BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         
 
         VIVIAN LORRAINE WILLIAMS,
 
         
 
              Claimant,                           File No. 771072
 
         
 
         vs.
 
                                                    A P P E A L
 
         JOHN DEERE COMPONENT WORKS,
 
                                                  D E C I S I 0 N
 
              Employer, 
 
              Self-Insured,
 
              Defendant.
 
         
 
         
 
         
 
         
 
                              STATEMENT OF THE CASE
 
         
 
              Defendant appeals from an arbitration decision filed May 31, 
 
         1985 and a decision on the extent of permanent partial disability 
 
         filed October 16, 1986 that awarded healing period benefits and 
 
         permanent partial disability benefits.
 
         
 
              The record on appeal consists of the transcript of the 
 
         arbitration proceeding; claimant's exhibits A, 1A, 2A, 3A, 4A, 
 
         5A, B, C, and D; and commissioner's exhibit 1.  Both parties 
 
         filed briefs on appeal.
 
         
 
                                      ISSUES
 
         
 
              Defendant states the following issues on appeal:
 
         
 
              1.  Whether claimant received an injury arising out of and 
 
         in the course of her employment.
 
         
 
              2.  Whether there is a causal relationship between the 
 
         alleged injury and the claimed disability.
 
         
 
              3.  Whether claimant is entitled to healing period 
 
         benefits.
 
         
 
         Defendant also filed an appeal of the decision dated October 15, 
 
         1986 which awarded permanent partial disability benefits.
 
         
 
                              REVIEW OF THE EVIDENCE
 
         
 
              The arbitration decision adequately and accurately reflects 
 
         the pertinent evidence and it will not be totally reiterated 
 
         herein.
 
         
 
               Briefly stated, claimant began work for defendant in 
 
         November 1972 in a clerical position.  In August 1982, a layoff 
 
         resulted in claimant being assigned to a janitorial position for 
 
         one to two months.  Claimant obtained a restriction on lifting 
 
         weights over 15-20 pounds as a result of a prior back condition.  
 
         Claimant was reassigned janitorial duties again from August 30, 
 
         1983 until September 23, 1983.  Her work as a janitor in 1983 
 

 
         required her to pinch together six to eight clamps that held 
 
         plastic garbage bags under a container, with this procedure being 
 
         repeated anywhere from eight to fourteen times per evening shift.  
 
         Claimant was also required to operate a floor buffer, which 
 
         required her to guide the device with her thumbs, and to use and 
 
         squeeze a mop.  Claimant's janitorial work in 1982 did not 
 
         involve these activities.  Claimant began to experience pain and 
 
         swelling in her hands and thumbs, with more pain in the right 
 
         thumb than the left.  Claimant also stated that in approximately 
 
         1978 or 1979, she injured her right thumb at work with a door.  
 
         Claimant did not report the injury as she felt it was not 
 
         significant.  Claimant stated she felt pain from that injury for 
 
         only a few days after and did not experience any pain in her 
 
         thumb until she was reassigned to the janitorial work.
 
         
 
              Claimant's foreman, Stephen Moriarty, testified that 
 
         claimant was unhappy about her reassignment and her inability 
 
         to obtain daytime work.  Claimant reported the pain in her 
 
         hands to him.  Moriarty testified that in his opinion 
 
         claimant's work did aggravate her hand condition.  He also 
 
         advised claimant that if she received a medical restriction on 
 
         her hands, he would have no work for her and claimant would be 
 
         laid off.  Claimant also discussed her hand and thumb problems 
 
         with the plant safety manager and a union steward, both of whom 
 
         also advised her that medical restrictions on her hands would 
 
         result in a layoff.  Claimant could not be reassigned to her 
 
         clerical position due to a lack of seniority.
 
         
 
              On September 21, 1983, claimant experienced painful 
 
         paralysis in her right hand.  Claimant reported her hand 
 
         problems to C. R. Buck, M.D., defendant's staff doctor.  Dr. 
 
         Buck's examination revealed crepitation and some tenderness of 
 
         the metacarpophalangeal joint and in the carpometacarpal joint 
 
         on the right thumb.  However, Dr. Buck felt these symptoms were 
 
         not of recent origin.  Dr. Buck opined that claimant would have 
 
         had symptoms in her thumb prior to her janitorial work since 
 
         her thumb condition was arthritic.  Dr. Buck imposed a 
 
         temporary restriction of claimant's use of her right thumb.
 
         
 

 
         
 
         
 
         
 
         WILLIAMS V. JOHN DEERE COMPONENT WORKS
 
         Page   3
 
         
 
         
 
              Claimant's private physician, Dr. Tarr, also observed 
 
         swelling and tenderness of the carpometacarpal joint of the 
 
         right hand, and advised claimant not to use her thumb at work.  
 
