Filed August 25, 1988
                                               DAVID E. LINQUIST
         NANCY L. McCONNELL,
         vs.                                     File No. 773872
         CITY OF CLIVE,                            A P P E A L
              Employer,                          D E C I S I O N
              Insurance Carrier,
         1108.50 - 1402.30
              Claimant was well advised on appeal to abandon her claim 
         that her condition (Raynaud's phenomenon) was caused by the 
         stress of her employment.  The medical evidence indicated that 
         the condition is idiopathic.
         1108.50 - 1402.30 - 2206
              Claimant alleged that employment stress of alleged sex 
         discrimination and sexual harassment exacerbated her condition. 
         medical opinions were that cold and cigarette smoking would also 
         exacerbate her condition.  Furthermore, temporary flareups of 
         claimant's conditions occurred after she left her employment.  
         Claimant did not prove that her employment aggravated her 
         NANCY L. McCONNELL,
                                                 File No. 773872
         CITY OF CLIVE,
                                               A R B I T R A T I 0 N
                                                 D E C I S I 0 N
              Insurance Carrier,
              This is a proceeding in arbitration brought by Nancy 
         McConnell against the City of Clive, Iowa, her former employer, 
         and Argonaut Insurance Companies, the employer's insurance 
         carrier.  Claimant alleges that she sustained a compensable 
         injury in the nature of a weakening of her immune system which 
         has been manifested by Raynaud's phenomenon, leukoplakia, 
         neurasthenia, dyspnea, chest pain, weakness, and painful limbs.  
         McConnell alleges that her ailments are a result of stress in her 
         employment with the City of Clive which arose from being 
         victimized by sex discrimination and sexual harassment 
         perpetrated by the chief and other members of the Clive, Iowa 
         police department.
              The issues presented for determination are whether claimant 
         sustained an injury which arose out of and in the course of her 
         employment; whether the alleged injury is a cause of disability, 
         temporary or permanent; and determination of her entitlement to 
         compensation for temporary or permanent disability.  The parties 
         stipulated that in the event of an award, McConnell's rate of 
         compensation is $177.01 per week.  The parties further stipulated 
         in the prehearing report that medical expenses in the amount of 
         $12,285.96 have been incurred, and that the providers of the care 
         would testify that the fees charged were reasonable. it was 
         stipulated that in the event of an award defendants are entitled 
         to credit in the amount of  $10,536.03 under section 85.38(2) for 
         benefits provided under  a nonoccupational group plan.
              The case was heard in Des Moines, Iowa, on December 9, 1986 
         and was fully submitted upon conclusion of the hearing.  The 
         record in this proceeding consists of testimony from Nancy 
         McConnell, Honorable Allen Danielson, Dennis Diddy, Janice 
         Rodriguez, Janet Hicks, Gary Walker, Jerry Miller, and Gilbert 
         Dean Dymond.  The record also contains joint exhibits 1 through 
         9, claimant's exhibits 10 and 11, and defendants, exhibits A, B, 
         C, Dr E. and I.
                          STATEMENT OF THE CASE
              The following is only a summary of pertinent evidence 
         necessary for deciding the issues in this case.  All evidence 
         received at hearing was considered when making this decision even 
         though it may not be specifically referred to herein.
              McConnell claims that her physical ailments developed or 
         were aggravated by stress in her employment.  She alleges that 
         the stress arose from being victimized by sex discrimination and 
         sexual harassment perpetrated by the chief and other members of 
         the Clive, Iowa, Police Department.  The events and practices of 
         which she testified are adequately summarized in claimant's 
         proposed findings of fact filed January 12, 1987.  They include 
         the following:
                   1.  In 1977, Claimant Nancy McConnell began 
              working for the Police Department, City of Clive, Iowa, 
              as a night-time Dispatcher. (Tr. p. 28).
                   2.  At the time of employment by the Clive Police 
              Department (Clive), Ms. McConnell enjoyed good health. 
              (Tr. p. 76).
                   3.  After she began to work for Clive, Ms. 
              McConnell was subjected to various job related 
              situations which caused her to feel stress.
                   4.  In 1978 Ms. McConnell applied for a patrol 
              person position with Clive, but was forced to withdraw 
              her name from consideration by her Supervisor, Dean 
              Dymond, Clive's Chief of Police. (Tr. pp. 30 ,349).
                   5.  Mr. Dymond admitted that he had felt that 
              women should not be police officers, and Ms. McConnell 
              recalled that he had said that women should be at home 
              having babies - "spreading her legs for some nice guy 
              instead of out there working." (Tr. pp. 32-3, 347-8 ) 
                   6.  As a result of the withdrawal of her name from 
              consideration as a patrol person, Ms. McConnell was 
              promoted to a daytime dispatch position, which included 
              the responsibility of serving as secretary to the Chief 
              of Police.  This was the preferred dispatch position. 
              (Tr. pp. 33-4, 368).
                   7.  Thereafter, and up to the date that she became 
              ill on the job, Ms. McConnell was subjected to a 
              variety of crude and sexist jokes and comments by Mr. 
