Page   1
 
            
 
            
 
            
 
            
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            SANDRA J. MORGAN,             :
 
                                          :
 
                 Claimant,                :         File No. 773761
 
                                          :
 
            vs.                           :           A P P E A L
 
                                          :
 
            OSCAR MAYER FOODS CORP.,      :         D E C I S I O N
 
                                          :
 
                 Employer,                :
 
                 Self-Insured,            :
 
                 Defendant.               :
 
            ____________________________________________________________
 
            
 
                 The record, including the transcript of the hearing 
 
            before the deputy and all exhibits admitted into the record, 
 
            has been reviewed de novo on appeal.  The decision of the 
 
            deputy filed October 23, 1989, is affirmed and is adopted as 
 
            the final agency action in this case, with the following 
 
            additional analysis:
 
            
 
                 Expert testimony that the condition could be causally 
 
            related to claimant's employment together with non-expert 
 
            testimony tending to show causation may be sufficient to 
 
            sustain an award, but does not compel an award.  Anderson v. 
 
            Oscar Mayer & Co., 217 N.W.2d 531, 536 (Iowa 1974).
 
            
 
                 An expert's opinion based on an incomplete history is 
 
            not necessarily binding on the commissioner, but must be 
 
            weighed with other facts and circumstances.  Musselman v. 
 
            Central Telephone Co., 261 Iowa 352, 360, 154 N.W.2d 128, 
 
            133 (1967).
 
            
 
                 Defendant relies on deposition testimony of Dr. Von 
 
            Gillern in which the doctor states that, "based primarily on 
 
            history, the fact that she had a time interval during which 
 
            she was basically free of symptoms, I think that is probably 
 
            the most logical conclusion to arrive at . . ." for arguing 
 
            the proposition that any present carpal tunnel syndromes are 
 
            probably attributable to recurrence of carpal tunnel 
 
            syndrome and not related to the original July 1984 incident.  
 
            Defendant's reliance is ill founded in that the record does 
 
            not show that claimant was ever free of symptoms.  Dr. 
 
            Sinning's medical notes of 1985 are replete with references 
 
            to claimant continuing to have pain symptomatology.  Indeed, 
 
            Dr. Sinning referred claimant to Dr. Campbell, a 
 
            psychiatrist for evaluation of pain complaints with 
 
            long-term disability.  Dr. Campbell then opined that 
 
            claimant did not suffer from any major nervous disorder.  
 
            Such clearly tends to show that claimant's pain symptoms 
 
            were physical in origin and, given the referral from Dr. 
 
            Sinning who treated claimant and performed her original 
 
            carpal tunnel surgeries, had their origins in the original 
 
            carpal tunnel syndrome development and its sequelae.
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            
 
                 Furthermore, Dr. Von Gillern's testimony overall 
 
            clearly shows a possibility of the requisite causal 
 
            connection, even given the fact that it is founded on 
 
            incomplete medical history.  His testimony, when considered 
 
            with all other medical notes and records in evidence clearly 
 
            supports the deputy's finding that claimant had experienced 
 
            problems with her hands and wrists from July 1984 onward.  
 
            Hence, the full medical history supports a finding of 
 
            causation.
 
            
 
                 Likewise, defendant on appeal places great weight on 
 
            the fact that claimant sought to have her medical 
 
            restrictions lifted in arguing that claimant is not entitled 
 
            to permanent partial disability benefits.  Again, 
 
            defendant's argument is ill founded.  The record clearly 
 
            demonstrates that claimant requested the lifting of her work 
 
            restrictions in order to retain her livelihood and not 
 
            primarily because she subjectively felt they were not 
 
            necessary.
 
            
 
                 Defendant shall pay the costs of the appeal, including 
 
            the preparation of the hearing transcript.
 
            
 
                 Signed and filed this ______ day of October, 1991.
 
            
 
            
 
            
 
            
 
                                          ______________________________
 
                                                   BYRON K. ORTON
 
                                              INDUSTRIAL COMMISSIONER
 
            
 
            Copies To:
 
            
 
            Mr. Earl Payson
 
            Attorney at Law
 
            409 Putnam Building
 
            Davenport, Iowa  52801
 
            
 
            Ms. Vicki L. Seeck
 
            Attorney at Law
 
            600 Union Arcade Building
 
            111 East Third Street
 
            Davenport, Iowa  52801
 
            
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                           9999
 
                           Filed October 4, 1991
 
                           BYRON K. ORTON
 
                           MAM
 
            before the iowa industrial commissioner
 
            ____________________________________________________________
 
		                      :
 
            SANDRA J. MORGAN,	      :
 
                      		      :
 
                 Claimant, 	      :         File No. 773761
 
                      		      :
 
 		           vs.        :           A P P E A L
 
                      		      :
 
            OSCAR MAYER FOODS CORP.,  :         D E C I S I O N
 
                       		      :
 
                 Employer,            :
 
                 Self-Insured,        :
 
                 Defendant.           :
 
            ___________________________________________________________
 
            
 
            9999
 
            Summary affirmance of deputy's decision filed October 23, 
 
            1989, with short additional analysis.
 
            
 
 
            
 
           
 
 
 
                     
 
                  BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         SANDRA J. MORGAN,                          File No. 773761
 
         
 
              Claimant,                          A R B I T R A T I O N
 
         
 
         vs.                                        D E C I S I O N
 
         
 
         OSCAR MAYER FOODS CORP.,                      F I L E D
 
         
 
              Employer,                               OCT 23 1989
 
              Self-Insured,
 
              Defendant.                     IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
                                     INTRODUCTION
 
         
 
              This is an arbitration proceeding brought by Sandra Morgan, 
 
         claimant, against Oscar Mayer Foods Corp., self-insured employer, 
 
         defendant.  The case was heard by the undersigned in Davenport, 
 
         Iowa on February 9, 1989.
 
         
 
              The record consists of the testimony of claimant.  The 
 
         record also consists of joint exhibits A to II.
 
         
 
                                    ISSUES
 
         
 
              As a result of the prehearing report and order submitted and 
 
         approved on February 9, 1989, the issues presented by the parties 
 
         are:
 
         
 
              1.  Whether there is a causal relationship between the work 
 
         injury of July 6, 1984 and any permanent disability; and,
 
         
 
              2.  Whether claimant is entitled to permanent partial or 
 
         total disability benefits.
 
