BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         STEVE LONG,
 
         
 
              Claimant,
 
                                                     File No. 791609
 
         vs.
 
                                                  A R B I T R A T I O N
 
         NATIONAL BY-PRODUCTS,
 
                                                     D E C I S I O N
 
              Employer,
 
                                                        F I L E D
 
         and
 
                                                       MAY 26 1989
 
         
 
         LIBERTY MUTUAL INSURANCE CO.,        IOWA INDUSTRIAL 
 
         COMMISSIONER
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
                                INTRODUCTION
 
         
 
              This is an arbitration proceeding brought by Steve Long, 
 
         claimant, against National By-Products, employer, and Liberty 
 
         Mutual Insurance Co., insurance carrier, defendants.  The case 
 
         was heard on November 16, 1988, in the Industrial Commissioner's 
 
         office in Des Moines, Iowa.
 
         
 
              The record consists of the testimony of claimant.  The 
 
         record additionally consists of the testimony of Charles Wayne 
 
         Wilson, Greg Allen Rice and Opal Long, all witnesses for 
 
         claimant.  For defendants' case, there is the testimony of Lewis 
 
         Vierling, and the testimony of Michael Raymond.  Also the record 
 
         is comprised of joint exhibits A1-80 and defendants' exhibit C 
 
         for rebuttal purposes.
 
         
 
              Prior to the hearing the claimant offered exhibits B1 and 
 
         B2. Defendants objected that the medical reports were not timely 
 
         served.  The undersigned finds that exhibits B1 and B2 are not 
 
         admissible.  The basis for that decision is that claimant 
 
         neglected to comply with paragraph 6 of the hearing assignment 
 
         order which was filed on September 28, 1988.  Specifically the 
 
         provision provides:
 
         
 
              6.  Witness and Exhibit Lists.  A list of all witnesses to 
 
              be called at the hearing and a list of all proposed exhibits 
 
              to be offered into the evidence at the hearing along with 
 
              copies of all written exhibits not previously served shall 
 
              be served upon opposing parties no later than fifteen (15) 
 
              days prior to the date of hearing.  Only those witnesses 
 
              listed will be permitted to testify at the hearing unless 
 
              their testimony is clearly rebuttal or sur-rebuttal.  
 
                                                
 
                                                         
 
                   Medical records, practitioners reports and all other written 
 
              evidence shall not be admitted as exhibits at the hearing 
 
              unless they have been timely served upon an opposing party 
 
              as ordered herein. The service of witness lists pursuant to 
 
              this Order does not modify the requirements of Iowa Rule of 
 
              Civil Procedure 125(c) to supplement responses to discovery 
 
              as to experts not less than thirty (30) days prior to 
 
              hearing.
 
         
 
              Claimant neglected to serve exhibits B1 and B2 pursuant to 
 
         paragraph 6, these exhibits are not part of the record.
 
         
 
                                   ISSUES
 
         
 
              As a result of the prehearing report and order submitted and 
 
         approved on November 16, 1988, the issues presented by the 
 
         parties are:
 
         
 
              1.  Whether there is a causal relationship between the 
 
         alleged injury and the disability;
 
         
 
              2.  Whether claimant is entitled to temporary 
 
         disability/healing period benefits or permanent partial or total 
 
         disability benefits;
 
         
 
              3.  Whether claimant is entitled to medical benefits under 
 
         section 85.27;
 
         
 
              4.  Whether claimant is entitled to benefits under section 
 
         86.13.
 
         
 
                              STIPULATIONS
 
         
 
              Prior to the hearing, the parties entered into a number of 
 
         stipulations.  These 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 April 1, 1985, 
 
         which arose out of and in the course of employment with 
 
         employer;
 
         
 
              3.  That the time off work for which claimant now seeks 
 
         either temporary total disability or healing period benefits is 
 
         stipulated to be from April 2, 1985;
 
         
 
              4.  The type of permanent disability, if the injury is found 
 
         to be a cause of permanent disability, is stipulated to be an 
 
         industrial disability to the body as a whole;
 
         
 
              5.  In the event of an award of weekly benefits, the rate of 
 
         weekly compensation is stipulated to be $188.94 per week; and,
 
         
 
              6.  Claimant's entitlement to medical benefits under Iowa 
 
                                                
 
                                                         
 
         Code section 85.27 have been or will be paid by defendants.
 
         
 
                           FACTS PRESENTED
 
         
 
              Claimant is a high school graduate.  At the time of the 
 
         hearing he was 30 years old.  He commenced his employment with 
 
         defendant on January 12, 1979.  Claimant was hired as a truck 
 
         driver who was assigned the task of picking up barrels of animal 
 
         waste and hides from meat lockers.  The barrels were plastic and 
 
         held up to 250 pounds.  On April 1, 1985, claimant attempted to 
 
         lift a barrel weighing approximately 150 pounds at the Bedford 
 
         Locker.  Claimant testified he felt a sharp pain in his lower 
 
         back and he fell to his knees.  Claimant stated he felt the pain 
 
         in his right leg.  Claimant had to terminate his regular route 
 
         because of the pain.  He never returned to work at defendant's 
 
         establishment after that date.
 
         
 
              Claimant testified at his hearing that he had been to a 
 
         chiropractor prior to April 1, 1985.  According to claimant, he 
 
         had injured his back at work, but he had not reported the injury 
 
         to anyone at work.
 
         
 
              Claimant's medical records indicate he was hospitalized at 
 
         Rosary Hospital in Corning, Iowa from April 1, 1985 to April 9, 
 
         1985, where conservative treatment was ordered by Ted P. George, 
 
         D.O.  Claimant was then referred to an orthopedic surgeon, 
 
         William R. Boulden, M.D., for examination on April 26, 1985.  Dr. 
 
         Boulden, in his report of May 14, 1985, opined:
 
         
 
              Follow up of low back pain with left leg pain.  The CAT scan 
 
              done in Des Moines, Metrizamide type, showed the patient to 
 
              have some abnormalities especially the L3-4 disc on the left 
 
              side.  The right side shows the consistency of a conjoined 
 
              nerve tendon, so I do not think this is anything to be 
 
              concerned about.  However, there is also some spinal 
 
              stenosis noted at L4-5 level.
 
         
 
              Therefore, with these multiple abnormalities at 2-3 
 
              different disc levels, I think it is imperative that we find 
 
              out the exact source or his pain, to make sure we give him 
 
              the right options for treatment.  Therefore, I have 
 
              recommended discograms to be done with the possibility of 
 
              following up with CAT scans after the discograms.  He is 
 
              agreeable to this, since he still continues to have a 
 
              significant amount of left leg sciatica.
 
         
 
              Therefore, we will re-evaluate him after his discograms and 
 
              CAT scan.
 
         
 
              Claimant requested a second opinion.  He was then seen by 
 
         Robert A. Hayne, M.D., a neurological surgeon.  He diagnosed 
 
         claimant as having a "myofascial strain of the low back region."
 
         
 
              In a report dated October 7, 1985, Dr. Hayne opined:
 
         
 
                                                
 
                                                         
 
              I last wrote you July 9, 1985, regarding Steven Long.  He 
 
              was seen by me for examination on August 19, 1985.  At that 
 
              time, he had not returned to work.  He was still having pain 
 
              in the low back region and in the back of the left lower 
 
              extremity.
 
         
 
              Neurological examination was essentially within normal 
 
              limits.
 
         
 
              His next appointment with me in the office is on October 21, 
 
              1985.  It was recommended to him in August that he would be 
 
              able to return to some type of employment.  In view of his 
 
              persistent low back pain, he probably should obtain a job 
 
              that does not require him to lift weights over 40 pounds.
 
         
 
              I feel that he has reached the end of his period of maximum 
 
              medical improvement.  I will assess him for a permanent 
 
              impairment at the time of his October 21 appointment.
 
         
 
              Dr. Hayne referred claimant to the neurology outpatient 
 
         clinic at the University of Iowa.  R. W. Fincham, M.D., and Steve 
 
         Geisler, M.D., determined in their report of February 11, 1986:
 
         
 
              Our impression and diagnosis was 1) Low back pain.
 
         
 
                           
 
                                                         
 
              Our recommendations were 1) we concur with the previous 
 
              decision not to pursue any surgical exploration presently 
 
              and to avoid heavy lifting as recommended by you.
 
         
 
                  ....
 
         
 
              In conclusion we concur with the previous decision not to 
 
              pursue any surgical exploration presently and to avoid any 
 
              heavy lifting as recommended by you.  He should return to 
 
              our clinic on a PRN basis.
 
         
 
              As of March 14, 1986, Dr. Hayne determined the following:
 
         
 
              I have not seen Steven Long for examination since he has 
 
              been evaluated at Iowa City.  I feel at this time that his 
 
              permanent disability is approximately 9% of body total.  I 
 
              base this on his CT and myelographic findings.
 
         
 
              Claimant also sought the opinion of Thomas B. Summers, M.D.
 
         In his report of May 14, 1986, Dr. Summers wrote:
 
         
 
              I have had an opportunity to personally review the 
 
              radiographic films obtained at the time of the examinations 
 
              on June 19, 1985.  In my opinion, the findings are 
 
              essentially normal.  Certainly, there is no definite 
 
              evidence of a herniated intervertebral disc.syndrome or 
 
              other abnormality.
 
         
 
              CLINICAL IMPRESSION:  Psychophysiologic reaction, 
 
              musculoskeletal type.
 
         
 
              COURSE AND PROGNOSIS:  In my opinion, the functional element 
 
              here is sizeable in degree and contributing to the 
 
              symptomatology in whole or in large part.  Quite frankly, 
 
              this young man is capable of regular and gainful employment 
 
              and without restrictions, if he can be so motivated, 
 
              however, therein lies the problem.
 
         
 
              Claimant then returned to Dr. Boulden.  Dr. Boulden, in his 
 
         report of September 17, 1986, opined:
 
         
 
              As it sounds by your letter and what I have been told by the 
 
              patient, there still seems to be some contradictions in what 
 
              is really happening.  To set the record straight, I feel 
 
              that the patient's best treatment and course of action is a 
 
              fusion based on the fact that most of his pain is in the 
 
              back. Therefore, with what we have found, I feel that a 
 
              fusion technique would be in his best interest.
 
         
 
              If however, most of his pain and symptomatology was in the 
 
              legs, then obviously a more conservative approach of 
 
              discectomy may be in order.  However, this does not seem to 
 
              hold true in this gentleman's case, at least that is what he 
 
              tells me.
 
         
 
                                                
 
                                                         
 
              Dr. Boulden also determined in a follow-up report, dated 
 
         October 1, 1986:
 
         
 
              As you know, I have recommended a fusion procedure to treat 
 
              Steven Long's problem.
 
         
 
              His problem is basically one of back pain and not so much of 
 
              leg pain.  Therefore, I feel any surgery that just attacks 
 
              the disc without fusion, in my opinion, will probably 
 
              continue to leave the patient with chronic back complaints.  
 
              I feel that in his best interest that the only logical choice 
 
              is a fusion after inspection of the disc.
 
         
 
              Dr. Hayne later concurred with the opinion of Dr. Boulden.  
 
         In the letter of January 26, 1987, Dr. Hayne wrote:
 
         
 
              I am enclosing a copy of the MRI report on Steve Long.  As 
 
              you will note, this does show a disc bulge in the lateral 
 
              foramen on the left side at the L-4, 5 level and there is 
 
              minimal displacement of the exiting L-4 nerve root seen.  In 
 
              addition, a disc herniation in the midline at the L-5, S-1 
 
              level and slightly to the left is present and there appears 
 
              to be mild displacement of the neural elements at that level 
 
              also.
 
         
 
              My recommendations at this time depend upon his pain.  Since 
 
              he has had considerable pain, I feel at this time that 
 
              surgery is probably indicated.  My recommendation at this 
 
              time would be a laminectomy with removal of disc material 
 
              that is herniated at the 4th and 5th lumbar segments.  In 
 
              view of this being his first operative procedure that I 
 
              would not recommend a fusion at this time.  I feel that with 
 
              a discectomy and possible alteration of his work that a 
 
              fusion could be avoided.  In any event, whatever the 
 
              decision is, I do not feel that he will be capable of 
 
              returning to heavy labor and should have restrictions in the 
 
              amount of lifting that he is required to do.
 
         
 
              In February of 1987, Dr. Hayne modified his earlier opinion. 
 
         He wrote on February 27, 1987:
 
         
 
              I would recommend at this time that Mr. Long continue on 
 
              nonsurgical measures.  In my experience, surgically treating 
 
              patients with the clinical course and the findings that we 
 
              have on the CAT scan and myelography on Mr. Long, is 
 
              generally disappointing.  I would recommend that he be seen 
 
              in the Low-Back Clinic in Iowa City.  He appears to be 
 
              indefinitely incapacitated from such work as he had at the 
 
              National By-Products Company.  Hopefully if he can gain some 
 
              type of work where his lifting would be limited to around 
 
              30-40 pounds, and even this, not of a repetitive nature, he 
 
              would be able to be gainfully employed.
 
         
 
              Eventually, claimant had a posterolateral fusion, L4-S1 with 
 
         Knodt's rodding and discectomies L4-5, L5-S1.  Subsequent to the 
 
                                                
 
                                                         
 
         surgery, Dr. Boulden wrote in his notes for October 15, 1987:
 
         
 
              Follow up of posterolateral fusion L4-S1 with Knodt's 
 
              rodding and discectomies L4-5, L5-S1.  The tomograms in my 
 
              interpretation show the fusion to be intact very well on the 
 
              right side with a little question on the left side.  However 
 
              because he has a unilateral fusion I feel we can end his 
 
              healing period.
 
         
 
              At this point in time I feel the patient needs job 
 
              vocational rehabilitation.  I have counselled him that he 
 
              should not do a job that involves prolonged sitting or do 
 
              any bending, twisting, or lifting activities with his back.  
 
              I feel that by doing this he should be able to be a 
 
              productive individual once again.  I have left his 
 
              appointment open, but I will be happy to evaluate any jobs 
 
              for him.
 
         
 
              At this point in time I feel he has a 15% impairment of the 
 
              spine based on the fact of fusion.
 
         
 
              Claimant testified he last saw Dr. Boulden on February 24, 
 
         1988.  It was also the last occasion where claimant had seen any 
 
         physician.
 
         
 
              At his hearing, claimant testified he had performed odd jobs 
 
         at the rate of $3.50 to $5.00 per hour since leaving the employ 
 
         of defendant.  Claimant reported he worked at his own pace.  He 
 
         performed such tasks as gardening, mowing, cleaning swimming 
 
         pools, driving a tractor and doing farm chores.  Claimant also 
 
         testified concerning the jobs for which he had applied since 
 
         working at defendant's establishment.
 