         Dr. Tarr referred claimant to Arnold E. Delbridge, M.D., a hand 
 
         and orthopedic specialist, in October 1983.  Dr. Delbridge 
 
         found claimant to have limited motion and a positive grinding 
 
         test in the right thumb, with pain in the carpal metacarpal 
 
         joint.  An x-ray revealed degenerative arthritis of the carpal 
 
         metacarpal joint of the right thumb and around the right 
 
         trapezium bone.  He described the trapezium bone in his 
 
         deposition as part of the wrist.
 
         
 
              Because she could no longer perform the janitorial duties 
 
         with her restrictions on the use of her thumb, claimant was 
 
         transferred to an assembly line job in October 1983.  This job 
 
         required claimant to use a hand operated polisher, which again 
 
         resulted in swelling of claimant's right hand.  Claimant was 
 
         then transferred to a job requiring her to lift heavy tractor 
 
         screens.  When she continued to experience pain in her hands, 
 
         she again consulted Dr. Buck, and was laid off in November 1983 
 
         due to a lack of work within her restrictions.  On January 4, 
 
         1984, Dr. Buck amended her medical records to add a permanent 
 
         restriction of no repetitive gripping or pinching of her-right 
 
         thumb.
 
         
 
              On February 10, 1984, Dr. Delbridge noted that "her main 
 
         problem ... is degenerative changes in her first metacarpal 
 
         carpal joint of the right thumb."
 
         
 
              On October 31, 1984, Dr. Delbridge stated:
 
         
 
              Very likely what precipitated her problems with her 
 
              thumb was changing from a job that did not require 
 
              great stress on her carpal metacarpal joints to jobs 
 
              that did require considerable stress.  She very likely 
 
              had some problem with her carpal metacarpal joints 
 
              prior to her changing jobs and the job change caused 
 
     
 
         
 
         
 
         
 
         
 
         WILLIAMS V. JOHN DEERE COMPONENT WORKS
 
         Page   4
 
         
 
         
 
              her additional problems.
 
         
 
                 ....
 
         
 
              ... After examining her right thumb, considering her 
 
              loss of motion and the fact that she has some 
 
              degenerative changes in her thumb, part of which are 
 
              very likely due to her aggravation, I would suggest 
 
              that she has 15% impairment of her thumb.  A 15% 
 
              impairment of her thumb is a 6% hand impairment.
 
         
 
                 ....
 
         
 
         
 
              ... It is my feeling that there may have been some 
 
              problems with her thumb which she was unaware of prior 
 
              to the placement of considerable stress on her thumb 
 
              when she changed jobs.
 
         
 
                 It is likely that she will not get better.  It is 
 
              virtually certain that this is a permanent condition 
 
              and will very likely be gradually progressive as she is 
 
              getting more and more collapse of her thumb because of 
 
              the loss of motion of her carpal metacarpal joint.
 
         
 
         Dr. Delbridge performed trapezium carpal metacarpal joint 
 
         replacement surgery on January 14, 1985.  This surgery was 
 
         designed to relieve pain only, and was not expected to 
 
         increase functional use.
 
         
 
              Dr. Buck opined:
 
         
 
              I don't think there was any significant injury to her 
 
              back as a result of those [janitorial] activities.  She 
 
              had longstanding back symptoms that could be triggered 
 
              by any strenuous activity, even mildly strenuous 
 
              activity.
 
         
 
         (Transcript, page 127)
 
         
 
              I don't feel her activities in ordinary janitorial 
 
              work, which she was doing, would have caused a 
 
              significant injury to her thumb.  I think that her 
 
              problem primarily pre-existed that assignment.  I don't 
 
              doubt that she was having some pain associated with the 
 
              use of her hands and that her hands were bothering her.  
 
              I don't doubt that at all.  But I don't think that 
 
              there was a significant additive or additional injury 
 
              to her thumb.
 
         
 
         (Tr., pages 123-124)
 
         
 
              Dr. Delbridge testified it was his opinion that claimant's 
 
         present impairment was a result of her janitorial work, and . 
 
         cited the absence of any pain or impairment of function prior to 
 
         commencing her janitorial work.  In his deposition, he stated:
 
         
 
              Lorraine had some arthritis in her thumb prior to ever 
 
              taking that mopping job, but that aggravated her 
 

 
         
 
         
 
         
 
         WILLIAMS V. JOHN DEERE COMPONENT WORKS
 
         Page   5
 
         
 
         
 
              arthritic situation to the point where it put her thumb 
 
              into sort of a tailspin, which made it move downhill 
 
              more rapidly.
 
         
 
         (Delbridge Deposition, page 18)
 
         
 
              I did feel that most of her motion loss was relatively 
 
              recent, and I felt that way because right under my very 
 
              eyes over a period of time she started developing 
 
              hyperextension of her metacarpal phalangeal joint, and 
 
              she hadn't had that before and she didn't have it when 
 
              I first saw her, so I felt that her thumb motion was 
 
              getting worse.  And so I really feel that most of that 
 
              impairment based on the loss of motion is relatively 
 
              recent.
 