         
 
                                  STIPULATIONS
 
         
 
              Prior to the hearing, the parties entered into a number of 
 
         stipulations.  The stipulations are as follows:
 
         
 
              1.  The existence of an employer-employee relationship 
 
         between claimant and employer at the time of the alleged injury;
 
         
 
              2.  That claimant sustained an injury on July 6, 1984, which 
 
         arose out of and in the course of employment with employer;
 
         
 
              3.  That the inJury is a cause of temporary disability 
 
         during a period of recovery;
 
         
 
              4.  That claimant is making no further claim for temporary 
 
         total disability or healing period benefits;
 
         
 
                                                  
 
                                                           
 
              5.  That the commencement date for permanent partial 
 
         disability, in the event such benefits are awarded, is stipulated 
 
         to be the 15th day of January, 1985;
 
         
 
              6.  That in the event of an award of weekly benefits, the 
 
         rate of weekly compensation is stipulated to be $277.68 per week; 
 
         and,
 
         
 
              7.  Defendant paid claimant 22.857 weeks of compensation at 
 
         the rate of $277.68 per week prior to hearing.
 
         
 
                               FACTS PRESENTED
 
         
 
              Claimant is 53-years-old.  She commenced her employment with 
 
         defendant in October of 1976.  However, her seniority date is 
 
         listed as June 27, 1977.  Since the onset of her employment, 
 
         claimant has worked as a relief operator in a number of 
 
         positions. Claimant has also worked "packing red band."  While 
 
         she was performing this task, claimant first noticed problems 
 
         with her hands and her wrists.  She was packing red band.  This 
 
         occurred in July of 1984.  Claimant reported the problems to the 
 
         company.
 
         
 
              Claimant, at first, was examined by her personal physician, 
 
         Erling Larson, M.D.  He then referred her to Gordon A. Flynn, 
 
         M.D. Dr. Flynn determined as of February 28, 1986:
 
         
 
              I have seen her only once in the last several months and 
 
              that was on December 16, 1985.  At that time I noted that 
 
              she was doing a very light job which involved simply packing 
 
              individual wieners that the machine had missed, but that she 
 
              was having pain and swelling in the metacarpal-phalangea and 
 
              carpal-metacarpal joints of the right thumb.  She also had 
 
              some swelling of most of the other interphalangeal joints 
 
              and definite swelling of the carpal-metacarpal joint, and 
 
              there was also tenderness of the elbow on that side.  
 
              Because of these symptoms, it was my feeling that her 
 
              problem was one of arthritis and not primarily carpal tunnel 
 
              or any other such problem--and it was on that basis that I 
 
              advised her that if she wished a referral she should ask you 
 
              because I could not authorize it as the company physician.
 
         
 
              Later, defendant arranged for claimant to be examined by 
 
         John E. Sinning, Jr., M.D.  Dr. Sinning is an orthopedic surgeon.  
 
         He opined claimant's bilateral carpal tunnel syndrome in August 
 
         of 1984 was causally related to claimant's work duties.  He wrote 
 
         in his letter of August 7, 1984:
 
         
 
              ...Sandra Morgan was seen here in the office on August 3rd. 
 
              Her bilateral carpal tunnel syndrome appears to be work 
 
              related in the sense that the symptoms are aggravated during 
 
              her times of work and are relieved during times of lay-off. 
 
              The last four months of full time work has made the pain 
 
              more severe than ever in the past.  I believe this is in 
 
              that sense work related and I am sending this information on 
 
                                                  
 
                                                           
 
                   to you so that I can get your agreement or not.
 
         
 
              Dr. Sinning performed surgery decompressing the right median 
 
         nerve on September 4, 1984.  He also performed the same surgery 
 
         on the left median nerve on October 31, 1984.  Claimant was 
 
         released to return to work on January 14, 1985.
 
         
 
              However, claimant testified she continued to have problems 
 
         in calendar year 1985.  She returned to Dr. Sinning in August.  
 
         He, in turn, referred claimant to Stephen C. Rasmus, M.D., a 
 
         neurologist.  Dr. Rasmus performed an EMG.  He explained the EMG 
 
         showed normal right and left median and ulnar nerve conductions.
 
         
 
              Claimant also went to Curtis M. Steyers, M.D., Division of 
 
         Hand Surgery at the Department of Orthopaedics.  He diagnosed and 
 
         treated claimant for:
 
         
 
              ... [C]arpal metacarpal joint arthritis, right thumb.  This 
 
              was evident by clinical exam and on X-ray.  Her symptoms are 
 
              precipitated by and aggravated by her work and relieved by 
 
              rest and splinting as well as anti-inflammatory medications. 
 
              She has never been treated by me for carpal tunnel syndrome 
 
              or any other diagnoses.
 
         
 
              Claimant, on her own, also went to see Thomas L. VonGillern, 
 
         M.D., an orthopedic surgeon.  Dr. VonGillern testified by 
 
         deposition.  He testified he first examined claimant on August 
 
         21, 1987 and that approximately six months prior to that date, 
 
         claimant had experienced some numbness in her hands.  Dr. 
 
         VonGillern also testified that for approximately 2 1/2 years 
 
         after her surgery, claimant had no problems with her hands and 
 
         wrists.
 
         
 
              Dr. VonGillern diagnosed claimant as having bilateral flexor 
 
         tenosynovitis, which is commonly called tendinitis.  He stated 
 
         tendinitis is not the same problem as carpal tunnel syndrome.  He 
 
         also indicated that the tendinitis could have been a residual 
 
         problem from the previous surgery, or it could have been a 
 
         separate and distinct problem.  Dr. VonGillern found only mild 
 
         carpometacarpal joint arthritis in the right thumb.  It was no 
 
         greater than the arthritis she had on the left side.
 
         
 
              Dr. VonGillern stated that at the time he examined claimant, 
 
         "...her symptoms were not localized to the thumb, carpometacarpal 
 
         joint, and they were not -- they were bilateral, not unilateral, 
 
         and they were complaints primarily of numbness.  First 
 
         carpometacarpal osteoarthritis, or any kind of arthritis with a 
 
         few exceptions, basically doesn't cause any symptoms of 
 
         numbness." (Exhibit DD, page 13, lines 15 to 21)
 
         
 
              Dr. VonGillern also stated during his deposition:
 
         
 
                   The fact that she had a time interval during which she 
 
              did not have numbness and had relief of her night pain and 
 
              had prompt relief of her pain following her surgery, all 
 
                                                  
 
                                                           
 
                   would lead me to believe that she probably did not have 
 
              persistent, but more likely had recurrent carpal tunnel 
 
              syndrome.  That is possibly a second occurrence or a second 
 
              event.
 
         
 
         (Ex. DD, p. 16, 11. 7-14)
 
         
 
                   The answer that you're probably looking for from a 
 
              historical standpoint is that her symptoms were gone in the 
 
              interval between the first time period and the presentation 
 
              of her new symptoms, and that certainly from a historical 
 
              standpoint would likely support the fact that this was a 
 
              recurrent -- that is, a -- the appearance of a second 
 
              episode of carpal tunnel syndrome, rather than persistence 
 
              of an on-going initial carpal tunnel syndrome.
 