         
 
              Charles Wayne Wilson testified on behalf of claimant.  Mr. 
 
         Wilson stated he had hired claimant since the fall of 1987 to 
 
         perform various farm chores on the Wilson farms.  Mr. Wilson 
 
         testified he paid claimant $3.50 per hour and claimant performed 
 
         light jobs.
 
         
 
              Greg Allen Rice also testified on behalf of claimant.  Mr. 
 
         Rice testified that he is engaged in farming.  He indicated he 
 
         had first hired claimant to assist with planting in the spring of 
 
         1988.  Mr. Rice advised the undersigned that claimant only did 
 
         lighter type jobs, and because of that fact, claimant was 
 
         terminated.
 
         
 
              Ms. Opal Long testified she is claimant's mother.  She 
 
         stated that prior to April 1, 1985, claimant had had no serious 
 
         back problems.  She also reported she had observed her son since 
 
         the date of the work injury, and in her opinion, her son was only 
 
         able to perform part-time light duty work.
 
         
 
              Lewis Vierling testified on behalf of defendants.  He 
 
         reported he was engaged as a vocational rehabilitation 
 
         consultant. He indicated he was assigned this particular case.  
 
                                                
 
                                                         
 
         According to Mr. Vierling, the first step which he did was to 
 
         contact claimant's attorney, William Garretson, for an 
 
         appointment.  The initial contact was made in August of 1988.  
 
         However, according to the witness, Mr. Garretson was unable to 
 
         keep the appointment. Consequently, a second appointment was set 
 
         for August 19, 1988. Mr. Vierling indicated he met with Mr. 
 
         Garretson and goals for vocational rehabilitation were discussed. 
 
          Mr. Garretson informed Mr. Vierling he only wanted claimant to 
 
         meet with Mr. Vierling when Mr. Garretson was present.  Mr. 
 
         Vierling stated an initial evaluation of claimant was made.  
 
         However, not much else was done for claimant because Mr. Vierling 
 
         believed there was no "open door" to claimant.  Normally, the 
 
         witness testified he would not continue to meet with a claimant 
 
         in the presence of his attorney after an initial evaluation.  
 
         Rather, Mr. Vierling stated he would meet alone with a claimant 
 
         and provide monthly reports to a claimant's attorney.  In the 
 
         opinion of the witness, claimant's attorney was attempting to 
 
         frustrate the goals of vocational rehabilitation because the 
 
         attorney was requiring all consultations to be done in the 
 
         attorney's presence.  Mr. Vierling testified there was only 
 
         limited cooperation and only minimal progress.
 
                                        
 
                                  APPLICABLE LAW
 
         
 
              An employee is entitled to compensation for any and all 
 
         personal injuries which arise out of and in the course of the 
 
         employment.  Section 85.3(l).
 
         
 
              The claimant has the burden of proving by a preponderance of 
 
         the evidence that the injury of April 1, 1985 is causally related 
 
         to the disability on which he now bases his claim.  Bodish v. 
 
         Fischer, Inc., 257 Iowa 516, 133 N.W.2d 867 (1965).  Lindahl v. 
 
         L.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).
 
         
 
              While a claimant is not entitled to compensation for the 
 
         results of a preexisting injury or disease, the mere existence at 
 
         the time of a subsequent injury is not a defense.  Rose v. John 
 
         Deere Ottumwa Works, 247 Iowa 900, 908, 76 N.W.2nd 756, (1956).  
 
         If the claimant had a preexisting condition or disability that is 
 
         aggravated, accelerated, worsened or lighted up so that it results 
 
         in disability, claimant is entitled to recover.  Nicks v Davenport 
 
         Produce Co., 254 Iowa 130, 115 N.W.2d 812, (1962).
 
         
 
              When an aggravation occurs in the performance of an 
 
         employer's work and a causal connection is established, claimant 
 
         may recover to the extent of the impairment.  Ziegler v. United 
 
         States Gypsum Co., 252 Iowa 613, 620, 106 N.W.2d 591, (1960).
 
         
 
              The Iowa Supreme Court cites, apparently with approval, the 
 
         C.J.S. statement that the aggravation should be material if it is 
 
         to be compensable.  Yeager v. Firestone Tire & Rubber Co., 253 
 
         Iowa 369, 112 N.W.2d 299 (1961); 100 C.J.S. Workmen's 
 
         Compensation section 555(17)a.
 
         
 
              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 Hospital 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, 253 Iowa 369, 112 N.W.2d 299 (1961); 
 
         Ziegler, 252 Iowa 613, 106 N.W.2d 591 (1960).
 
         
 
              An injury is the producing cause; the disability, however, 
 
         is the result, and it is the result which is compensated.  Barton 
 
         v. Nevada Poultry Co., 253 Iowa 285, 110 N.W.2d 660 (1961); 
 
         Dailey v. Pooley Lumber Co., 233 Iowa 758, 10 N.W.2d 569 
 
         (1943).
 
         
 
              If a claimant contends he has industrial disability he has 
 
         the burden of proving his injury results in an ailment extending 
 
         beyond the scheduled loss.  Kellogg v. Shute and Lewis Coal Co. 
 
         256 Iowa 1257, 130 N.W.2d 667 (1964).
 
         
 
              Functional impairment is an.element to be considered in 
 
         determining industrial disability which is the reduction of 
 
         earning capacity, but consideration must also be given to the 
 
         injured employee's age, education, qualifications, experience and 
 
         inability to engage in employment for which he is fitted.  Olson, 
 
         255 Iowa 1112, 125 N.W.2d 251 (1963).  Barton, 253 Iowa 285, 110 
 
         N.W.2d 660 (1961).
 
         
 
              A finding of impairment to the body as a whole found by a 
 
         medical evaluator does not equate to industrial disability.  This 
 
         is so as impairment and disability are not synonymous.  Degree of 
 
         industrial disability can in fact be much different than the 
 
         degree of impairment because in the first instance reference is 
 
         to loss of earning capacity and in the latter to anatomical or 
 
         functional abnormality or loss.  Although loss of function is to 
 
         be considered and disability can rarely be found without it, it 
 
         is not so that a degree of industrial disability is 
 
         proportionally related to a degree of impairment of bodily 
 
         function.
 
         
 
              Factors to be considered in determining industrial 
 
         disability include the employee's medical condition prior to the 
 
         injury, immediately after the injury, and presently; the situs of 
 
         the injury, its severity and the length of healing period; the 
 
         work experience of the employee prior to the injury, after the 
 
         injury and potential for rehabilitation; the employee's 
 
         qualifications intellectually, emotionally and physically; 
 
         earnings prior and subsequent to the injury; age; education; 
 
         motivation; functional impairment as a result of the injury; and 
 
         inability because of the injury to engage in employment for which 
 
         the employee is fitted. Loss of earnings caused by a job transfer 
 
         for reasons related to the injury is also relevant.  These are 
 
         matters which the finder of fact considers collectively in 
 
         arriving at the determination of the degree of industrial 
 
         disability.
 
         
 
              There are no weighting guidelines that indicate how each of 
 
                                                
 
                                                         
 
         the factors are to be considered.  There are no guidelines which 
 
         give, for example, age a weighted value of ten percent of the 
 
         total value, education a value of fifteen percent of total, 
 
         motivation - five percent; work experience - thirty percent, etc. 
 
         Neither does a rating of functional impairment directly correlate 
 
         to a degree of industrial disability to the body as a whole.  In 
 
         other words, there are no formulae which can be applied and then 
 
         added up to determine the degree of industrial disability.  It 
 
         therefore becomes necessary for the deputy or commissioner to 
 
         draw upon prior experience, general and specialized knowledge to 
 
         make the finding with regard to degree of industrial disability.  
 
         See Peterson v. Truck Haven Cafe, Inc., (Appeal Decision, 
 
         February 28, 1985); Christensen .v. Hagen, Inc., (Appeal 
 
         Decision, March 26, 1985).
 
         
 
              For example, a defendant employer's refusal to give any sort 
 
         of work to a claimant after he suffers his affliction may justify 
 
         an award of disability.  McSpadden v. Big Ben Coal Co., 288 
 
         N.W.2d 181 (Iowa 1980).
 
         
 
              Similarly, a claimant's inability to find other suitable 
 
         work after making bona fide efforts to find such work may 
 
         indicate that relief would be granted.  McSpadden, 288 N.W.2d 181 
 
         (Iowa 1980)
 
         
 
              "Claimant is not entitled to reimbursement for medical bills 
 
         unless he shows that he paid them from his own funds."  See 
 
         Caylor v. Employers Mut. Cas. Co., 337 N.W.2d 890 (Iowa App. 
 
         1983).
 
         
 
                                 ANALYSIS
 
         
 
              Claimant has established by a preponderance of the evidence 
 
         that his injury on April 1, 1985 is causally related to the 
 
         disability on which he now basis his claim.  Immediately after 
 
         the incident occurred at the Bedford Locker, claimant was taken 
 
         for medical attention.  There is medical evidence to substantiate 
 
         the necessary causal connection.
 
         
 
              The notes of Ted P. George, D.O., for April 1, 1985, 
 
         indicate there is a causal connection between the barrel incident 
 
         and claimant's claimed disability.  Dr. George writes:
 
         
 
              04-01-85 Lifted barrell [sic] of 125# this a.m. around 
 
              11:30. Is approx. 2:00 to 2:30 p.m.  Is having pain at the 
 
              area of the left hip and into the lumbar spine, it radiates 
 
              down into his leg.  He complains of numbness in both hands 
 
              as well as some back discomfort.  Complains of occasional 
 
              numbness in the feet.  Says he has had back problems a 
 
              couple months ago but it cleared on it's own after using 
 
              heat and ASA.  He has otherwise had no significant medical 
 
              history.
 
         
 
              Straight leg raising test in the left leg was only 45 degrees 
 
              before his left hip and lower lumbar pain was elicited.  
 
                                                
 
                                                         
 
                   Right leg was up to 60 degrees.  Dorsiflextion [sic] of the 
 
              foot elicited no significant difference in the pain.  
 
              Continued to be lo- [sic] left hip pain.  Extreme muscle 
 
              spasm was present and he was unable to sit in any comfortable 
 
              position.  Best position was lying supine with his knees 
 
              bent.  Had a good sensation to pin prick over the entire 
 
              lower extremities with lateral and medial hand grips were 
 
              excellent.  Deep tendon reflexes were +2-3/4 and equal in all 
 
              areas.  Herniated lumbar disc
 
         
 
              TX:  It was felt due to extreme pain he should have 
 
              immediate hospitalization for complete bed rest and 
 
              avaluation [sic]. He may need to see an orthopedic 
 
              specialist if the problem does not resolve with the bed rest 
 
              alone.  TPG/mcc
 
         
 
              Dr. Boulden,,after his initial examination of claimant, 
 
         wrote in his report of April 26, 1985:
 
         
 
              This is a 26 year old who approximately the first part of 
 
              April, was lifting a barrel in a flexed position that 
 
              weighed approximately 150 pounds.  He immediately had severe 
 
              pain and his left leg went numb.  Since that period of time, 
 
              he has been treated with physical therapy, medications, and 
 
              has not really responded at all.  He continues to have pain 
 
              in his left lower back, pain down his left leg at times, and 
 
              numbness in his left leg.  He has been seen by Dr. George in 
 
              Corning for this problem.
 
         
 
              Physical examination shows the patient to have good left and 
 
              right lateral bending, but causes pain with right lateral 
 
              bending.  Extension causes some discomfort.  Forward 
 
              flexion, he has a list to the left, and pain in the left 
 
     
 
                                 
 
                                                         
 
              buttock.  He has negative straight leg raising on the right.  
 
              Positive on the left.  Achilles tendon and knee tendon 
 
              reflexes are equal and symmetrical.  Great toe weakness is 
 
              noted on the left side.  Lumbar spine films shows 
 
              straightening.  Also disc space narrowing L4-5, L5-S1.
 
         
 
              Impression:  Rule out herniated disc, L4-5, left.
 
         
 
              Dr. Boulden corroborates the opinion of Dr. George.  The 
 
         requisite causal connection has been proven.
 
         
 
              The next issue to address is the issue of healing period 
 
         benefits.  The claimant was in the healing period from April 1, 
 
         1985 to October 7, 1985.  Dr. Hayne determined that as of October 
 
         7, 1985, claimant had reached "maximum medical improvement."
 
         
 
              Claimant was also in the healing period from April 22, 1987 
 
         to October 15, 1987.  The period of time reflects the period 
 
         during which claimant had the posterolateral fusion L4-S1 with 
 
         Knodt's rodding and discectomies at L4-5, L5-S1.  Dr. Boulden 
 
         determined that as of October 15, 1987, the healing period could 
 
         end.  According to Dr. Boulden, "he [claimant] should be able to 
 
         be a productive individual once again."
 
         
 
              The next issue to discuss is the issue of permanency.  Dr. 
 
         Hayne, prior to claimant's surgery, determined claimant was 9 
 
         percent functionally impaired.  Dr. Hayne did not provide any 
 
         other functional impairment rating subsequent to claimant's 
 
         surgery.
 
         
 
              Dr. Boulden, as of October 15, 1987, the day he determined 
 
         ended the healing period, evaluated claimant as having a 15 
 
         percent functional impairment.  Dr. Boulden also stated that 
 
         claimant should not work in a position where there is "prolonged 
 
         sitting, bending, twisting or lifting activities; with his 
 
         back."
 
         
 
              Claimant maintains he has an industrial disability.  
 
         Claimant alleges he has a loss of earning capacity because of his 
 
         work injury.  In support of his allegations, claimant maintains 
 
         he has only been able to perform light duty type jobs on a 
 
         part-time basis.  Claimant reports he has sought employment at 
 
         the following business establishment's:  Purina of Corning, 
 
         UARCO, Wirecraft Systems, Iowa Outdoor, Bunn O'Matic of Creston, 
 
         and at a sporting goods store.  Claimant has been refused 
 
         employment at the establishments, although the reasons cited for 
 
         nonemployment are unclear.  It is not evident claimant has been 
 
         refused employment because of his back condition.  In at least 
 
         two instances, claimant did not know why he was refused 
 
         employment.  Claimant was offered a position as a feed salesman 
 
         with Mormon Feed.  However, claimant testified he never met with 
 
         a representative of the company because claimant believed he 
 
         would.not be able to perform any deliveries.
 
