BEFORE THE IOWA INDUSTRIAL COMMISSIONER WILLARD DUFFIELD, Claimant, File No. 771083 vs. A P P E A L IOWA STATE PENITENTIARY, D E C I S I O N Employer, and STATE OF IOWA, Insurance Carrier, Defendants. STATEMENT OF THE CASE Defendants appeal from an arbitration decision awarding permanent total disability benefits and medical expenses. The record on appeal consists of the transcript of the arbitration hearing and joint exhibits 1 through 28. ISSUES The issues on appeal are whether claimant suffered an injury that arose out of and in the course of his employment; whether there is a causal connection between claimant's injury and his alleged disability; the extent of claimant's alleged disability; and whether the medical expenses are related to the injury. 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 defendants in 1977 as an electrical and refrigeration maintenance engineer. Prior to that time he had done automotive, electrical, and refrigeration work. Claimant has a high school education and attended a trade school for about one year. In 1980, he was diagnosed to have significant coronary artery disease. In October 1980, he underwent angiography and bypass surgery after which he returned to work full time. DUFFIELD V. IOWA STATE PENITENTIARY Page 2 Sometime prior to April 1984 claimant's employer, Iowa State Penitentiary (hereinafter prison), began an internal investigation of employees as a result of allegations of wrongdoing. Prior investigations by prison officers and authorities had resulted in what the claimant characterized as employees being "locked out." The investigation in 1984 eventually involved the department in which claimant worked and he was the last employee to be interviewed. Claimant testified on April 5, 1984 he was told by Major Harry Grabowski who was in charge of the internal investigative section of the prison to report for an interview. Claimant's union steward accompanied claimant at claimant's request. Claimant stated that he was bothered by the presence of the four investigators and that he thought they were going to try to take his job away. Claimant informed the investigative team that he had heart problems and that he did not feel he should have to go through the interrogation. Claimant was requested to make a statement to that effect and the interview was postponed. Claimant further testified he told a personnel officer for the prison that he was scared and he "felt like a sick rabbit with four hound dogs after [him]." Claimant was requested to get a statement from his doctor. he obtained a statement from his doctor, Artemio Santiago, M.D., dated April 6, 1984, which stated that claimant "may return to his maintenance work at Iowa State Prison as stress does not, or will not, prevent him from doing his normal duties, or any extra duties that may be required of him." (Joint Exhibit 23) On May 3, 1984 while claimant was eating at work, he was called by Grabowski to report to his office. Claimant again had the union steward accompany him. Grabowski and one other investigator were there. The interview started and-claimant testified that he was shook up, started getting arm pain and some chest pain, and he felt his blood pressure was terrible. Claimant informed the investigators that he felt bad and the interview was stopped. The transcription of the recording of the interview indicated that the interview lasted two minutes. Claimant stated he had not had chest and arm pain since his prior bypass surgery. Claimant went to the prison hospital where his blood pressure was checked. He then went to see Dr. Santiago and went home. Claimant stated that he started having chest pains and he took four "nitros" but still had chest pains. He called Dr. Santiago and Dr. Santiago told him to go to the hospital. Claimant was admitted to the Fort Madison Community Hospital on May 3, 1984 at 1:55 p.m. He was discharged on May 15, 1984 and the final diagnosis stated: "Acute inferior wall myocardial infarction. Complete heart block. Temporary pacemaker, resolved." (Jt. Ex. 10) The discharge summary states in part: ''After several hours in the SCU patient went into 3rd degree AV block, DUFFIELD V. IOWA STATE PENITENTIARY Page 3 ventricular rate dropped to 30. Patient was brought down to fluroscopy for pacemaker placement." (Jt. Ex. 10) Claimant had frequent angina and was seen by the Cardiology Clinic at the University of Iowa Hospitals on June 6, 1984. J. L. Ehrenhaft, M.D., Professor and Chairman, Division of Thoracic and Cardiovascular Surgery, University of Iowa Hospitals, described the care claimant received in a letter dated June 16, 1984 which reads in relevant parts: He has had recurrent angina which was rather incapacitating and was not manageable by medication