         
 
         (Delbridge Dep., pp. 26-27)
 
         
 
              Because claimant had recently undergone trapezium carpal 
 
         metacarpal joint replacement surgery at the time of the original 
 
         arbitration hearing, the record was held open to receive further 
 
         evidence in the form of a letter from Dr. Delbridge dated January 
 
         8, 1986, which stated in part:
 
         
 
              On exam she has pinch of eight pounds on the right, ten 
 
              pounds on the left and she has a grip at the first 
 
              notch on the grip meter of fifteen pounds on the right 
 
              and fifteen pounds on the left and at the second notch, 
 
              twenty pounds on the right and twenty pounds on the 
 
              left.   At the third no [sic] notch of the grip meter 
 
              she has grip of twenty-five pounds on the right and 
 
              thirty pounds on the left.
 
         
 
                 At this time I do not anticipate her improving 
 
              significantly in the future.  Originally I judged her 
 
              impairment to be 15% of her thumb or 6% of her hand.
 
         
 
                 Basically this has not changed.
 
         
 
         (Comm. Ex. 1)
 
         
 
              Claimant's last day of work was November 4, 1983.  Her 
 
         stipulated rate of compensation is $257.52.
 
         
 
                                 APPLICABLE  LAW
 
         
 
              Claimant has the burden of proving by a preponderance of the 
 
         evidence that he received injuries in August and September 1983 
 
         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 947, 124 N.W.2d 548 (1963) and Hansen v. State of Iowa, 
 
         249 Iowa 1147, 91 N.W.2d 555 (1958).
 
         
 

 
         
 
         
 
         
 
         WILLIAMS V. JOHN DEERE COMPONENT WORKS
 
         Page   6
 
         
 
         
 
              The words "out of" refer to the cause or source of the 
 
         injury.  Crowe, 246 Iowa 402, 68 N.W.2d 63.
 
         
 
              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.
 
         
 
              The claimant has the burden of proving by a preponderance of 
 
         the evidence that the injury of August and September 1983 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).
 
         
 
              A determination that an injury "arises out of" the 
 
         employment contemplates a causal connection between the 
 
         conditions under which the work was performed and the resulting 
 
         injury; i.e., the injury followed as a natural incident of the 
 
         work.  Musselman, 261 Iowa 352, 154 N.W.2d 128); Reddick v. Grand 
 
         Union Tea Co., 230 Iowa 108; 296 N.W. 800 (1941).
 
         
 
              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).
 
         
 
              When an aggravation occurs in the performance of an 
 
         employer's work and a causal connection is established, claimant 
 
         may recover to the extent of the impairment.  Ziegler v. United 
 
         States Gypsum Co., 252 Iowa 613, 620, 106 N.W:2d 591, 595 
 
         (1960).
 
         
 
              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. WorkmenOs 
 
         Compensation SS555(17)a.
 
         
 
              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, 252 Iowa 613, 620, 106 N.W.2d 591, 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, 
 

 
         
 
         
 
         
 
         WILLIAMS V. JOHN DEERE COMPONENT WORKS
 
         Page   7
 
         
 
         
 
         268 N.W. 598 (1936).
 
         
 
              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. DeLong's Sportswear, 
 
         332 N.W.2d 886, 887 (Iowa 1983).
 
         
 
              When the result of an injury is a loss to a scheduled 
 
         member, the compensation payable is limited to that set forth in 
 
         the appropriate subdivision of Iowa Code section 85.34(2). Barton 
 
         v. Nevada Poultry Company, 253 Iowa 285, 110 N.W.2d 660 (1961).
 
         
 
         
 
              "Loss of use" of a member is equivalent to "loss" of the 
 
         member.  Moses v. National Union C.M. Company, 194 Iowa 819, 184 
 
         N.W.2d 746 (1922).
 
         
 
              Iowa Code section 85.34(l) provides:
 
         
 
              If an employee has suffered a personal injury causing 
 
              permanent partial disability for which compensation is 
 
              payable as provided in subsection 2 of this section, 
 
              the employer shall pay to the employee compensation for 
 
              a healing period, as provided in section 85.37, 
 
              beginning on the date of injury, and until the employee 
 
              has returned to work or it is medically indicated that 
 
              significant improvement from the injury is not 
 
              anticipated or until the employee 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.
 
         
 
              Iowa Code section 85.34(2) provides:
 
         
 
              For all cases of permanent partial disability 
 
              compensation shall be paid as follows:
 
         
 
                 ....
 
         
 
              1.  For the loss of a hand, weekly compensation during 
 
              one hundred ninety weeks.
 
         
 
                                  ANALYSIS
 
         
 
              The record shows that claimant's assignment to janitorial 
 
         duties in August 1983 required her to engage in movements and 
 
         motions that involved pinching and gripping with her thumb.  Her 
 
         previous thumb injury, which occurred years earlier, was 
 
         considered by her to be insignificant.  She testified that the 
 
         earlier injury did not cause her any impairment prior to her job 
 
         reassignment in August 1983.  There is no evidence in the record 
 
         to the contrary.  Claimant sought medical assistance for her 
 
         condition even though she was repeatedly told it might result in 
 
         the loss of her job.  She appeared to be well motivated to work 
 
         throughout the record, but was thwarted by a system of seniority 
 
         and her medical restrictions.  Her description of the work duties 
 

 
         
 
         
 
         
 
         WILLIAMS V. JOHN DEERE COMPONENT WORKS
 
         Page   8
 
         
 
         
 
         and the pain and swelling caused by those duties was credible.  
 
