BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         GARY LEE MCKINNEY,
 
         
 
              Claimant,                                 File No. 793177
 
         
 
         vs.                                         A R B I T R A T I O 
 
         N
 
         
 
         VINERS, INC.,                                  D E C I S I O N
 
         
 
              Employer,                                    F I L E D
 
         
 
         and                                              JUN 30 1989
 
         
 
         U S F & G,                                   INDUSTRIAL SERVICES
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
                               INTRODUCTION
 
         
 
              This is a proceeding in arbitration brought by Gary Lee 
 
         McKinney against his former employer, Viners, Inc., and its 
 
         insurance carrier, U S F & G.  The case was heard and fully 
 
         submitted at Council Bluffs, Iowa on November 23, 1988.  The 
 
         record in the proceeding consists of testimony from Gary Lee 
 
         McKinney and Karen L. Stricklett.  The record also contains joint 
 
         exhibits 1, 3 through 13, 19 and 20, claimant's exhibits 14-18 
 
         and 21 and defendants' exhibit 22.
 
         
 
                                 ISSUE
 
         
 
              The only issue is determination of claimant's entitlement to 
 
         compensation for permanent disability.  An issue exists with 
 
         regard to whether the disability is a scheduled member disability 
 
         or whether it extends into the body as a whole.  Claimant seeks 
 
         compensation for permanent total disability.  The odd-lot 
 
         doctrine was not asserted at the time of the prehearing 
 
         conference and was not identified as an issue for hearing.
 
         
 
                           SUMMARY OF EVIDENCE
 
         
 
              The following is a summary of evidence presented in this 
 
         case.  Of all the evidence received at the hearing, only that 
 
         considered most pertinent to this decision is discussed. 
 
         Conclusions about what the evidence showed are inevitable with 
 
         any summarization.  The conclusions in the following summary 
 
         should be considered to be preliminary findings of fact.
 
         
 
              Gary Lee McKinney injured his left knee on March 4, 1985 
 
                                                
 
                                                         
 
         when he fell with his foot caught in the channel of the trailer 
 
         of the truck which he had been driving.  Claimant returned to the 
 
         Omaha, Nebraska area where he was treated by Michael J. Morrison, 
 
         M.D., an orthopaedic surgeon.  Claimant underwent an arthroscopic 
 
         procedure on March 12, 1985 consisting of a partial medial 
 
         meniscectomy.  Claimant continued to complain and exhibit a 
 
         restricted range of motion.  On April 26, 1985, a diagnostic 
 
         arthroscopic procedure was performed which showed no further 
 
         abnormalities.  Dr. Morrison released claimant to return to work 
 
         effective May 21, 1985 and assigned claimant a 10 percent 
 
         impairment rating of the left knee or leg (exhibit 1, page 3).
 
         
 
              Claimant next sought treatment for his knee from Patrick W. 
 
         Bowman, M.D., another orthopaedic surgeon.  Dr. Bowman followed 
 
         claimant's case for several months.  Eventually, on November 13, 
 
         1985, claimant made complaints to Dr. Bowman regarding his back 
 
         (exhibit 3, page 1).  A CT scan performed in November, 1985, 
 
         showed claimant to have a bulging disc at the L5-S1 level of his 
 
         spine as well as degenerative disc disease.  Dr. Bowman provided 
 
         treatment for claimant's back condition and, in June of 1986, the 
 
         CT scan was repeated.  It was essentially unchanged and continued 
 
         to show a bulge which did not impinge upon any neural tissues 
 
         (exhibit 3, page 5; exhibit 4; exhibit 8).
 
         
 
              In July, 1984, claimant was administered a functional 
 
         capacities test which produced results which indicated pain 
 
         magnification and a level of performance which was below 
 
         claimant's actual capabilities (exhibit 5, page 14; exhibits 4, 
 
         6, 9 and 11).
 
         
 
              Dr. Bowman indicated that claimant's back complaints were 
 
         probably related to gait abnormalities which in turn were related 
 
         to the problem with claimant's knee (exhibit 5; exhibit 19, pages 
 
         9-12).
 
         
 
              Claimant was evaluated by Michael T. O'Neil, M.D., who found 
 
         claimant to have an impairment of his knee and back pain (exhibit 
 
         15).
 
         
 
              Dr. Bowman assigned claimant a five percent permanent 
 
         impairment rating of the body as a whole due to an assumed 
 
         chronic musculoligamentous back strain with mild underlying and 
 
         predating degenerative disc disease (exhibit 7, page 1; exhibit 
 
         19, page 12).  Dr. Bowman was not aware of claimant having any 
 
         back problems prior to the March, 1985 accident (exhibit 19, page 
 
         13). Dr. Bowman felt that claimant was not totally disabled and 
 
         that it would be beneficial for him to return to work (exhibits 7 
 
         and 12).
 
         
 
              Claimant was evaluated by J. Fernandez, M.D., a 
 
         psychiatrist, on August 13, 1987.  Dr. Fernandez concluded that 
 
         claimant exhibited chronic pain syndrome and reactive depression 
 
         and that secondary gain affected claimant's symptoms.
 
         
 
              Claimant was seen by a vocational consultant, Ray Macrander, 
 
                                                
 
                                                         
 
         who felt that claimant was so severely disabled that there was no 
 
         point in attempting vocational rehabilitation (exhibit 16).
 
         
 
              Physician Kenneth A. Rodabaugh, M.D., indicated on September 
 
         18, 1987 that claimant was permanently disabled and was,unable to 
 
         seek work or participate in a rehabilitation program (exhibit 
 
         18).
 
         
 
              Claimant has been awarded Social Security disability, which 
 
         was based, to a large extent, on his pain complaints (exhibit 
 
         21).
 
         
 
              Claimant stated that he has consistently reported back 
 
         complaints to all his physicians, including Dr. Morrison when he 
 
         first saw Dr. Morrison.  Claimant stated that Dr. Morrison told 
 
         him that repairing his knee might resolve the back problems. 
 
         Claimant testified that Dr. Morrison also told him that his 
 
         changed gait was making his back hurt.
 
         
 
              Claimant testified that he has used a cane since recuperating 
 
         from his knee surgery.  He stated that he has pain in his joint 
 
         and pain in the middle of his back.  Claimant stated that he is, 
 
         restricted from bending, lifting and kneeling.  He stated that he 
 
         is unable to walk well and needs a cane to stand or walk.  
 
         Claimant testified that he has looked for employment, but found 
 
         none.  He was unable to find anyone who would even discuss it with 
 
         him. Claimant estimated that he can sit for approximately five 
 
         minutes. He stated that his mental state is not good.  Claimant 
 
         testified that his ability to drive is limited and that it was 
 
         necessary for him to stop during the 36-mile drive from his home 
 
         to the hearing.
 
         
 
              Claimant's work history consists primarily of occupations 
 
         involving manual labor and physical activity.  He dropped out of 
 
         school following the eighth grade and has no demonstrated 
 
         academic aptitude.  Claimant is 47 years of age.
 
         
 
                       APPLICABLE LAW AND ANALYSIS
 
         
 
              The claimant has the burden of proving by a preponderance of 
 
         the evidence that the injury of March 4, 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).
 
         
 
              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).
 
         
 
              Where an injury is limited to a scheduled member, the loss 
 
         is measured functionally, not industrially.  Graves v. Eagle Iron 
 
         Works, 331 N.W.2d 116 (Iowa 1983).
 
         
 
              An injury to a scheduled member may, because of after 
 
         effects (or compensatory change), result in permanent impairment 
 
         of the body as a whole.  Such impairment may in turn form the 
 
         basis for a rating of industrial disability.  Dailey v. Pooley 
 
         Lumber Co., 233 Iowa 758, 10 N.W.2d 569 (1943).  Soukup v. Shores 
 
 
 
                       
 
                                                         
 
         Co., 222 Iowa 272, 268 N.W. 598 (1936).
 
         
 
              An injury to a scheduled member which, because of 
 
         after-effects (or compensatory change), creates impairment to the 
 
         body as a whole entitles claimant to industrial disability.  
 
         Barton v. Nevada Poultry Co., 253 Iowa 285, 110 N.W.2d 660 
 
         (1961).  Daily v. Pooley Lumber Co., 233 Iowa 758, 10 N.W.2d 569 
 
         (1943).
 
         
 
              From the evidence, it appears that the primary trauma that 
 
         occurred on March 4, 1985 was to claimant's left knee.  While he 
 
         likely bumped his back, there is no evidence in any of the 
 
         medical records of any complaint s regarding claimant's back 
 
         until November of 1985.  It is therefore determined that 
 
         claimant's back was not initially, directly injured on March 4, 
 
         1985.
 
         
 
              For injury resulting from trauma to a scheduled member to be 
 
         compensated industrially, the claimant must prove the existence 
 
         of physical injury and impairment, accompanied by some 
 
         identifiable derangement or change and disability which extends 
 
         beyond the scheduled member.  He must also prove that the change 
 
         was proximately caused by the injury to the scheduled member.  
 
         Lauhoff Grain Co. v. McIntosh, 395 N.W.2d 834 (Iowa 1986); 
 
         Kellogg v. Shute and Lewis Coal Co., 256 Iowa 1257, 130 N.W.2d 
 
         667 (1964); Dailey v. Pooley Lumber Co., 233 Iowa 7581 10 N.W.2d 
 
         569 (1943). The only identifiable structural changes to 
 
         claimant's back are the degenerative disc disease and the bulging 
 
         disc.  No physician has indicated that either of those conditions 
 
         were in any manner caused by the March, 4, 1985 fall or any 
 
         continuing problem with claimant's left knee.
 
         
 
              Dr. Bowman has indicated that back complaints are not 
 
         uncommon for people who have an altered gait.
 
         
 
              Claimant's back complaints are apparently quite subjective. 
 
         When claimant was examined by Dr. Bowman on July 9, 1987, as 
 
         shown in exhibit 5, his straight leg raising test was positive at 
 
         45 degrees while only a few months earlier, when he was examined 
 
         by Dr. O'Neil, the same test was negative to 90 degrees, a result 
 
         which is generally considered to be normal.  The CT scans 
 
         consistently show that the bulging disc is not impinging upon any 
 
         of claimant's nerves and for that reason, the physicians have not 
 
         recommended any surgical treatment for claimant's back 
 
         condition.
 
         
 
              Claimant's back complaints first appear in the record 
 
         several months following the knee injury, despite the fact that 
 
         claimant testified that he had made back complaints consistently 
 
         following the injury.  There is reason to question the 
 
         credibility of claimant's back complaints.  This case further 
 
         presents a functional capacities assessment test wherein it was 
 
         indicated that the claimant was magnifying his symptoms and was 
 
         not performing up to his actual capabilities.  This is further 
 
         evidence that claimant's complaints are not as he alleges.  A 
 
                                                
 
                                                         
 
         further detractor from claimant's credibility is that, according 
 
         to the physicians, his knee has recovered and no identifiable 
 
         abnormality exists.  He does not appear to be afflicted with 
 
         fluid or swelling.  He complains only of pain and exhibits a 
 
         restricted range of motion.
 
         
 
              Upon examining claimant's appearance and demeanor as he 
 
         testified and upon considering all the evidence in the record, 
 
         particularly that from the medical practitioners, it is 
 
         determined that, if claimant has any problems with his back as a 
 
         result of an altered gait, the alteration of his gait is a result 
 
         of claimant's intentional effort to maximize his workers' 
 
         compensation recovery. In view of the claimant's impaired 
 
         credibility, his disability will be determined primarily based 
 
         upon the objective medical evidence which is in the record of 
 
         this case.  That evidence shows a 10 percent impairment of 
 
         claimant's left knee resulting from the injury.  The evidence 
 
         fails to show that there is any disability in claimant's back 
 
         which was proximately caused, directly or indirectly, by the 
 
         March 4, 1985 injury, other than perhaps some possible strain 
 
         resulting from claimant's attempt to make his disability appear 
 
         greater than it is.  Any injury resulting from such a source 
 
         would not be compensable due to the provisions of Code section 
 
         85.16(1) since it would essentially constitute willful 
 
         self-injury.
 
         
 
              It is therefore determined that claimant has been fully paid 
 
         all amounts which he is due under the Iowa workers' compensation 
 
         laws.
 
         
 
                            FINDINGS OF FACT
 
         
 
              1.  Claimant has a 10 percent permanent partial disability 
 
         of his left leg which was proximately caused by the injuries he 
 
         sustained on March 4, 1985.
 
         
 
              2.  Claimant has failed to introduce evidence showing it to 
 
         be more likely than not that he injured his back either in the 
 
         fall that he sustained on March 4, 1985 or as an indirect result 
 
         of the injury to his knee.
 
         
 
              3.  The evidence fails to show any discernible physical 
 
         abnormality or derangement affecting claimant's back which was 
 
         proximately caused by the March 4, 1985 injury, either directly 
 
         or indirectly.
 
         
 
              4.  Claimant has failed to establish the credibility of his 
 
         complaints.
 
         
 
                            CONCLUSIONS OF LAW
 
         
 
              1.  This agency has jurisdiction of the subject matter of 
 
         this proceeding and its parties.
 
         
 
              2.  Claimant has a 10 percent permanent partial disability 
 
                                                
 
                                                         
 
         of his left leg which entitles him to receive 22 weeks of 
 
         compensation under the provisions of Iowa Code section 
 
         85.34(2)(o), all of which has been previously paid.
 
         
 
              3.  Claimant's disability is limited to his leg and does not 
 
         extend into the body as a whole.
 
         
 
                                  ORDER
 
         
 
              IT IS THEREFORE ORDERED that claimant take nothing from this 
 
         proceeding.
 
         
 
              IT IS FURTHER ORDERED that the costs of this proceeding are 
 
         assessed against claimant pursuant to Division of Industrial 
 
         Services Rule 343-4.33.
 
         
 
              IT IS FURTHER ORDERED that defendants file claim activity 
 
         reports as requested by this agency pursuant to Division of 
 
         Industrial Services Rule 343-3.1.
 
         
 
              Signed and filed this 30th day of June, 1989.
 
         
 
         
 
         
 
         
 
         
 
         
 
         
 
                                            MICHAEL G. TRIER
 
                                            DEPUTY INDUSTRIAL 
 
                                            COMMISSIONER
 
         
 
         Copies To:
 
         
 
         Mr. Jon H. Johnson
 
         Attorney at Law
 
         P.O. Box 659
 
         Sidney, Iowa  51652
 
         
 
         Mr. W. Curtis Hewett
 
         Attorney at Law
 
         P.O. Box 249
 
         Council Bluffs, Iowa  51502
 
         
 
         
 
         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                
 
 
            
 
 
 
 
 
            
 
 
 
                                            51402.40, 51803.1
 
                                            Filed June 30, 1989
 
                                            MICHAEL G. TRIER
 
         
 
                  BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         GARY LEE MCKINNEY,
 
         
 
              Claimant,
 
         
 
         vs.                                           File No. 793177
 
         
 
         VINERS, INC.,                              A R B I T R A T I 0 N
 
         
 
              Employer,                                D E C I S I 0 N
 
         
 
         and
 
         
 
         U S F & G,
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
         51402.40, 51803.1
 
         
 
              Claimant fell and suffered a clear injury to his left knee. 
 
         It was treated by arthroscopic surgery and rated as having a 10 
 
         percent impairment.  Claimant, approximately eight months after 
 
         the injury, began to voice complaints of back pain.  The evidence 
 
         failed to show any abnormalities in claimant's back that were 
 
         proximately caused by the fall.  Claimant exhibited an altered 
 
         gait and walked with a cane, but his leg complaints were 
 
         determined not to be credible.  If claimant's altered gait had 
 
         produced a chronic back strain, such was a result of claimant's 
 
         efforts to exaggerate the difficulties with his knee.
 
         
 
         
 
         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                
 
 
        
 
 
 
 
 
        
 
        
 
                    BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
        
 
        
 
        JAN BURK,
 
        
 
            Claimant,
 
                                                        File No. 793416
 
        vs.
 
        
 
        DEPARTMENT OF HUMAN SERVICES,                   A R B I T R A T 
 
        I O N
 
        
 
            Employer,                                  D E C I S I O N
 
        
 
        vs.
 
                                                     F I L E D
 
        STATE OF IOWA,
 
                                                    MAY 18 1989
 
            Insurance Carrier,
 
            Defendants.                   IOWA INDUSTRIAL COMMISSIONER
 
        
 
        
 
                                      INTRODUCTION
 
        
 
             This is a proceeding in arbitration brought by the claimant, 
 
             Jan Burk, against the Department of Human Services, employer, and 
 
             State of Iowa, insurance carrier, to recover benefits as a result 
 
             of an injury sustained on April 22, 1985. This matter came on 
 
             for hearing before the undersigned deputy industrial commissioner 
 
             in Sioux City, Iowa, on March 30, 1989. The record consists of 
 
             the testimony of claimant; Wallace Burk, claimant's spouse; and 
 
             Lyle Fleshner; joint exhibit l; claimant's exhibits 1, 2(A) 
 
             through (J), 3(A) through (G), 4, 5, 6, 7(A) through (H), and 8; 
 
             and defendants' exhibit A through J.
 