              Dymond and other employees of Clive, inclusive of the 
                   a).  Mr. Dymond suggested that Ms. McConnell 
                   engage in sexual intercourse with him as had his 
                   previous secretary, whom he married, by asking Ms. 
                   McConnell if she "wouldn't like to have little 
                   Dymonds". (Tr. p. 37-8).
                   b).  Mr. Dymond told Ms. McConnell that the way to 
                   determine whether a woman is pregnant is to see if 
                   her nipples are pink, and asked Ms. McConnell to 
                   check her nipples. (Tr. p. 41).
         Page   3
                   c).  On occasion when Ms. McConnell would wear a 
                   dress that was not banded at the waist, Mr. Dymond 
                   would ask if she was pregnant, and how she had 
                   gotten that way.
                   d).  During the years 1981, '82, and '83, Mr. 
                   Dymond told Ms. McConnell that he would play with 
                   the penis of his young son. (Tr. pp. 40-1, 
                   e).  Mr. Dymond told Ms. McConnell that when he 
                   was intimate with his wife he would pinch her tit 
                   and call her a whore. (Tr. p. 49).
                   f).  In 1982, '83, and '84, Mr. Dymond would tell 
                   Ms. McConnell about the sex life of his young 
                   daughters.  (Tr. pp. 52-3, 377).
                   g).  Mr. Dymond would regularly ask Ms. McConnell 
                   if she had engaged in sexual intercourse the 
                   previous night when she would arrive at work 
                   looking tired. (Tr. pp. 39-40, 54, 311, 1. 8).
                   h).  When Ms. McConnell's dog became pregnant, Mr. 
                   Dymond suggested that her boyfriend had 
                   impregnated her dog. (Tr. pp. 54-5, 270, 373).
                   i).  Mr. Dymond would follow Ms. McConnell to the 
                   bathroom and talk to her through the door while 
                   she used the facility.  Ms. McConnell found this 
                   to be degrading. (Tr. p. 51).
                   j).  When Ms. McConnell wore a dress that was not 
                   banded at the waist, Mr. Dymond asked if she was 
                   pregnant. (Tr. pp. 56-7).
                   k).  Mr. Dymond would occasionally suggest that 
                   Ms. McConnell was a prostitute by asking her how 
                   much money she had made the previous night working 
                   the streets. (Tr. p. 200).
                   8.  Ms. McConnell objected to being subjected to 
              these sexist comments and expressed that opposition to 
              Mr. Dymond, but he took no action to correct the 
              situation.  In fact, Mr. Dymond encouraged his 
              employees to tell jokes, including racists and sexist 
              jokes. (Tr. pp. 43, 341-4).  Mr. Dymond was the highest 
              ranking employee in the department, and Ms. McConnell 
              had no one else to complain to.  (Tr . pp. 43, 221) .
                   9.  During a performance evaluation in 1982 or 
              '83, Mr. Dymond told Ms. McConnell that she would be a 
              more fun person if she would just participate in the 
              joking like other employees. (Tr. pp. 58-9, 31 2, 3 66 
              ) .
                   10.  Ms. McConnell occasionally told jokes, but 
              objected to jokes and comments that contained sexual 
         Page   4
              content as they made her feel uncomfortable, and found 
              some of them to be plain humiliating and degrading. 
              (Tr. p. 79, 1. 15; p. 202).
                   11.  Because of her objection to the sexist 
              treatment that she received, Ms. McConnell was denied a 
              salary increase comparable to other employees of Clive, 
              and was denied the opportunity to participate in 
              training opportunities and the opportunity to represent 
              the police department in collective bargaining 
              activities. (Tr. pp. 59-60, 242, 367-8).
                   12.  Ms. McConnell was subjected to other sexist 
              acts, including physical contact.
                   13.  On one occasion, in 1984, Mr. Dymond hit Ms. 
              McConnell on her buttocks with a ticket book. (Tr. pp. 
              43, 356).
                   14.  On one occasion, in 1983, Officer Dennis 
              Diddy accosted Ms. McConnell in the hallway near Mr. 
              Dymond's office, tore her clothing and simulated a sex 
              act. (Tr. pp. 46, 218, 230).
                   15.  Ms. McConnell did not consent to these acts, 
              and protested to Mr. Dymond, but he took no corrective 
                   16.  On June 20, 1984, Ms. McConnell arrived late 
              for work.  She was observed by the City Manager, Gary 
              Lago, who reported her tardiness to Mr. Dymond.  Mr. 
              Dymond required Ms. McConnell to complete a time slip 
              for this incident. (Tr. pp. 65-6, 323).
                   17.  Ms. McConnell had been both absent and late 
              for work on other occasions, but these were excused 
              absences. (Tr. p. 64).
                   18.  On the same date, Ms. McConnell telephoned 
              the office of the City Manager to inquire about job 
              benefits, and upon learning that the City Manager had 
              taken the afternoon off, jokingly asked his secretary 
              if he had completed a time slip. (Tr. p. 66).
                   19.  Several days later, on June 26, 1986, Mr. 
              Dymond suspended Ms. McConnell for one day for 
              demeaning the City Manager. (Tr. p. 67).