alone. For this reason the patient underwent coronary arteriography again on June 11, 1984. At that time it was found that the patient's vein graft to the circumflex system had clotted. The left anterior descending graft was still open, and the graft which had been placed previously into the right coronary artery also had clotted. There was progression of the native vessel disease as well. From previous exploration of this patient we knew that there were no further vessels to be grafted over the posterior surface of the heart. The left anterior descending coronary artery was still open and functioning and it was decided after some discussion to reoperate upon the patient and possibly place a graft into a branch of the right coronary artery or possibly the posterior descending coronary vessel. reexplored this patient on June 15, 1984 and were able to place one vein bypass graft into a very small posterior descending artery branch of the right coronary vessel..I do not know but I am hopeful that the single vein bypass graft will be of some benefit to the patient. Obviously this is a situation where we cannot promise lengthy relief of symptoms. (Jt. Ex. 8) Claimant and his wife testified that before claimant's condition in May 1984 he did not have physical limitations but after that time he was unable to do activities such as carrying groceries or firewood, lifting or repairing things, walking, climbing a ladder, hunting, running a vacuum cleaner, operating a garden tiller or lawnmower, chopping or splitting firewood, hoeing in the garden, raking the yard, or digging with a shovel or spade. Claimant admitted that he had not investigated the possibility of a job other than at the prison nor of being re-educated for another type of job. He also admitted he never contacted the prison for light duty work or vocational training. DUFFIELD V. IOWA STATE PENITENTIARY Page 4 Dr. Santiago testified: A. After the hospitalization he persist [sic] to have chest pain. The activity was very limited and so eventually he was referred to University of Iowa and was seen at the Cardiology Department, and let's see -- And finally a by-pass was done on June 15th, 1984. Q. And after the by-pass, did you also follow up with him? A. Uh-huh. Q. And could you explain to us what that follow-up consisted of then? A. Well, he -- I'd been seeing him quite regularly in the office and -- all this time. He -- In spite of the -- He improved for a while, and then the condition gradually worsens again to the point that even mild activity or just being nervous or upset will bring on chest pain. So to the point that he became disabled. Q. Okay. Doctor, do you have an opinion, within a reasonable degree of medical certainty, as to whether or not Mr. Duffield has a permanent impairment? A. Yes, it is my opinion that he is permanently disabled because of the disability of his heart condition. Q. And by that do you mean totally disabled? A. Totally disabled. Q. Do you have an opinion, within a reasonable degree of medical certainty, as to whether or not the stress that he had related he had on the job would have aggravated that pre-existing condition? In other words whether or not it is -- his disability today is causally connected to that incident or stress in terms of aggravating the previous condition to cause that? A. The time factor is there, you know. Usually there's always something that will bring on a chest DUFFIELD V. IOWA STATE PENITENTIARY Page 5 pain or bring on a heart attack. In this particular case I think the time factor is there, you know. He was under a lot of stress. Q. So is it your opinion then that it would have aggravated that condition or been caused from it? A. Yeah, stress will definitely aggravate or bring on heart attack. (Santiago Deposition, pp. 6-8; Jt. Ex. 16) Claimant was evaluated by Craig Blaine Rypma, who had a doctoral degree in clinical psychology. Dr. Rypma described claimant as a dependent individual who tended to become very easily attached to other individuals and experiences extreme anxiety at the possibility of losing or being rejected by those relationships he has developed. He opined that claimant would be extremely anxious about being involved in the internal investigation. He stated that individuals with personalities like claimant's are seen as denying physical symptomatology and that his advice to medical personnel would be to pay extremely close attention to complaints of physical ailments because when claimant complains physical symptomatology is obviously there and is bothering him. Claimant was evaluated by Randolph R. Rough, M.D., and Dr. Rough opined in a letter dated September 16, 1985 that claimant was "quite disabled by angina pectoris." APPLICABLE LAW The citations