         It is therefore concluded that her complaints of pain and 
 
         swelling were genuine and not the result of dissatisfaction with 
 
         the work assignment.
 
         
 
              Both Dr. Buck and Dr. Delbridge concluded that the previous 
 
         thumb injury may have caused claimant's arthritis.  Dr. 
 
         Delbridge, Dr. Buck and claimant's foreman all agreed that 
 
         claimant's janitorial work aggravated that condition.  Claimant 
 
         has met her burden in proving she had an aggravation of a 
 
         preexisting condition which arose out of and in the course of her 
 
         employment as a janitor for defendant.
 
         
 
              Claimant is entitled to compensation only if her present 
 
         impairment is causally connected to the injury.  Dr. Buck stated 
 
         that claimant's present condition was caused by her prior injury. 
 
          Dr. Buck also opined that although her work did aggravate her 
 
         preexisting arthritis, it was not a significant aggravation.
 
         
 
              Dr. Delbridge was of the opinion that claimant's condition 
 
         is permanent, and was the result of her janitorial work.  He 
 
         bases his conclusion on the absence of prior pain, impairment or 
 
         symptoms before claimant began her janitorial duties.
 
         
 
              Dr. Delbridge is a hand specialist and orthopedic surgeon.  
 
         He has performed surgery on claimant's hand and treated her 
 
         extensively, including examination of x-rays of her hand.  Dr. 
 
         Buck's opinion is based on more limited contact with claimant.  
 

 
         
 
         
 
         
 
         WILLIAMS V. JOHN DEERE COMPONENT WORKS
 
         Page   9
 
         
 
         
 
         In addition, Dr. Delbridge observed ongoing deterioration of 
 
         claimant's hand condition during the course of treatment, 
 
         corroborating his conclusion that the aggravation of her 
 
         condition was both ongoing and significant.  The opinion of Dr. 
 
         Delbridge will therefore be given the greater weight.
 
         
 
              Claimant is entitled to healing period benefits pursuant to 
 
         Iowa Code section 85.34(l).  Claimant was laid off work on 
 
         November 4, 1983.  Although defendant argues that claimant was 
 
         laid off due to a bad local economy and her lack of seniority, 
 
         the record clearly shows that claimant was laid off because 
 
         defendant had no work for her in keeping with her medical 
 
         restriction of the use of her right thumb.  But for that 
 
         restriction, claimant could have kept working for defendant in 
 
         her janitorial job.  Therefore, the healing period began on 
 
         claimant's last day of work on November 4, 1983.
 
         
 
              Dr. Delbridge gave a rating of permanent impairment for 
 
         claimant's right thumb on October 31, 1984.  Claimant's condition 
 
         did not significantly change after that.  Subsequent to the 
 
         surgery, Dr. Delbridge reiterated the same rating of impairment 
 
         to the thumb and hand.  Claimant did not ever return to work.  It 
 
         was never medically determined that she was capable of returning 
 
         to the same or substantially similar employment.  Thus, the 
 
         healing period would end under section 85.34(l) of the Code when 
 
         significant improvement from the injury is not anticipated.  The 
 
         surgery performed in January of 1985 was not expected to improve 
 
         the function of the hand or thumb, but was designed to relieve 
 
         pain.  It appears that at the time the rating of impairment was 
 
         given on October 31, 1984, no significant improvement was 
 
         anticipated and the healing period ended on that date.
 
         
 
              Claimant is also entitled to temporary total disability from 
 
         January 14, 1985, the date of her surgery, until recovery from 
 
         the surgery.  Dr. Delbridge estimated that recovery would take 
 
         six months.  Claimant is therefore entitled to temporary total 
 
         disability from January 14, 1985 until July 14, 1985.
 
         
 
              As to the extent of claimant's permanent partial disability, 
 
         Dr. Delbridge originally opined that claimant had a 15 percent 
 
         impairment of the thumb, or 6 percent of the hand.  After the 
 
         trapezium implant surgery, he reiterated that opinion.  As the 
 
         trapezium is part of the hand, the pathology of claimant's injury 
 
         extends beyond the thumb to the hand.  Dr. Delbridge's rating of 
 
         impairment is uncontroverted in the record.  Claimant is 
 
         determined to have a 6 percent permanent partial impairment of 
 
         the right hand.
 
         
 
              The record also contains references to an impairment of 
 
         claimant's left thumb and hand.  However, there is little medical 
 
         evidence pertaining to the left thumb and hand in the record, and 
 
         Dr. Delbridge indicated that impairment to the left hand is not 
 
         significant and therefore no award is made for the left hand or 
 
         thumb.  Claimant also failed to prove any impairment or 
 
         disability to her neck, back or leg.
 