                   20.  A male employee, Gary Walker, had told a 
              crude joke to the City Manager, but he was not 
              suspended for the action. (Tr. pp. 67-8; 266).
                   21.  On one occasion Ms. McConnell advised Mr. 
              Dymond that state investigators had advised her that 
              her name had come up during the investigation of a 
              prostitution ring, but that confidential personnel 
              information was revealed to other employees by Mr. 
              Dymond.  It was subsequently established that Ms. 
         Page   5
              McConnell's telephone number had been obtained by 
              accident. (Tr. pp. 198-9).
                   22.  Ms. McConnell felt that she was being 
              discriminated against on the basis of her sex and that 
              she was being sexually harassed, and Ms. McConnell, a 
              [sic] emotionally guarded and defensive individual 
              (Dep. of Dr. Hines, p. 41, 1. 16), suffered stress from 
              these acts.
                   23.  "Stress" is caused by the perceptions of an 
              individual that their expectations are being violated- 
              that what they expect to happen in a particular 
              situation, any situation irrespective of content, is 
              not happening and that those expectations are violated 
              with such intensity and such chronicity as to exceed 
              the person's capability of coping with to that unusual 
              or unexpected set of circumstances., It's basically a 
              process of a person's coping skills being overwhelmed. 
              (Dep. of Dr. Hines,p.45,1.1;Dep. of Dr. 
                   25.  The sexual harassment and sexual 
              discrimination that Ms. McConnell was subjected to at 
              the Clive Police Department violated her expectations 
              and caused her to suffer stress. (Dep. of Dr. Hines, pp 
              45-47; Testimony of Nancy McConnell).
                   26.  Stress may precipitate or exacerbate 
              Raynaud's disease and heart disease, such as Prolapse 
              Mitral Valve problems. (Dep. of Dr. Hines, p.48, 1. 8; 
              Dep. of Dr. Rooney, p. 10).
                   27.  During the winter of 1983, Ms. McConnell 
              began to suffer physical pains, and her hands and feet 
              would turn blue and purple.
                   28.  Ms. McConnell also began to experience 
              intermittent headaches on a regular basis. (Dep. of Dr. 
                   29.  Ms. McConnell began to suffer from such pain 
              that she began to see a physician in May or 1984, and 
              her illness was diagnosed as Raynaud's disease. (Dep. 
              of Dr. Ghrist, p. 10, 1. 7).
                   30.  Raynaud's disease is caused by an over 
              activity of the autonomic, especially the sympathetic, 
              nervous system. (Dep. of Dr. From, p. 63, 1.8; Dep. of 
              Dr. Rooney, p. 17).
                   31.  Raynaud's disease can be  induced or 
              aggravated by certain stressful events, either 
              emotional or physical (Dep. of Dr. Swieskowski, p. 15, 
              11. 9-19; p. 26, 11. 16-20; pp. 37-38); Dep. of Dr. 
              Rooney, p. 10; Deposition of Dr. Ghrist, p. 41; Dep. of 
              Dr. From, p. 64, 1. 16; Exhibit 1, T3. 126, par. 2).
                   32.  Sexual harassment and sexual discrimination 
         Page   6
              are the kinds of stimuli that may cause the autonomic 
              nervous system to react (Dep. of Dr. From, p. 75, 1. 
              5; p.  77, 11. 14-25), and precipitate or exacerbate 
              Raynaud's disease. (Dep. of Dr. Swieskowski, p. 17, 11. 
                   33.  Ms. McConnell suffered from a severe case of 
              Raynaud's disease.  (Dep. of Dr. Swieskowski, p. 9, 11. 
                   34.  The effects of a severe case of Raynaud's 
              disease is to eliminate the ability of a person to use 
              their hands for practically any purpose. (Dep. of Dr. 
              Swieskowski, P. 10, 11. 5-12).  It may also cause 
              constant fatigue, ulceration of the extremities, and a 
              variety of other debilitating conditions. (Dep. of Dr. 
              Swieskowski, p. 15, 11. 3-8; Dep. of Dr. Rooney, pp. 
                   35.  After receiving the notice of suspension from 
              her job in June of 1984, Ms. McConnell obtained the 
              services of legal counsel and served notice upon the 
              City of Clive that she intended to pursue her legal 
              rights by filing a civil rights complaint. (Tr. pp. 
              196, 197; 389-90).
                   36.  After serving notice of intent to sue, Ms. 
              McConnell was socially isolated in the workplace, and 
              this caused her stress level to increase. (Tr. pp. 335, 
              390, 406, 410).
                   37.  Ms. McConnell began to fear and dread going 
              to work and she had nightmares about it. (Tr. p. 406).
                   38.  Ms. McConnell found the work atmosphere to be 
              so strained that she began to suffer from cyanosis, a 
              condition associated with Raynaud's disease where the 
              hands and feet becomes discolored. (Tr. p. 407-8; Dep. 
              of Dr. Rooney, p. 9).
                   39.  On September 3, 1984, Ms. McConnell appeared 
              at work where she experienced a sudden onset of chest 
              pain, vertigo, nausea, and weakness. (Tr.p.72;Exhibit 
              1, P.75).