of law in the arbitration decision are appropriate to the issues and evidence. ANALYSIS The first issue to be discussed is whether claimant suffered an injury that arose out of and in the course of his employment. The record discloses that claimant was concerned about the internal investigation and that he thought he might lose his job. Claimant had the type of personality that would perceive his situation as threatening and stressful. Claimant had been able to work with no restrictions for over three years following his first bypass operation. His myocardial infarction occurred when he experienced stress relating to the internal investigation. For the claimant the stress of the internal investigation was greater than his regular employment or his nonemployment life. Claimant has suffered an injury that arose out of and in the course of his employment. The second issue to be discussed is whether there is a DUFFIELD V. IOWA STATE PENITENTIARY Page 6 causal connection between claimant's injury and his alleged disability. Dr. Santiago was of the opinion that there was a relationship between the stress claimant experienced and his injury. It was also Dr. Santiago's opinion that the stress and the heart attack resulted in claimant being totally "disabled." While the doctor is not qualified to make a determination of disability, it is obvious that the doctor viewed claimant's impaired condition as permanent. Claimant has had recurrent angina pain severe enough that he is unable to do physical activities. It should also be noted that the myocardial infarction occurred within a matter of hours after the attempted interview with the investigation team on May 3, 1984. As discussed in Exhibit 14 "the development of myocardial infarction rarely occurs as a result of physical effort alone." (Ex. 14, p. 314) and "[t]he shorter the time interval between the exposure to a potentially noxious stimulus and the appearance of clinical or pathologic evidence of new heart disease or dysfunction, the more likely is there to be a causal relationship. Conversely, the farther apart they are in time, the less likely is a cause and effect relationship." (Ex. 14, p. 316) Claimant has proved that there is a causal relationship between his work injury and his disability. The next issue to be discussed is the extent of claimant's disability. Claimant argues that claimant is totally disabled and agrees with the deputy's conclusion that claimant made a prima facie case of total disability under the "odd-lot" doctrine. Defendants seem to argue that claimant cannot be totally disabled because he is 59 years old and has retired. Age is merely one factor in determining industrial disability. In the instant case claimant has demonstrated that he is an older worker, he has limited education and training, his prior work history is manual or physical labor, and he cannot perform physical activities without angina pain. Dr. Santiago opined- that claimant was totally "disabled." Even though the doctor used the term disabled, it is apparent that it was his opinion that claimant was significantly impaired by his heart condition. After his myocardial infarction claimant's angina pain was caused by both nervousness and mild physical activity. There has been no medical evidence nor other evidence that contradicts claimant's evidence of his inability to perform even mild physical activity without the angina pain. In fact, there has been no showing that claimant has been offered any employment, including light duty work, by defendants. Claimant does not need to prove that his physical impairment is 100 percent to prove he is permanently totally disabled. See Dieoerich v. Tri-City Railway Co., 219 Iowa 587, 258 N.W. 899 (1935). When all factors and evidence are considered claimant has proved by the greater weight of evidence that he is permanently and totally disabled. Because claimant has proved that he is permanently and totally disabled, it not necessary to consider whether claimant is an "odd-lot" employee. DUFFIELD V. IOWA STATE PENITENTIARY Page 7 The last issue to be resolved is whether medical expenses are related to the injury. Defendants argue that there is no causal connection between claimant's injury and treatment after he was released from the Fort Madison Community Hospital on May 15, 1984. The evidence in this case indicates that claimant had angina pain as a result of his myocardial infarction. The majority of the medical expenses defendants dispute is for the treatment by the University of Iowa Hospitals after claimant's discharge from the Fort Madison Community Hospital. The coronary bypass operation performed there and follow-up care was an attempt to alleviate claimant's pain which was caused by his work injury. The remaining medical expense includes medications and doctor office visits reasonably related to treatment of claimant's angina pain. FINDINGS OF FACT 1. Claimant was born on July 10, 1927 and was 59 years of 2. Claimant has a high school education and has had one year of trade school. 