         
 
              Claimant reports he was offered no vocational rehabilitation 
 
                                                
 
                                                         
 
         from Management Consulting and Rehabilitation Services, Inc.  An 
 
         initial assessment was completed by Ms. Barbara Chaldy on 
 
         September 30, 1985.  Very little was accomplished after that 
 
         date. The case was transferred to another consultant, Lewis 
 
         Vierling. Mr. Vierling testified his efforts were frustrated by 
 
         claimant's attorney, and there was only limited cooperation.
 
         
 
              It is the determination of the undersigned that neither the 
 
         claimant and his attorney, nor the employer in conjunction with 
 
         Management Consulting and Rehabilitation Services, Inc., engaged 
 
         in full-hearted cooperative efforts for vocational 
 
         rehabilitation. From the facts presented at the hearing, it 
 
         appears little more than lip service was given by either side to 
 
         vocational rehabilitation.
 
         
 
              As far as claimant's educational background and experience 
 
         are concerned, claimant has a high school diploma.  Claimant has 
 
         also had a one year course in auto mechanics at Southwest 
 
         Community College, and a six month course in auto body skills. 
 
         While claimant has successfully completed the one year course in 
 
         auto mechanics, claimant has not worked in that field.
 
         
 
              Other than claimant's employment with National By-Products, 
 
         claimant has engaged in "handyman" type activities.  He has also 
 
         worked as a farmhand for both Mr. Wilson and for Mr. Rice. 
 
         However, there is evidence to indicate claimant is unable to 
 
         perform all types of agricultural duties.
 
         
 
              Claimant has been able to continue with his leisure 
 
         activities despite his back injury.  Claimant can still hunt, 
 
         fish and trap.  He is able to continue with the sport of archery. 
 
         Claimant engages in ice fishing.  There is no evidence the 
 
         extreme cold aggravates his condition.  Claimant raises hunting 
 
         dogs.  He is able to train them and claimant can walk several 
 
         miles with the dogs in order to exercise them.  Claimant's back 
 
         condition is not affected by these activities.
 
         
 
              Claimant does not appear terribly motivated to find work 
 
         other than casual labor or part-time seasonal farm,work.  It does 
 
         not appear to the undersigned that claimant has made a real 
 
         effort to seek full time gainful employment.  Claimant has 
 
         indicated on more than one occasion, he is unwilling to seek 
 
         employment outside of a 30 mile radius from his home.
 
         
 
              In light of the foregoing, and in light of:  1) the personal 
 
         observation of claimant; 2) agency expertise, (Iowa 
 
         Administrative Procedures Act 17A.14(s); and, 3) claimant's 
 
         testimony, the undersigned finds claimant has a 20 percent 
 
         industrial disability as a result of his injury on April 1, 
 
         1985.
 
         
 
              Since defendants have stipulated all medical bills under 
 
         section 85.27 have been or would be paid, the only issue to 
 
         address is whether claimant is entitled to benefits under section 
 
         86.13.  In the prehearing report, the parties write at item 
 
                                                
 
                                                         
 
         number 11 the following:
 
         
 
                   Claimant's claim for 86.13 which has been bifurcated 
 
              from these proceedings:
 
         
 
                   (X)  Remains asserted.
 
         
 
              The parties stipulated to item 11 in error.  According to 
 
         the hearing assignment order which was filed by Deputy Industrial 
 
         Commissioner Helenjean Walleser on September 28, 1988, section 
 
         86.13 was listed as a hearing issue under paragraph three.  There 
 
         was no mention of the fact on the hearing assignment order that 
 
         the issue was bifurcated.  Since the prehearing deputy did not 
 
         designate 86.13 as a bifurcated issue, section 86.13 remained an 
 
         issue to be proven at the hearing held on November 16, 1988.
 
         
 
              Section 86.13 of the Iowa Code provides in relevant 
 
              portion:
 
         
 
              If a delay in commencement or termination of benefits occurs 
 
              without reasonable or probable cause or excuse, the 
 
              industrial commissioner shall award benefits in addition to 
 
              those benefits payable under this chapter, or chapter 85, 
 
              85A, or 85B, up to fifty percent of the amount of benefits 
 
              that were unreasonably delayed or denied.
 
         
 
              Under section 86.13 benefits are not awarded for medical 
 
         expenses.  The section 86.13 benefits are only applicable to 
 
         weekly compensation benefits.  Zahn v. Iowa State Men's 
 
         Reformatory, IV Iowa Industrial Commissioner Report 409 (1983).
 
         
 
              If it is alleged that an employer wrongfully withholds 
 
         weekly compensation benefits from a claimant, the claimant must 
 
         establish the benefits were withheld unreasonably in order for 
 
         the claimant to receive additional benefits under section 86.13.  
 
         Curtis v. Swift Independent Packing, IV Iowa Industrial 
 
         Commissioner Report 88 at 93 (1983).  In a previous decision 
 
         before the Division of Industrial Services, a hearing deputy has 
 
         ruled that it was reasonable for an employer to withhold benefits 
 
         when the employer was not alerted to occurrences which would 
 
         notify a reasonable person that benefits would be due or when 
 
         there was no work time lost.  McCormack v. Sunsprout, I-1 Iowa 
 
         Industrial Commissioner Decisions 142 at 144 (1984).
 
         
 
              In a separate decision before the Division of Industrial 
 
         Services, the same deputy industrial commissioner awarded 
 
         benefits under section 86.13.  Here there was an unreasonable 
 
         delay since there were no contradictions in the claimant's claim.  
 
         Willis v. Ruan Transport Corporation, IV Iowa Industrial 
 
         Commissioner Report 395 at 396 (1984).  In the Willis case at 396 
 
         the deputy wrote:
 
         
 
              ...Reports and letters from the doctor are consistent with 
 
              claimant's statements regarding his injury.
 
         
 
                                                
 
                                                         
 
              There were no ambiguities and inconsistencies in claimant's 
 
              claim.  Withholding benefits was arbitrary and unreasonable. 
 
              The five percent award based on Iowa Code section 86.13 will 
 
              be attached to healing period only.  Although the evidence 
 
              presented clearly relates claimant's permanent impairment to 
 
              his injury, defendants will be given the benefit of the 
 
              doubt as to whether or not a failure to pay permanent 
 
              disability also was unreasonable.  Claimant had prior back 
 
              troubles and conceivably some portion of his impairment 
 
              might have been related to those difficulties or to a 
 
              preexisting arthritis rather than to his injury.
 
         
 
              Here, claimant has not met his burden of proving that 
 
         defendants unreasonably withheld his weekly compensation benefits 
 
         or that without probable cause, the defendants withheld the 
 
         benefits.  At the November hearing, claimant presented testimony 
 
         that he received benefits from April of 1985 to February 28, 
 
         1988. There was no evidence presented that defendant acted 
 
         unreasonably in any manner.  Claimant cannot prove he is entitled 
 
         to benefits under section 86.13.
 
         
 
                    FINDINGS OF FACT AND CONCLUSIONS OF LAW
 
         
 
              WHEREFORE, based upon the evidence presented and the 
 
         principles of law previously stated, the following findings of 
 
         fact and conclusions of law are made:
 
         
 
              FINDING 1.  Claimant sustained a back injury arising out of 
 
         and in the course of his employment on April 1, 1985.
 
         
 
              FINDING 2.  As a result of the injury on April 1, 1985, 
 
         claimant has an attributable functional impairment of 9 to 15 
 
         percent of the body as a whole.
 
 
 
                    
 
                                                         
 
              FINDING 3. Claimant was in the healing period from April 1, 
 
         1985 to October 7, 1985 and from April 22, 1987 to October 15, 
 
         1987.
 
         
 
              CONCLUSION A.  Claimant has met his burden of proving he has 
 
         a 20 percent permanent partial disability as a result of his 
 
         injury on April 1, 1985.
 
         
 
                                    ORDER
 
         
 
              THEREFORE, defendants are to pay unto claimant one hundred 
 
         (100) weeks of permanent partial disability benefits at the 
 
         stipulated rate of one hundred eighty-eight and 94/100 dollars 
 
         ($188.94) per week as a result of the injury on April 1, 1985.
 
         
 
              Defendants are to pay unto claimant fifty-one and six 
 
         sevenths weeks (51 6/7) of healing period benefits at the 
 
         stipulated rate of one hundred eighty-eight and 94/100 dollars 
 
         ($188.94) per week as a result of the injury on April 1, 1985.
 
         
 
              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 claimant.
 
         
 
              Costs of the action is assessed against the defendants 
 
         pursuant to Division of Industrial Services Rule 343-4.33.
 
         
 
              Defendants shall file a claim activity report upon payment 
 
         of this award.
 
         
 
              Signed and filed this 26th day of May, 1989.
 
         
 
         
 
         
 
         
 
         
 
         
 
                                       MICHELLE A. McGOVERN
 
                                       DEPUTY INDUSTRIAL COMMISSIONER
 
         
 
         Copies To:
 
         
 
         Mr. William W. Garretson
 
         Attorney at Law
 
         1200 35th St.
 
         Suite 206
 
         West Des Moines, Iowa  50265
 
         
 
         Mr. W. C. Hoffmann
 
         Attorney at Law
 
         500 Liberty Bldg.
 
                                                
 
                                                         
 
         Des Moines, Iowa  50309
 
         
 
         
 
         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                
 
 
            
 
 
 
                                
 
 
 
 
 
                                            51803; 54000.2
 
                                            Filed May 26, 1989
 
                                            MICHELLE A. McGOVERN
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         STEVE LONG,
 
         
 
              Claimant,
 
                                                    File No. 791609
 
         vs.
 
                                                 A R B I T R A T I O N
 
         NATIONAL BY-PRODUCTS,
 
                                                    D E C I S I O N
 
              Employer,
 
         
 
         and
 
         
 
         LIBERTY MUTUAL INSURANCE CO.,
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
         51803
 
         
 
              Claimant sustained a back injury on April 1, 1985, which 
 
         resulted in a 20 percent permanent partial disability.  Claimant 
 
         was not motivated to seek additional employment.
 
         
 
         54000.2
 
         
 
              Additional benefits under section 86.13 were not awarded to 
 
         claimant.
 
         
 
         
 
         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                
 
 
         
 
 
 
 
 
 
 
 
 
 
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         PAMELA HETHERINGTON,
 
         
 
              Claimant,
 
                                                 File No. 791716
 
         vs.
 
         
 
         MERCY HOSPITAL MEDICAL CENTER,        A R B I T R A T I 0 N
 
         
 
              Employer,                           D E C I S I 0 N
 
         
 
         and
 
                                                     F I L E D
 
         AETNA CASUALTY & SURETY
 
         COMPANY,                                   MAR 31 1989
 
         
 
              Insurance Carrier,          IOWA INDUSTRIAL COMMISSIONER
 
              Defendants.
 
              
 
              
 
                              STATEMENT OF THE CASE
 
         
 
              This is a proceeding in arbitration brought by Pamela 
 
         Hetherington, claimant, against Mercy Hospital Medical Center, 
 
         employer, and Aetna Casualty & Surety Company, insurance carrier, 
 
         to recover benefits under the Iowa Workers' Compensation Act as a 
 
         result of an alleged injury of April 1, 1985.  This matter came 
 
         on for hearing before the undersigned deputy industrial 
 
         commissioner May 24, 1988.  The record was considered fully 
 
         submitted at the close of the hearing.  The record in this case 
 
         consists of the testimony of claimant and Nancy DeVore, and joint 
 
         exhibits 1 through 8, inclusive.
 
         
 
                                      ISSUE
 
         
 
              Pursuant to the prehearing report and order submitted and 
 
         approved May 24, 1988, the following issues are presented for 
 
         resolution:
 
         
 
              1.  Whether claimant sustained an injury on April 1, 1985 
 
         which arose out of and in the course of her employment;
 
         
 
              2.  Whether the alleged injury is the cause of the 
 
         disability on which claimant bases her claim; and
 
         
 
              3.  The nature and extent of claimant's permanent partial 
 
         disability entitlement, if any.
 
         
 
                                 FACTS PRESENTED
 
         
 
              Claimant testified that on April 11 1985, while walking 
 
         from the employer's parking lot towards the hospital to work, 
 
         she slipped and fell on an icy spot landing on her right side. 
 
         Claimant stated she was "embarrassed" by the incident and went 
 
         directly to the floor on which she was working without 
 
         mentioning the fall to anyone.  Claimant recalled that later 
 
         that day, while taking care of a patient, her arm jerked and 
 
         she poked herself with a needle.  Claimant testified she then 
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         filled out an incident report, went to the emergency room where 
 
         splints were placed on her arm up to her elbow and that she was 
 
         told to go home.  Claimant offered she did not return to work 
 
         until August 1985 and that when she did return her symptoms of 
 
         pain in her arm, shoulder and hand were "essentially the same" 
 
         as when she left work.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              Claimant recalled that in August 1985 she was assigned a 
 
         light duty clerk position in the medical records department at a 
 
         rate of pay of $4.77 per hour.  Claimant stated she also received 
 
         temporary partial disability benefits while doing this job but 
 
         that she could not continue with this work because the repetitive 
 
         motion of "flipping paper" irritated her shoulder and arm. 
 
         Claimant testified she then went to the personnel department 
 
         where she answered phones, filed and did mailings and that this 
 
         job ended in May 1986 when a filing cabinet "tipped" on her 
 
         causing a "flare-up" of her symptoms.  Claimant stated she was 
 
         off work again from May 1986 until November 1986 during which 
 
         time she went to physical therapy, did exercises and used a TENS 
 
         unit.  Claimant described herself as "emotionally upset by all 
 
         this" and is "frustrated" because she cannot do her regular 
 
         nursing job and was not "getting any answers from the doctors."
 
         
 
              Claimant testified that when she did return to work in 
 
         November 1986 her symptoms ran from her shoulder down to her 
 
         hand, that currently her right upper extremity is weak, she loses 
 
         her grip, drops things, has "tremors" and seems "to have lost 
 
         total control" over the extremity.  Claimant recalled she 
 
         initially returned to a position in personnel paying $5.03 per 
 
         hour and that in January 1987 she was transferred to the 
 
         purchasing office where she answered phones and typed.  Claimant 
 
         found this work to bother her shoulder, arm and hand.  Claimant 
 
         testified that in the fall of 1987 her pay was changed to be 
 
         equal to that of a licensed practical nurse, her regular job, and 
 
         that, at the same time, she received a back pay award making up 
 
         the difference between the regular pay of a licensed practical 
 
         nurse and that which she had been receiving.  Claimant stated 
 
         that in April 1988 she was transferred to the patient accounts 
 
         area where she acts as a "collections agent," a job which she 
 
         does not enjoy and which she feels is not light duty or within 
 
         her restrictions.
 