                   40.  She was taken to a hospital for emergency 
              treatment where she was told by Dr. Ghrist that she had 
              had an anxiety attack, and that she should go home and 
              relax. (Tr. p. 73).
                   41.  On September 4, 1984, Ms. McConnell still 
              felt sick, and she began treatment with Dr. Brian 
              Taylor, who felt that she had Raynaud's disease, and 
              that she was suffering from "severe mental anguish she 
              has been suffering with regard to the present 
              employment situation."
         Page   7
                   42.  Dr. Taylor and his assistant provided Ms. 
              McConnell counseling for a stress problem growing out 
              of her employment situation. (Tr. p. 194; Exhibit 1, 
              pp. 66-7).
                   43.  Dr. Taylor recommended that Ms. McConnell not 
              return to her "aggravating job site" at that time. 
              (Exhibit 1, p. 105).
                   44.  Thereafter, Ms. McConnell saw and received 
              treatment from a number of physicians, including her 
              personal physician, Dr. David Swieskowski. (Tr. 
                   45.  Dr. Swieskowski confirmed the Raynaud's 
              disease diagnosis, and found Ms. McConnell to be, 
              disabled.  He advised her that she shouldn't work at 
              all because of the risk of sudden death associated with 
              cardiac arrythmia.(Dep.of Dr.Swieskowski, p.33,11.10-14).
                   46.  Dr. Swieskowski also found that Ms. McConnell 
              was and continues to be disabled because of fatigue. 
              (Dep. of Dr. Swieskowski, p. 34).
                   47.  Ms. McConnell's illness was the result of her 
              autonomics nervous system's response to job-related 
              stress. (Dep. of Dr. Swieskowski, p. 38, 11. 15-22; 
              Dep. of Dr. Rooney, pp. 21-2, 25-30, 32-34, 68).
         Page   8
                   48.  Ms. McConnell continues to suffer dizziness, 
              light-headedness, exhaustion and fatigue, swollen hands 
              and feet, cramps, headaches, and chest pains. 
                   49.  Ms. McConnell suffers from such exhausting 
              fatigue that she has to have help with her house 
              work.(Tr. p. 82).
                   50.  Ms. McConnell suffers from a severe case of 
              Raynuad's [sic] disease. (Dep. of Dr. Rooney, pp. 
              10-16; Dep. of Dr. Swieskowski, p. 9, 11. 9-25).
                   51.  Ms. McConnell has not been released to return 
              to work, her prognosis is poor, and she is not likely 
              to get better. (Dep. of Dr. Swieskowski, p.39, 11. 
              6-19; Dep. of Dr. Rooney, pp. 70-1).
                   52.  Dr. Swieskowski finds her to be completely 
              disabled and unable to work (Dep. of Dr. Swieskowski, 
              p. 40, 11. 8-24; Tr. p. 83, 11. 22-24), and Dr. Rooney 
              did not find that she was able to return to her present 
              job. (Dep. of Dr. Rooney, pp. 40, 60-1).
                   53.  Ms. McConnell has not worked since 
              September 3, 1984.
              The principal condition for which evidence was introduced 
         was an ailment known as Raynaud's phenomenon (also referred to as 
         Raynaud's syndrome or Raynaud's disease).  Claimant also 
         complained of extreme fatigue, headache and various other pains, 
         discomfort, and general ill-being.  The primary emphasis of the 
         medical testimony in the record deals with Raynaud's phenomenon.  
         Little emphasis is placed upon claimant's other complaints other 
         than noting that she has the complaints.
              The consensus from the medical practitioners who have dealt 
         with claimant is that she is afflicted by Raynaud's phenomenon.  
         The medical treatise, the Merck Manual, 14th Edition, which was 
         admitted into evidence as deposition exhibit 3 to exhibit 6 
         describes the ailment as follows:
                   Spasm of arterioles, especially in the digits (and 
              occasionally other acra parts such as the nose and 
              tongue), with intermittent pallor orcyanosis of the 
                   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 
         Page   9
              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....
                   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 vasoconstrictor.
              Theodore W. Rooney, D.O., a rheumatologist, a field of 
         medicine into which treatment of Raynaud's phenomenon falls, was 
         in general agreement with the description contained in the Merck 
         Manual and further stated:
              Well, Raynaud's Phenomena is the color changes that 
              would occur in fingers or toes characterized by three 
              phases of pallor, cyanosis, and ruber.  In order to 
              have a definite Raynaud's phenomena, you need to have 
              two of those three phases.
                   It's usually precipitated by exposure to cold but 
              may come on spontaneously or may be precipitated by a 
              variety of other factors.  It is felt that the color 
              changes seen in the fingers are used to make that 
              diagnosis due to spasm of small little arteries within 
              the digits, fingers, or toes.
              Q.  Doctor, you have suggested that in terms of 
         Page  10
              causation exposure to cold may be one of the things 
              that cause Raynaud's Phenomena, and then you suggested 
              that a variety of other things might cause it.
                   What are some of the other things that might cause it?
              A.  Well, besides cold which is the most common 
              precipitating factor, some people have a stress-related 
              component whether it be emotional or physical stress 
              that can precipitate their attacks.  Some people get 
              attacks without any underlying precipitating factors.  