        
 
                                      ISSUES
 
        
 
             Pursuant to the prehearing report, the issues for resolution 
 
             are:
 
        
 
            1. Whether claimant's disability is causally connected to 
 
        her injury of April 22, 1985;
 
        
 
            2. The extent of claimant's permanent disability;
 
        
 
            3. If benefits are awarded, the appropriate weekly rate of 
 
        compensation; and
 
        
 
            4. Whether there was authorization under 85.27.
 
        
 
                                 REVIEW OF THE EVIDENCE
 
        
 
             Claimant testified that on April 22, 1985, she was injured 
 
             in an automobile accident when she was driving to pay a surprise 
 
             visit to a customer of defendant employer. Claimant indicated 
 
             that another vehicle had failed to stop at a stop sign and 
 
             claimant was hit broadside on the driver's side. Claimant 
 
             testified that at the time of the accident, she was employed in 
 
             three part-time jobs, the three employers being Iowa Department 
 
             of Human Services, Crawford County; Ida County Shelter 
 
             Industries; and West Tech Community College. Claimant indicated 
 

 
        
 
 
 
 
 
             that her income from the three jobs amounted to $11,069.17 over 
 
             the twelve months prior to the date of her accident. Claimant 
 
             began working full-time for the Department of Human Services on 
 
             October 1, 1988.
 
        
 
             Claimant stated she had had no accidents, injuries, prior 
 
             back problems, facial scarring or noncorrectable eye loss prior 
 
             to April 22, 1985. Claimant acknowledged that at the time of the 
 
             accident, her driver's license was restricted to eye lenses to 
 
             correct nearsightedness. Claimant testified that she had a 
 
             second accident on September 9, 1988. Claimant contends the 
 
             accident did not affect her vision, nor did it affect her back 
 
             which was injured in the April 22, 1985 accident, but that it did 
 
             affect her neck. Claimant testified that as a result of her 
 
             April 22, 1985 accident, she was knocked unconscious and did not 
 
             remember some of the details of the accident. Claimant indicated 
 
             that the April 1985 accident caused injury to her left eye, left 
 
             shoulder, various lacerations on her face and forehead, two front 
 
             teeth were knocked out, three broken ribs, three facial fractures 
 
             around the left eye, and a cut to her jaw bone. Claimant 
 
             indicated that she has permanent nerve damage on the upper 
 
             left-hand side of her head above her eyebrow, resulting in her 
 
             being unable to wrinkle her forehead on that side. Claimant also 
 
             stated that as a result of this April 22, 1985 injury, she has a 
 
             10 percent loss of vision after correction caused by a scar in 
 
             the middle of her cornea. Claimant testified that she had 
 
             reconstruction surgery on her face beginning April 22, 1985 and 
 
             needed additional plastic surgery and reconstruction, but did not 
 
             go back to the plastic surgeon as she did not know who was going 
 
             to pay the bill and was already being harassed by collection 
 
             agencies for existing medical bills. Claimant also indicated that 
 
             she will need future plastic surgery and reconstruction in ten to 
 
             twenty years.
 
        
 
            Claimant was released to return to work by Dr. Bleicher on 
 
        July 5, 1985, and on that date she returned to her three 
 
        part-time jobs she had at the time of the accident.
 
        
 
            Claimant testified that she currently takes Advil and 
 
        Nuprin, as needed, three or four times a day, and sometimes as 
 
        many as eight a day and uses a heating pad a lot due to her neck 
 
        pain and back spasms. Claimant stated she uses an adaptive chair 
 
        because of her back pain. Claimant indicated that her job 
 
        requires her to drive and sit for long periods. Claimant 
 
        testified that her present restrictions are the things she can't 
 
        do because of the April 22, 1985 accident, and they are: cannot 
 
        lift over 20 pounds; cannot do household chores; cannot help her 
 
        husband with the farm chores, which includes lifting feed 
 
        buckets, climbing over fences in connection with her feeding 
 
        livestock; cannot haul and unload wood for the family's wood 
 
        burning stove; cannot roller-skate or golf; cannot hold her 
 
        children; her eye scar affects her desire to read and do 
 
        handcraft work; and several other tasks she used to do. Claimant 
 
        acknowledged that no doctor has currently placed any weight 
 
        restriction on her, but claimant indicated that she knows if she 
 
        lifts that amount or carries her child for awhile, her back gives 
 
        out.
 
        
 
             On cross-examination, claimant acknowledged that she had a 
 
             serious nonwork-related accident on September 9, 1988, resulting 
 
             in a broken neck, vertebra surgery, various head and leg cuts and 
 
             bruises, and knocked out her two front teeth, which were 
 
             replacements for the same two original front teeth knocked out in 
 
             her April 22, 1985 accident. Claimant indicated that due to this 
 
             second accident, the dentist had to take out a third front tooth 
 
             in order to adequately replace and secure the other two teeth 
 

 
        
 
 
 
 
 
             that were again knocked out. Claimant now has three fake front 
 
             teeth. Claimant also indicated that her five year old son was 
 
             killed in the September 1988 accident. Claimant contends that 
 
             her low back problems are the result of her injury of April 22, 
 
             1985, and were not affected by her September 9, 1988 accident 
 
             but, in fact, remains the same. Claimant stated she has not 
 
             continued to do her walking program she started after her first 
 
             accident. Claimant indicated she continues to use the adaptive 
 
             chair.
 
        
 
            Claimant testified that she had interviewed on September 9, 
 
        1988, before the second accident occurred for a full-time 
 
        Department of Human Services job and was offered this job on 
 
        October 1, 1988 at a salary of $18,000 plus added benefits, full 
 
        health single premium and dental insurance. Claimant related 
 
        this to $12.32 per hour plus benefits on her current job versus 
 
        her income on April 22, 1985 at $8.52 per hour with only benefits 
 
        being health insurance, which was paid half and half between the 
 
        employer and employee and involved working only part-time. 
 
        Claimant acknowledged that she has received the highest score on 
 
        her state evaluation, both from working part-time and now after 
 
        working six months full time. Claimant acknowledged she has had 
 
        no loss of income as a result of her April 22, 1985 accident, but 
 
        stated that if she sought new employment her back may be a 
 
        problem. Claimant testified that she thought the scar on the 
 
        left side of her face caused by the April 22, 1985 accident could 
 
        affect her employment or earning capacity. Claimant described 
 
        how the young children with whom she comes in contact in 
 
        connection with her social work for the state inquire as to what 
 
        happened in relation to her facial scar. Claimant indicated that 
 
        the young notices this scar more than the adults. Claimant 
 
        believes this scar impairs her ability to do her job as it raises 
 
        questions as to whether she was in a fight.
 
        
 
             Wallace Burk, claimant's husband, testified that on April 
 
             22, 1985, he was a self-employed farmer and also worked as a 
 
             self-employed for another farmer. Burk testified that due to his 
 
             wife's accident he had to quit his job working for the other 
 
             farmer. Mr. Burk indicated that prior to April 22, 1985, his 
 
             wife did the chores at the farm so he could leave early to work 
 
             for the other farmer in order to milk cows. Mr. Burk described 
 
             the various jobs his wife did, which included helping feed the 
 
             cattle, climbing over fences to make it easier to feed the 
 
             livestock, and the necessity of her lifting. Mr. Burk indicated 
 
             that his wife can no longer do those farm chores plus many other 
 
             chores that she used to do around the house which involved 
 
             lifting. Mr. Burk indicated that his wife's health was good 
 
             prior to this April 22, 1985 injury and that she had no prior 
 
             back problems nor any eye problems except that she wore contacts. 
 
             Mr. Burk indicated that his wife uses the heating pad because of 
 
             her pain, and that she is unable to do the third in a series of 
 
             three exercises prescribed by the doctor which involves using a 
 
             rubber band. Mr. Burk contends that the April 22, 1985 accident 
 
             affected claimant's body movements, she can't lift as much, must 
 
             be careful when walking, that she doesn't run, can't sit as long 
 
             or get up and stretch. Mr. Burk contends it has affected her 
 
             standing, her posture, long distance driving, can't climb or step 
 
             over fences, or lift feed to feed the livestock.
 
        
 
            Lyle Fleshner, a social service director for the Department 
 
        of Human Services, State of Iowa, testified that he hired 
 
        claimant in February 1985 to work part-time for Crawford County 
 
        and that he hired claimant full-time to work in Ida County for 
 
        the Department of Social Services. Fleshner stated that 
 
        claimant's work involves working with families and children 
 
        involving child abuse, removal of children or plans for foster 
 

 
        
 
 
 
 
 
        home care and treatment for the child and the family. Fleshner 
 
        indicated that he was very pleased with claimant's social work, 
 
        that she was an excellent employee in April 1985, and that since 
 
        becoming a full-time employee, she has also received the highest 
 
        rating. Fleshner indicated that the claimant can continue 
 
        working for the Department of Human Services as long as she wants 
 
        to.
 
        
 
            Joel N. Bleicher, M.D., had been asked to see the claimant 
 
        when she was brought into the St. Joseph Hospital emergency 
 
        department, in Omaha, Nebraska, on April 22, 1985. On July 15, 
 
        1987, Dr. Bleicher wrote:
 
        
 
                  At the time of my initial examination, Ms. Burk had 
 
                      extensive facial lacerations and avulsions of tissue from 
 
                      the left side of her face. These were treated with suture 
 
                      repair and she was later returned to the operating room on 
 
                      April 29, 1985, where she underwent an open reduction 
 
                      internal fixation of her left zygoma. Ms. Burk was 
 
                      ultimately discharged from that hospitalization, and was 
 
                      seen for follow-up in the office on numerous occasions. 
 
                      Because of residual scarring and deformity from this 
 
                      injury, she was most recently returned to the operating room 
 
                      where she underwent further revisional surgery and 
 
                      dermabrasion. She has continuously been seen on an 
 
                      outpatient basis periodically between the surgeries for 
 
                      examination and care.
 
             
 
                  My diagnosis at the time of her injury was multiple 
 
                      facial lacerations, contusions, abrasions and avulsion of 
 
                      soft tissue from the face. She also had a diagnosis of a 
 
                      malar fracture and laceration of the frontal branch of the 
 
                      facial nerve. The patient's overall prognosis is good, 
 
                      however, she does have considerable residual scarring and 
 
                      deformity as a result of this injury. This includes a 
 
                      permanent paralysis of the frontalis muscle. In the future, 
 
                      she will require further surgical procedures to improve the 
 
                      appearance and functions from this injury. The deficit to 
 
                      the facial nerve results in the inability to move the 
 
                      forehead and brow and this may require further revisional 
 
                      surgery in the future, and quite frequently, as the patient 
 
                      ages, may require a surgical procedure as much as ten or 
 
                      twenty years from now.
 
             
 
        (Exhibit 3(B), page l)
 
        
 
             Ira A. Priluck, M.D., was requested to see the claimant by 
 
             Dr. Bleicher on April 22, 1985,and after the claimant had been 
 
             life flighted to the hospital and he wrote the following:
 
        
 
             Eye Examination revealed the vision to be 20/30, right eye 
 
             and 10/400, left eye. Pinhole improved her vision to 20/25, 
 
             right eye and 20/80+2, left eye.
 
             
 
             IMPRESSION:
 
             
 
             l) Corneal abrasion and corneal edema, centrally, left eye.
 
             2) Traumatic iritis, left eye. 3) Retinal edema, left eye.
 
             3) Retinal edema, left eye.
 
             
 
        (Cl. Ex. 3(C), page 4)
 
        
 
            Dr. Priluck wrote on August 30, 1985:
 
        
 
             Re-examination of your client Mrs. Jan D. Burk revealed best 
 
             corrected vision of 20/20, right eye and 20/30, left eye.
 

 
        
 
 
 
 
 
             
 
                  Examination of her right eye was unremarkable. 
 
                      Significant occular findings of her left eye revealed a 
 
                      permanent corneal scar. The corneal scar is a direct result 
 
                      of her initial ocular trauma sustained in the auto accident. 
 
                      Because of the corneal scar, her vision cannot be corrected 
 
                      better than 20/30.
 
             
 
               The 20/30 visual acuity of her left eye represents a 10% 
 
             loss of central vision. This is permanent.
 
             
 
        (Cl. Ex. 3(C), p. 10)
 
        
 
             Dr. Priluck re-examined claimant on March 20, 1987 and 
 
             pursuant to that examination wrote:
 
                  
 
                  Re-examination of Mrs. Burk on March 20, 1987, revealed 
 
                      20/20 vision, right eye, with correction and 20/30 vision, 
 
                      left eye, with correction.
 
                  
 
                  Without correction, her visual acuity was 20/80, right 
 
                      eye, and 20/50, left eye.
 
                  
 
                  Ocular examination revealed complete healing from her 
 
                      previous episode of ocular trauma.
 
                  
 
                  The uncorrected visual acuity of 20/80 in her right eye 
 
                      represents a 40% loss of central vision. The uncorrected 
 
                      vision of 20/50 in her left eye represents a 25% loss of 
 
                      central vision.
 
             
 
        (Cl. Ex. 3(C), p. 13)
 
        
 
             Richard P. Murphy, M.D., opined that the claimant has 
 
             sustained a 15 percent whole body permanent impairment. Dr. 
 
             Murphy testified that this 15 percent would be based on the 
 
             muscle spasm, the rigidity and pain and relied, in evaluating the 
 
             pain, on what claimant told him. Dr. Murphy admitted that this 
 
             was a subjective evaluation. Dr. Murphy also emphasized that 
 
             claimant had no limitation and that his 15 percent rating was not 
 
             based on any kind of limitation in range of motion. (Ex. 4, p. 
 
             19) Dr. Murphy also testified that claimant has no limitation in 
 
             bending or twisting and at the time of his deposition of December 
 
             3, 1987, he did not indicate that the claimant would need any 
 
             further treatment for her neck or back. Dr. Murphy did indicate 
 
             that claimant's impairment would affect her work around the home 
 
             involving her normal housework and lifting and repetitive 
 
             activities would increase pain, but Dr. Murphy mentioned nothing 
 
             about any specific weight or pound limitation. Dr. Murphy was 
 
             asked:
 
        
 
             Q. Will she have a limitation in the amount or the weight 
 
             she can lift?
 
             
 
             A. Yes. The amount of weight that she could lift would be 
 
             within the limits of the pain and discomfort.
 
             
 
        (Richard P. Murphy, M.D., Deposition, page 14)
 
        
 
             David Boarini, M.D., examined the claimant on February 19, 
 
             1988, and subsequently wrote:
 
        
 
                  I think this patient has some mild residual myofascial 
 
                      back and neck pain. She has an intact neurological 
 
                      examination and only a minimal loss of range of motion in 
 
                      the lower back. I would recommend no further testing. I 
 

 
        
 
 
 
 
 
                      think simple symptomatic treatment with anti-inflammatories 
 
                      would be best. I would put no specific work restrictions 
 
                      upon her, although obviously heavy lifting and repetitive 
 
                      bending or twisting would probably not be tolerated. I 
 
                      would rate her as a 2-3% permanent partial impairment, based 
 
                      upon her residual decreased range of motion.
 
             
 
        (Defendants' Exhibit A, page 2)
 
        
 
             Claimant's medical record at St. Joseph Hospital involving 
 
             her September 9, 1988 automobile accident reflects the following:
 
        
 
                  HOSPITAL COURSE: The patient was admitted to the 
 
                      Intensive Care Unit. Plastic surgery consult was obtained 
 
                      and the patient underwent repair of the scalp laceration 
 
                      under local anesthesia. She was then placed on 
 
                      Gardner-Wells tongs and was placed on a Stryker frame for 
 
                      traction of the cervical vertebrae. The patient remained 
 
                      stable, awake, alert and oriented x 3. She continued to do 
 
                      well with incentive spirometry and had no respiratory 
 
                      distress. Serial lateral cervical spine revealed persistent 
 
                      subluxation of C-2, however the neural foramena was well 
 
                      aligned. The serial CBC's were obtained and revealed very 
 
                      slow decrease in hemoglobin. On September 12, the 
 
                      hemoglobin was noted to be 8.6 and hematocrit 25.2. The 
 
                      patient was then given 2 units of packed red blood cells 
 
                      with increase of the hemoglobin to 10.9 and hematocrit of 
 
                      31.9. After further discussion with the patient and her 
 
                      family, the decision was made to perform a posterior 
 
                      cervical fusion. The patient underwent posterior cervical 
 
                      fusion of C-l -and C-2 on September 15 without any 
 
                      complications. Postoperatively she continued to do well and 
 
                      was awake, alert and could move all extremities. The 
 
                      patient gradually was able to sit up on postoperative day 1 
 
                      with continued encouragement was able to ambulate and by 
 
                      postoperative day 3 she was able to ambulate in the hall 
 
                      with assistance. The scalp lacerations were also healing 
 
                      well. The patient had her sutures removed on postoperative 
 
                      day 18 and was discharged home on September 23. She is to 
 
                      be followed up with Dr. Fruin in one week. She will also be 
 
                      followed up with Dr. Stromberg for plastic surgery in one 
 
                      week. She was also given an appointment for mammogram.
 
                  
 
        (Def. Ex. I, p. 37)
 
        
 
                                 LAW AND ANALYSIS
 
             
 
             The claimant has the burden of proving by a preponderance of 
 
             the evidence that the injury of April 22, 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).
 
             
 
             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).
 
             
 
             As a claimant has an impairment to the body as a whole, an 
 
             industrial disability has been sustained. Industrial disability 
 
             was defined in Diederich v. Tri-City Railway Co., 219 Iowa 587, 
 
             593, 258 N.W. 899, 902 (1935) as follows: "It is therefore plain 
 
             that the legislature intended the term 'disability' to mean 
 
             'industrial disability' or loss of earning capacity and not a 
 
             mere 'functional disability' to be computed in the terms of 
 
             percentages of the total physical and mental ability of a normal 
 
             man."
 
             
 
             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).
 
             
 
             This 34-year-old claimant has a college degree and is highly 
 
             motivated. Prior to becoming employed full-time on October 1, 
 
             1988 with the Department of Human Services, the claimant held 
 
             three part-time jobs at the time of her injury on April 22, 1985. 
 