3. Prior to working for the prison, claimant had done physical type work such as automotive, electrical and refrigeration work. 4. Claimant was employed as an electrical and refrigeration maintenance engineer by the prison from May 3, 1977 until October 19, 1984 at which time he retired. 5. Sometime prior to April 1984 the prison began an internal investigation into wrongdoing by the employees of the prison. 6. Claimant was one of the employees who was to be interviewed 25 part of the internal investigation. 7. On May 3, 1984, claimant was to be interviewed but the interview was not conducted because claimant complained of arm and chest pain. 8. Claimant perceived the investigation as possibly resulting in his loss of employment with the prison. 9. Claimant experienced stress at work relating to the internal investigation that was greater than stress in his regular employment or his nonemployment life. 10. Claimant suffered a myocardial infarction within several hours after his interview was called off. 11. Claimant had had bypass surgery in December 1980 but DUFFIELD V. IOWA STATE PENITENTIARY Page 8 had returned to work without any restrictions after that surgery. 12. Claimant underwent hospital and surgical treatment to relieve angina pain, but he continues to have angina pain. 13. The angina pain is a permanent condition. 14. Claimant can no longer do physical activities because of the angina pain. Nervousness can also cause claimant's angina pain. 15. On May 3, 1984, claimant suffered an injury that arose out of and in the course of his employment with the prison. 16. The work injury of May 3, 1984 is a cause of permanent physical impairment. 17. The work injury of May 3, 1984 is a cause of claimant's current permanent and total loss of earning capacity. 18. Claimant has incurred reasonable medical expenses for the treatment of his work injury in the amount of $42,528.11 as listed in the list of medical expenses attached to the prehearing report filed in this case. CONCLUSIONS OF LAW Claimant has proved by the greater weight of evidence that on May 3, 1984 he suffered an injury that arose out of and in the course of his employment. Claimant has proved by the greater weight of evidence that there is a causal connection between his injury and his permanent disability. Claimant has proved by the greater weight of evidence that he is permanently and totally disabled. Claimant has proved by the greater weight of evidence that he is entitled to reasonable and necessary medical treatment for his injury. WHEREFORE, the decision of the deputy is affirmed and modified. ORDER THEREFORE, it is ordered: That defendants pay to claimant permanent total disability benefits during the period of his disability at the rate of two hundred fifteen and 72/100 dollars ($215.72) per week from May DUFFIELD V. IOWA STATE PENITENTIARY Page 9 3, 1984. That defendants pay claimant the medical expenses to the provider and in the amounts listed in the attachment to the prehearing report. That defendants pay accrued weekly benefits in a lump sum and shall receive credit against this award for all benefits previously paid. That defendants receive credit for previous payments of benefits under a nonoccupational group insurance plan, if applicable and appropriate under Iowa Code section 85.38(2). That defendants pay interest on benefits awarded herein as set forth in Iowa Code section 85.30. That defendants pay costs of this action including the costs of the appeal and transcription of the arbitration hearing pursuant to Division of Industrial Services Rule 343-4.33. That defendants file activity reports on the payment of this award as requested by this agency pursuant to the Division of Industrial Services Rule 343-3.1. Signed and filed this 21st day of September, 1988. DAVID E. LINQUIST INDUSTRIAL COMMISSIONER BEFORE THE IOWA INDUSTRIAL COMMISSIONER EDDIE L. HARRISON, Claimant, VS. File No. 771088 BUESING AUTOMOTIVE, INC., A P P E A L Employer, D E C I S I 0 N and BITUMINOUS INSURANCE COMPANY, Insurance Carrier, Defendants. STATEMENT OF THE CASE Claimant appeals from an arbitration decision awarding temporary total disability benefits but denying permanent partial disability benefits because he did not establish that his work injury has resulted in any loss in his earning capacity. The record on appeal consists of the transcript of the arbitration hearing together with claimant's exhibits 1 through 16; defendants' exhibits A