would pay for some of his 
 
         bills and it is possible that the claimant may have relied on 
 
         this information to some extent.  Nevertheless, it is determined 
 
         here that claimant's medical expenses in the amount of $650 as 
 
         shown in exhibits 19 through 22 are not authorized medical 
 
         expenses and the employer is not responsible for their payment.
 
         
 
              The claimant has the burden of proving by a preponderance of 
 
         the evidence that the injury of May 29, 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. 0. Boggs, 236 Iowa 296, 18 N.W.2d 607 (1945).  A possibility 
 
         is insufficient; a probability is necessary.  Burt v. John Deere 
 
         Waterloo Tractor Works, 247 Iowa 691, 73 N.W.2d 732 (1955).  The 
 
         question of causal connection is essentially within the domain of 
 
         expert testimony.  Bradshaw v. Iowa Methodist Hospital, 251 Iowa 
 
         375, 101 N.W.2d 167 (1960).
 
         
 
              However, expert medical evidence must be considered with all 
 
         other evidence introduced bearing on the causal connection. Burt, 
 
         247 Iowa 691, 73 N.W.2d 732.  The opinion of experts need not be 
 
         couched in definite, positive or unequivocal language. Sondag v. 
 
         Ferris Hardware, 220 N.W.2d 903 (Iowa 1974).  However, the expert 
 
         opinion may be accepted or rejected, in whole or in part, by the 
 
         trier of fact.  Id. at 907.  Further, the weight to be given to 
 
         such an opinion is for the finder of fact, and that may be 
 
         affected by the completeness of the premise given the expert and 
 
         other surrounding circumstances.  Bodish, 257 Iowa 516, 133 
 
         N.W.2d 867.  See also Musselman v. Central Telephone Co., 261 
 
         Iowa 352, 154 N.W.2d 128 (1967).
 
         
 
              Claimant has not sustained the burden of proof by a 
 
         preponderance of the evidence that he is entitled to temporary 
 
         disability benefits for his time off work from June 1, 1984 to 
 
         July 9, 1984.  On the two occasions that claimant saw the 
 
         employer's doctor, May 29, 1984 and June 13, 1984, it was 
 
         determined that claimant could be returned to work to do one 
 
         handed work with his left hand.  Although his right wrist was 
 
         splinted and his right arm was abrased, the rest of his body was 
 
         fully functional.  Walters enumerated a number of jobs which the 
 

 
         
 
         
 
         
 
         RUNGE V. FRENCH & HECHT
 
         Page   8
 
         
 
         
 
         claimant could perform with one hand.  When claimant returned to 
 
         work on July 9, 1984, he did in fact perform some of these very 
 
         same jobs because he was still restricted by Dr. Baker to light 
 
         duty and to avoid use of the right hand.  It was not shown that 
 
         Dr. Baker knew one handed work and light duty work was available 
 
         to the claimant from the start back on June 1, 1984.  Therefore, 
 
         claimant has failed to prove by a preponderance of the evidence 
 
         that he was unable to work during the period from June 1, 1984 to 
 
         July 9, 1984.
 
         
 
              In addition, Iowa Code section 85.33(3) provides as  
 
              follows:
 
         
 
              If an employee is temporarily, partially disabled and 
 
              the employer for whom the employee was working at the 
 
              time of injury offers to the employee suitable work 
 
              consistent with the employee's disability the employee 
 
              shall accept the suitable work, and be compensated with 
 
              temporary partial benefits.  If the employee refuses to 
 
              accept the suitable work the employee shall not be 
 
              compensated with temporary partial, temporary total, or 
 
              healing period benefits during the period of the 
 
              refusal.
 
         
 
              Again Walters enumerated several light duty jobs claimant 
 
         could possibly do one handed and testified that he did in fact do 
 
         some of these very same jobs when he returned to work on July 9, 
 
         1984 with the same restrictions from Dr. Baker that had been 
 
         imposed earlier by Dr. O'Connor and Dr. Koehler.
 
         
 
              Claimant also admitted he did these jobs but under the 
 
         mistaken belief that he did them May 30, 1984, May 31, 1984 and 
 
         June 1, 1984.  It is determined that the claimant was mistaken in 
 
         his testimony because the employer's attendance records (Ex. 9, 
 
         p. 5) show that claimant was absent from work from May 29, 1984 
 
         through July 7, 1984.  Walters further testified that she knew he 
 
         was absent from work also on these dates.  Claimant conceded in 
 
         his testimony that he suffered from memory problems especially 
 
         regarding dates and sequence of events.  Walters' notes show that 
 
         she called claimant to come to work on June 2, 1984 but that he 
 
         had no interest in one handed work and thought he would take a 
 
         vacation day that day and maybe a few after that (Ex.  A).  
 