              Certain medications may precipitate attacks, including 
              beta-blocker used to treat blood pressure or headaches, 
              Ergotamine used to treat migraine headaches so certain 
              medications can actually bring about an attack, and 
              then obviously people that smoke or have anything else 
              that is a stress to blood oxygen or whatever can be 
              another so there is many factors that can potentially 
              bring on episodes of this sort. (Ex. 2, pp. 10-11).
              The medical practitioners who have addressed the nature of 
         Raynaud's phenomenon and its causes are in substantial agreement 
         with Dr. Rooney and the Merck Manual. (David E. Swieskowski, 
         M.D., exhibit 3A, pages 20, 21, 43, 44, and 48; Paul From, M.D., 
         exhibit 5, pages 30 through 36, 62 through 64; John H. Ghrist, 
         M.D., exhibit 6, pages 20, 21, 25, 26, 38-48.)
              Recognized sources of aggravation of Raynaud's phenomenon 
         known to produce the attacks which characterize it are cold, 
         nicotine, stress, or emotional disturbance and certain 
         medications.  Attacks are also known to occur without any 
         identifiable precipitating factor. (Exhibit 2, pages 11, 25, 26, 
         41, 42, 68; exhibit 3A, pages 15-21; exhibit 34, pages 15-21, 37, 
         48; exhibit 6, pages 20, 21, and 26.) Dr. Rooney and Dr. 
         Swieskowski have indicated that stress is an aggravating factor 
         in McConnell's case. (Exhibit 2, pages 34 and 68; exhibit 3A, 
         pages 15-19.) Their opinions are accepted as correct.
              As indicated by Dr. From, some medical authorities have 
         suggested that stress may possibly cause the onset of Raynaud's 
         phenomenon, but the existence of any such cause and effect 
         relationship is only a theory and is not generally recognized in 
         the medical community. (Exhibit 5, pages 63-64 and 101.) The 
         greater weight of the evidence is that Raynaud's phenomenon is 
         either etiopathic (no known cause) or is caused by some other 
         underlying disease process.  When the condition results from an 
         underlying disease process, it is often progressive.  McConnell's 
         condition does not appear to have progressed during the past two 
         years.  It is possible that some as yet unidentified underlying 
         disease process exists, but any such disease has not been clearly 
         manifested. (Exhibit 2, pages 25, 42, 49, 67; exhibit 3A, pages 
         7, 11-13, 24, 31, 32, 43-45, 47 and 52; exhibit 5, page 89.)
              Raynaud's phenomenon is manifested by attacks of vasospasm 
         where the skin discolors.  The attacks are transient or temporary 
         and in most cases, including the McConnell's, do not result in 
         death or damage to the affected tissues.  The evidence has not 
         provided any indication that the source of the attack has any 
         bearing on the effect or the severity of the attack. (Exhibit 2, 
         Page  11
         pages 44, 51, 71, and 72; exhibit 3A, pages 8, 42, and 49; 
         exhibit 5, pages 81, 82, and 86; exhibit 6, pages 20, 21, 25, 26, 
         and deposition exhibit 3.)
              Claimant's testimony relates an ongoing course of working in 
         a setting filled with unwanted and offensive discussions and 
         comments of a sexual nature.  She also testified concerning 
         denial of an opportunity to apply for a regular police officer 
         position in 1978, being accosted and subjected to a simulated sex 
         act at the police department in 1983, being hit on the buttocks 
         with a ticket book in 1984, being denied salary increases 
         comparable to that received by other employees, being denied the 
         opportunity to participate in training opportunities, and being 
         denied the opportunity to represent the dispatchers in collective 
         bargaining activities.  Claimant fixed the onset of her Raynaud's 
         phenomenon symptoms as occurring in 1983.  Her suspension and 
         civil rights complaint were in June 1984.  She thereafter 
         apparently continued to work even though she was symptomatic 
         until September 3, 1984 when she had an attack or spell while at 
         work and was taken by ambulance to the hospital.  Dr. Ghrist, who 
         treated her for the Raynaud's phenomenon prior to the attack and 
         who also treated her for the attack, opined that the attack was 
         most likely pleuritic chest pain associated with an upper 
         respiratory infection.  He recognized the possibility that the 
         attack may have been a stress-induced attack of some type. 
         (Exhibit 6, pages 18, 56, and 57.) No definite diagnosis for the 
         cause or type of the attack has been made by any other medical 
         practitioner.  Dr. From acknowledged the possibility that the 
         September 3, 1984 attack could have resulted from something 
         connected with claimant's work as did Dr. Rooney. (Exhibit 2, 
         page 26; exhibit 5, pages 51 and 52.) Dr. Ghrist testified that 
         things that happened in 1984 would neither cause nor exacerbate 
         symptoms of the phenomenon at the present time. (Exhibit 6, pages 
         20-21.) Dr. From's statements are in substantial agreement with 
         those from Dr. Ghrist. (Exhibit 5, page 52.) Dr. Swieskowski 
         agreed that events from 1984 or earlier would not aggravate 
         claimant's condition at the present time. (Exhibit 3A, page 42.) 