through T and the briefs filed on appeal. Claimant states the following issue on appeal: "Whether or not the deputy erred in finding that the claimant-appellant did not sustain any permanent partial disability as the result of the accident of December 30th, 1983.O REVIEW OF THE EVIDENCE The arbitration decision adequately and accurately reflects the pertinent evidence it will not be totally reiterated herein. On December 30, 1983 claimant sustained a work injury to his low back when he slipped and fell on some ice in the parking lot maintained by defendant-Buesing Automotive, Inc. (hereinafter Buesing) for its employees. As a result of this injury, claimant has suffered a slight permanent partial impairment to the body. Claimant also has work restrictions against lifting in excess of HARRISON V. BUESING AUTOMOTIVE,INC. Page 2 50 pounds and repetitive bending and twisting. Although claimant is functionally impaired, he has successfully returned to his normal work activity. He was discharged from his employment with Buesing for reasons unrelated to this claim. Claimant is now self-employed. Claimant's normal work activity does not require heavy lifting or repetitive bending and twisting but generally involves sitting in front of a work bench. APPLICABLE LAW The citations of law in the arbitration decision are appropriate to the issue and evidence. ANALYSIS Claimant's brief seems to indicate that claimant is entitled to industrial disability because he now works longer hours in his own business to make the same amount of money he did when he worked for defendant, Buesing. As revealed in the deputy's decision claimant's change of employment was nonrelated to his injury. Therefore, the change in claimant's income as a result of his change of employment is irrelevant to the determination of claimant's industrial disability. There are no weighting guidelines that indicate how each of the factors are to be considered. There are no guidelines which give, for example, age a weighted value of ten percent of the total value, education a value of fifteen percent of total, motivation - five percent; work experience - thirty percent, etc. Neither does a rating of functional impairment directly correlate to a degree of industrial disability to the body as a whole. In other words, there are no formulae which can be applied and then added up to determine the degree of industrial disability. It therefore becomes necessary for the deputy or commissioner to draw upon prior experience, general and specialized knowledge to make the finding with regard to degree of industrial disability. See Peterson v. Truck Haven Cafe, Inc., (Appeal Decision, February 28, 1985); Christensen v. Hagen, Inc., (Appeal Decision, March 26, 1985) Vijay Verma, M.D., opined that claimant has a 10 percent permanent impairment to his body as a result of the work injury and resulting surgery. Dr. Verma indicates that claimant had minimal impairment because claimant had a good recovery from the surgery. It is also disclosed that Dr. Verma placed restrictions on claimant's lifting, bending and bending with twisting from side to side. Dr. Verma felt claimant could return to his former work and the evidence reveals that claimant did so. Claimant has not shown that he has had an actual reduction in earning as a result of his injury. However, reduction in earnings is only one of the considerations in determining reduction of earning capacity. HARRISON V. BUESING AUTOMOTIVE,INC. Page 3 The physical restrictions imposed on claimant as well as his back surgery would discourage some employers from hiring claimant. The fact that claimant may not ever have to seek employment from other employers does not completely negate the effect of the injury on claimant's earning capacity. It is determined that as a result of his injury, claimant has an industrial disability of four percent. FINDINGS OF FACT 1. Claimant is a credible witness. 2. Claimant worked for Buesing for 21 years until being terminated in September 1984 for reasons unrelated to his claimed work injury. 3. Claimant's job on December 30, 1983 consisted of the repair of electric automotive generators, starters, and electric motors. 4. On December 30, 1983 while returning from a lunch break at 12:45 p.m., claimant fell in the parking lot maintained by Buesing for its employees and injured his low back resulting in a herniated disc at the L4-5 level of the spine. 5. Buesing was informed by claimant on December 30, 1983 of the time and place of the fall resulting in the injury to his back. 6. Claimant did not become aware of the compensable nature of his injury until a few days before Buesing's first notification by claimant of his claim herein. 