         Therefore, it is found that claimant is not entitled to temporary 
 
         disability benefits because claimant refused suitable work (Iowa 
 
         Code section 85.33(3)).
 
         
 
              The injury was the cause of some permanent disability and 
 
         claimant is entitled to some permanent partial disability 
 
         benefits.  It is true claimant had prior injuries to his right 
 
         arm.  However, claimant testified that his partially severed 
 
         right thumb did not effect his strength in the rest of his right 
 
         upper extremity.  This appears to be true because claimant, Wayt 
 
         and Schlieper all testified as to the claimant's ability to 
 
         regularly lift extremely heavy weights every day at work.
 
         
 
              As to the right shoulder injury in 1981 from the automobile 
 
         accident the x-rays were negative and the claimant's diagnoses 
 
         was strain only.  No residuals from this automobile accident were 
 
         indicated (Ex. 11).
 

 
         
 
         
 
         
 
         RUNGE V. FRENCH & HECHT
 
         Page   9
 
         
 
         
 
         
 
              As to the incident when claimant was beat up with a baseball 
 
         bat in June of 1981 there appears to be a right knuckle injury as 
 
         the claimant admitted (Ex. 11, p. 2).  A careful search of the 
 
         University of Iowa records for this injury and his treatment show 
 
         that claimant was hit in the right hand and he received a 
 
         contusion of the right middle MCP joint (Ex. 18, p. 18).  
 
         Claimant testified that his right wrist and arm were casted to 
 
         immobilize the knuckle.  The right knuckle was noted to be 
 
         swollen but the x-ray of it was normal (Ex. 18, p. 22).  Claimant 
 
         was discharged from the orthopedic department without additional 
 
         follow-up (Ex. 18, p. 23).  A careful search of all the records 
 
         in exhibit 18 do not reveal any serious injury or disability to 
 
         the right arm or knuckle.
 
         
 
              Claimant failed to disclose these prior injuries to Dr. 
 
         Sprague prior to his evaluation.  It is not known and cannot be 
 
         determined how much, if any, Dr. Sprague would have discounted 
 
         his 10 percent permanent impairment assessment for the prior 
 
         injuries.  No evidence suggests that any prior permanency 
 
         existed.  The prior injuries do not appear to have affected the 
 
         nerves of the arm as were affected by this injury.  There is 
 
         sufficient evidence of permanent impairment for this injury for 
 
         the following reasons.  First, claimant testified that his prior 
 
         injuries had no residual effects and the medical records do not 
 
         show any either.  Secondly, claimant, Wayt and Schlieper all 
 
         testified that claimant did regularly lift items weighing up to 
 
         200 pounds and sometimes even greater than that without 
 
         difficulty.  These jobs involved flexibility of his arms and 
 
         wrists.  Thirdly, Dr. Baker's EMG/NCV performed by Dr. Chesser 
 
         showed evidence of denervation in the radial nerve distribution 
 
         of the right arm (Ex. 5, p. 3).  Fourth, Dr. Kreiter's EMG/NCV 
 
         performed by Dr. Johnson showed slowing of the motor conduction 
 
         of the right radial nerve suggestive of an injury to the 
 
         posterior interosseseous branch of the radial nerve (Ex. 6).  
 
         Fifth, Dr. Sprague also noted the results of these two EMG/NCV 
 
         tests and stated they go along with the patient's history and 
 
         would account for his symptomology (Ex. 8, p. 2).  Sixth, 
 
         claimant testified his current complaints are weakness in his 
 
         fingers and inability to dorsiflex the right wrist.  Urgent Care, 
 
         Dr. Baker, Dr. Kreiter, and Dr. Sprague all made note of these 
 
         very same symptoms all the way through the claimant's treatment 
 
         from beginning to end.  Seventh, claimant demonstrated his hand 
 
         and fingers at the hearing illustrating how much he could and 
 
         could not flex and extend the fingers and wrist on his right arm.  
 
         Therefore, applying agency expertise to the foregoing information 
 
         it is determined that the claimant has sustained a 10 percent 
 
         permanent impairment of the right arm. (Iowa Administrative 
 
         Procedure Act, section 17A.14(5)).
 
         
 
                                FINDINGS OF FACT
 
         
 
              WHEREFORE, based upon the evidence presented the following 
 
         findings of fact are made:
 
         
 
              That the medical expenses that the claimant incurred as 
 
         shown in exhibits 19 through 22 were not authorized by the 
 
         employer, but on the contrary were incurred by the claimant as 
 
         his own choice of care knowing that they would not be covered 
 

 
         
 
         
 
         
 
         RUNGE V. FRENCH & HECHT
 
         Page  10
 
         
 
         
 
         under the workers' compensation law.
 
         
 
              That claimant refused to work during the period June 1, 1984 
 
         through July 9, 1984 even though the employer made it clear that 
 
         special light duty one handed work was available and that Dr. 
 