         
 
         (Ex. DD, p. 23, 11. 12-21)
 
         
 
              Dr. VonGillern also opined in his deposition:
 
         
 
              ...I don't think in any one individual that you can say, 
 
              within a reasonable degree of medical certainty, whether or 
 
              not a given condition of accumulative traumas is caused by 
 
              an occupation.  The one thing that we can see is that in 
 
              large numbers of people that work in the same field, there 
 
     
 
                               
 
                                                           
 
              are certain fields that are more prone to developing certain 
 
              accumulative trauma disorders.
 
         
 
         (Ex. DD, p. 29, 11. 18-25)
 
         
 
              Finally, Dr. VonGillern determined claimant was permanently 
 
              impaired.  He wrote in his report of September 15, 1987:
 
         
 
              ...At present, permanent work restrictions should include 
 
              repetitive gripping activities, bilaterally, of the upper 
 
              extremities.  Based on the A.M.A. Guide for impairment, her 
 
              sensory deficit is to be permanently that of decreased two 
 
              point discrimination sensation, bilaterally.  This is mild 
 
              and would rate an upper extremity impairment, bilaterally, 
 
              which would combine total of 6% upper extremity impairment 
 
              which is equivalent to 4% whole person permanent partial 
 
              impairment.
 
         
 
              In his deposition, Dr. VonGillern defined the six percent 
 
         figure to be three percent impairment for each upper extremity. 
 
         (Exhibit DD, page 22, lines 16 to 21.)
 
         
 
              Records at the hearing indicate Dr. Sinning referred 
 
         claimant to Patrick G. Campbell, M.D., a psychiatrist.  Claimant 
 
         was referred to Dr. Campbell for an evaluation because of her 
 
         pain complaints.
 
         
 
              Dr. Campbell, in his letter of May 4, 1987, wrote:
 
         
 
              ...She was seen on June 6, 1985.  Medical information was 
 
              received from Dr. Sinning.  Ms. Morgan was cooperative with 
 
              the examination.
 
         
 
              In my opinion, Ms. Morgan did not suffer from any major 
 
              nervous disorder.  Work limitation because of psychiatric 
 
              illness were not indicated....
 
         
 
              Claimant, in her deposition, stated she had her work 
 
         restrictions lifted, so she could return to work.  She reported 
 
         she had a great deal of pain, but she was forced to work.
 
         
 
                                APPLICABLE LAW
 
         
 
              The claimant has the burden of proving by a preponderance of 
 
         the evidence that the injury of July 6, 1984, is 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 testimony.  Bradshaw v. Iowa Methodist Hospital, 251 Iowa 
 
         375, 101 N.W.2d 167 (1960).
 
         
 
              The opinions of experts need not be couched in definite, 
 
                                                  
 
                                                           
 
         positive or unequivocal language.  Sondag v. Ferris Hardware, 220 
 
         N.W.2d 903 (Iowa 1974).  An opinion of an expert based upon an 
 
         incomplete history is not binding upon the commissioner, but must 
 
         be weighed together with the other disclosed facts and 
 
         circumstances.  Bodish, 257 Iowa 516, 133 N.W.2d 867 (1965).  The 
 
         expert medical evidence must be considered with all other 
 
         evidence introduced bearing on the causal connection between the 
 
         injury and the disability.  Burt, 247 Iowa 691, 73 N.W.2d 732 
 
         (1955).  In regard to medical testimony, the commissioner is 
 
         required to state the reasons on which testimony is accepted or 
 
         rejected.  Sondag, 220 N.W.2d 903 (1974).
 
         
 
              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, 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).
 
         
 
              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.
 
         
 
              An employee is not entitled to recover for the results of a 
 
         preexisting injury or disease but can recover for an aggravation 
 
         thereof which resulted in the disability found to exist.  Olson 
 
         v. Goodyear Service Stores, 255 Iowa 1112, 125 N.W.2d 251 (1963); 
 
         Yeager v. Firestone Tire & Rubber Co., 253 Iowa 369, 112 N.W.2d 
 
         299 (1961); Ziegler, 252 Iowa 613, 106 N.W.2d 591 (1960).  See 
 
         also Barz v. Oler, 257 Iowa 508, 133 N.W.2d 704 (1965); Almquist 
 
         v. Shenandoah Nurseries, 218 Iowa 724, 254 N.W. 35 (1934).
 
         
 
              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).
 
         
 
              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).
 
         
 
                                  ANALYSIS
 
                                                  
 
                                                           
 
         
 
              The first issue to address is whether claimant's condition 
 
         is causally related to her injury on July 6, 1984.  There is no 
 
         question Dr. Sinning, the orthopedic surgeon causally related 
 
         claimant's original bilateral carpal tunnel syndrome to her work 
 
         situation.  Claimant returned to work in February of 1985.  She 
 
         had her two surgeries during the previous fall.  However, 
 
         problems persisted throughout 1985.
 
         
 
              Then Dr. Steyers, in August of 1986, causally connected 
 
         claimant's carpal metacarpal joint arthritis, right thumb to her 
 
         work activities.  However, Dr. Steyers did not state that the 
 
         arthritis in the right thumb was connected to the carpal tunnel 
 
         syndrome or to the resulting surgery.  Nor did Dr. Steyers relate 
 
         the arthritis back to the injury date of July 6, 1984.  
 
         Therefore, it is the determination of the undersigned that the 
 
         thumb condition is not causally connected to the injury on July 
 
         6, 1984. This condition does not appear to relate to the same set 
 
         of circumstances.  It was not included on the face of the 
 
         petition.
 
         
 
              With respect to the second episode of carpal tunnel 
 
         syndrome, Dr. VonGillern could not determine whether claimant's 
 
         problems remained from the first.surgery or whether the problems 
 
         were new developments.  Dr. VonGillern testified during his 
 
         deposition as follows:
 
         
 
              Q.  Could be either.  Is there any way to tell medically?
 
         
 
              A.  Well, historically if she had relief of pain and 
 
              numbness in the interim for two and a half years and then 
 
              developed recurrent symptoms, it would certainly at least be 
 
              historically be suggestive of a possible second occurrence. 
 
              That is, that there would be an interval that was pain 
 
              free.
 
         
 
         (Ex. DD, p. 9, 11. 16-23)
 
         
 
                   The fact that she had a time interval during which she 
 
              did not have numbness and had relief of her night pain and 
 
              had prompt relief of her pain following her surgery, all 
 
              would lead me to believe that she probably did not have 
 
              persistent, but more likely had recurrent carpal tunnel 
 
              syndrome.  That is possibly a second occurrence or a second 
 
              event.
 