             Claimant was injured while driving an automobile on her way to 
 
             see a client of the defendant employer, which was in connection 
 
             with the social service work that the claimant was performing as 
 
             a part of her job. The greater weight of medical testimony 
 
             causally connects the claimant's loss of vision in her left eye 
 
             and her current low back problems to her injury of April 22, 
 
             1985. The undersigned therefore finds that there is a causal 
 
             connection between the claimant's eye and low back impairments to 
 
             this April 22, 1985 accident.
 
             
 
             The evidence is undisputed that the claimant has a better 
 
             job, which is now full-time, and earning considerable more money 
 
             than she had at the time of her accident, plus she has 
 
             substantially more benefits. Claimant has had the highest 
 
             ratings or evaluations by her employer, the State of Iowa, during 
 
             the time that she was working for the state both part-time and 
 
             now full-time and her supervisor indicated that the claimant 
 
             could stay on the job as long as she wanted it. It is obvious 
 
             from the records that the claimant is an intelligent individual 
 
             and does her social services work very well.
 
             
 
             Dr. Murphy opined a 15 percent impairment to the body as a 
 
             whole, but he also testified that claimant had no limitation of 
 
             motion or functional limitation and that he based this on 
 
             claimant's muscle spasms, the rigidity and pain, and that it was 
 
             a subjective evaluation. Dr. Boarini opined a 2 to 3 percent 
 
             impairment to the body as a whole. Dr. Boarini based his opinion 
 
             on the claimant's residual decreased range of motion. Neither 
 
             Dr. Murphy or Dr. Boarini actually put any weight restrictions on 
 
             the claimant but it was obvious that heavy lifting or repetitive 
 
             bending or twisting would not be tolerated. The evidence shows 
 
             that claimant was in another very serious automobile accident 
 
             which was not work related. All of the medical evidence as to 
 
             the above impairments was made prior to the time of claimant's 
 
             second accident on September 9, 1988. The undersigned finds that 
 
             the claimant has a 10 percent impairment to her body as a whole 
 
             as a result of her back injury caused by her April 22, 1985 
 
             injury.
 
             
 

 
        
 
 
 
 
 
             Medical evidence indicates that the claimant injured her 
 
             left eye as a result of this April 22, 1985 injury and that she 
 
             has a loss of vision. Dr. Priluck opined that the claimant had a 
 
             10 percent loss of vision in her left eye based on her vision 
 
             corrected prior to the accident and as corrected subsequent to 
 
             the April 22, 1985 accident. Dr. Priluck also opined that the 
 
             claimant had a 25 percent loss of vision in the left eye based on 
 
             her uncorrected vision after the accident. There is no medical 
 
             evidence that has determined the claimant's actual vision 
 
             uncorrected prior to her April 1985 injury. Therefore, there is 
 
             no way to determine the percent of loss of her left eye pre and 
 
             post-injury, uncorrected. It cannot be assumed, as the claimant 
 
             likes to contend, that the claimant had a 20/20 vision in her 
 
             left eye prior to the accident uncorrected. In fact, the medical 
 
             testimony indicates that claimant had corrective devices for both 
 
             eyes prior to the accident, and it appears her right eye, which 
 
             is not involved, had substantial loss of vision before and after 
 
             her April 1985 accident from which one could infer that her left 
 
             eye was not perfect or at least not 20/20 prior to the accident. 
 
             The undersigned finds that the claimant incurred a 10 percent 
 
             loss of vision in her left eye, which was causally connected to 
 
             her April 22, 1985 injury.
 
        
 
             The claimant has not had a loss of earnings, but it is not 
 
             the loss of earnings but a loss of earning capacity that 
 
             determines the extent of claimant's industrial disability. 
 
             Taking into consideration the claimant's age, education, 
 
             motivation, and other things that determine industrial 
 
             disability, the undersigned finds that the claimant has an 8 
 
             percent industrial disability due to her low back injury of April 
 
             22, 1985.
 
        
 
            The claimant has a noticeable scar on the left side of her 
 
        face. It appears from the evidence that over time this will not 
 
        only get better but there could be additional plastic surgery 
 
        that can lessen the effect of this scar. It appears that the 
 
        claimant has not done anything further to lessen the scar's 
 
        effect because of the cost and no assurance that it would be paid 
 
        by the defendants. Claimant contends that this impairs her 
 
        earning capacity. Under 85.34(t), benefits for disfigurement of 
 
        the face or head are allowable only if this disfigurement impairs 
 
        the future usefulness and earnings of the employee in the 
 
        employee's occupation at the time of receiving the injury. There 
 
        is no evidence that this impairs or will impair the future 
 
        usefulness and earnings of the employee. The claimant contends 
 
        that this scar is a conversational piece to the young people to 
 
        which she administers her services and they may imply that she 
 
        has been in a fight. The undersigned feels that this scar in 
 
        reference to the claimant's dealings with the younger people 
 
        could have a positive effect and be a beneficial conversation 
 
        piece, along with the claimant's personality which would help in 
 
        her dealings with these children to which she consults and who 
 
        either have been abused or disadvantaged. The undersigned finds 
 
        that claimant's permanent disfigurement of her face has not 
 
        impaired her future usefulness and earnings in her occupation at 
 
        the time of receiving injury. See Albertson (Byrnes) v. Donaldson 
 
        Company,Inc., Appeal Decision, File 729018, filed September 30, 
 
        1988. There is no question that the claimant had a severe 
 
        accident which has given her a lot of problems and difficulties 
 
        and the undersigned deputy can sympathize for her, but the law 
 
        requires a reduction in earning capacity as opposed to pain and 
 
        permanent impairment.
 
        
 
             The parties were unable at the beginning of the hearing to 
 
             stipulate to the rate, but it appears obvious that had the 
 
             information concerning the fact that the claimant had three jobs 
 

 
        
 
 
 
 
 
             rather than the two jobs been known to the defendants before the 
 
             hearing rather than being disclosed at the hearing, the 
 
             defendants would have stipulated to the rate. Additional 
 
             information was provided which resulted in the obvious fact that 
 
             the rate would be $151.05 per week, but that the state's attorney 
 
             was unable under its instructions to stipulate since it did not 
 
             have that information prior to preparing for this hearing. It is 
 
             obvious that there is no dispute as to the income figures and 
 
             that there was, in fact, three part-time jobs. It is determined 
 
             rather than going through the details of the three jobs, that had 
 
             this information been given earlier to defendants the parties 
 
             would have stipulated to the $151.05 rate. It is found that 
 
             $151.05 is the weekly rate for any benefits found herein.
 
        
 
            There had been an issue raised under 85.38(2), Credits For 
 
        Benefits Paid Under Group Plans, which involved at most a 
 
        difference of $434.22, but this issue was not listed as an issue 
 
        on the hearing assignment order and, accordingly, the undersigned 
 
        is without jurisdiction to determine the amount of credit to 
 
        which the defendants may be entitled. See Joseph Presswood v. 
 
        Iowa Beef Processors, Appeal Decision filed November 14, 1986, 
 
        holding an issue not noted on the hearing assignment order as 
 
        waived. This ruling was made at the beginning of the hearing.
 
        
 
            The remaining issue to be resolved under 85.27 relates to 
 
        those remaining unpaid medical bills listed under item 8 attached 
 
        to the prehearing report and, also, the unpaid mileage incurred 
 
        for medical treatment. It is obvious from the records that in 
 
        almost every instance defendants had paid part of the bill. 
 
        Although payment by the defendants does not bind them or obligate 
 
        them, the undersigned finds that the state properly paid on these 
 
        bills and should, in fact, pay the balance. This claimant was 
 
        taken by life flight helicopter to a hospital in Omaha, Nebraska, 
 
        and treatment was begun on her by medical doctors then available, 
 
        who in turn referred to specialists because of the serious 
 
        condition of this claimant. It is obvious that the claimant 
 
        continued treatment with those who were familiar with her 
 
        beginning problems and that all her treatment and medical 
 
        services, in fact, helped the claimant's recovery. The one bill 
 
        of Hope Enterprises, of $554, on which nothing was paid, was 
 
        recommended by a doctor because of the condition of the claimant 
 
        when she was released from the hospital and the recommendation 
 
        that she have care because of the problems she was continuing to 
 
        have with both her eye and back for at least a month. All of 
 
        those medical bills and mileage reimbursement reflected in the 
 
        attachments under paragraph 8 to the prehearing report are to be 
 
        paid by the defendants.
 
        
 
             There is no determination in this decision as to healing 
 
             period benefits as the parties stipulated that whatever those 
 
             healing period benefits would be, they have determined that they 
 
             have been paid in full and is not an issue for this deputy to 
 
             further decide.
 
        
 
                                 FINDINGS OF FACT
 
        
 
             WHEREFORE, it is found:
 
        
 
            1. Claimant received a work-related disability to her low 
 
        back as a result of her injury incurred in an automobile accident 
 
        on April 22, 1985.
 
        
 
            2. Claimant received a work-related loss of vision in her 
 
        left eye as a result of her injury in an automobile accident on 
 
        April 22, 1985.
 
        
 

 
        
 
 
 
 
 
            3. Claimant received a permanent scar on the left side of 
 
        her face as a result of her injury incurred in an automobile 
 
        accident on April 22, 1985.
 
        
 
            4. Claimant has a 10 percent permanent impairment to her 
 
        low back as a result of her April 22, 1985 injury.
 
        
 
            5. Claimant has a 10 percent permanent loss of vision in 
 
        her left eye as a result of her April 22, 1985 accident.
 
        
 
            6. Claimant has a permanent scar on the left side of her 
 
        face which does not impair the future usefulness and earnings of 
 
        the claimant in the claimant's occupation at the time of 
 
        receiving the injury.
 
        
 
            7. Claimant's scar on her left side of her face can be 
 
        aesthetically improved by future plastic surgery.
 
        
 
            8. Claimant has a reduction in her earning capacity as a 
 
        result of her low back injury.
 
        
 
            9. Claimant was working three part-time jobs at the time of 
 
        her injury on April 22, 1988, which resulted in a weekly benefit 
 
        rate of $151.05.
 
        
 
            10. Claimant sought medical care in an emergency situation 
 
        after having been brought into a hospital by life flight and 
 
        continued with this medical care and medical referrals resulting 
 
        therefrom.
 
        
 
             11. The medical treatment claimant chose was beneficial and 
 
             necessary to her recovery.
 
        
 
                                 CONCLUSIONS OF LAW
 
        
 
             THEREFORE, it is concluded:
 
        
 
            Claimant's low back injury was caused by her involvement in 
 
        an automobile accident while working for the defendant employer.
 
        
 
            Claimant's loss of vision in her left eye was caused by her 
 
        involvement in an automobile accident while in the employment of 
 
        defendant employer.
 
        
 
            Claimant's permanent scar on the left side of her face was 
 
        causally connected to her involvement in an auto accident in the 
 
        employment with the defendant employer.
 
        
 
            Claimant has a 10 percent permanent impairment to her low 
 
        back as a result of her April 22, 1985 injury.
 
        
 
            Claimant has a 10 percent permanent loss of vision in her 
 
        left eye as a result of her April 22, 1985 accident.
 
        
 
            Claimant has a permanent scar on the left side of her face 
 
        which does not impair the future usefulness and earnings for the 
 
        claimant in the claimant's occupation at the time of receiving 
 
        the injury.
 
        
 
            Claimant's scar on her left side of her face can be 
 
        aesthetically improved by future plastic surgery, and defendants 
 
        should pay for the necessary plastic surgery and accompanying 
 
        medical expenses so as to enable the claimant to reach maximum 
 
        esthetic improvement.
 
        
 
            Claimant has a 20 percent industrial disability as a result 
 

 
        
 
 
 
 
 
        of her injuries.
 
        
 
            The weekly benefit rate for this claimant is $151.05.
 
        
 
            Defendants shall pay the unpaid medical bills of the 
 
        claimant as set out on the prehearing report, exhibit A, item 8, 
 
        which unpaid balance totals $5,325.30.
 
        
 
            Defendants shall reimburse the claimant for mileage expenses 
 
        connected therewith in the amount of $1,180.65 as set out on 
 
        exhibit A, item 8, attached to the prehearing report.
 
        
 
                                      ORDER
 
        
 
             THEREFORE, it is ordered:
 
        
 
            That claimant is entitled to one hundred (100) weeks of 
 
        permanent partial disability benefits at the rate of one hundred 
 
        fifty-one and 05/100 dollars ($151.05).
 
        
 
             That defendants shall pay the necessary medical expenses for 
 
             claimant to have plastic surgery to reach maximum improvement of 
 
             a scar on the left side of claimant's face. Defendants have the 
 
             right to choose plastic surgeon.
 
        
 
            That defendants shall pay unpaid medical bills as follows:
 
        
 
                  Vision Care Assoc.                          $ 69.00
 
                  Ira Priluck, M.D.                           40.00
 
                  Dr. "Pete" Danhoff                          30.00
 
                  A.B. Vasher, D.O.                           18.00
 
                  Hope Enterprises                            554.00
 
                  Daniel J. Patera, D.D.S.                    203.00
 
                  Orthopedic Clinic (Dr. Murphy)         166.00
 
                  Horn Memorial Hospital                      406.00
 
                  Creighton University Dept.
 
                   of Surgery (Drs. Bleicher
 
                   & Fruin)                                  2,470.00
 
                  Radiology Consultants                       1,369.30
 
        
 
                  Total                                       $5,325.30
 
        
 
             That defendants shall reimburse the claimant for mileage 
 
             incurred in seeking medical attention in the amount of one 
 
             thousand one hundred eighty and 65/100 dollars ($1,180.65).
 
        
 
            That defendants shall pay the accrued weekly benefits in a 
 
        lump sum and shall receive credit against the award for weekly 
 
        benefits previously paid.
 
        
 
            That defendants shall pay interest on benefits awarded 
 
        herein as set forth in Iowa Code section 85.30.
 
        
 
            That defendants shall pay the costs of this action pursuant 
 
        to Division of Industrial Services Rule 343-4.33.
 
        
 
            That defendants shall file an activity report upon payment 
 
        of this award as required by this agency pursuant to Division of 
 
        Industrial Services Rule 343-3.1.
 
        
 
            Signed and filed this 18th day of May, 1989.
 
        
 
        
 
        
 
        
 
        
 

 
        
 
 
 
 
 
                                       BERNARD J. O'MALLEY
 
                                       DEPUTY INDUSTRIAL COMMISSIONER
 
        
 
        Copies to:
 
        
 
        Mr. Robert L. Brink
 
        Attorney at Law
 
        40 N. Main
 
        P.O. Box 308
 
        Denison, IA 51442
 
        
 
        Mr. Greg Knoploh
 
        Assistant Attorney General
 
        Tort Claims
 
        Hoover State Office Building
 
        Des Moines, IA 50319
 
        
 
        
 
 
        
 
 
 
 
 
        
 
        
 
                                       51803; 51803.1
 
                                       Filed May 18, 1989
 
                                       Bernard J. O'Malley
 
        
 
                    BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
        
 
        
 
        JAN BURK,
 
        
 
            Claimant,
 
                                                 File No. 793416
 
        vs.
 
        
 
        DEPARTMENT OF HUMAN SERVICES,          A R B I T R A T I O N
 
        
 
            Employer,                           D E C I S I O N
 
        
 
        vs.
 
        
 
        STATE OF IOWA,
 
        
 
             Insurance Carrier,
 
             Defendants.
 
             
 
             
 
        51803; 51803.1
 
        
 
             Claimant's work-related automobile accident resulted in 10% 
 
             loss of vision in left eye and 10% impairment to her low back. 
 
             Claimant awarded 20% industrial disability for the combined 
 
             injuries .
 
        
 
        51803.1
 
        
 
             Claimant's permanent facial scar was determined not to have 
 
             impaired the future usefulness and earnings of the claimant in 
 
             the claimant's occupation at the time of receiving the injury.
 
             
 
        
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            JEANNINE ECHTERLING n/k/a     :
 
            JEANNINE ROLAND,              :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File No.  793494
 
            BISHOP BUFFETS, INC.,         :
 
                                          :  A R B I T R A T I O N
 
                 Employer,                :
 
                                          :      D E C I S I O N
 
            and                           :
 
                                          :
 
            K MART CORPORATION,           :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
                              statement of the case
 
            
 
                 This is a proceeding in arbitration brought by Jeannine 
 
            Echterling n/k/a Jeannine Roland, claimant, against Bishop 
 
            Buffets, Inc., employer and K Mart Corporation, insurance 
 
            carrier, to recover benefits under the Iowa Worker's 
 
            Compensation Act as a result of an injury sustained on April 
 
            21, 1985.  This matter came on for hearing before the 
 
            undersigned deputy industrial commissioner on April 23, 
 
            1991.  The matter was considered fully submitted at the 
 
            close of the hearing.  The record in this case consists of 
 
            the testimony of claimant, Robert Roland and Martin 
 
            Rosenfeld, D.O.; claimant's exhibits 1 through 64 and 
 
            defendants' exhibits B and C.  
 
            
 
                                      issues
 
            
 
                 Pursuant to the prehearing report and order submitted 
 
            and approved on April 23, 1991, the following issues are 
 
            presented for resolution:
 
            
 
                 1.  The extent of entitlement to weekly compensation 
 
            for permanent disability, if defendants are liable for the 
 
            injury;
 
            
 
                 2.  The type of permanent disability, if the injury is 
 
            found to be a cause of permanent disability; and
 
            
 
                 3.  Claimant's entitlement to a medical evaluation 
 
            under Iowa Code section 85.39.
 