         
 
              Claimant denied having any complaints concerning her right 
 
         side prior to April 1985 although she acknowledged she had had a 
 
         number of back strains and accidents both work and non-work 
 
         related.  Claimant stated she "did not know" about any future 
 
         employment because she "did not think [she] could do an adequate 
 
         nursing job" as she cannot lift and could cause a patient harm if 
 
         her hand "acted up" while providing care.  Claimant explained her 
 
         licensed practical nurse certification is currently inactive but 
 
         that she can get it back if she meets continuing education 
 
         requirements.  Claimant expressed her understanding that she is 
 
         still under medical restrictions, as she was when she was on the 
 
         employer's light duty program and that when she was removed from 
 
         the light duty program she did not see any doctor who lifted the 
 
         restrictions.
 
         
 
              Nancy DeVore, who identified herself as the workers' 
 
         compensation coordinator who is responsible for the overall 
 
         administration of the workers' compensation program including the 
 
         light duty program at Mercy Hospital, testified that the goal of 
 
         the employer is to allow employees who are injured to return to 
 
         work regardless of their restrictions.  Ms. DeVore explained that 
 
         the light duty program is for temporary placement only in that 
 
         the employer has no permanent light duty positions.  Ms. DeVore 
 
         agreed with claimant's testimony with regard to the number of 
 
         light duty jobs claimant has held since her return to work and 
 
         explained that changes were made because assignments are 
 
         short-term or claimant complained of an inability to do the job.  
 
         Ms. DeVore opined that claimant's nursing background could be 
 
         important to the correct performance of the job in patient 
 
         accounts although not necessarily so and acknowledged there are 
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         other areas in patient accounts which might better utilize an LPN 
 
         background.  On cross-examination, Ms. DeVore stated that the 
 
         light duty program is new, that claimant is one of the first 
 
         employees to be placed on the program, that she did not believe 
 
         claimant is able to perform the responsibilities of an LPN 
 
         "today" and that claimant's current wage is $.60 per hour greater 
 
         than the top scale for the position she currently holds.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              Medical records reveal claimant has been seen and/or treated 
 
         by a number of physicians.  Albert L. Clemens, M.D., surgeon, 
 
         examined claimant June 3, 1985, rendered a diagnosis of reflex 
 
         dystrophy, noted claimant had "obvious discoloration and coldness 
 
         in the right index thumb and long finger" and stated that 
 
         claimant's cervical spine x-ray, EMG and Doppler tests were 
 
         basically normal.  Dr. Clemens recommended claimant consider 
 
         Stellate ganglion block but claimant chose not to have anything 
 
         done and Dr. Clemens acknowledged he had nothing more to offer 
 
         claimant in the way of treatment.
 
         
 
              Claimant was then treated by Robert C. Jones, M.D., 
 
         neurosurgeon, who provided her with a series of five Stellate 
 
         blocks and indicated that a Dr. Simon was going to try 
 
         guanethidine synthetic block.
 
         
 
              In August 1985, claimant came under the care of William R. 
 
         Boulden, M.D., who concurred with Dr. Clemens' diagnosis of 
 
         reflex sympathetic dystrophy and recommended claimant be 
 
         "channeled right back to" Dr. Clemens for appropriate therapy.  
 
         Dr. Boulden stated on August 22,1985:  "I would also recommend to 
 
         get her working because she is becoming very frustrated and I 
 
         feel that she could do most light activities in nursing anytime, 
 
         and the only thing that would be restricted would be heavy use of 
 
         the arm."  (Joint Exhibit 1, page 1)  Dr. Boulden continued to 
 
         see claimant for shoulder pain and prescribed physical therapy, 
 
         of exercising and range of motion although on March 10, 1986 he 
 
         noted claimant had "really no pain" in the shoulder joint itself 
 
         or in the AC joint with full range of motion.  Claimant was 
 
         judged as doing "status quo" until June 1986 when the file 
 
         cabinet fell over and claimant caught it.  Dr. Boulden noted at 
 
         that time that claimant was having increasing problems with her 
 
         arm and shoulder.  Dr. Boulden referred claimant to the 
 
         University of Iowa Hospitals and Clinics in July 1986 where 
 
         claimant saw Dr. Blair who stated his impression as:
 
         
 
              Chronic pain syndrome.  On the basis of the history, 
 
              physical examination and special tests available to me, I 
 
              can identify no specific pathology.
 
         
 
              Plan:  I discussed in general terms with the patient that 
 
              she has a chronic pain syndrome.  I advised her that I would 
 
              recommend no specific treatment.  I strongly encouraged her 
 
              to begin the adjustment process accepting that a specific 
 
              diagnosis and treatment may not be available, that she may 
 
              have an element of pain with which she will have to live in 
 
              the future and to which she may need to make adjustments.  I 
 
              also strongly encouraged her to return to some sort of 
 
              employment as soon as possible.  I openly volunteered to 
 
              work with any employer including Mercy Hospital to define a 
 
              set of restrictions that would allow her to make a 
 
              transition back into a full-time, unrestricted state of 
 
              employment.  The patient in general, was not accepting of 
 
              and had many questions concerning these recommendation.
 

 
              
 
 
 
 
 
 
 
 
 
 
 
         
 
         (Jt. Ex. 1, p. 173)
 
         
 
              On October 16, 1986, Dr. Boulden advised he would end 
 
         claimant's healing period since "the diagnosis is totally unknown 
 
         and there is no neurological loss of strength and/loss of motion. 
 
         Dr. Boulden advised he "would not" rate claimant with any 
 
         permanent impairment, there being no objective findings and, with 
 
         reference to restrictions on employability, stated:  "I would 
 
         work within the guidelines that Mr. Bower has so described, and 
 
         as long as she uses proper biomechanics of the back, I think she 
 
         will be able to handle most duties within these capabilities."  
 
         (Jt. Ex. 1, p. 9)
 
         
 
              Claimant underwent a functional capacity evaluation March 
 
         11, 1987 which found:
 
         
 
              Pain scale:  The patient reports a starting level of pain of 
 
              2 on a scale from 0 to 10.  This did not substantially 
 
              increase during the exam process.
 
         
 
              Stress index:  The patient was able to perform a kyphotic 
 
              pull of 48 foot pounds, and a lordotic pull of 54 foot 
 
              pounds.  This yields a stress index of .89.  This is within 
 
              the accepted range of normal.
 
         
 
              Maximum effort tests:  The patient demonstrated a maximum 
 
              floor to waist lift of 37 pounds, knuckle to shoulder lift 
 
              of 35 pounds, shoulder to overhead lift of 35 pounds, carry 
 
              of 32 pounds, push of 25 pounds, and pull of 25 pounds.  
 
              This places her in the lowest percentile category when 
 
              comparing to healthy, industrial females.  The patient has 
 
              no difficulty ascending or descending stairs, squatting, 
 
              bending, or sitting or standing.
 
         
 
              Endurance projections:  Based on the low maximum effort, we 
 
              were unable to adequately project endurance projections one 
 
              time every five minutes or one time ever minute.
 
         
 
              Evaluator's observations:  Correlation of pain appeared to 
 
              be reasonably close to what she was describing.  There was a 
 
              flare up of the dramatic during the examination process when 
 
              she had to stop several times and lift, and then proceed on 
 
              with the activity.  Overall, sufficient and good body 
 
              mechanics was utilized during the testing procedure.  The 
 
              patient did not appear to fatigue easily.  Endurance 
 
              projections do not appear reliable simply because we were 
 
              unable to project those based on the low maximum efforts.  
 
              We do feel the overall test results to be valid.
 
         
 
              Recommendations:  Based on the patient's function on today's 
 
              exam, the patient would be placed in a light/medium category 
 
              of work setting based on her function at this time.  One way 
 
              to deal with this particular patient would be to place her 
 
              in a possible work hardening setting.  I am unsure of 
 
              exactly the specific goals that we would have in mind at 
 
              this time. Her strength certainly overall is decreased and 
 
              her flexibility is decreased in addition.  We would suggest 
 
              work hardening as a possibility at this time.
 

 
              
 
 
 
 
 
 
 
 
 
 
 
         
 
         (Jt. Ex. 1, p. 167)
 
         
 
              Thomas W. Bower, L.P.T., recommended claimant be placed on 
 
         an overall program developing strength and endurance for upper 
 
         and lower body and found no evidence of physical impairment.  In 
 
         a joint letter dated March 24, 1987 to defendant insurance 
 
         carrier, Dr. Boulden and Mr. Bower stated:  "It is apparent that 
 
         she will not be able to perform any frequency of lift which 
 
         certainly is going to be somewhat of a detriment in terms of 
 
         finding her a specific job."
 
         
 
              Claimant was seen by Alexander Matthews, M.D., of Central 
 
         Iowa Surgical Associates, P.C., on approximately December 20, 
 
         1985.  Dr. Matthews reported:
 
         
 
                   On examination there is no pain on compression of the 
 
              head and no tenderness over the cervical spine.  The Adson 
 
              and Roos maneuvers are negative.  Deep tendon reflexes are 
 
              somewhat depressed but equal bilaterally.  There is no 
 
              appreciable weakness in any of the muscle groups in the 
 
              upper extremity and no significant sensory changes.
 
         
 
                   This lady does not have a thoracic outlet compression 
 
              syndrome.  If she has a mild reflex dystrophy this is 
 
              certainly not responding to Stellate ganglion blocks and 
 
              therefore I feel that Stellate ganglionectomy is not 
 
              advisable.  I would advise her, however, to stop her smoking 
 
              in order to prevent vasospasm and to exercise her upper 
 
              extremity religiously, trying to restore full motor 
 
              function. I think that she has worried herself to the point 
 
              where she is afraid to use the extremity.  She should be 
 
              encouraged to resume full activities as soon as possible.
 
         
 
         (Jt. Ex. 1, pp. 170-171)
 
         
 
                           APPLICABLE LAW AND ANALYSIS
 
         
 
              An employee is entitled to compensation for any and all 
 
         personal injuries which arise out of and in the course of the 
 
         employment.  Section 85.3(l).
 
         
 
              Of first concern is whether or not claimant has shown that 
 
         on April 1, 1985 she sustained an injury arising out of and in 
 
         the course of her employment.
 
         
 
              The claimant must prove by a preponderance of the evidence 
 
         that her injury arose out of and in the course of her employment. 
 
         Musselman v. Central Telephone Co., 261 Iowa 352, 154 N.W.2d 128 
 
         (1967).
 
         
 
              In the course of employment means that the claimant must 
 
         prove her injury occurred at a place where she reasonably may be 
 
         performing her duties.  McClure v. Union, et al., Counties, 188 
 
         N.W.2d 283 (Iowa 1971).
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              Arising out of suggests a causal relationship between the 
 
         employment and the injury.  Crowe v. DeSoto Consolidated School 
 
         District, 246 Iowa 402, 68 N.W.2d 63 (1955).
 
         
 
              The claimant has the burden of proving by a preponderance of 
 
         the evidence that the injury of April 1, 1985 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).
 
         
 
              Expert medical evidence must be considered with all other 
 
         evidence introduced bearing on the causal connection.  Burt, 247 
 
         Iowa 691, 73 N.W.2d 732.  The opinion of experts need not be 
 
         couched in definite, positive or unequivocal language. Sondag v. 
 
         Ferris Hardware, 220 N.W.2d 903 (Iowa 1974).  However, the expert 
 
         opinion may be accepted or rejected, in whole or in part, by the 
 
         trier of fact.  Id. at 907.  Further, the weight to be given to 
 
         such an opinion is for the finder of fact, and that may be 
 
         affected by the completeness of the premise given the expert and 
 
         other surrounding circumstances.  Bodish, 257 Iowa 516, 133 
 
         N.W.2d 867.  See also Musselman, 261 Iowa 352, 154 N.W.2d 128
 
         
 
              Claimant has testified that she fell on the ice on April 1, 
 
         1985 while walking to work from the employer's parking lot. 
 
         Claimant was in an area which defendant employer could reasonably 
 
         anticipate she would be in and was there at a time and place 
 
         reasonable to her employment.  Claimant has consistently given 
 
         the same history to all the medical practitioners with whom she 
 
         has treated or by whom she has been evaluated.  No evidence was 
 
         presented by defendants to controvert claimant's testimony 
 
         outside of pointing to a number of accidents which claimant has 
 
         had that were both work and non-work related.  This is 
 
         insufficient to discredit claimant's recitation of the incident 
 
         on April 1, 1985. Therefore, it is concluded that claimant has 
 
         met her burden of establishing an injury arising out of and in 
 
         the course of her employment on April 1, 1985.  Concomitantly, 
 
         the undersigned does not question that it was this fall which was 
 
         the proximate cause of all the medical treatment which claimant 
 
         has received since April 1, 1985 and therefore that it was 
 
         claimant's fall that is the cause of claimant's inability to work 
 
         during the period stipulated to on the prehearing report.
 
         
 
              The essential question for resolution in this case is the 
 
         nature of claimant's disability, be that to a scheduled member, 
 
         the upper extremity, or to the body as a whole, an industrial 
 
         disability, and claimant's entitlement, if any, to permanent 
 
         partial disability benefits.
 
         
 
              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).
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              If a claimant contends he has industrial disability he has 
 
         the burden of proving his injury results in an ailment extending 
 
         beyond the scheduled loss.  Kellogg v. Shute and Lewis Coal Co., 
 
         256 Iowa 1257, 130 N.W.2d 667 (1964).
 
         
 
              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).
 
         
 
              Claimant argues her injury is the cause of an industrial 
 
         disability.  However, as cited above, the question of causal 
 
         connection is essentially within the domain of medical experts.  
 
         It is essential to note that the treatment which claimant has 
 
         received has centered on her upper extremity.  When describing 
 
         her current symptoms claimant, too, centers on problems with the 
 
         upper extremity, notably a loss of grip, dropping things, tremors 
 
         in her arm and a feeling that the arm is out of her control.  No 
 
         medical practitioner has advised of any disability extending into 
 
         the body as a whole.  In the case of Lauhoff Grain v. McIntosh, 
 
         395 N.W.2d 834 (Iowa 1986), the Iowa Supreme Court vacated a 
 
         court of appeals decision and, although primarily dealing in that 
 
         case with a hip joint, indicated that the court would look in 
 
         each instance now at shoulder injuries based on the "extent of 
 
         the injury."  No longer does the court make a blanket 
 
         determination that a shoulder injury should not be treated as a 
 
         scheduled injury but rather as a body as a whole injury.  The 
 
         court in the Lauhoff case has ruled that the extent of the injury 
 
         in each case will be examined and will be treated as a body as 
 
         whole injury only if the claimant establishes that the extent of 
 
         the injury extends beyond the schedule.  It must be determined 
 
         that claimant has failed to show her injury extends beyond the 
 
         schedule.  Accordingly, claimant's disability must be evaluated 
 
         by the functional impairment method.
 