         Dr. Rooney agreed that in claimant's case the exacerbation of 
         claimant's condition due to stress would be transient unless the 
         stimuli continued. (Exhibit 2, pages 51 and 69.)
              There is evidence in the record of a mitral valve prolapse, 
         which evidence arises from Stuart Winston, M.D. He indicated that 
         claimant's complaints of chest tightness could possibly be caused 
         by anxiety. (Exhibit 1, page 7.) A further extensive cardiac 
         workup performed under the direction of William S. Wheeler, M.D., 
         a cardiologist, showed no evidence of mitral valve prolapse. 
         (Exhibit 1, page 142.) Dr. Wheeler further indicated that 
         claimant's Raynaud's phenomenon was not related to going to work, 
         and that the supposed cardiac arrests which claimant had suffered 
         were not caused by her work.  He indicated that the records from 
         the paramedics did not confirm claimant's statements regarding 
         cardiac arrest.  He felt that claimant's Raynaud's phenomenon 
         would not prevent her from working. (Exhibit 1, page 142.) Brian 
         T. Taylor, M.D., received a history from claimant which indicated 
         that on two occasions she was pulseless and needed to be 
         resuscitated. (Exhibit 1, page 26.)  In September 1984, he 
         indicated that claimant had a physiologic dysfunction which was 
         apparently related to severe mental anguish resulting from her 
         Page  12
         employment.  He indicated that the history involved an attempted 
         rape by claimant's employer which was aborted by a fellow 
         employee. (Exhibit 1, pages 105 and 115.) He felt that she was 
         totally disabled. (Exhibit 1, page 104.)
              Dr. Rooney felt that claimant was not disabled from 
         performing some types of gainful employment but that she should 
         avoid exposure to cold temperatures. (Exhibit 2, pages 34-36.) 
         Dr. Ghrist felt that claimant was not totally disabled. (Exhibit 
         1, page 128.) Dr. From found claimant to have no cardiac 
         abnormalities and felt that she was capable of being employed. 
         (Exhibit 1, page 36; exhibit 5, pages 48, 51, 52, and 85.) Dr. 
         Swieskowski felt that claimant is currently completely disabled 
         because she fatigues easily. (Exhibit 3A, page 40.)
                           APPLICABLE LAW AND ANALYSIS
              It is assumed, without deciding, that the events of sexual 
         harassment and sex discrimination of which claimant complained 
         are true.  In a workers' compensation case, the burden of proof 
         that an injury which arose out of and in the course of employment 
         occurred rests upon the claimant.  McDowell v. Town of 
         Clarksville, 241 N.W.2d 904 (Iowa 1976).
              The injury must both arise out of and be in the course of 
         the employment.  Crowe v. DeSoto Consol.  Sch.  Dist., 246 Iowa 
         402, 68 N.W.2d 63 (1955) and cases cited at pp. 405-406 of the 
         Page  13
         Iowa Report.  See also Sister Mary Benedict v. St. Mary's Corp., 
         255 Iowa 847, 124 N.W.2d 548 (1963) and Hansen v. State of Iowa, 
         249 Iowa 1147, 91 N.W.2d 555 (1958).
              The words "out of" refer to the cause or source of the 
         injury.  Crowe, 246 Iowa 402, 68 N.W.2d 63.
              The claimant has the burden of proving by a preponderance of 
         the evidence that the injury of September 3, 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. 0. Boggs, 236 Iowa 296, 18 N.W.2d 607 (1945).  A 
         possibility is i sufficient; a probability is necessary. Burt v. 
         John Deere Waterloo Tractor Works, 247 Iowa 691, 73 N.W.2d 732 
         (1955).  The question of causal connection is essentially within 
         the domain of expert testimony.  Bradshaw v. Iowa Methodist. 
         Hospital, 251 Iowa 375, 101 N.W.2d 167 (1960).
              However, expert medical evidence must be considered with all 
         other evidence introduced bearing on the causal connection.  
         Burt, 247 Iowa 691, 73 N.W.2d 732.  The opinion of experts need 
         not be couched in definite, positive or unequivocal language.  
         Sondag v.Ferris Hardware, 220 N.W.2d 903 (Iowa 1974).  However, 
         the expert opinion may be accepted or rejected, in whole or in 
         part, by the trier of fact.  Id. at 907.  Further, the weight to 
         be given to such an opinion is for the finder of fact, and that 
         may be affected by the completeness of the premise given the 
         expert and other surrounding circumstances.  Bodish, 257 Iowa 
         516, 133 N.W.2d 867. See also Musselman v. Central Telephone Co., 
         261 Iowa 352, 154 N.W.2d 128 (1967).
              Our supreme court has stated many times that a claimant may 
         recover for a work connected aggravation of a preexisting 
         condition.  Almquist v. Shenandoah Nurseries, 218 Iowa 724, 254 
         N.W. 35 (1934).  See also Auxier v. Woodward State Hosp.  Sch., 
         266 N.W.2d 139 (Iowa 1978); Gosek v. Garmer and Stiles Co., 158 
         N.W.2d 731 (Iowa 1968); Barz v. Oler, 257 Iowa 508, 133 N.W.2d 
         704 (1965 ); 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 v. United States Gypsum Co., 
         252 Iowa 613, 106 N.W.2d 591 (1960).
              When an aggravation occurs in the performance of an 
         employer's work and a causal connection is established, claimant 
         may recover to the extent of the impairment.  Ziegler, 252 Iowa 
         613, 620, 106 N.W.2d 591, 595 (1960).