         
 
                                 FINDINGS OF FACT
 
         
 
              1.  Claimant was in the employ of defendant from August 
 

 
         
 
         
 
         
 
         WILLIAMS V. JOHN DEERE COMPONENT WORKS
 
         Page  10
 
         
 
         
 
         through October 1983.
 
         
 
              2.  Claimant's job from August through October 1983 
 
         consisted of janitorial duties and tasks in the parts reclamation 
 
         department requiring extensive use of her hands and thumbs.
 
         
 
              3.  From August through October 1983, claimant's work 
 
         aggravated a preexisting arthritic condition in her right thumb 
 
         and hand.
 
         
 
              4.  Prior to August 1983, claimant had no loss of function 
 
         of her right thumb or right hand.
 
         
 
              5.  As a result of her right thumb and right hand work 
 
         injury in 1983, claimant has been permanently restricted from 
 
         repeated gripping and pinching with her right thumb.
 
         
 
              6.  Claimant was terminated from the employ of defendant on 
 
         November 4, 1983 for the reason that no work was available within 
 
         claimant's medical restrictions.
 
         
 
              7.  As a result of her work injury of August through October 
 
         1983, claimant has a six percent permanent partial impairment of 
 
         the right hand.
 
         
 
              8.  Claimant's rate of compensation is $257.52 per week.
 
         
 
              9.  Claimant reached maximum healing on October 31, 1984.
 
         
 
             10.  Claimant's last day of work was November 4, 1983.
 
         
 
                                CONCLUSIONS OF LAW
 
         
 
              Claimant has established by a preponderance of the evidence 
 
         entitlement to healing period benefits from November 5, 1983 
 
         through October 31, 1984, and temporary total disability benefits 
 
         from January 14, 1985 through July 14, 1985.
 
         
 
              Claimant received an injury arising out of and in the course 
 
         of her employment with defendant in August through October 1983.
 
         
 
              As a result of her injury in August through October 1983, 
 
         claimant has a permanent partial impairment of six percent of her 
 
         right hand.
 
         
 
              WHEREFORE, the decision of the deputy is modified.
 
         
 
                                      ORDER
 
         
 
              THEREFORE, it is ordered:
 
         
 
              That John Deere shall pay to claimant eleven point four 
 
         (11.4) weeks of permanent partial disability benefits at the rate 
 
         of two hundred fifty-seven and 52/100 dollars ($257.52) per week 
 
         from July 15, 1985.
 
         
 
              That John Deere shall pay accrued weekly benefits in a lump 
 
         sum.
 
         
 

 
         
 
         
 
         
 
         WILLIAMS V. JOHN DEERE COMPONENT WORKS
 
         Page  11
 
         
 
         
 
              That John Deere shall pay interest on benefits awarded 
 
         herein as set forth in Iowa Code section 85.30.
 
         
 
              That John Deere shall pay the costs of this action pursuant 
 
         to Division of Industrial Services Rule 343-4.33.
 
         
 
              That John Deere shall file activity reports on the payment 
 
         of this award as requested by this agency pursuant to Division of 
 
         Industrial Services Rule 343-3.1.
 
         
 
         
 
              Signed and filed this 29th day of February, 1988.
 
         
 
         
 
         
 
         
 
         
 
         
 
         
 
         
 
                                             DAVID E. LINQUIST
 
                                             INDUSTRIAL COMMISSIONER
 
         
 
         
 
         Copies To:
 
         
 
         Mr. Robert D. Fulton
 
         Attorney at Law
 
         P.O. Box 2634
 
         616 Lafayette Street
 
         Waterloo, Iowa 50704-2634
 
         
 
         Mr. John W. Rathert
 
         Attorney at Law
 
         P.O. Box 178
 
         620 Lafayette Street
 
         Waterloo, Iowa 50704
 
 
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                                   1100 - 1108.50 - 2206
 
                                                   1802 - 1803.1
 
                                                   Filed February 29, 1988
 
                                                   DAVID E. LINQUIST
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         VIVIAN LORRAINE WILLIAMS,
 
         
 
              Claimant,                             File No. 771072
 
         
 
         vs.
 
                                                      A P P E A L
 
         JOHN DEERE COMPONENT WORKS,
 
                                                    D E C I S I 0 N
 
              Employer,
 
              Self-Insured,
 
              Defendant.
 
         
 
         
 
         
 
         1100 - 1100.50 - 2206
 
         
 
              Claimant was found to have suffered a six percent permanent 
 
         partial impairment to the right hand arising out of and in the 
 
         course of janitorial duties that required her to pinch heavy 
 
         clamps together.  Claimant's work was found to have aggravated a 
 
         preexisting arthritic condition.
 
         
 
         1802
 
         
 
              Claimant's healing period ended when significant medical 
 
         improvement was no longer anticipated and was not extended by 
 
         surgery designed not to improve functions but only to relieve 
 
         pain.
 
         
 
         1803.1
 
         
 
              Claimant's arthritis was aggravated by her work.  Since the 
 
         surgery involved the trapezium as well as the thumb, she was 
 
         found to have suffered an impairment of the hand.
 