         
 
              ...
 
         
 
              Q.  So I gather what you're saying, then, is that the 
 
              problems that she presented to you in August of 1987 are 
 
              probably attributable to a recurrence of carpal tunnel 
 
              syndrome.
 
         
 
              A.  I would say that based primarily on history, the fact 
 
              she had a time interval during which she was basically free 
 
                                                  
 
                                                           
 
                   of symptoms, I think that is probably the most logical 
 
              conclusion to arrive at.
 
         
 
         (Ex. DD, p. 16, 11. 7-14 & Ex. DD, p. 17, 11. 1-5)
 
         
 
              The undersigned finds that the second episode is causally 
 
         related to the original injury on July 6, 1984.  Dr. VonGillern 
 
         could not state that the second episode was separate and distinct 
 
         from the first episode.  Additionally, claimant had experienced 
 
         periodic problems with her hands and wrists since July of 1984. 
 
         Prior to the time of her two surgeries, claimant had been working 
 
         under medical restrictions.  It was not until August of 1988, 
 
         that the restrictions were lifted.  If the condition had not been 
 
         persistent, the medical restrictions would have been lifted.  The 
 
         restrictions were not lifted.  Claimant continually experienced 
 
         difficulties.
 
         
 
              The next issue to address is the nature and extent of 
 
         claimant's disability.  To determine the proper method for 
 
         calculating the disability, if any, the undersigned determines 
 
         section 85.34(2)(s) must be used.  Here, the parties stipulated 
 
         there was a single injury date.  Both upper extremities were 
 
         injured such as to cause a loss of both arms.
 
         
 
              Section 85.34(2)(s) provides as follows:
 
         
 
              The loss of both arms, or both hands, or both feet, or both 
 
              legs, or both eyes, or any two thereof, caused by a single 
 
              accident, shall equal five hundred weeks and shall be 
 
              compensated as such, however, if said employee is 
 
              permanently and totally disabled the employee may be 
 
              entitled to benefits under subsection 3.
 
         
 
                                  
 
                                                           
 
              In the case at hand, only Dr. VonGillern provided an 
 
         impairment rating.  He determined the following in his 
 
         deposition:
 
         
 
                   Q.  I have one more area to question you about, and 
 
              then I will be through.  In your report dated September 15, 
 
              1987, you offer the opinion that she has an upper extremity 
 
              impairment bilaterally, which would be a combined total of 6 
 
              percent upper extremity impairment which is equivalent to 4 
 
              percent whole person permanent partial impairment.  Does 
 
              this mean you would assess a permanent partial impairment to 
 
              each upper extremity of 3 percent?
 
         
 
                   A.  Correct.
 
         
 
                   Q.  So if we were to look at one upper extremity, it 
 
              would be 3 percent; and then at the other one, it would be 3 
 
              percent.
 
         
 
                   A.  Correct.
 
         
 
                   Q.  It's not 6 percent of each.
 
         
 
                   A.  Correct.
 
         
 
                   Q.  As of the time you wrote this report on September 
 
              15, 1987, did you attribute this to this what we have 
 
              discussed as a recurrence of bilateral carpal tunnel 
 
              syndrome, or does this go back to the original surgery?
 
         
 
                   A.  The impairment?
 
         
 
                   Q.  Yes.
 
         
 
                   A.  Doesn't make any difference from a medical 
 
              standpoint.  From a medical standpoint the findings are the 
 
              same, and that's the difference between impairment and 
 
              disability.  The question really is, from my standpoint, is 
 
              there any impairment.  And, if so, what is it.  Based on 
 
              what you found, that's what the physical findings are.  So I 
 
              can't tell you the answer to that.
 
         
 
         (Ex. DD, p. 22, 11. 6-25 & Ex. DD, p. 23, 11. 1-11)
 
         
 
              There is no other impairment rating provided by a physician. 
 
         Additionally, claimant requested Dr. VonGillern to lift all her 
 
         medical restrictions as of August of 1988.  Claimant returned to 
 
         a stuffing position, and eventually, to a reliever position.  At 
 
         the time of the hearing, claimant had been working as a relief 
 
         operator.  She testified she had been able to perform her job but 
 
         with some discomfort.
 
         
 
              Therefore, in light of the foregoing, it is the 
 
         determination of the undersigned that claimant sustained a four 
 
         percent permanent partial disability.  Under section 85.34(2)(s) 
 
                                                  
 
                                                           
 
         this equals weekly compensation for 20 weeks at the stipulated 
 
         rate of $277.68 per week.
 
         
 
                   FINDINGS OF FACT AND CONCLUSIONS OF LAW
 
         
 
              FINDING 1.  Claimant sustained bilateral carpal tunnel 
 
         syndrome to her right and left upper extremities as a result of a 
 
         work injury which occurred on July 6, 1984.
 
         
 
              CONCLUSION A.  Claimant's bilateral carpal tunnel syndrome 
 
         is causally related to claimant's injury on July 6, 1984.
 
         
 
              FINDING 2.  Claimant was able to return to work with medical 
 
         restrictions.
 
         
 
              FINDING 3.  The medical restrictions were lifted from 
 
         claimant by her physician in August of 1988.
 
         
 
              FINDING 4.  At the time of the hearing, claimant was working 
 
         as a relief operator in defendant's plant.
 
         
 
              CONCLUSION B.  Claimant has met her burden of proving she 
 
         has a four percent permanent partial disability as stated in 
 
         section 85.34(2)(s).
 
         
 
                                   ORDER
 
         
 
              THEREFORE, defendant is to pay unto claimant twenty (20) 
 
         weeks of permanent partial disability benefits at the stipulated 
 
         rate of two hundred seventy-seven and 68/100 dollars ($277.68) 
 
         per week as a result of the injury on July 6, 1984.
 
         
 
              Payments that have accrued shall be paid in a lump sum 
 
         together with statutory interest thereon pursuant to Iowa Code 
 
         section 85.30.
 
         
 
              Defendants are to be given credit for all benefits 
 
         previously paid to this claimant.
 
         
 
              Costs of this action are assessed against the defendant 
 
         pursuant to Division of Industrial Services Rule 343-4.33.
 
         
 
              Defendant shall file a claim activity report upon payment of 
 
         this award.
 
         
 
         
 
              Signed and filed this 23rd of October, 1989.
 