              The Iowa Supreme Court cites, apparently with approval, the 
         C.J.S. statement that the aggravation should be material if it is 
         to be compensable.  Yeager, 253 Iowa 369, 112 N.W.2d 299; 100 
         C.J.S. Workmen's Compensation 555(17)a.
              The pivotal issue in this case is proximate cause.  A cause 
         is proximate if it is a substantial factor in bringing about the 
         results; it need not be the only cause.  Blacksmith v. 
         All-American, Inc., 290 N.W.2d 348, 354 (Iowa 1980).  Expert 
         testimony that a condition could possibly be related to a 
         claimant's employment, although insufficient alone to support a 
         finding of causal connection, could be coupled with nonexpert 
         Page  14
         testimony to show causation and be sufficient to s sustain an 
         award.  Giere v. Aase Haugen Homes, Inc., 259 Iowa 1065, 146 
         N.W.2d 911, 915 (1966).  Such evidence does not, however, compel 
         an award as a matter of law.  Anderson v. Oscar Mayer & Co., 217 
         N.w.2d 531, 536 (Iowa 1974).
              The Merck Manual indicates that Raynaud's phenomenon may be 
         idiopathic or secondary to some other underlying disease.  The 
         idiopathic form is indicated to be most common in young women.  
         No underlying disease has been identified in claimant.  The 
         greater weight of the evidence is that McConnell's affliction 
         with Raynaud's phenomenon is idiopathic.  Even if the condition 
         were due to some underlying disease, there is no evidence in the 
         record which shows claimant to have contracted any such disease 
         as a result of her employment.  The theory that stress may induce 
         (rather than merely aggravate) the Raynaud's phenomenon is only a 
         theory and, under the current state of the medical knowledge as 
         reflected in the record, does not carry with it the probability 
         (as opposed to mere possibility) necessary to support an award.  
         Injuries arising out of risks or conditions personal to the 
         claimant do not arise out of the employment unless the employment 
         contributes to the risk or aggravates the injury.  1 Larson 
         Workmen's Compensation Law, section 12.00.
              The crucial issue in this case is, therefore, what caused 
         Nancy McConnell to be afflicted with Raynaud's phenomenon.  That 
         question is unanswerable.  The condition is generally considered 
         to be idiopathic and the greater weight of the evidence in this 
         case is consistent with the generally accepted view.  As a young 
         woman, claimant is in the group most commonly afflicted by the 
         condition, her history of smoking is a definite known aggravator 
         of the condition.  Claimant had stress from many sources.  It is 
         not necessary for the employer to prove that the condition is not 
         work related, to the contrary, the burden rests on the claimant to 
         prove that it is probable (more likely than not) that the 
         condition is work related.  The evidence in this case fails to 
         establish that it is more likely than not that something in 
         claimant's work at the Clive Police Department was a substantial 
         factor in causing her to become afflicted with Raynaud's 
              It is important to distinguish between a person being 
         afflicted by Raynaud's phenomenon and the occurrence of the 
         attacks which characterize the phenomenon.  The greater weight of 
         the evidence from the physicians in this case is that the attacks 
         are transitory and generally cause no permanent harm to the 
         individual.  Factors which produce the onset of the attacks have 
         been medically identified and are generally recognized.  Claimant 
         appears to fit the normal recognized pattern in this regard.  A 
         person afflicted with Raynaud's phenomenon, she reacts to stress, 
         cold, and nicotine.  She has been away from the employment 
         setting since 1984, but her condition has not shown any 
         substantial change since that time.  Claimant has been a 
         relatively heavy smoker throughout most of the time material to 
         this case.  That alone could be the most substantial aggravation 
         of her condition.  It would explain the lack of apparent 
         improvement since claimant's employment ended.  If claimant's 
         complaints of sexual harassment and sex discrimination are true, 
         it is certainly likely that those events, and any other events 
         which emotionally disturbed her, would have also induced attacks.  
         Page  15
         The record fails to include evidence, however, that the onset of 
         attacks Produced disability from performing the normal duties of 
         her employment.  The greater weight of the evidence fails to show 
         that she was ever physically unable to perform the duties of her 
         employment due to vasosoasm attacks.
              Claimant was evaluated by Todd Hines, Ph.D., who found her to 
         have no abnormal psychological condition.(Exhibit1,pages 22 and 
                               FINDINGS OF FACT
              On September 3, 1984, Nancy McConnell was employee as a 
         secretary and dispatcher for the Clive, Iowa, Police Department.
              Nancy McConnell is afflicted with a condition known as 
         Raynaud's phenomenon.