 
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                    BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         _________________________________________________________________
 
         
 
         VIVIAN LORRAINE WILLIAMS,
 
                                                 File No. 771072
 
              Claimant,
 
                                                 D E C I S I 0 N
 
         VS
 
                                                      0 N
 
         JOHN DEERE COMPONENT WORKS,
 
                                                   R E M A N D
 
              Employer,
 
              Self-Insured,
 
              Defendant.
 
         
 
         _________________________________________________________________
 
         
 
                              STATEMENT OF THE CASE
 
         
 
              This is a proceeding in arbitration brought by Vivian.  
 
         Lorraine Williams, claimant, against John Deere Component Works, 
 
         employer, hereinafter referred to as John Deere, a self-insured 
 
         defendant, for benefits as the result of an alleged injury in 
 
         August 1983.  Subsequent to an oral hearing on April 11, 1985 on 
 
         claimant's petition, the undersigned issued a proposed 
 
         arbitration decision on May 31, 1985.  This proposed arbitration 
 
         decision was appealed to the commissioner on July 11, 1985.  On 
 
         August 14, 1986 the commissioner remanded the case back to the 
 
         undersigned deputy commissioner for further proceedings to 
 
         determine the remaining issues in the case.
 
         
 
              As claimant was still recovering from surgery at the time of 
 
         the April 11, 1985 hearing and pursuant to the assignment order 
 
         setting the matter for hearing, the arbitration decision of May 
 
         31, 1985 did not attempt to resolve the issue as to when the 
 
         healing period ended and the issue of the extent of claimant's 
 
         entitlement to permanent disability benefits.  However, in his 
 
         review of the pending appeal, the commissioner felt that the 
 
         healing period may well have ended during the pendency of the 
 
         appeal and that all of the remaining controverted issues should 
 
         be decided before handling the appeal.  Therefore, the 
 
         commissioner remanded the case back to the undersigned for 
 
         resolution of the following issues:
 
         
 
                I.  Whether the healing period has ended and, if so, 
 
         when;
 
         
 
               II.  Whether claimant is entitled to any permanent partial 
 
         disability benefits and, if so, the extent of those benefits; 
 
         and,
 
         
 
              III.  Claimant's alleged entitlement to medical benefits.
 
         
 
         
 
              With reference to the remand order concerning medical 
 
         benefits, claimant has never requested arbitration of such an 
 
         issue in this proceeding and does not do so at this time.  
 
         Therefore, no determination shall be made on the extent of 
 

 
         claimant's entitlement to medical benefits.
 
         
 
              On September 26, 1986 the parties indicated to the 
 
         undersigned that neither party desired another oral proceeding 
 
         and are submitting the issues on remand to the undersigned on the 
 
         existing record in this case with the exception of an additional 
 
         letter report from Arnold E. Delbridge, M.D., dated January 8, 
 
         1986.  The matter was therefore considered fully submitted 
 
         pursuant to order of October 1, 1986.  For the sake of 
 
         maintaining a clear record on appeal, this additional report of 
 
         Dr. Delbridge has been labeled as commissioner's exhibit 1 and is 
 
         hereby received into the evidence of this contested case 
 
         proceeding and combined with the other exhibits received at the 
 
         April 19, 1985 hearing.  Commissioner's exhibit 1 along with all 
 
         of the other exhibits submitted in this case as set forth in the 
 
         last arbitration decision was considered in arriving at this 
 
         decision.
 
         
 
                             FINDINGS OF FACT
 
         
 
              1.  Claimant's healing period ended  on July 14, 1985.
 
         
 
              In the letter report of January 8, 1986, which is 
 
         uncontroverted in the record, Dr. Delbridge stated as follows: 
 
         "At this time I do not anticipate her (claimant) improving 
 
         significantly in the future."  This statement certainly 
 
         establishes that claimant's condition was stable in January of 
 
         this year but it does not indicate when her condition first 
 
         became stable following the surgery of January 14, 1985.  In his 
 
         deposition of February 20, 1985, exhibit D, Dr. Delbridge stated 
 
         that normal recovery period for the type of surgery he performed 
 
         upon claimant in January 1985 was six months following the 
 
         surgery and he would not be able to rate claimant's permanent 
 
         impairment until expiration of this recovery.  There is nothing 
 
         in the January 8, 1986 report from Dr. Delbridge to suggest that 
 
         claimant had anything other than a normal recovery from her 
 
         surgery.  Therefore, the most reasonable date for ending 
 
         claimant's healing period should be six months from the date of 
 
         surgery or July 14, 1986 as claimant apparently has not returned 
 
         to work since the last hearing.
 
         
 
              2.  As a result of the injury to her right hand arising out 
 
         of and in the course of her employment at John Deere from August 
 
         1983 through October 1983, claimant has suffered a six percent 
 
         permanent partial impairment to her right hand.
 