         
 
              Although claimant has shown that she currently has some work 
 
         restrictions, no physician who either saw or treated claimant has 
 
         rendered any opinion on permanent impairment.  Dr. Boulden was 
 
         unequivocal in his opinion that, due to the absence of any 
 
         objective finding, claimant has no permanent functional 
 
         impairment.  Claimant has full range of motion in the upper 
 
         extremity and no particular pathology has been identified by the 
 
         physicians involved in claimant's care.  In addition, the 
 
         undersigned is not convinced that the recommendations voiced by 
 
         Dr. Boulden and Mr. Bower are permanent.in nature.  Claimant did 
 
         not show she went through a work hardening program or a program 
 
         to strengthen the upper body as recommended.  There being no 
 
         evidence of functional impairment, it must be determined that 
 
         claimant is not entitled to an award of permanent partial 
 
         disability benefits. This is not to make light of claimant's pain 
 
         for the undersigned does not dispute claimant's perceptions of 
 
         pain.  However, it has long been the rule of this agency that 
 
         pain which is not substantiated by clinical findings is not a 
 
         substitute for impairment.  Waller v. Chamberlain Manufacturing, 
 
         II Iowa Industrial Commissioner Report 419, 425 (1981).  
 
         Accordingly, claimant has established the extent of her 
 
         entitlement to weekly compensation for temporary total disability 
 
         and temporary partial disability for the stipulated periods from 
 
         April 23, 1985 through August 27, 1985, August 28, 1985 through 
 
         May 11, 1986, and May 12, 1986 through November 21, 1986.  
 
         Claimant, pursuant to the stipulation found in the prehearing 
 
         report and order, has been paid for these periods of time and 
 
         therefore she shall take nothing further as a result of these 
 
         proceedings.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
                                 FINDINGS OF FACT
 
         
 
              Wherefore, based on all of the evidence presented, the 
 
         following findings of fact are made:
 
         
 
              1.  On April 1, 1985, while walking from the employer's 
 
         parking lot towards the hospital, claimant slipped and fell on an 
 
         icy spot.
 
         
 
              2.  Claimant sustained an injury arising out of and in the 
 
         course of her employment on April 1, 1985.
 
         
 
              3.  Claimant sustained an injury to her upper extremity and 
 
         did not sustain an injury to the body as a whole.
 
              
 
              4.  Claimant has not sustained any permanent functional 
 
         impairment as a result of the injury of April 1, 1985.
 
              
 
              5.  Claimant had periods of temporary total disability and 
 
         temporary partial disability for which she has been compensated.
 
         
 
                                CONCLUSIONS OF LAW
 
         
 
              Therefore, based on the principles of law previously stated, 
 
         the following conclusions of law are made:
 
         
 
              1.  Claimant has established that on April 1, 1985 she 
 
         sustained an injury which arose out of and in the course of her 
 
         employment.
 
         
 
              2.  Claimant has established that the injury of April 1, 
 
         1985 was the cause of temporary disability.
 
         
 
              3.  Claimant has established that her injury was to a 
 
         scheduled member and not to the body as a whole.
 
         
 
              4.  Claimant has failed to establish that the injury 
 
         resulted in any permanent partial disability.
 
         
 
                                      ORDER
 
         
 
              THEREFORE, it is ordered:
 
         
 
              Claimant, having been paid all that to which she is 
 
         entitled, shall take nothing further as a result of these 
 
         proceedings.
 
         
 
              Costs of this Action are assessed against defendants 
 
         pursuant to Division of Industrial Services Rule 343-4.36.
 
         
 
              Signed and filed this 31st day of March, 1989.
 
         
 
         
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
         
 
         
 
                                            DEBORAH A. DUBIK
 
                                            DEPUTY INDUSTRIAL COMMISSIONER
 
         
 
         Copies to:
 
         
 
         Mr. David D. Drake
 
         Attorney at Law
 
         West Towers Office
 
         1200 35th St Ste 500
 
         West Des Moines, IA  50265
 
         
 
         Ms. Lorraine J. May
 
         Mr. Glenn Goodwin
 
         Attorneys at Law
 
         4th floor Equitable Bldg
 
         Des Moines, IA  50309
 
         
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
 
                                            
 
 
 
 
 
 
 
 
 
 
 
                                            1803; 1803.1
 
                                            Filed March 31, 1989
 
                                           Deborah A. Dubik
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         PAMELA HETHERINGTON,
 
         
 
              Claimant,
 
                                                 File No. 791716
 
         vs.
 
         
 
         MERCY HOSPITAL MEDICAL CENTER,       A R B I T R A T I 0 N
 
         
 
              Employer,                          D E C I S I 0 N
 
         
 
         and
 
         
 
         AETNA CASUALTY & SURETY
 
         COMPANY,
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
         1803; 1803.1
 
         
 
              Claimant found to have met her burden of proof that she 
 
         sustained an injury arising out of and in the course of her 
 
         employment when she fell while walking to work from the 
 
         employer's parking lot.  Claimant failed to establish that her 
 
         injury extended to the body as a whole and claimant had no 
 
         functional impairment rating from an imposition.  Therefore, no 
 
         award of benefits was made.
 
         
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
 
         
 
 
 
 
 
 
 
 
 
 
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         FRANK E. SEARS,
 
         
 
              Claimant,
 
                               
 
         VS.
 
                                                    File No. 791847
 
         IOWA QUALITY MEATS,
 
                                                     A R B I T R A T I 0 N
 
              Employer
 
                                                     D E C I S I 0 N
 
         and
 
         
 
         IOWA MUTUAL INSURANCE COMPANY,
 
                                                       
 
              Insurance Carrier,
 
              Defendants.
 
         
 
                                   INTRODUCTION
 
         
 
              This is a proceeding in arbitration brought by claimant, 
 
         Frank E. Sears, claimant, against his employer, Iowa Quality 
 
         Meats, and its insurance carrier, Iowa Mutual Insurance Company, 
 
         defendants.  The case was heard by the undersigned on May 19, 
 
         1989.
 
         
 
              The record consists of the testimony of claimant.  The 
 
         record also consists of claimant's exhibits A-G and defendants' 
 
         exhibit 1.
 
         
 
                                   STIPULATIONS
 
         
 
              Prior to the hearing, the parties entered into a number of 
 
         stipulations.  The stipulations are:
 
         
 
              1.  The existence of an employer-employee relationship 
 
         between claimant and employer at the time of the alleged injury 
 
         is stipulated;
 
         
 
              2.  That the type of permanent disability, if the injury is 
 
         found to be a cause of permanent disability is stipulated to be a 
 
         scheduled member disability to the right upper extremity;
 
         
 
              3.  In the event of an award of weekly benefits, the rate of 
 
         weekly compensation is stipulated to be $109.06 per week; and,
 
         
 
         
 
         SEARS V. IOWA QUALITY MEATS
 
         Page 2
 
         
 
              4.  Defendants paid claimant 46.571 weeks of compensation at 
 
         the rate of $109.06 per week prior to the hearing.
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
                                      ISSUES
 
         
 
              1.  Whether claimant received an injury which arose out of 
 
         and in the course of employment;
 
         
 
              2.  Whether there is a causal relationship between the 
 
         alleged injury and the disability;
 
         
 
              3.  Whether claimant is entitled to temporary 
 
         disability/healing period benefits or permanent partial or total 
 
         disability benefits; and,
 
         
 
              4.  Whether claimant is entitled to medical benefits under 
 
         section 85.27.
 
         
 
                                 FACTS PRESENTED
 
         
 
              Claimant is 57 years old.  Currently he is unemployed.  
 
         Claimant testified he commenced his employment with defendants in 
 
         September of 1983 when he was hired as a laborer.  Claimant 
 
         reported he was required to carry five-ten pound roasts from the 
 
         work table to the conveyor belt.  He indicated that on April 2, 
 
         1985, claimant was picking up a box of meat when he felt his 
 
         right elbow snap.  Claimant stated he' reported the incident to 
 
         his foreman and claimant stated he was directed to proceed to 
 
         Charter Community Hospital.
 
         
 
              Medical records indicate claimant was treated by the 
 
         defendants' physician, Scott B. Neff, D.O..., for "tennis elbow."  
 
         In his report of October 7, 1985, Dr. Neff opines:
 
         
 
              Mr. Frank Sears calls today, saying that he wants another 
 
              note to keep him off work.
 
              
 
              I do not find any reason on physical examination why this 
 
              patient cannot do at least some kind of work, and I am not 
 
              certain why he grimaces and acts the way he does.
 
              
 
                  ....
 
              
 
              I certainly have no idea why his elbow should be giving him 
 
              this much difficulty.
 
              
 
              In November of 1985, Dr. Neff opines:
 
              Mr. sears had an injury to his elbow which was subsequently 
 
              surgically treated by Dr. Kirkland.  The
 
              
 
         SEARS V. IOWA QUALITY MEATS 
 
         Page 3
 
         
 
         
 
              injury was a strain or contusion of the extensor mechanism 
 
              at the origin of the lateral epicondyle, and the result is 
 
              lateral epicondylitis or, if you will forgive the 
 
              expression, tennis elbow.
 

 
              
 
 
 
 
 
 
 
 
 
 
 
              
 
              Mr. Sears has been thoroughly and carefully evaluated since 
 
              that surgery because he has continued to complain of pain, 
 
              and continues to present with a peculiar affect, holding his 
 
              arm in a peculiar position, and refusing to move it.
 
              
 
              He has undergone bone scan which was normal, and has been 
 
              evaluated by a neurologist, who found no evidence of 
 
              neurological disease.  He has had a CT scan of his cervical 
 
              spine, and this did not show any evidence of' herniated 
 
              disc.
 
              
 
              These other studies were done because of the patient's 
 
              persistent complaints of arm pain.
 
              
 
              I do not believe that this patient has any significant or 
 
              permanent impairment, although he refuses to use his right 
 
              arm, and winces, somewhat theatrically, in pain whenever he 
 
              is examined.
 
              
 
              I had previously recommended an MMPI evaluation (Minnesota 
 
              Multiphasic Personality Inventory), to see if this patient 
 
              responds abnormally to painful stimuli, or if there is some 
 
              evidence of hysterical conversion.
 
              
 
              In July of 1985, surgery was performed on claimant's elbow 
 
         by Mark B. Kirkland, D.0...  In his report of February 5, 1986, 
 
         Dr. Kirkland opined:
 
         
 
              I would continue to agree with Dr. Neff in his opinion that 
 
              Mr. Sears does not have any significant permanent impairment 
 
              of his right arm.  Of course we have not seen Frank since 
 
              the llth of.November 1985.  A reasonable period for normal 
 
              healing in surgery such as Frank had would be three months.
 
              
 
              Claimant testified he next went to the Veterans 
 
         Administration Medical Center in Des Moines.  Donald W. Blair, 
 
         M.D., Chief of Orthopedic Surgery summarized the treatment 
 
         claimant received at the VA.  In his report of December 31, 1987, 
 
         Dr. Blair wrote:
 
         
 
              Mr. Sears was re-examined in the orthopedic clinic on 
 
              December 28, 1987, relative to his right elbow.  By history, 
 
              his symptoms do appear to have originated from work related 
 
              activities described in April 1985.
 
              
 
         SEARS V. IOWA QUALITY MEATS
 
         Page 4
 
         
 
         
 
              He was initially treated by a private orthopedic physician 
 
              who carried out a surgical procedure on the common extensor 
 
              tendons at the right elbow.  The symptoms did persist and he 
 
              transferred his care to this facility.  A further trial of 
 
              conservative measures did not result in improvement and on 
 
              September 8, 1986, a modified Bosworth procedure was carried 
 
              out on this same elbow in an attempt to obtain.further 
 
              relief.
 

 
              
 
 
 
 
 
 
 
 
 
 
 
              
 
              There has been some benefit following this latter procedure, 
 
              particularly in regard to relief of some of the pain 
 
              radiating into the forearm.  He does, however, continue to 
 
              complain of a persisting degree of pain and discomfort over 
 
              the lateral aspect of the elbow to the extent that he states 
 
              he cannot resume his prior work activities which involved 
 
              handling packages of meat and cartons.  Prior 
 
              recommendations have also included.his attempting to change 
 
              to a primarily left handed type of work activity.
 
              
 
              My impression is that this man is experiencing pain relative 
 
              to this right elbow, although the degree of pain does appear 
 
              to be greater and more persistent than one would ordinarily 
 
              expect from this condition.  I also feel that there could be 
 
              a degree of functional overlay due to his chronic pain 
 
              symptoms.
 
              
 
              Currently, he has no plans for resuming employment and 
 
              indicates he could not handle his prior type of work.  He 
 
              has been off work since April 1985.
 
              
 
              After discussion with Mr. Sears, I did suggest that a 
 
              psychological evaluation would be recommended to see if some 
 
              further suggestions for help could be offered to help him to 
 
              better deal with his pain which has not responded to the 
 
              usual therapies.
 
              
 
              Mr. Sears is also being followed at Broadlawns Medical 
 
              Center for what he describes as "chronic pain syndrome', in 
 
              the abdomen secondary to a stab wound in the abdomen July 
 
              1986.
 
              
 
              In addition to the recommendation for psychological 
 
              evaluation, consideration would also be suggested for an 
 
              MMPI.  I did discuss this latter suggestion with Mr. Sears 
 
              and he is agreeable to having the additional consultation.
 
              
 
              
 
         SEARS V. IOWA QUALITY MEATS 
 
         Page 5
 
         
 
              As of January of 1989, A.P. Neptune, M.D., wrote in his 
 
         clinical notes:
 
         
 
              This is a 56 y/o male patient with a past history of right 
 
              lateral epicondylitis, for which he had surgery done in 
 
              1986, with some relief of his discomfort, mostly of the pain 
 
              in the muscles in the proximal lateral forearm.  The pain at 
 
              the elbow itself over the lateral epicondyle has been 
 
              present and is still quite annoying. when seen today, he was 
 
              holding the right upper limb flexed at the elbow protecting 
 
              it with the other arm and supporting it in a way.  He was 
 
              also wearing a forearm splint.  On physical examination 
 
              there was quite,a bit of tenderness on palpation or 
 
              percussion of the lateral epicondyle.  On the right, there 
 
              was no muscle tenderness specifically.
 

 
              
 
 
 
 
 
 
 
 
 
 
 
              Pronation/supination against resistance did elicit pain at 
 
              the elbow.  Tinel sign was negative for Median and Ulnar 
 
              nerves at wrist and elbow.  No gross muscular atrophy was 
 
              noted.  On electro-diagnostic studies, normal motor and 
 
              sensory latencies and conduction velocities were recorded 
 
              for the right Median and Ulnar nerves segments tested.  No 
 
              pathology was found on EMG.
 