            
 
                                        
 
            
 
                                 findings of fact
 
            
 
                 The undersigned has carefully considered all the 
 
            testimony given at the hearing, the arguments made, and the 
 

 
            
 
            Page   2
 
            
 
            
 
            
 
            
 
            evidence contained in the exhibits, and makes the following 
 
            findings:
 
            
 
                 The pertinent medical evidence of record reveals that 
 
            claimant was seen on May 28, 1976, by Sidney H. Robinow, 
 
            M.D., when she slipped while at work at Bishop's and 
 
            dislocated her left patella.  On August 27, 1980, she 
 
            slipped again while at work and twisted her left knee.  She 
 
            was seen by Marvin Dubansky, M.D., an orthopedic surgeon.  
 
            An x-ray examination showed that the left patella was 50 
 
            percent or more dislocated laterally.  She was seen 
 
            intermittently and treated conservatively.  She was able to 
 
            get along satisfactorily until April 21, 1985, when she 
 
            slipped again on a wet floor at Bishop's.  Thereafter, she 
 
            had continuing difficulty with her left knee.  
 
            
 
                 An examination on May 2, 1985, revealed crepitus and 
 
            grating in both knees due to subluxation of the patella.  
 
            Dr. Dubansky recommended surgery and warned claimant that 
 
            she may still have some crepitus and grating depending on 
 
            the amount of damage in the joint.  On June 17, 1985, 
 
            claimant was admitted to Mercy Hospital and underwent an 
 
            arthrotomy and skiving of the patella, trimming of the 
 
            lateral meniscus and Hauser procedure of the left knee. 
 
            (exhibit 6).  
 
            
 
                 Claimant was examined on September 26, 1985, by Dr. 
 
            Dubansky and he released her to return to work on a limited 
 
            basis.  She was restricted to standing no more than four 
 
            hours; sitting no more than six hours; squatting, climbing 
 
            or lifting more than 40 pounds (ex. 9).  
 
            
 
                 Claimant was seen by Dr. Dubansky for follow-up 
 
            evaluations.  On November 13, 1985, she presented with 
 
            soreness and popping in her knee after working a few hours.  
 
            These complaints could not be verified on examination.  An 
 
            x-ray showed no fracture or dislocation.  Claimant requested 
 
            a second opinion (ex. 1, page 11).  
 
            
 
                 On December 3, 1985, claimant was evaluated by Robert 
 
            F. Breedlove, M.D.  On examination, he observed as follows:
 
            
 
                    I do not feel that Ms. Echterling is 
 
                 malingering at this time.  She has significant 
 
                 decreased range of motion of her left leg, as well 
 
                 as a significant decrease in the amount of 
 
                 strength in her left quadriceps muscle group as 
 
                 compared to her right, both on physical 
 
                 examination and on muscle testing using Cybex 
 
                 testing unit.  She also has x-ray evidence of some 
 
                 malalignment of her left patella as compared to a 
 
                 presumably normal right patella.
 
            
 
            (exhibit 10)
 

 
            
 
            Page   3
 
            
 
            
 
            
 
            
 
         
 
              Dr. Breedlove indicated that a physical therapy program may 
 
         be indicated at this time and another surgical procedure carried 
 
         out before her pain is totally eliminated.  He indicated that she 
 
         could work more than three hours a day if her duties could be 
 
         performed while sitting (ex. 10).
 
         
 
              Claimant returned to Dr. Dubansky's care and continued to 
 
         complain of decreased motion and aching in her left knee.  He 
 
         recommended manipulation under general anesthesia.  On January 
 
         13, 1986, she underwent arthrotomy and removal of adhesions and 
 
         repair.  Postoperatively she did well with 90 degrees active 
 
         motion (ex. 11-14).
 
         
 
              Claimant continued treatment with Dr. Dubansky.  At his 
 
         recommendation, she participated in physical therapy and 
 
         exercises.  The insurance company then requested a second opinion 
 
         and scheduled claimant for an appointment with Scott B. Neff, 
 
         D.O.  Dr. Neff examined the claimant on July 17, 1986, and took 
 
         x-rays of both knees.  He reported that the x-rays showed 
 
         bilateral patella alta, which is a developmental situation where 
 
         the patellae are small and high-riding making them more easily 
 
         dislocated or injured and prone to developing chondromalacia 
 
         patella.  On examination, Dr. Neff observed continued 
 
         degeneration in the left patella with significant quadriceps 
 
         atrophy and wasting on the left side with significant crepitus.  
 
         He recommended a patellectomy if she is unable to tolerate normal 
 
         everyday activity (ex. 17).  
 
         
 
              On August 14, 1986, a bone scan was performed and showed 
 
         some increased bone reaction about the left knee as compared to 
 
         the right (ex. 18).  Mr. Thomas W. Bower, L.P.T., saw claimant on 
 
         August 14, 1986, for evaluation with the Cybex.  Her complaints 
 
         were referable to diffuse pain through the kneecap and into the 
 
         shin on the left side.  On examination, strength of the left 
 
         quads appears to be 80 percent deficient as compared to the right 
 
         side.  Power measurements demonstrated a 75 percent deficiency on 
 
         the left when compared to the right.  Thigh measurements showed 
 
         the quads to be 49 centimeters on the right and 47 centimeters on 
 
         the left.  Mr. Bower concluded that further physical therapy or 
 
         exercise would not have a significant impact on claimant's 
 
         problems (ex. 19). 
 
         
 
              EMG studies of the left lower extremity were performed on 
 
         August 28, 1986, and were within normal limits (ex. 22).  That 
 
         same day, claimant saw Dr. Neff for follow-up evaluation.  He 
 
         reported:
 
         
 
                 I have told her again, for about the tenth time now, 
 
              that she will never be normal, and if we had an 
 
              excellent result we would have functional knee range of 
 
              motion with her ability to walk without pain, go up and 
 
              down stairs in a limited fashion, and not do any 
 
              squatting or repetitive lifting.
 
         
 
         (exhibit 21)
 

 
         
 
         Page òòò  4        
 
         
 
         
 
         
 
         
 
              Claimant returned to Dr. Dubansky on September 8, 1986.  At 
 
         this time, Dr. Dubansky reported that:
 
         
 
                 I feel, overall, that she has some chondromalacia 
 
              with relationship to the recurrent dislocation where 
 
              there are some changes present where I explored the 
 
              knee, therefore feel that she has approximately 15% 
 
              impairment to the left lower extremity as a result of 
 
              the recurrent dislocation and chondromalacia of the 
 
              knee.  No future appointments have been made.
 
         
 
         (exhibit 2, page 16)
 
         
 
              On December 22, 1986, claimant presented to Dr. Dubansky 
 
         with bilateral knee pain.  He reported that:
 
         
 
                 As far as her right knee, I told her that I think 
 
              she had a congenital variation to start with with the 
 
              patellae partially subluxated and she had an injury 
 
              which made the left one dislocate and the right one 
 
              hasn't and as the right one has never dislocated, never 
 
              had a specific trauma, I have no recommendations as far 
 
              as the right one at this time, except she continue 
 
              exercising and I feel that it is not involved in her 
 
              present W/C situation.
 
         
 
         (exhibit 2, page 18)
 
         
 
              On May 24, 1989, Dr. Dubansky reported that, "I do not feel 
 
         the problem that Mrs. Roland has in her right knee is related to 
 
         the industrial injury she sustained in the left knee."  (ex. 30).  
 
         He stated that it is not infrequent that people who have 
 
         dislocation of one patella may have the built-in propensity to 
 
         develop it in the other.  He noted that at this time, there was 
 
         no dislocation in the right knee.  (ex. 30). 
 
         
 
              On December 12, 1990, claimant saw Martin S. Rosenfeld, 
 
         D.O., for an independent medical evaluation.  Claimant presented 
 
         with complaints referable to both knees and low back pain.  After 
 
         conducting an examination and reviewing x-rays, Dr. Rosenfeld's 
 
         impression included (1) chronic subluxing dislocating patellae, 
 
         left greater than right with reconstructive surgery on the left 
 
         and (2) lumbar strain.  He opined that, "I would feel that the 
 
         1985 injury caused a significant amount of the symptoms that led 
 
         to the surgery, although the underlying disease was present from 
 
         her previous injuries."  As to her back, he stated, "I am not 
 
         sure whether she will have any residual impairment if she would 
 
         once obtain some treatment for her back."  He assigned a 20 
 
         percent permanent physical impairment to the left knee as a 
 
         result of the patellar problems and a 10 percent permanent 
 
         physical impairment to the right knee. (ex. 33).  
 
         
 
              At the hearing, claimant testified she was born March 14, 
 
         1957, and graduated from high school in 1975.  In December of 
 
         1975, she started working for Bishop's Buffets as a cook.  She 
 
         was eventually promoted to assistant food manager and then food 
 
         manager with supervisory duties.  She had two incidents at work 
 
         regarding her left knee, one in 1976 and the other in 1980, when 
 

 
         
 
         Page òòò  5        
 
         
 
         
 
         
 
         she slipped on the wet floor.  She lost no time from work as a 
 
         result of either injury.  On April 21, 1985, she fell again at 
 
         work and reinjured her left knee.  
 
         
 
              At the time of the injury, she was earning $1850 per month 
 
         or $27,000 per year.  Claimant received workers' compensation 
 
         benefits during her time off work.  She underwent two surgical 
 
         procedures on her left knee and received permanent partial 
 
         disability benefits from September 11, 1986 to May 1, 1987, as a 
 
         result of Dr. Dubansky's 15 percent impairment rating of the left 
 
         lower extremity.  Claimant testified that she married Mr. Roland 
 
         in 1987 and had a child in February 1988 and February 1990.  She 
 
         and her husband have shared a joint farming operation since 1985 
 
         and she does all of the bookkeeping, taxes and purchasing.  In 
 
         addition to the work she does on the farm, she has worked for 
 
         Beelers, a bakery/meat market, since September 1990.  
 
         
 
              Claimant's husband also testified at the hearing.  He stated 
 
         that claimant does very little outside work on the farm, but does 
 
         household chores in addition to keeping business records and 
 
         filing income tax returns.  
 
         
 
                                conclusions of law
 
         
 
              Claimant seeks additional permanent partial disability as a 
 
         result of her accident of April 21, 1985.  It is her contention 
 
         that she has sustained an impairment to the left leg of 20 
 
         percent, 15 percent of which has been paid by the employer.  She 
 
         also contends that as a result of placing too much stress on her 
 
         left leg, she has sustained an additional injury to her right leg 
 
         as well.  In addition, she contends that she has sustained an 
 
         injury to her back entitling her to have her injury compensated 
 
         industrially under Iowa Code section 85.34(2)(u).
 
         
 
              Defendants dispute claimant's contentions and argue that 
 
         claimant is not presently suffering from any condition of health 
 
         or impairment causally related to the incident for which claimant 
 
         has not been fully compensated.  
 
         
 
              The claimant has the burden of proving by a preponderance of 
 
         the evidence that the injury of April 21, 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). 
 
         
 
              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 
 

 
         
 
         Page òòò  6        
 
         
 
         
 
         
 
         516, 133 N.W.2d 867.  See also Musselman v. Central Telephone 
 
         Co., 261 Iowa 352, 154 N.W.2d 128 (1967).
 
         
 
              After carefully reviewing the total evidence in this case, 
 
         the undersigned concludes that claimant's right knee discomfort 
 
         and low back pain are not the result of her injury on April 21, 
 
         1985.  This assessment was made by Dr. Dubansky, claimant's 
 
         treating orthopedic surgeon, on May 24, 1989, when he stated 
 
         that, "I do not feel the problem that Mrs. Roland has in her 
 
         right knee is related to the industrial injury she sustained in 
 
         the left knee."  (ex. 30).  While there is no dispute that 
 
         claimant had a work-related injury to her left knee and that she 
 
         has bilateral patella alta, there is no evidence of a 
 
         work-related trauma involving her right knee.  No physician who 
 
         has treated and/or examined the claimant has causally related her 
 
         right knee problems to the work injury on April 21, 1985.
 
         
 
              As to her alleged lumbar strain, this complaint did not 
 
         surface until claimant was examined by Fouad Salama, M.D., at the 
 
         request of the Social Security Administration pursuant to a claim 
 
         for benefits, on April 21, 1988.  On examination, Dr. Salama 
 
         noted that:
 
         
 
              Straight leg raising was full bilaterally with no 
 
              symptoms of pain.  Flexion of the spine with extended 
 
              knees was up to 85 to 90o with no symptoms of pain 
 
              elicted [sic].  Neurologic exam revealed good motor 
 
              power; sensory systems reflex appear to be intact.  
 
              Patient does have normal gait and coordination. 
 
         
 
         (exhibit 28)
 
         
 
              Dr. Rosenfeld alluded to x-rays of the claimant's back in 
 
         his December 12, 1990, report and indicated that they showed no 
 
         gross bony abnormalities (ex. 33).  
 
         
 
              Claimant bears the burden of proof.  She has failed to show 
 
         by a preponderance of the evidence that she has suffered 
 
         additional injuries causally related to the injury of April 21, 
 
         1985, which are compensable industrially under Iowa Code section 
 
         85.34(2)(u).
 
         
 
              Claimant also alleges additional permanency as a result of 
 
         her left leg injury.  Again, claimant bears the burden of proof 
 
         in this regard.  She must demonstrate by a preponderance of the 
 
         evidence that her left leg injury has resulted in a permanent 
 
         physical impairment of 20 percent.  Claimant relies on Dr. 
 
         Rosenfeld's December 12, 1990, assessment to support her claim.  
 
         He stated that, "I would feel that the left knee has a 20% 
 
         permanent physical impairment as a result of the patellar 
 
         problems." (ex. 33).  Dr. Rosenfeld saw claimant on one occasion 
 
         and for the specific purpose of rendering an independent medical 
 
         examination.  In contrast, claimant has been followed by Dr. 
 
         Dubansky since October 1980.  He performed surgery on claimant's 
 
         left knee in June 1985 and in January 1986.  He saw claimant for 
 
         follow-up evaluations and on September 8, 1986, reported that, "I 
 
         feel, overall, that she has some chondromalacia with relationship 
 
         to the recurrent dislocation where there are some changes present 
 
         where I explored the knee, therefore feel that she has 
 
         approximately 15% impairment of the left lower extremity as a 
 

 
         
 
         Page òòò  7        
 
         
 
         
 
         
 
         result of the recurrent dislocation and chondromalacia of the 
 
         knee." (ex. 2, p. 16).
 
         
 
              A treating physician's testimony is not entitled to greater 
 
         weight as a matter of law than that of a physician who later 
 
         examines claimant in anticipation of litigation.  Weight to be 
 
         given to the testimony of a physician is a fact issue to be 
 
         decided by the industrial commissioner in light of the record the 
 
         parties develop.  In this regard, both parties may develop facts 
 
         as to the physician's employment in connection with litigation, 
 
         if so; the physician's examination at a later date and not when 
 
         the injuries were fresh; his arrangement as to compensation; the 
 
         extent and nature of the physician's examination; the physician's 
 
         education, experience, training, and practice; and all other 
 
         factors which bear upon the weight and value of the physician's 
 
         testimony.  Both parties may bring all this information to the 
 
         attention of the factfinder as either supporting or weakening the 
 
         physician's testimony and opinion.  All factors go to the value 
 
         of the physician's testimony as a matter of fact not as a matter 
 
         of law.  Rockwell Graphic Systems, Inc. v. Prince, 366 N.W.2d 
 
         176, 192 (Iowa 1985).
 
         
 
              After carefully considering the total evidence in this case, 
 
         the undersigned concludes that the greater weight of the evidence 
 
         supports the assessment made by Dr. Dubansky, claimant's treating 
 
         orthopedic surgeon, rather than Dr. Rosenfeld who had no 
 
         involvement in claimant's long-term care or treatment.  
 
         Therefore, the findings of Dr. Dubansky as to claimant's 
 
         impairment rating are entitled to significant weight and 
 
         consideration.
 
         
 
              The final issue for resolution is whether claimant is 
 
         entitled to reimbursement of $270 paid to Dr. Rosenfeld for an 
 
         independent medical examination pursuant to Iowa Code section 
 
         85.39.
 
         
 
              Iowa Code section 85.39 provides, in part:
 
         
 
                 If an evaluation of permanent disability has been 
 
              made by a physician retained by the employer and the 
 
              employee believes this evaluation to be too low, the 
 
              employee shall, upon application to the commissioner 
 
              and upon delivery of a copy of the application to the 
 
              employer and its insurance carrier, be reimbursed by 
 
              the employer the reasonable fee for a subsequent 
 
              examination by a physician of the employee's own 
 
              choice, and reasonably necessary transportation 
 
              expenses incurred for the examination.  The physician 
 
              chosen by the employee has the right to confer with and 
 
              obtain from the employer-retained physician sufficient 
 
              history of the injury to make a proper examination.
 
         
 
              An evaluation of permanent disability had previously been 
 
         made by Dr. Dubansky and pursuant to Iowa Code section 85.39, 
 
         claimant believed that his evaluation was too low and is entitled 
 
         to a subsequent examination by her own choosing.  Iowa Code 
 
         section 85.39 allows reimbursement to claimant for the reasonable 
 
         fee of this examination.  Defendants did not dispute that Dr. 
 
         Rosenfeld's fee is other than fair and reasonable.  Claimant is 
 
         entitled to medical benefits under Iowa Code section 85.39 and 
 

 
         
 
         Page òòò  8        
 
         
 
         
 
         
 
         should be reimbursed the $270 she paid him for that examination.
 
         
 
                                      order
 
         
 
              THEREFORE, IT IS ORDERED:
 
         
 
              Pursuant to Iowa Code section 85.39, claimant should be 
 
         reimburse two hundred seventy dollars ($270) for the cost of Dr. 
 
         Rosenfeld's examination.
 