         
 
              There has been only one impairment rating submitted into the 
 
         evidence in this case concerning the extent of claimant's 
 
         permanent impairment to her right hand.  Dr. Delbridge in the
 
         
 
         letter report of January 8, 1986 opines that claimant's 
 
         impairment rating remains unchanged from his last evaluation in 
 
         1984.  This opinion is consistent with Dr. Delbridge's previous 
 
         statements contained in his deposition that claimant's last 
 
         surgery was not intended to improve the functional impairment but 
 
         to relieve some of her pain.  There is little doubt that the 
 
         aggravation injury led to the surgery and the surgery permanently 
 
         modified structures of the hand extending beyond the thumb.  
 
         Therefore, the evaluation of disability must be to the hand, 
 
         rather than the thumb.
 
         
 
              Previous findings of fact contained in the arbitration 
 
         decision of May 31, 1985 are modified to the extent they are 
 
         inconsistent with the above findings.
 

 
         
 
         
 
         
 
         WILLIAMS V. JOHN DEERE COMPONENT WORKS
 
         Page   3
 
         
 
         
 
         
 
                            CONCLUSIONS OF LAW
 
         
 
              In this case, there was no controversy raised by the parties 
 
         concerning the applicable law to be followed in the determination 
 
         of the issues on remand.  The foregoing findings of fact were 
 
         made under the following principles of law:
 
         
 
              Claimant must establish by a preponderance of the evidence 
 
         the extent of weekly benefits for permanent disability to which 
 
         claimant is entitled.  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. DeLong's Sportswear, 332 N.W.2d 886, 997 (Iowa 1983). 
 
          When the result of an injury is loss to a scheduled member, the 
 
         compensation payable is limited to that set forth in the 
 
         appropriate subdivision of Code section 85.34(2). Barton v. 
 
         Nevada Poultry Co., 253 Iowa 285, 110 N.W.2d 660 (1961).  "Loss 
 
         of use" of a member is equivalent to "loss" of the member.  Moses 
 
         v. National Union C.M. Co., 194 Iowa 819, 184 N.W. 746 (1922).  
 
         Pursuant to Code section 85.34(2)(u) the industrial commissioner 
 
         may equitably prorate compensation payable in those cases wherein 
 
         the loss is something less than that provided for in the 
 
         schedule.  Blizek v. Eagle Signal Company, 164 N.W.2d 84 (Iowa 
 
         1969).
 
         
 
              It was found in this decision that there has been a 
 
         permanent injury to the right hand as a result of surgery 
 
         necessitated by the aggravation of the carpal metacarpal joint of 
 
         the right thumb.  It is well established that it is the situs of 
 
         the injury not the situs of the disability caused by the injury 
 
         which determines which schedule should apply under Iowa Code 
 
         section 85.34(2). Dailey v. Pooley Lumber Co., 233 Iowa 758, 10 
 
         N.W.2d 569 (1943).
 
         
 
         
 
         
 
         
 
              Based upon the finding of a six percent permanent partial 
 
         impairment as the result of an injury to the right hand, claimant 
 
         is entitled to eleven point four weeks of permanent partial 
 
         disability benefits under Iowa Code section 85.34(2)(1) which is 
 
         six percent of the 190 weeks allowable for an injury to a hand in 
 
         that subsection.
 
         
 
              As claimant has established entitlement to permanent partial 
 
         disability, claimant is entitled to weekly benefits for healing 
 
         period under Iowa Code section 85.34(l) from the date of injury 
 
         until claimant returns to work; until claimant is medically 
 
         capable of returning to substantially similar work to the work 
 
         she was performing at the time of the injury; or, until it is 
 
         indicated that significant improvement from the injury is not 
 
         anticipated, whichever occurs first.
 
         
 
              It was previously found in the arbitration decision of May 
 
         31, 1985 that claimant was entitled to healing period benefits 
 

 
         
 
         
 
         
 
         WILLIAMS V. JOHN DEERE COMPONENT WORKS
 
         Page   4
 
         
 
         
 
         from the time she left her employment on November 5, 1983 until 
 
         the time of hearing and that she was still in her healing period 
 
         as of the date of the hearing.  It was found in this decision 
 
         that claimant's healing period ended on July 14, 1985.  
 
         Therefore, claimant is entitled to healing period benefits from 
 
         November 5, 1983 through July 14, 1985, a total of eighty-eight 
 
         and two-sevenths weeks (taking into account the 1984 leap year).
 
         
 
                                  ORDER
 
         
 
              IT IS THEREFORE ORDERED AS FOLLOWS:
 
         
 
              1.  John Deere shall pay to claimant eleven point four 
 
         (11.4) weeks of permanent partial disability benefits at the rate 
 
         of two hundred fifty-seven and 52/100 dollars ($257.52) per week 
 
         from July 15, 1985.
 
         
 
              2.  John Deere shall pay to claimant healing period benefits 
 
         from November 5, 1983 through July 14, 1985 at the rate of two 
 
         hundred fifty-seven and 52/100 dollars ($257.52) per week.
 
         
 
              3.  John Deere shall pay accrued weekly benefits in a lump 
 
         sum.
 