         
 
         
 
         
 
         
 
         
 
         
 
                                       MICHELLE A. McGOVERN
 
                                       DEPUTY INDUSTRIAL COMMISSIONER
 
                                                  
 
                                                           
 
         
 
         Copies To:
 
         
 
         Mr. Earl A. Payson
 
         Attorney at Law
 
         126 Kirkwood Bldg.
 
         Davenport IA  52803
 
         
 
         Ms. Vicki L. Seeck
 
         Attorney at Law
 
         600 Union Arcade Bldg.
 
         Davenport IA  52801
 
         
 
         
 
         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                  
 
 
            
 
          
 
 
 
                 
 
                                            5-1803.1
 
                                            Filed October 23, 1989
 
                                            MICHELLE A. McGOVERN
 
         
 
                  BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         SANDRA J. MORGAN,
 
         
 
              Claimant,
 
                                                     File No. 773761
 
         vs.
 
                                                 A R B I T R A T I 0 N 
 
         OSCAR MAYER FOODS CORP.
 
                                                     D E C I S I 0 N
 
              Employer,
 
              Self-Insured,
 
              Defendant.
 
         
 
         
 
         5-1803.1
 
         
 
              Claimant awarded 20 weeks of permanent partial disability 
 
         benefits under section 85.34(2)(s).  The parties stipulated there 
 
         was a single injury date.  Both upper extremities were injured.
 
         
 
         
 
         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                
 
 
        
 
 
 
 
 
                       BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
        
 
        
 
        NANCY L. McCONNELL,
 
        
 
            Claimant,
 
        
 
        vs.                               File No. 773872
 
        
 
        CITY OF CLIVE,                       A P P E A L
 
        
 
            Employer,                     D E C I S I O N
 
        
 
        and
 
        
 
        ARGONAUT INSURANCE COMPANIES,
 
        
 
            Insurance Carrier,
 
            Defendants.
 
        
 
        
 
                                 STATEMENT OF THE CASE
 
        
 
        Claimant appeals from an arbitration decision denying any 
 
        benefits to claimant.
 
        
 
        The record on appeal consists of the transcript of the 
 
        arbitration hearing; joint exhibits 1 through 9; claimant's 
 
        exhibits 10 and 11; and defendants' exhibits A through E and I. 
 
        Both parties filed briefs on appeal.
 
        
 
                                      ISSUES
 
        
 
        The issue on appeal is whether claimant received an injury that 
 
        arose out of and in the course of her employment.
 
        
 
                                 REVIEW OF THE EVIDENCE
 
        
 
        The arbitration decision adequately and accurately reflects the 
 
        pertinent evidence and it will not be totally reiterated herein.
 
        
 
        Briefly stated, in 1977 claimant began working for the police 
 
        department of the City of Clive, Iowa as a dispatcher. She worked 
 
        there until September 3, 1984. She alleges that there was stress 
 
        in her employment caused by sex discrimination and sexual 
 
        harassment. Claimant testified at the arbitration hearing and 
 
        admitted that she had emotional turmoil in her life outside the 
 
        workplace in 1983 and 1984. That emotional turmoil included her 
 
        stepfather having a myocardial infarction in 1984.
 
        
 
        MCCONNELL V. CITY OF CLIVE
 
        Page 2
 
        
 
        
 
        The consensus of the physicians who dealt with claimant is that 
 
        she is afflicted by Raynaud's phenomenon. It was also the 
 
        consensus of the physicians who testified that the cause of 
 
        claimant's affliction was idiopathic, i.e., unknown or uncertain. 
 
        The ailment was described in the Merck Manual, 14th Edition, 
 
        which was given in exhibit 6 (deposition exhibit 3) as follows:
 
        
 
                            RAYNAUD'S PHENOMENON AND DISEASE
 
        
 

 
        
 
 
 
 
 
        Spasm of arterioles, especially in the digits (and occasionally 
 
        other acral parts such as the nose and tongue), with intermittent 
 
        pallor or cyanosis of the skin.
 
        
 
        Etiology
 
        
 
        Raynaud's phenomenon may be idiopathic (Raynaud's disease) or 
 
        secondary to conditions such as connective tissue disorders 
 
        (e.g., scleroderma, RA, SLE), neurogenic lesions (including the 
 
        thoracic outlet syndromes), drug intoxications (ergot and 
 
        methysergide), dysproteinemias, myxedema, primary pulmonary, 
 
        hypertension, and trauma. Idiopathic Raynaud's disease is most 
 
        common in young women.
 
        
 
        Pathology and Pathophysiology
 
        
 
        Attacks of vasospasm of the digital arteries may last for minutes 
 
        to hours, but are rarely severe enough to cause gross tissue 
 
        loss....
 
        
 
        Symptoms, Signs, and Diagnosis
 
        
 
        Intermittent attacks of blanching or cyanosis of the digits is 
 
        precipitated by exposure to cold or by emotional upsets. The 
 
        color changes may be triphasic, pallor, cyanosis, redness 
 
        (reactive hyperemia); or biphasic: cyanosis, then reactive 
 
        hyperemia. Normal color and sensation are restored by rewarming 
 
        the hands. Color changes are not present proximal to the 
 
        metacarpophalangeal joints and rarely involve the thumb. Pain is 
 
        uncommon, but paresthesias consisting of numbness, tingling, or 
 
        burning are frequent during the attack.
 
        
 
        Idiopathic Raynaud's disease is differentiated from secondary 
 
        Raynaud's phenomenon by bilateral involvement and a history of 
 
        symptoms for at least 2 yrs with no progression of the symptoms 
 
        and no evidence of an underlying cause. In idiopathic Raynaud's 
 
        disease, trophic skin changes and gangrene are either absent or 
 
        present only in minimal cutaneous areas. The symptoms and signs 
 
        of the underlying disease
 
        
 
        MCCONNELL V. CITY OF CLIVE
 
        Page 3
 
        
 
        
 
        usually become manifest within 2 yr, occasionally longer....
 
        
 
        Treatment
 
        
 
        Therapy of the secondary forms depends on recognition and 
 
        treatment of the underlying disturbance. Mild cases of idiopathic 
 
        Raynaud's disease may be controlled by protecting the body and 
 
        extremities from cold and by using mild sedatives (e.g., 
 
        phenobarbital 15 to 30 mg orally t.i.d. or q.i.d.). The patient 
 
        must stop smoking since nicotine is a vascoconstrictor.
 
        
 
        John H. Ghrist, M.D., saw claimant on May 18, 1984 and testified 
 
        that part of her history was that she had been a smoker of 
 
        approximately one pack a day for approximately ten years. He 
 
        testified that he instructed claimant to discontinue all smoking 
 
        as it would directly exacerbate her problems with cyanosis of the 
 
        extremities. He opined that at times moderate to severe stress 
 
        may cause very temporary exacerbation of Raynaud's disease as may 
 
        many other factors particularly temperature. He also opined that 
 
        smoking was a contributing but not the sole cause of claimant's 
 
        cyanosis. He further testified that at the time of his evaluation 
 
        of claimant her Raynaud's disease was not found to be exacerbated 
 

 
        
 
 
 
 
 
        by emotional distress and at that time no severe history of 
 
        emotional distress was obtained.
 