         
 
              That claimant is not entitled to additional permanent 
 
         partial disability benefits and therefore, takes nothing further 
 
         from these proceedings.
 
         
 
              Signed and filed this ____ day of May, 1991.
 
         
 
         
 
         
 
         
 
                                       ______________________________
 
                                       JEAN M. INGRASSIA
 
                                       DEPUTY INDUSTRIAL COMMISSIONER    
 
         
 
         Copies to:
 
         
 
         Mr. Robert W. Pratt
 
         Attorney at Law
 
         1913 Ingersoll
 
         Des Moines, Iowa  50309-3320
 
         
 
         Mr. John M. Bickel
 
         Attorney at Law
 
         500 MNB Bldg. 
 
         PO Box 2107
 
         Cedar Rapids, Iowa  52406
 
         
 
         
 
              
 
         
 
 
            
 
            Page   1
 
            
 
            
 
            
 
            
 
                      51108 1803
 
                      Filed May  29, 1991
 
                      Jean M. Ingrassia
 
            
 
                     before the iowa industrial commissioner
 
            ____________________________________________________________
 
                                          :
 
            JEANNINE ECHTERLING n/k/a     :
 
            JEANNINE ROLAND,              :
 
                                          :
 
                 Claimant,                :
 
                                          :
 
            vs.                           :
 
                                          :      File No.  793494
 
            BISHOP BUFFETS, INC.,         :
 
                                          :  A R B I T R A T I O N
 
                 Employer,                :
 
                                          :      D E C I S I O N
 
            and                           :
 
                                          :
 
            K MART CORPORATION,           :
 
                                          :
 
                 Insurance Carrier,       :
 
                 Defendants.              :
 
            ___________________________________________________________
 
            
 
            51108 1803
 
            Claimant seeks additional permanent partial disability 
 
            benefits as result of left knee injury compensated at 15 
 
            percent by employer.  She also seeks to be industrially 
 
            compensated for a right knee and back injury allegedly 
 
            related to her original left knee injury in June 1985.  
 
            No evidence of a work-related trauma involving the right 
 
            knee and back found, therefore, not compensable industrially 
 
            under Iowa Code section 85.34(2)(u).
 
            Furthermore, no evidence of additional permanency as result 
 
            of left leg injury.  Claimant relied on independent exam by 
 
            Dr. Rosenfeld on December 12, 1990.  Dr. Dubansky has 
 
            treated claimant since October 1980 and performed surgery on 
 
            her left knee in June 1985 and January 1986.  He gave a 15 
 
            percent permanent impairment rating.  Greater weight of 
 
            evidence supports Dr. Dubanksy's assessment.
 
            
 
 
        
 
 
 
 
 
                       BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
        
 
        
 
        EDWIN E. CARUTH,
 
        
 
            Claimant,                     File No. 793512
 
        vs .
 
        
 
        TENNECO/CASE POWER &                  A P P E A L
 
        EQUIPMENT CO.,
 
                                            D E C I S I O N
 
            Employer,
 
        
 
        and
 
        
 
        TRAVELERS INSURANCE CO.,
 
        
 
            Insurance Carrier,
 
            Defendants.
 
        
 
        
 
                                 STATEMENT OF THE CASE
 
        
 
        Defendants appeal and claimant cross-appeals from an arbitration 
 
        decision awarding claimant healing period benefits, medical 
 
        expenses and mileage, and permanent partial disability benefits 
 
        based on an industrial disability of 50 percent resulting from an 
 
        injury on April 24, 1985. The record on appeal consists of the 
 
        transcript of the arbitration hearing; claimant's exhibits 1 
 
        through 26 and 29 through 36; and defendants' exhibit A. Exhibit 
 
        5 is part of exhibit 21. Both parties filed briefs on appeal. 
 
        There were two motions to dismiss and an application for 
 
        immediate hearing filed by claimant that have not been previously 
 
        ruled on, but these have been withdrawn by claimant on June 22, 
 
        1988 and need not be considered further. Both parties filed 
 
        applications for extension of time to file briefs. Those 
 
        applications are now moot as the briefs have been filed and are 
 
        considered in this appeal.
 
        
 
                                      ISSUE
 
        
 
        The issue on appeal is the extent of claimant's disability, 
 
        including whether claimant is an odd-lot employee.
 
        
 
                                 REVIEW OF THE EVIDENCE
 
        
 
        The arbitration decision adequately and accurately reflects the 
 
        pertinent evidence and it will not be set forth herein.
 
        
 
                                 APPLICABLE LAW
 
        
 
        The citations of law in the arbitration decision are appropriate
 
        
 
        CARUTH V. TENNECO/CASE POWER & EQUIPMENT CO.
 
        Page 2
 
        
 
        
 
        to the issue and evidence.
 
        
 
                                      ANALYSIS
 
        
 
        The analysis of the deputy in conjunction with the issue
 
        and evidence presented is adopted.
 

 
        
 
 
 
 
 
        
 
                                 FINDINGS OF FACT
 
        
 
        1. On April 24, 1985, Edwin E. Caruth was a resident of the state 
 
        of Iowa employed by Case Power & Equipment Company, also known as 
 
        Tenneco, in the state of Iowa.
 
        
 
        2. Claimant was injured on that date when the semi he was driving 
 
        for the employer struck a pile of gravel.
 
        
 
        3. Following the injury, claimant was medically incapable of 
 
        performing work in employment substantially similar to that he 
 
        performed at the time of injury from the date of injury until 
 
        September 1, 1986 when he reached the point it was medically 
 
        indicated that further significant improvement from the injury 
 
        was not anticipated.
 
        
 
        4. Claimant is a 48-year-old married man with one minor dependent 
 
        child. At the time of injury, he was earning approximately $8.00 
 
        per hour.
 
        
 
        5. All the medical care which claimant has received at hospitals 
 
        or from licensed physicians is reasonable care and was provided 
 
        in treatment of the injuries he sustained on April 24, 1985.
 
        
 
        6. The reflexology treatments claimant received from Linda Bruno 
 
        are not shown to be reasonable care for the injury, even though 
 
        they have provided some relief of his symptoms.
 
        
 
        7. Claimant is not physically capable of engaging in farming on a 
 
        full-time basis or of working as an automotive or farm implement 
 
        mechanic. He is restricted in his ability to bend, stoop, lift or 
 
        engage in standing or sitting for extended periods.
 
        
 
        8. Claimant is a high school graduate, but his entire work 
 
        history has been primarily in the area of automotive or farm 
 
        implement mechanics.
 
        
 
        9. Claimant is reasonably motivated to be gainfully employed.
 
        
 
        10. Claimant has a four percent permanent impairment of the body 
 
        as a whole as a result of the injury.
 
        
 
        11. Claimant has suffered a 50% loss of his earning capacity as a 
 
        result of the injury he sustained on April 24, 1985.
 
        
 
        CARUTH V. TENNECO/CASE POWER & EQUIPMENT CO.
 
        Page-3
 
        
 
        
 
        12. Claimant was not offered treatment at a pain center or any 
 
        work hardening program.
 
        
 
        13. Claimant did not unreasonably fail to cooperate with the 
 
        rehabilitation consultant.
 
        
 
        14. Claimant has not made bona fide efforts to obtain gainful 
 
        employment.
 
        
 
                                 CONCLUSIONS OF LAW
 
        
 
        Claimant sustained an injury on April 24, 1985 which arose out of 
 
        and in the course of his employment with Case Power & Equipment 
 
        Company, also known as Tenneco.
 
        
 
        Claimant has a 50% permanent partial disability in industrial 
 

 
        
 
 
 
 
 
        terms as a result of that injury.
 
        
 
        Claimant is entitled to recover medical expenses in the amount of 
 
        $131.00 and mileage expenses in the amount of $317.70.
 
        
 
        Defendants have failed to introduce sufficient evidence to 
 
        establish, by a preponderance of the evidence, that claimant 
 
        failed to cooperate with his treating physicians or with the 
 
        vocational consultant.
 
        
 
        Defendants should offer claimant treatment at a pain clinic and 
 
        such other treatment as may be recommended by the authorizing 
 
        treating physicians.
 
        
 
        Claimant has not established by a preponderance of the evidence 
 
        that he is entitled to permanent total disability benefits as an 
 
        odd-lot employee.
 
        
 
        Central Iowa Orthopaedics and Semler Medical, P.C., should be 
 
        designated as authorized treating physicians.
 
        
 
        WHEREFORE, the decision of the deputy is affirmed.
 
        
 
                                      ORDER
 
        
 
        THEREFORE, it is ordered:
 
        
 
        That defendants pay claimant seventy and five-sevenths (70 5/7) 
 
        weeks of compensation for healing period at the stipulated rate 
 
        of two hundred ten and 98/100 dollars ($210.98) per week 
 
        commencing April 24, 1985.
 
        
 
        That defendants pay claimant two hundred fifty (250) weeks of 
 
        compensation for permanent partial disability at the stipulated 
 
        rate of two hundred ten and 98/100 dollars ($210.98) per week 
 
        commencing September 1, 1986.
 
        
 
        
 
        CARUTH V. TENNECO/CASE POWER & EQUIPMENT CO.
 
        Page 4
 
        
 
        
 
        That defendants receive credit in the amount of sixteen thousand 
 
        forty-two and 32/100 dollars ($16,042.32) for payments that have 
 
        been previously paid and shall pay the past due, accrued 
 
        compensation in a lump sum together with interest pursuant to 
 
        section 85.30 computed from the date each payment came due until 
 
        the date of actual payment.
 
        
 
        That Central Iowa Orthopaedics and Semler Medical, P.C., are 
 
        designated as authorized treating physicians for treatment of 
 
        claimant's injuries sustained on April 24, 1985.
 
        
 
        That defendants make pain clinic treatment available to claimant 
 
        if the same remains recommended by the authorized treating 
 
        physicians.
 
        
 
        That defendants make a work hardening program available to 
 
        claimant if the same remains recommended by the authorized 
 
        treating physicians.
 
        
 
        That defendants pay claimant's medical expenses in the amount of 
 
        seventy-six dollars ($76.00) with McFarland Clinic and John 
 
        Mckee, M.D., and fifty-five dollars ($55.00) with Thomas W. 
 
        Bower.
 
        
 

 
        
 
 
 
 
 
        That defendants pay claimant's transportation expenses in the 
 
        amount of three hundred seventeen and 70/100 dollars ($317.70).
 
        
 
        That defendants pay the costs of the arbitration proceeding 
 
        pursuant to Division of Industrial Services Rule 343-4.33 in the 
 
        amount of five hundred sixty-nine and 96/100 dollars ($569.96).
 
        
 
        That defendants pay the costs of this appeal, and one-half the 
 
        costs of the transcription of the arbitration hearing.
 
        
 
        That claimant pay one-half the costs of the transcription of the 
 
        arbitration hearing.
 
        
 
        That defendants file claim activity reports as requested by this 
 
        agency pursuant to Division of Industrial Services rule 343-3.1.
 
        
 
        
 
        Signed and filed this 31th day of October, 1988.
 
        
 
        
 
                                         DAVID E. LINQUIST
 
                                       INDUSTRIAL COMMISSIONER
 
        
 
        
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                   BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         EDWIN E. CARUTH,
 
         
 
              Claimant,
 
                                                 File No. 793512
 
         vs.
 
         
 
         TENNECO/CASE POWER &                     A P P E A L
 
         EQUIPMENT CO.,
 
                                                D E C I S I 0 N
 
               Employer,
 
         
 
         and
 
         TRAVELERS INSURANCE CO
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
         
 
                              STATEMENT OF THE CASE
 
         
 
              Defendants appeal and claimant cross-appeals from an 
 
         arbitration decision awarding claimant healing period benefits, 
 
         medical expenses and mileage, and permanent partial disability 
 
         benefits based on an industrial disability of 50 percent 
 
         resulting from an injury on April 24, 1985.  The record on appeal 
 
         consists of the transcript of the arbitration hearing; claimant's 
 
         exhibits 1 through 26 and 29 through 36; and defendants' exhibit 
 
         A.  Exhibit 5 is part of exhibit 21.  Both parties filed briefs 
 
         on appeal.  There were two motions to dismiss and an application 
 
         for immediate hearing filed by claimant that have not been 
 
         previously ruled on, but these have been withdrawn by claimant on 
 
         June 22, 1988 and need not be considered further.  Both parties 
 
         filed applications for extension of time to file briefs.  Those 
 
         applications are now moot as the briefs have been filed and are 
 
         considered in this appeal.
 
         
 
                                    ISSUE
 
         
 
              The issue on appeal is the extent of claimant's disability, 
 
         including whether claimant is an odd-lot employee.
 
         
 
                              REVIEW OF THE EVIDENCE
 
         
 
              The arbitration decision adequately and accurately reflects 
 
         the pertinent evidence and it will not be set forth herein.
 
         
 
                                  APPLICABLE LAW
 
         
 
              The citations of law in the arbitration decision are 
 
         appropriate to the issue and evidence.
 
         
 
                                     ANALYSIS
 
         
 
              The analysis of the deputy in conjunction with the issue and 
 
         evidence presented is adopted.
 
         
 

 
         
 
         
 
         
 
         CARUTH V. TENNECO/CASE POWER & EQUIPMENT CO.
 
         PAGE   2
 
         
 
                                 FINDINGS OF FACT
 
         
 
              1.  On April 24, 1985, Edwin E. Caruth was a resident of the 
 
         state of Iowa employed by Case Power & Equipment Company, also 
 
         known as Tenneco, in the state of Iowa.
 
         
 
              2.  Claimant was injured on that date when the semi he was 
 
         driving for the employer struck a pile of gravel.
 
         
 
              3.  Following the injury, claimant was medically incapable 
 
         of performing work in employment substantially similar to that he 
 
         performed at the time of injury from the date of injury until 
 
         September 1, 1986 when he reached the point it was medically 
 
         indicated that further significant improvement from the injury 
 
         was not anticipated.
 
         
 
              4.  Claimant is a 48-year-old married man with one minor 
 
         dependent child.  At the time of injury, he was earning 
 
         approximately $8.00 per hour.
 
         
 
              5.  All the medical care which claimant has received at 
 
         hospitals or from licensed physicians is reasonable care and was 
 
         provided in treatment of the injuries he sustained on April 24, 
 
         1985.
 
         
 
              6.  The reflexology treatments claimant received from Linda 
 
         Bruno are not shown to be reasonable care for the injury, even 
 
         though they have provided some relief of his symptoms.
 
         
 
              7.  Claimant is not physically capable of engaging in 
 
         farming on a full-time basis or of working as an automotive or 
 
         farm implement mechanic.  He is restricted in his ability to 
 
         bend, stoop, lift or engage in standing or sitting for extended 
 
         periods.
 
         
 
              8.  Claimant is a high school graduate, but his entire work 
 
         history has been primarily in the area of automotive or farm 
 
         implement mechanics.
 
         
 
              9.  Claimant is reasonably motivated to be gainfully 
 
         employed.
 
         
 
             10. Claimant has a four percent permanent impairment of the 
 
         body as a whole as a result of the injury.
 
         
 
              11.  Claimant has suffered a 50% loss of his earning 
 
         capacity as a result of the injury he sustained on April 24, 
 
         1985.
 
         
 
              12.  Claimant was not offered treatment at a pain center or 
 
         any work hardening program..
 
         
 
              13.  Claimant did not unreasonably fail to cooperate with 
 
         the rehabilitation consultant.
 
         
 
              14.  Claimant has not made bona fide efforts to obtain 
 
         gainful employment.
 
         
 

 
         
 
         CARUTH V. TENNECO/CASE POWER & EQUIPMENT CO.
 
         PAGE   3
 
 
 
 
 
                             CONCLUSIONS OF LAW
 
              
 
              Claimant sustained an injury on April 24, 1985 which arose 
 
         out of and in the course of his employment with Case Power & 
 
         Equipment Company, also known as Tenneco.
 
         
 
              Claimant has a 50% permanent partial disability in 
 
         industrial terms as a result of that injury.
 
         
 
              Claimant is entitled to recover medical expenses in the 
 
         amount of $131.00 and mileage expenses in the amount of $317.70.
 
         
 
              Defendants have failed to introduce sufficient evidence to 
 
         establish, by a preponderance of the evidence, that claimant 
 
         failed to cooperate with his treating physicians or with the 
 
         vocational consultant.
 
         
 
              Defendants should offer claimant treatment at a pain clinic 
 
         and such other treatment as may be recommended by the authorizing 
 
         treating physicians.
 
         
 
              Claimant has not established by a preponderance of the 
 
         evidence that he.is entitled to permanent total disability 
 
         benefits as an odd-lot employee.
 
         
 
              Central Iowa Orthopaedics and Semler Medical, P.C., should 
 
         be designated as authorized treating physicians.
 
         
 
              WHEREFORE, the decision of the deputy is affirmed.
 
         
 
                                      ORDER
 
         
 
              THEREFORE, it is ordered:
 
         
 
              That defendants pay claimant seventy and five-sevenths (70 
 
         5/7) weeks of compensation for healing period at the stipulated 
 
         rate of two hundred ten and 98/100 dollars ($210.98) per week 
 
         commencing April 24, 1985.
 
         
 
              That defendants pay claimant two hundred fifty (250)  weeks 
 
         of compensation for permanent partial disability at the 
 
         stipulated rate of two hundred ten and 98/100 dollars ($210.98) 
 
         per week commencing September 1, 1986.
 
              That defendants receive credit in the amount of sixteen 
 
         thousand forty-two and 32/100 dollars ($16,042.32) for payments 
 
         that have been previously paid and shall pay the past due, 
 
         accrued compensation in a lump sum together with interest 
 
         pursuant to section 85.30 computed from the date each payment 
 
         came due until the date of actual payment.
 