         
 
              4.  John Deere shall pay interest on benefits awarded herein 
 
         as set forth in Iowa Code section 85.30.
 
         
 
              5.  John Deere shall pay the costs of this action pursuant 
 
         to Division of Industrial Services Rule 343-4.33 (formerly 
 
         Industrial Commissioner Rule 500-4.33).
 
         
 
              6.  John Deere shall file activity reports on the payment of 
 
         this award as requested by this agency pursuant to Division of 
 
         Industrial Services Rule 343-3.1 (formerly Industrial 
 
         Commissioner Rule 500-3.1).
 
              7.  Previous orders contained in the arbitration decision of 
 
         May 31, 1985 are modified to the extent they are inconsistent 
 
         with the above orders.
 
         
 
         
 
         
 
              Signed and filed this 15th day of October, 1986.
 
         
 
         
 
         
 
         
 
                                             LARRY P. WALSHIRE
 
                                             DEPUTY INDUSTRIAL COMMISSIONER
 
         
 
         Copies To:
 
         
 
         Mr. Robert D. Fulton
 
         Attorney at Law
 
         616 Lafayette Street
 
         P. 0. Box 2634
 
         Waterloo, Iowa 50704-2634
 
         
 
         Mr. John W. Rathert
 

 
         
 
         
 
         
 
         WILLIAMS V. JOHN DEERE COMPONENT WORKS
 
         Page   5
 
         
 
         
 
         Attorney at Law
 
         620 Lafayette Street
 
         P. 0. Box 178
 
         Waterloo, Iowa 50704
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                                 1802; 1803
 
                                                 Filed: October 15, 1986
 
                                                 LARRY P. WALSHIRE
 
         
 
                    BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         _________________________________________________________________
 
         
 
         VIVIAN LORRAINE WILLIAMS,
 
                                                 File No. 771072
 
              Claimant,
 
                                                 D E C I S I 0 N
 
         VS.
 
                                                       0 N
 
         JOHN DEERE COMPONENT WORKS,
 
                                                   R E M A N D
 
         
 
              Employer,
 
              Self-Insured,
 
              Defendant.
 
         
 
         _________________________________________________________________
 
         
 
         1802; 1803
 
         
 
              Upon remand to determine all remaining issues after appeal 
 
         from bifurcated proceedings, claimant was awarded healing period 
 
         benefits from the time she was terminated by her employer during 
 
         her healing period until the time she reached maximum healing six 
 
         months after surgery to her hand.  Claimant was also awarded six 
 
         percent permanent partial disability benefits as a result of the 
 
         injury to her hand.
 
 
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         VIVIAN LORRAINE WILLIAMS,
 
                                                  File No. 771072
 
              Claimant,
 
                                                    0 R D E R
 
         vs.
 
                                                     N U N C
 
         JOHN DEERE COMPONENT WORKS,
 
                                                      P R 0
 
              Employer,
 
              Self-Insured,                          T U N C
 
              Defendant.
 
         
 
              It was brought to the attention of the undersigned that 
 
         there was an error in the order portion of the Appeal Decision 
 
         filed February 29, 1988.  The order should read as follows:
 
         
 
              THEREFORE, it is ordered:
 
         
 
              That John Deere Shall pay to claimant healing period 
 
         benefits from November 5, 1983 through October 31, 1984 and 
 
         temporary total disability benefits from January 14, 1985 through 
 
         July 14, 1985 at the rate of two hundred fifty-seven and 50/100 
 
         dollars ($257.52) per week.
 
         
 
              That John Deere shall pay to claimant eleven point four 
 
         (11.4) weeks of permanent partial disability benefits at the rate 
 
         of two hundred fifty-seven and 52/100 dollars ($257.52) per week 
 
         from July 15, 1985.
 
         
 
              That John Deere shall pay accrued weekly benefits in a lump 
 
         sum.
 
         
 
              That John Deere shall pay interest on benefits awarded 
 
         herein as set forth in Iowa Code section 85.30.
 
         
 
              That John Deere shall pay the costs of this action pursuant 
 
         to Division of Industrial Services Rule 343-4.33.
 
         
 
              That John Deere shall file activity reports on the payment 
 
         of this award as requested by-this agency pursuant to Division 
 
         of Industrial Services Rule 343-3.1.
 
         
 
         
 
              Signed and filed this 2nd day of March, 1988.
 
         
 
         
 
         
 

 
         
 
         
 
         
 
         WILLIAMS V. JOHN DEERE COMPONENT WORKS
 
         Page   2
 
         
 
         
 
                                                  DAVID E. LINQUIST
 
                                                  INDUSTRIAL COMMISSIONER
 
         
 
         
 
         Copies To:
 
         
 
         Mr. Robert D. Fulton
 
         Attorney at Law
 
         P.O. Box 2634
 
         616 Lafayette Street
 
         Waterloo, Iowa 50704-2634
 
         
 
         Mr. John W. Rathert
 
         Attorney at Law
 
         P.O. Box 178
 
         620 Lafayette Street
 
         Waterloo, Iowa 50704