              
 
              IMPRESSION: Normal electrodiagnostic study of the tight 
 
              upper limb.  Clinical evidence of right lateral 
 
              epicondylitis. .
 
              
 
              During direct examination, claimant testified his right 
 
         elbow hurts all of the time.  He indicated he wears splints and 
 
         he cannot lift with his arm.  Claimant maintains he is unable to 
 
         work because of his pain.
 
         
 
                                  APPLICABLE LAW
 
         
 
              An employee is entitled to compensation for any and all 
 
         personal injuries which arise out of and in the course of the 
 
         employment.  Section 85.3(l).
 
         
 
              Claimant has the burden of proving by a preponderance of the 
 
         evidence that he received an injury on April 2, 1985 which arose 
 
         out of and in the course of his employment.  McDowell v. Town of 
 
         Clarksville, 241 N.W.2d 904 (Iowa 1976); Musselman v. Central 
 
         Telephone Co., 261 Iowa .352, 154 N.W.2d 128 (1967).
 
         
 
              The injury must both arise out of and be in the course of 
 
         the employment.  Crowe v. DeSoto Consol. Sch. Dist., 246 Iowa 
 
         402, 68 N.W.2d 63 (1955) and cases cited at pp. 405-406 of the 
 
         Iowa Report.  See also Sister Mary Benedict v. St. Mary's Corp., 
 
         255 Iowa 847, 124 N.W..2d 548 (1963) and Hansen v. State of Iowa, 
 
         249 Iowa 1147, 91 N.W.2d 555 (1958).
 
         SEARS V. IOWA QUALITY MEATS
 
         Page 6
 
         
 
         
 
              The words "out of" refer to the cause or source of the 
 
         injury.  Crowe v. DeSoto Consol. Sch. Dist., 246 Iowa 402, 68 
 
         N.W.2d 63 (1955).
 
         
 
              The words "in the course of" refer to the time and place and 
 
         circumstances of the injury.  McClure v. Union et al. Counties, 
 
         188 N.W.2d 283 (Iowa 1971); Crowe v. DeSoto Consol. Sch. Dist., 
 
         246 Iowa 402, 68 N.W.2d 63 (1955).
 
         
 
              "An injury occurs in the course of the employment when it is 
 
         within the period of employment at a place the employee may 
 
         reasonably be, and while he is doing his work or something 
 
         incidental to it."  Cedar Rapids Comm. Sch.  Dist. v. 
 
         Cady, 278 N.W.2d 298 (Iowa 1979), McClure v. Union et al. 
 
         Counties, 188 N.W.2d 283'(Iowa 1971); Musselman v. Central 
 
         Telephone Co., 261 Iowa 352, 154 N.W.2d 128 (1967).
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              The claimant has the burden of proving by a preponderance of 
 
         the evidence that the injury of April 2, 1985 is causally related 
 
         to the disability on which he now bases his claim.  Bodish v. 
 
         Fischer, Inc., 257 Iowa 516, 133 N.W.2d 867 (1965).  Lindahl v. 
 
         L. 0. Boggs, 236 Iowa 296, 18 N.W.2d 607 (1945).  A possibility 
 
         is insufficient; a probability is necessary.  Burt v. John Deere 
 
         Waterloo Tractor Works, 247 Iowa 691, 73 N.W.2d 732 (1955).  The 
 
         question of causal connection is essentially within the domain of 
 
         expert testimony.  Bradshaw v. Iowa Methodist Hospital, 251.Iowa 
 
         375, 101 N.W.2d 167 (1960).
 
         
 
              However, expert medical evidence must be considered with all 
 
         other evidence' introduced bearing on the causal connection. 
 
         Burt, 247 Iowa 691, 73 N.W.2d 732.  The opinion of experts need 
 
         not be couched in definite, positive or unequivocal language. 
 
         Sondag v. Ferris Hardware, 220 N.W.2d 903 (Iowa 1974).  However, 
 
         the expert opinion may be accepted or rejected, in whole or in 
 
         part, by the trier of fact.  Id. at 907.  Further, the weight to 
 
         be given to such an opinion is for the finder of fact, and that 
 
         may be affected by the completeness of the premise given the 
 
         expert and other surrounding circumstances.  Bodish, 257 Iowa 
 
         516, 133 N.W.2d 867.  See also Musselman v. Central Telephone Co.
 
         , 261 Iowa 352, 154 N.W.2d 128 (1967).
 
         
 
              The right of a worker to receive compensation for injuries 
 
         sustained which arose out of and in the course of employment is 
 
         statutory.  The statute conferring this right can also fix the 
 
         amount of compensation to be paid for different specific 
 
         injuries, and the employee is not entitled to compensation except 
 
         as provided by the statute.  Soukup v. Shores Co., 222 Iowa 272, 
 
         268 N.W. 598 (1936).
 
         
 
         SEARS V. IOWA QUALITY MEATS
 
         Page 7
 
                                     ANALYSIS
 
         
 
              The evidence is unrefuted that claimant sustained an injury 
 
         to his right elbow on May 2, 1985.  At the time of the injury 
 
         claimant was loading boxes of meat for his employer.  The injury 
 
         arose out of and in the course of claimant's employment.
 
         
 
              Claimant has also established the requisite causal 
 
         connection between the injury and the claimed condition.  Prior 
 
         to April 2, 1985, claimant testified he had not experienced any 
 
         right upper extremity difficulties.  After April 2, 1985, 
 
         claimant was diagnosed as having tendonitis or "tennis elbow."  
 
         Dr. Blair maintains, "By history, his symptoms do appear to have 
 
         originated from work related activities described in April 1985.  
 
         "No other physician has attributed claimant's condition to a 
 
         source other than the injury of April 2, 1985.  Therefore, the 
 
         requisite causal connection has been established.
 
         
 
              The third issue to address is whether claimant has sustained 
 
         any permanent disability.  Neither authorized treating physician 
 
         has assessed a functional impairment rating to claimant's right 
 
         upper extremity.  Dr. Neff can find no objective reason for 
 
         claimant's complaints of pain.  Claimant had a normal EMG.  
 
         Claimant had a normal bone scan as well.  There is no evidence of 
 
         a herniated disc.  Dr. Neff opined claimant was capable of some 
 
         type of work.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              The physicians at the VAMC performed a "Bosworth procedure 
 
         with dissection of the insertion of the common extensor tendon 
 
         from the right lateral humeral epicondyle and also a release of 
 
         the radial lateral ligament.  An osteotome was then used to shave 
 
         off part of the underlying bone and the radial collateral 
 
         ligament and common extensor tendon were reinserted.  The 
 
         postoperative course was uneventful and the patient noted 
 
         immediate and continued relief of his preoperative pain."
 
         
 
              Subsequent to the surgery, no physician at VAMC provided a 
 
         functional impairment rating.  Claimant is acknowledged to have 
 
         pain in the right upper extremity.  However, even the physicians 
 
         at VA recommend psychological evaluation and counseling as a 
 
         means to alleviate the pain.  No physician at VA found an 
 
         objective basis for the pain, once the Bosworth procedure had 
 
         been performed.  The pain appears to be subjective in nature.
 
         
 
              Therefore, in light of the above, it is the determination of 
 
         the undersigned that claimant has not proven by a preponderance 
 
         of.the evidence that he has a permanent partial disability to the 
 
         right upper extremity.
 
         
 
              The next issue to address is whether claimant is entitled to 
 
         temporary total disability benefits.  Claimant was paid weekly
 
         
 
         
 
         SEARS V. IOWA QUALITY MEATS 
 
         Page 8
 
         
 
         
 
         benefits from April 2, 1985 to March 6, 1986 with the exception 
 
         of two,weeks where claimant returned to work.  This time computes 
 
         to 46.571 weeks.
 
         
 
              Claimant, however, was temporarily and continuously disabled 
 
         through May 20,.1986, when claimant was released from physical 
 
         therapy from the VAMC.  As of May 9, 1986, claimant had near 
 
         normal range of motion.  Claimant was again temporarily disabled 
 
         from September 5, 1986 when the modified Bosworth procedure was 
 
         performed, through January 15, 1987, when the records seemingly 
 
         indicate physical therapy for the right elbow was to end and 
 
         there were only home exercises prescribed.  The entire number of 
 
         weeks for which claimant is entitled to temporary total 
 
         disability benefits is 74.571 weeks.
 
         
 
              The final issue to address is whether claimant is entitled 
 
         to medical benefits pursuant to section 85.27. Claimant has 
 
         incurred $4,903.00 in medical expenses at the VAMC.  Iowa Code 
 
         section 85.27 provides that a claimant is entitled to reasonable 
 
         medical expenses for a work related injury.  The defendants have 
 
         the right to select the treating physician.
 
         
 
              Unauthorized treatment which improves an employee's 
 
         condition and which ultimately may mitigate the employer's 
 
         liability may subsequently be found reasonable and necessary for 
 
         treatment of an injury.  Butcher v. Valley Sheet Metal, IV Iowa 
 
         Industrial Commissioner Report 49 (Appeal Decision 1983); 
 
         Rittgers v. United Parcel Service, III Iowa Industrial 
 
         Commissioner Report 210 (Appeal Decision 1982); Hutchinson v. 
 
         American Freight Systems, Inc., I-1 Iowa Industrial Commissioner 
 
         Decision 94 (Appeal Decision 1984).  The evidence, in the instant 
 
         proceeding, is uncontroverted that claimant's condition improved 
 
         subsequent to the Bosworth procedure which he received at VAMC.  
 
         Therefore, defendants are liable for claimant's hospital expenses 
 
         from September 5, 1986 to September 11, 1986.  The expenses total 
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         $2,718.00. Defendants are not liable for the balance of the 
 
         medical expenses.  There was no evidence that other treatments 
 
         improved claimant's condition.  Neither was there evidence that 
 
         the remainder of the expenses were even causally connected to 
 
         claimant's work injury of April 2, 1985.  There was evidence of 
 
         claimant having treatments for a right shoulder condition.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
                     FINDINGS OF FACT AND CONCLUSIONS OF LAW
 
         
 
              WHEREFORE, based on the evidence presented and the 
 
         principles of law previously stated, the following findings of 
 
         fact and conclusions of law are made:
 
         
 
              FINDING 1. Claimant sustained an injury to the right (elbow) 
 
         upper extremity on April 2, 1985.
 
         
 
         
 
         SEARS V. IOWA QUALITY MEATS
 
         Page 9
 
         
 
         
 
              CONCLUSION A. Claimant sustained an injury on April 2, 1985 
 
         which arose out of and in the course of his employment.
 
         
 
              FINDING 2. As a result of his injury on April 2, 1985, 
 
         claimant had two surgical procedures on his right elbow.
 
         
 
              FINDING 3. Claimant did not have an attributable functional 
 
         impairment as a result of his injury on April 2, 1985.
 
         
 
              FINDING 4. Claimant was unable to work because of his injury 
 
         from April 2, 1985 through May 20, 1986 and from September 5, 
 
         1986 through January 5, 1987.
 
         
 
              CONCLUSION B. Claimant was temporarily totally disabled from 
 
         April 2, 1985 through May 20, 1986 and from September 5, 1986 
 
         through January 5, 1987, which is a.period of 74.571 weeks.
 
         
 
              FINDING 5. Claimant has incurred reasonable and necessary 
 
         medical expenses as a result.of his injury on April 2, 1985.
 
         
 
              CONCLUSION C. Defendants are liable for medical expenses to 
 
         the VAMC in the sum of $2,718.00.
 
         
 
                                      ORDER
 
         
 
              THEREFORE, defendants are to pay unto claimant seventy-four 
 
         point five seventy-one (74.571) weeks of temporary total 
 
         disability benefits at the stipulated rate of one hundred nine 
 
         and 06/100 dollars ($109.06) per week.
 
         
 
              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 also liable for the aforementioned medical 
 
         expenses for the VAMC in the sum of two thousand seven hundred 
 
         eighteen dollars ($2,718.00).
 
         
 
              Defendants shall take credit for all benefits previously 
 
         paid.
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
              Costs of this action are assessed against defendants 
 
         pursuant to Division of Industrial Services Rule 343-4.33.
 
         
 
              Defendants shall file a claim activity report upon payment 
 
         of this award.
 
         
 
         
 
         SEARS. V. IOWA QUALITY MEATS
 
         Page 10
 
         
 
         
 
         Signed and filed this 28th day of December, 1989.
 
         
 
         
 
         
 
                                         MICHELLE A. McGOVERN
 
                                         DEPUTY INDUSTRIAL COMMISSIONER
 
         
 
         
 
         
 
         Mr. Virgil Moore
 
         Attorney at Law
 
         2454 SW Ninth St
 
         Des Moines IA 50315
 
         
 
         Mr Roy M Irish
 
         Attorney at Law
 
         729 Ins Exch Bldg
 
         Des Moines IA 50309
 
         
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
 
           
 
 
 
 
 
 
 
 
 
 
 
           
 
                                                1801; 5-2209; 5-2500
 
                                                Filed December 28, 
 
           1989
 
                                                MICHELLE A. McGOVERN
 
           
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
                                        
 
           FRANK E. SEARS,
 
           
 
                Claimant,
 
           
 
           vs.
 
                                                File No. 791847
 
           IOWA QUALITY MEATS,
 
                                                A R B I T R A T I O N
 
                Employer,
 
           
 
           and                                     D E C I S I O N
 
           
 
           IOWA MUTUAL INSURANCE COMPANY,
 
           
 
                Insurance Carrier,
 
                Defendants.
 
           
 
         5-2209
 
         
 
              Claimant did not sustain a permanent partial disability to 
 
         his right upper extremity (elbow).
 
         
 
         1801
 
         
 
              Claimant sustained temporary total disability benefits 
 
         because of an injury to his right upper extremity.
 
         
 
         5-2500
 
         
 
              Claimant is entitled to have some medical benefits paid to 
 
         the VA Hospital for unauthorized services rendered but which 
 
         improved claimant's condition.
 
         
 

 
         
 
 
 
 
 
 
 
 
 
 
 
         
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            RAY E. STICKLER,              :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :      File No. 877854
 
                                          :               791857
 
            YOUNG RADIATOR COMPANY,       :
 
                                          :    A R B I T R A T I O N
 
                 Employer,                :
 
                                          :       D E C I S I O N
 
            and                           :
 
                                          :
 
            FIREMAN'S FUND INSURANCE CO., :
 
                                          :
 
                 Insurance Carrier,       :
 
                                          :
 
            and                           :
 
                                          :
 
            SECOND INJURY FUND OF IOWA,   :
 
                                          :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
                              STATEMENT OF THE CASE
 
            
 
                 This is a proceeding in arbitration brought by Ray E. 
 