         
 
              That Central Iowa Orthopaedics and Semler Medical, P.C., are 
 
         designated as authorized treating physicians for treatment of 
 
         claimant's injuries sustained on April 24, 1985.
 
         
 
              That defendants make pain clinic treatment available to 
 
         claimant if the same remains recommended by the authorized 
 
         treating physicians.
 
         
 
              That defendants make a work hardening program available to 
 
         claimant if the same remains recommended by the authorized 
 
         treating physicians.
 
         
 

 
         
 
         
 
         
 
         CARUTH V. TENNECO/CASE POWER & EQUIPMENT CO.
 
         PAGE   4
 
         
 
              That defendants pay claimant's medical expenses in the 
 
         amount of seventy-six dollars ($76.00) with McFarland Clinic and 
 
         John McKee, M.D., and fifty-five dollars ($55.00) with Thomas W. 
 
         Bower.
 
         
 
              That defendants pay claimant's transportation expenses in 
 
         the amount of three hundred seventeen and 70/100 dollars 
 
         ($317.70).
 
         
 
              That defendants pay the costs of the arbitration proceeding 
 
         pursuant to Division of Industrial Services Rule 343-4.33 in the 
 
         amount of five hundred sixty-nine and 96/100 dollars ($569.96).
 
         
 
              That defendants pay the costs of this appeal, and one-half 
 
         the costs of the transcription of the arbitration hearing.
 
         
 
              That claimant pay one-half the costs of the transcription of 
 
         the arbitration hearing.
 
         
 
              That defendants file claim activity reports as requested by 
 
         this agency pursuant to Division of Industrial Services rule 
 
         343-3.1.
 
         
 
              Signed and filed this 31st day of October, 1988.
 
         
 
         
 
         
 
         
 
         
 
                                               DAVID E. LINQUIST
 
                                               INDUSTRIAL COMMISSIONER
 
         
 
         
 
         Copies to:
 
         
 
         Mr. John K. Vernon
 
         Attorney at Law
 
         212 Equitable Building
 
         Des Moines, IA 50309
 
         
 
         Mr. Jerrold Handsaker
 
         Attorney at Law
 
         1009 6th Avenue
 
         Nevada, IA 50201
 
         
 
         Mr. M. Gene Blackburn
 
         Attorney at Law
 
         142 North Ninth St
 
         P.O. Box 817
 
         Fort Dodge, IA 50501
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                                  1803; 4100
 
                                                  Filed October 31, 1988
 
                                                  David E. Linquist
 
         
 
                     BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         EDWIN E. CARUTH,
 
         
 
              Claimant,
 
                                                File No. 793512
 
         vs.
 
         
 
         TENNECO/CASE POWER &                     A P P E A L
 
         EQUIPMENT CO.,
 
                                                D E C I S I 0 N
 
         
 
              Employer,
 
         
 
         and
 
         
 
         TRAVELERS INSURANCE CO.,
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
         
 
         1803
 
         
 
              Deputy's decision awarding 50% permanent partial disability 
 
         was affirmed on appeal.  Claimant was unable to resume prior 
 
         employments as an automotive and farm implement mechanic.  
 
         Claimant had not looked for or pursued other work opportunities.  
 
         Defendants had refused to re-employ claimant.
 
         
 
         4100
 
         
 
              Claimant who had not looked for other employment had not 
 
         made bona fide efforts to obtain employment.  Claimant failed to 
 
         make a prima facie showing that he was an odd-lot employee.
 
 
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                    
 
                    BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         EDWIN E. CARUTH,
 
         
 
              Claimant,                                File No. 793512
 
         
 
         vs.                                        A R B I T R A T I O N
 
         
 
         TENNECO/CASE POWER &                          D E C I S I O N
 
         EQUIPMENT CO.,
 
         
 
              Employer,                                   F I L E D
 
         
 
          and                                            MAR 29 1988
 
         
 
         TRAVELERS INSURANCE CO.,              IOWA INDUSTRIAL COMMISSIONER
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
                                 INTRODUCTION
 
         
 
              This is a proceeding in arbitration brought by Edwin E. 
 
         Caruth against Case Power & Equipment Company, also referred to 
 
         as Tenneco, employer, and Travelers Insurance Company, the 
 
         employer's insurance carrier.
 
         
 
              The case was heard and fully submitted on September 10, 1987 
 
         in Fort Dodge, Iowa.  The record in this case consists of 
 
         testimony from Edwin E. Caruth, Ruth Caruth, Lori Feaker, Theroy 
 
         Hovick, William J. Shaw, Darrel Severson and Marvin Stakey.  The 
 
         evidence includes claimant's exhibits 1 through 26 and 29 through 
 
         36.  The record also contains defendants' exhibit A.  It should 
 
         be noted that exhibit 5 is part of exhibit 21.
 
         
 
                                   ISSUES
 
         
 
              Claimant seeks compensation for permanent total disability 
 
         and asserts that the odd-lot doctrine should be applied.  
 
         Claimant also seeks to have certain medical expenses which he has 
 
         incurred paid by defendants.  Claimant seeks to have designated 
 
         authorized treating physicians and treatment at a pain clinic.
 
         
 
              The issues identified by the parties at the time of hearing 
 
         include:
 
         
 
              Whether claimant sustained an injury which arose out of and 
 
         in the course of employment on April 24, 1985;
 
         
 
              Whether the alleged injury is a cause of temporary 
 
         disability during a period of recovery;
 
                                                
 
                                                         
 
         
 
              Whether the alleged injury is a cause of permanent 
 
         disability;
 
         
 
              Determination of the nature and extent of any permanent 
 
         disability caused by the alleged injury;
 
         
 
              Recovery of section 85.27 benefits including payment of 
 
         medical expenses, mileage, designation of an authorized 
 
         physician, pain clinic treatment and a work hardening program.
 
         
 
              It was stipulated that, if defendants are liable for the 
 
         alleged injury, the healing period runs from April 24, 1985 until 
 
         September 1, 1986 and that any compensation for permanent partial 
 
         disability would be payable commencing on September 1, 1986.  It 
 
         was further stipulated that the correct rate of compensation is 
 
         $210.98 per week and that 74 and 1/7 weeks of compensation have 
 
         been paid at an incorrect rate of $216.37 per week.  It was 
 
         further stipulated that the providers of medical services would 
 
         testify that the fees charged were reasonable and that the 
 
         treatment rendered was reasonable treatment for the alleged work 
 
         injury.
 
         
 
              Defendants raised the defense of lack of authorization for 
 
         the medical expenses claimant seeks to recover.  Defendants also 
 
         assert that claimant has failed to mitigate his damages by 
 
         failing to cooperate with the care and treatment offered by the 
 
         defendants.
 
         
 
                             SUMMARY OF EVIDENCE
 
         
 
              The following is a summary of evidence presented in this 
 
         case.  Only the evidence most pertinent to this decision is 
 
         discussed, but all of the evidence received at the hearing was 
 
         considered in arriving at this decision.  Conclusions about what 
 
         the evidence showed are inevitable with any summarization.  The 
 
         conclusions in the following summary should be considered to be 
 
         preliminary findings of fact.
 
         
 
              Edwin E. Caruth is a 48-year-old married man with one minor 
 
         dependent child.  Caruth is a 1958 high school graduate who has 
 
         not served in the military.  His only formal education and 
 
         training since high school is mechanic's schools to which he has 
 
         been sent by his employers over the years.
 
         
 
              Claimant's work history has consisted primarily of 
 
         employment as a mechanic, both automotive and farm implement.  He 
 
         has also engaged in farming on a full-time basis.  In recent 
 
         years he has farmed on a part-time basis.
 
         
 
              Claimant's employment prior to that with the defendant 
 
         employer was with Stratford Implement Company.  He worked as a 
 
         shop foreman.  During the last one and one-half to two years, he 
 
         also performed sales work.  Claimant testified that he is 
 
         physically unable to perform any job that he has previously held 
 
                                                
 
                                                         
 
         during his lifetime.  Claimant stated that work as a farm 
 
         implement salesman involves climbing into the machines, operating 
 
         them and inspecting them, particularly implements which were 
 
         being considered for trade-in.  Claimant stated that the sales 
 
         work also involves driving a pick-up to farms to solicit business 
 
         and that it includes driving into farm fields.  Claimant 
 
         testified that he now gets cramps if he drives and that driving 
 
         on gravel bothers him more than driving on a smooth road.
 
         
 
              Claimant testified that he commenced employment with Case on 
 
         January 7, 1984 and was employed there steadily until the 
 
         accident occurred.  Claimant testified that he was driving the 
 
         employer's semi-tractor and trailer returning to the shop with a 
 
         loaner tractor on the trailer.  Claimant testified that new 
 
         gravel was being placed on the gravel road on which he was 
 
         driving and that, all of a sudden, there was a pile of gravel in 
 
         the middle of the road.  Claimant testified that he was too close 
 
         to stop so he swerved and that, in doing so, he hit the pile of 
 
         gravel which bounced him around in the cab of the semi causing 
 
         him to hit his head on the ceiling.  It also broke the farm 
 
         tractor loose from the trailer.  Exhibits 19 and 20 depict the 
 
         scene of the accident. Claimant stated that the post in the 
 
         picture was placed in the gravel pile after the accident 
 
         occurred.  Claimant's supervisor, William J. Shaw, came to the 
 
         scene of the accident and, upon discussing whether claimant was 
 
         hurt, recommended that claimant seek medical treatment.
 
         
 
              Claimant was taken to Story City Memorial Hospital where he 
 
         was under the care of C. E. Semler, M.D.  He was hospitalized for 
 
         five days during which he was treated with traction, medication, 
 
         physical therapy and a trigger point injection.  Claimant was 
 
         discharged from the hospital on April 29, 1985 with a TENS unit 
 
         and prescription medication (exhibit 2).  Claimant stated that, 
 
         when he arrived home from the hospital, he was pretty well 
 
         bedfast, getting up only to eat or to go to the bathroom.
 
         
 
              Claimant was then placed into a program of physical therapy 
 
         with Ron Eagan, L.P.T.  Claimant testified that the therapy and 
 
         exercises produced pain, but that the heat treatments helped 
 
         (exhibit 3).  Claimant was referred to Robert Larson, D.O., in 
 
         Roland, Iowa who performed additional therapy on claimant's back. 
 
         Claimant stated that, after doing the exercises from Dr. Larson, 
 
         his back was worse (exhibit 4).
 
         
 
              Claimant was referred to Scott B. Neff, D.O., in Des Moines, 
 
         Iowa where he was first seen on July 1, 1985.  At the initial 
 
         examination, claimant related the semi accident and that he had 
 
         attempted to do some farming, but was unable to do it.  Dr. Neff 
 
         found muscle spasms, but did not detect any neurologic 
 
         abnormalities (exhibit 21, depo. exhibit 1, page 1).  On July 10, 
 
         1985, claimant was admitted to Iowa Lutheran Hospital.  A 
 
         myelogram and CT scan of his spine showed no abnormalities.  The 
 
         final diagnosis upon his discharge was low back pain of unknown 
 
         etiology (exhibit 6, page 2).
 
         
 
                                                
 
                                                         
 
              Claimant continued treating with Dr Neff.  Dr. Neff had 
 
         suspected a sacroiliac joint problem, but a total body bone scan 
 
         performed on August 7, 1985 showed no abnormalities (exhibit 7).  
 
         A left sacroiliac joint injection provided temporary relief of 
 
         claimant's symptoms (exhibit 21, depo. exhibit 1, page 3).  A CT 
 
         scan of the sacroiliac joint did not show any abnormality and 
 
         further injections were then performed (exhibit 21, depo. exhibit 
 
         1, pages 4 and 5).
 
         
 
              Claimant was referred to the University of Iowa Hospitals 
 
         and Clinics for an evaluation on November 20, 1985 where the 
 
         physicians formed the impression that claimant's low back pain 
 
         was possibly due to facet arthropathy.  A 10-12 percent 
 
         impairment rating was assigned (exhibit 21, depo. exhibit 7).
 
         
 
              In early 1986, it appeared that claimant was improving, but 
 
         in June, he complained of increased discomfort.  In August, 1986, 
 
         it was indicated that William R. Boulden, M.D., expected claimant 
 
         to reach his maximum medical healing during the first part of 
 
         September, 1986.  Dr. Boulden also indicated that he did not 
 
         anticipate any permanent physical impairment rating, but that, in 
 
         his opinion, claimant could not return to his previous employment 
 
         (exhibit 21, depo. exhibit 2, page 27).
 
         
 
              In a report dated November 17, 1986, Dr. Boulden provided a 
 
 
 
                             
 
                                                         
 
         summary of his opinions about the case.  Dr. Boulden stated that 
 
         surgery is not indicated and that the best treatment is 
 
         protection of the back and a good exercise program.  The doctor 
 
         stated that the condition is a soft tissue injury that is 
 
         symptomatic.  Dr. Boulden also stated that claimant should not 
 
         return to his former work and should have some type of vocational 
 
         retraining.  Dr. Boulden expressed the opinion that there is a 
 
         definite relationship between the injury of April 24, 1985 and 
 
         claimant's present symptoms and complaints.  Dr. Boulden also 
 
         stated that, from a structural standpoint, claimant did not have 
 
         a physical impairment rating (exhibit 21, depo. exhibit 3).
 
         
 
              Claimant testified that, through the spring and summer of 
 
         1986, his condition remained generally unchanged.
 
         
 
              Claimant testified that, for the last seven or eight years, 
 
         he has rented 200 acres of farmland from his mother and Leo 
 
         Christenson.  Claimant testified that, in early May of 1985, he 
 
         and his daughter Lori were planting beans.  Claimant stated that 
 
         he made the first round to start the field and that Lori then 
 
         took over.  Claimant testified that, on one occasion, Lori left 
 
         to get fuel and that, while she was gone, claimant did some 
 
         planting. Claimant testified that, on that evening, he went to 
 
         bed in bad shape.  Claimant testified that, on the following 
 
         morning, he arranged to have Smith Custom complete the planting.
 
         
 
              Claimant testified that Darrel Severson stopped at the farm 
 
         during the time of approximately one-half hour that claimant was 
 
         planting.  Claimant testified that he was replacing a blown fuse 
 
         in his pick-up at the Smith farm when William Shaw came by the 
 
         Smith farm.
 
         
 
              Claimant testified that, in 1986, his daughter Lori and his 
 
         son did the farm work.  Claimant stated that, in 1985, he tried 
 
         to drive a tractor on approximately five occasions and that the 
 
         time he operated it varied from one-half hour to two hours on 
 
         each occasion.  Claimant stated that, in 1986, he was again on a 
 
         tractor for periods ranging from one-half hour to two hours and 
 
         that he did so on six or seven occasions.  Claimant testified 
 
         that he experiences pain that is very sharp from driving a 
 
         tractor and that after he does so, he is in bed for the next 
 
         couple of days. Claimant stated that, in 1986, his daughter, 
 
         Lori, did all of the planting.
 
         
 
              Claimant testified that he owns no farm land, but does own 
 
         machinery having a value of approximately $20,000.  He stated that 
 
         he has no farm debt except the bill owed to Smith Custom.  
 
         Claimant testified that he decides when to plant, harvest and 
 
         sell.  Claimant testified that 35% of the crop land is out of 
 
         production in a government program.  In 1986, 20% was in the 
 
         program and in 1985, 10% was in the program.
 
         
 
              Claimant stated that the farm operation is the same size now 
 
         as it was in 1984.  Claimant stated that he has not engaged in 
 
         full-time farming at any time in or since 1985 and that he has no 
 
                                                
 
                                                         
 
         intention of foregoing other work in order to farm on a full-time 
 
         basis.  Claimant agreed that he paid more for machine hire in 
 
         1984 than he did in 1985 or 1986, but that the machine hire to 
 
         Smith Custom in 1985 is unpaid and has not been deducted on his 
 
         tax returns.  Claimant testified that he did not pay for any 
 
         hired labor in 1983 and that he has not paid his daughter or son 
 
         anything for the work they have performed in the farming 
 
         operation.
 
         
 
              Claimant's exhibit 14 is a bill from Smith Custom for 
 
         planting.  The bill is dated December 15, 1986 and is in the 
 
         total amount of $2,942.70.  Claimant's 1984 income tax return 
 
         shows a net loss from farming in the amount of $7,188.00.  The 
 
         1985 farm return shows a net loss of $394.00.  The 1986 farm 
 
         operation showed a $224.00 loss (exhibits 15, 16 and 17).
 
         
 
              Claimant testified that he is able to drive between Story 
 
         City and Jewell, Iowa, a distance of approximately 10 miles.  He 
 
         stated that he has driven to Des Moines, but that he is stiff and 
 
         sore when he gets there.  Claimant indicated that his endurance 
 
         for driving is about the same in 1987 as it was in 1985 and 
 
         1986.
 
         
 
              Claimant testified that he started treating with Linda Bruno, 
 
         a reflexologist, in Davenport, Iowa upon the recommendation of a 
 
         friend.  Claimant testified that travel was made in the friend's 
 
         van which permitted claimant to lie down during the trip.  
 
         Claimant testified that Ms. Bruno massages his feet and that the 
 
         treatments have helped relieve his pain.  Claimant stated that he 
 
         wants to continue treating with Bruno.  Claimant testified that he 
 
         has gone to her on four occasions and has paid the charges 
 
         himself, as shown in exhibit 36, in the total amount of $233.00.  
 
         Claimant stated that the motel bill of $22.84, that is part of 
 
         exhibit 34, was incurred in obtaining treatment from Bruno.
 
         
 
              Claimant testified that he has been contacted by a couple of 
 
         rehabilitation people.  He stated that one was a nurse who 
 
         visited him three or four times, but did not set up any programs.  
 