        
 
        Theodore W. Rooney, D.O., first saw claimant on February 23, 
 
        1985. He testified that symptoms of Raynaud's phenomenon can be 
 
        caused by exposure to cold temperatures, emotional or physical 
 
        stress, certain medications, or smoking. He stated that cold was 
 
        the most common precipitating factor. He also saw claimant on 
 
        January 29, 1986 and he testified that claimant related she had 
 
        had frequent attacks especially with the colder weather. He also 
 
        testified that a series of repetitive events whether it be 
 
        emotional or physical could precipitate the symptoms. He 
 
        indicated that claimant was a smoker and that smoking is one of 
 
        the most potential stimulus or exacerbating factors of vasospasm 
 
        of small blood vessels.
 
        
 
        David E. Swieskowski, M.D., treated claimant for the first time 
 
        on July 31, 1985. He testified that stress, distress, fatigue and 
 
        medications can exacerbate Raynaud's phenomenon. He further 
 
        testified that he agreed that smoking is a major aggravating 
 
        cause in Raynaud's phenomenon and that in some patients smoking 
 
        itself can cause spasm of the blood vessels. He indicated that it 
 
        would be conjecture on his part that alleged occurrences at work 
 
        were a possible aggravation to claimant's condition. He stated 
 
        that it was his opinion that events that occurred three or four 
 
        years prior to his testimony would not cause Raynaud's phenomenon 
 
        at the time of his testimony.
 
        
 
        MCCONNELL V. CITY OF CLIVE
 
        Page 4
 
        
 
        
 
                                 APPLICABLE LAW
 
        
 
        The citations of law contained in the arbitration decision are 
 
        appropriate to the issues and evidence.
 
        
 
                                      ANALYSIS
 
        
 
        On appeal claimant concedes that her employment did not cause 
 
        Raynaud's phenomenon but argues that her employment aggravated 
 
        her condition. Claimant's concession on the cause of her 
 
        condition is well advised because it is the consensus of the 
 
        medical experts in this case that the cause of her condition is 
 
        unknown.
 
        
 
        Claimant must prove that the probable cause of the aggravation of 
 
        her condition is her employment. Claimant has clearly not met her 
 
        burden of proof. On page 28 of her brief claimant refers to the 
 
        principle that a cause need not be the only cause of a problem to 
 
        make a condition compensable. This is well recognized. Where 
 
        claimant's argument falls short is in her proof that employment 
 
        stress was a cause in the aggravation of her condition. None of 
 
        the doctors who testified could state that the probable 
 
        aggravating cause was her employment. Dr. Rooney thought that 
 
        stress could be a cause but he included emotional and physical 
 
        stress as possible precipitating factors. There is no evidence 
 
        that claimant experienced physical stress on the job that would 
 
        aggravate her condition. If claimant's condition were aggravated 
 
        by stress it may have also been emotional or physical stress 
 
        outside her employment. Claimant admitted to being subject to 
 
        emotional turmoil outside the work place in 1983 and 1984 and her 
 
        condition was apparently aggravated during that time.
 
        
 
        The three doctors who saw and treated claimant for her condition 
 
        all agreed that smoking could be an exacerbating factor. Claimant 
 

 
        
 
 
 
 
 
        was a smoker during her employment with the defendant employer. 
 
        Also, when claimant saw Dr. Rooney in January 1986 she had had 
 
        frequent attacks of her condition. These attacks continued more 
 
        than a year after she was last employed by the defendant employer 
 
        and they occurred during cold weather. The continuation of 
 
        claimant's attacks after termination of her employment indicates 
 
        that employment factors played little, if any, role in her 
 
        condition. Thus, it cannot be said that claimant's employment 
 
        was the probable cause of the aggravation of her condition. The 
 
        other possible causes such as smoking and exposure to the cold 
 
        would be probable causes. Especially,since claimant continued to 
 
        have problems after leaving her employment, the greater weight of 
 
        evidence clearly fails to causally connect claimant's later 
 
        problems to her job stress.
 
        
 
        Two other points are worth noting. First, the symptoms of 
 
        claimant's attacks last only a few hours. The aggravation
 
        
 
        MCCONNELL V. CITY OF CLIVE
 
        Page 5
 
        
 
        
 
        of her condition, whatever the cause, is only temporary. Second, 
 
        there is no apparent correlation between the alleged emotional 
 
        stressors on the job and the onset of the aggravation of 
 
        claimant's condition. It is not clear from the record when the 
 
        stressors on the job occurred and when claimant's condition was 
 
        aggravated.
 
        
 
                                 FINDINGS OF FACT
 
        
 
        1. From 1977 to September 3, 1984 claimant was employed as a 
 
        secretary and dispatcher for the Clive, Iowa, Police Department.
 
        
 
        2. Claimant is afflicted with a condition known as Raynaud's 
 
        phenomenon.
 
        
 
        3. Claimant's Raynaud's phenomenon is idiopathic in nature, and 
 
        the reason why she is afflicted with the ailment is unknown.
 
        
 
        4. During the time claimant was employed by defendant employer 
 
        and after her employment with defendant, she had attacks of the 
 
        type which are characteristic of persons with Raynaud's 
 
        phenomenon.
 
        
 
        5. Attacks may be precipitated by use of nicotine, stress, cold 
 
        and the other factors.
 
        
 
        6. Claimant smokes and has also experienced problems in cold 
 
        weather.
 
        
 
        7. Claimant has had stress in and outside of her employment with 
 
        defendant.
 
        
 
        8. Claimant's Raynaud's phenomenon was not aggravated, 
 
        accelerated, worsened or lighted up by her employment with 
 
        defendant employer.
 
        
 
                                 CONCLUSION OF LAW
 
        
 
        Claimant has failed to prove by the greater weight of evidence 
 
        that suffered an injury that arose out of and in the course of 
 
        her employment or was caused by the stress of her employment.
 
        
 
        WHEREFORE, the decision of the deputy is affirmed.
 
        
 

 
        
 
 
 
 
 
                                      ORDER
 
        
 
        THEREFORE, it is ordered:
 
        
 
        That claimant take nothing from this proceeding.
 
        
 
        That claimant pay the costs of this proceeding including the 
 
        costs of transcription of the arbitration hearing.
 