            Stickler, claimant, against Young Radiator Shop, employer 
 
            (hereinafter referred to as Young Radiator), and Fireman's 
 
            Fund Insurance Co, insurance carrier, and the Second Injury 
 
            Fund of Iowa, defendants, for workers' compensation benefits 
 
            as a result of an alleged injury on December 5, 1984 and 
 
            December 7, 1987.  On April 3, 1991, a hearing was held on 
 
            claimant's petition and the matter was considered fully sub
 
            mitted at the close of this hearing.
 
            
 
                 The parties have submitted a prehearing report of con
 
            tested issues and stipulations which was approved and ac
 
            cepted as a part of the record of this case at the time of 
 
            hearing.  Oral testimony and written exhibits were received 
 
            during the hearing from the parties.  The exhibits received 
 
            into the evidence are listed in the prehearing report.
 
            
 
                 According to the prehearing report, the parties have 
 
            stipulated to the following matters:
 
            
 
                 1.  An employee-employer existed between claimant and 
 
            Young Radiator at the time of both alleged injuries.
 
            
 
                 2.  On December 5, 1984, claimant received an injury 
 
            which arose out of and in the course of his employment with 
 
            Griffin.
 
            
 
                 3.  Claimant is seeking the payment of additional tem
 
            porary total disability or healing period benefits only as a 
 
            result of the alleged second injury of December 7, 1987.
 
            
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
                 4.  Claimant is claiming such benefits for the time 
 
            period from February 2, 1988 through September 10, 1989, and 
 
            for a second period of time from November 27, 1989 through 
 
            May 28, 1990.  Defendants agree that claimant was not work
 
            ing during these two periods of time.
 
            
 
                 5.  If the injury of December 5, 1984 is found to have 
 
            caused permanent disability, permanent partial disability 
 
            benefits will begin as of July 8, 1987.  There was no agree
 
            ment as to a commencement date for permanent partial dis
 
            ability benefits for the second injury of December 7, 1987.
 
            
 
                 6.  Claimant's rate of weekly compensation for both al
 
            leged injuries shall be $218.20.
 
            
 
                 7.  With reference to the issue medical benefits, the 
 
            only issue was authorization for the expense of whirlpool 
 
            treatment in May, June and July 1989.
 
            
 
                                      issue
 
            
 
                 The parties issued the following issues for determina
 
            tion in this proceeding:
 
            
 
                 I.  Whether claimant received an injury on December 7, 
 
            1987 arising out of and in the course of his employment;
 
            
 
                 II. The extent of claimant's entitlement to disability 
 
            benefits; and,
 
            
 
                 III. The extent of claimant's entitlement to medical 
 
            benefits.
 
            
 
                                 findings of fact
 
            
 
                 Having heard the testimony and considered all the evi
 
            dence, the deputy industrial commissioner finds as follows:
 
            
 
                 A credibility finding is necessary to this decision as 
 
            defendants places claimant's credibility at issue during 
 
            cross-examination as to the nature and extent of the injury 
 
            and disability.  From his demeanor while testifying, 
 
            claimant is found credible.
 
            
 
                 Claimant has worked for Young Radiator since 1977 and 
 
            continues to do so on a part-time basis at the present time.  
 
            Young Radiator makes radiators for large trucks, buses, mil
 
            itary vehicles and large powered equipment such as cranes.  
 
            Until the injury of December 7, 1987, claimant operated 
 
            heavy presses in this employment.  Claimant's job involved 
 
            the repetitious handling with his hands and arms 60 to 500 
 
            parts per day weighing from 30 to 35 pounds each.  In this 
 
            employment, claimant earned approximately $17,000 in 1984; 
 
            $14,000 in 1985; $15,000 in 1986; $20,000 in 1987; $15,000 
 
            in 1988; and $3,000 in 1989.  Claimant is currently working 
 
            only two to four hours per day at Young Radiator due to his 
 
            pain and physical restrictions imposed upon the time and 
 
            amount of work he can perform by his physicians.  Until re
 
            cently, claimant also operated a farm.  On this farm, he 
 
            bred and fed out cattle on 94 acres of farmland.  The 
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
            farming operation ended with the recent sale of the land and 
 
            the farm equipment.  Claimant testified that after the 
 
            second work injury, he could only perform light duty farm 
 
            work, leaving the heavy work to his close relatives.  This 
 
            testimony is believed.  According to claimant's supervisor, 
 
            claimant was always a good worker at Young Radiator.
 
            
 
                 On or about December 5, 1984, claimant injured his 
 
            right shoulder while pulling on a wrench during the perfor
 
            mance of his duties at Young Radiator.  He said that he 
 
            could actually hear his shoulder "pop" after which severe 
 
            pain ensued.  Upon a diagnosis of shoulder strain and 
 
            rotator cuff tear, claimant was treated conservatively by a 
 
            family physician and then a neurosurgeon.  However, the pain 
 
            and loss of use continued and claimant was referred to 
 
            Donald D. Berg, M.D., an orthopedic surgeon, who surgically 
 
            repaired the tear in the shoulder rotator in September 1985.  
 
            Following a long period of recovery after the surgery, 
 
            claimant returned to work in July 1987 with restrictions 
 
            against heavy work with the right arm.  It is specifically 
 
            found that the injury of December 5, 1987 involved not only 
 
            the anatomical structures of the arm but also extended into 
 
            the body as a whole.  This finding is based upon the expla
 
            nation of a rotator cuff injury and its repair in the depo
 
            sition of Albert Richard Coates, M.D., an orthopedic 
 
            surgeon, who  performed surgery on claimant's left shoulder 
 
            in a subsequent work injury.  Clearly, structures of the 
 
            shoulder were involved which go beyond the head of the upper 
 
            arm which forms the ball of the ball and socket shoulder 
 
            joint.
 
            
 
                 The injury of December 5, 1984 was a cause of a 15 per
 
            cent permanent loss of earning capacity.  Claimant suffered 
 
            a significant permanent partial impairment to the right arm 
 
            and to the body as a whole.  Claimant's treating and evalu
 
            ating physicians rated the impairment of the arm from 20 to 
 
            37 percent and the impairment to the body as a whole from 12 
 
            to 20 percent.  Clearly, there is a significant physical 
 
            loss of use of the right arm and shoulder with permanent 
 
            restrictions against heavy use of the arm following the 
 
            injury.  Claimant stated that he never fully recovered from 
 
            this injury and remained symptomatic after his return to 
 
            work.  However, claimant did not have any major problems 
 
            until his second injury in the latter part of 1987.  The 
 
            evidence reveals that claimant suffered an injury to the 
 
            right shoulder in 1980 but this problem resolved and 
 
            claimant was able to continue working.  There were no 
 
            records submitted in the evidence to suggest what type of 
 
            problem occurred in 1980 or its exact diagnosis.  From the 
 
            evidence submitted, it is found that claimant had no prior 
 
            permanent partial impairment to either of his arms or 
 
            shoulders before December 5, 1984.  At the time of injury, 
 
            claimant was 58 years of age.  Apart from his recovery 
 
            period following surgery, claimant lost no income and re
 
            turned to the same job and at the same wages he was earning 
 
            at the time of the injury.
 
            
 
                 On or about December 7, 1987, claimant suffered a 
 
            second injury to his right shoulder and a new injury to his 
 
            left shoulder.  These injuries arose out of and in the 
 

 
            
 
            Page   4
 
            
 
            
 
            
 
            
 
            course of his employment with Young Radiator.  The injury to 
 
            the right shoulder was an aggravation of the prior injury of 
 
            December 5, 1984.  The injury to the left shoulder was 
 
            another rotator cuff tear.  Both of these injuries occurred 
 
            over a period of time starting in the summer of 1987 and 
 
            ending on December 7, 1987.  During this time, claimant's 
 
            right arm and shoulder became very painful and he was unable 
 
            to use his right shoulder or arm.  Claimant then suffered 
 
            severe pain and loss of use of his left shoulder. Claimant 
 
            explained that due to his right shoulder problems, he was 
 
            compelled beginning in the summer of 1987 to extensively use 
 
            his left arm and shoulder more than he had been in the past.  
 
            The symptoms grew gradually worse until December 7, 1987, 
 
            when claimant's pain became so severe that he had to leave 
 
            work and seek treatment in the form of pain pills and 
 
            aspirin.  It was at that time that he reported an injury to 
 
            his supervisors at Young Radiator.  A few days later, 
 
            claimant sought an evaluation and treatment from Dr. Coates.  
 
            Dr. Coates had previously evaluated claimant for his right 
 
            shoulder problems.  The above finding as to the exact nature 
 
            of the December 7, 1987 injury was based upon Dr. Coates' 
 
            office notes of December 10, 1987.  Dr. Coates clearly 
 
            opined that the injury was due to chronic repetitive motion 
 
            in claimant's job as a press operator with Young Radiator.  
 
            Dr. Coates saw claimant again on January 28, 1988, and wrote 
 
            Young Radiator stating that he recommended surgery to the 
 
            left shoulder.  Claimant stated at hearing that Dr. Coates 
 
            also told him at that time to remain off work.  This was not 
 
            reflected in the January 1987 letter by Dr. Coates.  
 
            Claimant's testimony is credible and it is found that Dr. 
 
            Coates did, in fact, instruct claimant to remain off work 
 
            until further treatment and evaluation.
 
            
 
                 As a result of the work injury of December 7, 1987, 
 
            claimant was off work from February 2, 1988 through 
 
            September 10, 1989.  This period of time is in dispute as 
 
            claimant was also off work at that same time for treatment 
 
            of a nose infection problem.  However, given the above find
 
            ing as to Dr. Coates' recommendations of January 28, 1988, 
 
            it is found that claimant's shoulder problems remain as at 
 
            least one substantial causative factor in his absence from 
 
            work during this period of time.
 
            
 
                 Claimant returned to work part-time from September 12, 
 
            1989 until November 26, 1989, to a light duty welding job at 
 
            Young Radiator.  Claimant was paid voluntary temporary 
 
            partial disability benefits during this time.  There does 
 
            not appear to be a dispute as to the amount of money paid to 
 
            claimant during this temporary partial disability period and 
 
            there is no need for a finding as to what claimant may have 
 
            earned during this period of time.
 
            
 
                 As a result of the work injury of December 7, 1987, 
 
            claimant was also off work from September 11, 1989 through 
 
            May 28, 1990.  During this period of time, claimant was 
 
            under active care and treatment of Dr. Coates who performed 
 
            rotator cuff surgery in November 1988.  Following another 
 
            long recovery, claimant was released to part-time work at 
 
            Young Radiator on May 28, 1990.  Claimant also reached maxi
 
            mum healing at that point in time.
 

 
            
 
            Page   5
 
            
 
            
 
            
 
            
 
            
 
                 Assuming that claimant had no preexisting disability 
 
            (this assumption is required by law as will be explained in 
 
            the conclusions of law section of this decision), the work 
 
            injury of December 7, 1987 alone was a cause of a 15 percent 
 
            loss of earning capacity.  No physician has opined that 
 
            claimant suffered permanent partial impairment from the ag
 
            gravation injury to the prior right shoulder injury.  
 
            However, claimant suffered permanent partial impairment to 
 
            the left arm and shoulder from the second rotator cuff tear 
 
            and surgery.  Dr. Coates and other physicians rate 
 
            claimant's permanent partial impairment on the left side as 
 
            60 percent to the arm and 12 percent to the body as a whole.  
 
            Dr. Coates indicates in his reports that he was quite 
 
            disappointed that the left shoulder surgery did not improve 
 
            the functioning of the shoulder as expected.  Similar to the 
 
            prior right shoulder injury, the injury of December 7, 1987 
 
            involves structures of the arm as well as structures forming 
 
            the socket of the ball and socket shoulder joint and 
 
            extended into the body as a whole.  At the time of injury, 
 
            claimant was 62 years of age with no immediate plans to 
 
            retire.  Claimant did not return to full-time work but this 
 
            is due to the combined effects of the first and second 
 
            injuries, not just the second injury.  As the second injury 
 
            was quite similar to the first injury of December 5, 1984, 
 
            the same finding of a loss of earning capacity solely as a 
 
            result of the second injury will be made.
 
            
 
                 As a result of the combined effect of the first and 
 
            second injuries and the resulting permanent partial impair
 
            ment, claimant suffered an additional 10 percent loss of 
 
            earning capacity over and above the total combined 
 
            disability (30 percent) caused by the first and second 
 
            injuries looking at each separately.  In other words, 
 
            claimant's current industrial disability or loss of earning 
 
            capacity from both injuries is 40 percent.  As a result of 
 
            the combined injuries, physicians were forced to impose 
 
            severe permanent work restrictions of allowing him only to 
 
            return to work on a part-time basis from two to four hours 
 
            per day depending upon his ability on any particular day to 
 
            withstand any ongoing pain.  At hearing, claimant described 
 
            deep and lingering pain into his shoulder, extending into 
 
            the armpit on each side and into the chest area.  Claimant 
 
            described this pain as similar to that of a large toothache 
 
            and states that his shoulder never quits hurting along.  He 
 
            also states that the right is worse than the left.  All 
 
            physicians have noted bilateral atrophy of the shoulder 
 
            muscle indicating nerve damage.  Claimant is unable to sit 
 
            in a recliner for any lengthy period of time and he has 
 
            difficulty sleeping at night.  All of these problems appear 
 
            to the undersigned to be a result of the combination of the 
 
            two shoulder injuries and this is verified by the medical 
 
            reports.  Claimant also has severe work restrictions against 
 
            carrying over 20 pounds and lifting anything over 5 to 10 
 
            pounds.  According to Scott B. Neff, D.O., another 
 
            orthopedic surgeon, claimant is unable to perform any repet
 
            itive activity of his arms at or above shirt pocket level.  
 

 
            
 
            Page   6
 
            
 
            
 
            
 
            
 
            Claimant is released to return to work as a result of both 
 
            injuries to only the part-time press and welding work at 
 
            Young Radiator.  Claimant is earning the same rate of pay as 
 
            before the second injury in December 1987 which is $9.68 per 
 
            hour but is only working six to fifteen hours per week.  
 
            Consequently, he has suffered a significant drop in earnings 
 
            as a result of the combined effect of the two injuries.  
 
            Claimant said that he would be retired now and looking for 
 
            more suitable part-time work had he received an acceptable 
 
            settlement offer from defendants' insurance carrier.  
 