         Baker's release was not recognized as excusing the claimant from 
 
         work.
 
         
 
              That claimant did not return to work and attempt to do the 
 
         one handed light duty work that was offered.
 
         
 
              That claimant sustained a 10 percent permanent impairment of 
 
         the right arm based upon the factors discussed above.
 
         
 
                            CONCLUSIONS OF LAW
 
         
 
              WHEREFORE, based upon the evidence presented and the 
 
         principles of law previously stated, the following conclusions of 
 
         law are made:
 
         
 
              That claimant is not entitled to payment of the medical 
 
         expenses which he is claiming under Iowa Code section 85.27.
 
         
 
              That claimant is not entitled to temporary disability 
 
         benefits for the period June 1, 1984 to July 9, 1984 under Iowa 
 
         Code section 85.23 or Iowa Code section 85.34.
 
         
 
              That claimant is entitled to 25 weeks of permanent partial 
 
         disability for a 10 percent permanent impairment of the right 
 
         arm.
 
         
 
                                   ORDER
 
         
 
              WHEREFORE, IT IS ORDERED:
 
         
 
              That defendant pay to claimant twenty-five (25) weeks of 
 
         permanent partial disability benefits at the rate of two hundred 
 
         sixty and 83/100 dollars ($260.83) per week in the total amount 
 
         of six thousand five hundred twenty and 75/100 dollars 
 
         ($6,520.75) commencing on May 30, 1984.
 
         
 
              That the defendant pay these accrued benefits in a lump 
 
         sum.
 
         
 
              That interest shall accrued as provided by Iowa Code section 
 
         85.30.
 
         
 
              That defendant will pay the cost of this action as provided 
 
         by Division of Industrial Services Rule 343-4.33, formerly Iowa 
 
         Industrial Commissioner Rule 500-4.33.
 
         
 
              That defendant file claim activity reports as requested by 
 
         this agency as provided by Division of Industrial Services Rule 
 
         343-3.1, formerly Iowa Industrial Commissioner Rule 500-3.1.
 
         
 
         
 
         
 
         
 
         
 

 
         
 
         
 
         
 
         RUNGE V. FRENCH & HECHT
 
         Page  11
 
         
 
         
 
         
 
         
 
         
 
                  Signed and filed this 31st day of March, 1987.
 
         
 
         
 
         
 
         
 
         
 
         
 
         
 
         
 
         
 
         
 
                                            WALTER R. McMANUS, JR.
 
                                            DEPUTY INDUSTRIAL COMMISSIONER
 
         
 
         Copies To:
 
         
 
         Mr. James M. Hood
 
         Attorney at Law
 
         302 Union Arcade
 
         Davenport, Iowa 52801
 
         
 
         Mr. Craig A. Levien
 
         Mr. Larry Shepler
 
         Attorneys at Law
 

 
         
 
         
 
         
 
         RUNGE V. FRENCH & HECHT
 
         Page  12
 
         
 
         
 
         600 Union Arcade Bldg.
 
         111 E. 3rd Street
 
         Davenport, Iowa 52801
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                            1402.60; 1802; 1803 
 
                                            Filed March 31, 1987
 
                                            WALTER R. McMANUS, JR.
 
         
 
                    BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         _________________________________________________________________
 
         
 
         DENNIS RUNGE,
 
         
 
              Claimant,
 
                                                      FILE NO. 771016 
 
         VS.
 
                                                    A R B I T R A T I 0 N
 
         FRENCH & HECHT,
 
                                                      D E C I S I 0 N
 
              Employer,
 
              Self-Insured,
 
              Defendant.
 
         _________________________________________________________________
 
         
 
         1402.60
 
         
 
              Medical care payments were denied for care that claimant 
 
         incurred from his own choice of physician in the face of 
 
         admonitions by the employer and his union that they would not be 
 
         covered by workers' compensation.
 
         
 
         1802
 
         
 
              Claimant was denied healing period benefits for the period 
 
         that he refused to do light duty one handed work where the 
 
         employer's physicians authorized it and employer offered it even 
 
         though his own choice of physician said he could not work.  
 
         Claimant's own physician was not familiar with employer's policy 
 
         of returning employees to work as soon as possible and making 
 
         employment available to them.
 
         
 
         1803
 
         
 
              Claimant was allowed 10 percent permanent partial disability 
 
         based on defendant's doctor's evaluation which was the only 
 
         evaluation of impairment.  Although claimant had several prior 
 
         injuries and accidents, none of them had caused any impairment 
 
         that conflicted with the current evaluation.
 
 
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         
 
         LINDA L. FERNS,
 
         
 
              Claimant,
 
         
 
         vs.
 