         He stated that the other was a man named Ron who checked on him 
 
         to see how he was doing and asked about rehabilitation.  Claimant 
 
         stated that the man did not set up any job interviews.  Claimant 
 
         testified that he mentioned the possibility of Snap-On Tools to 
 
         Ron and that Ron found some literature on the company.  Claimant 
 
         testified that he checked into it and found that the cost of 
 
         getting started would be in the range of $40,000-$60,000.  Since 
 
         he did not have those resources, he did not pursue it further. 
 
         Claimant could not recall being told by Ron to sign up with job 
 
         service.  Claimant testified that he has not signed up with job 
 
         service or applied for unemployment because it is his 
 
         understanding he would have to certify that he was ready, willing 
 
         and able to work and claimant does not feel he is capable of 
 
         working for eight hours per day.  Claimant testified that he has 
 
         not applied for any jobs because he does not know of any that are 
 
         available which he could perform.
 
         
 
                                                
 
                                                         
 
              Claimant testified that he currently has no authorized 
 
         treating physician.  He stated that, when he last saw Dr. 
 
         Boulden, he was told that there was not much more that could be 
 
         done, but that Dr. Boulden did recommend a pain clinic treatment.  
 
         Claimant testified that treatment at a pain clinic or a work 
 
         hardening program has not been offered to him.  Claimant 
 
         testified that, since he last saw Dr. Boulden, he has seen Dr. 
 
         Semler in Story City and John R. McKee, M.D., at the McFarland 
 
         Clinic.  Claimant stated that he saw Dr. McKee at the McFarland 
 
         Clinic in Ames when he was unable to get in to see Dr. Boulden.  
 
         Claimant testified that the charges summarized in exhibit 34 were 
 
         incurred in treating his back, but have not been paid by 
 
         Travelers Insurance Company.  Claimant testified that all of the 
 
         mileage claims were for trips to obtain treatment for his back 
 
         condition.  He stated that Travelers had generally paid one-way 
 
         mileage, but had failed to pay round trip expenses.
 
         
 
              Claimant testified that, as a child and during high school, 
 
         he enjoyed excellent health.  He stated that he had back trouble 
 
         and was treated with traction for three or four days in 1983, but 
 
         that he recovered and returned to work without any restrictions 
 
         or limitations.  Claimant denied sustaining any other injuries 
 
         since April 24, 1985.
 
         
 
              Claimant testified that the sales work he performed at 
 
         Stratford Implement was only part-time and that the remainder of 
 
         his time was spent doing mechanic work.  He testified that he 
 
         would be unable to push in the clutch on some older tractors.  He 
 
         felt he could maybe perform the strenuous part of sales work for 
 
         one hour per day, but that he does not know of anyone who would 
 
         hire him on that basis.
 
         
 
              Ruth Caruth, claimant's wife of 28 years, testified that 
 
         claimant had performed mechanic work, body work and farming as 
 
         long as she has known him.  Mrs. Caruth stated that claimant had 
 
         not had much trouble with his back prior to the accident now 
 
         under consideration, except for in 1983.  She testified that, in 
 
         1984 and early 1985, he had done well with his back.  She stated 
 
         he had not sustained any other accidents or injuries since 1985.
 
         
 
              Mrs. Caruth confirmed claimant's testimony regarding his 
 
         farming operation.  She testified that, prior to the 1985 
 
         accident, he did everything there was to do, including putting 
 
         duals on the tractor and lifting sacks of beans and corn.  She 
 
         stated that, since the accident, she has seen him drive a 
 
         tractor, but has not seen him do any of the other activities.  
 
         She testified that, after a couple hours of driving a tractor or 
 
         after doing other things, he would come home irritable, would not 
 
         eat supper and would go for his pills.  She stated that he would 
 
         walk hunch-backed and could not sit for long.  Mrs. Caruth 
 
         testified that claimant does not go to the farm as much as he did 
 
         prior to the accident.
 
         
 
              Mrs. Caruth testified that, when claimant was initially 
 
         discharged from the hospital, he was not very good and was down. 
 
                                                
 
                                                         
 
         She stated that, since the accident, claimant has trouble 
 
         traveling in a car.
 
         
 
              Mrs. Caruth testified that, at first, claimant did the 
 
         exercises the doctors recommended.  She related that they 
 
         discussed the Snap-On Tools business, but that it was too 
 
         expensive to get into.  She was not aware of claimant seeking 
 
         employment.
 
         
 
              Mrs. Caruth testified that claimant's personality and 
 
         attitude has changed since the accident and that it has had an 
 
         effect on their marriage.  She stated that her observations of 
 
         the claimant were from 1986, but that they are now separated and 
 
         she has not observed him as much during 1987.  Mrs. Caruth felt 
 
         that claimant's injuries were a source of their marital problems, 
 
         but she acknowledged that they had marital problems prior to the 
 
         accident.
 
         
 
              Lori Feaker, claimant's daughter, testified that claimant 
 
         had always been able to do farm work prior to the accident.  She 
 
         stated that she has always helped with the farm work, but that 
 
         since the accident, her involvement has increased.  She stated 
 
         that, in 1985, she was at the farm almost every day and that, in 
 
         1985, Smith Custom was hired to plant.  Feaker testified that she 
 
         got the seed because claimant was unable to do so.  She testified 
 
         that she cultivated the fields, but that claimant did get on a 
 
         tractor sometimes for one or two hours at a time.
 
         
 
              Feaker testified that, when Darrel Severson came to the 
 
         farm, she had been planting, but had gone to town to get fuel.  
 
         She stated that she met Severson while she was returning, but 
 
         that he apparently did not recognize her because he did not wave 
 
         back to her when she waved to him.  Feaker testified that 
 
 
 
                             
 
                                                         
 
         claimant was on the tractor for approximately one hour on that 
 
         day.
 
         
 
              Feaker testified that, in 1986 and 1987, claimant operated 
 
         the tractor some, but that he would hardly be able to get out of 
 
         it afterwards.  She testified that she performed one-half to 
 
         three-fourths of the work.  She testified that she has never been 
 
         paid by the claimant for the farm work she has performed.  Feaker 
 
         stated she has not seen claimant perform any mechanical work in 
 
         1986 or 1987.
 
         
 
              Theroy Hovick testified that he raises and races greyhounds. 
 
         Hovick testified that he has known claimant since claimant was 
 
         approximately eight years old and that he was once married to 
 
         claimant's sister who died approximately 30 years ago.  Hovick 
 
         stated that he sees claimant occasionally and had seen him in 
 
         late March or early April of 1985 working on a four-wheel drive 
 
         tractor without any apparent difficulty.  Hovick stated that he 
 
         saw claimant regularly between September, 1985 and August, 1986. 
 
         Hovick stated that claimant was having a lot of physical problems 
 
         and that they had coffee together frequently.  Hovick stated 
 
         that, at times, claimant would go along when Hovick did his daily 
 
         chores with the dogs.  Hovick testified that he could observe 
 
         that claimant was in a lot of pain.  He did not want claimant to 
 
         perform any lifting.  Hovick characterized the work with his dog 
 
         kennel as light.  Hovick was injured in an auto accident and has 
 
         a disability which prevents him from doing heavy work.  Hovick 
 
         stated he did not think claimant was capable of performing even 
 
         the light work at the dog kennel.  He felt that claimant would 
 
         not be able to handle any job on an eight hour per day, every day 
 
         basis.  Hovick stated that claimant was ambitious and would not 
 
         want to just watch, however, and would on occasion mix feed and 
 
         put it into the crates for the dogs at the rate of two to three 
 
         pounds per dog.  On some occasions, he would maybe push a broom a 
 
         little.
 
         
 
              Hovick testified that claimant could not move around freely 
 
         and that, after the days when claimant did very much, he often 
 
         would not go along on the following day.
 
         
 
              Hovick testified that, in 1986, he helped claimant with the 
 
         farming.
 
         
 
              William J. Shaw, general manager of the Case Power & 
 
         Equipment Company in Nevada, Iowa, the employer in this case, 
 
         confirmed that claimant was injured in an accident that occurred 
 
         on April 24, 1985 and that he recommended that claimant go to the 
 
         hospital.  Shaw testified that the accident happened in the busy 
 
         season and that he wanted claimant back to work as soon as 
 
         possible.  Shaw testified that claimant initially indicated he 
 
         expected to return to work at approximately the end of May, but 
 
         that claimant has not kept him informed of his recovery, has 
 
         never indicated that he would return to work and has not returned 
 
         to work.
 
         
 
                                                
 
                                                         
 
              Shaw testified that, when he observed claimant at a farmer's 
 
         residence, claimant was on his back under the dashboard of his 
 
         truck doing something.
 
         
 
              Shaw testified that claimant was a very good mechanic.  Shaw 
 
         was unsure if claimant had missed any work prior to the time of 
 
         the accident.  Shaw agreed that exhibits 19 and 20 show the 
 
         accident scene and that the post in the gravel pile was put there 
 
         after the accident had occurred.
 
         
 
              Shaw testified that claimant is still an employee of the J. 
 
         I. Case Company and that his employment has not been terminated, 
 
         but that Shaw does not have a position for claimant.  Shaw 
 
         confirmed that he would not give claimant work if claimant was 
 
         released to return to work.
 
         
 
              Shaw testified that, prior to the accident, claimant was a 
 
         service technician who worked on farm implements.  He stated that 
 
         the work involved bending, lifting and carrying heavy objects in 
 
         the process of disassembling and rebuilding equipment.
 
         
 
              Shaw testified that salespeople do some activities which may 
 
         involve bending and lifting and that they would operate the 
 
         implements.  He stated that salespeople must thoroughly inspect 
 
         and appraise used farm equipment that is being traded in.
 
         
 
              Darrel Severson is the Case Power & Equipment parts manager. 
 
         Severson was familiar with claimant's accident.  He testified 
 
         that, in May, 1985, he went to claimant's farm one afternoon and 
 
         observed claimant planting beans.  He testified that he saw 
 
         claimant climb out of the tractor and go under the planter. 
 
         Severson testified that claimant appeared to be in pain, but was 
 
         doing the work.  He testified that, after claimant crawled under 
 
         the planter, he left the scene.  Severson did not recall if he 
 
         had met claimant's daughter, Lori, on the way back to town.  He 
 
         testified that he had not seen claimant perform any manual labor 
 
         since then.
 
         
 
              Marvin Stakey, a co-owner of Stratford Implement Company, 
 
         claimant's prior employer, testified that he had employed 
 
         claimant as a mechanic, shop foreman and machinery salesman.  
 
         Stakey indicated that claimant understood machinery and got along 
 
         well with people.
 
         
 
              Stakey recalled claimant having some problem with his back 
 
         and being off work for a week or so, but stated that, when 
 
         claimant returned, he had little trouble working and got back up 
 
         to par.  Stakey testified that claimant was primarily a mechanic 
 
         and shop foreman, but that he did perform some sales work.  
 
         Stakey confirmed that, when doing sales work, it is necessary to 
 
         check out the equipment that is being traded in.  Stakey agreed 
 
         that mechanics must bend, lift, stoop, climb and carry parts that 
 
         weigh up to 75 pounds.
 
         
 
              Exhibit 11 is a collection of records from McFarland Clinic. 
 
                                                
 
                                                         
 
         The records dealing with the 1983 back problem indicate that 
 
         claimant was admitted on February 8, 1983, improved with bed rest 
 
         and physical therapy and was dismissed on February 14, 1983 with 
 
         prescription medication and with instructions to resume activity 
 
         at home at the same level he had practiced at the time of 
 
         discharge from the hospital (exhibit 11, page 16).
 
         
 
              Claimant was seen at McFarland Clinic by Allen G. Lang, 
 
         M.D., on May 30, 1985.  Dr. Lang indicated that claimant's CT 
 
         scan was within normal limits.  He diagnosed claimant's condition 
 
         as a degenerative lumbosacral disc and symptoms that had been 
 
         exacerbated by the accident.  He expected a complete, but 
 
         prolonged, recovery (exhibit 11, pages 2, 3 and 11).
 
         
 
              Exhibit 21 is the deposition of William R. Boulden, M.D., 
 
         taken May 20, 1987.  Dr. Boulden practices with Scott B. Neff, 
 
         D.O., under the name of Central Iowa Orthopaedics.
 
         
 
              Dr. Boulden testified that claimant initially was treated by 
 
         Dr. Neff and that the treatment involved physical therapy, 
 
         diagnostic tests and injections.  Dr. Boulden testified that the 
 
         problem in this case is that they have been unable to find 
 
         anything objective to support claimant's complaints (exhibit 21, 
 
         pages 24 and 25).  Dr. Boulden indicated that the injury is a 
 
         soft tissue injury to the sacroiliac joint, but there are no bony 
 
         changes and the joint itself is not eroding (exhibit 21, page 
 
         32). Dr. Boulden did not recommend surgery because no abnormality 
 
         had been identified (exhibit 21, pages 15 and 16).
 
         
 
              Dr. Boulden testified that the accident which occurred on 
 
         April 24, 1985 is the cause of claimant's injuries and complaints 
 
         (exhibit 21, pages 26, 27, 30 and 31).  Dr. Boulden stated that 
 
         claimant should not return to work as a mechanic.  The doctor 
 
         recommended that claimant perform exercises and stretching and 
 
         that he find work which does not require any bending, stooping, 
 
         lifting with his back or prolonged sitting (exhibit 21, pages 
 
         28-30).
 
         
 
              Dr. Boulden stated that he does not expect any significant 
 
         improvement in claimant's condition and that no future treatment 
 
         is anticipated.  He did recommend that claimant be treated at a 
 
         pain clinic (exhibit 21, pages 30, 37 and 38).  Dr. Boulden 
 
         assigned claimant a four percent permanent impairment of the body 
 
         as a whole (exhibit 21, page 30).
 
         
 
              Exhibit 22 is a deposition of Thomas W. Bower, L.P.T., taken 
 
         April 29, 1987.  Bower administered a functional capacities 
 
         evaluation to claimant and interpreted it as showing claimant to 
 
         have an extremely low functional level.  He felt that the test 
 
         results were valid and that there was no reason to suspect 
 
         malingering, or symptom magnification (exhibit 22, pages 11-16).
 
         
 
              Bower stated that claimant was not a candidate for a quick 
 
         return to work due to his level of functioning and that any work 
 
         claimant could perform would fall into the sedentary work 
 
                                                
 
                                                         
 
         category.  Bower recommended claimant be placed into a work 
 
         hardening program (exhibit 22, pages 16-18).  Bower also stated 
 
         that travel between Story City and Des Moines to participate in 
 
         the work hardening program could be a problem and that, if the 
 
         travel caused a great deal of pain, the entire effort may be more 
 
         trouble than it is actually worth (exhibit 22, pages 23 and 24).
 
         
 
              A report from the Constitution Rehabilitation Company, also 
 
         referred to as ConServCo, dated October 27, 1986, appears in the 
 
         record as deposition exhibit 8, part of exhibit 21.  The report 
 
         indicates that, in October, 1986, John Hammer, a rehabilitation 
 
         consultant, contacted claimant.  The report indicates that Hammer 
 
         met with claimant on October 16, 1986, at which time claimant 
 
         indicated that his level of physical discomfort had decreased 
 
         since the last epidural steroid injection.  The report indicates 
 
         that claimant volunteered he had been active in farming 
 
         operations with assistance from his two sons.  The report states 
 
         that claimant had not followed through with the consultant's 
 
         suggestion that claimant schedule an appointment with the manager 
 
         of Snap-On Tools and that claimant had not registered with Job 
 
         Service as the consultant had recommended.  The report further 
 
         indicates that, on October 16, 1986, the Travelers Insurance 
 
         Company requested that this case file be closed.  The report 
 
         indicates that, on October 17, 1986, the consultant contacted 
 
         claimant's spouse and that she voiced concern regarding 
 
         claimant's desire to remain in farming and disappointment that 
 
         claimant had not contacted the manager from Snap-On Tools.
 
         
 
                        APPLICABLE LAW AND ANALYSIS
 
         
 
              Claimant has the burden of proving by a preponderance of the 
 
         evidence that he received an injury on April 24, 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 evidence in this case, including that from William Shaw, 
 
         clearly establishes, beyond any question, that claimant sustained 
 
         an injury which arose out of and in the course of his employment 
 
         as is alleged.
 
         
 
              The claimant has the burden of proving by a preponderance of 
 
         the evidence that the injury of April 24, 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).
 
         
 
              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 evidence from Dr. Boulden is quite clear and concise in 
 
         that claimant's disability is directly related to the accident 
 
         that occurred on April 24, 1985.  Dr. Lang from McFarland Clinic 
 
         corroborates Dr. Boulden in that regard.  Claimant may have had 
 
         some preexisting degenerative condition, but such is no defense 
 
         since it was not symptomatic prior to the accident in question 
 
         and any aggravation of a preexisting condition is considered to 
 
         be a compensable personal injury.  Ziegler v. U. S. Gypsum, 252 
 
         Iowa 613, 620 106 N.W.2d 591 (1961).
 
         
 
              The healing period in this case was established by 
 
         stipulation to commence on April 24, 1985 and to run until 
 
         September 1, 1986, the date upon which it is stipulated that 
 
         payment for permanent partial disability, if any is awarded, 
 
         should commence.
 
         
 
              Dr. Boulden assigned claimant a four percent permanent 
 
         impairment rating of the body as a whole.  A 10-12 percent rating 
 
         was made at the University of Iowa.
 