            Claimant has ended his farming operating in part due to his 
 
            bilateral shoulder disabilities.
 
            
 
                 However, claimant failed to show that the industrial 
 
            disability loss from the combined effect of the injuries 
 
            exceed 40 percent due to his age and apparent desire to 
 
            remove himself from the work force.  Claimant was 64 years 
 
            of age at the time he returned to work after the second 
 
            surgery.  He was very close to the normal retirement age.  
 
            His loss of earning capacity is not as great as would be the 
 
            case for any younger individual.  Vocational rehabilitation 
 
            counselor have indicated that claimant is able to secure at 
 
            least some part-time sedentary work.  Claimant has not 
 
            looked for such work preferring instead to remain employed 
 
            in a job with people he enjoys.  Obviously, if claimant had 
 
            been younger, the loss of earning capacity would have been 
 
            much greater.
 
            
 
                 It is found that the whirlpool therapy in June, July 
 
            and August 1989 is causally connected to both work injuries 
 
            herein.  Such treatment also constitutes reasonable and nec
 
            essary treatment of the injuries and was authorized.  Dr. 
 
            Coates stated in his office note of April 20, 1989 that he 
 
            would allow claimant to continue on his own therapy program.  
 
            This included the whirlpool therapy.  Dr. Coates was an 
 
            authorized physician.
 
            
 
                                conclusions of law
 
            
 
            
 
                 I.  Claimant has the burden of proving by a preponder
 
            ance of the evidence that claimant received an injury which 
 
            arose out of and in the course of employment.  The words 
 
            "out of" refer to the cause or source of the injury.  The 
 
            words "in the course of" refer to the time and place and 
 
            circumstances of the injury.  See Cedar Rapids Community 
 
            Sch. v. Cady, 278 N.W.2d 298 (Iowa 1979); Crowe v. DeSoto 
 
            Consol. Sch. Dist., 246 Iowa 402, 68 N.W.2d 63 (1955).  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 
 
            therein.
 
            
 
                 It is not necessary that claimant prove his disability 
 
            results from a sudden unexpected traumatic event.  It is 
 
            sufficient to show that the disability developed gradually 
 
            or progressively from work activity over a period of time.  
 

 
            
 
            Page   7
 
            
 
            
 
            
 
            
 
            McKeever Custom Cabinets v. Smith, 379 N.W.2d 368 (Iowa 
 
            1985).  The McKeever court also held that the date of injury 
 
            and gradual injury cases is the time when pain prevents the 
 
            employer from continuing to work.
 
            
 
                 In the case sub judice, a gradual injury was found for 
 
            the December 1987 injury.  Although it could be reasonably 
 
            argued that a different injury date should have been chosen 
 
            by the claimant in filing his petition under McKeever, there 
 
            is no issue of timeliness or rate in this case.  Therefore, 
 
            the exact date of the gradual injury is unimportant to this 
 
            decision.
 
            
 
                 II. Claimant must establish by a preponderance of the 
 
            evidence the extent of weekly benefits for permanent dis
 
            ability to which claimant is entitled.  As the claimant has 
 
            shown that the work injury was a cause of a permanent physi
 
            cal impairment or limitation upon activity involving the 
 
            body as a whole, the degree of permanent disability must be 
 
            measured pursuant to Iowa Code section 85.34(2)(u).  
 
            However, unlike scheduled member disabilities, the degree of 
 
            disability under this provision is not measured solely by 
 
            the extent of a functional impairment or loss of use of a 
 
            body member.  A disability to the body as a whole or an 
 
            "industrial disability" is a loss of earning capacity 
 
            resulting from the work injury.  Diederich v. Tri-City 
 
            Railway Co., 219 Iowa 587, 593, 258 N.W. 899 (1935).  A 
 
            physical impairment or restriction on work activity may or 
 
            may not result in such a loss of earning capacity.  The 
 
            extent to which a work injury and a resulting medical condi
 
            tion has resulted in an industrial disability is determined 
 
            from examination of several factors.  These factors include 
 
            the employee's medical condition prior to the injury, 
 
            immediately after the injury and presently; the situs of the 
 
            injury, its severity and the length of healing period; the 
 
            work experience of the employee prior to the injury, after 
 
            the injury and potential for rehabilitation; the employee's 
 
            qualifications intellectually, emotionally and physically; 
 
            earnings prior and subsequent to the injury; age; education; 
 
            motivation; functional impairment as a result of the injury; 
 
            and inability because of the injury to engage in employment 
 
            for which the employee is fitted.  Loss of earnings caused 
 
            by a job transfer for reasons related to the injury is also 
 
            relevant.  Olson v. Goodyear Service Stores, 255 Iowa 1112, 
 
            1121, 125 N.W.2d 251, 257 (1963).  See Peterson v. Truck 
 
            Haven Cafe, Inc., (Appeal Decision, February 28, l985).
 
            
 
                 Claimant also seeks additional disability benefits from 
 
            the Second Injury Fund under Iowa Code sections 85.63 
 
            through 85.69.  This fund was created to compensate an 
 
            injured worker for an industrial disability resulting from 
 
            the combined effect of two separate injuries to a scheduled 
 
            member.  The purpose of such a scheme of compensation was to 
 
            encourage employers to hire or retain war veterans and 
 
            handicapped workers.  See Anderson v. Second Injury Fund, 
 
            262 N.W.2d 789 (Iowa 1978).  There are three requirements 
 
            under the statute to invoke Second Injury Fund liability.  
 

 
            
 
            Page   8
 
            
 
            
 
            
 
            
 
            First, there must be a permanent loss or loss of use of one 
 
            hand, arm, foot, leg or eye.  Secondly, there must be a 
 
            permanent loss or loss of use of another such member or 
 
            organ through a compensable subsequent injury.  Third, there 
 
            must be permanent industrial disability to the body as a 
 
            whole arising from both the first and second injuries which 
 
            is greater in terms of relative weeks of compensation than 
 
            the sum of the scheduled allowances for those injuries.  If 
 
            there is a greater industrial disability due to the combined 
 
            effects of the prior loss and secondary loss than equals the 
 
            value of the prior and secondary losses combined, then the 
 
            fund will be charged with the difference.  Second Injury 
 
            Fund of Iowa v. Neelans, 436 N.W.2d 355 (Iowa 1989).
 
            
 
                 The Second Injury Fund is also not relieved of liabil
 
            ity simply because one or both of the injuries may also ex
 
            tend into the body as a whole.  Id.  However, when either 
 
            the first or second injuries extend into the body as a 
 
            whole, there is to be an apportioning process of the various 
 
            resulting industrial disabilities and respective liabili
 
            ties.  A determination of industrial disability must first 
 
            be made for each injury individually.  The employer at the 
 
            time of the second injury is liable for the difference, if 
 
            any, between the industrial disability of the second injury 
 
            alone and the industrial disability as a result of the com
 
            bined effect of both injuries.  The fund is liable for the 
 
            difference less the industrial disability found for the 
 
            first injury.  See Second Injury Fund of Iowa v. Braden, 459 
 
            N.W.2d 467, 470-471 (Iowa 1990).
 
            
 
                 In the case sub judice, claimant demonstrated by the 
 
            greater weight of the evidence that the combined effect of 
 
            both industrial disabilities from the first and second 
 
            injures resulted in a 40 percent industrial disability.  Of 
 
            this amount, the employer is liable for the 15 percent per
 
            manent partial disability found to have been caused solely 
 
            by the second injury.  The employer is liable also for the 
 
            15 percent permanent partial disability found caused by the 
 
            first injury.  The Fund, therefore, is liable for the dif
 
            ference, or for a 10 percent permanent partial disability.
 
            
 
                 Based upon these findings, claimant is entitled as a 
 
            matter of law to 75 weeks of permanent partial disability 
 
            benefits from the employer, Young Radiator, for each work 
 
            injury herein under Iowa Code section 85.34(2)(u), which is 
 
            15 percent of 500 weeks, the maximum allowable number of 
 
            weeks for an injury to the body as a whole in that subsec
 
            tion.  Claimant is also entitled as a matter of law to 50 
 
            weeks of permanent partial disability benefits from the 
 
            Second Injury Fund under Iowa Code section 85.34(2)(u), 
 
            which is 10 percent of 500 weeks, the maximum allowable for 
 
            an injury to the body as a whole in that subsection.
 
            
 
                 As claimant has established entitlement to permanent 
 
            partial disability benefits as a result of his December 7, 
 
            1987 injury, claimant is entitled to weekly benefits for 
 
            healing period under Iowa Code section 85.34(1) for the 
 
            periods of time stipulated he was off work.  Claimant is 
 

 
            
 
            Page   9
 
            
 
            
 
            
 
            
 
            also entitled to temporary partial disability benefits under 
 
            Iowa Code section 85.33(2) for the period of time he was 
 
            working part-time before reaching maximum healing.
 
            
 
                 III.  Pursuant to Iowa Code section 85.27, claimant is 
 
            entitled to payment of reasonable medical expenses incurred 
 
            for treatment of a work injury.  Claimant is entitled to an 
 
            order of reimbursement if claimant is paid those expenses.  
 
            Otherwise, claimant is entitled only to an order directing 
 
            the responsible defendants to make such payments.  See Krohn 
 
            v. State, 420 N.W.2d 463 (Iowa 1988).
 
            
 
                 In the case at bar, the only dispute concerns the 
 
            whirlpool treatment.  This was found reasonable, necessary 
 
            and authorized in the findings of fact.  However, even if 
 
            not authorized, defendants had no right to choose the 
 
            medical treatment for the December 7, 1987 injury as defen
 
            dants disputed liability for that injury.  This agency has 
 
            held that it is inconsistent to deny liability and the obli
 
            gation to furnish care on one hand and at the same time 
 
            claimant the right to choose the care.  Kindhart v. Fort Des 
 
            Moines Hotel, I Iowa Indus. Comm'r Dec. 611 (Appeal Dec. 
 
            1985); Barnhart v. Maq., Inc., I Iowa Indus Comm'r Rep. 16 
 
            (Appeal Dec. 1981).
 
            
 
                                      order
 
            
 
                 1. Defendants Young Radiator and Fireman's Fund 
 
            Insurance Company shall pay to claimant seventy-five (75) 
 
            weeks of permanent partial disability benefits at the rate 
 
            of two hundred eighteen and 20/100 dollars ($218.20) per 
 
            week from July 8, 1987 as a result of the injury of December 
 
            5, 1984.  Defendants Young Radiator and Fireman's Fund 
 
            Insurance Company shall pay to claimant an additional 
 
            seventy-five (75) weeks of permanent partial disability ben
 
            efits at the rate of two hundred eighteen and 20/100 dollars 
 
            ($218.20) per week from May 29, 1990 as a result of the 
 
            injury of December 7, 1987.
 
            
 
                 2. Defendants Young Radiator and Fireman's Fund 
 
            Insurance Company shall pay to claimant healing period bene
 
            fits as a result of the injury of December 7, 1987 from 
 
            February 2, 1988 through September 10, 1989, and for a 
 
            second period beginning on November 27, 1989 and extending 
 
            through May 28, 1990, at the rate of two hundred eighteen 
 
            and 20/100 dollars ($218.20) per week.  Defendants Young 
 
            Radiator and Fireman's Fund Insurance Company shall pay tem
 
            porary partial disability benefits from September 11, 1989 
 
            through November 26, 1989.
 
            
 
                 3.  Defendant Second Injury Fund shall pay to claimant 
 
            fifty (50) weeks of permanent partial disability benefits at 
 
            the rate of two hundred eighteen and 20/100 dollars 
 
            ($218.20) per week beginning on the seventy-sixth (76th) 
 
            week following the May 28, 1990 commencement of benefits by 
 
            defendants Young Radiator and Fireman's Fund.
 
            
 
                 4.  Defendants shall pay the whirlpool expenses re
 
            ferred to in the prehearing report.  Claimant shall be reim
 
            bursed for any of these expenses paid by him.  Otherwise, 
 

 
            
 
            Page  10
 
            
 
            
 
            
 
            
 
            defendants shall pay the provider directly along with any 
 
            lawful late payment penalties imposed upon the account by 
 
            the provider.
 
            
 
                 5.  Defendants shall pay accrued weekly benefits in a 
 
            lump sum and shall receive credit against this award for all 
 
            benefits previously paid.
 
            
 
                 6. Defendants Young Radiator and Fireman's Fund 
 
            Insurance Company shall receive credit for previous payments 
 
            of benefits under a nonoccupational group insurance plan, if 
 
            applicable and appropriate under Iowa Code section 85.38(2), 
 
            less any tax deductions from those payments.
 
            
 
                 7.  All defendants shall pay interest on weekly bene
 
            fits awarded herein as set for in Iowa Code section 85.30.
 
            
 
                 8. Defendants Young Radiator and Fireman's Fund 
 
            Insurance Company shall pay the costs of this action pur
 
            suant to 343 IAC 4.33, including reimbursement to claimant 
 
            for any filing fee paid in this matter.
 
            
 
                 9.  Defendants shall file activity reports upon payment 
 
            of this award as requested by this agency pursuant to 343 
 
            IAC 3.1.
 
            
 
                 Signed and filed this ____ day of May, 1991.
 
            
 
            
 
                                          ______________________________
 
                                          LARRY P. WALSHIRE
 
                                          DEPUTY INDUSTRIAL COMMISSIONER
 
            
 
            Copies to:
 
            
 
            Mr Daniel P Wilson
 
            Attorney at Law
 
            303 W State St
 
            P O Box 367
 
            Centerville IA 52544
 
            
 
            Mr Richard G Book
 
            Attorney at Law
 
            500 Liberty Bldg
 
            Des Moines IA 50309
 
            
 
            Ms Joanne Moeller
 
            Assistant Attorney General
 
            Tort Claims
 
            Hoover Building
 
            LOCAL
 
            
 
            
 
                 
 
            
 
                 
 
            
 
                 
 
            
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                      3201
 
                      Filed May 24, 1991
 
                      Larry P. Walshire
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            RAY E. STICKLER,              :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :      File No. 877854
 
                                          :               791857
 
            YOUNG RADIATOR COMPANY,       :
 
                                          :    A R B I T R A T I O N
 
                 Employer,                :
 
                                          :       D E C I S I O N
 
            and                           :
 
                                          :
 
            FIREMAN'S FUND INSURANCE CO., :
 
                                          :
 
                 Insurance Carrier,       :
 
                                          :
 
            and                           :
 
                                          :
 
            SECOND INJURY FUND OF IOWA,   :
 
                                          :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
            3101
 
            Second Injury Fund held liable for an excess industrial 
 
            disability caused by the combined effects of right and left 
 
            shoulder injuries occurring at separate times.