                                           File Nos. 771026 & 838625
 
         
 
         HON INDUSTRY SYSTEMS GROUP,
 
                                            A R B I T R A T I 0 N
 
              Employer,
 
                                              D E C I S I 0 N
 
         and
 
         
 
         HARTFORD INSURANCE,
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
         
 
         
 
                                   INTRODUCTION
 
         
 
              This is a proceeding in arbitration brought by Linda L. 
 
         Ferns, claimant, against Hon Industry Systems Group, employer, 
 
         and Hartford Insurance Company, insurance carrier, defendants.  
 
         The case was heard by the undersigned in Davenport, Iowa on 
 
         September 15, 1988.  The case was fully submitted at the close of 
 
         the hearing.
 
         
 
              The record consists of the testimony of claimant and Evelyn 
 
         Norris Burns.  The record also consists of the testimony of the 
 
         following witnesses for defendants:  William Shellabarger and 
 
         Peggy Sue Hinbaugh Stackweather.  Additionally, the record 
 
         consists of claimant's exhibits A and B, as well as joint 
 
         exhibits 1 and 2.
 
         
 
              The parties stipulate to the existence of an 
 
         employer-employee relationship between claimant and defendant at 
 
         the time of the alleged injuries.
 
         
 
                                 ISSUES PRESENTED
 
         
 
              The issues presented by the parties at the time of the 
 
         prehearing and hearing for each of the case files are as 
 
         follows:
 
         
 
              1)   Whether claimant received an injury which arose out of 
 
         and in the course of employment;
 
              2)   Whether there is a causal relationship between the 
 
         alleged injuries and the claimed disability; and,
 
         
 
              3)   Whether claimant is entitled to temporary 
 
         disability/healing period benefits or permanent partial or total 
 
         disability benefits.
 
         
 

 
         
 
         
 
         
 
         FERNS V. HON INDUSTRY SYSTEMS GROUP
 
         PAGE   2
 
         
 
                                FACTS PRESENTED
 
         
 
              Claimant had been employed by defendant as a sewing machine 
 
         operator.  According to claimant on October 25, 1983, she had 
 
         finished making covers and had grabbed her time card.  Suddenly, 
 
         she experienced a jerk from the tables in front of her.  Claimant 
 
         struck her left knee against the work station table.  Claimant's 
 
         chair tipped and she jumped back with bent knees.  She stated it 
 
         hurt to stand and she felt a "shooting pain" across her front as 
 
         well as a soreness in her hips.  After the above events occurred, 
 
         claimant testified she reported the incident to George Williams, 
 
         a supervisor.  She then completed an accident report and returned 
 
         to work.
 
         
 
              Claimant also related the events of her second injury which 
 
         allegedly occurred on February 15, 1985.  She testified she was 
 
         at her work station.  Nearby, another employee was driving a 
 
         forklift containing a stack of tables.  The tables fell from the 
 
         forklift causing a "domino effect."  One of the tables apparently 
 
         struck claimant.  Claimant related she experienced a "smack on 
 
         the back of her leg."  She also reported she felt a tremendous 
 
         pain on her shin bone from the knee cap to the ankle.  
 
         Additionally, claimant stated she was hit behind and below the 
 
         hip on her right upper thigh.  After the incident claimant 
 
         completed an accident report.  Several days later, claimant was 
 
         terminated.
 
         
 
                                  APPLICABLE LAW
 
         
 
              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).
 
         
 
              Claimant has the burden of proving by a preponderance of the 
 
         evidence that she received injuries on October 25, 1983 and 
 
         February 15, 1985 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).
 
         
 
              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, 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, 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, 188 N.W.2d 283 (Iowa 1971); 
 

 
         
 
         
 
         
 
         FERNS V. HON INDUSTRY SYSTEMS GROUP
 
         PAGE   3
 
         
 
         Musselman, 261 Iowa 352, 154 N.W.2d 128 (1967).
 
         
 
                   The supreme court of Iowa in Almquist v. Shenandoah 
 
         Nurseries, 218 Iowa 724, 254 N.W. 35 (1934) at 731-32, 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.
 
         
 
                 ....
 
         
 
              A personal injury, contemplated by the WorkmenOs 
 
              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.
 
         
 
              The claimant must prove by a preponderance of the evidence 
 
         that her injuries arose out of and in the course of her 
 
         employment.  Musselman, 261 Iowa 352, 154 N.W.2d 128 (1967).
 
         
 
              In the course of employment means that the claimant must 
 
         prove her injuries occurred at a place where she reasonably may 
 
         be performing her duties.  McClure, 188 N.W.2d 283 (Iowa 1971).
 
         
 
              Arising out of suggests a causal relationship between the 
 
         employment and the injury.  Crowe, 246 Iowa 402, 68 N.W.2d 63 
 
         (1955).
 