        
 
        MCCONNELL V. CITY OF CLIVE
 
        Page 6
 
        
 
        
 
        Signed and filed this 25th day of August, 1988.
 
        
 
        
 
        
 
                                      DAVID E. LINQUIST
 
                                   INDUSTRIAL COMMISSIONER
 
        
 
        
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                    BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         NANCY L. McCONNELL,
 
         
 
              Claimant,
 
         
 
         vs.                                       File No. 773872
 
         
 
         CITY OF CLIVE,                              A P P E A L
 
         
 
               Employer,                           D E C I S I O N
 
         
 
         and
 
         
 
         ARGONAUT INSURANCE COMPANIES,
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
                              STATEMENT OF THE CASE
 
         
 
              Claimant appeals from an arbitration decision denying any 
 
         benefits to claimant.
 
         
 
              The record on appeal consists of the transcript of the 
 
         arbitration hearing; joint exhibits 1 through 9; claimant's 
 
         exhibits 10 and 11; and defendants' exhibits A through E and I.  
 
         Both parties filed briefs on appeal.
 
         
 
                                      ISSUES
 
         
 
              The issue on appeal is whether claimant received an injury 
 
         that arose out of and in the course of her employment.
 
         
 
         
 
                              REVIEW OF THE EVIDENCE
 
         
 
              The arbitration decision adequately and accurately reflects 
 
         the pertinent evidence and it will not be totally reiterated 
 
         herein.
 
         
 
              Briefly stated, in 1977 claimant began working for the 
 
         police department of the City of Clive, Iowa as a dispatcher.  
 
         She worked there until September 3, 1984.  She alleges that there 
 
         was stress in her employment caused by sex discrimination and 
 
         sexual harassment.  Claimant testified at the arbitration hearing 
 
         and admitted that she had emotional turmoil in her life outside 
 
         the workplace in 1983 and 1984.  That emotional turmoil included 
 
         her stepfather having a myocardial infarction in 1984.
 
         
 
              The consensus of the physicians who dealt with claimant is 
 
         that she is afflicted by Raynaud's phenomenon.  It was also the 
 
         consensus of the physicians who testified that the cause of 
 
         claimant's affliction was idiopathic, i.e., unknown or uncertain.  
 
         The ailment was described in the Merck Manual, 14th Edition, 
 
         which was given in exhibit 6 (deposition (exhibit 3) as follows:
 

 
         
 
         
 
         
 
         McCONNELL V. CITY OF CLIVE
 
         PAGE   2
 
         
 
         
 
         
 
                         RAYNAUD'S PHENOMENON AND DISEASE
 
         
 
                 Spasm of arterioles, especially in the digits 
 
              (and occasionally other acral parts such as the 
 
              nose and tongue), with intermittent pallor or 
 
              cyanosis of the skin.
 
         
 
              Etiology
 
         
 
                 Raynaud's phenomenon may be idiopathic 
 
              (Raynauds disease) or secondary to conditions such 
 
              as connective tissue disorders (e.g., scleroderma 
 
              RA, SLE), neurogenic lesions (including the 
 
              thoracic outlet syndromes), drug intoxications 
 
              (ergot and methysergide), dysproteinemias, 
 
              myxedema, primary pulmonary, hypertension, and 
 
              trauma.  Idiopathic Raynaud's disease is most 
 
              common in young women.
 
         
 
              Pathology and Pathophysiology
 
         
 
                 Attacks of vasospasm of the digital arteries 
 
              may last for minutes to hours, but are rarely 
 
              severe enough to cause gross tissue loss ....
 
         
 
              Symptoms, Signs, and Diagnosis
 
         
 
                 Intermittent attacks of blanching or cyanosis 
 
              of the digits is precipitated by exposure to cold 
 
              or by emotional upsets.  The color changes may be 
 
              triphasic, pallor, cyanosis, redness (reactive 
 
              hyperemia); or biphasic: cyanosis, then reactive 
 
              hyperemia.  Normal color and sensation are 
 
              restored by rewarming the hands.  Color changes 
 
              are not present proximal to the 
 
              metacarpophalangeal joints and rarely involve the 
 
              thumb.  Pain is uncommon, but paresthesias 
 
              consisting of numbness, tingling, or burning are 
 
              frequent during the attack.
 
         
 
                 Idiopathic Raynaud's disease is differentiated 
 
              from secondary Raynaud's phenomenon by bilateral 
 
              involvement and a history of symptoms for at least 
 
              2 yrs with no progression of the symptoms and no 
 
              evidence of an underlying cause.  In idiopathic 
 
              Raynaud's disease, trophic skin changes and 
 
              gangrene are either absent or present only in 
 
              minimal cutaneous areas.  The symptoms and signs 
 
              of the underlying disease usually become manifest 
 
              within 2 yr, occasionally longer ....
 
         
 
              Treatment
 
         
 
                 Therapy of the secondary forms depends on 
 
              recognition and treatment of the underlying 
 
              disturbance.  Mild cases of idiopathic Raynaud's 
 
              disease may be controlled by protecting the body 
 
              and extremities from cold and by using mild 
 
              sedatives (e.g., phenobarbital 15 to 30 mg orally 
 
              t.i.d. or q.i.d.). The patient must stop smoking 
 
              since nicotine is a vascoconstrictor.
 
         
 

 
         
 
         
 
         
 
         McCONNELL V. CITY OF CLIVE
 
         PAGE   3
 
         
 
         
 
              John H. Ghrist, M.D., saw claimant on May 18, 1984 and 
 
         testified that part of her history was that she had been a smoker 
 
         of approximately one pack a day for approximately ten years.  He 
 
         testified that he instructed claimant to discontinue all smoking 
 
         as it would directly exacerbate her problems with cyanosis of the 
 
         extremities.  He opined that at times moderate to severe stress 
 
         may cause very temporary exacerbation of Raynaud's disease as may 
 
         many other factors particularly temperature.  He also opined that 
 
         smoking was a contributing but not the sole cause of claimant's 
 
         cyanosis.  He further testified that at the time of his 
 
         evaluation of claimant her Raynaud's disease was not found to be 
 
         exacerbated by emotional distress and at that time no severe 
 
         history of emotional distress was obtained.
 
         
 
              Theodore W. Rooney, D.O., first saw claimant on February 23, 
 
         1985.  He testified that symptoms of Raynaud's phenomenon can be 
 
         caused by exposure to cold temperatures, emotional or physical 
 
         stress, certain medications, or smoking.  He stated that cold was 
 
         the most common precipitating factor.  He also saw claimant on 
 
         January 29, 1986 and he testified that claimant related she had 
 
         had frequent attacks especially with the colder weather.  He also 
 
         testified that a series of repetitive events whether it be 
 
         emotional or physical could precipitate the.symptoms.  He 
 
         indicated that claimant was a smoker and that smoking is one of 
 
         the most potential stimulus or exacerbating factors of vasospasm 
 
         of small blood vessels.
 