              Raynaud's phenomenon is a condition which the greater weight 
         of medical authority characterizes as being either idiopathic, 
         with no definite known cause, or as secondary to some other 
         underlying disease.  The idioioathic form is most common in young 
         women.  Claimant has not been diagnosed as having any underlying 
         disease which would produce her Raynaud's phenomenon.
              The evidence in this case indicates that claimant's 
         Raynaud's phenomenon is idiopathic in nature, and the reason why 
         she is afflicted with the ailment is unknown.
              The evidence in this case fails to show that it is more 
         likely than not that anything connected with claimant's 
         employment was a substantial factor in producing the Raynaud's 
         phenomenon with which she is afflicted, or any of her other 
         symptoms even if it is assumed that her complaints of stress 
         resulting from sexual harassment and sex discrimination are 
              During the time claimant was employed by the Clive, Iowa, 
         Police Department she had attacks of the type which are 
         characteristic of persons with Raynaud's phenomenon.  The attacks 
         were precipitated by her use of nicotine, stress and the other 
         factors known to produce the attacks.  The evidence fails to show 
         that the attacks which occurred made claimant unable to perform 
         the duties of her employment at any time.  The evidence further 
         fails to show that suffering the attacks in any way produced any 
         change, acceleration or lighting up of the Raynaud's phenomenon 
         beyond the time that the attack continued.
              The evidence fails to show that it is probable, as opposed 
         to merely possible, that claimant's current physical condition is 
         in any way a result of anything that occurred during her term of 
         employment with the Clive, Iowa, Police Department.
              No findings are made with regard to whether or not the 
         incidents of sexual harassment or sex discrimination of which 
         claimant complains actually occurred.
         Page  16
              The evidence fails to show that anything connected with 
         claimant's employment was a substantial factor in producing the 
         attack which claimant sustained while at work on September 3, 
         1984, or the similar attack which she suffered later during the 
         month of September 1984.
              The evidence fails to establish that claimant's employment 
         was a substantial factor in bringing about any cardiac condition 
         with which she is afflicted.
              The evidence fails to establish, by a preponderance of the 
         evidence, that claimant is afflicted by a mitral valve prolapse 
         or any other abnormal cardiac condition.
              The evidence fails to establish that claimant is afflicted 
         by any abnormal psychological condition or disability.
              The evidence fails to establish that anything connected with 
         claimant's employment was a substantial factor in bringing about 
         any psychological condition with which claimant may be 
                                CONCLUSIONS OF LAW
              Claimant has failed to prove by a preponderance of the 
         evidence that her affliction with Raynaud's phenomenon was 
         proximately caused by sex discrimination, sexual harassment, or 
         any other occurrences connected with her employment with the City 
         of Clive, Iowa.
              Claimant has failed to prove by a preponderance of the 
         evidence that the Raynaud's phenomenon with which she is 
         afflicted is the result of an injury which arose out of and in 
         the course of her employment with the Clive, Iowa,'Police 
              Claimant has failed to prove by a preponderance of the 
         evidence that she suffered any disability that was proximately 
         caused in any manner by her employment with the Clive, Iowa, 
         Police Department.
              Claimant has failed to establish, by a preponderance of the 
         evidence, that she is entitled to receive any benefits available 
         under chapters 85 or 85A of the Code of Iowa.
              IT IS THEREFORE ORDERED that claimant take nothing from this 
         proceeding and her petition is dismissed on the merits with 
              IT IS FURTHER ORDERED that costs are assessed against 
         Page  17
              Signed and filed this 1st day of June, 1987.
                                          MICHAEL G. TRIER
                                          DEPUTY INDUSTRIAL COMMISSIONER
         Copies To:
         Mr. Thomas Mann, Jr.
         Attorney at Law
         4921 Douglas Ave., Suite 4
         Des Moines, Iowa 50310
         Mr. Harry Dahl
         Attorney at Law
         974 73rd St., Suite 16
         Des Moines, Iowa 50312
                                                 1108.50; 1402.10;
                                                 1402.20; 1402.30;
                                                 2206; 2209
                                                 Filed 6-1-87
                                                 Michael G. Trier
         NANCY L. McCONNELL,
                                                 File No. 773872
         CITY OF CLIVE,
                                               A R B I T R A T I 0 N
                                                 D E C I S I 0 N
              Insurance Carrier,
         1108.50; 1402.10; 1402.20; 1402.30; 2206; 2209
              Claimant, who is afflicted with Raynaud's phenomenon, 
         alleged that her condition was either induced or aggravated by 
         practices of sex discrimination and sexual harassment that 
         occurred in her employment with the Clive Police Department.  The 
         medical evidence indicated that Raynaud's phenomenon is an 
         idiopathic condition and that stress is not a recognized cause of 
         the condition.   The medical evidence further indicated that 
         stress is known to precipitate attacks of vasospasm in 
         individuals who are afflicted with Raynaud's phenomenon, but that 
         such attacks are transitory and produce no permanent or lasting 
         effects.   No specific findings were made with regards as to 
         whether or not claimant's complaints of sex discrimination and 
         sexual harassment were true. (It was assumed, arguendo, that they 
         were true for purposes of deciding the case.) It was nevertheless 
         found that there was a lack of causal connection between the 
         alleged stress and claimant's condition.