         
 
              The claimant has the burden of proving by a preponderance of 
 
         the evidence that the injuries of October 25, 1983 and February 
 
         15, 1985 are causally related to the disability on which she now 
 
         bases her claim.  Bodish v. Fischer, Inc., 257 Iowa 516, 133 
 
         N.W.2d 867 (1965).  Lindahl v. L.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  
 

 
         
 
         
 
         
 
         FERNS V. HON INDUSTRY SYSTEMS GROUP
 
         PAGE   4
 
         
 
         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, 261 Iowa 352, 154 
 
         N.W.2d 128 (1967).
 
         
 
              An employer takes an employee subject to any active or 
 
         dormant health impairments, and a work connected injury which 
 
         more than slightly aggravates the condition is considered to be a 
 
         personal injury.  Ziegler v. United States Gypsum Co., 252 Iowa 
 
         613, 620, 106 N.W.2d 591 (1960), and cases cited.
 
         
 
              The right of a worker to receive compensation for injuries 
 
         sustained which arose, out of and in the course of employment is 
 
         statutory.  The statute conferring this right can also fix the 
 
         amount of compensation to be paid for different specific 
 
         injuries, and the employee is not entitled to compensation except 
 
         as provided by the statute.  Soukup v. Shores Co., 222 Iowa 272, 
 
         268 N.W. 598 (1936).
 
         
 
              An injury is the producing cause; the disability, however, 
 
         is the result, and it is the result which is compensated.  Barton 
 
         v. Nevada Poultry Co., 253 Iowa 285, 110 N.W.2d 660 (1961); 
 
         Dailey v. Pooley Lumber Co., 233 Iowa 758, 10 N.W.2d 569 
 
         (1943).
 
         
 
              If a claimant contends he has industrial disability he has 
 
         the burden of proving his injury results in an ailment extending 
 
         beyond the scheduled loss.  Kellogg v. Shute and Lewis Coal Co., 
 
         256 Iowa 1257, 130 N.W.2d 667 (1964).
 
         
 
              As a claimant has an impairment to the body as a whole, an 
 
         industrial disability has been sustained.  Industrial disability 
 
         was defined in Diederich v. Tri-City Railway Co., 219 Iowa 587, 
 
         593, 258 N.W. 899, 902 (1935) as follows:  "It is therefore plain 
 
         that the legislature intended the term 'disability' to mean 
 
         'industrial disability' or loss of earning capacity and not a 
 
         mere 'functional disability' to be computed in the terms of 
 
         percentages of the total physical and mental ability of a normal 
 
         man."
 
         
 
              The opinion of the supreme court in Olson v. Goodyear 
 
         Service Stores, 255 Iowa 1112, 125 N.W.2d 251 (1963) at 1121,    
 
           , cited with approval a decision of the industrial commissioner 
 
         for the following proposition:
 
         
 
              Disability * * * as defined by the Compensation Act 
 
              means industrial disability, although functional 
 
              disability is an element to be considered . . . In 
 
              determining industrial disability, consideration may be 
 

 
         
 
         
 
         
 
         FERNS V. HON INDUSTRY SYSTEMS GROUP
 
         PAGE   5
 
         
 
              given to the injured employee's age, education, 
 
              qualifications, experience and his inability, because 
 
              of the injury, to engage in employment for which he is 
 
              fitted. * * * * 
 
         
 
              Functional impairment 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, 
 
         255 Iowa 1112, 1121 125 N.W.2d 251, 257 (1963).
 
         
 
              In Parr v. Nash Finch Co.,(Appeal Decision, October 31, 
 
         1980) the industrial commissioner, after analyzing the decisions 
 
         of McSpadden v. Big Ben Coal Co., 288 N.W.2d 181 (Iowa 1980) and 
 
         Blacksmith v. All-American, Inc., 290 N.W.2d 348 (Iowa 1980), 
 
         stated:
 
         
 
              Although the court stated that they were looking for 
 
              the reduction in earning capacity it is undeniable that 
 
              it was the "loss of earnings" caused by the job 
 
              transfer for reasons related to the injury that the 
 
              court was indicating justified a finding of "industrial 
 
              disability."  Therefore, if a worker is placed in a 
 
              position by his employer after an injury to the body as 
 
              a whole and because of the injury which results in an 
 
              actual reduction in earning, it would appear this would 
 
              justify an award of industrial disability.  This would 
 
              appear to be so even if the worker's "capacity" to earn 
 
              has not been diminished.
 
         
 
              For example, a defendant employer's refusal to give any sort 
 
         of work to a claimant after he suffers his affliction may justify 
 
         an award of disability.  McSpadden, 288 N.W.2d 181 (Iowa 1980).
 