         
 
              If claimant has an impairment to the body as a whole, an 
 
         industrial disability has been sustained.  Industrial disability 
 
         was defined in Diederich v. Tri-City Railway Co., 219 Iowa 587, 
 
                                                
 
                                                         
 
         593, 258 N.W. 899, 902 (1935) as follows:  "It is therefore plain 
 
         that the legislature intended the term 'disability' to mean 
 
         'industrial disability' or loss of earning capacity and not a 
 
         mere 'functional disability' to be computed in the terms of 
 
         percentages of the total physical and mental ability of a normal 
 
         man."
 
         
 
              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 
 
         v. Goodyear Service Stores, 255 Iowa 1112, 1121, 125 N.W.2d 251 
 
         257 (1963).
 
         
 
              It is quite clear that claimant cannot return to the 
 
         occupations he has formerly held.  Claimant's testimony regarding 
 
         the extent of his farming activities is corroborated by the 
 
         testimony of the witnesses he called and also by the 
 
         recommendations from Dr. Boulden and Dr. Bower regarding the 
 
         level of activity in which claimant should be expected to engage. 
 
         Claimant's testimony with regard to his farming activities is 
 
         accepted as being correct.
 
         
 
              Dr. Boulden is obviously correct when states that the 
 
         problem with this case is the lack of objective findings to 
 
         support claimant's complaints.  Based upon Dr. Boulden's 
 
         recommendations, however, it appears that the doctor did not 
 
         dispute the credibility of claimant's complaints.  Mr. Bower also 
 
         found no basis for questioning the credibility of claimant's 
 
         complaints. Having observed claimant's appearance and demeanor 
 
         and that of the other witnesses, claimant's complaints are found 
 
         to be credible.
 
         
 
              Defendants assert that claimant has failed to mitigate his 
 
         damages by refusing to cooperate in vocational rehabilitation, 
 
         work hardening or pain center treatment.  The theory of law 
 
         propounded by the defense finds support in the cases of McKeever 
 
         Custom Cabinets v. Smith, 379 N.W.2d 368 (Iowa 1985) and 
 
         Stufflebeam v. City of Fort Dodge, 233 Iowa 438, 9 N.W.2d 281 
 
         (1943).  The law dealing with mitigation also provides, however, 
 
         that the duty of proving that damages could be minimized is on 
 
         the defendant.  Vorthman v. Keith E. Myers Enterprises, 296 
 
         N.W.2d 772, 14 A.L.R.4th 1085 (Iowa 1980); 1 Larson Workmen's 
 
         Compensation Law, section 13.22.   What the record in this case 
 
         actually shows is that Dr. Boulden recommended pain center 
 
         treatment and Bower recommended work hardening.  There is no 
 
         showing in the record of this case that either of those programs 
 
         was ever offered to claimant.  Claimant testified that he favored 
 
         those programs.  The record therefore fails to establish that 
 
         claimant ever refused either the pain clinic or the work 
 
         hardening program.
 
         
 
              Claimant has admittedly not sought employment.  He has not 
 
         registered with Job Service.  He has not pursued the 
 
                                                
 
                                                         
 
         possibilities of a job with Snap-On Tools.  There is no evidence 
 
         in the record to indicate whether or not the job with Snap-On 
 
         Tools would be within claimant's physical capabilities.  Such a 
 
         job could very well require a substantial physical investment, 
 
         the means of which do not appear to be available to claimant.  
 
         Claimant stated that he has not registered with Job Service 
 
         because he does not feel physically capable of performing 
 
         full-time employment.  If such is in fact his honest belief, it 
 
         is certainly proper that he should not misrepresent his 
 
         capabilities to any potential employer.
 
         
 
              Claimant urges that he is totally disabled and asserts that 
 
         the odd-lot doctrine should be applicable.  Certainly, defendants 
 
         have suggested possible areas of employment for claimant, if it 
 
         is assumed that he is physically capable of engaging in gainful, 
 
         full-time employment.  Defendants have not, however, established 
 
         that any of the suggested employments are available within the 
 
         geographic area of claimant's residence.  The employer in this 
 
         case is a large corporation with many different types of jobs in 
 
         its work force.  Under such circumstances, the refusal to 
 
         reemploy is strong evidence of lack of employability. 2 Larson 
 
         Workmen's Compensation Law, section 57.61.
 
         
 
              In order for claimant to fall under the odd-lot doctrine, he 
 
         must have made bona fide efforts to obtain employment.  Emshoff v. 
 
         Petroleum Transportation Services, file number 753723, (App Decn. 
 
         March 31, 1987).  In following agency precedent, as the 
 
         undersigned is obligated to do, it is concluded that claimant has 
 
         failed to make a prima facie showing that he is totally disabled 
 
         under the odd-lot doctrine and the burden of proof therefore does 
 
         not shift to the employer.  It is therefore found and concluded 
 
         that Edwin Caruth has failed to establish that he is permanently 
 
         and totally disabled under the odd-lot doctrine or otherwise.  
 
         When all the applicable factors of industrial disability are 
 
         considered, it is found and determined that claimant has a 50% 
 
         permanent partial disability as a result of injuries he sustained 
 
         on April 24, 1985.
 
         
 
              The employer has denied liability for the injury in its 
 
         answer and has continued with such denial up to the time of 
 
         hearing.  It therefore waived the right to control medical care. 
 
         Barnhart v. MAQ, Incorporated, I Iowa Industrial Commissioner 
 
         Report, 16 (App. Decn. 1981).  Claimant seeks to have an 
 
         authorized physician designated.  Central Iowa Orthopaedics and 
 
         Semler Medical, P.C., are therefore designated as authorized 
 
         treating physicians.
 
         
 
              The right provided to employers with regard to selecting 
 
         medical care under section 85.27 gives the employer the right to 
 
         select the physicians who will furnish the care.  It does not, 
 
         however, give the employer or its insurance carrier the right to 
 
         tell medical professionals how they should practice medicine.  
 
         Pote v. Mickow Corporation, file number 694639, (Review-reopening 
 
         decn. 1986); Martin v. Armour-Dial, Inc., file number 754732, 
 
         (Arbitration decn. 1985).  Since Dr. Boulden recommended pain 
 
                                                
 
                                                         
 
         center treatment and claimant desires to participate in it, 
 
         defendants should be required to make it available to claimant.  
 
         The same is true with the work hardening program, should it be 
 
         medically indicated or recommended.
 
         
 
              Surgery is likewise within the realm of medical 
 
         professionals.  It has not been recommended and, therefore, 
 
         should not be performed at this time.
 
         
 
              Since defendants had denied liability, the defense of lack 
 
         of authorization is not available as against the expenses sought 
 
         by claimant in exhibit 34.  The treatment at McFarland Clinic and 
 
         the charges made for the treatment both appear reasonable.  The 
 
         same is true with the treatment provided by Thomas Bower.  
 
         Defendants are, accordingly, responsible for payment of those 
 
         charges in the amounts of $76.00 and $55.00, respectively.
 
         
 
              Reflexology is not a well-established part of the healing 
 
         arts.  Claimant feels that it is helpful.  The medical 
 
         professionals who have provided some of the evidence in the case 
 
         do not address the reflexology treatment.  Since it appears that 
 
         the reflexology treatments were not recommended or prescribed by 
 
         any of the physicians who have treated claimant, the cost of 
 
         those treatments will not be assessed against the defendants.
 
         
 
              The provision for payment of travel expenses under Iowa Code 
 
         section 85.27 and Division of Industrial Services Rule 343-8.1 
 
         provide for payment of mileage.  The only practical and 
 
         reasonable construction that can be applied is that the mileage 
 
         be paid round trip.  Claimant is therefore entitled to recover 
 
         the mileage he requests except for the travel to Davenport, Iowa.  
 
         The total is therefore $92.40 for 1987.  When added with the 1986 
 
         and 1985 mileage claims, defendants are responsible for payment 
 
 
 
                        
 
                                                         
 
         of an additional $317.70 in mileage.
 
         
 
              Since claimant is successful in this case he is entitled to 
 
         recover costs in accordance with Division of Industrial Services 
 
         Rule 343-4.33.  The costs which claimant seeks to recover are 
 
         itemized in exhibit 33.  Items 2, 8, 9, 10 and 11 are clearly 
 
         assessable.  Rule 343-4.33(6) also allows recovery of the costs 
 
         of no more than two doctors' or practitioners' reports.  In that 
 
         regard, items 3 and 5 are also recoverable by claimant.  There is 
 
         no provision, however, for recovering the costs of other or 
 
         additional medical records, reports or conferences.  Therefore, 
 
         items 1, 4, 6 and 7 are not recoverable by claimant.  Claimant's 
 
         costs which are recoverable from defendants are therefore 
 
         determined to total $569.96.
 
         
 
                               FINDINGS OF FACT
 
         
 
              1.  On April 24, 1985, Edwin E. Caruth was a resident of the 
 
         state of Iowa employed by Case Power & Equipment Company, also 
 
         known as Tenneco, in the state of Iowa.
 
         
 
              2.  Caruth was injured on that date when the semi he was 
 
         driving for the employer struck a pile of gravel.
 
         
 
              3.  Following the injury, claimant was medically incapable 
 
         of performing work in employment substantially similar to that he 
 
         performed at the time of injury from the date of injury until 
 
         September 1, 1986 when he reached the point it was medically 
 
         indicated that further significant improvement from the injury 
 
         was not anticipated.
 
         
 
              4.  All witnesses who testified at hearing are found to be 
 
         credible witnesses.
 
         
 
              5.  Claimant is a 48-year-old married man with one minor 
 
         dependent child.  At the time of injury, he was earning 
 
         approximately $8.00 per hour.
 
         
 
              6.  All the medical care which claimant has received at 
 
         hospitals or from licensed physicians is reasonable care and was 
 
         provided in treatment of the injuries he sustained on April 24, 
 
         1985.
 
         
 
              7.  The reflexology treatments claimant received from Linda 
 
         Bruno are not shown to be reasonable care for the injury, even 
 
         though they have provided some relief of his symptoms.
 
         
 
              8.  Claimant is not physically capable of engaging in 
 
         farming in a full-time basis or of working as an automotive or 
 
         farm implement mechanic.  He is restricted in his ability to 
 
         bend, stoop, lift or engage in standing or sitting for extended 
 
         periods.
 
         
 
              9.  Claimant is a high school graduate, but his entire work 
 
         history has been primarily in the area of automotive or farm 
 
                                                
 
                                                         
 
         implement mechanics.
 
         
 
              10.  Claimant is reasonably motivated to be gainfully 
 
         employed.
 
         
 
              11.  Claimant has a four percent permanent impairment of the 
 
         body as a whole as a result of the injury.
 
         
 
              12.  Claimant has suffered a 50% loss of his earning 
 
         capacity as a result of the injuries he sustained oh April 24, 
 
         1985.
 
         
 
              13.  Claimant was not offered treatment at a pain center or 
 
         any work hardening program.
 
         
 
              14.  Claimant did not unreasonably fail to cooperate with 
 
         the rehabilitation consultant.
 
         
 
              15.  Claimant has not made bona fide efforts to obtain 
 
         gainful employment.
 
         
 
              16.  Defendants have not shown that there is any work 
 
         available within the geographic area of claimant's residence 
 
         which is within his capabilities of performance.
 
         
 
                             CONCLUSIONS OF LAW
 
         
 
              1.  This agency has jurisdiction of the subject matter of 
 
         this proceeding and its parties.
 
         
 
              2.  Claimant sustained an injury on April 24, 1985 which 
 
         arose out of and in the course of his employment with Case Power 
 
         & Equipment Company, also known as Tenneco.
 
         
 
              3.  Claimant has a 50% permanent partial disability in 
 
         industrial terms as a result of that injury.
 
         
 
              4.  Claimant is entitled to recover medical expenses in the 
 
         amount of $131.00 and mileage expenses in the amount of $317.70.
 
         
 
              5.  Defendants have failed to introduce sufficient evidence 
 
         to establish, by a preponderance of the evidence, that claimant 
 
         failed to cooperate with his treating physicians or with the 
 
         vocational consultant.
 
         
 
              6.  Defendants should offer claimant treatment at a pain 
 
         clinic and such other treatment as may be recommended by the 
 
         authorized treating physicians.
 
         
 
              7.  Central Iowa Orthopaedics and Semler Medical, P.C., 
 
         should be designated as authorized treating physicians.
 
         
 
                                     ORDER
 
         
 
              IT IS THEREFORE ORDERED that defendants pay claimant seventy 
 
                                                
 
                                                         
 
         and five-sevenths (70 5/7) weeks of compensation for healing 
 
         period at the stipulated rate of two hundred ten and 98/100 
 
         dollars ($210.98) per week payable commencing April 24, 1985.
 
         
 
              IT IS FURTHER ORDERED that defendants pay claimant two 
 
         hundred fifty (250) weeks of compensation for permanent partial 
 
         disability at the stipulated rate of two hundred ten and 98/100 
 
         dollars ($210.98) per week commencing September 1, 1986.
 
         
 
              IT IS FURTHER ORDERED that defendants receive credit in the 
 
         amount of sixteen thousand forty-two and 32/100 dollars 
 
         ($16,042.32) for payments that have been previously paid and 
 
         shall pay the past due, accrued compensation in a lump sum 
 
         together with interest pursuant to section 85.30 computed from 
 
         the date each payment came due until the date of actual payment.
 
         
 
              IT IS FURTHER ORDERED that Central Iowa Orthopaedics and 
 
         Semler Medical, P.C., are designated as authorized treating 
 
         physicians for treatment of claimant's injuries sustained on 
 
         April 24, 1985.
 
         
 
              IT IS FURTHER ORDERED that defendants make pain clinic 
 
         treatment available to claimant if the same remains recommended 
 
         by the authorized treating physicians.
 
         
 
              IT IS FURTHER ORDERED that defendants make a work hardening 
 
         program available to claimant if the same remains recommended by 
 
         the authorized treating physicians.
 
         
 
              IT IS FURTHER ORDERED that defendants pay claimant's medical 
 
         expenses in the amount of seventy-six and 00/100 dollars ($76.00) 
 
         with McFarland Clinic and John McKee, M.D., and fifty-five and 
 
         00/100 dollars ($55.00) with Thomas W. Bower.
 
         
 
              IT IS FURTHER ORDERED that defendants pay claimant 
 
         transportation expenses in the amount of three hundred seventeen 
 
         and 70/100 dollars ($317.70).
 
         
 
              IT IS FURTHER ORDERED that the costs of this proceeding are 
 
         assessed against defendants pursuant to Division of Industrial 
 
         Services Rule 343-4.33 in the amount of five hundred sixty-nine 
 
         and 96/100 dollars ($569.96).
 
         
 
              IT IS FURTHER ORDERED that defendants file Claim Activity 
 
         Reports as requested by this agency pursuant to Division of 
 
         Industrial Services Rule 343-3.1.
 
         
 
         
 
              Signed and filed this 29th day of March, 1988.
 
         
 
                                               
 
                                                 
 
                                                
 
                                                         
 
         
 
                                            MICHAEL G. TRIER
 
                                            DEPUTY INDUSTRIAL COMMISSIONER
 
         
 
         Copies To:
 
         
 
         Mr. John K. Vernon
 
         Attorney at Law
 
         212 Equitable Building
 
         Des Moines, Iowa  50309
 
         
 
         Mr. Jerrold Handsaker
 
         Attorney at Law
 
         1009 6th Avenue
 
         Nevada, Iowa  50201
 
         
 
         Mr. M. Gene Blackburn
 
         Attorney at Law
 
         142 North Ninth Street
 
         P.O. Box 817
 
         Fort Dodge, Iowa  50501
 
 
 
         
 
         
 
 
            
 
 
 
 
 
 
 
 
 
 
 
                                            1402.30, 1402.40, 1403.30
 
                                            1600, 1803, 4100
 
                                            Filed March 29, 1988
 
                                            MICHAEL G. TRIER
 
         
 
                   BEFORE THE IOWA INDUSTRIAL COMMISSIONER
 
         
 
         
 
         EDWIN E. CARUTH,
 
         
 
              Claimant,
 
         
 
         vs.
 
                                                   File No. 793512
 
         TENNECO/CASE POWER &
 
         EQUIPMENT CO.,                         A R B I T R A T I 0 N
 
         
 
              Employer,                            D E C I S I 0 N
 
         
 
         and
 
         
 
         TRAVELERS INSURANCE CO.,
 
         
 
              Insurance Carrier,
 
              Defendants.
 
         
 
         
 
         1402.30, 1402.40, 1403.30, 1600, 1803, 4100
 
         
 
              Claimant was injured in an accident for which there was no 
 
         factual dispute, even though defendants failed to admit the same. 
 
         After thorough and extensive testing, no objective basis was 
 
         found for claimant's complaints, but the treating physicians and 
 
         physical therapist found them to be valid.  Upon observing 
 
         claimant at hearing and considering all the evidence, his 
 
         complaints were found to be credible and valid.  Claimant was 
 
         awarded 50% permanent partial disability where he was unable to 
 
         resume his prior employments as an automotive and farm implement 
 
         mechanic.  Claimant had not looked for work and no work within 
 
         his physical capabilities and other qualifications was shown to 
 
         be available for him in the area of his residence.
 
         
 
              Defendants urged that claimant failed to mitigate his 
 
         damages by not cooperating with his physicians and the vocational 
 
         consultant.  While such was recognized to be a plausible theory 
 
         of law, there was no evidence in the record to support 
 
         defendants' claim.
 
         
 
              Treating physicians were designated and defendants were 
 
         ordered to make pain clinic treatment and a work hardening 
 
         program available to claimant if the same was still recommended 
 
         by those physicians as had been recommended prior to the 
 
         hearing.
 
         
 
              Claimant was not allowed to recover for reflexology 
 
                                                
 
                                                         
 
         treatments where the same were not recommended by any of the 
 
         treating physicians, but were rather sought out by claimant on 
 
         his own.