         
 
              David E. Swieskowski, M.D., treated claimant for the first 
 
         time on July 31, 1985.  He testified that stress, distress, 
 
         fatigue and medications can exacerbate Raynaud's phenomenon.  He 
 
         further testified that he agreed that smoking is a major 
 
         aggravating cause in Raynaud's phenomenon and that in some 
 
         patients smoking itself can cause spasm of the blood vessels.  He 
 
         indicated that it would be conjecture on his part that alleged 
 
         occurrences at work were a possible aggravation to claimants 
 
         condition.  He stated that it was his opinion that events that 
 
         occurred three or four years prior to his testimony would not 
 
         cause Raynaud's phenomenon at the time of his testimony.
 
         
 
                                  APPLICABLE LAW
 
         
 
              The citations of law contained in the arbitration decision 
 
         are appropriate to the issues and evidence.
 
         
 
                                     ANALYSIS
 
         
 
              On appeal claimant concedes that her employment did not 
 
         cause Raynaud's phenomenon but argues that her employment 
 
         aggravated her condition.  Claimant's concession on the cause of 
 
         her condition is well advised because it is the consensus of the 
 
         medical experts in this case that the cause of her condition is 
 
         unknown.
 
         
 
              Claimant must prove that the probable cause of the 
 
         aggravation of her condition is her employment.  Claimant has 
 
         clearly not met her burden of proof.  On page 28 of her brief 
 
         claimant refers to the principle that a cause need not be the 
 
         only cause of a problem to make a condition compensable.  This is 
 
         well recognized.  Where claimant's argument falls short is in her 
 
         proof that employment stress was a cause in the aggravation of 
 
         her condition.  None of the doctors who testified could state 
 
         that the probable aggravating cause was her employment.  Dr. 
 
         Rooney thought that stress could be a cause but he included 
 

 
         
 
         
 
         
 
         McCONNELL V. CITY OF CLIVE
 
         PAGE   4
 
         
 
         
 
         emotional and physical stress as possible precipitating factors.  
 
         There is no evidence that claimant experienced physical stress on 
 
         the job that would aggravate her condition.  If claimant's 
 
         condition were aggravated by stress it may have also been 
 
         emotional or physical stress outside her employment.  Claimant 
 
         admitted to being subject to emotional turmoil outside the work 
 
         place in 1983 and 1984 and her condition was apparently 
 
         aggravated during that time.
 
         
 
              The three doctors who saw and treated claimant for her 
 
         condition all agreed that smoking could be an exacerbating 
 
         factor.  Claimant was a smoker during her employment with the 
 
         defendant employer.  Also, when claimant saw Dr. Rooney in 
 
         January 1986 she had had frequent attacks of her condition., 
 
         These attacks continued more than a year after she was last 
 
         employed by the defendant employer and they occurred during cold 
 
         weather.  The continuation of claimant's attacks after 
 
         termination of her employment indicates that employment factors 
 
         played little, if any, role in her condition.  Thus, it cannot be 
 
         said that claimant's employment was the probable cause of the 
 
         aggravation of her condition.  The other possible causes such as 
 
         smoking and exposure to the cold would be probable causes.  
 
         Especially,since claimant continued to have problems after 
 
         leaving her employment, the greater weight of evidence clearly 
 
         fails to causally connect claimant's later problems to her job 
 
         stress.
 
         
 
              Two other points are worth noting.  First, the symptoms of 
 
         claimant's attacks last only a few hours.  The aggravation of her 
 
         condition, whatever the cause, is only temporary.  Second, there 
 
         is no apparent correlation between the alleged emotional 
 
         stressors on the job and the onset of the aggravation of 
 
         claimant's condition.  It is not clear from the record when the 
 
         stressors on the job occurred and when claimant's condition was 
 
         aggravated.
 
         
 
                                 FINDINGS OF FACT
 
         
 
              1.  From 1977 to September 3, 1984 claimant was employed as 
 
         a secretary and dispatcher for the Clive, Iowa, Police 
 
         Department.
 
         
 
              2.  Claimant is afflicted with a condition known as 
 
         Raynaud's phenomenon.
 
         
 
              3.  Claimant's Raynaud's phenomenon is idiopathic in nature, 
 
         and the reason why she is afflicted with the ailment is unknown.
 
         
 
              4.  During the time claimant was employed by defendant 
 
         employer and after her employment with defendant, she had attacks 
 
         of the type which are characteristic of persons with Raynaud's 
 
         phenomenon.
 
         
 
              5.  Attacks may be precipitated by use of nicotine, stress, 
 
         cold and the other factors.
 
         
 
              6.  Claimant smokes and has also experienced problems in 
 
         cold weather.
 
         
 
              7.  Claimant has had stress in and outside of her employment 
 
         with defendant.
 
         
 
              8.  Claimant's Raynaud's phenomenon was not aggravated, 
 

 
         
 
         
 
         
 
         McCONNELL V. CITY OF CLIVE
 
         PAGE   5
 
         
 
         
 
         accelerated, worsened or lighted up by her employment with 
 
         defendant employer.
 
         
 
                                  CONCLUSION OF
 
         
 
              Claimant has failed to prove by the greater weight of 
 
         evidence that suffered an injury that arose out of and in the 
 
         course of her employment or was caused by the stress of her 
 
         employment.
 
         
 
              WHEREFORE, the decision of the deputy is affirmed.
 
         
 
                                      ORDER
 
         
 
              THEREFORE, it is ordered:
 
         
 
              That claimant take nothing from this proceeding.
 
         
 
              That claimant pay the costs of this proceeding including the 
 
         costs of transcription of the arbitration hearing.
 
         
 
         
 
              Signed and filed this 25th day of August, 1988.
 
         
 
         
 
         
 
         
 
         
 
         
 
                                                 DAVID E. LINQUIST
 
                                                 INDUSTRIAL COMMISSIONER
 
         
 
         
 
         Copies To:
 
         
 
         Mr. Thomas Mann, Jr.
 
         Attorney at Law
 
         4921 Douglas Ave., Suite 4
 
         Des Moines, Iowa 50310
 
         
 
         Mr. Robert E. McKinney
 
         Attorney at Law
 
         480 6th St.
 
         P.O. Box 209
 
         Waukee, Iowa 50263
 
         
 
         Mr. Harry W. Dahl
 
         Attorney at Law
 
         974 73rd St., Suite 16
 
         Des Moines, Iowa 50312