         
 
              Similarly, a claimant's inability to find other suitable 
 
         work after making bona fide efforts to find such work may 
 
         indicate that relief would be granted.  McSpadden, 288 N.W.2d 181 
 
         (Iowa 1980)
 
         
 
              Permanent partial disabilities are classified as either 
 
         scheduled or unscheduled.  A specific scheduled disability is 
 
         evaluated by the functional method; the industrial method is used 
 
         to evaluate an unscheduled disability.  Martin v. Skelly Oil Co., 
 
         252 Iowa 128, 133, 106 N.W.2d 95, 98 (1960); Graves v. Eagle Iron 
 
         Works, 331 N.W.2d 116 (Iowa 1983); Simbro v. DeLongOs Sportswear, 
 
         332 N.W.2d 886, 887 (Iowa 1983).
 
         
 
                                     ANALYSIS
 
         
 
              In the case at bar, claimant contends she suffered a 
 
         permanent impairment as a result of either or both of the work 
 
         injuries which she received.  There is a dispute as to how the 
 
         events in question occurred.  However, there is no genuine issue 
 
         whether the two incidents took place.  It is acknowledged 
 
         claimant has some type of recurring health problems.  There is 
 
         only very minimal support in the record that claimant's alleged 
 
         disability is causally connected to the two incidents which give 
 
         rise to these proceedings.  Moreover, there is little evidence to 
 
         establish that claimant has a permanent impairment.  The treating 
 

 
         
 
         
 
         
 
         FERNS V. HON INDUSTRY SYSTEMS GROUP
 
         PAGE   6
 
         
 
         physician, Richard L. Kreiter, M.D., in his letter of October 26, 
 
         1984, writes:
 
         
 
              ...Her exam is basically unremarkable except for some 
 
              mild restricted motion but her neurological exam is 
 
              normal.
 
         
 
              ... She may well be one, as you know, who tries to 
 
              manipulate her work situation and seems to have done a 
 
              good job of that ....
 
         
 
              Dr. Kreiter does not determine whether there is any 
 
         impairment.. He does not causally relate claimant's alleged 
 
         disability to the injury dates in question.  Patrick A. Tranmer, 
 
         M.D., claimant's treating physician, has determined claimant 
 
         suffered from the following as of July 24, 1985:  "Linda Ferns 
 
         suffers from a rheumatoid condition that involves her lower back, 
 
         shoulders and hands...." He, however, does not attribute the 
 
         rheumatoid condition to the work injuries which are at issue.
 
         
 
              Another of claimant's treating physicians, W. McCrady, M.D., 
 
         at the University of Arizona, Student Health Service, disputes 
 
         the diagnosis of Dr. Tranmer.  Dr. McCrady does not establish 
 
         that claimant is even suffering from rheumatoid arthritis.  He 
 
         writes in his progress notes for December 15, 1987:
 
         
 
              ... They sent her here to school to learn to be an 
 
              accountant after she had been in 2 industrial accidents 
 
              being hit by a fork lift [sic] with injury to the back 
 
              of her right leg on one occasion.  She states that she 
 
              has as a result of these injuries, acquired rheumatoid 
 
              arthritis ...
 
         
 
                 ....
 
         
 
              I see no evidence for rheumatoid arthritis.  This 
 
              persons [sic] pain pattern sounds like a chronic pain 
 
              syndrome no doubt induced by the injuries of a few 
 
              years ago.  The accidents were in 1983 and 1985 ....
 
         
 
              Later, H. C. Tretbar, M.D., of The Tucson Clinic, P.C., in 
 
         his progress notes of April 6, 1988 writes in relevant part:
 
         
 
              ...The neck has good range of motion.  There is a 
 
              little bit of tightness in the trapezia.  Upper 
 
              extremities show normal shoulders, elbows, arms, hands 
 
              and fingers.  There is some spot tenderness over the 
 
              lumbosacral and she is able to flex past 45 degrees.  
 
              The lateral bending is good and there is a little bit 
 
              of soreness on the posterior flexion.  There is some 
 
              sensitive areas over the pelvic brims and she is 
 
              sensitive over both trochanteric areas, greater on the 
 
              left side.  She has a little bit of soreness in the 
 
              left sciatic notch, but there is no radicular symptoms 
 
              down the leg.  She has normal movement of the left hip 
 
              and the right hip has a little bit of soreness on full 
 
              flexion and on internal rotation and I wonder if she 
 
              may have a little intra-articular hip change which 
 
              would be demonstrable on x-ray.  Knees, ankles and feet 
 
              look normal.  She has normal knee and ankle jerks.  
 

 
         
 
         
 
         
 
         FERNS V. HON INDUSTRY SYSTEMS GROUP
 
         PAGE   7
 
         
 
              There is no weakness in the legs or feet.  Sensory exam 
 
              is grossly normal.
 
         
 
              IMPRESSION:  History of injury to the legs, 
 
              particularly the right.  There may be some residual 
 
              right hip problem which x-ray would be helpful in 
 
              evaluating.  Basically if she can lose weight, [sic] do 
 
              her back exercises and stay on MOTRIN she should do 
 
              quite well.
 