7. As a result of the work injury, claimant underwent a surgical operation termed a lumbar hemilaminectomy, L4-5, with removal of the extruded disc and decompression of the nerve root. 8. Prior to the work injury of December 30, 1983, claimant was in auto accidents in which he injured his head and cervical spine but suffered no permanent damage to his spine from these injuries and was able to fully resume his work activity following a period of recovery. 9. Prior to December 30, 1983, claimant had no permanent physical impairments or ascertainable disabilities. 10. As a result of his work injury of December 30, 1983, claimant has suffered a slight permanent partial impairment to the body as a whole. 11. As a result of the work injury of December 30, 1983, claimant has work restrictions against lifting in excess of 50 pounds, repetitive bending, and repetitive twisting. 12. Despite his functional impairment and work restrictions, claimant is physically able to return to his normal HARRISON V. BUESING AUTOMOTIVE,INC. Page 4 work activity and has done so. 13. Claimant has not suffered a significant loss in actual earnings from employment due to his work injury. Claimant's normal work activity does not involve heavy lifting, repetitive bending, repetitive twisting, and for the most part involves sitting in front of a work bench. 14. Claimant is motivated to remain gainfully employed and is currently working from 12 to 17 hours per day in the same type of work that he was performing at the time of the work injury. 15. Claimant is 46 years of age, has a high school education with one year of college and has above average intelligence. 16. Vocational rehabilitation is unnecessary as claimant has returned to his normal occupation. 17. Claimant has suffered a loss of earning capacity as a result of his work injury of December 30, 1983. 18. Pursuant to the parties' stipulation, as a result of his work injury of December 30, 1983, claimant was absent from work for treatment of his back condition from January 8, 1984 through February 26, 1984. 19. Pursuant to the parties' stipulation, claimant's rate of compensation is $252.52 per week. 20. Claimant has incurred medical expenses for the treatment of his back condition as a result of his work injury on December 30, 1983 in the total amount of $7,797.97, but defendants are eligible for a credit in the amount of $7,007.97 under Iowa Code section 85.38(2) for prior payments of expenses under a nonoccupational group insurance plan. CONCLUSIONS OF LAW On December 30, 1983 claimant suffered an injury arising out of and in the course of employment at Buesing. Defendants had notice of claimant's injury. The injury of December 30, 1983 resulted in claimant having an industrial disability of four percent. Claimant is entitled to healing period disability benefits in the amount of 7 1/7 weeks. Claimant is entitled to medical benefits in the amount of $790. WHEREFORE, the decision of the deputy is affirmed and modified. ORDER THEREFORE, it is ordered: HARRISON V. BUESING AUTOMOTIVE,INC. Page 5 That defendants shall pay to claimant seven and one-seventh (7 1/7) weeks of healing period disability benefits at the rate of two hundred fifty-two and 52/100 dollars ($252.52) per week and twenty (20) weeks of permanent partial disability benefits at a rate of two hundred fifty-two and 52/100 dollars ($252.52) per week. That defendants shall pay to claimant the sum of seven hundred ninety dollars ($790) as reimbursement for medical expenses. That defendants shall pay accrued weekly benefits in a lump sum. That defendants shall pay interest on benefits awarded herein as set forth in Iowa Code section 85.30. That defendants shall pay the costs of this proceeding. That defendants shall file activity reports on the payment of this award as requested by this agency pursuant to Division of Industrial Services Rule 500-3.1. Signed and filed this 27th day of July, 1987. DAVID E. LINQUIST ACTING INDUSTRIAL COMMISSIONER Copies To: Mr. John H. Westensee Attorney at Law 1703 Second Avenue Plaza Office Building Rock Island, Illinois 61201 Mr. Larry L. Shepler Attorney at Law 111 East Third Street 600 Union Arcade Building Davenport, Iowa 52801-1550 1402.40 - 1803 Filed July 27, 1987 DAVID E. LINQUIST BEFORE THE IOWA INDUSTRIAL COMMISSIONER EDDIE L. HARRISON, Claimant, VS. File No. 771088 BUESING AUTOMOTIVE, INC., A P P E A L Employer, D E C I S I 0 N and BITUMINOUS INSURANCE COMPANY, Insurance Carrier, Defendants. 1402.40 - 1803 Although claimant suffered no loss in actual earnings, he did suffer a loss of earning capacity because the physical restrictions imposed on claimant as well as his back surgery would discourage some employers from hiring claimant. Industrial disability found to be four percent. Affirmed and modified.