         
 
              Dr. Tretbar is unable to find any objective clinical 
 
         findings which establish an alleged disability.  He does not 
 
         determine whether claimant has a permanent impairment.
 
         
 
              Next, claimant's treating chiropractors can find no 
 
         permanent impairment.  Jeffrey A. Shay, D.C., makes no findings 
 
         of functional impairment.  Ben F. Hanssen, D.C., reports:
 
         
 
              ...She (claimant) was released with no apparent 
 
              permanent injury on Jan. 18, 1984, but still complained 
 
              of reoccurring pain in her hips and lower back .... I 
 
              felt the structural misalignment had been corrected at 
 
              that time but was uncertain of any future care because 
 
              of her complaints of the reoccurring back pain.
 
         
 
              Finally, there is the nearly exhaustive report from the 
 
         medical personnel at the Industrial Injury Clinic at the Theda 
 
         Clark Regional Medical Center.  Claimant was referred to the 
 
         clinic by defendants.  She was admitted for examination and 
 
         evaluation on November 4, 1984 and she was discharged on November 
 

 
         
 
         
 
         
 
         FERNS V. HON INDUSTRY SYSTEMS GROUP
 
         PAGE   8
 
         
 
         7, 1984.  Numerous tests were conducted.  The relevant results of 
 
         the tests, as well as the staff diagnosis, reveal the subsequent 
 
         evidence:
 
         
 
              A CT of the Lumbar Spine was performed on 11-5-84 and 
 
              interpreted by M.A.SanDretto, M.D., Radiologist:  Axial 
 
              sections were obtained through three levels, L3-4, L4-5 
 
              and L5-Sl.  At all three levels studied, the posterior 
 
              disc margin is normal in appearance.  There is no 
 
              evidence of disc herniation or other abnormality.  The 
 
              facette joints and neural foramina are also normal at 
 
              the levels studied.  Impression: Normal lumbar CT of 
 
              L3-4, L4-5 and L5-Sl.  There is no evidence of disc 
 
              herniation.
 
         
 
              A Chest X-ray was performed on 11-5-84 and interpreted 
 
              by L.L. Bauer, M.D., Radiologist:  There is no active 
 
              cardiopulmonary disease.
 
         
 
              An X-Ray of the Lumbar Spine was normal.  X-Rays of the 
 
              hands were normal.
 
         
 
              A Bone Scan was performed on 11-5-84 and interpreted by 
 
              L.L. Bauer, M.D.:  Pharmaceutical is 21.7 mCi of Tc 
 
              99MDP.  Uptake of radiopharmaceutical is normal and 
 
              physiological.  Conclusion:  Normal bone scan.
 
         
 
              All Body Chemistries performed while at the IIC were 
 
              essentially within normal limits.
 
         
 
              The Urinalysis was essentially normal.
 
         
 
              A Rheumatoid Arthritis Quantitative Titre was reported 
 
              as negative.  The Sed. Rate is elevated at 28 mm.  A 
 
              Street Drug Screen was reported as negative.
 
         
 
              Serum Protein Electrophoresis was performed on 11-5-84 
 
              and interpreted by P.N. Gohdes, M.D., Pathologist:  The 
 
              total protein is within the reference range.  There are 
 
              no abnormalities of the serum protein electrophoretic 
 
              study.  There is no evidence of areas of restricte 
 
              protein mobility or beta-gamma bridging.  Impression: 
 
              Normal serum protein electrophoretic study.
 
         
 
              An Electrocardiogram was performed on 11-4-84 and 
 
              resulted in a normal sinus rhythm with premature 
 
              ventricular or aberrantly conducted complexes and an 
 
              otherwise normal EKG.
 
         
 
              An Electromyogram was performed on 11-6-84 and 
 
              interpreted by T.J. Michlowski, M.D.:  Nerve conduction 
 
              studies of the lower extremities including the H reflex 
 
              bilaterally were within normal limits.  On needle 
 
              examination there was normal insertional activity, no 
 
              abnormal spontaneous activity and normal motor unit 
 
              potential characteristics in all muscles examined
 
         
 
              Impression:  This NCS/EMG study is within normal 
 
              limits.  Specifically, there was no evidence to suggest 
 
              a myopathic, neuropathic or active radicular process.
 

 
         
 
         
 
         
 
         FERNS V. HON INDUSTRY SYSTEMS GROUP
 
         PAGE   9
 
         
 
         
 
                 ....
 
         
 
              STAFF RECOMMENDATIONS AND CONCLUSIONS
 
         
 
              1.  It is the opinion of the staff that this individual 
 
              does not have any permanent physical impairment or 
 
              disability relative to the industrial injury in 
 
              question.
 
         
 
                 ....
 
         
 
              3.  It is the opinion of the staff that this individual 
 
              can return to work at this time within the work 
 
              capacity classification attached to this report.  
 
              Because of the low grade underlying rheumatic 
 
              condition, it is recommended that she avoid high and 
 
              very high speed rapid alternating work activity 
 
              especially of a repetitive impact loading type.  Other 
 
              major factors that will probably help with improvement 
 
              of her symptoms and better endurance at the job will be 
 
              resolution of the current interpersonal conflict with 
 
              her immediate supervisor.  If this cannot be resolved, 
 
              relocation at another job site and job task at her 
 
              place of employment may be prudent.
 
         
 
              Given the disparity of medical diagnoses and the statements 
 
         from claimant that on occasions prior to the two injuries in 
 
         question, she had sought chiropractic treatments from Dr. Shay 
 
         for back pain, it is not possible to state that claimant's 
 
         alleged disability was proximately caused by the two work 
 
         incidents.  The evidence as to causation as it relates to 
 
         permanent disability is minimal at best.  Claimant has not 
 
         sustained her burden of proof.  Likewise, there has been no 
 
         permanency established by any medical personnel.
 
         
 
              The next issue to address is whether claimant, on account of 
 
         her work incidents, is entitled to temporary total disability 
 
         benefits under section 85.33(l).
 
         
 
              This section provides:
 
         
 
              Except as provided in subsection 2 of this section, the 
 
              employer shall pay to an employee for injury producing 
 
              temporary total disability weekly compensation 
 
              benefits, as provided in section 85.32, until the 
 
              employee has returned to work or is medically capable 
 
              of returning to employment substantially similar to the 
 
              employment in which the employee was engaged at the 
 
              time of injury, whichever occurs first.
 
         
 
              It is not easily ascertainable whether claimant's injury 
 
         produced temporary total disability.  The evidence presented at 
 
         the hearing was scant regarding when claimant was absent from 
 
         work and the purposes of each such absence.  Also, since the 
 
         major portion of the time claimed was more than six months after 
 
         the first work incident, it is impossible to determine whether 
 
         the absences are proximately related to the incident on October 
 
         25, 1983.  As no causal relationship has been established, no 
 
         entitlement to temporary total disability benefits is 
 

 
         
 
         
 
         
 
         FERNS V. HON INDUSTRY SYSTEMS GROUP
 
         PAGE  10
 
         
 
         determined,.
 
         
 
                                 FINDING OF FACT
 
         
 
              WHEREFORE, based on the evidence presented and the 
 
         principles of law previously cited, the following finding of fact 
 
         and conclusion of law are made:
 
         
 
              FINDING 1.  Claimant did not sustain permanent or temporary 
 
         injuries to her back, hip, or leg as a result of two work related 
 
         incidents which occurred on October 25, 1983 and on February 15, 
 
         1985.
 
         
 
                                CONCLUSION OF LAW
 
         
 
              Claimant has not established by a preponderance of the 
 
         evidence that she is entitled to any temporary or permanent 
 
         disability benefits.
 
         
 
                                      ORDER
 
         
 
              THEREFORE, IT IS ORDERED:
 
         
 
              Claimant takes nothing from these proceedings.
 
         
 
              Claimant pays costs of these proceedings pursuant to 
 
         Division of Industrial Services Rule 343-4.33.
 
         
 
              Signed and filed this 14th day of December, 1988.
 
         
 
         
 
         
 
         
 
         
 
                                         MICHELLE A. McGOVERN
 
                                         DEPUTY INDUSTRIAL COMMISSIONER
 
         
 
         
 
         Copies To:
 
         
 
         Mr. William G. Gillies, Jr.
 
         Mr. Christopher J. Klockau
 
         Attorneys at Law
 
         1808 Third Ave.
 
         P. 0. Box 1279
 
         Rock Island, Illinois  61204
 
         
 
         Mr. Larry L. Shepler
 
         Attorney at Law
 
         STE 102, Executive Sq.
 
         400 Main St.
 
         Davenport, Iowa 52801
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                              1801.1; 1803
 
                                              Filed December 14, 1988
 
                                              MICHELLE A. McGOVERN
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         LINDA L. FERNS,
 
         
 
              Claimant,
 
         
 
         vs.
 
                                                File Nos. 771026 & 838625
 
         HON INDUSTRY SYSTEMS GROUP,
 
                                                  A R B I T R A T I O N
 
              Employer,
 
                                                      D E C I S I O N
 
         and
 
         
 
         HARTFORD INSURANCE,
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
         
 
         1803
 
         
 
              Claimant failed to show a causal connection between the 
 
         claimed permanent disability and two separate work incidents.
 
         
 
         1801.1
 
         
 
              Claimant failed to show an entitlement to temporary total 
 
         disability benefits as a result of two separate work incidents.